' am London County Council. ANNUAL REPORT OF THE COUNCIL, 1911. '/ V/3 VOL. Ill 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 odhams limited, 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. Aqenlt for the sale of the Publications of the London County Council. 1000—18. '2.13—12532 C.720B. CONTENTS. Chapter XXXII. Public Health Reports of the Medical Officer of Health (Dr. W. H. Hamer) for the year 191— a—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—Meteorology 1 b—Administration.—Dairies, cowsheds and milkshops—Offensive businesses—Nuisances—Housing of the Working Classes Act—Underground rooms—Overcrowding—Houses let in lodgings— Common lodging houses—Seamen’s lodging houses—Cleansing of Persons Act, 1897—Water supply to tenement houses—Revenue Act, 1903—Factory and Workshop Act—Places where food is prepared for sale—Inspection of food—Disinfection—Shelters—Mortuaries—Rat plague —Equalisation of Rates Act—Conference on Public Health—Rag Flock Act, 1911—Homeless persons—Water supply—Health visitors—Midwives Act 47 Chapter XXXIII. Public Health Reports (continued)—Special report submitted by the Medical Officer of Health during the year 1911—Typhoid Fever 83 Chapter XXXIV. Public Health Reports (continued)—Report of the Education Committee, submitting the Report of the Medical Officer (Education) (Dr. J. Kerr) for the year 1911—Report of the Medical Officer (Education) for the year 1911— Medical Inspection;—Elementary schools- -Secondary and trade schools—Non-maintained secondary schools—Training colleges 90 Medical Treatment.—.Suppurating ears—Tonsils and adenoids—Teeth—Ringworm- Open-air schools—Playground classes—Kensal House turberculosis school—Residential schools— Secondary and trade schools—Training colleges 93 Examination of Candidates.—Permanent service—References—Scholarships—Candidates for the teaching profession 112 Personal Hygiene Schemes.—Elementary schools: (a) Heads; (b) Persons and clothing—Secondary and trade schools: Heads 115 Infectious Diseases.—Zymotic diseases in schools—Scarlet fever—Diphtheria—Aural discharge and diphtheria—Measles—Small pox—Catarrhal conjunctivitis 117 Defective Chiidren.—Results of examinations—Tests of mental ability—Visual—Aural—Speech—- Semi-blind—Deaf—Epilepsy—Heart disease—Spinal curvature 135 School Planning and Apparatus.—Lighting -Ventilation—Swimming baths; -Seats and desks 160 Miscellaneous.—Physical exercises—Closure of Stormont House—Remand homes—Hop-picking— 168 Dust—Feeding—Racial characteristics—Inattention. Chapter XXXV. Public Health—Infectious Diseases—Homeless persons—Tuberculosis—Milk—Infant Life Protection—Midwives—Health Visitors—Common Lodging Houses—Seamen’s Lodging Houses—Nuisances—Offensive businesses—Drainage by-laws—Diseases of Animals 172 Chapter XXXVI. Main Drainage 178 Chapter XXXVTl. Housing of the Working Classes 183 Chapter XXXV1I1. Housing Accounts and Statistics.-—Memorandum by the Comptroller (Mr. H. E. Haward) submitting Housing Accounts for the year ended 31st March, 1912—Memorandum by the Housing Manager (Mr. S. G. Burgess), submitting Housing Statistics for the year ended 31st March, 1912 189 iv. Diagrams. facing page Diagram A.—Marriages, 1851-1911 3 B.—Births, 1851-1911 3 „ C.—Deaths (all causes), 1841-1911 7 „ D.—Infantile Mortality, 1858-1911 8 „ E.—Smallpox (mortality), 1841-1911 15 „ F.—Measles (mortality), 1841-1911 18 „ G.—Measles and Whooping-cough (monthly deaths), 1891-1911 19 „ H.—Scarlet Fever (mortality), 1859-1911 22 ,, K.—Scarlet Fever (admissions to hospitals of Metropolitan Asylums Board, percent, of total notified cases in London), 1890-1911 22 „ L.—Scarlet Fever (monthly notified cases and case-mortality), 1891-1911 23 „ M.—Diphtheria and Croup (mortality), 1859-1911 25 „ N.—Diphtheria (admissions to hospitals of Metropolitan Asylums Board, per cent, of total notified cases in London), 1890-1911 25 „ 0.—Diphtheria (monthly notified cases and case-mortality), 1891-1911 25 „ P.—Whooping-cough (mortality), 1841-1911 29 „ Q.—Typhus (mortality), 1869-1911 32 „ R.—Enteric Fever (mortality), 1869-1911 32 „ S.—Enteric Fever (weekly notified cases, 1911, and mean weekly notified cases, 1910— 1911) 32 „ T.—Enteric Fever (monthly notified cases and case-mortality), 1891-1911 33 „ U.—Typhoid Fever (cases notified in ten London Boroughs) 35 „ V.—Diarrhoea and Enteritis (deaths under 2 years of age 1862-1911) 36 „ W.—Phthisis (mortality—males and females), 1851-1911 40 „ X.—Vermin (seasonal prevalence, 1909-1911) 62 „ Y.—Fleas and Scarlet Fever and Diphtheria (seasonal prevalence, 1909-1911) 63 „ Z.—Scarlet Fever in Schools 117 „ AA.—Scarlet Fever in Schools 117 „ BB.—Diphtheria in Schools 117 „ CC.—Diphtheria in Schools 117 Map. I.—Area of outbreak of Typhoid Fever in Finsbury, September, 1911 84 Appendixes. page *1.—Proceedings of sanitary authorities under the Factory and Workshop Act ii II.—Cases of Typhoid Fever in Finsbury, August and September, 1911 iv. III.—Summary of reports on 638 school buildings inspected by School Doctors, 1911 vii. IV.—Summary of defects in children as found by School Doctors—age 8-9 years viii. V.—Summary of defects in children as found by School Doctors—age 12-13 years x. VI.—Summary of defects in children as found by School Doctors—Infants xii. VII.—Medical Inspection— A.—Children presented by School Teachers for special examination xiv. B.—Summary of inspections, 1911 xiv. VIII.—Defects found—Summary xv. IX.—Re-inspection, 1911 xvi. X.—Training college, pupil teacher centres, secondary and trade schools—Defects noted on medical examination xvii. XI.—Number of candidates examined for the permanent service and the conditions found xviii. XII.—Number of County Scholarship candidates examined and the conditions found xix. V. page XIII.—Number of Trade Scholarship candidates examined and the conditions found xx. XIV.—Number of Special Scholarship candidates examined and the conditions found xxi. XV.—Number of candidates examined for the teaching profession and the conditions found xxii. XVI.—Housing accounts— A.—Housing of the Working Classes Act, 1890 xxiv. B.—Dwellings under Improvement Acts xxxiv. C.—Dwellings under the Housing of the Working Classes Act, 1890, and Improvement Acts combined xl. D.—Details of Revenue Account— I.—Housing of the Working Classes Act, 1890 xlii. II.—Dwellings under Improvement Acts xlii. E.—Percentages on gross rental of the several items of Income and Expenditure in respect of dwellings in D xliv. F.-Summary of Financial Results— I.—Housing of the Working Classes Act, 1890 xlvi. II.—Dwellings under Improvement Acts xlvi. G.—Details of Repairs and Renewals Fund xlviii. H.—Contributions from and to rates xlviii. XVII.—Capital expenditure on clearance schemes under the Housing of the Working Classes Act, 1890 xlix. XVIII.—Commercial and housing values of sites utilised for the erection of Working Class Dwellings 1. XIX.—Housing Statistics— A.—Number of tenements in the Council's working-class dwellings li. B.—Accommodation in the Council’s working-class dwellings liii, C.—Rents charged in the Council's working-class dwellings lix, D.—Accommodation provided and gross rent per annum on 31st March, 1892, and each subsequent year lxi. E.—-Number of persons re-housed lxi, F.—Number of tenants transferred or who vacated, 1911-1912 lxii G.—Percentage of total outgoings on rent receivable for the last five years., lxiii H.—Population of the Council's dwellings according to a census taken in March, 1912 lxiv. K.—Cases of infectious disease removed from the Council’s dwellings, 1911-1912 lxv, L.—Births and deaths in the Council's dwellings, 1911-1912 Ixvi M.—Occupations of the Council's tenants lxvii XX.—Statement of the Statutes under which dwellings under Improvement Acts were erected Ixviii, London County Council. TREATMENT OF TUBERCULOSIS. Conference with representatives of the London Sanitary Authorities. [ Memorandum by the Chairman of the Public Health Committee. zS 2.//■$ The Chairman of the Committee has considered it desirable to set out his 'personal views in this Memorandum, rather than to embody them in an address from the Chair. During the past year, I have had under continual consideration the necessity for a scheme for the treatment of tuberculosis within the county of London. Now that my year of office as Chairman of the Public Health Committee is on the point of expiring, it appears to me desirable that I should place on record such general views as I hold with regard to the methods of dealing with tuberculosis. It is desirable to emphasise that, in so doing, I commit no one to the adoption of my views, but in the absence of any other suggestions, what I now propose may possibly form a basis for discussion with a view to evolving a scheme for London. I may as well candidly confess that it appears to me that, however desirable it may be both from the public health and humane point of view to deal thoroughly with the whole population afflicted with tuberculosis, it is impracticable to do so.except within certain defined limits. I would rather that money should be spent in preserving the rising generation than in attempting to cure the present, for cure is only attainable in certain selected cases. Treatment for adults must be undertaken to some extent, although the limit I suggest should be fixed mainly on preventative grounds. It is accepted that some persons are much more resistant to infection from bovine or human sources than others, and that the same persons are unequally resistant at different times. Hence, hygienic measures tending to improve general health must always bear an important part in the prevention of tuberculosis. However high the importance of such measures be placed, the prevention of infection from milk, or from human cases of open tuberculosis must always form an essential part of a campaign against tuberculosis. This can only be changed, if in the future it should be proved that small doses of infection in early life protect against tuberculosis in later life, and if it should become possible to vaccinate everyone with measured doses of a vaccinating material. It is doubtful what proportion of adults suffering from tuberculosis have been infected with the cause of their present illness in childhood, and what proportion within a few years of their illness. There is no doubt that some measure of infection— from which recovery has occurred, or which has not caused appreciable illness,—is very common in the first ten years of life. This, as before, is derived from bovine or human sources. Whether this latent infection of childhood, resuscitated under the influence of such conditions as insanitary ci rcumstances, alcoholism, debilitating illness (e.g., influenza), or overwork, is the main source of adult tuberculosis or whether adult tuberculosis is caused mainly by the more recent infection which must very commonly be received, may be regarded as an open point. Whichever view be adopted, the practical action required is the same. Action is needed— (a) to increase the powers of resistance. (b) to diminish the dosage of infection received. For both children and adults, the removal of the conditions favouring infection, including careful attention to convalescents from diseases other than tuberculosis, is very important. For both children and adults, apart from milk infection, a main item in the campaign must also be to prevent infection from cases of “open” human tuberculosis. This occurs chiefly from adult consumptives. Any provisions made should include, apart from domiciliary treatment and the dispensaries now in process of organisation: (a) hospital beds for advanced cases of open tuberculosis, from whom is received the most dangerous massive infection (vide later Best Homes); (b) beds for “short-term” treatment of cases of open tuberculosis, where such patients can be taught practically to adopt hygienic habits, and where other patients can be kept under observation, or special treatment commenced; (c) beds for early cases of pulmonary tuberculosis, who may thus be prevented from becoming a source of infection, and who may themselves become cured. It will be clear, therefore, that from the point of view of children’s welfare, it is essential that adults with “open” tuberculosis should be properly treated. The existence of the two schools of thought as to the occurrence of infection in early or adult life, does not appear to me to be much more than an academic point. It is common ground that ample arrangements must be made for the adequate treatment of tuberculous children under the best jonditions. The situation which has arisen out of the National Insurance Act, offering moneys towards the treatment of insured persons suffering from this disease and its subsequent developments, is fully set forth in the report of the Public Health Committee, dated 30th January, 1913. That report was adopted by the Council, and a scheme is now to be formulated by the Public Health Committee. It is suggested in that report that the scheme should be divided into parts, any or all of which can be put 500—22 2.13—14373 C./1335 2 into force, according as opportunity, which, largely means money, affords. But in any case, the first part of the scheme must be that which relates actually to the machinery for dealing with the disease. I therefore propose to outline first my views with regard to the administrative machinery. Part I.—Dispensary and general administration.—To begin with the dispensary. Dispensaries should be established for every borough, but there is no reason why several boroughs should not make use of the same dispensary whenever possible. It is extremely desirable that the dispensary should, when possible, be either a hospital or dispensary already in existence. The executive officer in charge of the dispensary will be charged with the clinical care of the patients, and will be closely associated with the medical officer of health, who, in addition to this close association with this officer will represent the administrative side. “Whenever a hospital undertakes the duties of a tuberculosis dispensary, the public will get the advantage of all the highly-specialised resources, laboratories, apparatus, etc., and the advice of the whole consultant staff of the hospital, instead of the opinion of one man only. Generally speaking, the duties of the clinical officer should be strictly confined to work in the institution, and the medical officer of health should deal with the home conditions of the patient, the general practitioner being encouraged in all suitable cases, to retain control of the patient in his own home. The chief tuberculosis officer for London should be the County Medical Officer of Health. He should act as the chief administrative executive officer. I propose that, as his clinical experts, he should have a voluntary advisory committee drawn from tuberculosis experts within the medical profession. I feel sure that the stafi of such specialist institutions as Brompton, Victoria Park and City Road Hospitals, etc., would gladly co-operate, as would also doubtless, the Royal Colleges of Physicians and Surgeons. By obtaining the voluntary co-operation of the medical profession, London will gain the valuable services of the leading medical experts having knowledge of this disease. The efficient working of the scheme must largely depend on the medical staff of the various institutions concerned, and at the present moment there is an inadequate supply of highly specialised officers. I am of opinion that it is essential, in order to improve this supply that appointments to institutions dealing with tuberculosis, should only be given to those who can produce evidence of having received adequate training in the methods of dealing with this particular disease. Where dispensaries, other than hospitals are established, the salaries of the dispensary medical officers should be standardised. Where the dispensary is a hospital, the hospital authorities will doubtless arrange the question of payment of its staff, in accordance with such standard. The question as to whether the payment of the salaries of the dispensary medical officers should be made through the Council, as are the salaries of the medical officers of health, at present, is one for future determination. I recommend it, so as to ensure that a proper standard of efficiency is attained by the medical officers, before joining the dispensary. In this connection it is desirable to draw attention to the fact that the Local Government Board evidently intends that cases of tuberculosis should be transferred from the Insurance to the health authorities. The Insurance Committee, should, through their local committees, have brought to their notice, such cases of tuberculosis as are locally discovered, as a preliminary to such transfer. With a proper tuberculosis scheme, insurance will be relegated to its true function, namely one of pure finance. I might here remark that it appears to me that a ticket system should be instituted for attendance at dispensaries. Tickets, which should be of two colours, one for insured and one for non-insured persons, should be readily obtained through medical officers of health and local insurance committees. They would entitle the holder to a visit and treatment at any dispensary, and would be a voucher for charges incurred, when presented to the authority responsible for payment. Such ticket system would very largely obviate book-keeping, and it is desirable to reduce clerical labour to a minimum. Part II.—Hospital and sanatorium treatment of patients.—-This part of the scheme relates to adults other than poor law persons, and should be divided into two sections, namely (a) insured, and (b) uninsured persons. (a) Insured persons.—The funds provided by the National Insurance Act ought to be adequate to meet the cost of treating insured persons, and it may be reasonably expected that, if they are not adequate to-day, they will be made so. Provision has already been made at Downs Sanatorium (L.C.C.) for 300 male persons, and the provision is capable of some extension. It is probable, moreover, that in the near future accommodation for a further 200 patients will be provided. The amount of money available for the treatment of insured persons is 1s. 3d. a head, of which 6d. is earmarked for domiciliary treatment and about ½d. for administrative expenses. There is also provided, primarily for research purposes, the sum of Id. a head, and I think that a portion of this sum should, if possible, incidentally, be utilised for the training of experts in the treatment of tuberculosis. As I have stated earlier in this memorandum, the supply of highly specialised officers is very inadequate. Moreover, I am of opinion that it would be of great advantage if the Insurance Committee, under the powers conferred upon them by section 60 (1) (6) of the National Insurance Act, would arrange for the education, by means of lectures, of nurses to be employed in institutions for the treatment of tuberculosis. It is clearly of importance that at an early stage it should be defined to what extent the various forms of treatment (sanatorium, domiciliary or dispensary) can be provided as regards insured persons. Personally, I am of opinion, that sanatorium treatment should only be given in such cases as, being incipient, show good prospects of recovery, or where a case is so advanced and the conditions of the home are exceptionally unfavourable as to make the movement of the patient imperative. It must be 3 realised that the extension of notification to all forms of tuberculosis encourages the belief that all forms of tuberculosis will be treated in sanatoria, but obviously only certain carefully selected cases of pulmonary tuberculosis should be so treated. It will require the closest attention of medical officers working on clearly defined lines to ensure equality of treatment throughout London. I commend attention to two difficult points, viz. (1) Rest Homes ; (2) Care of the Teeth. (1) Great difficulty is experienced in finding beds for hopeless cases, nor is it desirable that generally speaking, these cases should be mixed with the more hopeful cases. I deprecate the term “Homes for the dying,” but it is probable that a certain number of beds will need to be provided locally, situated in " Rest Homes.” (2) Tubercular patients frequently have bad or neglected teeth. All persons intended for sanatorium treatment should have their teeth attended to, with a view to removing one of the main obstacles to improved nutrition. (b) Uninsured ’persons.—This term includes dependents of insured persons, but I consider it advisable to distinguish children from adults in the scheme, in view of the fact that the Education Authority has statutory relations with regard to this class of dependents. In all treatment of uninsured persons carried out locally, the local rates should bear a percentage of the cost, and, if, as is proposed by the Government, half is borne by the State, this proportion should be not less than a quarter; the county rate finding the remainder. With regard to adults, I see no reason why, if unable to pay for themselves, they should not be dealt with as at present, when suffering from certain other infectious diseases, that is to say, by admitting to suitable institutions such as are provided by the Metropolitan Asylums Board, or are found in the voluntary hospitals. It is worthy of consideration whether voluntary hospitals could in any cases by means of the proposed capital government grants under the National Insurance Act, extend their existing accommodation. Evidently the same reservations as to who should undergo institutional treatment, must be enforced as in the case of insured persons, but I consider that it is essential that local authorities should not find it more economical to give treatment in residential institutions rather than elsewhere. I therefore would propose that, as regards the Metropolitan Asylums Board, the Local Government Board be asked to make such rules as would enable a moietyof the expenses falling on the rates, to be met locally. Part III.—Children.—The London County Council, as education authority, at present deals with the health of children, and has already provided and maintains a few institutions and open air classes for tuberculous children. I should like to see sanatorium provision where education is also given, to accommodate some 500 children; I believe this to be essential. Of these, some 350 would be surgical cases and 150 other forms. As prevention is better than cure, open air classes should be developed everywhere, and be brought into association with dispensaries. I contemplate classes of children who are tuberculous or come from homes where tuberculosis exists, being medically provided for, in association with the dispensary. Educationally, of course, the London County Council would be responsible. The borough medical officer of health will thus have a much greater responsibility as well as a greater opportunity as regards children living in contact with tuberculous persons. It is inadvisable to prolong this memorandum, although there are many details to which I have not referred, but those who read the letter of the Local Government Board, which was addressed on 11th December, 1912, to the County Council and published in the report of the County Council of the 17th December, 1912, and who have followed the various documents issued by the Local Government Board will be able to supply the gaps in this necessarily imperfect outline, which I desire to place on record, and I shall welcome criticisms and suggestions in the hope that a suitable solution shall be found of what is a very difficult problem. Cecil B. Levita. County Hall, Spring Gardens, 22nd February, 1913. London County Council ANNUAL REPORT OF THE COUNCIL, 1911. CHAPTER XXXII. Report of the Medical Officer of Health (Dr. W. H. Hamer) for the Year 1911. A—Vital Statistics. The mean temperature of the air during 1911 was 17 degrees above the average of the preceding 65 years. The greatest excess over the monthly average occurred in August, December, July and May; the temperature being below the average in April, March and January only. The rainfall during the year was very slightly below the average, the deficit being greatest in the months of July, August and September, and the excess greatest in November and December. In the preparation of this report the results of the census of 1911 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 (17’8) was slightly above the marriage rate of the preceding year (17.3). The birth-rate (24.8) was the lowest on record in London since the institution of civil registration. The infantile mortality (129), and the “all ages” death-rate (150) were both considerably higher than in 1910. The deaths from cancer, measles and diarrhoea were above the annual average of the preceding 10 years, and the deaths from small-pox, whooping-cough, scarlet fever, diphtheria, enteric fever and phthisis were below the average. Population. The population of the Administrative County of London, estimated to the middle of the year 1911, was 4,521,301. The census populations of London boroughs in 1901 and 1911 and the mid-year populations in 1911, as estimated by the Registrar-General, are shown in the following table:— Metropolitan borough. Census Population 1st April, 1901. Census Population :3rd April, 1911. Estimated Population (middlo of year 1911). Metropolitan borough. Census Population 1st April, 1901. Census Population 3rd April, 1911. Estimated Population (middle of year 1911). Paddington 143,976 142,551 142,513] Shoreditch 118,637 111,390 111,199 Kensington 176,628 172,317 172,203 Bethnal Green 129,680 128,183 128,144 Hammersmith 112,239 121,521 121,766 Stepney 298,600 279,804 279,309 Fulham 137,289 153,284 153,705 Poplar 168,822 162,442 162,274 Chelsea 73,842 66,385 66,189 Southwark 206,180 191,907 191,531 Westminster. City of 183,011 160,261 159,662 Bermondsey 130,760 125,903 125,775 St. Marylebone 133,301 118,160 117,761 Lambeth 301,895 298,058 297,957 Hampstead 81,942 85,495 85,589 Battersea 168,907 167,743 167,712 St. Pancras 235,317 218,387 217,941 Wandsworth 231,922 311,360 313,453 Islington 334,991 327,403 327,203 Camberwell 259,339 261,328 261,380 Stoke Newington 51,247 50,659 50,644 Deptford 110,398 109,496 109,472 Hackney 219,110 222,533 222,623 Greenwich 95,770 95,968 95,973 Holborn 59,405 49,357 49,092 Lewisham 127,495 160,834 161,712 Finsbury 101,463 87,923 87,566 Woolwich 117,178 121,376 121,487 London, City of 26,923 19,657 19,466 London 4,536,267 4,521,685 4,521,301 The above table shows that the population of London has declined during the last intercensal period notwithstanding that, as a matter of fact, the number of births has exceeded the number of deaths annually. This diminution, of course, is due to the increment of population in Greater London. 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, and this should be borne in mind in any general comparison of the crude natural increase rates. 12532 Natural increase of popu’ation. Diagram A. Marriages. Diagram B. -Births. — Report of the Medical Officer of Health 3 Marriages. number of marriages in the Administrative County of London in 1911, was 40,201 (365 days), annual rate of 17.8 persons married per 1,000 living, 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 17.8 1861-1870 20.3 1904 17.5 1871-1880 19.1 1905 17.5 1881-1890 17.6 1906 17.9 1891-1900 17.8 1907 17.9 1901-1910 17.5 1908 16.9 1909 16.9 1901 17.7 1910 17.3 1902 18.0 1911 17.8 Marriagerate s— London. The accompanying diagram (A) shows the marriage-rate in each year since 1850, in relation to the mean marriage-rate of the period 1851-1911. In the year 1911 among males 31 per cent, married were under 21 years of age, and among females 10.9 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:— Marriages of minors per cent, of total marriages. Period. London. England and Wales. Males. Females. Males. Females. 1851-18G0 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 12.9 11.3 4.0 14.0 1909 3.1 11.1 4.0 13.7 1910 2.9 10.8 3.8 13.3 Births. The number of births registered in the Administrative County of London in 1911 (52 weeks) was 111,738, giving a birth-rate of 24.8 per 1,000 persons living per annum. The male births numbered 56,939 and female 54,799, there being, therefore, 1,039 males born per 1,000 females. The steady decline in the London birth-rate noted in previous reports has continued, and the birth-rate for 1911 is the lowest recorded rate in London since the institution of civil registration. (a) See footnote (b), page 2. 12532 a 2 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 28.8a 1861-1870 35.4 1904 28.5a 1871-1880 35.4 1905 27.9a 1881-1890 33.2 1906 27.6a 1891-1900 30.2a 1907 26.9a 1901-1910 27.5a 1908 26.7a 1909 25.8a 1901 28.9a 1910 25.5a 1902 28.7a 1911 24.8a Birth-rates — London. Marriages of minors. The giving an 4 Annual Report of the London County Council, 1911. Birth-rates 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. (a) Period. Birth-rate per 1,000 persons living. (a) 1851-1860 34.1 1903 28.5 1861-1870 35.2 1904 28.0 1871-1880 35.4 1905 27.3 1881-1890 32.4 1906 27.2 1891-1900 29.9 1907 26.5 1901-1910 27.2 1908 26.7 1909 25.8 1901 28.5 1910 25.1 1902 28.5 1911 24.4 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; it should be borne in mind, however, 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. 1906-10. 1911. Town. 1906-10. 1911. London 26.5a 24.8a Bradford 19.9 19.0 Greater London 26.3 24.4 Hull 29.7 28.6 Liverpool 32.l 30.2 Newcastle-on-Tyne 30.4 26.6 Manchester 28.6 26.2 Nottingham 26.6 24.5 Birmingham 29.5 28.1 Stoke-on-Trent 31.5 Leeds 26.0 23.8 Portsmouth 26.7 25.0 Sheffield 30.5 27.8 Salford 29.9 27.2 Bristol 24.8 21.8 Leicester 24.7 22.7 West Ham 31.4 30.0 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; 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 material for only approximate comparison. Town. 1906-10. 1911. Town. 1906-10. 1911. London 26.5a 24.8a St. Petersburg 29.3 28.2 Paris 18.3 17.2 Berlin 23.5 20.8 Brussels 17.3 17.1 Vienna 23.7 20.0 Amsterdam 24.7 22.7 New York 27.5 27.0 Copenhagen 27.5 24.6 Stockholm 24.3 22.0 Birth-rates in foreign towns, The diagram (B) facing page 3 shows the London birth-rate in each year since 1850, in relation to the mean birth-rate of the period 1851-1911. 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. (a) See footnote (b) page 2, Report of the Medical Officer of Health. 5 The following table shows the birth-rate in the several sanitary districts per 1,000 persons living in the period 1906-10 and in the year 1911:— Metropolitan borough. Births, 1911 (52 weeks). (a) Birth-rate per 1,000 persons living. (a) 1906-10. 1911. Paddington 3,038 22.6 21.4 Kensington 3,252 19.5 18.9 Hammersmith 2,927 25.8 24.1 Fulham 4,121 30.5 26.9 Chelsea 1,269 21.6 19.2 Westminster, City of 2,358 16.9 14.8 St. Marylebone 2,376 21.5 20.2 Hampstead 1,276 16.2 14.9 St. Pancras 5,559 26.0 25.6 Islington 8,108 25.9 24.8 Stoke Newington 1.045 20.6 20.7 Hackney 5,226 24.8 23.5 Holborn 945 20.5 19.3 Finsbury 2,674 31.4 30.6 London, City of 226 13.3 11.6 Shoreditch 3,533 32.9 31.9 Bethnal Green 4,029 33.0 31.5 Stepney 8,743 34.9 31.4 Poplar 5,015 32.1 31.0 Southwark 5,693 31.0 29.8 Bermondsey 3,908 32.0 31.2 Lambeth 7,292 26.0 24.5 Battersea 4,372 27.1 26.1 Wandsworth 6,747 24.6 21.6 Camberwell 6,399 25.9 24.5 Deptford 3,000 28.7 27.5 Greenwich 2,376 26.5 24.8 Lewisham 3,420 23.3 21.2 Woolwich 2,811 26.2 23.2 London 111,738 26.4 24.8 Birth-rates in London sanitary districts. It will be seen from the above table that the birth-rates of the several sanitary districts vary greatly, ranging from 11.6 in the City of London, to 31.9 in Shoreditch, when the rates for the year 1911 are compared. 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). Excesj of registered over notified births (corrected). Paddington 3,060 74 2,986 3,038 + 52 Kensington 3,078 79 2,999 3,252 + 253 Hammersmith 2,382 57 2,325 2,927 + 602 Fulham 3,270 68 3,202 4,121 + 919 Chelsea 1,009 30 979 1,269 + 290 Westminster, City of 1,782 50 1,732 2,358 + 626 St. Marylebone 2,625 46 2,579 2,376 - 203 Hampstead 1,173 20 1,153 1,276 + 117 St. Pancras 5,150 152 4,998 5,559 + 561 Islington 7,523 205 7,318 8,108 + 790 Stoke Newington 936 8 928 1,045 + 117 Hackney 5,399 161 5,238 5,226 - 12 Holborn 874 32 842 945 + 103 Finsbury 2,740 57 2,683 2,674 — 9 London, City of 206 4 202 226 + 24 Notification of births. Continued on next page. (a) See footnote (b) page 2. 6 Annual Report of the London County Council, 1911. Metropolitan borough. Total births notified (corrected for institutions). Stillbirths (corrected). Births, less stillbirths (corrected). Births registered (corrected) Excess of registered over notified births (corrected). Shoreditch 3,386 113 3,273 3,533 + 260 Bethnal Green 3,848 79 3,769 4,029 + 260 Stepney 8,898 214 8,684 8,743 + 59 Poplar 4,551 106 4,445 5,015 + 570 Southwark 6,057 148 5,909 5,693 - 216 Bermondsey 3,637 43 3,594 3,908 + 314 Lambeth 7,080 130 6,950 7,292 + 342 Battersea 2,907 48 2,859 4,372 + 1,513 Wandsworth 4,654 93 4,561 6,747 + 2,186 Camberwell 5,469 137 5,332 6,399 + 1,067 Deptford 2,984 85 2,899 3,000 + 101 Greenwich 2,462 19 2,443 2,376 - 67 Lewisham 3,529 90 3,439 3,420 - 19 Woolwich 2,574 65 2,509 2,811 + 302 London 103,243 2,413 100,830 111,738 + 10,902 Still-births and multiple births, 1911. The number and percentage of still-births and of multiple births notified in 1911 (uncorrected for institutions) is shown in the following table:— Metropolitan borough. Total births notified. Stillbirths. Percentage still born. 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 2,834 73 2.6 36 4 - - - - - 72 1.3 Kensington 2,910 77 2.7 32 7 — — — — — 64 1.1 Hammersmith 2,276 57 2.5 11 2 l — — — — 22 0.5 Fulham 3,161 68 2.2 2 2 - - - - - 4 0.0 Chelsea 956 30 3.1 13 4 — — — — — 26 1.4 Westminster, City of 1,563 47 3.0 14 2 - - - - - 28 0.9 St. Marylebone 4,031 57 1.4 42 2 - - - - - 84 1.0 Hampstead 1,123 20 1.8 12 - - - - - - 24 1.1 St. Pancras 4,665 141 3.0 50 6 — — — — - 100 1.1 Islington 7,208 197 2.7 97 9 — 1 — — - 197 1.2 Stoke Newington 907 8 0.9 9 - - - - - - 18 1.0 Hackney 5,342 161 3.0 58 7 — 2 1 — — 122 1.1 Holborn 1,217 42 3.4 16 — 1 1 — — - 35 1.4 Finsbury 3,467 73 2.1 62 5 3 — — — - 124 1.8 London, City of 195 3 1.6 1 - - - - - - 2 0.5 Shoreditch 3,218 108 3.4 44 4 1 — — — - 88 1.4 Bethnal Green 3,818 78 2.0 43 4 — 1 — — — 89 1.1 Stepney 8,874 213 2.4 122 11 4 1 (Quadruplet) — — — 248 1.4 Poplar 4,5 44 106 2.3 61 1 4 - — — — 122 1.4 Southwark 6,036 148 2.4 57 6 2 1 — — — 117 0.9 Bermondsey 3,629 42 1.2 27 1 — - - — — 54 0.8 Lambeth 7,052 130 1.8 84 10 1 1 1 — — 171 1.2 Battersea 2,884 48 1.7 29 3 1 - - - - 58 1.0 Wandsworth 4,637 92 2.0 37 4 — - — — - 74 0.8 Camberwell 5,454 137 2.5 61 2 - 1 - - - 125 1.1 Deptford 2,980 85 2.9 32 4 - - - - - 64 1.1 Greenwich 2,461 19 0.8 14 1 - - - - - 28 0.6 Lewisham 3,524 90 2.6 39 3 — - - — - 78 1.1 Woolwich 2,572 65 2.5 2 - - - - - - 4 0.1 London 103,538 2,415 2.3 1.107 104 18 8 2 — — 2,242 1.1 & (1 Quad ruplet). Deaths. The number of deaths in the Administrative County of London in 1911 (52 weeks) was 67,826 giving an annual death rate of 15.0 per 1,000 of the estimated population. Q> $ Report of the Medical Officer of Health. 7 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 17.4a 1851-1860 23.7 1903 15.4a 1861-1870 24.4 1904 16.5a 1871-1880 22.5 1905 15.6a 1881-1890 20.3 1906 15.8a 1891-1900 19.2a 1907 15.3a 1901-1910 15.7a 1908 14.6a 1909 15.0a 1901 17.2a 1910 13.7a 1911 15.0a The death-rate in each year since 1840 in relation to the mean death-rate of the period 1841-1911 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 1911. Tbe 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 1911. (b) Crude death-rate Death-rate per 1 ,000 Comparative Estimated per mortality Population 1,000 persona living. (corrected for age sex distribution) figure. Town (middle of 1911). 1906-10. 1911. 1906.10. 1911. 1911. England A Wales 36,163,833 14.70 14.60 14.70 14.60 1,000 London 4,521,301 14.88a 15.04a 15-64a 1581a 1,083 Liverpool 747,566 19.60 19.96 20.98 21.36 1,463 Manchester 716,180 18.12 16.99 20.18 ! 18.92 1,296 Birmingham 525,903 16.62 16.78 17.88 18.05 1,236 Sheffield 455,817 16.30 16.12 17.57 17.37 1,190 Leeds 445,967 16.00 16.37 17.45 17.86 1,223 Bristol 357,493 13.86 15.12 14.24 15.53 1,064 West Ham 289,601 15.54 15.77 16.62 16.87 1,155 Bradford 288,695 15.32 14.89 16.93 16.46 1,127 Hull 278,984 16.10 16.67 16.50 17.09 1,171 Newcastle-on-Tyne 267,116 16.50 16.11 17.77 17.35 1,188 Nottingham 260,425 16.24 16.06 17.11 16.92 1,159 Stoke-on-Trent 235,051 18.48 19.89 19.94 21.46 1,470 Portsmouth 232,253 14.06 14.05 14.44 14.43 988 Salford 231,624 18.22 16.65 20.13 | 18.39 1,260 Leicester 227,632 13.80 13.29 14.73 14.18 971 London had therefore (comparing the corrected death-rates), both in the quinquennium 1906-10 and in the year 1911 a lower death-rate than any of these towns except Bristol, Portsmouth, and Leicester. The following table enables comparison to be made of the crude death-rate of London with that of several foreign towns:— Town. 1906-10. 1911. Town. 1906-10. 1011 London 14.9a 15.0a Stockholm 15.1 12.7 Greater London 13.7 13.8 St. Petersburg 25.6 20.8 Paris 17 .5 17.2 Berlin 15.5 15.6 Brussels 14.1 13.9 Vienna 17.1 16.4 Amsterdam 13.1 12.4 New York 17.0 15.1 Copenhagen 15.1 14.8 It will be seen from the foregoing table that in the quinquennium 1906-10 the London death-rate was exceeded by the death-rates of Paris, Copenhagen, Stockholm, St. Petersburg, Berlin, Vienna, and New York, and in 1911 was lower than that of any except Brussels, Amsterdam, Copenhagen and Stockholm. (a) See footnote (c) page2. (i) The corrective factors shown in the table and elsewhere in this report where calculated upon the age-and sexconstitution of the population enumerated in 1901. Their application to the deaths in 1911 assumes that the constitution of the population has remained unchanged during eleven 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. (c) Rates, for years prior to 1911, are for an approximate area. Death-rates in foreign towns. Death-rates in large English towns. 8 Annual Report of the London County Council, 1911. Death-rates in London boroughs. 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 1911; the mean death-rates for the period 1906-10 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). 1906-10. 1911. 1906-10. 1911. 1906-10. 1911. England and Wales 18.19 1.0000 • 14.70 14.60 l4.70 14.60 940 923 London 17.31 1.0511 14.88 15.04 15.64 15.81 1,000 1,000 Paddington 17.4 1.0677 13.32 13.35 14.22 14.25 909 901 Kensington 16.88 1.0778 13.80 13.68 14.87 14.74 951 932 Hammersmith 17.47 1.0414 14.50 15.57 15.10 16.21 965 1,025 Fulham 17.39 1.0462 14.26 14.37 14.92 15.03 954 951 Chelsea 17.56 1.0361 15.80 15.45 16.37 16.01 1,047 1,013 Westminster, City of 16.22 1.1217 12.90 12.45 14.47 13.97 925 884 St. Marylebone 17.08 1.0652 14.82 15.09 15.79 16.07 1,010 1,016 Hampstead 16.13 1.1280 9.76 9.64 11.01 10.87 704 688 St. Pancras 17.40 1.0456 15.76 15.51 16.48 16.22 1,054 1,026 Islington 17.51 1.0391 14.72 14.87 15.30 15.45 978 977 Stoke Newington 17.43 1.0438 12.24 13.03 12.78 13.60 817 860 Hackney 17.46 1.0420 13.68 14.35 14.25 14.95 911 946 Holborn 16.90 1.0766 17.16 15.69 18.47 16.89 1,181 1,068 Finsbury 17.57 1.0355 19.86 19.79 20.57 20.49 1,315 1,296 London, City of 16.55 1.0993 15.50 15.09 17.04 16.59 1,090 1,049 Shoreditch 17.34 1.0493 18.94 20.07 19.87 21.06 1,270 1,332 Bethnal Green 18.01 1.0102 17.46 18.15 17.64 18.34 1,128 1,160 Stepney 17.41 1.0450 17.18 17.35 17.95 18.13 1,148 1,147 Poplar 17.64 1.0314 17.10 18.87 17.64 19.46 1,128 1.231 Southwark 17.41 1.0450 18.28 18.37 19.10 19.20 1,221 1,214 Bermondsey 17.76 1.0244 18.72 18.42 19.18 18.87 1,226 1,194 Lambeth 17.63 1.0320 14.94 14.91 15.42 15.39 986 973 Battersea 16.96 1.0728 13.78 14.30 14.78 15.34 945 970 Wandsworth 17.25 1.0547 11.76 11.97 12.40 12.62 793 798 Camberwell 17.54 1.0373 14.28 14.29 14.81 14.82 947 937 Deptford 17.31 1.0511 15.32 15.63 16.10 16.43 1,029 1,039 Greenwich 17.82 1.0210 14.20 14.72 14.50 15.03 927 951 Lewisham 17.46 1.0420 11.24 11.29 11.71 11.76 749 744 Woolwich 17.02 1.0690 12.96 12.83 13.85 13.72 886 868 It will be seen from the foregoing table (comparing the corrected death-rates) that in the quinquennium 1906-10, Finsbury (20.6) had the highest rate and Hampstead (11.0) the lowest; in the year 1911, Shoreditch (211) had the highest, and Hampstead (10.9) the lowest. The death-rates in each of the four quarters of the year 1911, were as follows : first quarter, 17 2; second quarter, 13 2; third quarter, 15.5; and fourth quarter, 143 per 1,000 persons living. Infantile Mortality. The deaths of children under one year of age in the Administrative County of London during 1911 (52 weeks) numbered 14,440, being in the proportion of 129 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 157c 1908 130d 1851-1860 155c 1904 145d 1861-1870 162c 1905 130d 1871-1880 158c 1906 131d 1881-1890 152 1907 116d 1891-1900 159d 1908 113d 1901-1910 126d 1909 108d 1910 103d 1901 148d 1911 129d 1902 140d The accompanying diagram (D.) shows the infantile mortality in each year since 1857 in relation to the mean infantile mortality of the period 1858-1911, 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 (a) See footnote (A), page 7. (b) All death-rates in this report relating to metropolitan boroughs are fully corrected for institutions (see foot-note (c), page 2.) (c) The registration of births was not made compulsory until the beginning of 1875; before that year many births were probably unregistered. (d) See footnotes (d) and page 2- Diagram D. Infantile Mortality (Deaths under one year of age per 1000 births.) 9 Report of the Medical Officer of Health. affected in greater degree than the deaths under any other heading by the more complete registration of recent years. Infantile mortality in large English towns. The following table enables comparison to be made of the infantile mortality in London and other large English towns. Town. 1906-10. 1911. Town. 1906-10. 1911. London 114a 129a Bradford 132 138 Greater London 109 124 Hull 136 155 Liverpool 148 154 Newcastle-on-Tyne 130 136 Manchester 146 154 Nottingham 152 162 Birmingham 145 164 Stoke-on-Trent 165 202 Sheffield 138 140 Portsmouth 110 126 Leeds 134 158 Salford 134 149 Bristol 109 141 Leicester 137 132 West Ham 127 141 London had therefore in the period 1906-10 a lower infantile mortality than any of these towns except Bristol and Portsmouth. In 1911 the London rate was below all except that of Portsmouth. The rates are uncorrected (except in the case of London) for births in institutions. The uncorrected London rate for 1911 was 131. 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. Infantile mortality in foreign towns. 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 1906-10, owing to the incomplete registration of births prior to 1908. Town. 1906-10. 1911. Town. 1906-10. 1911. London 114a 129a Stockholm 103 77 Paris 106 118 St. Petersburg 256 231 Brussels 145 137 Berlin 164 173 Amsterdam 90 91 Vienna 172 166 Copenhagen 129 113 New York 136 112 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 1906-10 and for the year 191l(a):— Metropolitan borough. Deaths under one year of age, 1911 (52 weeks). Deaths under one year of age per 1,000 births. 1906-10. 1911. Paddington 387 103 127 Kensington 432 120 133 Hammersmith 428 118 146 Fulham 517 118 125 Chelsea 138 114 109 Westminster, City of 244 99 103 St. Marylebone 257 105 108 Hampstead 99 70 78 St. Pancras 624 108 112 Islington 1,032 107 127 Stoke Newington 107 87 102 Hackney 621 109 119 Holborn 109 114 115 Finsbury 418 134 156 London, City of 28 93 124 Shoreditch 601 149 170 Bethnal Green 610 135 151 Stepney 1,261 123 144 Poplar 787 129 157 Southwark 818 130 144 Bermondsey 609 137 156 Lambeth 897 112 123 Battersea 540 109 124 Wandsworth 823 97 122 Camberwell 696 109 109 Deptford 425 119 142 Greenwich 305 110 128 Lewisham 354 89 104 Woolwich 273 96 97 London 14,440 114 129 (a) See footnotes (b) and (c), page 2, 12532 e 10 Annual Report of the London County Council, 1911. It will be seen from the foregoing table that in the period 1906-10 and the year 1911 Shoreditch (149 and 170 respectively) had the highest infantile death-rates and Hampstead (70 and 78 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 108; second quarter 89; third quarter 203 ; fourth quarter 113. The reports of Medical Officers of Health of the several sanitary districts of the Administrative County for the year 1911 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 1911. It will be seen that the total deaths here shown differ slightly from the total in the preceding table derived from the annual summary of the Registrar-General. Cause of death. Under1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 0-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under one year.[/### Common Infectious Diseases— Small-pox — — — — — 1 — — — 1 Chicken-pox — — — — — 2 — 2 1 5 Measles — 3 3 3 9 13 31 168 319 631 Scarlet Fever — — — — — — 1 1 4 6 Diphtheria and Group — — — — — 4 6 13 30 53 Whooping-cough — — 2 4 6 56 79 134 155 424 Diarrhœal Diseases— Diarrhoea, all forms 6 14 30 57 106 648 1,067 793 582 3,090 Enteritis (not tuberculous) 1 21 29 31 82 348 414 295 227 1,284 Gastritis, Gastro-intestinal Catarrh 3 5 2 7 17 41 19 7 2 69 Wasting Diseases— Premature Birth 1,374 179 144 102 1,799 1,944 23 2 1 1,970 Congenital Malformations 191 52 39 18 300 390 40 27 15 472 Atelectasis 123 18 12 2 155 168 4 1 2 175 Injury at Birth 114 4 1 — 119 121 2 — — 123 Want of Breast-milk 286 134 115 119 654 1,140 375 143 80 1,738 Atrophy, Debility, Marasmus Tuberculous Diseases— Tuberculous Meningitis — 1 1 1 3 19 55 69 68 211 Tuberculous Peritonitis: Tabes Mesenterica — — — 4 4 24 29 28 18 99 Other Tuberculous Diseases — — — — — 14 45 38 51 148 Erysipelas — 3 2 2 7 16 6 4 — 26 Syphilis 11 21 10 14 56 119 32 13 8 172 Rickets — 2 — — 2 4 7 9 18 38 Meningitis (not Tuberculous) 1 3 2 4 10 25 44 66 48 183 Convulsions 64 44 40 25 173 269 76 49 34 428 Bronchitis 11 26 40 31 108 335 210 150 152 847 Laryngitis 1 1 — — 2 6 3 4 4 17 Pneumonia 12 23 33 31 99 357 258 327 392 1,334 Suffocation, overlaying 43 7 14 16 80 183 59 12 7 261 Other causes 134 56 52 35 277 422 150 130 102 804 Total (All Causes) 2,374 617 571 506 4,068 6,669 3,035 2,485 2,320 14,509 Comparison may be made between the number of deaths from the several causes in the above table with those of the six 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. 1911. 52 weeks. Deaths in 1911 in excess or defect of the corrected average for 1905-10 Diminution in 1911 Excess in 1911 Small-pox — — — — — — 1 — 1 Chicken-pox 3 3 5 3 10 4 5 — 1 Measles 389 420 400 333 503 391 531 — 155 Scarlet Fever 34 18 35 24 20 10 6 15 — Diphtheria and Croup 52 59 53 67 60 30 53 — 4 Whooping-cough 623 502 746 469 524 602 424 110 —- (Continued on next page.) 11 Report of the Medical Officer of Health. Cause of death. 1905. 52 weeks. 1906. 52 weeks. 1907. 52 weeks. 1908. 53 weeks. 1909. 52 weeks. 1910. 52 weeks. 1911. 52 weeks. Deaths in 1911 in excess or defect of the corrected average for 1905-10 Diminution in 1911 Excess in 1911. Diarrhœa 3,423 4,468 1,790 2,709 1,849 1,536 4,443 — 2,042 Enteritis (not tuberculous) Gastritis, Gastro-intestinal Catarrh Premature Birth 2,423 2,208 2,299 2,197 2,122 2,086 1,970 79 — Congenital Malformation 547 613 645 705 667 657 472 — 56 Atelectasis 175 Injury at Birth 99 113 117 110 113 108 123 — 21 Want of Breast-milk 2,281 2,130 1,922 1,843 1,825 1,682 1,738 55 — Atrophy, Debility, Marasmus Tuberculous Meningitis 273 241 239 259 203 179 211 3 — Tuberculous Peritonitis: Tabes Mesenterica 192 225 153 168 145 129 99 56 — Other Tuberculous Diseases 284 246 264 255 188 142 148 63 — Erysipelas 64 50 52 35 48 32 26 17 — Syphilis 271 233 226 229 216 186 172 37 — Rickets 79 67 58 51 45 54 38 16 — Meningitis (not tuberculous) 300 302 210 246 170 174 183 31 — Convulsions 803 660 603 520 495 475 428 116 — Bronchitis 1,276 1,043 1,284 982 960 843 847 133 — Laryngitis 25 23 15 18 15 13 17 — — Pneumonia 1,490 1,335 1,629 1,431 1,334 1,442 1,334 — 2 Suffocation, overlaying 462 417 421 417 322 321 261 101 — Other causes 1,004 1,009 979 885 852 751 804 37 — Total 16,397 16,385 14,145 13,956 12,686 11,847 14,509 Number of births (a) 125,939 124,880 121,408 122,898 116,559 115,190 111,738 Net excess 1,413 Deaths of infants at certain age periods. The total deaths among children under one year of age from "all causes" at certain age periods in 1911 may be compared with similar figures included in the Annual Reports for the preceding six years as follows:— Year. Under 1 Week 1 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 0-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under one year. 1905 2,886 808 667 564 4,925 8,132 3,227 2,665 2,373 16,397 1906 2,683 707 722 545 4,657 7,764 3,439 2,736 2,446 16,385 1907 2,758 760 676 533 4,727 7,504 2,580 2,087 1,974 14,145 1908 2,645 651 631 485 4,412 7,189 2,736 2,097 1,934 13,956 1909 2,535 612 540 471 4,158 6,564 2,352 1,910 1,860 12,686 1910 2,465 598 500 451 4,014 6,230 2,148 1,795 1,674 11,847 1911 2,374 617 571 506 4,068 6,669 3,035 2,485 2,320 14,509 The following table has been prepared to show approximately the death-rates in age-periods per 1,000 living at the beginning of each period:— Year. Under 1 Week 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 0-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total under one year. (a) 1905 22.9 6.6 5.5 4.6 39.1 64.6 27.4 23.3 21.2 130.2 196 21.5 5.8 5.9 4.5 37.3 62.2 29.4 24.1 22.0 131.2 1907 22.7 6.4 5.7 4.5 38.9 61.8 22.7 18.7 18.1 116.5 1908 21.5 5.4 5.3 4.1 35.9 58.5 23.6 18.6 17.4 113.6 1909 21.7 5.4 4.8 4.2 35.7 56.3 21.4 17.7 17.6 108.8 1910 21.4 5.3 4.5 4.0 34.8 54.1 19.7 16.8 15.9 102.8 1911 21.2 5.6 5.3 4.7 36.4 59.7 28.9 24.4 23.3 129.8 (a) Corrected for births in the principal maternity institutions only. (b) These rates are based upon the Death returned by the Medical Officers of Health of the metropolitan boroughs, and in some cases differ slightly from the similar rates based upon the Registrar-General's returns. 12532 B 2 12 Annual Report of the London County Council, 1911. With a view to comparing the rates of mortality from the several groups of diseases in the years 1905-11 the following table has been prepared:— 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 102.8 3.4 5.2 13.3 39.4 3.9 5.6 7.3 12.5 12.2 1911 129.8 4.7 3.8 39.7 40.1 4.1 5.5 7.6 11.9 12.4 The following tables, which are based upon the figures in the table on page 10, show the number of survivors at the beginning of each of five periods in the first twelve months of life, and the probability of living through each period, per 100,000 born in the year 1911. For the purpose of comparison, the corresponding figures for the preceding six years are shown. Age-period. X Number living at the beginning of each of five periods in the first year of life. 1 X 1911. 1910. 1909. 1908. 1907. 1906. 1905. 0—1 month 100,000 100,000 100,000 100,030 100,000 100,000 100,000 1—3 months 96,384 96,523 96,458 96,422 96,122 96,292 96,112 3—6 ,, 94,074 94,609 94,409 94,179 93,851 93,826 93,587 6—9 „ 91,418 92,761 92,416 91,977 91,760 91,095 91,068 9—12 ,, 89,246 91,214 90,826 90,279 90,080 88,926 89,000 0—1 year 87,249 89,779 89,286 88,718 88,500 86,993 87,163 Age-period. x Probability of living through each of five periods in the first year of life. P X 1911. 1910. 1909. 1908. 1907. 1906. 1905. 0—1 month .96384 .96523 .96458 .96422 .96122 .96292 .96112 1—3 months .97603 .98017 .97876 .97674 .97637 .97439 .97373 3—6 ,, .97177 .98047 .97889 .97662 .97772 .97089 .97308 6—9 ,, .97624 .98332 .98280 .98154 .98169 .97619 .97729 9—12 ,, .97762 .98427 .98304 .98271 .98246 .97826 .97936 0—1 year .87249 .89779 .89286 .88718 .88500 .86993 .87163 Deaths of infants in London boroughs. The following table shows the age-distribution of the deaths under one year of age in the several sanitary districts of London:— Metropolitan borough. Under 1 Week. 1-2 Weeks. 2—3 Weeks. 3-4 Weeks. Total under 1 Month. j 0—3 Months. j 3—6 Months. 6—9 Months. 9—12 Months. Total under 1 Year Paddington 58 17 17 11 103 177 81 63 66 387 Kensington 78 22 11 15 126 192 93 69 81 435 Hammersmith 85 11 15 16 127 207 105 61 61 434 Fulham 89 19 20 18 146 254 108 90 65 517 Chelsea 20 3 11 4 38 63 35 22 19 139 Westminster, City of 54 12 6 6 78 128 48 38 29 243 St. Marylebone 42 10 14 10 76 146 30 43 42 261 Hampstead 26 2 7 4 39 54 15 21 15 105 St. Pancras 106 29 33 27 195 329 114 101 79 623 (Continued on next page.) (a) See footnote (b), page 11. 13 Report of the Medical Officer of Health. Metropolitan borough. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 0-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total under 1 Year. Islington 170 52 34 37 293 500 201 171 168 1,040 Stoke Newington 14 5 5 7 31 49 20 22 15 106 Hackney 106 35 25 21 187 298 99 131 105 633 Holbom 19 5 1 3 28 42 20 22 20 104 Finsbury 65 24 12 15 116 194 85 69 63 411 London, City of 7 — — — 7 10 3 2 4 19 Shoreditch 94 21 17 22 154 252 152 104 90 598 Bethnal Green 80 25 24 27 156 265 141 90 103 599 Stepney 194 44 42 34 314 546 261 225 229 1,261 Poplar 127 28 30 20 205 340 158 149 140 787 Southwark 128 38 35 36 237 386 172 144 121 823 Bermondsey 84 22 26 11 143 253 141 104 113 611 Lambeth 135 44 38 36 253 422 200 155 128 905 Battersea 94 23 27 22 166 249 108 92 97 546 Wandsworth 134 29 43 37 243 360 183 138 142 823 Camberwell 117 44 25 25 211 322 158 118 137 735 Deptford 71 14 21 16 122 193 98 68 69 428 Greenwich 48 9 13 8 78 132 72 57 45 306 Lewisham 67 20 12 5 104 171 81 65 40 357 Woolwich 62 10 7 13 92 135 53 51 34 273 London 2,374 617 571 506 4,068 6,669 3,035 2,485 2,320 14,509 • Infantile mortality and "social condi tiati," 1911. Infantile mortality in relation to "social condition"—1911. Age-period. Group of boroughs in order of " social condition." I. II. III. IV. #] Under 1 week 20.3 20.2 20.3 22.1 22.6 1-2 weeks 4.5 5.0 5.8 5.3 5.9 2-3 „ 3.9 5.2 4.7 5.6 5.3 3-4 „ 1.8 4.6 4.3 5.0 4.8 Under 1 month 30.5 35.0 35.1 38.0 38.6 0-3 months 47.7 54.7 58.0 61.7 66.0 3-6 „ 20.1 27.0 24.4 26.5 34.1 6-9 ,, 17.9 21.3 20.5 22.7 25.9 9-12 „ 12.0 21.2 19.2 19.8 26.1 0-12 months 97.7 124.2 122.1 130.7 152.1 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 :— 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:— Number of group of boroughs in order of " social condition." Comparative mortality—Group 1. taken as 100. Children aged 0-3 mouths. Children aged 3-6 months. Children aged 6-9 months. Children aged 9-12 months. Children under 1 year. 1905-10. 1911. 1905-10. 1911. 1905-10. 1911. 1905-10. 1911. 1905-10. 1911. I. 100 100 100 100 100 100 100 100 100 100 II. 114 115 128 134 149 119 162 177 126 127 III. 119 122 134 121 159 115 179 160 133 125 IV. 124 129 146 132 175 127 190 165 141 134 V. 129 138 175 169 207 145 238 218 159 156 (a) 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 Council for education purposes in the 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. 14 Annual Report of the London County Council, 1911. The figures for the period 1905-10 show that 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 1911, although not so consistent, are in general agreement with those for the period 1905-10. 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, and enteric fever during 1911 (52 weeks) was 4,545, giving an annual death-rate of 1.01 per 1,000 persons living. The death-rates in successive periods, including typhus and pyrexia, have been as follows :— Period. Death-rate per 1,000 persons living. Period. Death-rate per 1,000 persons living. . 1841-1850 3.74 1902 l.69a 1851-1860 3.69 1903 l.14o 1861-1870 3.95 1904 l.14a 1871-1880 2.87 1905 1.00a 1881-1890 2.26 1906 1.02a 1891-1900 l.90a 1907 l.15a 1901-1910 1.14a 1908 0.87a 1909 l.04a 1901 l.37a 1910 0.93a 1911 1.01ab Epidemic diseases in large English towns. It will be seen from the following table that in the quinquennium 1906-10, London had a lower death-rate from the above diseases than any of the undermentioned English towns, except Leeds, Bristol, Bradford, Nottingham, and Leicester, and in 1911 had a lower death-rate than any except Manchester Leeds, Bradford, Nottingham, Salford, Portsmouth, and Leicester. Town. 1906-10. 1911. (b) Town. 1906-10. 1911. (b) London 0.99a 1.01a Bradford 0.80 0.72 Greater London 0.92 0.93 Hull 3.04 1.08 Liverpool 1.52 1.11 Newcastle-on-Tyne 1.07 1.18 Manchester 1.38 0.92 Nottingham 0.91 0.78 Birmingham 1.26 1.06 Stoke-on-Trent 1.44 1.46 Sheffield 1.23 2.11 Portsmouth 1.02 0.80 Leeds 0.97 1.00 Salford 1.82 0.98 Bristol 0.71 1.05 Leicester 0.88 0.67 West Ham 1.46 1.30 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 1906-10, higher than the death-rate of all the under-mentioned foreign towns, except St. Petersburg and New York, and in 1911 was higher than that of all except St. Petersburg:— Town. 1906-10. 1911. Town. 1906-10. 1911. London l.00a l.01a St. Petersburg 3.07 1.81 Paris 0.54 0.63 Berlin 0.83 0.95 Brussels 0.52 0.36 Vienna 0.75 0.43 Amsterdam 0.72 0.66 New York 1.01 0.73 Copenhagen 0.65 0.74 Stockholm 0.64 0.32 (a) See footnote (c), page '2. (b) Excluding Typhus and Pyrexia. Diagram E. Smallpox. 15 Report of the Medical Officer of Health. Deaths from epidemic diseases in London boroughs. The following table shows the deaths from the principal epidemic diseases, excluding pyrexia and diarrhoea and enteritis, and the death-rates per 1,000 persons living in each of the sanitary districts of the County in 1911, and the death-rates for the period 1906-10 :— Metropolitan borough. Deaths, 1911 (52 weeks). Death-rate per 1,000 persons living. 1906-10. 1911. Paddington 111 0.70 0.79 Kensington 172 0.70 0.99 Hammersmith 111 1.01 0.92 Fulham 134 1.13 0.88 Chelsea 46 0.94 0.70 Westminster, City of 70 0.43 0.44 St. Marylebone 108 0.1 0.92 Hampstead 36 0.40 0.42 St. Pancras 219 0.99 1.01 Islington 284 0.99 0.87 Stoke Newington 53 0.62 1.05 Hackney 245 0.81 1.11 Holborn 27 0.80 0.55 Finsbury 134 1.69 1.52 London, City of 4 0.50 0.20 Shoreditch 191 1.72 1.72 Bethnal Green 208 1.42 1.62 Stepney 404 1.43 1.46 Poplar 339 1.47 2.09 Southwark 225 1.33 1.19 Bermondsey 129 1.69 1.03 Lambeth 242 0.88 0.82 Battersea 175 1.01 1.05 Wandsworth 352 0.70 1.13 Camberwell 194 0.94 0.75 Deptford 130 1.20 1.19 Greenwich 77 1.08 0.81 Lewisham 77 0.62 0.47 Woolwich 48 0.81 0.39 London 4,545 0.99 1.01 It will be seen from the foregoing table that the death.rate from these diseases in the period 1906.10 was highest in Shoreditch (1.72) and lowest in Hampstead (0.40), and in 1911 was highest in Poplar (2.09) and lowest in the City of London (0.20). The death.rates from these diseases during each of the four quarters of the year were as follows : First quarter, 2.00; second quarter, 1.03; third quarter, 0.48; and fourth quarter, 0.46 per 1,000 persons living. Smallpox and Vaccination. Sixty-three cases of smallpox are known to have occurred in the Administrative County of London during the year 1911, of which 9 were fatal. 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 1903 0.003a 1851-1860 0.280 1904 0.006a 1861-1870 0.276 1905 0.002a 1871-1880 0.457 1906 — 1881-1890 0.142 1907 — 1891-1900 0.009a 1908 — 1901-1910 0.035a 1909 0.000a 1910 — 1901 0.051a 1911 0.002a 1902 0.285a The smallpox death-rate in each year since 1840 in relation to the mean death-rate during the period 1841-1911 is shown in diagram (E). (a) See footnote (c), page 2, 16 Annual Report of the London County Council, 1911. 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 1911 72 0.016 Smallpox death-rates in large English towns. It will be seen from the following table that in the quinquennium 1906-10 only two of the under mentioned towns, namely, Bristol and Hull, had a rate of 0.01 per 1,000, and that in 1911, deaths occurred in London and Birmingham only. Town. 1906-10. 1911. Town. 1906-10. 1911. London 0.00 a 0.00a Bradford — — Greater London o.oo o.oo Hull 0.01 — Liverpool 0.00 — Newcastle-on-Tyne 0.00 — Manchester — — Nottingham 0.00 — Birmingham — 0.00 Stoke-on-Trent — — Sheffield 0.00 — Portsmouth — — Leeds — — Salford — Bristol 0.01 — Leicester — — West Ham — — Smallpox death-rates in foreign towns. The following table shows that of the undermentioned towns, Paris, St. Petersburg and Vienna are the only towns which had an appreciable death-rate from smallpox during the last six years :— Town. 1906-10. 1911. Town. 1906-10. 1911. London 0.00a 0.00a Stockholm — — Paris 0.01 0.00 St. Petersburg 0.12 0.09 Brussels 0.00 — Berlin 0.00 o.oo Amsterdam — — Vienna o.oo — Copenhagen — — New York o.oo 0.00 Smallpox in Loadon. Of the 72 cases of smallpox notified in London during 1911, 63 occurred during February and March. Forty of these cases occurred in Stepney, where the outbreak originated. In his annual report, Dr. Thomas mentions that the first case was that of an out-patient of the London Hospital who was on February 5th removed to the Mile End Infirmary, suffering from an illness accompanied by a rash. She was accommodated in a general ward, where there were 60 women and children, but the true nature of the ailment was not discovered until February 20th, when two other patients in the ward presented symptoms of smallpox. The next day four other patients were removed to the smallpox hospital, two of them being from the same ward, and on each day until February 28th, fresh cases were removed from the Infirmary, most of them from the infected ward. Dr. Thomas states that his inquiries into the outbreak suggest, as the (a) See footnote (c), page 2. 17 Report of the Medical Officer of Health. probable origin of the disease in Stepney, several cases of unrecognised illness, accompanied by a rash occurring among the members of a family which had been visited by the first patient, who, as above stated, afterwards attended the London Hospital. On the 23rd February, a widow, a scrubber at the Mile End Infirmary, residing in Poplar, was removed to hospital suffering from smallpox. On March 7th, a child was removed from a house in Eglinton Road, Bow, followed by a group of connected cases, but there was no evidence of association with the infirmary case. Three cases attributed to infection from the Stepney outbreak occurred in Hackney, and two cases in Shoreditch were probably infected as the result of a visit to the home of one of the Hackney cases. A third case in Shoreditch could not be connected with any other case. A youth living in Westminster, but working in Stepney, was also attacked. He had, however, only been employed there for a week before he contracted the disease, and did not work in the same premises as any of the Stepney patients. Three sporadic cases occurred in Bethnal Green, and several others in boroughs so far removed as Paddington, Camberwell and Deptford. Vaccinal ion 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 1892 18.4 1873 8.7 1893 18.2 1874 8.8 1894 20.6 1875 9.3 1895 24.9 1876 6.5 1896 26.4 1877 7.1 1897 29.1 1878 7.1 1898 33.0 1879 7.8 1899 27.7 1880 7.0 1900 25.8 1881 5.7 1901 24.1 1882 6.6 1902 21.3 1883 6.5 1903 20.7 1884 6.8 1904 19.1 1885 7.0 1905 18.9 1886 7.8 1906 21.2 1887 9.0 1907 22.7 1888 10.3 1908 21.5 1889 11.6 1909 20.6 1890 13.9 1910 20.5 1891 16.4 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; 1910, 13.6. Number of children unaccounted for as regards vaccination per cent. of total births. 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. 19?4. 1905. 1906. 1907. 1908. 1909. 1910. 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 22.3 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 56.8 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 45.3 Chelsea 17.3 14.9 16.0 13.4 14.9 13.9 10.0 8.9 130 14.3 16.9 19.8 19.3 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 23.5 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 11.8 . 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 19.6 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 30.8 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 21.4 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 43.8 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 22.1 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 22.5 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 34.2 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 30.8 12532 (Continued on next page.) 0 18 Annual Report of the London County Council, 1911. Metropolitan Union. 1898. 1899. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 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 13.8 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 34.6 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 33.9 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 22.0 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 15.7 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 51.1 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 20.1 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 41.9 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 57.6 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 47.0 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 37.0 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 56.6 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 26.3 Wandsworth 32.2 25.1 23.0 20.5 19.2 17.2 16.3 14.8 18.0 22.8 28.2 30.1 34.5 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 17.2 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 18.8 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 28.8 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 34.1 The above table shows increase since 1905 in the proportion of children born who are remaining unvaccinated. Measles. The deaths from measles in the Administrative County of London during 1911 (52 weeks numbered 2,570, as compared with 1,980 in 1910 (52 weeks). The death.rates from this disease per 1,000 persons living in 1911 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 1903 0.45a 1851-1860 0.53 1904 0.50a 1861-1870 0.58 1905 0.38a 1871-1880 0.51 1906 0.42a 1881-1890 0.64 1907 0.40a 1891-1900 0.58a 1908 0.33a 1901-1910 0.44a 1909 0.51a 1901 0.43a 1910 0.44a 1902 0.51a 1911 0.57a Mortality among children at ages 0—5. 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 :— 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 3.89 1903 4.02a 1861-1870 4.18 1904 4.49a 1871-1880 3.65 1905 3.38a 1881-1890 4.74 1906 3.83a 1891-1900 4.82a 1907 3.58 a 1901-1910 3.92a 1908 3.00 a 1909 4.73 a 1901 3.71a 1910 4.00a 1902 4.49a 1911 5.18a (a) See footnote (c), page 2, Diagram F. —Meaasles— D/a gram G. -Measles &Whooping-Cougli(Deatbs 1891-1911.) 19 Report of the Medical Officer of Health. The death-rate in each year since 1840 in relation to the mean death-rate of the period 1841 1911, 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 1891-1911 is shown in diagram (G). Deaths from measles in London boroughs. The following table shows the deaths and death-rates from measles in 1911 (52 weeks) in each of the sanitary districts of the County:— Metropolitan borough. Deaths, 1911 (52 weeks). Death-rate per 1,000 persons living. 1906-10. 1911. Paddington 48 0.27 0.34 Kensington 94 0.30 0.55 Hammersmith 36 0.46 0.30 Fulham 64 0.45 0.42 Chelsea 30 0.45 0.45 Westminster, City of 23 0.13 0.14 St. Marylebone 66 0.25 0.56 Hampstead 14 0.13 0.16 St. Pancras 108 0.43 0.50 Islington 130 0.47 0.40 Stoke Newington 28 0.19 0.55 Hackney 148 0.29 0.67 Holborn 15 0.29 0.31 Finsbury 79 0.80 0.90 London, City of 1 0.12 0.05 Shoreditch 128 0.81 1.15 Bethnal Green 130 0.58 1.02 Stepney 303 0.65 1.09 Poplar 225 0.59 1.39 Southwark 120 0.65 0.03 Bermondsey 55 0.94 0.44 Lambeth 112 0.34 0.38 Battersea 112 0.38 0.67 Wandsworth 230 0.23 0.74 Camberwell 112 0.40 0.43 Deptford 69 0.51 0.63 Greenwich 41 0.40 0.43 Lewisham 21 0.14 0.13 Woolwich 28 0.31 0.23 London 2,570 0.42 0.57 In the distribution of measles mortality throughout the year 1911, the highest death-rates obtained in Poplar (1.39) and the lowest in the City of London (0.05). For the period of 1906-10, Bermondsey (0.94) had the highest measles death-rate, and the City of London (0.12) the lowest. The deathrates from this disease in London in each of the four quarters of the year 1911 were as follows : first quarter, 1.40; second quarter, 0.61; third quarter, 0.14; and fourth quarter, 0.12 per 1,000 persons living. Measles death rates in London boroughs. Ages 0—5. 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 1911. Metropolitan borough. Death-rate per 1,000 children living aged 0-5, 1911. Metropolitan borough. Death-rate per 1,000 children living aged 0- 5, 1911. Metropolitan borough. Death-rate per 1,000 children living aged 0-5, 1911. Paddington 3.91 Stoke Newington 5.17 Bermondsey 3.18 Kensington 6.72 Hackney 5.87 Lambeth 3.53 Hammersmith 2.62 Holborn 3.99 Battersea 5.58 Fulham 3.52 Finsbury 7.97 Wandsworth 6.27 Chelsea 5.31 London, City of 1.04 Camberwell 3.50 Westminster, City of 2.16 Shoreditch 8.79 Deptford 4.96 St. Marylebone 6.99 Bethnal Green 7.60 Greenwich 3.43 Hampstead 1.90 Stepney 7.83 Lewisham 1.11 St. Pancras 4.79 Poplar 10.23 Woolwich 2.10 Islington 3.62 Southwark 5.10 London 5.09 (a) See footnote (b) page 11. 12532 c 2 20 Annual Report of the London County Council, 1911. Measles mortality in relation to " social condition 1901-10 and 1911. The following table shows the measles mortality under five years of age in five groups of districts, arranged in order of "social condition."(a) The figures show that there is marked parallelism between measles mortality and " social condition " :— Number of group of boroughs in " order of social condition." (a) Measles death-rate at ages 0-5 per 1,000 living 1901-10. (b) 1911 ##] I. 1.61 1.31 II. 3.13 5.39 III. 3.56 4.00 IV. 4.28 5.41 V. 5.14 7.15 Measles death-rates in large English towns. 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 1906-10, the London death-rate was exceeded by the death-rates of Liverpool, Manchester, Birmingham, Sheffield, West Ham, Stoke on-Trent, and Salford and in the year 1911 exceeded that of all except Birmingham, Sheffield and West Ham. Town. 1906-10. 1911. Town. 1906-10. 1911. London 0.42b 0.57b Bradford 0.29 0.04 Greater London 0.36 0.51 Hull 0.37 0.36 Liverpool 0.55 0.42 Newcastle-on-Tyne 0.40 0.47 Manchester 0.54 0.47 Nottingham 0.34 0.37 Birmingham 0.44 0.57 Stoke-on-Trent 0.51 0.40 Sheffield 0.50 1.74 Portsmouth 0.33 0.12 Leeds 0.36 0.18 Salford 0.64 0.42 Bristol 0.22 0.46 Leicester 0.39 0.31 West Ham 0.58 0.79 Measles death-rates in foreign towns. The following table shows that the London measles death-rate, in the quinquennium 1906-10, and in the year 1911 was higher than that of any of the undermentioned foreign towns except St. Petersburg. Town. 1906-10. 1911. Town. 1906-10. 1911. London 0.42b 0.57b Stockholm 0.13 0.01 Paris 0.20 0.23 St. Petersburg 0.94 0.64 Brussels 0.16 0.11 Berlin 0.18 0.09 Amsterdam 0.32 0.29 Vienna 0.33 0.16 Copenhagen 0.15 0.09 New York 0.21 0.13 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 case.s of this disease concerning which the medical officers of health received intimation. The age distribution ol the cas3s made known to the medical officer ol health is shown in the reports relating to Paddington and Stepney. In the latter district, however, the analysis does not cover all the reported cas3s, but only tho33 coming to the knowledge of the medical officer of health during the period of compulsory notification in this borough from May 6th to the 2nd December, 1911. Metropolitan borough. 0— 1— 2— 3— 4— 5— 13— ##] Paddington 82 141 146 139 176 529 16 52 Stepney 207 384 290 330 281 180 147 (a) See footnote (a) page 13. (i) See footnote (c) page 2. (r) See footnote (A) page 11. 21 Report of the Medical Officer of Health. The medical officer of health of Paddington shows the number of houses in which there occurred during the year more than one case of measles and the medical officer of health of Stepney gives similar information for a limited period. 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 377 196 97 36 13 2 — — — *Stepney 323 47 17 4 — — — — — One of the main difficulties in the way of reducing the mortality from measles is the fact that parents so frequently fail to realise the serious nature of the disease. The measures referred to in the reports which have been adopted for the prevention of the spread of measles have, for the most part been limited to the exclusion of affected children and contacts from school, though uniformity of procedure in this respect is far from being established. In recent years, however, the services of women sanitary inspectors, health visitors, and voluntary workers, have rendered possible the observance of precautionary measures, both at home and at school, in a way not hitherto attainable, and it may be anticipated that in the course of time, the educative effect of the visits of these officers will be more widely felt. At the time of the exceptional prevalence of measles in the early part of 1911, and with a view to devising improved methods of dealing with the disease a conference of London medical officers was held on the 13th March at the offices of the Local Government Board. As a result of this conference, the Board, on the 10th April, issued the following advice in the form of a circular letter. "I am directed by the Local Government Board to state that they have had under consideration the present outbreak of measles in London, and that on the suggestion of the President their medical officer has conferred with the medical officers of the London County Council and of the various borough councils as to the measures which may be taken for dealing with it. At the conference the view was generally expressed that Sanitary Authorities have been hampered in their efforts to check the spread of the disease by the absence of early information of cases, and the question was considered whether this difficulty would be removed if measles were made a notifiable disease. On this question widely divergent views as to the value of notification were shown to exist. A very large number of cases are not attended by a doctor, and it was pointed out that in such cases the adoption of the Notification Act would be a dead letter. It may also be observed that the notification of measles has been tried in a large number of towns and then abandoned. Without, therefore, expressing any view on the question whether the notification of measles would be justified, it is clear that such other means of obtaining information as are available should be fully utilised. The Board find that the School Attendance Department of the London Education Authority have supplied much valuable information as regards measles in the past, and in view of the proceedings at the conference, it appeared to the Board that it might be practicable to arrange that this source of information should be made more readily available. On this question the Board have consulted the Board of Education, and it has now been arranged that so long as the present emergency lasts, the school attendance officers will give speedy information to the medical officers of Health of all cases of illness coming under their notice. It is hoped that, by this means, early information of the majority of cases of measles will reach the medical officers of health. The information thus obtained will necessarily require to be followed up. Probably many cases will be reported which are not measles, and arrangements should be made for obtaining a proper diagnosis, for securing that the cases are properly isolated, and for urging on the parents the need of obtaining medical aid where such aid is required. No doubt the Council's official who visits the home will be able to do much in the way of giving advice as to the care and nursing of the patients. Removal to Hospital.—The Board have been in correspondence with the Metropolitan Asylums Board, and it is understood that that Board will agree to receive cases of measles on the recommendation of the medical officer of health. The accommodation of the Metropolitan Asylums Board for this purpose is necessarily limited, and arrangements will be made by which preference will be given to those cases most needing hospital treatment. The Board may also remind the borough council that they have power to provide temporary hospitals, and if at a subsequent date the amount of accommodation for measles which is available in the hospitals of the Metropolitan Asylums Board should come to be exhausted, this power might have to be utilised. Staff required for dealing with outbreak.—For dealing with this outbreak and properly following up the information which will be obtained, it is essential that each medical officer of health should be provided with an adequate staff, and the Board trust that the Council will at once appoint any additional temporary assistants (medical and other) that may be required." * Genuine cases notified between March 22nd and May 12th from 391 houses. 22 Annual Report of the London County Council, 1911. With this letter a copy of a Memorandum which the Board's medical officer had prepared on the subject of measles was enclosed. This memorandum was followed by the Metropolitan Asylums (Measles) Order of the 30th May, 1911, which provided that non-pauper cases of measles might be received into the hospitals of the Metropolitan Asylums Board, on the recommendation of the medical officer of health of the district concerned. Admission, however, is confined to children of the poorest class and to urgent cases recommended by medical officers of health. 3,144 patients suffering from measles were admitted during the year, and there were 438 deaths, giving a fatality rate of 13.9 per cent. The fact that the cases admitted to the Board's hospitals are specially selected, as has been noted above, of course explains the exceptionally high fatality rate. In Stepney where measles was a notifiable disease from the week ended May 13th to the week ended December 2nd, 1,819 cases were notified, whilst in the same period there were 92 deaths, giving roughly a case mortality rate of 5 per cent. The medical officer of health of Stepney discusses the whole question fully in his annual report and deals particularly with incidence, mortality, and the effect of isolation and school closure. Soarlet fever death-rates. Scarlet Fever. The cases of scarlet fever notified in the Administrative County of London during 1911 (52 weeks) numbered 10,483, compared with 10,509 in 1910 (52 weeks). The number of deaths registered from this cause was 172 in the year 1911 (52 weeks), compared with 214 in 1910 (52 weeks). The scarlet fever case-rates, death-rates and case-mortality for 1911 and preceding periods ard 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 113 — a — a 1871-1880 0.60 — a —a 1881-1890 0.33 — a — a 1891-1900 0.196 4.8 3.8 1901-1910 0.106 3.9 2.7 1901 0.136 4.1 3.2 1902 0.126 4.0 3.1 1903 0.086 2.8 2.9 1904 0.086 3.0 2.7 1905 0.126 4.3 2.8 1906 0.126 4.5 2.6 1907 0.146 5.7 2.5 1908 0.126 4.8 2.5 1909 0.086 3.8 2.2 1910 0.056 2.3 2.0 1911 0.046 2.3 1.6 The death-rate in each year since 1858 in relation to the mean death-rate of the period 18591911 will be seen on reference to diagram (H). It will be observed that the death-rate of 1911 was the lowest recorded in London. The monthly case-rate and case-mortality in each of the years 1891-1911 in relation to the mean of the whole period is shown in diagram (L). Scarlet lever death-rates in large English towns. It will be seen from the following table that in the period 1906-10 the London scarlet fever deathrate was exceeded by that of Liverpool, Manchester, Birmingham, Sheffield, West Ham, Stoke-onTrent, Salford and Leicester. In 1911 it was exceeded by all except Bristol, West Ham, Bradford, Nottingham and Leicester. Town. 1906-10. 1911. Town. 1906-10. 1911. London 0.10b 0.04b Bradford 0.07 0.03 Greater London 0.10 0.03 Hull 0.04 0.05 Liverpool 0.25 0.17 Newcastle-on-Tyne 0.07 0.05 Manchester 0.18 0.06 Nottingham 0.05 0.03 Birmingham 0.15 0.12 Stoke-on-Trent 0.18 0.26 Sheffield 0.20 0.06 Portsmouth 0.06 0.09 Leeds 0.07 0.10 Salford 0.25 0.09 Bristol 0.05 0.04 Leicester 0.14 0.04 West Ham 0.16 0.02 (a) The Infectious Disease (Notification) Act came into force in 1889. (6) see footnote (c) page 2. D /ag ra m H. Scarlet Fever. Dia.gra.rn K. S carlet Fever. Number of admissions to Hospitals of the Metropolitan Asylums Board per cent of total cases notified in London. 1830-1911 23 Report of the Medical Officer of Health. The following table shows that in the year 1911 the London scarlet fever death-rate was exceeded by the death-rate of all the undermentioned towns, except Paris and Amsterdam, and in the quinquennium 1906.10 was exceeded by the death-rates of all except Paris, Brussels, Amsterdam, and Copenhagen. Town. 1906-10. 1911. Town. 1906-10. 1911. London 0.10a 0.04a Stockholm 0.16 0.08 Paris 0.06 0.04 St. Petersburg 0.55 0.31 Brussels 0.07 0.05 Berlin 0.17 0.20 Amsterdam 0.04 0.01 Vienna 0.13 0.08 Copenhagen 0.10 0.15 New York 0.20 0.15 Scarlet fever death rates in foreign towns, The following table shows the scarlet fever cases, deaths, case-rates, and death-rates for the year 1911 and the case-rates and death-rates for the period 1906-10 in the several sanitary districts. Metropolitan borough. Notified cases, 1911 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1911 (52 weeks). Death-rate per 1,000 persons living. 1906-10. 1911. 1906-10. 1911. Paddington 227 3.99 1.60 3 009 0.02 Kensington 232 2.45 1.35 2 0.04 0.01 Hammersmith 238 3.58 1.96 5 0.09 0.04 Fulham 382 3.75 2.49 7 0.09 0.05 Chelsea 143 3.17 217 1 0.07 0.02 Westminster, City of 252 2.89 1.58 3 0.06 0.02 St. Marylebone 329 3.10 2.80 7 0.10 0.06 Hampstead 129 3.27 1.51 — 0.05 — St. Pancras 443 3.61 2.04 12 0.10 0.06 Islington 805 3.64 2.47 21 0.08 0.06 Stoke Newington 99 3.03 1.96 3 0.08 0.06 Hackney 611 4.78 2.75 11 0.10 0.05 Holborn 120 2.50 2.45 3 0.06 0.06 Finsbury 179 3.84 2.05 6 0.13 0.07 London, City of 23 2.96 1.18 1 0.08 0.05 Shoreditch 240 4.66 2.16 6 0.16 0.05 Bethnal Green 243 5.80 1.90 5 0.22 0.04 Stepney 467 5.79 1.68 7 0.15 0.03 Poplar 376 5.26 2.32 10 0.16 0.06 Southwark 480 4.60 2.51 6 0.13 0.03 Bermondsey 302 5.43 2.41 6 0.19 0.05 Lambeth 763 4.17 2.57 8 0.10 0.03 Battersea 354 5.21 2.12 4 0.10 0.02 Wandsworth 866 3.66 2.77 10 0.06 0.03 Camberwell 633 4.06 2.43 7 0.09 0.03 Deptford 375 5.11 3.43 7 0.09 0.06 Greenwich 307 4.60 3.21 3 0.09 0.03 Lewisham 349 4.30 2.16 5 0.09 0.03 Woolwich 514 6.13 4.24 3 0.10 0.02 Port of London 2 London 10,483 4.22 2.32 172 0.10 0.04 Scarlet fever cases, deaths and death. rates in London boroughs. It will be seen that the scarlet fever death-rate was, in the period 1906.10, highest in Bethnal Green (0.22), and lowest in Kensington (0.04); in the year 1911, Finsbury (0.07) had the highest death-rate, and Kensington (0'01) the lowest, exclusive of Hampstead, where no death occurred. The scarlet fever death-rates obtaining in London in the four quarters of the year 1911 were as follows: first quarter, 0.04; 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 1911. It will be seen that at "all ages" the case-rate was higher among females, while the death-rate and fatality were higher among males. In the age-groups adopted for the purposes of this table, the greatest incidence of (a) See footnote (c), page 2. Scarlet fever —Age and sex incidence. 24 Annual Report of the London County Council, 1911. attack was upon males and females aged 4.5. The greatest incidence of death was upon males 2.3 and females 1.2. The fatality was highest among males aged 2.3 and females aged 1.2. Age-period. Males. Females. Notified cases. (a) Deaths. (b) Case. mortality per cent. Rates per 100,000 living. Notified cases. (a) Deaths. (d) Case. mortality per cent. Rates per 100,000 living. Cases. Deaths. Cases. Deaths. All Ages 4,829 95 2 0 228 4 5,654 79 1.4 237 3 0— 59 4 6.8 120 8 63 2 3.2 131 4 1— 198 9 4.5 441 20 171 15 8.8 385 34 2— 316 22 7.0 665 46 320 10 3.1 681 21 3— 446 13 2.9 955 28 427 10 2.3 908 21 4— 471 9 1.9 1,030 20 579 10 1.7 1,270 22 5— 2,078 27 1.3 965 13 2,422 19 0.8 1,116 9 10— 746 7 0.9 376 4 977 9 0.9 483 4 15— 256 1 0.4 133 1 227 — — 107 — 20— 115 1 0.9 60 1 187 — — 79 — 25— 111 2 1.8 31 1 230 2 0.9 53 0 35— 27 — — 9 — 37 2 54 11 1 45— 6 — — 3 — 10 — — 4 — 55 & upwards — — — — — 4 — — 1 — 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 1911 on Thursday, the 27th July, i.e., the latter part of the 30th week, and the schools re-opened on Monday, the 28th August, i.e., at the beginning of the 35th week. If the number of cases notified in the four weeks which would be most subject to holiday influence be compared with the number of cases notified in the four preceding and four succeeding weeks, the results shown in the following table are obtained:— Period. Notified cases—Age.periods. Increase (+) or decrease (—) per cent. 13 0-3 3-13 and up. 0-3 3-13 and up. wards.wards. Four weeks preceding weeks of 110 650 98 — — — holiday influence (28th to 31st Four weeks of holiday influence 80 460 111 — 27.3 — 29.2 +13.3 (32nd to 35th) Four weeks following weeks of 91 836 154 +13.7 +81.7 +38.7 holiday influence (6th to 39th) As in 1910 the mild character of the disease is referred to in many of the reports, and caused difficulty in tracing the origin of local prevalence, which is due, in many instances, to infection from unrecognised cases. In some reports, record is made of the attempts to trace the origin of outbreaks. For instance, in Paddington, of 194 cases, 28 were ascribed to infection from outside the borough; 9 to return cases from patients discharged from hospital; 7 cases in hospital supervened on diphtheria. In Kensington, 84 cases, out of 227 showed a definite history of contact infection; 7 cases were attributed to infection in school; 17 were "return cases"; 16 were infected from outside the borough; 3 were contacts of missed cases. Of the 329 cases notified in St. Marylebone, in 38 instances a previous case in the same family was suspected; 9 cases were supposed to be infected by a previous case in the same house and 16 by previous cases in the same neighbourhood. In Hampstead, of 125 cases, 31 were the result of infection by a previous case. Stoke Newington had 97 cases, of which 6 were ascribed to school attendance; 9 to previous illness in the house; there was also 1 return case. Of the 171 cases in Finsbury, the supposed source was in 10 cases, schoolfellows; in 4 cases, visits to the houses of friends; 1 the out-patients' department of a hospital; 16 were ascribed to visits in the vicinity; 2 to places of entertainment, and 3 were the result of cross infection in hospital. In Bermondsey with 305 cases, there was a history of previous infection in 25 cases; 5 of them were due to school infection; and 6 were return cases. The Woolwich report shows that of 496 cases notified, 46 were infected by other inmates of the house; 28 cases were due to school attendance , 12 cases were the result of visits to friends and neighbours; 2 cases were attributed to the fever hospital and 2 to school excursions; there were 29 " return cases." (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 case. mortality is calculated. Diagram M. Diphtheria. Diagram N. Diphtheria. Number of admissions to Hospitals of the Metropolitan Asylums Board per cent of total cases notified in London. 1890-1911. Diagram o. Diphtheria 25 Report of the Medical Officer of Health. 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. Five cases. More than five cases. Paddington 133 16 3 2 1 (7 cases). Fulham 282 34 10 1 — — Westminster 179 19 6 2 — — Hampstead 84 12 1 — — 1 (6 cases). Islington 546 80 19 3 1 1 (8 cases). Holborn 83 4 4 2 — — Scarlet fever Multiple cases. Thus of 1,530 houses invaded, multiple cases occurred in 223 or 14.6 per cent. In 1910, the number of houses in which multiple cases occurred was 13.4 per cent. of the houses invaded in the districts concerning which the facts were stated in the annual reports. 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. 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:— Proportion of cases admitted to hospital. Errors of diagnosis. Year. Percentage. Year. Percentage. 1901 5.6 1907 6.8 1902 4.7 1908 5.8 1903 64 1909 6.9 1904 6.7 1910 9.5 1905 5.4 1911 8.7 1906 4.9 Diphtheria. The cases of diphtheria (including membranous croup) notified in the Administrative County of London in 1911 (52 weeks) numbered 7,385, compared with 5,494 in 1910 (52 weeks). The number of deaths was 612 in 1911 (52 weeks), compared with 434 in 1910 (52 weeks). It should be borne 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 0.49b 2.6 18.8 1901-1910 0.17b 1.8 9.3 1901 0.29b 2.7 10.9 1902 0.25b 2.3 10.8 1903 0.16b 1.7 9.6 1904 0.16b 1.6 10.0 1905 0.12b 1.4 8.4 1906 0.15b 1.8 8.6 1907 0.17b 1.9 8.9 1908 0.16b 1.7 9.0 1909 0.13b 1.5 9.1 1910 0.10b 1.2 7.9 1911 0.14b 1.6 8.3 Diptheria death rates in London. The death-rate in each year since 1858 in relation to the mean death-rate of the period 1859. 1911 is shown for diphtheria and also for diphtheria and croup combined in diagram (M). The monthly case.rate and case.mortality in each of the years 1891.1911 in relation to the mean of the period is shown in diagram (O). 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 1906.10 the London rate was exceeded by that (a) The Infectious Disease (Notification) Act came into force in 1889. (b) See footnote (c), page 2. 12539 D 26 Annual Report of the London County Council, 1911. of all except that of Sheffield, Nottingham and Leicester, and in 1911 was exceeded by the rates of all except Manchester, Birmingham, Sheffield, Bristol, Hull, Newcastle-on-Tyne, Nottingham and Leicester. Town. 1903-10. 1911. Town. 1906-10. 1911. London 0.14 a 0.14 a Bradford 0.16 0.17 Greater London 0.15 0.14 Hull 0.27 0.08 Liverpool 0.16 0.16 Newcastle-on-Tyne 0.19 0.14 Manchester 0.17 0.12 Nottingham 0.13 0.12 Birmingham 0.18 0.12 Stoke-on-Trent 0.29 0.38 Sheffield 0.11 0.10 Portsmouth 0.27 0.31 Leeds 0.15 0.34 Salford 0.39 0.23 Bristol 0.17 0.11 Leicester 0.07 0.09 West Ham 0.21 0.17 Diphtheria death rates ill large English towns. Diptheria death rates in foreign towns. The following table shows that in the quinquennium 1906-10 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 1911 the London rate was exceeded by that of St. Petersburg, Berlin and New York. Town. 1906-10. 1911. Town. 1906-10. 1911. London 0.15a 0.14a Stockholm 0.16 0.13 Paris 0.08 0.09 St. Petersburg 0.55 0.23 Brussels 0.09 0.09 Berlin 0.27 0.42 Amsterdam 0.08 0.07 Vienna 0.17 0.11 Copenhagen 0.08 0.10 New York 0.39 0.26 Diphtheria cases, deaths and death. rates in London boroughs. The following table shows the diphtheria cases, deaths, case-rates, and death-rates for the year 1911, and the case-rates and death-rates for the period 1906.10, in the several sanitary districts:- Metropolitan borough. Notified Oases, 1911 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1911 (52 weeks). Death-rate per 1,000 persons living. 190'5.10. 1911. 1906.10. 1911. Paddington 169 1.12 1.19 11 0.10 0.08 Kensington 219 1.14 1.28 18 0.12 0.10 Hammersmith 196 1.76 1.61 28 0.17 0.23 Fulham 313 2.66 2.04 27 0.21 0.18 Chelsea 83 1.87 1.26 5 0.15 0.08 Westminster, City of 145 1.09 0.91 14 0.09 0.09 St. Marylebone 135 1.02 1.15 5 0.10 0.04 Hampstead 151 0.88 1.77 17 0.07 0.20 St. Pancras 422 1.35 1.94 37 0.11 0.17 Islington 594 1.42 1.82 51 0.11 0.16 Stoke Newington 79 1.22 1.56 3 0.06 0.06 Hackney 314 1.59 1.41 20 0.13 0.09 Holborn 85 1.04 1.74 3 0.11 0.06 Finsbury 177 1.82 2.03 17 0.20 0.19 London, City of 23 1.05 1.18 1 0.08 0.05 Shoreditch 175 1.57 1.58 24 0.15 0.22 Bethnal Green 201 1.83 1.57 21 0.16 0.16 Stepney 517 2.09 1.86 32 0.21 0.11 Poplar 284 1.59 1.74 44 0.18 0.27 Southwark 293 1.66 1.53 30 0.17 0.16 Bermondsey 254 2.05 2.03 13 0.17 0.10 Lambeth 404 1.20 1.36 43 0.15 0.14 Battersea 223 1.79 1.33 20 0.13 0.12 Wandsworth 513 1.68 1.64 33 0.12 0.11 Camberwell 352 1.38 1.35 25 0.14 0.10 Deptford 165 2.10 1.51 15 0.15 0.14 Greenwich 318 2.53 3.32 16 0.17 0.17 Lewisham 343 2.16 2.13 28 0.16 0.17 Woolwich 237 2.44 1.96 11 0.15 0.09 Port of London 1 London 7,385 1.63 1.64 612 0.14 0.14 (a) See footnote (c), page 2, 27 Report of the Medical Officer of Health. It will be seen from the foregoing table that in the period 1906.10 the diphtheria death-rate was highest in Fulham and Stepney (0.21) and lowest in Stoke Newington (0.06); in the year 1911, Poplar (0.27) had the highest death-rate, and St. Marylebone (0.04) the lowest. The diphtheria death-rates in London in each of the four quarters of the year 1911 were as follows: first quarter, 0.15; second quarter, 0.11; third quarter, 0.11 ; and fourth quarter, 0.17. 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 1891.1911 inclusive, i.e., the case-rates of each district are shown 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 1890 1896 1897 1898 1899 1900 1901 1902 1903 190.1 1905 1906 1907 1908 1909 1910 1911 Paddington 104 77 73 117 74 66 91 98 68 44 88 65 61 63 47 72 61 59 87 69 73 Kensington 78 60 68 63 86 70 67 49 51 74 53 45 60 67 52 57 74 78 69 74 78 Hammersmith 195 164 87 72 77 67 49 58 58 85 75 68 85 111 146 134 94 97 108 112 99 Fulham 61 58 78 126 139 99 109 145 135 178 175 130 122 132 139 156 212 152 145 139 125 Chelsea 138 110 83 107 143 184 107 79 61 74 54 77 80 54 51 130 118 117 98 102 77 Westminster, City of 58 91 57 53 61 53 59 67 50 59 52 67 61 52 48 69 44 64 93 76 56 St. Marylebone 70 81 88 78 64 66 53 64 47 59 73 76 103 58 72 63 53 55 63 88 70 Hampstead 105 96 73 53 61 84 47 65 48 74 70 50 61 43 55 67 69 43 38 49 108 St. Panoras 89 95 103 83 90 64 76 78 79 93 149 152 132 95 88 69 80 78 98 99 119 Islington 152 119 86 103 70 106 73 60 68 70 102 112 81 66 74 75 75 91 89 119 111 Stoke Newington 83 113 97 77 70 70 52 59 34 111 105 82 46 75 110 52 120 72 37 86 95 Hackney 131 147 135 108 93 89 122 152 106 107 167 139 145 163 122 99 127 99 81 70 86 Holborn 52 89 79 61 66 61 104 102 46 70 105 86 53 51 58 69 62 54 62 74 106 Finsbury 118 82 130 81 86 112 170 163 93 74 110 101 77 94 103 118 86 105 125 139 124 London, City of 59 130 60 49 51 74 71 60 68 89 95 158 63 102 47 44 65 76 62 82 72 Shoreditoh 124 89 131 95 80 97 103 80 103 111 103 84 77 101 110 71 101 105 112 96 96 Bethnal Green 154 230 181 168 143 114 144 100 89 115 133 105 110 206 165 110 116 122 97 117 96 Stepney 106 132 112 123 157 150 128 93 89 107 106 111 108 176 154 118 135 131 139 118 113 Poplar 191 148 214 159 179 133 141 105 83 141 137 118 149 252 207 85 113 109 88 88 107 Southwark 71 72 116 113 86 106 102 151 207 141 101 111 102 88 106 114 110 78 89 121 94 Bermondsey 68 60 84 126 80 99 97 90 177 133 94 92 79 94 91 147 129 112 105 137 124 Lambeth 88 97 91 83 88 74 83 103 121 104 65 68 67 68 105 79 56 65 86 90 83 Battersea 144 123 132 122 97 81 125 178 116 70 59 74 109 85 80 92 110 123 116 111 81 Wandsworth 74 83 84 79 60 51 100 114 99 74 76 132 125 98 92 114 117 115 84 77 100 Camberwell 69 65 67 112 140 180 154 102 156 130 125 113 82 65 66 77 80 86 97 86 82 Deptford 72 68 86 153 225 113 141 132 121 111 144 103 243 111 94 156 150 107 121 98 92 Greenwich 60 43 84 85 137 189 82 105 122 89 73 81 127 100 107 240 138 132 115 144 203 Lewisham 48 74 82 70 57 122 85 127 170 126 87 129 121 59 77 101 105 176 170 117 130 Woolwich 32 68 66 66 81 96 91 86 100 115 69 91 91 85 161 182 120 173 150 117 119 London 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Diphtheria case-rates, London boroughs, 1891.1911. 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 1911. At "all ages" the fatality was higher among females, while the incidence of attack and of death were approximately the same in both sexes. In the age.groups adopted for the purposes of this table the greatest incidence of attack was upon males and females aged 4-5; the greatest incidence of death was upon males and females aged 1.2. The fatality was greatest among males and females aged 0.1. Age.period. Males. Females. Notified Cases. (a) Deaths (a) Case mortality per cent. Rates per 100,000 living. Cases. Deaths. Notified Cases. (a) Deaths. (a) Case mortality per cent. Bates per 100,000 living. Cases. Deaths. All Ages 3,460 288 8 3 163 14 3,925 338 8.6 164 14 0— 96 24 25.0 196 49 81 27 33.3 168 56 1— 280 68 24.3 623 151 207 50 24.2 466 112 2— 332 42 12.7 699 88 267 39 14.6 569 83 3— 395 33 8.4 846 71 366 49 13.4 778 104 4— 409 32 7.8 895 70 398 38 9.5 873 83 5— 1,250 75 6.0 581 35 1,428 113 7.9 : 658 52 10— 351 6 1.7 177 3 502 11 2.2 248 5 15— 131 3 2.3 68 2 202 3 1.5 95 1 20— 78 — — 41 — 174 2 1.1 73 1 25— 85 2 2.4 23 1 192 2 1.0 45 0 35— 34 2 5.9 12 1 83 2 2.4 25 1 45— 13 1 7.7 6 0 20 — _ 8 — 55 & upwards 6 — — 3 — 5 2 40.0 2 1 (a) See footnote (a), page 24. 12532 D 2 Diphtheria . Age and sex incidence. 28 Annual Report of the London County Council, 1911. Diphtheria— Incidence in relation to School attendance. In connection with the question of the reduction 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 27th July, i.e., the latter part of the 30th week, and the schools re.opened on Monday, the 28th August, i.e., at the beginning of the 35th 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, 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 79 372 95 — — — holiday influence (28th to 31st) Four weeks of holiday influence 70 244 68 —11.4 — 34.4 — 28.4 (32nd to 35th) Four weeks following weeks of 79 418 108 +12.9 + 71.3 + 58.8 holiday influence (36th to 39th) From the annual reports of medical officers of health, it appears that there was no considerable outbreak of the disease during the year; although the Hampstead report refers to an unusual prevalence of high infectivity. In several of the reports reference is made to a special incidence upon school children, amounting in Wandsworth to 46 per cent. of the total number of cases. The medical officer of health of Greenwich comments upon the insidious nature of the complaint and mentions the exclusion from school of children actively infectious, but having symptoms only of cold in the head, with slight nasal discharge. In the Kensington report details are given of particular cases illustrative of the difficulty of diagnosis, and the length of the infective period, whilst the medical officer of health of Chelsea gives an account of a school outbreak where 6 cases are ascribed to contact with a "chronic carrier" whose father died of membranous croup. The result of inquiry into the source of infection is shown in some of the reports as follows:— Paddington, of 152 cases, 7 were contracted in hospital after scarlet fever; there were 29 secondary cases, and 3 return cases; Finsbury, of 159 cases, 10 were due to infection by members of the same family; 8 were infected by previous cases in the same house or near by; 8 were infected in hospital, and 2 while visiting relatives, 6 were return cases; Bermondsey, of 260 cases 13 were due to previous cases in house or family; in Woolwich, of 204 cases, there were 29 infected by other inmates of the house ; 16 were attributed to school infection, 3 to infection by neighbours and friends, 4 to ordinary hospitals, and 11 to fever hospitals, 1 was a return case. Some of the reports give the number of houses where more than one case of the disease occurred. Thus in Paddington, multiple cases occurred in 14 houses, including 1 house with 4 cases. In Fulham, there were 27 houses with multiple cases amongst the 274 houses invaded. One of these had 5 cases. In Westminster 1 house had 4 cases, 1 house had 3, and 4 houses had 2 cases each. Hampstead had 2 families with 4 cases each, whilst in Holbom, there were 61 single cases, 3 houses with 3 cases each, and 4 houses with 2 cases each. In the report for 1910 reference was made to the Order of the Local Government Board, sanctioning the supply of anti.toxin by local authorities. This subject is dealt with in some of the reports of medical officers of health, two making mention of the fact that no applications were received, whilst 13 record the supply of anti.toxin for curative and prophylactic purposes. Bacterio logical diagnosis, 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 210 60 Shoreditch 36 8 Fulham 198 70 Bethnal Green 47 7 Chelsea 107 31 Stepney 122 42 Westminster, City of 143 18 Poplar 157 52 St. Marylebone 143 32 Southwark 179 38 Hampstead 157 53 Bermondsey 176 33 St. Pancras 152 53 Lambeth 667 78 Islington 484 157 Battersea 394 96 Stoke Newington 145 57 Wandsworth 597 202 Hackney 248 91 Deptford 189 41 Holborn 71 29 Greenwich 1,926 288 Finsbury 221 50 Lewisham 510 125 London, City of 1 — Woolwich 705 92 Diagram P. Whooping Cough 29 Report of the Medical Officer of Health 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. Proportion of cases admitted to hospital. Errors of diagnosis. 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 1907 17.0 1902 13.5 1908 18.1 1903 14.7 1909 16.8 1904 16.1 1910 14.2 1905 18.0 1911 13.5 1906 15.5 Whooping-cough. The deaths from whooping-cough in the Administrative County of London during the year 1911 (02 weeks) numbered 1,038, as compared with 1,363 in 1910 (52 weeks). The death-rates from this disease in 1911 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 1903 0.36a 1851-1860 0.88 1904 0.33a 1861-1870 0.88 1905 0.33a 1871-1880 0.81 1906 0.27a 1881-1890 0.69 1907 0.40a 1891-1900 0.50a 1908 0.21a 1901-1910 0.32a 1909 0.28a 1901 0.35a 1910 0.30a 1902 0.41a 1911 0.23a 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 3.23 1861.1870 6.53 1904 3.01b 1871.1880 6.02 1905 3.01b 1881-1890 5.34 1906 2.47b 1891-1900 4.216 1907 3.64b 1901-1910 2.956 1908 2.00b 1909 2.56b 1901 3.146 1910 2.83b 1902 3.646 1911 2.15b The death-rate in each year since 1840 in relation to the mean of the period 1841.1911 is shown in diagram (P.), while the deaths in each month since 1890 in relation to the mean monthly deaths of the period 1891.1911 are shown in diagram (G.), facing page 19. It will be seen from the following table that in the quinquennium 1906.10 the London whooping. cough death-rate was exceeded by that of all the undermentioned towns except Bristol, Bradford, Hull, (a) See footnote (c), page 2. (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. (c) See footnote (b), page 11. 30 Annual Report of the London County Council, 1911. Whooping, congh death rates in large English towns. Nottingham, Portsmouth and Leicester; while in the year 1911 it exceeded that of all except Liverpool, Leeds, Bristol, West Ham, Bradford, Newcastle, Hull and Stoke-on-Trent. Town. 1906-10. 1911. Town. 1906-10. 1911. London 0.29a 0.23a Bradford 0.18 0.33 Greater London 0.27 0.21 Hull 0.26 0.36 Liverpool 0.46 0.32 Newcastle-on-Tyne 0.36 0.48 Manchester 0.38 0.20 Nottingham 0.28 0.15 Birmingham 0.42 0.19 Stoke-on-Trent 0.31 0.31 Sheffield 0.34 0.14 Portsmouth 0.23 0.17 Leeds 0.31 0.33 Salford 0.39 0.16 Bristol 0.22 0.40 Leicester 0.24 0.19 West Ham 0.42 0.23 Whoopingcough death rates in foreign towns. The following table shows that the London whooping-cough death-rate was, in the quinquennium 1906-10, higher than that of any of the undermentioned foreign towns, and in the year 1911 higher than that of all except Amsterdam and Copenhagen. Town. 1906-10. 1911. Town. 1906-10. 1911. London 0.29a 0.23a Stockholm 0.16 0.08 Paris 0.10 0.09 St. Petersburg 0.24 0.19 Brussels 0.08 0.03 Berlin 0.17 0.21 Amsterdam 0.19 0.24 Vienna 0.08 0.06 Copenhagen 0.28 0.38 New York 0.07 0.08 Whooping, cough deaths and deathrates in London boroughs. The following table shows the whooping-cough deaths and death-rates for the year 1911 and death-rates for the period 1906-10 in the several sanitary districts:— Metropolitan borough. Deaths, 1911 (52 weeks). death-rate per 1,000 persons living. 1906-10. 1911. Paddington 44 0.20 0.31 Kensington 54 0.21 0.31 Hammersmith 35 0.24 0.29 Fulham 28 0.33 0.18 Chelsea 10 0.24 0.15 Westminster, City of 26 0.11 0.16 St. Marylebone 28 0.23 0.24 Hampstead 3 0.11 0.04 St. Pancras 55 0.31 0.25 Islington 70 0.28 0.21 Stoke Newington 18 0.25 0.36 Hackney 58 0.24 0.26 Holborn 3 0.29 0.06 Finsbury 24 0.48 0.27 London, City of 1 0.16 0.05 Shoreditch 32 0.54 0.29 Bethnal Green 49 0.37 0.38 Stepney 49 0.36 0.18 Poplar 44 0.46 0.27 Southwark 64 0.33 0.34 Bermondsey 50 0.35 0.40 Lambeth 67 0.25 0.23 Battersea 36 0.36 0.22 Wandsworth 70 0.26 0.22 Camberwell 45 0.28 0.17 Deptford 37 0.40 0.34 Greenwich 14 0.37 0.15 Lewisham 18 0.21 0.11 Woolwich 26 0.22 0.05 London 1038 0.29 0.23 It will be seen from the foregoing table that in the period 1906.10 the highest whooping-cough death-rate obtained in Shoreditch (0.54), and the lowest in Westminster and Hampstead (0.11) ; in the year 1911, Bermondsey (0.40) had the highest death-rate and Hampstead (0.04) the lowest. The (a) See footnote (c), page 2. 31 Report of the Medical Officer of Health. whooping-cough death-rates in London in each of the four quarters of the year 1911 were as follows: first quarter, 0.38; second quarter, 0.32; third quarter, 0.15; and the fourth quarter, 0.08. The following table shows 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. (a) Number of group of boroughs in order of "social condition." Whooping-cough death-rate at ages 0.5 per 1,000 living, 1901-10. (b) 1911. (c) I. 2.09 0.87 II. 2.76 2.57 III. 2.77 2.15 IV. 3.19 1.95 V. 3.29 2.07 Whooping cough mortality in relation to "social condition," 1901-10 and 1911. 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 632 Finsbury 119 Kensington 255 Shoreditch 165 Hammersmith 250 Southwark 361 Chelsea 63 Bermondsey 317 Westminster, City of 279 Lambeth 639 St. Marylebone 177 Battersea 51 St. Pancras 377 Wandsworth 565 Islington 533 Lewisham 208 Hackney 374 Woolwich 41 In most of the reports of medical officers of health there is little reference to whooping-cough. In the report relating to Paddington mention is made of undue prevalence during the past three years. 344 houses were invaded in 1911, and of these, 177 houses had more than one case each. In the Kensington report it is stated that of 255 cases into which inquiry was made only 65 had received medical treatment. There were outbreaks at two schools, one with 35 cases, the other with 28 cases. The medical officers of health of Westminster and Paddington both comment upon the higher fatality as compared with previous years, although in London as a whole there is a decline in the mortality from whooping.cough. In Wandsworth, 97 per cent. of the deaths occurred amongst children under 5 years of age. It is stated in the Greenwich report that application has been made to the Local Government Board asking the Board to make whooping-cough a notifiable disease. From the latter end of 1910 cases of whooping-cough, as well as of measles, were received into the hospitals of the Metropolitan Asylums Board with apparently satisfactory results. Typhus. There were no deaths from typhus registered in the Administrative County of London during the year 1911. 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 •001b 1901-1910 •000b 1901 •001b 1902 - 1903 •001b 1904 - 1905 - 1906 - 1907 - 1908 - 1909 - 1910 - 1911 - (a) See footnote (a) page 13. (b) See footnote (c) page 2 (c) See footnote (b) page 11. 32 Annual Report of the London County Council, 1911. The death-rate in each year since 1868 in relation to the moan death-rate of the period 1869. 1911 is shown in diagram (Q). No case of typhus fever occurred in 1911. A case notified as typhus was removed to hospital. The patient resided in Hammersmith, and the case was subsequently diagnosed as one of miliary tuberculosis. Enteric Fever. The number of cases of enteric fever notified in the Administrative County of London during 1911 (52 weeks) was 1,022, compared with 1,284 in the year 1910 (52 weeks). The deaths from this disease numbered 144 in 1911 (52 weeks), compared with 196 in 1910 (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 0.116 0.7 15.6 1902 0.126 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 0.4 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 1911 0.03b 0.2 14.1 Enteric fever death-rates, London The death-rate in each year since 1868 in relation to the mean death-rate of the period 1869.1911 is shown in diagram (R). The notified cases in each week of 1911 may be compared with the average weekly notifications of the period 1890.1911 on reference to diagram (S). The monthly case-rate and case-mortality in each of the years 1891.1911 in relation to the mean of the whole period is shown in diagram (T). The following table shows the enteric fever cases, deaths, case-rates and death-rates for the year 1911, and the case-rates and death-rates for the period 1906.10 in the several sanitary districts— Metropolitan borough. Notified cases, 1911 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1911 (52 weeks). Death-rate per l,000 persons living. 1906-10. 1911. 1906-10. 1911. Paddington 37 0.23 0.26 5 0.04 0.04 Kensington 23 0.24 0.13 4 0.03 0.02 Hammersmith 27 0.25 0.22 7 0.05 0.06 Fulham 38 0.27 0.25 8 0.05 0.05 Chelsea 7 0.24 0.11 — 0.03 — Westminster, City of 30 0.25 0.19 4 0.04 0.03 St. Marylebone 18 0.25 0.15 2 0.03 0.02 Hampstead 14 0.24 0.16 2 0.04 0.02 St. Pancras 69 0.29 0.32 7 0.04 0.03 Islington 73 0.31 0.22 12 0.05 0.04 Stoke Newington 6 0.22 0.12 1 0.04 0.02 Hackney 46 0.35 0.21 8 0.05 0.04 Holborn 10 0.36 0.20 3 0.05 0.06 Finsbury 80 0.35 0.92 8 0.08 0.09 London, City of 8 0.31 0.41 — 0.06 — Continued on next page. Enteric fever cases, deaths and death. rates in London boroughs. (a) The Infectious Disease (Notification) Act came into force in 1889. (b) See footnote (c), page 2. Diagram Q. Typhus. Diagram R Enteric Fever. Diagram S. Enteric Fever. Notified Cases. Diagram T Enteric Fever 33 Report of the Medical Officer of Health. Metropolitan borough. Notified cases, 1911 (52 weeks). Case rate per 1,000 persons living. Deaths, 1911 (52 weeks). Death-rate per 1,000 persons living. 1900-10. 1911. 1906-10. 1911. Shoreditch 22 0.49 0.20 1 0.06 0.01 Bethnal Green 31 0.52 0.24 3 0.09 0.02 Stepney 80 0.37 0.29 6 0.06 0.02 Poplar 63 0.42 0.39 14 0.08 0.09 Southwark 45 0.33 0.24 5 0.05 0.03 Bermondsey 26 0.33 0.21 5 0.04 0.04 Lambeth 61 0.22 0.21 12 0.04 0.04 Battersea 32 0.27 0.19 3 0.04 0.02 Wandsworth 58 0.24 0.19 9 0.03 0.03 Camberwell 33 0.23 0.13 5 0.03 0.02 Deptford 13 0.29 0.12 2 0.05 0.02 Greenwich 10 0.30 0.10 3 0.05 0.03 Lewisham 36 0.18 0.22 5 0.02 0.03 Woolwich 18 0.18 0.15 - 0.03 - Port of London 8 London 1,022 0.29 0.23 144 0.04 0.03 It will be seen that among the several sanitary districts in the period 1906.10 the enteric fever death-rate was highest in Bethnal Green (0.09), and lowest in Lewisham (0.02); in the year 1911, Poplar and Finshury (0.09) had the highest enteric fever death-rate; while Shoreditch (0.01) had the lowest, exclusive of Chelsea, City of London and Woolwich, where no deaths occurred. The death-rates from enteric fever in London in each of the four quarters of the year 1911 were as follows: first quarter, 0.02; second quarter, 0.01; third quarter, 0.04; and fourth quarter, 0.05. 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 1911. The case-rate, death. rate and fatality were, at "all ages," 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 aged 15.25 and females aged 10.15, and the greatest incidence of death was upon males aged 25.35 and females aged 20-25. The fatality was greatest among males aged 45.55 and females over 45 years of age:— Age.period. Males. Females. Notified Cases. (a) Deaths. (b) Case. mortality per cent. Rates per 100,000 living. Notified Cases. (a) Deaths. (b) Case. mortality per cent. Rates per 100,000 living. Cases. Deaths. Enteric fever — age and sex— incidence. Cases. Deaths. All Ages— 541 77 14 2 26 4 481 68 141 20 3 0— - - - - 1— - - 4- 2— 3 1 5.9 7 0 4 1 15.0 9 1 3— 7 — 7 1 4— 7 - 5 1 5— 68 2 2.9 32 1 63 7 11.1 29 3 10— 66 6 9.1 33 3 73 6 8.2 36 3 15— 84 6 71 44 3 55 7 12.7 26 3 20— 82 12 14.6 43 6 66 11 16.7 28 5 25— 107 24 22.4 30 7 97 12 12.4 22 3 35— 64 12 18.7 22 4 64 11 17.2 19 3 45— 39 11 28.2 18 5 29 6 20.7 12 2 55&upwards 14 3 21.4 6 1 14 5 35.7 5 2 The annual reports of medical officers show that considerable effort is made to trace the source of infection where enteric fever cases have occurred. As was noted last year a large number of cases are stated to be imported cases, most of them giving a history of seaside or foreign infection. Thus, of 471 cases occurring in 18 boroughs it is stated that 91, or 19.3 per cent., were infected outside the borough. This is a somewhat higher percentage than that observed last year when it was found that 5.7 per cent, of 735 cases were so infected. In 57 cases among the 471 in respect of which attempt was made to trace the source of infection there was a history of eating shellfish. In 7 cases the illness was attributed to cockles, in 3 cases to winkles, in 2 cases to mussels, and in 1 case to oysters. In a few instances the consumption of fried fish is mentioned as a probable cause. Suspicion has also alien upon watercress and ice cream in some cases. In some of the reports mention is made of the difficulty of diagnosis and the length of time which elapses before the true nature of the disease is discovered. Dr. Allan, of Westminster, directs (a) See footnote (a) page 24. 12532 E 34 Annual Report of the London County Council, 1911. tion to a case recognised only after death. In Deptford the mortality rate is said to be the lowest on record. Dr. Davies makes mention of 4 cases occurring in Woolwich amongst persons supplied with milk from a particular dairy where a girl was employed who had had enteric fever a year-anda-half previously. In each of the annual reports of Dr. Thomas, the medical officer of health of Finsbury, for 1910 and 1911, special reference is made to localised prevalences of typhoid fever and to possible sources of infection. For instance, the suggestion is made that hawkers suffering from incipient typhoid fever, while selling watercress or fruit, may be a means of spreading the disease. A further possibility considered is the existence of undiscovered "carriers"; and in the case of an outbreak including upwards of 50 cases in September, 1911, infection by means of missed and early cases of patients, some of whom "fed and ate in the neighbouring ice cream shops and fried fish and other restaurants and possibly infected the feeding utensils." In connection with the outbreak last referred to, question arose as to whether cases occurring in other parts of London were due to one and the same cause as the Finsbury cases, and all the circumstances were, therefore, studied in detail by me, and I received every assistance from Dr. Thomas and his staff. My report was submitted by Sir Shirley Murphy to the County Council, and is set out in extenso in Chapter XXXIII. As Sir Shirley pointed out, "prima facie there were some grounds for suspecting that the outbreak might possibly have been due to ice cream," but an analysis of all the evidence" failed to show any other explanation than the consumption of fried fish as the cause of the prevalence." Dr. Thomas in his report for 1911 criticises the fried fish and ice cream hypotheses and states that all the cases cannot be satisfactorily explained on the basis of infection by one or the other of these two food substances. Dealing with the theory of fried fish infection, he raises doubt as to the reliability of the statements made by the sufferers under examination; he also refers to the temperature difficulty and points out that the evidence in favour of the fish theory is based upon statistical grounds, and that it is thus a " statistical probability " that is raised. At the commencement of the Finsbury outbreak there was some ground for suspecting ice. cream, inasmuch as more than one-third of the sufferers had obtained this article of food from one particular source ; but 35 of the 56 sufferers had not partaken of ice cream. On the other hand, no fewer than 52 of the 56 persons in whom the diagnosis of typhoid fever was confirmed had partaken of the suspected fish, and having regard to the extent of the area involved in Finsbury and the degree of prevalence of typhoid fever in London at the time, 3 or 4 individuals may be regarded as repre. senting sporadically occurring cases of the disease unconnected with the special prevalence. More. over, careful study of the age incidence and topographical distribution both of the persons attacked and the purchasers of fried fish at the particular shop, yielded strong evidence in support of the hypothesis of fish infection, evidence which is further strengthened by the fact that there were numerous instances among families where a single person bought suspected fish and was alone attacked, whilst among families sharing fish multiple cases occurred. Dr. Thomas points out that during a period of three weeks 18,000 dinners and suppers were served from the fish shop and that only 74 cases of typhoid fever developed. The presumption that all the fish supplied during the three weeks' period fell under suspicion has not, of course, at any time been raised. My report dealt fully with the question of the particular consignment or consignments of fish, if any, at fault, and analysis of the available evidence makes it clear that it was only the "cheaper portions of fried fish sold to the early evening customers on a particular evening in August" which could be held to fall under suspicion (see Chapter XXXIII.). Incidentally, evidence was obtained which raised some presumption that the infected fish was distributed not only in Finsbury but also in two other boroughs. The dates of onset of illness pointed to the delivery in London of the infected consignment of fish on Thursday, 17th August, or Friday, 18th August. It is a matter of interest to note that the deliveries of fish in London on these dates were in some instances from unusual sources owing to dislocation of traffic caused by a strike. Thus the Times of 22nd August, in commenting upon the unusual sight presented by thirteen North Sea steam trawlers at Billingsgate on the preceding day, notes that, " owing to the strike, trawler owners on the coast found it impossible to dispose of their boat catches at the end of the preceding week." In the course of the enquiry into the Finsbury outbreak it was ascertained that at least 20 sufferers from typhoid fever in other parts of London in September had been infected whilst staying at Ramsgate in the latter part of August. These persons were ascertained by Dr. Dundas, medical officer of health of Ramsgate, to have in nearly every instance partaken of cockles, usually in a raw state. In none of the London outbreaks which were presumably attributable to fish had any sufferer partaken of cockles at Ramsgate. The occurrence of the Finsbury outbreak attributed to infected fish adds to the number of prevalences of typhoid fever in London which have been held to be due to this cause. Sir Shirley Murphy, in his annual report for 1910 thus summarised the facts with regard to these prevalences : — "In the year 1900 three localised prevalences of typhoid fever occurred, and one of these prevalences (in Southwark), involving, as it did, some 120 cases of typhoid fever, developing within a period of five weeks, was on a sufficiently large scale to allow statistical inferences to be drawn. Dr. Hamer was, in fact, able to adduce a considerable body of evidence in favour of his thesis that the Southwark prevalence was due to consumption of infected fish, and he raised the question as to whether the other two prevalences (in Lambeth and in Kensal Town) might not have had a similar origin. In 1903 the same cause was assigned by him, as result of enquiry, for small prevalences of typhoid fever in Holborn and in Southwark, and in 1906 there was some evidence pointing in a similar direction. In 1908 fish again fell under suspicion in Bethnal Green and Shoreditch. D i a g r a m U. Diagram shewing cases of Tyhoid Fever notified in ten London Boroughs distributed m so as Indicate the probable source of' infection in each instance. 35 Report of the Medical Officer of Health. "The prevalence of 1910 affected an area in Bethnal Green almost identical in extent with that involved two years before. The outbreak was, moreover, of sufficient dimensions to enable the question of shellfish, which had complicated the problem in 1908, to be eliminated, and an examination of the sources of supply of fried fish, to the 49 sufferers from typhoid fever in the affected locality, showed that they had in all probability obtained their fish from one or other of three shops, two of which had a common source of fish supply. Analysis of the facts, indeed, showed that while there were 27 fried fish shops within the affected area, 24 had supplied none, or only one, or at most two, sufferers; but in the case of the remaining three shops, 25, 12 and 12 sufferers respectively had been supplied. Thus all 49 sufferers obtained fried fish from one or other of these three shops.'' " Meantime it had become apparent that coincidentally with the outbreak in the specially affectcd area in Bethnal Green, a number of other localised prevalences of typhoid fever had been developed in other parts of Bethnal Green, in other parts of London generally, and in Tottenham and Edmonton. Examination of the facts concerning these localised prevalences (33 in all) failed to show in each instance that any ordinarily accepted cause of typhoid fever had been operative, but it was found that all sufferers contributing to the excessive prevalences had partaken of fish (usually fried fish), and that in all the instances in which information on this head could be obtained, small plaice belonging to the category described by fried fish vendors as 'late steamer fish,' was in question. The chances against such a combination of circumstances being the result of mere coincidence were, of course, very great." "Dr. Hamer draws attention to the interesting fact, established by the enquiries and reports of officers of the Board of Trade, that much of the small plaice sold at Billingsgate comes from an area in which are situated certain)' nursery grounds,' not far from the mouth of the Elbe, and he suggests as a possibility that estuary fish may be in question." A full examination of the facts elicited with regard to the outbreak of 1910 was published in Chapter XXXII. of last year's Annual Report. The accompanying diagram (v), which shows the allocation of typhoid fever cases to the suspected shops, stalls, etc., in ten London boroughs, was not then included, and is here reproduced for purposes of reference. The report of 1910 is summarised and commented upon by Dr. Collingridge in his report for 1911. He says, "At the time that this matter w.as under the consideration of your Committee and the Court of Common Council it was resolved that your medical officer of health should arrange for the supervision of Billingsgate Market to be carried out by the existing staff. It was at that time hoped that such arrangement could be carried out, but it has, however, since been found that in consequence of the very large increase of work thrown upon your meat inspectors, it is not possible to spare an officer for this purpose. It is important that the supervision should be constant, and it is further necessary that such officer should have expert knowledge of fish inspection, and the appointment of a special officer to act in regard to fish is now under the consideration of the Sanitary Committee." 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 15 14 Shoreditch 6 2 Fulham 21 10 Bethnal Green 34 9 Chelsea . . Stepney 47 20 Westminster, City of 16 5 Poplar 36 18 St. Marylebone 12 1 Southwark 15 1 Hampstead 8 5 Bermondsey 14 2 St Pancras 40 14 Lambeth 55 22 Islington 52 19 Battersea 26 3 Stoke Newington 13 3 Wandsworth 27 11 Hackney 21 7 Deptford 11 — Holborn 3 . Greenwich 9 3 Finsbury 19 10 Lewisham 25 11 London, City of 5 2 Woolwich 20 8 Bacteriological 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 1911 34.2 Enteric fever. Errors of diagnosis. 12532 E 2 36 Annual Report of the London County Council, 1911. Diarrhœa and Enteritis. The deaths at all ages from diarrhoea and enteritis in the administrative County of London during 1911 (52 weeks) numbered 6,162. Of these 4,408 occurred during the first year of life, and 905 in the second year. In each quarter the deaths numbered 298, 316, 4,826 and 722 respectively. In diagram V the Death-rate from diarrhœa and enteritis among infants under two years of age in each year since 1861 is shown in relation to the mean Death-rate for the period 1862.1911. Diarrhœa deaths in large English towns. The following table shows that the London Death-rate in 1911 from diarrhœa and enteritis among infants under two years of age (calculated upon the population at all ages) was lower than the Death-rate of any of the undermentioned large English towns, except Sheffield, Bristol, Bradford, Newcastle.on. Tyne, and Leicester. Town. Deaths. Death.rate. Town. Deaths. Death.rate London 5,313a 1.18a Bradford 195 0.68 Greater London 8,267 1.14 Hull 550 1.98 Liverpool 1,458 1.96 Newcastle.on.Tyne 225 0.84 Manchester 1,090 1.53 Nottingham 410 1.58 Birmingham 881 1.68 Stoke.on.Trent 614 2.62 Sheffield 534 1.17 Portsmouth 276 1.19 Leeds 568 1.28 Salford 348 1.51 Bristol 344 0.96 Leicester 202 0.89 West Ham 513 1.78 Diarrhœa deaths in London boroughs. The deaths and death.rates from diarrhœa and enteritis among infants under two years of age for the year 1911 in each of the sanitary districts of London, are shown in the following table:— Metropolitan borough Deaths, 1911 (52 weeks). Death-rate 1911. Per 1,000 living, all ages. Per 100 born. Paddington 134 0.94 4.41 Kensington 146 0.85 4.49 Hammersmith 178 1.47 6.08 Fulham 213 1.39 5.17 Chelsea 55 0.83 4.33 Westminster, City of 63 0.40 2.67 St. Marylebone 83 0.71 3.49 Hampstead 22 0.26 1.72 St. Pancras 201 0.92 3.62 Islington 365 1.12 4.50 Stoke Newington 28 0.55 2.68 Hackney 195 0.88 3.73 Holborn 34 0.69 3.60 Finsbury 142 1.63 5.31 London, City of 10 0.52 4.42 Shoreditch 222 2.00 6.28 Bethnal Green 248 1.94 6.16 Stepney 468 1.68 5.35 Poplar 316 1.95 6.30 Southwark 298 1.56 5.23 Bermondsey 212 1.69 5.42 Lambeth 336 1.13 4.61 Battersea 222 1.33 5.08 Wandsworth 293 0.94 4.34 Camberwell 276 1.06 4.31 Deptford 171 1.57 5.70 Greenwich 152 1.59 6.40 Lewisham 128 0.79 3.74 Woolwich 102 0.84 3.63 London 5,313 1.18 4.75 It will be seen from the foregoing table that the Death-rate from diarrhoea and enteritis per 1,000 living of all ages, in 1911, was highest in Shoreditch (2.00) and Poplar (1.95) and lowest in Hamp. stead (0.26). The death.rates in London in each of the four quarters of the year 1911 were as follows : first quarter, 0.19 ; second quarter, 0.19 ; third quarter, 3.82 ; and fourth quarter, 0.52. (a) See footnote (c) page 2. Diagram V. Diarrhœa Enteritis (Deaths under two years of age per 1000 births.) 37 Report of the Medical Officer of Health. Erysipelas. The deaths (a) from erysipelas in the Administrative County of London during 1911 (52 weeks) numbered 202, as compared with 130 in 1910 (52 weeks). The age.distribution of these deaths was as follows:— Under 1 Year. 1— 5 — 10— 15 — 20— 25— 35— 45— 55— 65— 75+ All ages. 26 4 — — 5 5 9 24 33 29 39 28 202 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. (b) 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 1891 6,080 1.40 221 0.05 1815 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 0.97 183 0.04 1904 4,943 1.09 232 0.05 1905 4,972 1.10 226 0.05 1906 5,019 1.11 245 0.05 1907 4,497 1.00 189 0.04 1908 4,203 0.91 160 0.03 1909 4,192 0.93 180 0.04 1910 3,982 0.88 133 0.03 1911 4,845 107 202a 0.04a The number of cases of erysipelas notified and the Case-rate for the year 1911, together with the Case-rate for the period 1906.10, in the several sanitary districts are shown in the following table:— Metropolitan borough. Notified Cases, 1911 (52 weeks). Case-rate per 1,000 persons living. 1900.10. 1911. Paddington 117 0.80 0.82 Kensington 125 0.78 0.73 Hammersmith 100 0.69 0.82 Fulham 118 0.83 0.77 Chelsea 52 0.63 0.79 Westminster, City of 82 0.57 0.51 St. Marylebone 109 1.07 0.93 Hampstead 50 0.48 0.59 St. Pancras 199 0.82 0.92 Islington 276 0.72 0.85 Stoke Newington 42 0.63 0.83 Hackney 361 1.23 1.63 Holborn 37 0.86 0.76 Finsbury 223 1.40 2.55 Continued on next page. (a) See footnote (c) page 2. (6) See footnote (b) page 29. 38 Annual Report of the London County Council, 1911. Metropolitan borough. Notified Cases, 1911 (52 weeks). Case-rate per 1,000 persons living. 1906.10. 1911. London, City of 14 0.62 0.72 Shoreditch 160 1.21 1.44 Bethnal Green 218 1.66 1.94 Stepney 488 1.52 1.75 Poplar 205 1.18 1.27 Southwark 316 1.31 1.65 Bermondsey 152 1.22 1.21 Lambeth 246 0.74 0.83 Battersea 162 0.96 0.97 Wandsworth 204 0.73 0.65 Camberwell 254 0.96 0.97 Deptford 180 1.45 1.65 Greenwich 133 1.00 1.40 Lewisham 105 0.58 0.65 Woolwich 81 0.81 0.67 Port of London 6 London 4,845 0.96 1.07 The following table shows the age and sex distribution of the notified cases of erysipelas in 1911— Sex. Under 1 year. 1. 5. 10. 15. 20. 25. 35. 45. 55. 65. 75 and upwards. All Ages. Males 72 114 82 96 106 85 283 380 383 279 174 58 2,112 Females 68 98 79 117 158 159 364 532 490 354 218 96 2,733 Persons 140 212 161 213 264 244 647 912 873 633 392 154 4,845 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 1911 (52 weeks) attributed to puerperal fever(b) numbered 142, as compared with 161 in 1910 (52 weeks) and 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 1911 302 142c (a) See footnote (b) page 29. (b) Including deaths from puerperal septicæmia and puerperal pyaemia, (c) See footnote (c) page 2 39 Report of the Medical Officer of Health. 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 birth. 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 1903 0.05 1.86 0.03 1.11 1909 0.06 2.46 0.04 1.54 1910 0.06 2.53 0.04 1.40 1911 0.07 2.70 0.03b 1.27b An account of cases of puerperal fever occurring in the practice of midwives will be found on page 77. Influenza, Bronchitis and Pneumonia. The deaths(6) attributed to influenza, which in 1910 numbered 715 (52 weeks), fell to 496 in 1911 (52 weeks). The deaths from bronchitis numbered 5,203 in 1911, as compared with 4,996 in 1910. In 1911 there were 5.618 deaths attributed to pneumonia. as compared with 6.547 in 1910. 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 1911 4966 0.11b 5,2036 1.15b 5,618b 1.25b (a) See footnote (6) page 29. (6) See footnote (c) page 2, 40 Annual Report of the London County Council, 1911. The distribution of deaths (a) from influenza throughout the year (b) for each of the years 1890 to 1911 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 1911 (c) 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 61 5— 8 167 7 637 96 96 164 58 55 368 259 298 75 224 103 62 119 44 186 276 90 151 77 9—12 75 8 119 162 69 1,343 61 94 193 430 130 134 298 89 74 119 98 104 424 430 98 57 13—16 39 29 42 180 56 257 50 121 140 302 172 102 89 54 62 75 129 81 209 257 64 51 17—20 13 770 33 125 32 106 50 96 61 121 105 81 58 46 40 56 105 48 94 85 41 39 21—24 5 1,044 22 72 27 35 33 54 51 82 57 30 35 37 21 38 40 41 36 46 16 15 25—28 6 242 15 49 19 28 17 26 25 42 16 21 20 25 17 16 21 25 28 34 11 11 29—32 6 51 7 23 17 14 15 18 27 27 12 18 7 18 5 4 20 14 15 15 9 10 33—36 3 32 9 23 20 17 10 13 10 11 11 11 16 6 9 11 15 18 12 10 17 6 37—40 6 13 6 18 14 15 12 19 17 19 15 12 13 17 24 22 18 19 21 15 29 17 41—44 5 15 20 28 29 22 27 29 46 55 17 23 35 13 92 39 35 42 30 31 25 40 45—48 13 35 18 152 41 47 56 35 49 61 55 44 65 44 98 44 86 39 45 56 75 46 49—52 6 81 28 546 58 49 56 71 52 342 46 56 99 51 138 52 228 59 57 86 75 66 Phthisis. The deaths from phthisis, fully corrected for institutions, in the Administrative County of London during 1911 (52 weeks) numbered 6,084, including acute miliary tuberculosis. 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 l.57c 1861-1870 2.84 1904 1.67c 1871-1880 2.51 1905 1.45c 1881-1890 2.08 1906 l.50c 1891-1900 1.79c 1907 l.46c 1901-1910 l.49c 1908 l.39c 1909 l.40c 1901 l.65c 1910 l.25c 1902 1.61c 1911 l.35cd The phthisis Death-rate since 1850 (corrected (e) for differences in the age constitution of the population) in relation to the mean Death-rate of the period 1851.1911 (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 recent years the decline has been more manifest in females than in males. The figures for 1911 (d) are more fully corrected (c) than those for previous years, and the increased incidence of phthisis in this year may be partly or wholly accounted for by this fact. Phthisis death-rates in London boroughs. The following table shows the crude phthisis Death-rate; and the rate corrected lor differences in the age and sex constitution of the population of the various sanitary districts, (e) The factors for correction, also shown in the table, have been calculated by applying the 1901 census 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.(f) Factor for correction for age and sex distribution. Crude death-rate. Corrected death-rate. Comparative mortality figure. (London 1,000.) 1906-10. 1911. 1906-10. 1911. 1906-10. 19ll. London 1.74 1.00000 1.40 1.35 1.40 1.35 1,000 1,000 Paddington 1.80 0.96659 1.09 1.22 1.05 1.18 750 874 Kensington 1.78 0.97419 1.05 0.93 1.02 0.91 729 674 Hammersmith 1.74 0.99600 1.22 1.26 1.22 1.25 872 926 Fulham 1.69 1.02786 1.28 1.46 1.32 1.50 943 1,111 Chelsea 1.83 0.95018 1.52 1.45 1.44 1.38 1,029 1,022 Westminster, City of 1.95 0.89205 1.32 1.21 1.18 1.08 843 800 St. Marylebone 1.85 0.93836 1.38 1.46 1.29 1.37 922 1,015 Hampstead 1.75 0.98862 0.73 0.61 0.72 0.60 514 444 St. Pancras 1.80 0.96551 1.67 1.57 1.61 1.52 1,150 1,126 (Continued on next page.) (a) See footnote (b) page 29. (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 2. (d) Including miliary tuberculosis, which would probably be 2 per cent, of the total cases. (e) See footnote (b) page 7. (f) 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. Diagram W. Phthisis Mortality in London. 1851-1911 Annual Death-rate among males and females per 1,000 living. (Corrected for differences in age-constitution of the population) 41 Report of the Medical Officer of Health, Metropolitan borough. Standard deathrate. Factor for correction for age and sex distribution. Crude death-rate. Corrected death-rate. Comparative mortality figure. (London 1,000.) 1906-10. 1911. 1906-10. 1911. 1906-10. 1911. Islington 1.75 0.99145 1.30 1.24 1.29 1.23 922 911 Stoke Newington 1.77 0.97914 1.02 1.09 1.00 1.07 714 793 Hackney 1.68 1.02969 1.27 1.40 1.31 1.44 936 1,067 Holborn 1.97 0.87894 2.31 2.08 2.03 1.83 1,450 1,356 Finsbury 1.72 1.01050 221 1.87 2.23 1.89 1,593 1,400 London, City of 1.89 0.91946 1.66 1.60 1.53 1.47 1,093 1,089 Shoreditch 1.66 1.04206 1.90 1.84 1.98 1.92 1,414 1,422 Bethnal Green 1.59 1.08984 1.78 1.63 1.94 1.78 1,386 1,319 Stepney 1.65 1.05281 1.70 1.77 1.79 1.86 1,279 1,378 Poplar 1.66 1.04772 1.43 1.32 1.50 1.38 1,071 1,022 Southwark 1.74 0.99829 2.04 1.71 2.04 1.71 1,457 1,266 Bermondsey 1.65 1.05026 1.88 1.78 1.97 1.87 1,407 1,385 Lambeth 1.75 0.99258 1.49 1.41 1.48 1.40 1,057 1,037 Battersea 1.69 1.02483 1.31 1.33 1.34 1.36 957 1,007 Wandsworth 1.72 1.01050 0.94 0.89 0.95 0.90 679 667 Camberwell 1.68 1.03522 1.28 1.34 1.33 1.39 950 1,030 Deptford 1.69 1.02969 1.33 1.27 1.37 1.31 979 970 Greenwich 1.67 1.04143 1.21 1.17 1.26 1.22 900 904 Lewisham 1.69 1.02543 0.82 0.64 0.84 0.66 600 489 Woolwich 1.70 1.01881 1.31 1.34 1.33 1.37 950 1,015 It will be seen from the foregoing table (comparing the corrected death-rates) that among the several sanitary districts in the quinquennium 1906.10, Finsbury (2.23) had the highest phthisis Death-rate and Hampstead (0.72) the lowest; in the year 1911, Shoreditch (1.92) had the highest death-rate, the lowest obtaining in Hampstead (0.60). The death-rates from phthisis in London in each of the four quarters of the year 1911 were as follows: first quarter, 1.52; second quarter, 127; third quarter, 120; and fourth quarter, 140. The following table enables comparison to be made between the phthisis death-rates in the several sanitary districts for each of the years 1901.1911, 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:— Metropolitan borough. Corrected phthisis death-rates per 1,000 persona living (1901.1911). 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Lewisham 0.92 1.10 0.85 0.93 0.88 0.87 0.96 0.90 0.83 0.58 0.66 Hampstead 0.93 0.90 0.72 0.86 0.86 0.69 0.72 0.81 0.67 0.65 0.60 Paddington 1.07 1.04 1.02 1.19 0.94 1.14 1.05 1.01 1.13 0.87 1.18 Wandsworth 1.16 0.95 0.93 1.11 1.01 1.00 0.97 0.96 0.95 0.87 0.90 Greenwich . 1.22 1.28 1.22 1.48 1.38 1.37 1.20 1.32 1.19 1.16 1.22 Deptford 1.23 1.11 1.44 1.52 1.28 3.37 1.50 125 1.40 1.34 1.31 Stoke Newington 1.32 1.22 1.26 1.69 1.32 0.99 0.90 1.07 0.90 0.97 1.07 Kensington 1.34 1.20 1.22 1.39 1.14 1.30 1.10 1.04 0.96 0.80 0.91 Hammersmith 1.40 1.43 1.47 1.37 1.17 1.27 1.24 1.26 1.13 1.09 1.25 Fulham 1.42 1.47 1.49 1.55 1.35 1.28 1.37 1.34 1.39 1.15 1.50 Battersea 1.51 1.34 1.38 1.51 1.46 1.38 1.35 1.32 1.37 1.19 1.36 Islington 1.51 1.48 1.42 1.57 1.27 1.25 1.36 1.30 1.30 1.20 1.23 Camberwell 1.51 1.61 1.28 1.42 1.30 1.35 1.40 1.20 1.35 1.22 1.39 Hackney 1.52 1.49 1.34 1.46 1.20 1.40 1.23 1 .34 1.33 1.20 1.44 Chelsea 1.60 1.39 1.45 1.72 1.47 1.58 1.55 1.31 1.54 1.24 1.38 Lambeth 1.65 1.70 1.40 1.47 1.39 1.41 1.60 1.50 1.50 1.27 1.40 Westminster, City of 1.67 1.59 1.49 1.33 1.34 1.25 1.22 1.13 1.23 1.03 1.08 St. Marylebone 1.71 1.76 1.78 1.56 1.34 1.50 1.39 1.06 1.30 1.08 1.37 St. Pancras 1.78 1.86 1.78 1.86 1.47 1.82 1.63 1.57 1.65 1.33 1.52 Woolwich 1.79 1.54 1.51 1.76 1.61 1.45 1.33 1.34 1.32 1.14 1.37 Bermondsey 1.85 1.90 1.80 2.23 1.86 2.08 1.98 1.97 1.87 1.86 1.87 Poplar 1.89 1.83 1.82 1.84 1.63 1.67 1.45 1.51 1.40 1.51 1.38 London, City of 1.92 1.41 1.45 1.33 1.15 1.54 1.75 1.47 1.53 1.32 1.47 Stepney 2.22 2.00 2.30 2.31 1.88 1.91 1.72 1.79 1.93 1.54 1.86 Shoreditch 2.24 1.89 2'40 2.30 2.02 2.14 2.16 2.10 1.84 1.58 1.92 Finsbury 2.26 2.31 2.27 2.52 2.07 2.22 2.44 2.27 2.38 1.82 1.89 Bethnal Green 2.35 2.17 2.31 2.36 2.22 2.45 2.12 1.74 1.71 1.60 1.78 Holborn 2.43 2.65 2.59 2.45 2.49 2.16 2.17 1.81 1.94 1.85 1.83 Southwark 2.48 2.61 2.42 2.46 2.20 2.16 2.15 1.99 1.93 1.91 1.71 12532 f 42 Annual Report of the London County Council, 1911. Phthisis death-rates in relation to "social condition," 1911. The following table shows the mortality from phthisis during the year 1911 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. (b) Corrected Death-rate (London, 1,000). I. 0.70 0.70 519 II. 1.07 1.06 778 III. 1.33 1.32 980 IV. 1.45 1.46 1,088 v. 1.76 1.85 1,378 London 1.35 1.35 1,000 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. "With a view to learning whether this relationship is more specially marked at particular ages, tables are appended showing phthisis death rates per 100,000 living among males and females in several age groups. The measure of " social condition " is that used throughout this report and is based on the percentage of all children between the ages of 5 and 14 scheduled in the borough by the Council for education purposes in the years 1905.7. The figures on which the rates for the age periods 0.15 years are calculated are too small for definite conclusions to be drawn, but it is evident upon consideration of the rates at higher ages, especially from 45 to 65 years, that " social condition " has marked influence upon phthisis mortality. This influence is also to be observed in connection with the mortality from all tubercular diseases, including phthisis, tabes mesenterica, tubercular meningitis, and other tubercular diseases, and for the purpose of comparison tables have been prepared showing the mortality from all tubercular diseases in the same form as the phthisis mortality tables to which reference has just been made. Pulmonary Tuberculosis.{a) Males. Group. Age-period. All ages. 0— 1— 2— 3— 4— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75+ I. 25 18 27 23 14 4 5 72 117 145 227 230 201 177 93 120 II. 49 63 25 16 11 12 15 70 150 188 284 335 319 227 109 161 III. 72 83 44 30 21 13 14 69 139 219 339 416 371 287 134 187 IV. 63 85 48 29 23 16 18 86 178 237 386 472 410 292 137 203 V. 97 116 47 32 24 18 17 91 179 311 518 628 597 406 179 250 London 69 84 42 28 20 15 15 78 156 230 365 441 397 288 133 195 Females. Group. Age.period. All ages. 0— 1— 2— 3— 4— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75+ I. 31 27 13 9 23 11 24 59 71 80 111 88 89 67 49 68 II. 41 58 33 13 15 16 29 64 70 103 139 150 110 99 47 87 III. 70 67 32 27 23 18 27 70 89 123 172 165 137 109 72 101 IV. 64 70 36 26 29 22 33 94 118 162 228 214 186 116 62 124 v. 70 101 49 40 25 21 32 89 120 189 297 280 209 150 88 139 London 62 71 36 26 24 19 30 77 95 134 192 185 150 111 65 108 (a) See footnote (a) to page 13 and (c) to page 2, (b) See footnote (b) page 7. 43 Report of the Medical Officer of Health. All Tubercular Diseases. Males. Group. Age.period. All ages. 0— 1— 2— 3— 4— 5— 10— 15— 20— 25 — 35— 45— 55— 65— 75 + I. 441 351 223 113 112 47 27 90 132 157 246 250 221 193 93 162 II. 634 465 222 149 106 63 33 87 168 203 300 352 335 239 122 210 III. 820 561 243 167 119 70 38 87 156 235 354 438 395 310 152 244 IV. 713 518 272 169 123 78 46 106 195 253 401 492 432 314 163 262 V. 1,034 733 343 222 155 80 44 113 196 332 537 650 613 433 183 330 London 788 558 267 173 125 72 40 97 173 247 382 461 418 309 149 254 Females. Group. Age.period. All ages. 0— 1— 2— 3— 4— 6— 10— 16— 20— 25— 35— 45— 55— 65— 75 + I. 438 324 164 113 92 56 49 71 83 92 120 96 100 89 61 98 II. 519 394 212 129 112 67 54 80 80 112 148 161 121 117 68 121 III. 642 461 242 162 117 69 53 89 102 134 184 178 150 123 95 144 IV. 590 467 222 171 134 82 60 111 132 174 241 223 200 131 78 173 V. 831 688 343 214 167 89 58 106 129 203 308 297 217 173 117 209 London 639 491 249 168 130 76 56 94 107 145 204 197 162 128 86 154 Cancer. The deaths from cancer, fully corrected for institutions, in the Administrative County of London during 1911 (52 weeks), numbered 4,746, as compared with 4,563 for the 52 weeks of 1910. 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 0.98a 1861-1870 0.48 1904 0.94a 1871-1880 0.55 1905 0.96a 1881-1890 0.68 1906 l.01a 1891-1900 0.85a 1907 0.99a 1901-1910 0.98a 1908 l.02a 1909 l.04a 1901 0.88a 1910 l.03a 1902 0.93a 1911 1.05a Cancer death-rate 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 death. rate. (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). 1906.10 1911. 1906.10. 1911. 1906.10. 1911. (a) (d) (a) (d) (a) (d) London 0.87 1.00000 1.01 1.05 1.01 1.05 1,000 1,000 Paddington 0.98 0.89478 1.19 1.17 1.06 1.05 1,045 1,004 Kensington 1.02 0.85622 1.12 1.14 0.96 0.98 947 937 Hammersmith 0.90 0.96811 1.08 1.02 1.05 1.00 1,036 956 Fulham 0.77 1.13828 0.95 1.11 1.08 1.26 1,065 1,205 Chelsea 1.03 0.84874 1.20 1.41 1.02 1.20 1,006 1,147 Westminster, City of 0.96 0.91348 1.11 1.29 1.01 1.18 996 1,128 St. Marylebone 0.99 0.88571 1.27 1.37 1.12 1.21 1,105 1,157 Continued, on next page. (a) See footnote (c), page 2. (b) See footnote (b), page 7. (c) See footnote (f), page 40. (d) See footnote (b), page 11, 12532 F 2 Cancer death-rates in London boroughs. 44 Annual Report of the London County Council, 1911. Cancer death.rates in London boroughs. Metropolitan borough. Standard death. rate. 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). 1906.10. 1911. 1906.10. 1911. i 1906.10. j 1911. Hampstead 0.92 0.94816 1.02 1.00 0.97 0.95 957 908 St. Pancras 0.92 0.95229 1.14 1.26 1.09 1.20 1,075 1,147 Islington 0.90 0.96704 1.10 1.01 1.06 0.98 1,045 937 Stoke Newington 0.98 0 0.89387 1.20 1.11 1.07 0.99 1,055 946 Hackney 0.88 0.99341 0.95 0.97 0.94 0.96 927 918 Holborn 0.95 0.91924 1.08 1.10 0.99 1.01 976 966 Finsbury 0.84 1.04071 0.92 0.93 0.96 0.97 947 927 London, City of 1.06 0.82316 1.24 0.72 1.02 0.59 1,006 564 Shoreditch 0.79 1.10518 0.84 0.81 0.93 0.90 917 860 Bethnal Green 0.78 1.12077 0.93 0.94 1.04 1.05 1,026 904 Stepney 0.74 1.17976 0.83 0.84 0.98 0.99 966 946 Poplar 0.81 1.08327 0.86 0.92 0.93 1.00 917 956 Southwark 0.82 1.06350 0.96 1.10 1.02 1.17 1,006 1,119 Bermondsey 0.81 1.08462 1.02 0.92 1.11 1.00 1,095 956 Lambeth 0.92 0.95333 1.13 1.12 1.08 1.07 1,065 1,023 Battersea 0.79 1.10798 0.96 0.97 1.06 1.07 1,045 1,023 Wandsworth 0.88 0.99116 0.96 1.02 0.95 1.12 937 1,071 Camberwell 0.87 1.00483 0.97 1.00 0.97 1.00 957 956 Deptford 0.81 1.07396 0.92 1.11 0.99 1.19 976 1,138 Greenwich 0.87 1.01064 0.90 0.84 0.91 0.85 897 813 Lewisham 0.92 0.95333 0.99 1.06 0.94 1.01 927 966 Woolwich 0.78 1.1933 0.91 1.02 1.02 1.14 1,006 1,090 It will be seen from the foregoing table (comparing the corrected death-rates) that in the quinquennium 1906.10 among the several sanitary districts, St. Marylebone (1.12) had the highest. cancer death-rate, and Greenwich (0.91) the lowest; in the year 1911 Fulham (1.26) had the highest, the lowest obtaining in the City of London (0.59). The following table shows the corrected Death-rate from cancer in each of the sanitary districts of London, annually for the last eleven years:— Metropolitan borough. Corrected Cancer death-rates. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. (a) Paddington 0.93 0.86 1.02 0.99 0.94 l.04 1.12 1.17 0.96 1.05 1.05 Kensington 0.96 0.77 0.93 0.88 0.84 0.87 1.05 0.93 1.06 0.87 0.98 Hammersmith 0.82 0.83 0.84 0.98 1.00 1.17 1.12 0.98 0.92 1.05 100 Fulham 1.01 0.88 0.95 1.02 1.07 1.09 1.21 0.89 1.08 1.13 1.26 Chelsea 0.77 0.90 1.09 1.07 0.91 1.05 0.87 0.91 1.07 120 1.20 Westminster, City of 0.76 0.98 0.94 0.93 0.97 0.92 0.90 1.10 1.11 1.03 118 St. Marylebone 0.92 0.98 1.19 0.98 1.19 0.95 1.09 1.20 1.20 1.19 1.21 Hampstead 0.91 1.07 1.23 0.97 0.70 1.10 0.81 1.00 0.96 0.98 0.95 St. Pancras 0.84 0.99 1.04 0.94 0.97 1.05 0.90 1.24 1.05 12.0 1.20 Islington 0.88 0.96 1.06 0.94 0.98 1.09 1.02 1.08 1.04 1.10 0.98 Stoke Newington 0.82 0.77 0.99 0.94 0.96 0.96 1.13 1.19 1.09 1.00 0.99 Hackney 0.80 0.88 0.90 0.85 0.91 0.83 0.91 1.00 0.97 1.01 0.96 Holborn 0.92 0.99 0.93 0.88 0.86 1.08 0.77 0.89 1.18 1.06 1.01 Finsbury 0.81 0.84 0.96 0.87 0.74 0.92 0.96 0.98 1.04 0.88 0.97 London, City of 1.05 1.26 0.81 110 1.10 1.03 0.99 1.02 1.06 1.02 0.59 Shoreditch 0.90 115 0.94 0.86 0.98 0.81 1.05 0.89 0.94 0.94 0.90 Bethnal Green 0.96 0.92 0.97 0.97 0.91 1.09 0.97 0.99 1.04 1.10 1.05 Stepney 0.87 0.79 0.94 0.93 0.90 1.16 0.91 0.95 0.86 0.98 0.99 Poplar 0.79 0.92 0.91 0.77 0.91 0.84 0.86 0.96 0.99 0.98 1.00 Southwark 0.92 0.90 1.06 0.93 1.16 0.98 1.03 0.99 1.02 1.06 1.17 Bermondsey 0.73 1.03 0.93 0.78 0.91 1.05 1.09 0.94 1.22 1.25 1.00 Lambeth 0.95 0.97 0.99 1.01 1.04 1.01 1.08 1.08 1.22 1.02 1.07 Battersea 0.90 0.97 0.97 1.08 1.15 1.12 1.05 1.01 1.20 0.95 1.07 Wandsworth 0.88 0.91 1.02 0.97 0.84 0.97 0.98 0.94 0.91 0.98 112 Camberwell 0.98 0.96 0.88 0.90 0.89 1.03 0.92 1.01 1.01 0.91 1.00 Deptford 0.88 1.04 1.00 1.03 1.00 1.08 0.78 0.95 1.02 1.10 1.19 Greenwich 0.71 0.88 0.80 0.91 1.03 0.83 0.87 1.00 0.91 0.91 0.85 Lewisham 0.91 0.94 0.83 0.82 0.88 0.92 0.94 0.93 0.96 0.96 1.01 Woolwich 0.79 0.98 0.90 0.95 0.78 1.11 1.04 0.88 1.11 0.97 1.14 London 0.88 0.93 0.97 0.94 0.95 1.01 0.98 1.01 1.04 1.03 1.05 (a) See footnote (b) page 11, Cancer corrected death-rates 1901-11. 45 Report of the Medical Officer of Health. 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 year 1911 according to "social condition" as defined in footnote (a) page 13. Number of group of boroughs in order of "social condition." Crude cancer death. rate per 1,000 persons living. (b) Corrected Death-rate per 1,000 persons living. (b) Corrected Death-rate (London, 1,000). I. 1.02 0.96 918 II. 1.06 0.99 949 III. 1.10 1.05 1,000 IV. 1.08 1.15 1,097 V. 0.88 0.99 943 London 1.05 1.05 1,000 Cancer death-rates in relation to "social condition," 1911. 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 42). Cerebrospinal Fever. During 1911, 101 persons were certified to be suffering from cerebro-spinal fever and 9 deaths were attributed to this disease. The number of deaths in each year since. 1901 has been as follows:— Deaths.(c) Deaths, (c) 1902 4 1907 25 1903 6 1908 12 1904 6 1909 15 1905 5 1910 10 1906 4 1911 9 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, 1911, the Council extended the Order for another period of twelve months. The age distribution of the 101 cases notified in 1911 was as follows:— Sex. Cerebro-spinal fever—Ago distribution of notified cases, 1911. 0— 1— 2— 3— 4— 5— 6— 7— 8— 9— 10— 13— 15 + All ages. Males 23 11 3 5 1 — 5 1 2 — 1 1 12 65 Females 16 4 5 1 1 — — — 2 1 1 2 3 36 Persons 39 15 8 6 2 — 5 1 4 1 2 3 15 101 Three of the deaths were those of infants under one year of age, four of infants aged between one and five years, and the remaining two those of persons over five years of age. No cases were notified in Chelsea, Hampstead, Stoke Newington, Holborn, City of London and Deptford. Inquiry was made into the notified cases by Dr. Wanklyn, who found no evidence that any one verified case was connected with another. Of the 101 cases notified, in 57 the final diagnosis confirmed the original diagnosis, in 18 this diagnosis was reversed, and in the remaining 26 the evidence was doubtful. Of the 57 cases verified on final diagnosis a post-mortem examination was made in 15 and bacteriological evidence was obtained in 25; the nature of this evidence was usually not stated, and as the examinations were made by different bacteriologists, there would in all probability be varying definitions of what might be considered as bacteriological evidence of the disease. 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 of that year. (a) See footnote (b), page 11. (b) See footnote (b), page 7. (c) See footnote (c), page 2. 46 Annual Report of the London County Council, 1911. During 1911 three notifications were received of cases residing in London and two of cases residing outside but working inside the County boundary. An unnotified case is referred to in the Stepney report. All the known cases recovered. The available information is as follows :— Bermondsey.—H. L., residing at Edmonton, was employed as a dock sorter. Illness attributed to foreign hides. D. P., aged 58 years, residing in Bermondsey, was a leather dresser at a manufacturer's premises where no raw hides were received. The origin of illness could not be traced. A. A., aged 29 years, also resided in Bermondsey, and had been employed as a general labourer by dealers in foreign hides. J. B., also was employed by dealers in foreign hides. He resided in Islington. Southwark.—W. M., aged 25 years, had been working with grey hair received in a dressed condition from certain firms. The patient was operated on and recovered. All the hair supplied had been submitted to steam at a temperature over 212 deg. F. as required by the Home Office Regulations. The practice with dark hair is to submit it to a temperature of 260 deg. F., but grey hair would be seriously injured by this treatment. Dr. Millson, however, had all the grey hair unbound and exposed to formalin vapour for several hours. Stepney.—A man employed at Morocco Wharf unloading foreign skins contracted the disease. Dr. Thomas refers to the removal from a licensed cowshed in the borough of a cow suffering from anthrax. The cow had been in the shed two months, and Dr. Thomas suggests as a likely source the oil cakes used for feeding. He states that these cakes, which are about 18 inches long and from 6 to 7 inches wide, are imported from India without sacks or covering, and suggests that skins or hides may have been placed on them in the course of transit and thus infected the cakes. Glanders. No case of human glanders was reported during the year 1911. 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 1911 was 51.8 deg. Fahrenheit, which is 17 degrees above the average of the pie. ceding 65 years. The rainfall during the year amounted to 23.67 inches, being 0.45 inches below the average of the preceding 65 years, the temperature and rainfall in each month of the year 1911 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 52 24 38.1 — 0.3 12 1.23 — 0.65 February 55 22 40.7 + 0.9 16 1.38 — 0.10 March 62 29 42.1 — 0.4 15 1.66 + 0.14 April 67 27 46.9 — 1.2 12 1.73 + 0.16 May 82 35 57.2 + 3.4 8 1.88 — 0.04 June 84 41 60.6 + 0.3 12 2.10 + 0.06 July 96 46 68.0 + 4.3 4 0.27 — 2.13 August 100 48 69.0 + 6.1 8 1.34 — 1.00 September 94 38 60.0 + 1.8 10 1.34 — 0.81 October 68 28 50.7 + 0.3 17 3.30 + 0.52 November 59 28 43.8 + 0.4 21 3.42 + 1.20 December 54 29 44.1 + 4.5 23 4.02 + 2.19 47 Report of the Medical Officer of Health B—Administration. Dairies, Cowsheds and Milkshops. The County Council received during the year 194 applications for cowhouse licences, of which 187 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 premises for which licences were granted. Year. No. of applications received. 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 1911 194 187 Cowshed 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, but in some cases it has been necessary to use figures otherwise contained in their reports. Inspection of cowshed premises. The following table relating to cowsheds has been thus prepared:— Metropolitan borough. Number of cowshed premises. Number of inspections by the sanitary authority, 1911. Number of prosecutions by sanitary authority, 1911. On register at end of 1910. Added in 1911. Removed in 1911. On register at end of 1911. Battersea 3 — 1 2 — Bermondsey 4 — 1 3 20 — Bethnal Green 15 — 2 13 63 — Camberwell 11 — 1 10 97 — Chelsea 1 — — 1 11 — Deptford 2 — — 2 27 — Finsbury 3 — — 3 12 — Fulham 2 — 1 1 24 — Greenwich 4 — — 4 28 — Hackney 19 — 3 16 255 — Islington 5 — — 5 56 — Kensington 1 — — 1 45 — Lambeth 13 — — 13 38 — Lewisham 13 — — 13 145 — Paddington 1 — — 1 4 — Poplar 14 — — 14 48 — St. Marylebone 5 — — 5 40 — St. Pancras 7 — — 7 126 — Shoreditch 7 — — 7 16 — Southwark 4 — 1 3 47 — Stepney 33 — 1 32 61 — Stoke Newington 2 — 1 1 — — Wandsworth 12 — — 12 67 — Westminster, City of 1 — — 1 25 — Woolwich 17 — — 17 64 — Totals for 25 districts 199 — 12 187 1319 — 48 Annual Report of the London County Council, 1911. Milkshops. 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 Greenwich there were 9 refusals of applications for registration ; in Hampstead 3. In Hackney the proprietors of 21 milk premises ceased to sell milk rather than make the necessary alterations required by the Public Health Committee, to render the premises suitable under the General Powers Act. In the City registration was withheld in 2 instances until the proprietors had complied with the Act. Dr. Collingridge states that the Act has had a most beneficial effect in enabling authorities to deal with the sale of milk in small chandler and grocers' shops. In Kensington 2 applications were refused; and in Lambeth 37 applications were refused on the ground that they were unsuitable. Dr. Porter states that in St. Maryle. bone 33 names were removed from the Register on account of the unsuitability of the premises for the sale of milk, and on the same grounds 3 applications were refused. In Stepney 49 premises were removed from the register and 29 applications were refused; in Westminster the Council refused to register in 2 instances. No reference is made by medical officers to any case where the proprietor has exercised his right of appeal against the refusal to register the premises. In Battersea proceedings were instituted against a firm of dairymen for a serious breach of Regulation 32 made under the Dairies, Cowsheds and Milkshops Order, which provides that adequate precautions shall be taken for preserving the purity of the milk and for protecting it against infection or contamination. The milk in question was exposed in a passage way leading from a public street, and evidence was given by the inspectors of the Borough Council that it was in a dirty condition. For the defence it was contended that the regulation was ultra vires inasmuch as it did not prescribe the precautions to be taken, and that to make the regulation effective this should have been done. The magistrate stated that he reluctantly came to the conclusion that the summons must be dismissed, and explained that he was compelled to decide the case according to his view of the law as it stands. He offered to state a case, but the Battersea Borough Council did not think it advisable to appeal to the High Court. It was decided, however, to ask the County Council to take steps to have the Regulations amended in the direction indicated. Dr. Thomas refers in his report to action taken against the proprietors of restaurants in Finsbury in respect of the sale of milk. In 4 instances restaurant keepers were prosecuted for selling milk without being registered for this purpose, and convictions followed in each case; but an appeal has been entered in one case. Dr. Thomas states that there arc 49 such premises in the borough where milk is sold ; 34 of these were registered in the usual way, and as the result of notices served on the remaining 15, registration was effected or the sale of milk given up. With regard to the 127 other restaurants where milk is sold in small quantities in connection with the sale of " tea and milk," " pot of tea," " bread and milk," or " porridge and milk," action was deferred pending a judicial decision in the case raised for appeal. This case was the appeal of a firm of restaurant keepers against a conviction for selling milk without being registered, and has since been decided, the Lord Chief Justice giving judgment on the 21st October, 1912. His Lordship took the view that there was nothing in the various regulations to show that the sale of a glass of milk incidental to the ordinary trade of restaurant keeper involved that the restaurant keeper should be registered as a purveyor of milk. He did not decide what would, under other circumstances, constitute the purveying of milk, but in his opinion there was no evidence that the appellants were carrying on the trade of purveyors of milk. Mr. Justice Chamiell and Mr. Justice Avory concurred, the latter adding that to be a purveyor of milk the selling of milk must be a substantial part of the business carried on. The appeal, therefore, was allowed. The following table shows the number of milkshop premises at the end of 1910 and 1911 in the metropolitan borouehs of London, the number of inspections and the proceedings taken. Inspection of milkshop premises. The table has mainly been compiled from information contained in the annual reports:— Metropolitan borough. Number of premises, (a) Number of inspections, 1911. Number of notices, 1911. Number of prosecutions, 1911. On register at end of 1910. Added in 1911. Removed in 1911. On register at end of 1911. City of London 638 33 32 639 - 1 - Battersea 185 25 34 176 620 18 1 Bermondsey 286 35 27 294 1,118 10 - Bethnal Green 243 20 7 256 806 33 1 Camberwell 610 29 25 614 1,331 22 - Chelsea 115 10 11 114 152 7 - Deptford 206 57 57 206 559 22 1 Finsbury 263 31 34 260 242 38 4 Fulham 175 41 5 211 620 15 - Greenwich 182 9 18 173 205 - - Hackney 351 14 54 311 1,490 14 - Hammersmith 355 67 75 347 703 38 1 Hampstead 107 4 8 103 549 35 - (a) Figures in italics refer to persons registered. 49 Report of the Medical Officer of Health. Metropolitan borough. Number of premises. (.) Number of inspections, 1911. Number of notices, 1911. Number of prosecutions 1911. On register at end of 1910. Added in 1911. Removed in 1911. On register at end of 1911. Holborn 172 14 9 177 658 3 — Islington 565 28 25 568 1,661 242 — Kensington 196 13 12 197 1,339 12 — †Lambeth 627 111 629 109 1,071 111 — Lewisham 199 18 59 158 514 5 — Paddington 114 7 1 120 210 — — Poplar 329 14 18 325 1,110 3 — St. Marylebone 208 25 33 200 506 10 — St. Pancras 413 — — 413 966 — — Shoreditch 292 15 15 292 2,868 17 — Southwark 428 107 79 456 1,346 10 — Stepney 1,102 39 49 1,092 2,375 406 9 Stoke Newington 51 — — 58 99 1 — Wandsworth 336 57 38 355 912 41 7 Westminster 872 38 28 382 899 49 — Woolwich 137 14 22 129 193 30 — Totals 8,0291 — — 7,4591 — — — 1,228 1,271 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 (а) 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 three. quarters 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. Tuberculosis of the udder in London COWs. London County Council (General Powers) Act, 1904 (Part V.) During the year 1911 there were six 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, 11th Dec., 1910, to 21st Feb., 1911. 2nd period, 22nd Feb. to 10th April, 1911. 3rd period, 11th April to 9th June, 1911. 4th period, 10th June, to 1st August, 1911. 5th period, 2nd August to 19th Oct. 1911. 6th period, 20th Oct,, 1911,to 12th Jan, 1912. Total number of cows examined 3,015 3,051 3,065 2,934 3,091 2,998 Affected with disease or defects of the udder 116 114 109 81 87 83 Affected with tubercular disease of the udder 1 3 4 4 2 4 Subjects of acute mastitis 32 13 29 9 14 26 Affected with chronic induration of the udder 31 38 27 22 26 20 Atrophy of one or more quarters 51 59 43 45 42 31 Injuries, abscesses, simple eruptions, Btrictures and obliterations of milk ducts 1 1 6 1 3 2 The 18 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. One other cow was seized and slaughtered on suspicion of being affected with tuberculosis of the udder. On post.mortem examination, however, the animal presented no definite pathological evidence of being so affected. 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 tuber. (*)Figures in italics refer to persons registered. †Tho milkshop premises are being re registered under now regulations, 12532 G Tuberoulous milk ; London County Council (General Powers) Act, 1807. Part IV. 50 Annual Report of the London County Council, 1911. culosis 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. The method of procedure adopted is as follows : Samples are taken by the Council's inspectors from churns of milk consigned from the country to the various London railway termini, and these are submitted to the Lister Institute for bacteriological examination. In the case of those samples in respect of which the examination proves that there is evidence of the presence of tubercle bacilli, a clinical examination of the cows at the dairy farm from which the milk is consigned is made by a veterinary inspector appointed for the purpose under the Act, and cows found to have tuberculous udders are certified for the purposes of the Dairies and Cowsheds Orders and copies of the certificates forwarded to the local sanitary authorities concerned. During the year 1911, 3,038 samples of milk were taken. The milk had been sent to London from the following counties : Bedfordshire, Berkshire, Buckinghamshire, Cambridgeshire, Cheshire, Cornwall, Derbyshire, Devonshire, Dorsetshire, Essex, Gloucestershire, Hampshire, Herefordshire, Hertfordshire, Huntingdonshire, Kent, Leicestershire, Lincolnshire, Middlesex, Norfolk, Northamptonshire, Northumberland, Nottinghamshire, Oxfordshire, Rutlandshire, Shropshire, Somersetshire, Staffordshire, Suffolk, Surrey, Sussex, Warwickshire, Wiltshire, Worcestershire and Yorkshire; 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. 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 60 2 54 4 Berkshire 155 7 142 6 Buckinghamshire 138 4 121 13 Cambridgeshire 14 4 9 1 Cheshire 16 7 9 — Cornwall 3 — 3 — Derbyshire 320 59 252 9 Devonshire 1 — 1 — Dorsetshire 46 2 39 5 Essex 121 11 105 5 Gloucestershire 127 6 116 5 Hampshire 76 7 66 3 Herefordshire 1 — 1 — Hertfordshire 62 0 47 6 Huntingdonshire 8 3 5 — Kent 15 5 9 1 Leicestershire 306 31 265 10 Lincolnshire 21 — 19 2 Middlesex 9 3 6 — Norfolk 5 — 5 — Northamptonshire 154 9 138 7 Northumberland 1 — 1 — Nottinghamshire 33 2 29 2 Oxfordshire 125 8 112 5 Rutlandshire 1 — 1 — Shropshire 15 3 9 3 Somersetshire 247 16 198 33 Staffordshire 201 38 151 12 Suffolk 15 — 12 3 Surrey 21 1 19 1 Sussex 60 7 53 — Warwickshire 79 6 70 3 Wiltshire 562 48 492 22 Worcestershire 10 — 10 — Yorkshire 10 — 10 — Total 3,038 298 2,579 161 51 Report of the Medical Officer of Health. This table shows that out of 2,877 completed examinations of samples taken from churns con., signed to London, 298 proved to be tuberculous, i.e., 10.4 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 2,497 samples of milk examined during the year 1910, of which 268, or 107 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 1 43 — Berkshire 11 345 5 Buckinghamshire 4 181 1 Cambridgeshire 1 54 1 Cheshire 3 144 1 Derbyshire 71 1,582 17 Dorsetshire 9 170 2 Essex 16 730 6 Gloucestershire 5 227 — Hampshire 26 999 7 Hertfordshire 10 306 8 Huntingdonshire 2 100 1 Kent 9 344 4 Leicestershire 21 771 6 Middlesex 2 102 1 Norfolk 2 44 1 Northamptonshire 9 351 1 Nottinghamshire 2 47 — Oxfordshire 4 148 1 Shropshire 1 32 — Somersetshire 19 651 3 Staffordshire 127 2,985 6 Suffolk 4 166 1 Surrey 3 162 3 Sussex (East) 6 216 — Sussex (West) 3 103 3 Warwickshire 6 175 1 Wiltshire 126 4,332 11 Total 503 15,510 91 Farms inspected in English counties. This table shows that 0.6 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. Offensive Businesses. In the year 1911 the County Council received 247 applications for licences for slaughter-houses, and granted 243. 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 continually decreasing;— Slaughter-. houses. 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 1893 442 429 1908 281 273 1899 419 411 1909 265 264 1900 405 393 1910 257 255 1901 384 381 1911 247 243 2532 G 2 52 Annual Report of the London County Council, 1911. Inspection of slaughterhouses. The number of slaughter-houses in each metropolitan borough (other than those under the jurisdiction of the City Corporation) 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. of inspections, 1911. No. of notices, 1911. Licensed at end of 1910. Licence lapsed or refused in 1911. Remaining at end of 1911. Battersea 5 1 4 328 Bermondsey 1 — 1 23 — Bethnal Green 5 1 4 34 — Camberwell 13 — 13 96 — Chelsea 6 — 6 66 — Deptford 3 — 3 46 — Finsbury 3 — 3 95 — Fulham 4 1 3 50 — Greenwich 4 — 4 24 — Hackney 21 — 21 319 3 Hammersmith 9 — 9 112 15 Hampstead 4 — 4 81 1 Holborn 1 — 1 12 — Islington 32 2 30 1,759 — Kensington 10 — 10 228 — Lambeth 20 1 19 40 4 Lewisham 15 1 14 131 — Paddington 7 — 7 479 — Poplar 16 2 14 92 — St. Marylebone 7 — 7 130 1 St. Pancras 18 1 17 616 — Shoreditch 6 — 6 12 — Southwark 6 — 6 22 — Stepney 6 — 6 16 2 Stoke Newington 4 — 4 19 — Wandsworth 17 2 15 320 3 Woolwich 12 — 12 48 4 Totals, 27 districts 255 12 243 5,198 33 During the year the following authorised offensive businesses, other than that of a slaughterer of cattle, were discontinued: the business of a knacker in Southwark; the business of a tallow-melter and soap-boiler in Lambeth; the business of a fat-melter and a tripe-boiler in Poplar. Hence the number of scheduled offensive businesses declined from 79 to 74. 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 melters15 Manure manufacturers 2 Tripe boilers 21 Soap boilers 11 Glue and size manufacturers .. 5 Tallow melters 5 Knackers 4 Gut manufacturers 3 Fellmongers 6 — Bane boilers 2 74 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. Inspection of offensive trade premises. 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 1911. No. of inspections, 1911. Metropolitan borough. No. on Register at end of 1911. No. of inspections, 1911. Battersea 2 19 Lambeth 3 24 Bermondsey 12 Poplar 6 39 Bethnal Green 1 4 St. Marylebone 2 28 Camberwell 4 St. Pancras 2 43 Deptford 3 35 Shoreditch 1 10 Finsbury 1 6 Southwark 5 66 Greenwich 3 Stepney 7 28 Hackney 1 13 Wandsworth 4 99 Islington 6 89 Total 63 (a) The seven slaughter-houses under the jurisdiction of the City of London Corporal ion are not licensed by the London County Council. 53 Report of the Medical Officer of Health. Nuisances. There are few references in any of the reports to nuisance arising from accumulations of stable manure. This fact was also observed in 1910. There is little doubt that the more rigid enforcement of the bylaws and the obvious reduction in the number of horse.drawn vehicles have together combined materially to reduce nuisance from this cause. It must not be overlooked, however, as was pointed out last year that the removal of small accumulations of manure will probably become a matter of increasing difficulty, inasmuch as contractors will not find its collection sufficiently remunerative. The question is deserving of the consideration of local authorities who have power to act under section 36 of the Public Health (London) Act, 1891. Nuisance from stable manure. In several of the reports mention is made of proceedings for the removal of offensive refuse during prohibited hours. In a few instances, too, proceedings were taken for keeping animals so as to be a nuisance. Dr. Sandilands states that 190 fixed ashpits were abolished under section 23 of the London County Council (General Powers) Act, 1904. During 1911 the system of making a bi.weekly collection of house refuse where recommended by the medical officer of health was continued in Paddington. In other boroughs there is little variation from the methods adopted in 1910, or previously, in the matter of dust collection. Dr. Harris, in the report relating to Islington, states that it is certain that the time will come when all household dust shall be removed at least twice a week. Other nuisances. The annual reports of medical officers of health show that considerable effort is made in London to deal with smoke nuisance, and in several 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, restaurants, etc. Smoke nuisanco. Dr. Allan states that in Westminster much of the smoke nuisance complained of is, as in previous years, the result of careless stoking of the furnaces. Dr. Collingridge again refers to nuisance experienced by occupiers of offices from smoke issuing from neighbouring chimneys at an inconveniently low level. Dr. Annis refers in his report to a prosecution in Greenwich which was dismissed on the ground that although the magistrate was satisfied that there was a recrudescence of the nuisance from the same chimney within 6 months of the service of the statutory notice requiring not only the abatement of such nuisance, but also to do whatever might be necessary to prevent the recurrence of the nuisance, yet that this said recrudescence was not in fact a recurrence because the circumstances connected with the emission of the smoke on the respective dates were entirely different. On an appeal to the High Court the magistrate's decision was upheld. The following table, which is compiled mainly from information contained in the annual reports, shows the action taken by sanitary authorities in respect of smoke nuisance during the year, so far as this is stated in those reports. Metropolitan borough. Observations and inspections. Nuisances and complaints. Intimations. Statutory Notices. Summonses. City of London 334 13 13 — Battersea 62 62 2 — Bermondsey 220 (chimneys) 36 — Bethnal Green 555 — 34 9 4 Camberwell — — 75 — — Chelsea — very few — — — Deptford 31 14 — 14 — Finsbury 67 11 — 25 1 Fulham — — 7 3 — Greenwich 250 — — 5 1 Hackney 777 — 49 — — Hammersmith 26 (premises) — 9 4 — Hampstead — 10 — — — Holborn 117 — _ 8 1 — Islington 161 19 — 19 — Kensington 268 — — 2 1 Lambeth — . 23 10 — — Lewisham 317 — 11 1 — Paddington 29 (premises) 11 — — — Poplar — 63 33 25 2 St. Marylebone 1,292 11 — 1 — St. Pancras 653 — 15 — — Shoreditch — 28 14 1 1 South wark 280 48 16 5 — Stepney — 70 — 70 — Stoke Newington — 6 6 — — Wandsworth 189 42 — 31 — Westminster, City of 2,620 63(a) 99 7 — Woolwich 48 11 — 4 — (a) Complaints only. 54 Annual Report of the London County Council, 1911. Housing of the Working Classes. Proceedings under Part I, of the Housing of the Working Classes Act, 1890. In last year s report reference was made to the Council s proposal to treat as an improvement scheme two areas in Southwark known as the Tabard.street and Grotto-place areas, and an area in Ber. mondsey known as the Crosby.row area, which had been represented to the Council by the respective medical officers of health of those boroughs. In November, 1911, after correspondence with the Local Government Board on the subject the Council agreed to modify the scheme in the following particulars :— (1) To provide as many cottages as could be conveniently erected on the detached portion of the Tabard.street area between Law.street and Little Hunter.street. (2) To provide sheds on the area for the convenience of street traders, and accommodation for barrows as may be required for the use of such street traders as may be displaced by the scheme. (3) To retain and use part of the land as an open space accessory to the scheme for rehousing. Proceedings of the Council under Part III. of the Act. A copy of the resolutions on these proposals was forwarded to the Local Government Board. In October, the Council accepted a tender of £3,241 for the erection of 15 cottages on Section C of the Norbury estate. Housing, 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." Information of these proceedings is not given in tabular form in several of the reports, and the following table has been mainly compiled from the information otherwise contained in them: Metropolitan borough. No. of houses inspected. No. of houses dealt with under Section 15. No. of representations, 1911. No. of closing orders, 1911. No. of houses, defects remedied without closing orders. No. of houses, defects remedied after closing orders No. of houses demolished. Remarks. Battersea 78 some Bermondsey 2,075 6 43 6 27 2 Bethnal Green 382 90 177 9 A large amount of repairs effected. Camberwell 30 14 Chelsea 108 69 1 3 4 closed and 3 demolished voluntarily. Deptford 2,154 50 44 44 2 closed voluntarily. Finsbury 19 Represented in 1910and subsequently closed. Fulham 157 43 38 91 10 19 Greenwich 478 — — 323 17 45 closed and 17 demolished voluntarily. Hackney 260 Hammersmith 766 — — 362 Hampstead 171 1 1 80 1 appeal dismissed. Holborn 129 1 31 1 23 1 21 28 closed voluntarily. Islington 17 17 9 17 Kensington 46 4 4 21 1 1 6 houses converted to other uses. Lambeth 60 27 27 27 43 27 demolished voluntarily without closing orders. Lewisham 781 5 2 Paddington 154 5 5 4 2 closed voluntarily. Poplar 130 7 7 118 6b St. Marylebone 588 †l06 5 5 504 1 2 Informalities in procedure caused delay. St. Pancras No information. Shoreditch 13 11 11 22 11 Southwark 33 109 76 31c Stepney 38 38 38a Informalities in procedure caused delay. Stoke Newington * 4 — 1 Wandsworth 2,486 — — — — — — Westminster, City of 21 8 — 6 — 2 Woolwich 340 18 14 4 7 8 Representations included 3 underground rooms. Totals 11,513 207 392 334 1,833 144 139 55 Report of the. Medical Officer of Health. All the 171 inspections in Hampstead were concerned with basement houses and 93 underground rooms were found to be illegally occupied. In 80 cases structural works were carried out; in 12 cases the use of the room was discontinued, and in 1 case, a Closing Order was made in 1912. In Battersea the 78 inspections were of underground rooms. 35 of these were illegally occupied. In 14 cases the use of the room was at once discontinued. Notices requiring alterations were served with respect to the others. Eight underground rooms were represented in Westminster. Four Closing Orders were made, and the remaining 4 rooms were dealt with under the Public Health Act. In "Woolwich, 3 underground rooms were represented, and dealt with under the Housing, Town Planning, Act. Underground Rooms. The number of underground rooms dealt with in 1911 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 35 14 Kensington 9 9 Bermondsey — — Lambeth 21 21 Bethnal Green — 3 Paddington 10 16 Camberwell 2 2 St. Marylebone 245 245 Chelsea 5 5 St. Pancras 427 * Deptford 3 3 Shoreditch 8 8 Finsbury 17 17 Southwark — — Fulham — — Stepney 62 62 Greenwich 5 5 Stoke Newington 10 10 Hackney 2 2 Westminster, City of 49 49 Hampstead 93 93 Woolwich 14 14 Holborn 24 24 Islington 22 22 Total 1,163 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 in the annual reports of medical officers of health, regulations made by eight authorities have been approved by the Local Government Board, these authorities being the metropolitan borough councils of Battersea, Hampstead, Lambeth, Poplar, St. Marylebone, Stoke Newington, Wandsworth and Woolwich. In five other cases draft regulations were, at the end of the year, awaiting the approval of the Board. In the report relating to Holborn, Dr. Bond, the medical officer of health, states that he prepared regulations in accordance with the provisions of the Act, and after careful consideration by the Committee, the matter was adjourned for the present. 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, in their annual reports:— Metropolitan borough. No. of dwelling. rooms overcrowded. No. remedied. No. of prosecutions. City of London 7 7 - Battersea 84 84 - Bermondsey 169 169 - Bethnal Green 246 231 - Camberwell 102 102 - Chelsea 7 7 4 Deptford 33 33 - Finsbury 121 121 - Fulham 32 32 . - Greenwich 29 29 - Continued on next page. • * Time allowed to tenants to find room elsewhere. 56 Annual Report of the London County Council, 1911. Metropolitan borough. No. of dwellingrooms overcrowded, No, remedied, No. of prosecutions. Hackney 118 116 — Hammersmith — — — Hampstead 16 16 — Holborn 64 64 — Islington 112 112 — Kensington 83 83 2 Lambeth 39 39 — Lewisham 27 27 — Paddington 207 173a — Poplar 183 183 — St. Marylebone 85 85 — St. Pancras 159 159 — Shoreditch 148 148 — Southwark 104 104 — Stepney 548 547 1 Stoke Newington 10 10 — Wandsworth 91 91 — Westminster, City of 107 107 — Woolwich 97 97 — Totals 3,028 2,976 7 (a) No action taken in 34 cases, the deficiency of air space being very slight. Houses let in lodgings. Registration and inspection of houses let in lodgings. The following table has been compiled from the annual reports of medical officers of health, and shows the number of houses let in lodgings on the register and the number of inspections, notices issued and proceedings taken during the year 1911. Metropolitan borough. Number of places. No. of Inspections, 1911. No. of Notices, 1911. No. of Prosecutions, 1911, On register at end of 1901. Added in 1911. Removed in 1911. On register at end of 1911. City of London 248 — — 247 — 305 — Battersea 123 — 123 330 127 — Bermondsey 227 4 — 231 924 179 — Bethnal Green 517 30 11 536 2,006 590 — Camberwell 254 — — 254 490 429 — Chelsea 583 — 14 569 453 194 — Deptford 273 — — 273 273 9 — Finsbury 1,209 — — 1,209 8,824 221 — Fulham 114 — — 114 — — — Greenwich 95 120 — 215 682 69 — Hackney 463 38 — 501 393 213 — Hammersmith 4,623 186 1,314 3,495 — 678 — Hampstead 364 61 — 425 748 86 8 Holborn 641 4 12 633 1,002 188 — Islington (a) (a) 8,217 908 1 Kensington 2,091 — — 2,091 7,625 1,032 11 Continued on next page. (a) No register is now kept, under the Borough of Islington's new by-laws, but during the year there were 1,022 houses on the lists for inspection. 57 Report of the Medical Officer of Health. 57 Metropolitan borough. Number of places. On register at end of 1910. Added in 1911. Removed in 1911. On register at end of 1911. No. of Inspections, 1911. No. of Notices, 1911. No of Prosecutions, 1911. Lambeth 372 372 744 _ Lewisham 15 1 5 11 70 11 — Paddington 1,326 32 10 1,348 6,945 4,188 8 Poplar 1,095 21 — 1,124 2,747 590 3 St. Marylebone 758 294 - 1052 7,539 1,465 St. Pancras 2,282 71 - 2,353 9,064 1,197 — Shoreditch 263 3 — 266 426 67 — Southwark 1,270 24 34 1,260 11,692 2,935 — Stepney 2,881 36 6 2,911 4,842 2,521 9 Stoke Newington 263 — — 217 — — — Wandsworth 292 292 721 637 4 Westminster 1,447 - 55 1,392 7,559 1,297 — Woolwich 409 30 10 429 539 257 Totals including Islington 25,507 24,965 Reference was made in the annual report for 1910 to a provision in the Housing, Town Planning, etc., Act, 1909 (section 16) which extends the power of making by-laws as to lodging-houses for the working classes so as to impose duties upon the owner of the premises in addition to or in substitution for any other person. In Paddington, Poplar and St. Marylebone amended by-laws were adopted during the year and were awaiting confirmation by the Local Government Board. In Islington, Dr. Harris reports that amended by-laws have been approved. In Wandsworth Dr. Caldwell Smith states that the borough council, on the advice of their solicitor, did not consider it necessary to make any alteration in the existing by-laws. In the Battersea and Lambeth reports it is stated that new by-laws are under consideration. Death Rates in Council's Dwellings. 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 1911. The population thus dealt with comprised 27,704 persons, and the death-rate at " all ages," after correction for age and Rex distribution, was 9.5 per 1,000 living, compared with 15-0 for London :— Death-rate per 1,000 living, 1911. Cause of death. Council's dwellings. London. All Causes—All Ages 9.5 15.0 ,, „ age 0—5 27.7 47.7 „ „ „ 5-20 1.9 2.7 „ ,, ,, 20 and upwards 8.6 15.0 Diarrhoea 0.8 1.4 Principal epidemic diseases (excluding Diarrhoea) 0.7 1.0 Phthisis 0.8 1.3 Tubercular diseases other than Phthisis 0.3 0.4 Bronchitis 0.8 1.2 Pneumonia 1.1 1.2 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. 12532 H 58 Annual Report of the London County Council, 1911. Accommodation in common lodging houses and details of inspection. 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 1894 :— 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 costs. £ s. d. No. of cases of infectious disease. 1895 626 29,574 — — 16 12 37 6 0 99 1896 596 29,140 28,331 — 31 30 112 16 0 71 1897 581 28,718 26,121 — 31 30 92 11 0 48 1898 560 28,332 27,658 — 29 29 167 3 0 44 1899 544 28,448 28,229 1,162 25 22 183 9 0 54 1900 528 28,311 28,428 668 16 13 102 15 0 40 1901 514 28,037 35,225 2,133 16 15 96 3 0 166 1902 491 28,970 40,512 1,449 22 21 98 4 0 684 1903 470 28,893 33,402 4,790 6 6 26 11 0 53 1904 451 28,896 27,501 2,970 15 14 62 6 0 66 1905 413 27,571 28.158 1,565 21 16 77 3 0 14 1906 402 28,063 30,028 2,349 4 4 11 1 0 22 1907 395 28,651 33,630 2,307 3 3 12 9 0 27 1908 387 23,379 32,297 2,429 1 1 2 2 0 13 1909 383 28,302 29,324 1,286 3 3 22 0 0 19 1910 368 27,914 26,733 1,589 2 2 7 4 0 13 1911 364 28,000 25,243 2,066 2 2 5 8 0 16 It will be observed that since 1894 the number of common lodging-houses has steadily diminished. It should be noted, however, that previously to 1903 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 beds 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, 5 ; scarlet fever, 4 ; diphtheria, 2 ; enteric fever, 5—Total 16. Licensed common lodging houses and accommodation provided. The following table shows the total number of common lodging houses, and the authorised accommodation for the different classes of lodgers in the several sanitary areas of London, other than that of the City, on 31st December, 1911 :— Sanitary District. Number of Houses. Authorised Accommodation. Men. Women. Couples. Total. Battersea 9 157 144 23 347 Bermondsey 5 1,297 — — 1,297 Betlinal Green 13 674 — — 674 Camberwell 5 549 — — 549 Chelsea 5 212 — — 212 Deptford 8 1,155 80 — 1,235 Finsbury 8 535 — — 535 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 1,171 275 18 1,482 Kensington 22 398 272 — 670 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 8 706 36 — 742 Shoreditch 12 764 — — 764 Southwark 42 3,173 449 — 3,622 Stepney 53 5,367 694 180 6,421 Stoke Newington 1 37 — — 37 Wandsworth 10 185 20 230J Westminster, City of 13 2,248 62 — 2,310 Woolwich 23 480 76 — 556 London—excluding the City of London 364 25,055 2,455J 245 *28,000½ * ½=l child. Report of the Medical Officer of Health.- 59 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 infirmaries and other like public institutions have been included. The total number of deaths among lodgers (males and females) in common lodging-houses during the year was 754; the large majority of these deaths occurred in public institutions. Deaths among inmates of common lodging houses. Table showing the number of deaths of males at five age periods from certain causes per 1,000 deaths from all causes in London (1910) and licensed common lodging-houses (1910 and 1911). Cause of death. Age 25 to 35. Age 35 to 45. Age 45 to 55. Age 55 to 65. Age 65 and upwards. London, 1910. C.L.H 1910. C.L.H. 1911. London 1910. C.L.H. 1910. CL.H. 1911. London, 1910. C.L.H. 1910. C.L.H. 1911 London 1910. C.L.H. 1910. C.L.H 1911. London, 1910 C.L H. 1910. C.L.H. 1911 Phthisis 399 415 451 314 460 500 187 325 286 101 205 256 25 83 64 Other tubercular diseases 37 24 32 16 — — 11 6 6 4 12 12 3 — 5 Alcoholism (including cirrhosis of the liver) 14 47 32 27 19 — 35 32 26 25 24 12 8 — 13 Urinary diseases 37 47 96 51 46 11 73 57 80 86 69 68 83 73 60 Violence, suicide 95 70 64 81 27 11 66 19 20 46 19 18 24 14 30 Cancer 35 24 — 60 10 35 131 09 68 174 106 86 112 79 84 Circulatory diseases 90 24 197 135 82 90 179 76 96 235 87 132 245 51 112 Nervous diseases 30 24 — 40 55 57 36 76 28 32 81 30 32 47 40 Bronchitis 12 24 32 27 73 35 49 107 102 87 154 152 152 216 166 Pneumonia 99 93 64 106 109 139 103 107 169 88 94 132 71 106 66 Other causes 152 208 32 143 119 122 130 126 119 122 149 102 245 331 360 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 Enquiry has been made with regard to 238 persons notified under the orders and giving addresses at common lodging houses licensed by the Council, viz., 221 males and 17 females. The age distribution of 237 of these cases was as follows :— Phthisis in Common Lodging Houses. 15— 20— 25— 35— 45— 55— 65— 4 5 33 65 81 44 5 As the result of enquiry, information was obtained in respect of 221 of the patients as to whether their illness began before or after they had resorted to this mode of living. Of the total (221) the onset of illness was stated in 89 cases to date from a time prior to that when resort was made to common lodging-houses, while in 16 other cases it was practically coincident with entry. As regards cases developing after commencement of this mode of life in 31 cases the illness was first manifested before the expiration of three years ; in 14 cases in from three to five years, in 35 cases in from five to ten years, in 24 cases between ten and twenty years and in 12 cases the illness developed after more than twenty years of common lodging house life. Seamen's Lodging-houses. Under the provisions of section 214 of the Merchant Shipping Act, 1894, the Council made by-laws for the regulation of houses accommodating seamen. These by-laws came into force on the 1st October, 1901. As the result of correspondence with the Board of Trade on the subject of the licensing of seamen's lodging-houses, it was thought desirable that the by-laws should be amended in certain particulars. This was accordingly done, the new by-laws were sealed by the Council on 16th December, 1909, and came into force on 1st January, 1910. An Order of His Majesty in Council making it an offence to keep a seamen's lodging-house within the County of London unless such house is licensed by the County Council, came into force on 19th February, 1910. Seamen's lodging-houses are now annually licensed by the Council. The annual licensing meeting is held in November and the licences then granted date from 1st January and expire on 31st December. The number of seamen's lodging houses under supervision at the end of 1911 was 36, situated in the following metropolitan boroughs :— Metropolitan borough. Poplar Stepney Total Houses. Lodgers. 11 323 25 850 36 1,173 12332 H 2 60 Annual Report of the London County Council, 1911. 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 costs. £ 8. d. No. of cases of infectious disease. 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 — 1911 36 1,173 1,465 201 7 6 52 13 0 — In the year 1911 proceedings before the magistrate were instituted in seven instances, resulting in six convictions, the penalties amounting to £46 and £6 13s. costs. Five of the six convictions were in respect of keeping unlicensed houses, the sixth was for breaches of the by-laws. Cleansing of Persons Act, 1897, etc. Cleansing of persons Act,18597. The Cleansing of Persons Act provides " that any local authority shall have the power when in their discretion they shall see fit, to permit any person who shall apply to the said authority on the ground that he is infested with vermin to have the use, free of charge, of the apparatus (if any) which the authority possesses for cleansing the person and his clothing from vermin." It is also provided that the use of such apparatus shall not be considered to be parochial relief or charitable allowance, and local authorities may expend any reasonable sum on buildings, appliances, etc., required for carrying out the Act. The Act, however, is a permissive one only. In recent years considerable attention has been paid to this subject and most of the local authorities in London have in greater or less degree made provision for the cleansing of verminous persons and their clothing. Some information on this subject is given in the annual reports and the following table has been compiled from the material thus made available :— Number of persons cleansed during the year 1911. Metropolitan borough. Adults. Children. Metropolitan borough. Adults. Children. City of London — 24 Poplar 432 24 Battersea 1,459 191 St. Marylebone 9,085 967 Bermondsey 73 391 St. Pancras 1,764 2,369c Bethnal Green 14 — Southwark 137 18 Camberwell 2,338d Stepney 2,015 96 Finsbury 7b — Stoke Newington 2 254 Hackney 177 544 Wandsworth 5 14 Holborn 1336 — Westminster, City of 19 — Islington 23 — Woolwich 123 386 Kensington 34b — General Powers Act, 1904 sects. 19,20,21,24. In dealing with verminous persons and more particularly with children, it was recognised that the cleansing of the individual could be of little service unless accompanied by the cleansing of his home (furniture and clothing), and the County Council in its General Powers Bill of 1904 included clauses to effect this end. These clauses became law and the powers thus obtained have been largely used by local authorities, as many as 10,000 rooms being cleansed in 1910 and a somewhat larger number in 1911. Most of the reports contain reference to the action taken under section 20 of the (b) Dealt with by the Board of Guardians at the expense of the Borough Council. (c) In addition to the number of children disinfected shown in the table, 397 children, bed-fellows of such children, were also cleansed. (d) Adults and children.. Report of the Medical Officer of Health. 61 London County Council (General Powers) Act of 1904, to which reference has just been made and the information given on this subject relative to the year 1911 has been summarised in the following table:— Metropolitan borough. Number of rooms or premises cleansed. Metropolitan borough. Number of rooms or premises cleansed. City of London Lambeth 535 rooms. Battersea — Lewisham — Bermondsey — Paddington 202 premises. Bethnal Green 552 rooms. Poplar 136 rooms. Camberwell 87 premises. St. Marylebone 325 rooms. Chelsea 240 rooms. St. Pancras 302 premises. Deptford 75 rooms. Shoreditch 275 premises. Finsbury 135 premises. Southwark *3,196 rooms. Fulham 32 rooms. Stepney 1,953 rooms. Greenwich 44 premises. Stoke Newington 76 rooms. Hackney 448 premises. Wandsworth 240 premises. Hammersmith — Westminster 244 rooms. Hampstead 96 rooms. Woolwich 248 rooms. Holborn 57 premises. Islington 313 premises. Total 8,016 rooms. Kensington 308 rooms. 2,103 premises. Cleansing of verminous rooms or premises. * 1,900 of these cleansed by owners. In 1907, yet further powers were obtained in the Council's General Powers Act of that year. These powers were much in advance of anything in any previous Act and provided for the cleansing of school children and of the inmates of common lodging-houses found to be verminous. In the latter case power was given to detain and convey to suitable premises for the purpose of cleansing, any inmate of a common lodging-house being verminous and failing to comply with a twenty-four hour notice requiring him to be cleansed. Section 38 of the Act empowered the Council to enter into arrangements and agreements with local authorities for the cleansing of children and inmates of common lodginghouses, and agreements under this section have since been made as mentioned below. The Children Act of 1908 made further provision for the cleansing of school children and section 122 of this Act, giving somewhat greater facility of action than section 36 of the General Powers Act, 1907, has mainly been used in London. General Powers Act, 1907, sects. 36.40. Under the provisions of section 38 of the General Powers Act, 1907, the County Council has entered into agreements where possible with the various sanitary authorities for the cleansing of verminous school children. The conditions of agreement are as follows :— Cleansing of children. 1. "That the place of treatment of children shall be entirely distinct from any establishment used for the isolation of suspected cases of infectious disease contacts." 2. " That the exclusive use of the baths for the cleansing of children shall be allowed on certain days." 3. " That the cleansing station shall be in a convenient position and that the children shall be efficiently supervised with female attendants for the treatment of girls." 4. " That a payment at the rate of 2s. per child shall be made to the local authority in respect of the cleansing of children infested with vermin, the payment to cover any number of attendances by such child at the cleansing station within a period of one calendar month from the date upon which the child is first cleansed there and to be irrespective of the number of baths required within that period before the child can reasonably be regarded as cleansed." The work of cleansing children was undertaken at the stations of the City, Stoke Newington, Hackney, Poplar, Bermondsey, Camberwell, St. Marylebone, Hampstead and Woolwich Sanitary Authorities. The City Corporation cleansed children without making a charge to the Council. In addition,the Council established stations at the Finch-street, Chaucer, Bath-street, Fountain-road and Sedlescomberoad schools. During the year the school nurses examined 251,592 children, of whom 14,893 were found to be verminous and a warning card was sent to the parents of each child. Of the children found verminous, 4,976 returned to school cleansed, statutory notices under section 122 of the Children Act, 1908, were served in 9,917 cases, 3,682 children were cleansed at the L.C.C. stations and 1,517 at the sanitary authority stations. In the case of 285 children who relapsed into a verminous condition the parents were prosecuted. When a school child is found verminous, opportunity is taken at once to inform the local medical officer so that he, if necessary, may arrange for the cleansing of the home under the provisions of the General Powers Act, 1904. Local authorities generally have willingly co-operated with the Council in this matter, though as the result of experience gained, it has been found desirable recently to modify in some degree the mode of procedure. A considerable amount of work has been done, however, and it is hoped that the new arrangement will result in increased activity in this direction. Cleansing of homes. as mentioned in the annual report for 1910, the principle adopted by the Council with regard to the cleansing of adults from common lodging-houses was that the sanitary authorities should cleanse, fee of charge, any persons sent for that purpose to the cleansing station by the County Council from Cleansing of adults. 62 Annual Report of the London County Council, 1911. common lodging-houses within their respective districts, and that a fee should be paid for cleansing all persons sent from common lodging-houses not within the district where the cleansing was performed. In the latter half of 1911 agreements to this effect were made with the borough councils of Bermondsey, Camberwell, Hackney, Poplar, St. Marylebone, St. Pancras and Woolwich. In Finsbury, Holborn, and Kensington lodgers were cleansed by arrangement with the Guardians, the borough council paying a capitation fee for each person cleansed. As has already been mentioned, persons were cleansed in other boroughs, but there was no agreement with the County Council for the special treatment of common lodging-house inmates. From the information supplied by the Council's inspectors it appears that during the year 1911 some 345 men and 5 women were sent to have their persons and clothing cleansed by reason of their beds being found to be verminous. Of these numbers, 141 men and 1 woman returned to the common lodging-house in a clean condition, 2 men returned still verminous, and 181 men and 4 women went away and were not again traced. 21 men were expelled by the keepers for declining to go to the cleansing station. During the same period the Salvation Army cleansed some 15,000 men, the numbers at the Westminster shelter alone averaging from 200 to 250 a week. Since the week ending 15th September, 1911, distinction has been made in the figures obtained and they now show whether the lodger was voluntarily or compulsorily cleansed. The details for each of the four months are shown in the following table :—■ Lodgers cleansed. Salvation Army Shelter, St. Ann's Salvation Army Shelter, Charles-street, Westminster. Holborn. Sept. Oct. Nov. Dec. Sept. Oct. Nov. Dec. Voluntarily 260 305 379 265 148 56 67 67 Compulsorily 487 516 633 431 15 34 18 38 Refused to be cleansed 42 33 45 14 — — — — Total cleansed from 15th. Sept. to 31st Dec., 1911. 747 821 1,012 696 163 £0 85 105 It is difficult to account for the different results at the St. Ann's, Westminster, and Charlesstreet, Holborn, shelters. Compulsion appears to be much more necessary in one place than the other, but possibly there is less selection of lodgers at the former place. The fact that the Salvation Army cleanses such a large number of men during the year shows the need for this work and suggests that the 345 men sent from other common lodging-houses form a very small proportion of the men needing treatment, though, of course, here again the question of class needs to be taken into consideration. It is evident, however, from the material available that the objection to cleansing is being slowly overcome, and there are many instances of men who on the first occasion have been cleansed only as the result of a 24 hours' notice, have afterwards when necessary gone to the station voluntarily. Vermin Inquiry. During the years 1909, 1910. and 1911, an attempt was made to obtain information relative to the seasonal prevalence of three kinds ox vermin (fleas, lice, and bugs). Some remarks on this subject were made in a report on " Flies and Vermin " (which appeared as an appendix to the Annual Report of 1909) and these were based on observations made in that year. The figures for the two later years have since become available and the opportunity is now taken, therefore, to compare the results obtained in the several years. Dealing in the first place with the curves for lice for the three years it will be seen that in each instance the figures show that lice were more prevalent in the winter months. It is an interesting fact that the percentage of beds found to be infested was distinctly higher in 1909 than in 1910, and again in 1910 than in 1911. The fact that the attention of keepers and deputies of common lodging houses was especially directed in 1909 to the need of dealing with this question was no doubt largely responsible for the lessened prevalence of lice observed in the two later years. Too much stress must not, however, be laid on small variations in the figures in the three years, inasmuch as the percentages may not be strictly comparable. In the first year inquiry was more specially directed to the presence of lice, whilst in the two later years fleas were made the principal subject of observation. It is possible, therefore, that there may have been some slight differences in the standards applied by the inspectors in the two later years, as compared with 1609. Thus in 1909 the standard for fleas is perhaps lower than in 1910 and 1911, and in the two latter years the standard for lice may be somewhat lower than in 1909. Subject to some qualification in this sense the figures may be accepted. If reference is made to Diagram X in this report it will be seen that there is a tendency for fleas to show a late summer and autumnal prevalence. In 1909 the curve for buys showed correspondence with the curve for fleas, but in the two later years this correspondence is less marked. In these two years the curve for bugs was raised during the whole of the summer, in contrast to the seasonal curve for lice which shows a rise during the winter months. Though the standard adopted during 1909 in determining the prevalence of the three kinds of vermin was not, as already stated, quite the same Diagram X. Diagram shewing the seasonal prevalence of three kinds of oermin in the years 1909,1910, and 1911. * Diagram 1. Diagram shewing the seasonal pervalence of Fled compared with the notified cases of Scarlet Fever and Diphtheria each week in London in the years 1909 Report of the Medical Officer of Health. 63 as that made use of in the years 1910 and 1911 there is clear evidence that there was in the two later years a marked diminution in the proportion of infested beds. The lessened prevalence of vermin though affected in noteworthy degree by climatic changes, heat and cold, sunshine and rain, is without doubt in large measure due to the increased amount of attention devoted to infested clothing and bedding, and to the improved facilities for personal cleansing provided in the more recent years. In the report for 1909 reference was made to the fact that the high autumnal level in the flea and bug curves suggested comparison with the curves of diseases which have an autumnal prevalence. Having regard to the attention which has been devoted to study of the curves of seasonal prevalence of flies and diarrhoea, it becomes a matter of interest to examine a little more closely the rough correspondences observed, in the case of the curves for fleas and certain diseases prevailing in the autumn, with a view to learning whether they throw any light upon the general question of the possibility of infection by insect carriers. The report just referred to continues :— " In the cases of scarlet fever and diphtheria, there are certain facts which suggest the desirability of keeping an open mind as to whether the last word has been said concerning the mode of spread of infection. For example—the special incidence upon children, and particularly upon children in schools; and the evidence as to fomites and the alleged clinging of infection to houses or rooms, or in schools to particular departments or even classrooms.—Dr. Niven has referred (Annual Reports, 1897-1901) to evidence of the tenacity of the disease as regards particular departments.' He says, ' It may go on for a year or more in a department, attacking a case in May, another in June, another in July, and so on.' Again, he observes, ' The history of scarlet fever in schools seems to imply a low power of aerial transmission.' " Furthermore, mention may be made of the fact that scarlet fever rarely spreads from an infected to an uninfected child in the ward of a well-managed hospital, but such spread does occur (' return cases') after children are sent back to their homes. Mr. T. W. Thompson (Vol. XV. Epidem. Soc. Trans.), in discussing the ' return case ' problem, enumerated possible causes of the differing incidence, on one as compared with another class of household. He referred to the influence of school attendance social circumstances, etc., but concluded,' some more obscure factors are at work, factors perhaps closely bound up with the natural history of scarlet lever.' The possibility cannot, of course, be absolutely excluded that a biting insect has played a part in transmitting infection from case to case in some instances, and that in the absence of such intermediary infection has not been transmitted." " In the year 1909 the London scarlet fever and diphtheria curves, it may be said at once, were quite atypical. A considerable milk outbreak of scarlet fever occurred in June and July, and disturbed the ordinary development of the rise usually observed in those months. Apparently, however, the true autumnal maximum for scarlet fever occurred in the thirty-eighth, and that for diphtheria in the thirty-ninth week, while the maximafor both the biting insect curves occurred in the thirtyfifth week. There was thus an interval of three or four weeks between the attainment of the maxima in the latter instances and in the former." (N.B.—The dates of ending the several weeks given in diagram Y are those for 1911.) In 1910 the maximum for scarlet fever occurred in the thirty-ninth week, and for diphtheria in the forty-first week (see diagram Y), whilst the maximum for fleas occurted in the thirty-sixth week, thus giving an interval of from four to five weeks. In 1911 the maximum for scarlet fever occurred in the weeks ending October 14th and 21st, and that for diphtheria not until November 18th. The maximum for fleas in this year was reached in the week ending August 19th, the interval of time between the respective maxima being from 8 to 13 weeks, and thus was greater than in the two former years. In the Report of 1909 already referred to comment was made upon the interval between the attainment of maxima in that year and it was stated that— " In the case of flies and diarrhoea, no such interval is, as a rule, observed, the curves are practically superimposed one upon another. The bearing of this fact upon the hypothesis of fly causation of diarrhoea has been already considered, and it has been pointsd out that there is, in the absence of any such interval, little, if any, time available for dissemination of infection, incubation, etc. It must be remembered, however, in this connection, that there is no need for time for development of an organism in the body of the fly. The suggestion has never been made that the hypothetical organism of diarrhoea passes a phase of its existence within the fly in the manner demonstrated for the malaria organism within the mosquito. If the fly merely acts as a carrier there is, at any rate, no question of allowing time for such development." " It will be interesting to learn whether or no the figures for future years confirm those of last year, in respect of showing an interval between the time of occurrence of the maxima for fleas (or bugs) and the maxima for scarlet fever and diphtheria. Obviously, at the present time, no more can be said than that the subject is one deserving of further study." It will be observed that the figures for 1910 and 1911 exhibit an interval between the time of occurrence of the maxima for fleas and the maxima for scarlet fever and diphtheria. The interval in 1910 is, however, one week longer, and in 1911 five weeks longer than in 1909. Water supply to tenement houses. Sanitary authorities have increasingly used the powers provided by section 78 of the London ounty Council (General Powers) Act, 1907, for requiring the provision of a water supply to the upper floors of tenement houses. G4 Annual Report of the London County Council, 1911. So far as can be gathered from the information contained in the reports of medical officers of health, the following table shows the extent to which the powers referred to have been applied duri ng 1911 :— Metropolitan borough. No. of premises caused to be supplied. No. of legal proceedings. Battersea 148 — Bethnal Green 5 — Finsbury 131 — Fulham 15 — Greenwich 39 — Hackney 8 — Hampstead 105 — Holborn 14(a) — Islington 358 5 Lambeth 1 Paddington 21 Poplar 9 1 St. Marylebone 327 — Shoreditch 78 13 Southwark 129 6 Stepney 40 — Westminster, City of 143 1 Woolwich 2 — Total for 17 boroughs 1,572 27 (a) Number of notices served. In the majority of cases the work was completed during the year. Revenue Act, 1903. 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, again, 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 than before Applications for certificates, Revenue Ait, 19 . The number of applications received and certificates granted during 1911 is shown in the following table:— Metropolitan borough. No. of houses for which applications for certificates were received during 1911. No. of tenements comprised therein. No. of tenements for which applications for certificates were Granted. Refused. Deferred or withdrawn. Battersea 17 29 12 9 8 Bermondsey — — — — — Bethnal Green 7 26 — — — Camberwell 63 289 3 8 278 Chelsea 6 63 6 57 — Deptford 7 14 1 6 — Finsbury 7 houses block dwellgs 35 346 - 381 - Fulham — 1,109 942 60 107 Greenwich - - — — — Hackney - 1,156 1,156 — — Hammersmith 45 119 25 — 94 65 Report of the Medical Officer of Health. 65 Metropolitan borough. No. of houses for which applications for certificates were received during 1911. No. of tenements comprised therein. No. of tenements for which applications for certificates were made. Granted. Refused. red or withdrawn. Hampstead 6 7, - - 12 Holborn 4 9 2 7 0 Islington 2 4 3 1 0 Kensington 33 74 59 4 11 Lambeth 60 134 100 34 - Lewisham 148 244 232 12 - Paddington 6 37 35 — 2 Poplar — — None — - St. Marylebone 6 49 49 — — St. Pancras 11 30 — 17 13 Shoreditch 62 28 34 South wark 56 Stepney 4 37 30 7 - Stoke Newington - — — - - Wandsworth 127 269 239 24 6 Westminster, City of 6 40 35 5 Woolwich None Section 35 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. Factory and Workshop Act, 1901. Section 132 of the Factory and Workshop Act, 1901, requires that every medical officer of health shall every year report specifically on the administration of the Act in workshops and workplaces in the district under his supervision. A form of table is prescribed by the Home Secretary and contains a summary of the inspections made and the defects found and remedied in workshops and factories, together with other information that lends itself to statistical statement. It will be seen from the following table, comparing the work done in 1911 with that done in previous years that there is little variation from year to year in the number of defects found, although there has been some increase in the number of workshops under inspection. It will be seen from the following table, comparing the work done in 1911 with that done in previous years that there is little variation from year to year in the number of defects found, although there has been some increase in the number of workshops under inspection. 1905. 1906. 1907. 1908. 1 1909. 1910. 1911. Number of workshops on register 35,187 36,632 37,891 37,673 37,782 37,742 43,085 Number of inspections, excluding inspections of outworkers' premises 86,071 79,526 81,171 84,058 84,174 89,040 89,997 Total number of defects found 19,023 19,407 22,071 22,012 21,522 21,888 21.013 "Want of cleanliness 6,522 7,206 8,319 7,130 7,256 7,248 6,725 Want of ventilation 828 736 652 639 727 607 681 Overcrowding 347 461 295 237 278 250 253 Sanitary Insufficient 284 296 256 278 377 262 293 conve- Unsuitable or defective 3,411 3,717 4,229 5,255 5,377 5,402 5,516 niences Not separate for sexes 239 251 388 376 292 312 277 Workshops. Dr. Collingridge, medical officer of the City, again comments on the fact that workplaces, however unsuitable, may be brought into use without notice, and that unless nuisance can be proved the unsatisfactory conditions cannot be remedied. In the Camberwell report, there is mention of a case of scarlet fever occurring in a house occupied by a furrier, necessitating the disinfection of several hundred pounds' worth of furs, which was, however, successfully carried out. Dr. Parkes again calls attention to the unsatisfactory condition as regards lighting, warming, and ventilation of the 54 basement workrooms in Chelsea, which have accommodation for some 400 workers. Dr. Whitehouse, medical officer of health of Deptford, comments upon the generally satisfactory condition of the home of the woman outworker, which, he states, is often more cleanly than that of the woman who is not a homeworker. This fact was also observed in Kensington, by Dr. Sandilands. Dr. Thomas gives some interesting particulars of the outworkers in Finsbury. Incidentally he mentions that 80 per cent, of the whole number were apparently well. 20 per cent, were ailing. There were 9 cripples and 4 persons with phthisis. It is remarked that the boxmakers had a lower standard of cleanliness than other persons and their homes were more frequently verminous. In the Hampstead report, mention is made of the discovery that an 12532 I 66 Annual Report of the London County Council, 1911. underground bake-house was being used, although not so used at the passing of the Factory Act of 1901. The occupier was informed that the use of the room was illegal, and it was thereupon discontinued. Dr. Allan, medical officer of health of Westminster, refers to the use of market basements for pea shelling and walnut shelling, and directs attention to one where 20 women were found, who stated that they were occasionally employed from 3 a.m. to 5 p.m. In another basement, where fruit sorting was being performed, there was a disused water closet in a very objectionable condition. Overcrowding during working hours is also found in the neighbourhood of the market and special inspection is necessary to ensure better conditions. There is mention in one or two of the reports of unventilated or defective gas heating arrangements, but this defect appears to be much less frequent than in previous years. With regard to Islington, it is stated that the drying of clothes in bakehouses still continues in some instances, and the closing of inlet ventilators is prevalent and reqiures careful watching, Ice-cream premises. Places where food is prepared for sale. Section 43 of the London County Council (General Powers) Act, 1902, gives powers for controlling the conditions under which ice cream is prepared for sale. The provisions of this section are now widely applied and nearly all the reports give account of the action taken. The following table summarises the information thus available and shows the number of these premises in each metropolitan borough and other particulars :— . Metropolitan borough. Number of places No of inspections,1911. No of notices,1911. No.of prosecutions 1911. On register On register at end of 1910 Added in 1911 Removed in 1911. On register at end of 1911 City of London 241 243 Battersea 185 16 27 174 583 4 1 Bermondsey 144 — 5 139 195 12 — *Bethnal Green 104 209 — Camberwell 219 12 12 219 444 6 Chelsea 33 4 3 34 20 2 Deptford 122 22 15 129 197 19 1 Finsbury 82 97 142 17 — Fulham 129 22 6 145 214 14 _ Greenwich 126 1 9 118 138 — — Hackney 159 19 3 175 193 21 — Hammersmith 212 8 50 170 182 14 — Hampstead 83 3 4 82 314 36 — Holborn 40 — 5 35 140 1 — Islington 235 35 41 229 134 18 _ Kensington 173 15 12 176 172 2 — *Lambeth 24 — *Lewisham — — — — — — — Paddington 116 2 10 108 67 — Poplar 151 116 45 — St. Marylebone 86 10 — 96 121 8 — St. Pancras 491 491 385 — Shoreditch 89 11 13 87 115 14 *Southwark 129 72 18 — Stepney 160 35 10 185 354 46 — *Stoke Newington 38 Wandsworth 287 42 25 304 480 53 — *Westminster, City of 150 — Woolwich 86 9 6 83 178 9 — Totals, excluding boroughs marked* 3,648 3,641 Other premises where food is prepared for sale. Further powers for the sanitary control of 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. 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. Report of the Medical Officer of Health. 67 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 usee for the preparation and sale of food, (a) Number of inspections. City of London 883 1,598 Kensington 604 1,516 Battersea 174 383 Lambeth 248 25 Bermondsey 919 6,430 (b) Lewisham 67 9 Bethnal Green 225 977 Paddington 616 102 Camberwell 182 395 Poplar 278 965 Chelsea 64 82 St. Marylebone 183 445 Deptford 117 244 St. Pancras 622 1,157 Finsbury 237 293 Shoreditch 264 Fulham 85 147 Southwark 311 2,069 Greenwich 119 219 Stepney.. 400 869 Hackney 71 109 Stoke Newington 585 Hammersmith 162 Wandsworth 539 816 Hampstead 494 958 Westminster, City of 3,630 Holborn 349 1,915 Woolwich 83 Islington 746 412 Total for 26 boroughs 8,959 Inspection of food. Nearly all the reports have accounts of the seizure or surrender of unsound food. Dr. Collingridge states that the inspectors of the City Corporation seized nearly 2,240 tons of diseased, unsound and unwholesome meat, poultry, offal and fish during the year, including 23½ tons of meat found to be tuberculous. At Billingsgate Market, fish to the amount of 1,835½ tons was condemned by the inspectors of the Fishmongers' Company. As the result of inspection at the City wharves, 166 loads of unsound food were removed, the greater portion being voluntarily surrendered by the owners. In Bermondsey, it was found necessary to destroy nearly 200 tons of food at the wharves and a much larger quantity than this, chiefly grain, was disposed of for purposes other than human consumption. From other premises within the borough miscellaneous food to the extent of over 27½ tons was conveyed and destroyed as trade refuse. Reference is made to the large proportion of complete pigs' carcases arriving from Russia, which were found to show tuberculosis in the glands of the neck. The disease would not have been detected if the carcases had been divided and wholly or partly cured. Pressure was brought to bear upon the exporters, with beneficial result, so that later the seizures became much fewer. In Finsbury, 48 tons of diseased meat and 165 tons of decomposed food were confiscated during the year. Dr. A. E. Thomas states that the quantity of meat confiscated was much more than that in any previous year, and suggests the hot weather and railway strikes as probable causes. Reference is made to the importation into cold stores in Finsbury of Australian beef containing worm nests in the parts adjacent to the stifle joint, 51.6 per cent, of the hind quarters were found to be so affected. In Southwark 3½ tons of beef was destroyed for this cause. Dr. D. L. Thomas, of Stepney, also had experience of this parasite, which has been described as occurring in Australian cattle, under the name of Spiroptera reticulata. Early in January, 1911, 80 casks of about 3 cwt. each of salt beef were received at one of the Stepney wharves. The casks contained briskets and flanks and as the result of a superficial examination, 14 per cent, of the meat was found to be unfit for food. The attention of the owners was directed to this condition, and it was suggested that the meat should be destroyed. The owners, however, asked permission to re-ship the goods to Australia, in order that it might be converted into manure, but the Stepney Public Health Committee, after consideration of all the facts, refused to grant permission for this to be done, and ultimately the meat was destroyed. In Dr. Collingridge's report there is also reference to this matter, but the chief veterinary inspector to the City Corporation points. out that some little time was necessary to inaugurate a satisfactory system of inspection in a country like Australia, and adds that improvement is shown in some of the latest consignments. Unsound food to the amount of some 200 tons including the 80 casks of Australian beef, was destroyed in Stepney. In Southwark, 196 tons were destroyed or otherwise disposed of, and of 43,353 samples of foodstuffs examined in the borough, 10,054 were found to be unsound. Dr. Lennane mentions that in Battersea, during 1911, of 1,897 pigs slaughtered at one slaughterhouse, 7 carcases and 79 heads showed evidence of tuberculosis and were surrendered and destroyed. (a) 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. 68 Annual Report of the London County Council, 1911 The reports relating to the following districts show that proceedings betore the magistrate in connection with unsound food were instituted in the instances stated. Sanitary Authority. No. of Proceedings. Result City of London 1 1 conviction. Battersea 1 Defendant absconded. Bermondsey, 4 3 convictions. 1 bound over. Bethnal Green 8 7 convictions. 1 defendant absconded. Finsbury 4 4 convictions. Fulham 2 1 conviction. 1 case dismissed. Poplar 1 Committed for trial. St. Marylebone 5 5 convictions. St. Pancras 1 1 conviction. Shoreditch 2 1 conviction. 1 defendant bound over. Southwark 2 1 conviction. 1 case dismissed. Stepney 7 7 convictions. Wandsworth 3 2 convictions. 1 case dismissed. Westminster 5 3 convictions. 1 case dismissed with costs against City Council. 1 defendant absconded. Woolwich 1 1 conviction. Totals 47 37 convictions. It will be seen from the above table that of the 47 instances in which proceedings were taken, convictions were secured in 37 instances, four cases were dismissed, in three instances the defendants absconded, in two instances defendants were bound over, and one case was committed for trial. In some of the reports illustration is given of the difficulties met with in instituting proceedings against the vendors of unsound food. Thus, in Finsbury, the defendant asserted that the business and the seized meat belonged to another person, and an unstamped agreement was produced to confirm this statement. The magistrate, however, convicted and defendant was fined £100 and costs. In Fulham a quantity of unsound meat found in the ice safe of a butcher was seized by the inspector, but the summons was dismissed on the ground that it was doubtful whether the meat was intended for the food of man. Dr. Porter, in the report relating to St. Marylebone, mentions the case of the seizure of two tuberculous pigs' heads. The defendant pleaded that he had purchased the heads from a dealer in the Central Meat Market, and had paid full price for them. The dealer was found and corroborated this statement, but the magistrate convicted. Neither the vendor nor the dealer denied that the heads were tuberculous, but both evidently relied on the system of inspection in vogue in the market, and had not made a personal examination of the goods which had, as a matter of fact, escaped inspection. The St. Marylebone Borough Council drew the attention of the City Corporation to the matter, and communicated with the Councils of all the Metropolitan Sanitary Authorities with a view to united action being taken. Several of the reports contain reference to similar experiences in connection with meat derived from the Central Market, and Westminster instituted a prosecution of a central market salesman, which was, however, unsuccessful. Dr. Millson, of Southwark, makes mention of a quantity of condensed milk on the premises of a general grocer. On one of the cases was found a paper, on which was written " This milk is intended for pigs'food." It was argued that the defendant was accustomed to sell condensed milk for this purpose, but at the adjourned hearing of the case the magistrate convicted, with a fine of £50 and costs. In the Stepney report, Dr. Thomas mentions a case where the defendants, evidently in good faith, admitted that they had no idea what a tuberculous gland would look like, and he raises question as to the knowledge of the symptoms of this disease possessed generally by slaughtermen in the country, where inspection is inadequate and often non-existent. He suggests as a remedy the licensing of slaughtermen, and instances as a parallel the Midwives Act. He points out that the enforcement of the latter Act has not created any dearth of midwives, and that similarly if slaughtermen were licensed there would in a little while be no want of qualified men to fill the demand. In Dr. Collingridge's report the chief veterinary inspector of the City Corporation also comments on the lack of knowledge of farmers and pig breeders concerning tuberculosis, and suggests that County Councils might arrange lectures and demonstrations at various centres, to which interested persons should be invited. Report of the Medical Officer of Health. 69 Shelters. The following figures, which are taken from the annual reports, show the extent to which the existing shelters were used during the year 1911, for the accommodation of persons and families, while their homes were being disinfected. Metropolitan borough. No. of persons accommodated. Metropolitan borough. No. of persons accommodated. City of London - Kensington (a) Battersea 14 Lambeth — Bermondsey 23 Lewisham — Bethnal Green 2 Paddington (a) Camberwell — Poplar — Chelsea 40 St. Marylebone 28 Deptford — St. Pancras 10 Finsbury 26 Shoreditch 8 Fulham — South wark C66 Greenwich — Stepney 59 Hackney 35 Stoke Newington — Hammersmith (a) Wandsworth — Hampstead - Westminster, City of 1 Holborn 3a Woolwich — Islington 32 (a) No shelter maintained by borough council. In the case of Holborn 3 persons were accommodated in the Finsbury Borough Council's shelter. 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 204 - Kensington 340 2 Battersea 287 10 Lambeth 376 4 Bermondsey 186 5 Lewisham 152 — Bethnal Green 362 4 Paddington 282 2 Camberwell 346 Poplar 471 — Chelsea 115 — St. Marylebone 322 3 Deptford 92 1 St. Pancras 417 15 Finsbury 260 9 Shoreditch 397 1 Fulham 174 2 Southwark 716 2 Greenwich 120 1 Stepney 581 2 Hackney 446 1 Stoke Newington 35 — Hammersmith 262 —- Wandsworth 206 — Hampstead 84 — Westminster, City of . 373 2 Holborn 107 — Woolwich 192 1 Islington. 646 5 Rat Plague. Towards the end of 1910 special attention was directed by the Local Government Board to the possibility of plague being spread by the agency of rats, and Dr. Thomas, the medical officer of health of Stepney, in December of that year asked the managers of all the wharves in Stepney to communicate with him immediately if dead rats were observed in any number on the wharf premises. In June, 1911, Dr. Thomas received information that dead rats had been found at Middleton's wharf. Four of the rats had died. One was in a moribund condition, and was killed. Three of the dead rats were sent to the Local Government Board for bacteriological examination, and it was reported that two of them had died from pneumonic plague. The third was in a state of advanced decomposition and could not be examined. Four days later six more dead rats were found, one of them too decomposed to touch. Of the five sent for examination two were deemed to have died from pneumonic and one from bubonic plague. The remaining two, owing to decomposition, could not be examined. The Public Health Committee of the Stepney Borough Council at once made arrangements for rats to be caught and examined, and issued a circular to medical practitioners asking that information of suspicious enlargement of glands occurring in the course of their practice might be communicated to the medical officer. It was thought possible that the disease amongst rats might spread by way of the County Council's sewers. The Public Health Committee of the London County Council, therefore, arranged for rats to be caught and sent for examination to the London School of Tropical Medicine. During the course of the inquiry, which lasted from July to October, 119 rats were caught and sent to Dr. H. B. Newham for examination. Not one rat, however, was found to be infected, and the work was discontinued. 70 Annual Report of the London County Council, 1911. 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 the sanitary districts in the county in respect of the year ended 31st March, 1912, will be found in Volume I., page 51. Conference on Public Health. On the 6th April, 1911, at the County Hall, a Conference of Public Health Authorities in London was held in order to discuss matters of importance arising out of the administration of the Public Health (London) Act and cognate Acts. One of the principal subjects of discussion was the regulation of furnished rooms, which has been under the consideration of the Council's Public Health Committee for several years. In March, 1909, the Committee had before it a report pointing out that the Poor Law Commission laid stress on the pressing need for further regulation of furnished rooms which it was stated are a conspicuous evil not only in London but in many provincial towns In the same report some particulars were given of the examination of some 800 houses in London wholly or partly let out in this way. There was evidence that the rooms were generally dirty, overcrowded, and improperly used, and that the class of person accommodated was similar to the class received in common lodging-houses. There was difficulty, however, in framing a definition, and the matter was adjourned by -the Committee for the consideration of the Conference in the hope that further discussion might lead to some solution of this difficulty. Other subjects discussed and on which resolutions were adopted by the Conference were as follows:— Houses let in lodgings.—That the efficient administration of section 94 of the Public Health (London) Act, 1891, relating to the registration and regulation of houses let in lodgings is a matter of extreme importance to the public health of London. Pulmonary Tuberculosis.—(A) That the principle of compulsory notification should be extended to all cases of pulmonary tuberculosis. (The Order of the Local Government Board of November, 1911, has given effect to this resolution.) (B) That the establishment of tuberculosis dispensaries throughout London is urgently required. Measles.—A. (1) That a better organisation is desirable in London for the control of measles in schools. (2) That during a serious outbreak of measles children under five years of age should be excluded from school attendance. (3) That compulsory notification of measles is desirable. (4) That the cleansing of the infants' departments and of the furniture, lower walls and floors thereof, shall take place once a week. (5) That accommodation should be provided in the Metropolitan Asylums Board's Hospitals for urgent non-pauper cases of measles. (This part of the resolution has been met by the provisions of the Metropolitan Asylums (Measles) Order of the 30th May, 1911.) (B) That in the interests of public health the school regulations should provide that all children from houses infected with measles should be prohibited from school attendance. Water supply to tenement houses.—That houses of three or more storeys occupied by more than one family of the working class should have at least one water supply and a sink placed on a landing convenient for the occupants of the sepond and third storeys. Places where food is prepared and exposed for sale.—(A) That it is desirable that regulations should be made to limit the pollution resulting from exposure in an improper manner in public places or adjacent to the public way of food and food receptacles. Report of the Medical Officer of Health. 71 (B) That it is desirable that all places where food is prepared for sale should be regulated by by-laws made by the London County Council and administered by the sanitary authorities, and should be subject to annual licensing by the sanitary authority. Notification of Births Act, 1907.-—That in view of the adoption of the Notification of Births Act, 1907, throughout London, and the provisions of the recent orders of the Local Government Board with regard to the compulsory notification of consumption, the appointment of one or more women health visitors, or women sanitary inspectors, in each metropolitan borough is eminently desirable. Chapels of rest.—That it is desirable that chapels of rest, apart from mortuaries for bodies awaiting inquest, should be established by sanitary authorities. That all private mortuaries should be registered and regulated. Rag Flock Act, 1911. An Act entitled the Rag Flock Act, 1911, was passed during the year, and has for its object the prevention of the use of flock made from rags unless such flock conforms to a standard of cleanliness prescribed by regulations to be made by the Local Government Board. The possession, use, or sale, of flock in contravention of the Act renders a person liable on summary conviction to a penalty of £10 for a first offence or to a penalty of £50 for any subsequent offence. At the end of the year the Local Government Board had under consideration the question of making regulations under the Act prescribing a standard. Homeless persons. On the instruction of the Public Health Committee the sixth census of homeless persons in London was undertaken on the night of the 17th February, 1911. The following table enables comparison to be made of the figures obtained for the several years from 1904. Number of persons found homeless at night. Date. Men. w Women. Young Persons. Total. 29th January, 1904‡ 1,563 184 50 1,797 17th February, 1905 1,869 312 2,181 8th February, 1907 1,998 402 4 2,404 15th January, 1909 566 †l,629 170 23 2,388 18th February, 1910.. 732 †1,778 220 17 2,747 17th February, 1911 768 *†694 256 †65 2 1,785 In explanation of the above table it should be mentioned that in each case where the sets of figures are shown in brackets for any one year, the uppermost set denotes the number of persons, presumably homeless, found actually in the street on that particular night. The figures marked with a dagger, relate to persons who most probably would have been in the streets were it not for charitable effort. Thus, on the night of the 17th February, 1911, there were 160 men receiving food in a Salvation Army shelter in Great Peter-street, Westminster. In the King's Tents belonging to the Church Army, there were 41 men at work, and in two shelters used in conjunction with the tents, there were 101 men, and 298 men respectively. In the school room of the Primitive Methodist Mission in Whitechapel-road, there were 94 men, and in a shelter in Paul-street, Shoreditch, under the control of the Willow-street Mission, there were 65 women. These figures together make up the 694 men, and 65 women referred to in the table. The people found actually in the streets, included 768 men, 256 women, 1 boy of about 16 years of age, 1 baby in arms ; in all 1,026 persons. Therefore for comparison with the figures obtained in previous years, the total number of homeless persons is 1,785. This is the lowest recorded number, and is less by 962 than the total for 1910. * 160 of these men were in a shelter consuming soup and bread, hut would be turned out immediately on the conclusion of their meal. † Men or women accommodated for a few hours in shelters but unprovided with beds. ‡ A smaller area than in later years. Estimated total about 2,000 persons. 72 Annual Report of the London County Council, 1911. The following table shows the total number of persons who, on the night of the 17th February, 1911, might have been regarded as homeless, on the ground of being unable to pay for a bed. Description. Men. Women. Young Persons. Total. Number of men who were receiving food in a Salvation Army shelter 160 — — 160 Number of men in the King's Tents 41 - - 41 Number in shelters in connection with the King's Tents 399 — — 399 In other institutions where food and shelter only are given 94 65 — 159 Persons found homeless in the streets 768 256 2 1,026 In licensed common lodging-houses where no charge is made 1,148 27 22 1,197 In unlicensed houses where no charge is made 731 352 14 1,097 Beds in licensed common lodging-houses paid for by charitable institutions 246 - - 246 Persons in casual wards 962 129 — 1,091 Total number of persons found homeless, or resting in shelters, or occupying free beds in common lodging-houses, shelters and casual wards 4,549 829 38 5,416 A detailed report on the subject was printed and placed on sale. Water supply. In his sixth annual report Dr. Houston refers to the passing of the Metropolitan Water Board (New Works) Act and the Thames Conservancy Act, 1911, and comments on the deletion from the former Act of the clause conferring an " unrestricted right" to abstract 130 million gallons of water daily from the Thames. He quotes figures to show the loss of water that occurred in 1906, an excepttionally dry year, and points out that any circumstance which prevents or curtails abstraction of river water during drought means the provision of increased storage accommodation, and may mean that the water taken into store is of inferior quality. Several reasons are advanced in support of this latter contention. Periods of drought are usually associated with bright sunshine and warm weather, and Dr. Houston states that his experiments show that the typhoid bacillus in water dies much more rapidly in summer as compared with winter temperatures. Dr. Houston continues as follows :—• " Again it should be noted that curtailment of abstraction powers during drought must coincidently lead to serious depletion of the reservoirs, and so when the floods come subsequently there is the temptation to abstract water of unsatisfactory quality, which entering partially empty reservoirs, of course cannot be fit for filtration purposes for some time afterwards." From the experience gained during the drought of 1911, Dr. Houston infers that high temperatures need not necessarily result in " algal" troubles. Some remarks are moreover made on the respective merits of sand filters and mechanical filters, and it is stated that bacteriological tests did not demonstrate perfect efficiency of the former under strenuous conditions of working. Dr. Houston concludes by stating that to a progressively increasing extent the safety of London's water supply is being secured,but expresses the opinion that the " quality policy " of the Metropolitan Water Board should be directed towards securing an " epidemiologically sterile " water antecedent to filtration by means of storage (sedimentation, devitalisation and equalisation) aided, if need be, by the occasional employment of supplementary processes of water purification. 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. On 4th July, 1911, the Finance Committee advised the Council that the Exchequer Contribution Account was likely to show a deficiency each year in future, in which event no payments would be possible towards the salaries of health visitors. It was estimated that the deficiency in respect of the financial year 1910-11 would probably amount to £31,000, and that in view of the conditions attached to the contributions made in the year 1909-10, it would not be possible to make any payment for the year 1910-11. Report of tlie Medical Officer of Health. 73 Midwives Act, 1902. The number of midwives giving addresses in London whose names appear on the Roll of Mid- Registrator wives for 1911 is 3,797. 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, 578 notified their intention to practise during the whole year or for shorter periods. The qualification of the London midwives is as follows :— Number not giving notice of intention to paractise. Number giving notice of intention to paractise. Total. Qualification of Midwife. (a) Holding certificates from the Central Midwives 1,854 278 2,132 Board (b) Holding a certificate, obtained as the result of an examination prior to the passing of the Midwives Act 1,294 212 1,506 (c) Enrolled by virtue of having been in bona fide practice as midwives a year previous to the passing of the Act 71 88 159 3,219 578 3,797 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 15 per cent. Inspection, The 578 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 400 to 450 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 56 were working entirely within poor-law institutions or lyingin hospitals and were under medical supervision ; 160 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 inspection 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 E. Macrory, M.B., Ch.B., L.M., D.P.H., and Miss M. A. Pilliet, M.B., Ch.B. 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 of 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 of work. On occasion a midwife is accompanied by the inspector either to a confinement or on a subsequent visit to a patient 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 the Central Midwives Board for approval to supervise the training of pupils for the Board's examination. The inspectors paid 1,468 visits to midwives or institutions employing midwives. In 930 cases the report was satisfactory, in 83 unsatisfactory, and in 455 the midwife was not seen. The 83 unsatisfactory reports relate to 61 midwives, 44 were reported unsatisfactory on one occasion, 12 on two occasions and five 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. I-n cases of a more serious nature, or where the midwife had a bad record 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 twelve cases on the following grounds:— Delay in advising medical assistance for the mother 1 „ „ „ „ feeble child 2 „ „ „ „ inflammation of child's eyes 4 Not making arrangements for care of patient when unable to attend 2 Failure to take temperature and pulse 1 Resuming work before complete disinfection after a septic case 1 Not giving notice of intention to practise 1 Prima facie cases of negligence or misconduct were found against three midwives, in one case a conviction 12532 K 74 Annual Report of the London County Council, 1911. on a charge of drunkenness was communicated to the Central Midwives Board, and conviction of a midwife for procuring abortion was also reported to the Board Charge. Result. Neglect and want of cleanliness Cautioned by Board. Negligence and want of cleanliness Name removed from Roll. Evading inspection and want of care for patients Cautioned by Board. Drunkenness (conviction) Cautioned. Illegal operation (conviction, sentence of five years' penal servitude). Name removed from Roll. There is a gradual improvement in the work of midwives generally, 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 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 Italian midwives in practice in London. Fees charged by Midwives. Ihe 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 midwife 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 civen bv the midwife. Maternity charity. Many midwives are employed in Poor Law Infirmaries, and a large proportion of the 3,000 confinements in infirmaries 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. Births notified by midwives. From information received under the Notification of Births Act the following figures have been obtained showing the number of births notified by midwives:— 8 midwives reported over 500 cases in the year. 3 „ „ between 400 and 500 cases in the year. 11 „ „ „ 300 and 400 „ „ 9 „ „ „ 250 and 300 „ „ 20 „ „ „ 200 and 250 „ „ 28 „ „ „ 150 and 200 „ „ 36 „ „ „ 100 and 150 „ „ 90 „ „ „ 50 and 100 „ „ 86 „ „ „ 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. Since 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. 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 17 instances there was evidence that the woman had been engaged beforehand and had received fees for three or more confinements. Proceedings were instituted and fines in fourteen cases amounting to £23 11s., with £11 7s. costs were imposed In three cases the woman was convicted and bound over for 12 months. In one instance an uncertified woman was tried on a charge of manslaughter and was sentenced to four months' imprisonment. 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. Report of the Medical Officer of Health. 75 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 3,477 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; 1910, 3,026. 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 353 midwives. Midwives in infirmaries and hospitals under the direction of a qualified medical practitioner are not required to comply with this rule. Medical help The number of instances of advising medical help in the practice of midwives during the year may be summarised as follows :— 1 midwife reported advising medical help 146 times during the year. 1 „ „ „ „ 100 „ „ 1 „ „ „ „ 81 „ „ 5 midwives „ „ „ 40 to 60 times during the year. 36 „ „ „ „ 20 to 40 „ „ 66 „ „ „ „ 10 to 20 „ „ 243 „ „ „ „ less than 10 times during the year. The reasons assigned by the midwife for giving the advice were as follows:— Pregnancy. Pregnancy— Labour— Lying-in— Purulent discharge 3 Abortion or miscarriage 53 Deformed pelvis 8 Varicose veins 20 Ante partum haemorrhage 119 General unhealthy conditions 80 Presentations— Unable to make out 25 Difficult breech .. 54 Face 26 Funis 46 Transverse 37 Difficult twins 16 „ triplets 2 Persistent occipito posterior . 39 Hand 20 Placenta praevia 18 Prolonged labour (uterine inertia, contracted pelvis, etc.) 581 Laceration of perineum 298 Prolapse of uterus 4 Haemorrhage during labour 9 Betained or adherent placenta 245 Exhaustion or collapse 26 Hysteria or fits 10 Excessive liquor amnii 4 Uterus not contracting 1 Bise of temperature 225 Post partum haemorrhage 133 Pain or swelling in leg 23 Abdominal pain or swelling 21 Pain or swelling of breast 11 Quick pulse 5 Eclampsia, convulsions 15 Collapse 15 Puerperal mania 4 Offensive lochia 6 Sub-involution of uterus 4 Excessive sickness or headache 12 Severe diarrhoea 4 Continued sleeplessness 3 Other illness 37 283 1,461 12532 518 K 2 76 Annual Report of the London County Council, 1911. Child— Injury at birth 10 Malformation or deformity 112 Skin eruption or rash 42 Jaundice 25 Convulsions 44 Partial asphyxia 57 Bronchitis, etc. 19 Inflammation of eyes 261 Feebleness and prematurity 488 Bleeding from cord 5 Stillborn (before midwife arrived) 65 Death of infant 42 Congenital specific disease 3 Inflammation of navel 3 Abnormal sickness 9 Other conditions in child 27 1,212 Infections diseases in patient's house 3 3,477 Assuming that 30,000 births are attended annually by midwives, the above figures show that medical assistance was required in 11.5 per cent, of the cases ; in 7.5 per cent, on behalf of the mother and 4.0 per cent, on account of the child. Still births. During the year, 220 midwives reported having stillbirths in their practice. The number of stillborn children being 634. This represents 2 per cent, of the births. 1 midwife reported 18 stillbirths 18 1 „ „ 12 „ 12 3 midwives each reported 10 stillbirths 30 3 9 27 6 ,, „ 8 „ 48 7 „ „ 7 „ 49 7 „ „ 6 „ 42 12 „ ,, 5 ,, . 60 19 „ „ 4 „ 76 28 „ ,, 3 „ 84 55 „ „ 2 „ 110 78 „ „ 1 stillbirth 78 220 634 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 336 still-born infants were males, 295 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 375 154 88 95 38 — Not macerated 253 151 43 35 23 1 No statement 6 1 — — 2 3 Total 634 306 131 130 63 4 The presentations were as follows :— Vertex 398 Complicated vertex 26 Breech 93 Complicated breech 9 Footling 27 Transverse 8 Face or brow 2 Hand, arm and shoulder 6 Funis 4 Placenta prævia 3 Born before arrival and presentation not known 58 Total 634 Report of the Medical Officer of Health. 77 Some additional information was obtained as to still-born infants not macerated, of eight or more months' gestation, as follows :— Concerning the child— Born in membranes 1 One of twins 10 Hydrocephalus 7 Concerning the mother— Malformed child 8 Ante partum haemorrhage 3 White asphyxia 1 Small pelvis 1 Cord round neck 1 Difficult labour 5 Anencephalic head 1 The rules of the Central Midwives Board require the midwife to notify to the local supervising authority all cases in which the mother or child dies before the attendance of a registered medical practitioner. In 53 cases midwives notified the deaths of infants, and in two cases notices of deaths of mothers were received. Death of mother or child. By the courtesy of the London coroners notices are sent of inquests in which midwives are concerned and one of the Council's inspectors attends the court to hear the evidence and learn whether the midwife has complied with the rules of the Board. One hundred and eleven inquests were thus reported upon. These included inquests on cases attended by uncertified women, as well as by certified midwives. The verdict in 103 cases attributed no blame to the person in attendance. The following table summarises the verdict with respect to cases in which blame was attributed:— Confinement conducted by Total number of inquest. Deaths of mothers. Deaths of infants. Censured. No censure. Censured. No censure. Midwives 102 1 9 5 87 Uncertified women 9 1 1 1 6 111 2 10 6 93 The cause for the censure shown in the foregoing table was as follows:— Not advising medical assistance to mother early enough 1 Not making arrangements with another midwife when unable to attend case 1 Want of ordinary skill (uncertified women) 2 Delay in advising medical assistance for infant 4 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. Septicaemia 4 Rupture of uterus 2 Pulmonary embolism 1 Heart disease 1 Haemorrhage during labour 1 Bursting of cyst in pancreas 1 Suffocation from regurgitation of food from stomach during labour 1 Collapse from long labour 1 12 Infants. Atelectasis 11 Suffocation at birth 14 Suffocation in bed 13 Prematurity 19 Convulsions 8 Bronchitis and pneumonia 8 Concussion of brain at birth 1 Malnutrition 2 Tetanus 1 Shock from scalding (accident) 1 Haemorrhage from cord 1 Septicaemia from pemphigus 2 Congenital heart disease or malformation 6 Stillbirth 12 99 During the year 1911, 302 cases of puerperal fever were notified in the County and the Registrar General records 142 deaths from puerperal septic disease during the year. Two deaths recorded by the Registrar General refer to cases which were notified in 1910, and three deaths occurred in 1912 of cases notified in 1911, while in two cases notified as puerperal fever the deaths were certified to be due to eclampsia and were classified by the Registrar General under accidents of childbirth. The term puerperal septic disease used by the Registrar General includes puerperal septicaemia, pyaemia and sapræmia, as well as peritonitis and metritis occurring in connection with parturition. A list of deaths is received weekly from the Registrar General and the deaths are compared with the notified cases so that it is possible to ascertain whether the latter terminate fatally. Of the 302 Puerperal fever. 78 Annual Report of the London County Council, 1911. notified cases, 97 proved fatal, a case mortality of 32 per cent. Of the remaining deaths recorded, 3 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 302 notified cases and 48 deaths of cases not notified in London:— Delivery conducted by Cases. Deaths. (а) Medical practitioners (including cases attended by medical students and also cases in which a medical practitioner was in charge of the case, but the birth took place before his arrival) 219 92 (б) Certified midwives (including cases in which birth took place before her arrival) 68 16 (c) Medical practitioner and certified midwife, i.e., cases in which a midwife was unable to deliver and called in a medical practitioner 8 4 (d) Hospitals and poor law institutions 24 14 (e) Uncertified women 4 2 (f) Cases of miscarriage or abortion where no attendant was engaged 24 14 (g) Cases where patient died in London, but was confined elsewhere 3 3 350 145 The cause of death as stated in the death certificates in the 142 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.. 71 19 90 (15) Puerperal peritonitis 6 13 19 (3) Pyaemia 5 — 5(2) Sapraemia 1 2 3(1) Puerperal fever (not defined) 8 3 11 Metritis, perimetritis, parametritis and endometritis 1 2 3 Toxaemia of pregnancy — 1 1 Infective endocarditis — 1 1 Phlegmasia alba dolens — 1 1 Post partum eclampsia 2 — 2 Pelvic cellulitis 2 — 2 Phlebitis after parturition — 1 1 Erysipelas after parturition — 1 1 Pyonephrosis and toxaemia.. — 1 1 Salpingitis 1 — 1 97 45 142 The number of fatal cases of puerperal fever which followed abortion or miscarriage was 21. 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 350 cases was as follows : Total. 15-20 20-25 25-30 30-35 35-40 40-15 Over 45 Age not given. Recovery cases 205 10 39 61 53 26 7 - 9 Fatal cases.. 145 4 25 41 28 23 22 2 — 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. Report of the Medical Officer of Health. 79 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; 225 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 181 cases it was found that the temperature had fallen, or that 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 44 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 on which (a) the rise ol temperature (if noted) 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. 4 th day. 5 th day. 6th day. 7th day. 8th day. 9th day. 10th day. After 10th day. Total. Rise of temperature— Recovery cases 1 1 10 9 6 6 1 — 5 1 6 46 Fatal cases — 6 3 2 1 1 — — — — 2 15 Medical aid obtained— Recovery cases 3 1 6 13 5 4 2 3 5 2 8 52 Fatal cases 2 6 1 2 — 2 — % — — 3 16 Notified as puerperal fever— Recovery cases — — 2 6 4 3 3 3 5 7 19 52 Fatal cases — — 2 2 3 2 2 — — — 2 13* When death took place in fatal cases — — 1 2 — — 1 2 — 2 8 16 Of the 8 deaths occurring after the 10th day of lying in, five occurred before the 20th day, another before the 30th day, and two after the 30th day. In 7 cases (1 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. The parity of women who contracted puerperal fever was ascertained from the midwife to be Total. Primipara. 2 para. 3 para. j 4 para. 5 para. 6 para. 7 para. 8 para. 9 para. 10 para.- Over 10 para. Recovery 52 13 9 8 3 6 4 l 3 2 l 2 Fatal 16 5 1 4 1 — 2 3 — — — — The following conditions were noted among the cases of puerperal fever attended by midwives :— Recovery. Fatal. Laceration of perineum 2 — Retained or adherent placenta . 4 3 Ante partum haemorrhage 1 — Post partum haemorrhage 5 1 Ragged placenta (thought complete by midwife) 3 — Prolonged labour 1 — Syphilis or gonorrhoea 1 1 Pneumonia 1 Macerated infant 1 — Domestic trouble after confinement 2 1 In six cases of puerperal fever, birth took place before the arrival of the midwife. Nine midwives each had two cases during the year, in three instances the interval between the cases was three months or more and there was no reason to connect the cases with one another. * 3 fatal cases attended by midwives were not notified. 80 Annual Report of the London County Council, 1911. The circumstances of the remaining six cases were as follows :— A had a case in June, was disinfected and resumed work and conductcd some 30 deliveries, all doing well. Six weeks after the first confinement a second case occurred, the patient was found to be suffering from syphilis and to this cause the disease was attributed. The later case proved fatal. B had two cases in the same month, the second case was delivered before the first was notified as puerperal fever. The first case was fatal. C had two cases in three weeks. The first case was normal during the midwife's attendance on it, but when notified the midwife was disinfected. The second case was confined four days after her disinfection. Neither case was fatal. D had two cases within three weeks. She was disinfected after the first case was notified and resumed her work. Four days later the second case was confined and developed the disease the day following. Both these cases were fatal. E had two cases within six weeks. After the first case was notified the midwife was disinfected and conducted several cases which went on well; the second patient had a ragged placenta. Neither case was fatal. F had two cases within 16 days. She was disinfected after the first case and seven days later delivered the second case, which proved to be a very mild case. The former proved fatal. Accidents ofChildbirth, In addition to the list of deaths from puerperal septic diseases, the Registrar-General supplies a weekly list 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. 152 deaths from accidents of childbirth were recorded during 1911. In 15 of these cases the deceased was attended in her confinement by a midwife. The cause of death in the 15 cases was as follows :— Collapse following ante partum haemorrhage .. „ „ post partum „ Rupture of the uterus Eclampsia Pulmonary embolism Phlebitis Suffocation due to regurgitation of food during labour Convulsions .6 2 2 1 1 1 1 1 15 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 medical officer of health of the borough in which the patient resides is immediately informed of the severity or otherwise of the case and whether the infant is being removed to a hospital for treatment. 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 seek again 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 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 during the year their services were made use of in 68 cases. During the year 261 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, 17 other cases came to light in which medical help was not called by the midwife ; the onset is stated to have occurred after the midwife had ceased to attend in 13 of these 17 cases, in 3 the midwife failed to advise medical help because the symptoms were slight and in one case a medical practitioner was already attending the infant for other reasons. In 7 instances where medical help was advised it had not been obtained when the Council's inspector visited the child. None of these cases was very severe and the infants eventually recovered. There was delay in obtaining medical help in 14 cases due to Report of the Medical Officer of Health. 81 the fact that signs of inflammation were not recognised. 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. 218 cases were reported to be completely cured. In 13 cases there was impairment of vision, 17 died while still suffering from the disease, and in 30 instances the result could not be ascertained owing to the removal of the parents, who could not be traced. The day of the puerperium on which signs of inflammation were first noticed was : day of confinement, 18 cases ; second day, 23 ; third day, 38 ; fourth day, 33 ; fifth day, 28 ; sixth day, 29 ; seventh day, 26 ; eighth day, 23; ninth day, 19 ; tenth day, 11 ; later than tenth day, 26 ; not ascertained, 4 cases. A history of vaginal discharge in the mother was obtained in 111 instances, i.e., in 40 per cent, of the cases. The antiseptics used for the child's eyes at birth or as soon afterwards as possible were boracic lotion in 125 instances ; perchloride of mercury (1 in 4,000 or weaker) in 102 ; silver nitrate (a 1 or 2 per cent. solution)in 27 ; protargol in 1, and biniodide of mercury in 1 instance ; in the remaining 22 cases sterile water was used. An interval between the birth and the use of an antiseptic occurred in 50 instances owing to the fact that the infant was born before the arrival of the midwife. The following facts relating to the 13 cases in which impairment of vision supervened were learnt: (1) History of vaginal discharge in the mother during pregnancy. Perchloride of mercury (1 in 4,000) followed by boric acid lotion, used for eyes 15 minutes after birth (infant born before midwife's arrival). Onset of symptoms on day-of birth. Medical help called in on day after birth. Infant removed with mother to hospital on third day. Result: Infant reported blind. (2) History of gonorrhea in father of child. Boric acid lotion used for eyes 30 minutes after birth (infant born before arrival of midwife). Onset of symptoms on third day. Medical help obtained on fourth day, and infant removed with mother to infirmary on fifth day. Result: Infant reported blind. (3) No history of vaginal discharge in mother obtained. Boric acid lotion used for eyes 15 minutes after birth (infant born before arrival of midwife). Onset of symptoms on fifth day. Medical help obtained at once. Infant removed with mother to infirmary on seventh day. Result: Infant reported blind. (4) History of vaginal discharge in mother during pregnancy. Perchloride of mercury (1 in 4,000) used for eyes 20 minutes after birth (infant born before arrival of midwife). Onset of symptoms on day after birth. Parents refused to call medical help until fourth day. Out-patient at Ophthalmic Hospital. Result: Sight in one eye lost, the other seriously injured. (5) History of inflammation of the vagina in mother. Boric acid lotion used for eyes at birth. Slight symptoms on third day, but medical help not obtained until thirteenth day Infant removed to hospital. The midwife was severely cautioned for not advising medical help in this case. Result: Sight in one eye lost. (6) No history of vaginal discharge in mother, but a child in same house had inflamed eyes. Boric acid lotion used for eyes 15 minutes after birth of child (born before midwife's arrival). Onset of symptoms on tenth day. Medical help obtained at once. Out-patient at hospital. Result: Sight in one eye lost. (7) No history of vaginal discharge in mother. Boric acid lotion used for eyes 15 minutes after birth (infant born before midwife's arrival). Onset of symptoms on third day. Medical help not obtained until eighth day. Result: Loss of sight in one eye. * The midwife was severely cautioned as to delay in advising medical help in this case. (8) No history of vaginal discharge in mother obtained. Boric acid lotion used for eyes at birth. Slight symptoms on eighth day. Medical help obtained on tenth day. Result: Loss of sight in one eye. (9) History of vaginal discharge in mother. Boric lotion used for eyes at birth. Onset of symptoms on eighth day. Medical help obtained on ninth day. Result: Both eyes affected, but no loss of vision. (10) No history of vaginal discharge in mother. Boric lotion used for eyes at birth. Mother is stated to have " washed " the eyes with breast milk. Onset of symptoms on eighth day. Medical help obtained at once. Result: Sight of both eyes impaired. (11) History of vaginal discharge in mother. Perchloride of mercury (1 in 4,000) used for eyes at birth. Onset of symptoms on fourth day. Medical help obtained at once. Result: One eye permanently injured, other eye normal. (12) No history of vaginal discharge in mother, onset of symptoms on eleventh day. Result: Sight of one eye impaired. (13) History of vaginal discharge in mother. Perchloride of mercury used for eyes at birth. Onset on fourth day. Result: Infant has a slight squint; otherwise normal. 12532 i 82 Annual Report of the London County Council, 1911. These results summarised are as follow:— Blind in both eyes Blind in one eye, other damaged Blind in one eye, other uninjured Both eyes damaged One eye damaged 3 cases. 1 case. 4 cases. 2 „ 3 „ In 8 of the 13 cases where impairment of vision resulted; the onset of symptoms occurred on or before the fifth day of life. In 6 instances among the 13 there was a history of vaginal discharge in the mother. The 278 cases of inflammation of the eyes occurred in the practices of 135 midwives. 1 midwife and her assistant had 19 cases during the year .. 19 1 midwife had 9 cases during the year 2 midwives each had 7 cases during the year 2 4 12 9 25 79 6 5 4 3 2 1 case 9 14 12 20 48 27 50 79 135 278 All the midwives who had three or more cases during the year have extensive practices, and it was found that many of the cases reported were very slight and the eyes were normal in a few days. So far as could be ascertained there was no evidence that infection was carried from one case to another. The Council had under consideration the question of hospital treatment for severe cases and an endeavour was made to secure accommodation for the mother and infant so that while the child was being treated it would not be deprived of the advantage of being breast-fed. The ophthalmic hospitals and the general hospitals had difficulty in providing such accommodation, but in some instances both mother and child were admitted to the poor-law infirmaries. Of the cases occurring in the practice of midwives during the year, in 12 instances mother and child were admitted to hospitals or infirmaries and in 20 cases the child alone was admitted ; 101 other cases were treated by the ophthalmic and general hospitals as out-patients. In March the Council made an order extending the provisions of section 55 of the Public Health (London) Act, 1891, to ophthalmia neonatorum. Of the 673 cases notified from that time until the end of the year, 188 were in the practice of midwives. Classes for midwive?. The Council has arranged classes for the further instruction of midwives at four centres in London. These classes are attended by midwives who have been in practice for many years, and also to some extent by pupils to supplement the training they are receiving elsewhere. Midwives showing lack of knowledge of their work have been advised by the Council's inspectors to attend these classes. 83 CHAPTER XXXIII. Special Report submitted by the Medical Officer of Health during the year 1911 I.—Report by Dr. Hamer on an Outbreak of Typhoid Fever in London in September, 1911. On Thursday, 14th September, the notification list showed marked increase in the number of cases of typhoid fever, there being 30 cases notified during the week ending Saturday, 9th September, in Finsbury, as compared with 0, 0, 1, 0 and 1 in the preceding five weeks.* On proceeding to Finsbury Town Hall it was ascertained that the outbreak was an explosive one, most of the patients having sickened during the last week in August or the first week in September. In families in which multiple attacks had occurred, the interval between the dates of sickening of the several relatives in question was quite short. (See particular as to dates of onset in appended Table.) Dr. Thomas, Medical Officer of Health for Finsbury, and I analysed the information available and, prima facie, it was obvious that some suspicion attached to two articles of food, viz., ice cream and fried fish. Milk, to which of course consideration was in the first instance given, was clearly not at fault. Approximately one-third of the total number of sufferers (at that time already amounting to more than 40), might, it transpired, have consumed milk supplied by a particular vendor, but with regard to at least 24, i.e., more than half the total number, the possibility of consumption of milk retailed by this vendor could be excluded. There still remained a remote chance that some of the 24 sufferers who had not partaken of the milk of this vendor, as milk, might have consumed milk, derived from one and the same source as that supplying the particular vendor, in the form of ice cream. Careful enquiry as to the sources of milk supply of the ice cream vendor who had sold ice cream to a considerable number of the sufferers did not, however, show that he had obtained any milk from the source supplying the suspected milk vendor. Even if the supplies of the milk vendor and the ice cream vendor had been, unknown to either of them, derived from some common source, there remained at least 9 out'of 40 sufferers (within the area of the explosion) who had not partaken of either the suspected milk or the suspected ice cream. Moreover, it was learnt later that 5 or 6 other sufferers living within the area, and at least 6 sufferers living outside the area of the explosion, but whose illness was in all probability contracted within the area, had not partaken of either the suspected milk or the suspected ice cream. This outstanding 20 or 21 cases could not, having in view dates of onset of attack, be ascribed to contact with preceding cases. It was, further, in the highest degree improbable that, at the time of occurrence of the explosive outbreak, 14 or 15 other cases (or, including the cases living outside the area, 20 or 21 other cases) would arise in the affected area quite independently of the cases constituting the explosive outbreak itself. It was noted that some 5 or 6 of the total number of sufferers living within the area had been away from London at a time when they might conceivably have been infected. On the other hand, the dates of going away from, and of returning to, the area permitted of these 5 or 6 sufferers having been infected within the area itself. The possibility of contamination of a water main was, of course, considered, but the distribution of the cases lent no support to such an hypothesis, and it may here be noted that the age distribution of the sufferers from typhoid fever in this outbreak was quite an exceptional one, children and young adults were affected in altogether undue proportion, indeed all the persons attacked, with only four exceptions, were between 5 and 26 years of age. It will be seen later, moreover, that sufferers were in the main drawn from a particular social class. This notable selection for attack of persons at certain ages, and, further, of persons of a particular social class practically negatived the possibility of the outbreak having been due to water or milk. On the other hand, it strengthened a suspicion which was now increasingly entertained that some such medium as ice cream or fried fish was in question. Enquiry was made as to other possible sources of infection, e.g., shellfish or watercress ; very few of the sufferers had consumed either of these articles of food. At the time of the outbreak the mussel season had barely commenced, and as a matter of fact the sufferers had only quite exceptionally eaten shellfish. The same statement is true with regard to watercress. Enquiry was also made as to common use of swimming baths, but again with a negative result. It was now felt that the important point to determine, in the first instance, was the proportion of sufferers who had partaken, within the possible period of incubation, of one or other of the two foods, upon which suspicion was now seen especially to fall, viz., ice cream and fried fish. All the patients who could be found, and who were able to answer, were seen and questioned, and the results now to be summarised were ultimately obtained. For the purposes of the enquiry an area included within a radius of one-twelfth of a mile (440 feet), from a centre around which the cases were aggregated, was defined as the area of the explosion. The centre of the area was fixed at a point midway between the shops of the vendors of fried fish and ice cream referred to below as X and Y. * The notifications in London as a whole were 73 in the week ending 9th September as compared with 17, 17, 14 and 28 in the preceding five weeks. 12532 L 2 84 Annual Report of the London County Council, 1911. The analysis includes 54 cases notified from houses within or immediately adjoining the area of the explosion, and 8 other cases. Limiting consideration for the moment to the 54 cases— *22 of the sufferers had within a period of one month, and at a time before the beginning of the illness which was consistent with the hypothesis that the article of food might have been the cause of the illness, obtained ice cream from a particular vendor, Y. 7 may have done so. *25 had not done so. §48 of the sufferers had within a period of one month, and at a time before the beginning of the illness which was consistent with the hypothesis that the article of food might have been the cause of the illness, obtained fried fish from a particular vendor, X. †l may have done so. *5 had not done so. The 8 cases notified from outside the area include a man living at Walthamstow and a girl living in Camberwell, both of whom worked in the area ; a child, aged 9, living in Fulham who was staying with relations near the area, at the time when she was presumably infected; a man, a lad, and two girls, all of whom lived at some little distance from the area, but frequently made purchases withinit. Of these 8 patients, 2 had frequently eaten ice cream, obtained from Y, 4 others ate ice cream, but had not obtained it from the suspected shop, the remaining two were adults who were quite clear that they never ate ice cream. Seven of the patients had been in the habit of visiting the suspected fried fish shop, but one of them as a rule only bought fried potatoes there. The remaining case was that of a girl who passed the fish shop on her way from work and may have purchased there, though as to this there was an element of uncertainty. If the 8 cases just referred to be included as constituting part and parcel of the special outbreak, and if the 6 notified within the area which were probably not cases of typhoid fever be excluded, there are 56 cases in all. Of these 21 had, and 28 had not, partaken of ice cream from the suspected shop, and as to 7 others there is an element of doubt. Again, 52 had, and 2 had not, partaken of fried fish, and as to 2 cases there is an element of doubt. It is clear that an ice cream hypothesis is in itself inadequate as an explanation of the special prevalence. A fried fish hypothesis, on the other hand, would account for all the cases save two, or at most four.‡ Having regard to the size of the population residing in the area, and to the degree of prevalence of typhoid fever in London at the time, it might have been anticipated that, apart from any special cause operating in the area, some two or three cases would have occurred there during the month of September (i.e., coincidently with the special prevalence). Thus the exceptional cases referred to above might conceivably be regarded as entirely unconnected with the special prevalence, and on this view of the matter a fried fish hypothesis would fit the facts ascertained concerning all the 54 cases of the special prevalence. This hypothesis is seen, therefore, to demand careful examination, but before proceeding further it is desirable to refer to a preliminary difficulty which may perhaps be felt. A consideration frequently advanced in connection with study of the percentage of sufferers from typhoid fever, who give a history of having obtained fish from a particular source, is the following. Everyone eats fish just as everyone eats bread or meat, and hence it can be no matter for surprise if all the sufferers in a particular outbreak are found to have eaten fish. Further, it is argued, when, an outbreak involves a particular area, it may be that one fried fish shop has practically a monopoly of the supply in that area; and hence again, it is said, no one need be surprised if it transpires that all the sufferers have obtained fish from the particular shop. These lines of argument, prima facie, command acceptance. Anyone, however, who endeavours to obtain a considerable number of histories as regards fish eating from sufferers from typhoid fever in London, will be convinced of their inapplicability, and observation of control populations conclusively demonstrates that the lines of argument in question are beside the mark. In 1900, on the occurrence of the first recognised outbreak of fish typhoid, enquiry was made by the Council's officers in Southwark as to the habits as regards fish eating of a control population; a similar enquiry was made in 1908 in Bethnal Green, and yet * Includes three cases which were probably not typhoid fever. § Includes two cases which were probably not typhoid fever. † Includes one case which was probably not typhoid fever. ‡ The two cases occurred in one family. Both patients had been out of London during some portion of the period in which they must have been infected, and it may be that the cases were thus wholly unconnected with the cause of the special prevalence in Finsbury. On the other hand, the patients lived only a few doors from the fried fish shop, and it is, of course, conceivable that they may, despite the testimony given by them, have been infected from this source by reason of their having eaten fish of unknown origin which was, as a matter of fact, obtained there. The two remaining cases were those of the child who, when she went to the fried fish shop, usually purchased " taters," and of the girl who passed the shop on her way from work and may have purchased there. It should be added that a worker in the Finsbury area who did not live there developed typhoid fever in Poplar at the time of the occurrence of the prevalence in Finsbury. This man was a fried fish eater, but he stated that he had not obtained fried fish from the Finsbury shop. Diagram Z. Maps of the particular area affected by the outbreak; the upper map shews the distribution of cases of Typhoid Fever; the lower map shews the distribution in the same area of purchasers of fried fish {childrenand young adults} at a particular shop. The hatching which is purposely confined to the area within the circle represepts certain grades of social condition based on Mr Chas.Both's classification. The unhatched portions represent areas in chich the population belongs to higher social grades. The classification is referred to in the text and is repesented in the maps as follows:- grade B grade C grade D. Report of the Medical Officer of Health. 85 another enquiry was made in connection with the present outbreak by Dr. Thomas of Finsbury and myself. The results of these enquiries were as follows :— Borough in which outbreak occurred. » Total population of area in which enquiry was made. Percentage of popul lation who did not eat fried flsh at all. Percentage of population eating fried fish obtained from I a particular suspected shop. Percentage of population eating fried flsh obtaine I from other sources and not from suspected shop. Southwark 900 42 42 16 Bethnal Green 283 37 63 Finsbury— Outer ring 769 41 49 10 Inner ring 148 32 68 — Total area 917 39 53 8 From these enquiries it is clear that more than one-third of the control populations in the areas selected (and they were in each instance populations in which there might be expected to be a speciallylarge percentage of eaters of fried fish from a particular source) gave a history of not having eaten fried fish from any single shop. This statement also holds good if the analysis be limited to persons between 5 and 25 years of age, i.e., to persons of the ages which are specially apt to suffer in outbreaks of fish typhoid. (See Report on outbreak of 1900, Ann. Rep. Med. Off. of Health, County of London). It is therefore clear that the fact that a history of fried fish eating from a particular shop (within a period which may be looked upon as covering the time of infection) is obtained in practically all the persons who may be regarded as making up the special prevalence, strongly points to fried fish as the source of the mischief, provided always, of course, that a number of persons sufficiently large is concerned, to eliminate mere chance coincidence. It is in point of fact exceedingly improbable that distribution of cases of typhoid fever among, say, fifty fried fish eaters, without involvement of any persons who had not partaken of fried fish, could be the result of mere chance, unless, of course, the fifty fried fish eaters had all been assembled together on a particular occasion upon which they all partook of fried fish and also of some infected article of food such as cockles or mussels. This much being premised, it remains to examine the results obtained in the Finsubry enquiry relating to control populations from another point of view. In Finsbury the enquiries as to fried fish were supplemented and controlled by similar questions with reference to ice cream, and they were made in two control populations, one to the north, the other to the south, of the two shops coming under suspicion. The results also admit of being analysed according to the distance of the component populations from the particular centre in question. " Inner radius " refers to a population living in some portion of an area within 220 feet of a central point, taken midway between the ice cream shop and the fried fish shop, and situated some 30 yards from each shop. " Outer ring " refers to families living within the ring included between two circles of 220 feet and 440 feet radius described from the same centre. The two control population include merely sample families and not the entire population within the " inner radius " and the " outer ring." The results obtained are exhibited in the annexed table. Result of enquiries made in two " control populations " in Finsbury, October, 1911. FRIED FISH. Inner Radius. Outer Ring. Age. Population X's shop. Others. Non-eaters Population. X*s shop. Others. Non-eaters. M F P M F P M F P M F P M F P M F M" F P M F P 0— 2 9 11 — 8 8 — 1 1 2 1 3 43 31 74 21 15 36 8 2 10 18 15 33 5— 9 6 15 7 4 11 1 2 3 2 2 -t 52 51 103 30 28 58 1 11 12 22 18 40 10— 9 — 9 5 — 5 — — 4 — 4 41 49 90 24 32 56 8 5 13 14 13 27 15— 2 8 10 2 7 9 — — — — 1 1 28 47 75 16 26 42 6 8 14 9 15 24 20— 9 7 16 7 5 12 — — — 2 2 4 23 32 55 7 13 20 5 8 13 11 11 22 25— 14 18 32 12 16 28 — 1 1 2 2 4 58 60 118 29 41 70 12 8 20 21 17 38 35— 7 9 16 7 8 15 1 — 1 — 1 1 50 64 114 24 27 51 7 7 14 21 31 52 45— 8 10 18 3 4 7 — — — 5 6 11 40 29 69 13 13 26 4 4 8 25 13 38 55 — 1 9 10 — 3 3 — — 1 6 7 19 26 45 5 8 13 6 5 11 8 14 22 65— 4 7 11 2 1 3 — — _ 2 6 8 10 13 23 4 4 8 — — — 6 9 15 75 + — — — — — — — — — — — — 1 2 3 — — — — — — 81 2 3 All ages 65 83 148 45 56 101 2 4 • 6 20 27 47 365 404 769 173 207 380 57 58 115 156 158 314 0-5 2 9 11 8 8 1 1 2 1 3 43 31 74 21 15 36 8 2 10 18 15 33 5-15 18 6 24 12 4 16 1 2 3 6 2 8 93 100 193 54 62 114 9 16 25 36 31 67 15-55 40 52 92 31 40 71 1 1 2 9 12 21 199 232 431 89 120 209 34 35 69 87 87 174 55 + . 5 16 21 2 4 6 — — — 3 12 15 30 41 71 9 12 21 6 5 11 15 25 40 86 Annual Report of the London Comity Council, 1911. ICE CREAM. Inner Radius. Outer Ring. Age. Population. Y's shop Others. Non-eaters. Population. Y's shop. Others. Non-eaters 0— 2 9 11 2 2 — — — 2 7 9 41 33 74 — — — 9 3 12 33 30 63 5— 9 6 15 3 3 6 1 1 2 5 2 7 51 47 98 1 2 3 13 8 21 38 37 75 10— 8 — 8 4 — 4 2 — 2 2 — 2 40 48 88 1 2 3 10 12 22 29 34 63 15— 3 8 11 — 6 6 — 1 1 3 1 4 25 44 69 2 — 2 5 18 13 18 36 54 20— 9 7 16 4 1 5 —. 2 2 5 4 9 23 33 56 — — 1 5 6 22 28 50 25— 13 19 32 1 2 3 1 1 2 11 16 27 57 59 116 — 1 1 6 f 5 11 52 54 106 35— 7 9 16 1 — 1 — 1 1 6 8 14 49 65 114 — — — 5 8 13 44 57 101 45— 8 9 17 1 1 — — — 8 8 16 41 30 71 — — — 3 3 6 38 28 66 55— 1 9 10 — — — — — — 1 9 10 18 25 43 — 1 1 1 1 2 17 23 40 65— 4 7 11 — — — — — — 4 7 11 9 — 24 — — — — — — 9 15 24 75+ .— — — — — — — — — — — — 1 3 4 — — — — — — 1 3 4 All ages 64 83 147 13 15 28 4 6 10 47 62 109 355 402 757 4 6 10 53 53 106 301 345 646 0-5 2 9 11 2 2 2 7 9 41 33 74 9 3 12 33 30 63 5-15 17 6 23 7 3 10 3 1 4 7 2 9 91 95 186 2 4 6 23 20 43 67 71 1,58 15-55 ... 40 52 92 6 10 16 1 5 6 33 37 70 195 231 426 2 1 3 20 29 49 174 203 377 55 + ... 5 16 21 — — — — — — 5 16 21 28 43 71 — 1 1 1 1 2 27 41 68 N.B.—In some oases persons returned as fish eaters or ice cream eaters have purchased not only at X's shop or Y's shop, but also elsewhere. These persons are necessarily included both under the heading " X's shop " (or " Y's shop ") and under " Others," and consequently some of the total numbers of eaters and non-eaters shown in the above table exceed the total population. The rejection, moreover, of a few indefinite returns causes slight differences in the total populations shown in the two tables. An important inference may be drawn from the figures as regards the areas supplied by the fried fish shop and ice cream shop respectively. The proportion of eaters of fried fish from the suspected shop, in the families questioned, of course diminishes on receding from the shop (from 68 per cent, in the " inner radius " to 49 per cent, in the " outer ring "). The proportion of ice cream eaters from the suspected shop is much smaller to begin with, and diminishes far more rapidly than this (from 19 per cent, in the " inner radius " to 1 per cent, in the " outer ring,").' It is quite clear, in fact, that the area from which the suspected ice cream vendor drew his customers is a much smaller one than the area from which the fried fish vendor drew his customers. From these figures it clearly follows that an ice cream hypothesis (apart from any examination into the number of ice cream eaters among the sufferers from typhoid fever) is "prima fac:e inadequate as an explanation of the outbreak; for nearly three-fourths of the ice cream vendor's customers were from the " inner radius," and yet more than half the sufferers were in the " outer ring." Further study of the table shows that in the " inner radius " only six fried fish eaters were found who obtained fried fish from a source other than the suspected shop, all of whom, however, also purchased from X's shop, but in the " outer ring " there were numerous fried fish eaters obtaining fish from other sources than the suspected shop. A difficulty, however, with regard to the fried fish hypothesis here presents itself. If the control populations be divided into those to the north and those to the south of the centre, it transpires that nearly half the former give a history of purchasing fried fish from the suspected shop, and yet the number of cases of typhoid occurring in this population is quite small, for the brunt of the epidemic fell upon the population south and east of the centre. It was found later, however, that this comparative freedom from attack of the population north of the centre finds explanation when consideration is limited to the early evening purchasers (see p. 88). For, when the middle day and later evening purchasers are excluded, the percentage of customers among the northern population to total customers of the suspected vendor becomes quite low—in fact is less than 2 per cent. A further point of considerable importance may now be mentioned. If a fried fish hypothesis be, for the purpose of argument, accepted, it is possible to predict (from the figures given in the Table) the number of sufferers from typhoid fever who would probably be found to eat ice-cream. In the " inner radius " the ice cream eaters supplied by a particular vendor, at ages 5-25, are 42 per cent, of the whole number of persons. It might be expected, therefore, that out of the total number of sufferers in the inner radius, about half would be Y's customers ; in fact 14 out of 25, i.e., 56 per cent, were found to purchase ice cream from him. On limiting the enquiry to a sample of the " outer ring " population lying to the south of the shop, there were at ages 5-25 only 6 per cent, of Y's customers, but in certain portions of the " outer ring " close to the " inner radius " the percentages rises higher, say, to from 15 to 25 per cent. Hence, out of the total number of sufferers in the " outer ring," less than a quarter should be Y's customers ; in fact, there were only 6 or 7 out of 26, i.e., about 25 per cent. This analysis dempnstrates, therefore, the inadequacy of an ice cream hypothesis on the one hand, and on the other the adequacy of a fried fish hypothesis to explain the distribution of ice cream eaters among the sufferers. Having now disposed of the ice cream hypothesis, it becomes necessary to examine how far a fried fish hypothesis explaius the peculiar topographical distribution, age distribution and distribution of attacks among families and in single sufferers, observed in the Finsbury outbreak. Study of the topograp\icil distribution of the cases shows, as has already been mentioned, certain Report of the Medical Officer of Health. 87 marked peculiarities ; thus, if the area surrounding the fried fish shop be divided into four quadrants— north, south, east and west—the cases of typhoid fever will be seen to be almost entirely confined to the eastern and southern quadrants. There was, in fact, only one case in the northern quadrant and no case at all in the western quadrant. The escape of the western quadrant is readily explained when it is noted that that quadrant has no ordinary resident population, being entirely covered by Post Office buildings. A large staff occupies these buildings, but the men are catered for upon the premises, and they do not as a rule purchase food at shops in the area. The escape of the northern quadrant with only one case cannot, however, be similarly explained. It hence becomes clear that, if fish sold at the fried fish shop were the cause of the special Finsbury prevalence, there must have been circumstances associated with the distribution of the fish which caused differentiation as regards incidence of typhoid fever upon the areas surrounding the shop. It was, of course, possible that only one particular batch of fish was at fault. Examination showed, moreover, that there were certain special features with regard to fish distribution, considered in relation to time and space, from the shop and these are clearly deserving of detailed study. (a) At the dinner hour every day some scores of persons who do not reside in Finsbury purchase fish at the fried fish shop—the outbreak, on the other hand, was, with the few exceptions noted, confined to the near neighbourhood of the shop. If fish were at fault it was unlikely to be fish consumed in the middle of the day. (b) The almost exclusive attack of sufferers at the ages included in the age group 5-25, points to limitation of the operation of the cause of the outbreak to persons at these ages, and question, therefore, arose as to whether at any time of day children and young adults constituted an exceptionally large percentage of the purchasers. (c) The topographical distribution of the cases already referred to raises questions as to the possible existence of differentiating circumstances—for example, such as are associated with social status of the people living in the various streets and courts surrounding the fish shop. Purchasers of fish might be, so to speak, selected for attack by reason of their buying a special kind of fish, and paying a special price for it. In this outbreak, as has already been found to be the case in fish-borne outbreaks of typhoid fever occurring in 1900, 1903, 1908 and 1910, the history given by some of the sufferers clearly directed suspicion to plaice, and in a few instances mention was especially made of the fact that a |d. of Id. piece of his fish had been purchased, the sufferers giving such a history being as a rule young children. It was clear, therefore, if the infected fish had been distributed on one particular occasion only, that the incidence of the resulting disease upon age, and upon localities enar the shop, would vary considerably according to the time when the fish was sold. Suspicion was in this connection naturally directed to the evening when frying first commenced, inasmuch as observation showed that at this time the ages of the persons leaving the shop, and returning to houses in the area, were not greatly different from the ages of the sufferers in the outbreak. Moreover, distribution of infected fish at this time might conceivably explain the topographical distribution of the cases, for in certain obvious respects the northern quadrant differed from the southern and eastern quadrants. It was decided, therefore, to have precise observation made of the customers visiting the fried fish shop in the early hours of the evening. It may here be convenient to describe briefly the peculiarities of those portions of the area surrounding the fried fish shop which are occupied by a resident population. In doing this Mr. Charles Booth's scheme of classification of London populations will be used.* The northern quadrant consists in part of houses fronting upon two main streets coloured for the most part pink or red on Mr. Booth's colour scheme, and in part of a much poorer side street (C, light blue) and a cul-de-sac (B, dark blue) opening out of the same, The eastern and southern quadrants each contain large blocks of artizans' dwellings (D, purple). They also contain houses fronting upon main streets (E, F, etc.), though not so large a proportion of the population lives in such houses as is the case in the northern quadrant. The population living in houses fronting upon main streets (E, F, etc.) has almost entirely escaped attack. Leaving this better circumstanced population out of account, the eastern and southern quadrants contain large blocks of artisans' dwellings (D, purple) ; and certain streets and courts (B, and C, light blue and dark blue, or even black) cover the remaining portion of these quadrants, The persons in these two quadrants belonging to classes C and D have specially suffered from typhoid fever. Examination of the topographical distribution of the suffering population shows that if the cause producing typhoid fever in the area had been one which operated more especially upon persons of the classes C and D, then the distribution of cases in that area would necessarily have closely approximated to the distribution actually observed in this outbreak. On such an assumption the heavy incidence of the disease upon the eastern and southern quadrants at once finds explanation. Before illustrating this in detail it is desirable, however, to allude to the question of age-incidence. The peculiar age-incidence in this outbreak has been already referred to. On "Wednesday, 11th October, observation was kept upon all persons coming out of the fried fish shop between * Mr. Booth's scheme of classification, beginning from below, included A, black—lowest class, vicious, semicriminal ; B, dark blue, very poor, casual, chronic want; C, light blue, poor, 18s. to 21s. a week for a moderate family ; D, purple, mixed, some comfortable, others poor ; and so upwards to E, F, G and H, pink, red and yellow, the more well-to-do populations. Previous experience in London has shown that fried fish outbreaks do not, on the one hand, as a rule implicate the pink, red and yellow streets, and on the other hand only slightly implicate the black and dark blue streets. It is the intermediate social class which especially suffers. Light blue and purple (C and D) dominate the areas implicated in fried fish outbreaks (see Annual Report, Medical Officer of Health, County of London, 83 Annual Report of the London County Council, 1911. 6.30 p.m. and 8.30 p.m. Of the total number leaving the shop (279) about half returned, during the five or ten minutes during which they were watched, to houses within the area of the explosion ; the large majority of these parsons were under 20 years of age* In fact, the age-distribution of the customers who were tracad to houses within the area was practically identical with that of the sufferers from typhoid fever. The peculiar age-incidence observed in this outbreak, it may now be noted, very closely resembled that obtaining in the original fried fish outbreak of 1900, and in correspondence with this the ages of the persons who on leaving the Finsbury shop returned to houses in the area, in 1911, were practically identical with those of the population studied 11 years before in Southwark (Annual Report, Medical Officer of Health, 1900,)† A precise test can now be made as to the sufficiency of an hypothesis that the cheaper portions of fried fish sold to the early evening customers on a particular evening in August were responsible for this outbreak. It may be safely assumed that the children and young adults would buy the cheaper portions of fish, and hence, if the destinations of the persons, say between 5 and 20 years of age, who left the shop between 6.30 and 8.30 p.m., and who were traced to their homes in the area, be plotted out upon a map, the distribution of these cases should correspond with that of the sufferers from typhoid fever. It will be seen on referring to the two maps that the correspondence is remarkably close ; and the fact is even more important when the marked asymmetry of the distribution of the sufferers from typhoid fever and their exceptional age-distribution is borne in mind. On the lower map certain houses to which a customer was traced are indicated, and further an " o " represents customers who can be assigned to a paticular area or street but whose precise home cannot be specified. Seventy customers in all were thus traced (see Diagram). On the corresponding upper map are shown the houses in which 56 sufferers from typhoid fever lived. Study of the two maps reveals the close similarity of the two distributions. The closeness of this correspondence may be further illustrated by dividing up the area (within the circle of 440 feet radius described around the chosen centre) into five areas with, roughly speaking, equal populations of some six or eight hundred persons each. Areas. Customers. Sufferers. Total. Percentage. Total. Percentage. 1 2 4 1 2 II 6 12 7 12 II I 5 10 2 3 I V 21 41 30 53 V 17 33 17 30 51 100 57 100 It will be seen that area IV. has over 40 per cent, of both customers and sufferers ; area V. has approximately 30 per cent, in both categories; in area II. the percentage is 12 in each, and in areas I. and III. neither the customers nor the sufferers exceed 10 per cent. The chances against such correspondence being the result of mere coincidence must be very great. These two lines of enquiry therefore, topographical distribution and age-distribution, considered separately and in conjunction, yield strong confirmatory evidence in favour of the fried fish hypothesis. The third line of enquiry has concern with the distribution of attacks in families and among single sufferers. An analysis of 52 cases shows that there were 29 sufferers who were the only members of their families attacked, there were eight families with 2 cases each, one family with 3, and one with 5. Of the 29 single sufferers all except one may have bought their fried fish independently of other members of the family to which they belonged. Six of the pairs of sufferers had bought fish conjointly but independently of any other members of their families. In the family with 5 sufferers, 4 had habitually eaten their fried fish together, the fifth had eaten fish from the same source, but not on the same occasion as the other 4. This last case was in all probability not a case of typhoid fever. The intervals of time between successive attacks in each house can be studied in the appended table. (See " Remarks " column as to the relationship of cases in family groups.) These intervals varied from a day or two to as long, in one instance, as twelve days. In striking contrast with multiple attacks in fried fish eating families stand the histories in cases 21 and 29 with regard to ice cream. Both sufferers were members of ice cream eating families and in each family only one member suffered. It should be mentioned that coincidently with the Finsbury outbreak two groups of cases of typhoid fever occurred in other parts of London. Five cases belonged to St. Pancras and five to Lewisham. In each borough the sufferers had been supplied with fish from a particular shop, one shop being in St. Pancras and one in Lewisham. The attempt was made to trace the source of supply of the fish to the Finsbury, St. Pancras and Lewisham shops, but no community of supply was established. Judging from the dates of onset of illness in the sufferers the indications point in all three boroughs * Persons who did not return to houses in the area include a few who went into public houses, some dozen who went into a picture palace, upwards of a hundred who walked away from the area (whether to return to it or not cannot be stated) a cabman who drove away, and one or two persons who mounted upon tramcars. The persons who did not immediately return to houses within the area included a much larger proportion of adults and correspondingly fewer children than did the persons who were seen to return to houses within the area. † The age distribution of the Finsbury customers, as a whole, did not correspond quite so closely with (hat of the Southwark customers. The Finsbury shop clearly supplied a number of persons who lived at some distance from it, and these persons were as a rule older than were the customers who returned to houses in the area. Report of the Medical Officer of Health. 89 to the delivery in London of a consignment of infected fish on Thursday, August 17th, or Friday, August 18th. The deliveries of fish in London on these dates were in some instances from unusual sources, owing to the dislocation of traffic caused by the strike. This outbreak adds yet another instance to the now growing list of outbreaks in which enquiry failed to show any other explanation than the consumption of fried fish. The circumstances of the outbreak afford further illustration of the peculiar features which have been described as typical of such outbreaks. There is the attack of a particular social class, the peculiar age-incidence, the peculiar distribution of the cases in family groups, the same frequency of the separate purchase of fish by the sufferer himself or herself, in cases in which only one attack occurred in a house. But the present outbreak is very instructive inasmuch as it was at first attributed to ice cream, and prima facie, there was something to be said for an ice cream hypothesis. Analysis of the facts shows, however, that at least half the sufferers in the outbreak had not eaten the suspected ice cream, and eight of the ten persons over twenty years of age attacked had not partaken of this ice cream. Moreover, study of the topographical distribution of the cases negatives an ice cream hypothesis. The history of typhoid fever in London during the last twenty years shows that in numerous instances explosive localised outbreaks of the disease have occurred and that suspicion has fallen upon a food supply. In some instances question has been raised as to shell fish, in some as to ice cream, in some as to watercress, and in some as to fried fish. It is noteworthy that difficulty has arisen in some outbreaks as between cockles and fried fish, watercress and fried fish, mussels and fried fish and ice cream and fried fish. The need for careful analysis of the facts in each instance is apparent, and the present outbreak is deserving of study inasmuch as it strikingly illustrates difficulties which may be encountered in discriminating between one and another suspected food supply. 12532 u CHAPTER XXXIV Public Health Reports (continued). Report of the Education Committee Submitting the Annual Report of the Medical Officer (Education) (Dr. J. Kerr) for the year 1911. We present the report of the medical officer (Education) for the year ended 31st December., 1911. In presenting this report it should be pointed out that the Council on 25th July, 1911 (p. 329), decided to place the control of educational medical work under the county medical officer of health, and that Dr. Hamer, the officer newly appointed by the Council, entered upon his duties on 1st January, 1912. It will be seen that the present report relates to the year ended 31st December, 1911, and, for the views expressed in it, Dr. Kerr, who was then medical officer (Education), is solely responsible. The report shows that during the year the doctors inspected 204,000 children at 9,785 sessions and that 62 per cent, of the parents were present at the time of inspection. More than one half of the children showed defects when examined in detail, and 38 per cent, had advice cards given. One third of the children suffered from enlarged tonsils and adenoids, and four-fifths from caries of the teeth. Cases of ringworm under observation numbered from two to three thousand throughout the year. The two open-air schools at Birley House and Shrewsbury House were open during the year. The tuberculosis school at Kensal House has now been working since April, 1911, and playground classes have been considerably developed. Nine cleansing stations for verminous children were at work, and the school nurses inspected. 251,592 children, of whom 14,893 were reported verminous, and 9,917 had notices served under the Children Act. Of these, 5,209 were ultimately cleansed at the Council's stations, and the parents of 285 prosecuted. During the year there was an exceptional prevalence of measles, but the report points out that the measles death rate of 1911 was exceeded by that of every alternate year of the nineties. Candidates taking up permanent appointments in the school service, and candidates to whom scholarships have been awarded are medically examined in the Public Health Department. The report shows that the number of candidates submitting themselves for a first examination during the year was 5,975. Reference is made in the report to such subjects as (i.) enquiry into the means of differentiating the mentally defective ; (ii.) the extension of special means of education for myopes, the semi-blind and the hard-of-hearing ; (iii.) further provision for epileptics ; (iv.) stammering; (v.) seating of classes, floor spacfc, ventilation and heating of schools. Statistics of the work done are given in the appendixes. Report of the Medical Officer (Education) for the year 1911. With this report the series for which I have been responsible during the past ten years is concluded. An attempt has been made to lay the foundations of school hygiene, as a study of national interest and value, on the basis of problems worked out on scientific lines by the staff of the department. Administrative rearrangements under the Council at the end of 1911, transfers from the education officer to the medical department all arrangements for medical treatment. At the same time the educational medical work has been placed under the control of the medical officer of health, a change in organisation which can be justified if it is regarded as a first step to the co-ordination, under the control of one authority, of the sanitary service of the Metropolis, now carried out under a score and a half of different bodies. Report of the Medical Officer (Education). 91 The knowledge of school hygiene acquired is far ahead of practice, and with the exception of the opening of the Tuberculosis School at Kensal House there is no distinctly new step to record. Much, however, is slowly emerging, for with the demonstration, which is here practically completed, of the minor part played by the school under present-day conditions in the dissemination of scarlatina and diphtheria, and probably also of measles, the importance of the house becomes apparent. This also is apparent in the conditions of adenoids, anaemia and debility, largely due to the want of playing spaces, and to stuffy homes. During the past decennium the London Education Authority has expended over £30,000 annually for the education of children who have died from tubercle before attaining adult working life. Small groups of children still remain for whom no Authority seems statutorily responsible. The non-pauper imbecile, the morally uncontrollable, and the epileptic child are yet generally unprovided for. although legislation is in prospect. Private schools occasionally seem hiding places in which children are concealed from the protection which a public authority would exert over them. A suggestion put forward some years ago that the statutory responsibility for all children should rest with the Education Authority, involves a further consideration not yet mentioned. The conditions of the public elementary schools are not wholly satisfactory from the health or social point of view ; they will soon become good enough if every child in the country is compelled to spend some five or six years of its life in attendance at a State school. The ultimate benefit of such a requirement in the development of national solidarity and citizenship, and in the removal of class distinctions need not be dwelt upon here, but the benefit in national health and improved schools, and the desire for the betterment of education can scarcely be overstated. The opposition which such a proposition, as a matter of practical politics, would be likely to receive on sanitary and educational grounds is alone a proof of its necessity. School hygiene has already passed beyond the school, in the wider outlook derived from study of the children there. It has become a matter of public health and national interest. Room to live, increased space for play, food and opportunities for cleanliness are the evident wants. Already public health considerations suggest that a statutory limit should be assigned to the number of people who may live on a certain area of land, and further that for each defined area buildings should only be allowed to cover a small proportion of the surface. These larger considerations will have to be ever in mind in all school health problems. Medical inspection. The administration of medical inspection is set out in the tables of analyses printed in Appendixes II. to V. to this Report. The full results of the medical inspection of children in London in 1911 gave over one-half of those examined as presenting defects, of which about two-thirds were recommended for treatment. This is neglecting dental defects, which are almost universal. As the diseases or defects are separately classified, the defects and children are not strictly comparable, but the proportion who are doubly notified is not large, so that the differences in the various age groups are scarcely significant. A summary from the tables shows the following numbers :— Age Groups. Departments Numbers examined Defects found. Percentages. Leavers— 12-13 Boys 36,954 18,034 48.8}49.3 Girls 35,565 17,727 49.8 8-9 1 Boys 36,499 18,889 51.8}15.2 Girls 34,964 17,732 50.7 Specials (any ages) Boys 5,840 5,538 94.8}98.7 presented by teachers, etc. Girls 7,260 7,394 101.8 Entrants Infants 40,8880 27,713 67.8 In the general summary of medical administration in the Appendix, 54 per cent, of the children had defects, and 38 per cent, had medical advice cards issued. Obviously the medical inspection now carried on, on about one-third of the children annually is not sufficient in the extent of the children examined, or else the results must be considerably discounted. The majority of individuals if examined carefully enough, will be found to present variations from normal which may be recorded as defects, but only in a minority of these cases is the defect material. The fixing of standards is of extreme difficulty, and when first it was thought necessary to inform parents that their children were in any way defective, the amount of defect was stated to be such that 12532 M 2 92 Annual Report of the London County Council, 1911. " unless remedied it is likely to materially interfere with progress in school or future success in life." The majority of cases now recorded as defects could only very doubtfully be brought under this definition. In the enquiries conducted some years ago it was considered as a result of experience that too detailed records of the findings of medical inspection tended to exaggerate the trivial. As a matter of economy in time and money these unimportant defects did not seem worth recording for all children. At the same time, as a scientific enquiry, no detail can be too small to record for some, but not necessarily all, children. As was pointed out in a previous report, the two purposes are quite distinct, scientific enquiry to gain accurate knowledge and general medical inspection for the detection and remedying of defects. Statistical analysis showed that all methods of inspection, whilst differing enormously in cost, gave practically identical results for the defects which really mattered, whilst for trivial things the more detailed the record the greater the number of defects noted. So far as the doctors themselves are concerned, serious defects are about equally noted, but the slighter defects show increasingly the effect of personal equation. The differences of standard taken as to what requires treatment shows up too in the numbers referred. The following table shows the effect of personal equation in twenty-three fairly comparable schools taken at random as examined by five different doctors on examination in regard to these points. Percentage of Examining referred for Percentage of Percentage of dootor. treatment. throat defects. ear defects. A 41 23 3 B 41 25 1 C 47 26 8 D 58 26 7 E 59 33 2 Average 49 29 4 Here the variation in numbers of children referred for treatment lies between 40 and 60 per cent. As the highest number occurred in the district which, if anything, was the best socially, the variation may be largely ascribed to personal equation in the examiner. This small enquiry should be extended, as it may mean, as has already been suggested, that a series of definitions will have to be laid down for the degree of each sign or symptom to be registered under each heading, or the variability of the records taken later or elsewhere will make comparisons fallacious. Re-inspection. During 1911 the only share in medical treatment taken by the school doctors was in re-inspecting cases which they had recommended for treatment. The results of the re-inspection is given for the several electoral divisions in the Appendix VII. From this it is seen that 63,752 children were reinspected. The work of taking out the figures from the cards was so laborious that two representative schools for each division were taken, and analysis of the details made. These 116 schools with 120,534 children on the rolls are probably sufficient to give nearly average results. Reinspection returns from two schools in each electoral division (116 schools, with 120,534 on roll. Numbers. Percentages. Defects reinspected 7,639 100.0 Defects referred for treatment under Council's schemes .. 4,842 63.4 Not under Council's schemes 1,074 14.1 Dental defects .. .. 1,723 22 .6 Defects in children not traced 753 9.9 Defects not treated— Still requiring treatment 3,422 44.8 Not requiring treatment 218 2.9 Defects treated— Privately 578 7.6 Otherwise 2,668 34.9 Results of treatment— Satisfactory 1,979 25.9 Unsatisfactory 434 5.7 Still under treatment 833 10.9 03 Report of the Medical Officer (Education). from the total 63,752 children re-inspected, there would be proportionately about 74,671 defect requiring treatment. There would be 31,730 who had received treatment, of whom 19,345 would have been satisfactorily treated, 4,242 would have been unsatisfactorily treated, and 8,143 would be still undergoing treatment, or otherwise undecided. These results may be taken as on the whole satisfactory for the nresent. Since 1908, medical inspection has been 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 effect 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 are not permitted to continue at the institution, if through illness or other causes they become unfit. Annendix VIII shows the defects noted. Training Colleges, Secondary and Trade Schools. A comparison of the lists of defects found in 1910 and 1911 shows a considerable improvement, the physique of many children previously noted as unsatisfactory having materially altered. The head masters and mistresses exercise vigilance and show keenness in obtaining prompt treatment of any ailments noted at the medical examinations, and the parents have responded to their efforts. Medical inspection is now looked on as part of the school routine, and opposition or dislike is not experienced in any quarter. The general physique of the students at the Islington College is superior to that of the students at the London Day Training College, probably on account of their less strenuous life. Dr. Riviere points out that while many of the boys in the trade schools improve remarkably in physique under the combination of physical and mental training a few fail to benefit. This may be due to the lack of sufficient food, as many boys at these institutes appear to come from very poor homes. Good nutrition is essential if the best value is to be obtained from the scholarship. A boy of first-class ability may learn so easily as to get on in spite of a third-class physique. A boy of first-class physique will not be harmed by trying to push on his third-class wits, but a boy of rather poor physique and average intellect suffers from the strain, as do those who get really insufficient comforts and nourishment. This could be remedied by giving scholarships for a combination of mental and physical qualities, and not to children who are in the second grade in both respects. Such procedure would involve a medical examination of more candidates than at present when the examination is confined to those Who have been awarded scholarships as a result of their mental work. On the 31st October, 1910, it was decided that the Council's scholars in attendance at non-maintained secondary schools, and all scholars attending aided trade and domestic economy schools, at which a system of medical inspection had not been adopted, should be periodically examined by the medical officer. About 3,500 scholars are affected by this resolution. Of the 38 aided secondary and other schools concerned, the Governors of 15 preferred that the scholars should be examined at the head office, on the grounds either of lack of accommodation or the undesirableness of differentiating at the schools between the Council and other scholars. Non-maintained Secondary Schools. Medical treatment. In the first medical report to the School Board for London ten years ago it was stated that— " The selection of children whose efficiency in school is damaged by dirt, parasites, chronic diseases of the ears or impaired visual acuity is just beginning. The treatment of all these matters is tedious, has to be thorough, but is a routine of the most monotonous and uninteresting description. The burden at present falls on the hospitals, and they have not vet adapted themselves to it. "Whether even with time they can ever efficiently discharge this public duty is at least doubtful." Discharging ears. Experience in the case of chronic discharging ears has since then shown that it is hopeless to expect sufficient service from the hospitals. When on the passing of the Administrative Provisions Act in 1907 the management of the Queen's Jubilee Nurses proposed that the Council should subsidise them to act in connection with the schools, the aid was declined. Miss Susan Lawrence suggested that the institution might be useful in connection with discharging ears, for which nothing was being done. The difference in the cost of education in deaf schools as compared with ordinary schools would alone make treatment of aural cases a justifiable economy. In the case of children presenting chronic middle ear suppuration, not only is the deafness of account but the liability of the disease to invasion of the cranial cavity, and to end by death from meningitis, brain abscess or blood poisoning is considerable. Simple cleanliness if constantly maintained aids recovery, and by such treatment as an adjunct to the surgeon's efforts, a considerable proportion of recoveries are obtainable without the risk of serious and costly operation. If after several weeks of honest and maintained effort recovery is not obtained, then additional steps should be taken. Probably the child is still suffering from some throat or nose condition, adenoids or hypertrophic rhinitis or deep recesses of the ear are involved which requiresurgical relief, without which recovery is almost hopeless. Other cases are seen in such a condition of anæmia, ill-nutrition or debility that a residence for a time in a convalescent school in the country may be needed to stimulate the natural effort to recovery. The important point is that the nurse's treatment alone is often insufficient, that efficient syringing twice or thrice daily is but a first selective step, and that all cases which do not respond should be followed up to recovery. Without this end being reached, any scheme is incomplete and fails to accomplish its object. 94 Annual Report of the London County Council, 1911. An arrangement already reported on was carried out by Jubilee nurses in Shoreditch and Bethnal Green during 1909-10. The scheme here, owing to the absence of local hospitals or dispensaries, was not considered to have had a fair chance, and after an experimental trial of six months was abandoned as unsatisfactory. Its result was that of 405 children selected for treatment, the nurses treated 133, paying 5,014 visits to the homes. In 31 cases the discharge ceased and the ears remained dry, but in 61 other cases stimulated by the scheme, but not handled by the nurses, recovery was obtained from other sources. The cost of each case healed by the nurses' attention averaged £2 18s., but if the other cases are included as a result of the scheme, the average cost to the Council of each case recovered was a trifle under £1. As a financial transaction the Shoreditch scheme was therefore good value, but as an efficient means of dealing with discharging ears among a mass of school children it was a failure in that it left the majority of the cases no better than it found them. The cause of failure was chiefly want of medical prescription without which the nurses would not act, further, there were difficulties with parents, who refused to trouble about the nurses, and it was doubtful whether the nurses' work was sufficiently skilfully done. On the termination of this experiment, another district of London was selected in Paddington, where the existence of St. Mary's Hospital and the Paddington Green Children's Hospital made conditions very favourable. Lists of children with discharging ears were compiled by the doctors and nurses in seventeen schools. The parents were notified that careful nursing is often efficacious, and a nurse called at the home and explained the necessity for treatment and how it could be obtained by the parent getting a prescription. Three weeks' daily treatment was given by the nurse in accordance with the medical prescription, and at the expiry of that time the nurse's record card was reviewed by the doctor. Every case was followed as far as possible. The majority were medically examined and prescribed for without cost to the Council. When inspected later by the Council's officials, discharge had recurred in certain cases; they were, therefore, returned for treatment as new cases. During the year, including the period in the early autumn when there was some interruption, the work may be summarised as having 245 cases put forward for treatment, of which 167 cases were handled by the nurses, 88 were returned as cured or relieved to the extent of not requiring further treatment, and 38 remained on hand. There were 8,088 visits paid to homes, of which 284 were preliminary. The cost of the nursing service to the Council was £90, so that each visit costs 2.67 pence. There were also 75 hospital vouchers used by the cases, so that this brings the cost up to £97 10s. Neglecting the 38 cases on hand and counting all the 88 as permanent cures this means an average cost per case cured of £1 2s. 2d., which is extremely moderate, and good value for the money spent. They represent about one-third of the number of cases sent forward, probably a better result than has ever been obtained from any systematic attempt to cure discharging ears among children on a considerable scale. Tonsils and adenoids. The children who suffer from enlarged tonsils and adenoids form the bulk of cases requiring treatment. No teacher should think herself fit to have charge of an elementary school class who cannot give a just opinion in the majority of cases as to whether a child is suffering seriously in this respect. Certain powers of destroying or digesting hurtful foreign elements, whether living or dead, and possessed by nearly all the body cells, were described in previous reports. In the more specialised structures these powers are in comparative abeyance, but are prominent in some leucocytes or white corpuscles, and especially those found in lymphatic structures. The defensive powers of these lymphatic cells may be seriously lowered by poisons such as alcohol, or the chemical products of fatigue they may also be raised by certain chemical vaccines now prepared. These powers should be vigorous and active in ordinary good health. The normal tissues about the surfaces of the nasal and mouth cavities are chiefly exposed to noxious foreign elements, of which perhaps the most dangerous are living organisms. In individuals of robust health the leucocytes have such powers that conditions of chronic inflammation rarely show, but in others of less vigorous constitution, or debilitated by depressing surroundings, or such causes as want of food or fatigue, chronic inflammatory conditions soon show themselves. The tonsils on each side of the fauces are the most easily seen of such lymphatic masses. All degrees of enlargement may be seen. It may be such that from mere mechanical obstruction correct articulation is prevented (this is noticed sometimes even in pupil teachers), or the enlargement may cause increased efforts at breathing resulting in mouth breathing. The accumulation of decomposing secretions on the surface and in the crypts of the tonsils often lead to the production of offensive and poisonous bacterial material. The surface of the tonsil itself appears as a weak spot for the entrance of various organisms, being a main portal for instance for the entry of rheumatic, scarlatinal, diphtheritic, or other dangerous blood infections. The enlarged tonsils are usually indicators of further changes. The lymphatic masses about the upper part of the naso pharynx, and the mucous tissues about the posterior ends of the turbinate bones especially, are liable to become greatly hypertrophied and sometimes cause much trouble from their chronic irritation whether by mechanical substances in the air or more commonly micro-organisms, from want of proper drainage of the surfaces, from actual deformities in development of the upper jaw, or from want of development, due to the habit of mouth-breathing having become established at an early age. Mere catarrh started probably by the baby's comforter is apt to set up mouth breathing. Catarrhal attacks may result in infection of the lymphatic tissues and in children of low vitality the infection sets up chronic inflammation. Thickening of the soft palate leads to impaired tones in the nasal sounds. Discharges sometimes start pharyngitis, which gives the child an excoriated upper lip and the appearance of having nasal trouble. A remote result not Report of the Medical Officer (Education). 95 uncommon is persistent conjunctival troubles and blepharitis, which if a cure is to be hoped for requires treatment at a throat rather than an eye hospital. The associated conditions of throat and nose are a common cause of recurrent headaches in young children. For some reason apart from the organs of the special senses the existence of hypertrophied lymphatic structures in the naso-pharyngeal region, adenoids especially, is associated with a peculiar mental condition which has been termed aprosexia. Such children are often submitted for examination as suitable for special schools, and the condition has been classed as spurious mental defect. Apperception is greatly lowered and the attention cannot be maintained. The nutrition of the frontal areas of the brain seems affected, whether by accumulation of fatigue products from interference with lymphatic drainage, or in other ways, cannot be settled. The condition is remarkable for variability. Quite sharp and intelligent at times, they are as often dreamy, absent-minded and wool-gathering. The variations depend on the condition of the nose and throat, and are more obvious when the structures there are swollen from catarrh, or from humidity of the weather. These children are always mouth breathers, and often have other sequelae of the adenoids from which they suffer, not the least of which is said to be a character in later life timid, fearful and doubting. The most important immediate change is, however, a thickening of the tissues starting in the structures about the Eustachian tubes, leading to the middle ears, often causing secondary aural changes and leading to very intractable deafness in later life. In slighter cases recovery appears to take place, and they may leave school apparently well, whilst the slow changes are leading to ultimate inefficiency from hardness of hearing. Dr. Fairfield has drawn attention to the considerable number, over 5 per cent., of the mothers attending medical inspection who present hardness of hearing due to aural suppuration or old adenoids. Sometimes during childhood the grosser form of suppuration of the ears takes place and this is more likely to happen in those scarlatinal or measles cases who suffer from adenoids than in others. In 1,000 East-End children Miss Ivens found aural suppuration existing in 15 per cent, of the mouth-breathers, but only in 2.8 per cent, of the others. Mouth-breathers are more disposed to all the dangers of suppuration of the ears, meningitis, or blood poisoning than other children, and many lives are cut short from neglect of this condition. Even in the inspection of children sitting in their places the majority of mouth-breathers are at once apparent, and it is also noticeable how educationally they gravitate to the lower classes. It is difficult to be sure whether by mere mechanical obstruction a vicious circle is set up, but every surgeon with experience knows how the child with open mouth, frequently nasal discharge, and generally unintelligent appearance is often wonderfully altered by operative treatment. The breathing drills of the infant school should require the child to breathe both in and out with the mouth shut, and would have good effect in calling the teacher's attention to the condition when existing. Any teacher who notices the conditions should warn the parents. If in addition the child habitually snores regularly at night, it may be confidently asserted that such child requires operation to clear the naso-pharynx from obstructions. Up to 10 per cent, of children at admission will be found to be mouth-breathers, and during school ages the proportions remain comparatively steady. In the Islington schools about one-third of the children were noted by Mr. Cecil Rowntree as having enlarged tonsils or adenoids, and in one-third of these (10 per cent, of all) to a pathological extent, whilst about one-third of this last number (about 3 per cent, of all) urgently required surgical treatment. The proportions, however, vary at different seasons and in different districts. Miss Ivens, found in the East-End among the aliens that 34 per cent, of those who heard well had open mouths, whilst of those who presented discharging ears 78 per cent, were mouth-breathers. In a careful examination of 1,500 children in Chelsea schools Mr. Macleod Yearsley gave 44 per cent, as having enlarged tonsils or adenoids and 7 per cent, as requiring surgical treatment. It has hitherto been taken that other conditions, such as dental caries would be materially caused by or contribute to this lymphatic hypertrophy, but enquiries carried out by Dr. Norman show that, at different ages in both boys and girls, dental caries is about equal in amount in both mouth and nasal breathers. In many cases, even after operation, mouth breathing persists unless the child is taught correct breathing, and in the mentally defective about 50 per cent, are mouth-breathers, the habit having been set up by some infantile catarrh and allowed to persist. Some medical authorities have suggested that mere breathing exercises alone will act as a remedial means for the relief of the symptoms of nasal obstruction arising in connection with adenoids, and by this means one large hospital is reputed to keep its operative list of child out-patients down. It would only be in the slightest cases of mouth-breathing that it would ever be practicable to get material benefit by means only of breathing exercises. Dr. A. C. Williams selected boys whose throats were not normal, but in whom the symptoms scarcely required surgical treatment. They included cases without other symptoms but with enlarged tonsils ; or which showed a tendency to mouth-breathing ; cases which might mean slight adenoid growth where there was a history of snoring, some nasal discharge, or granules noticeable in the pharynx. Several of these had previously had operations for adenoids. Some of these cases were treated by the ordinary school breathing exercises. Some others were always put in the front row and the teachers kept them under special observation. The mothers were also asked to see that the children went through ten minutes' breathing exercise night or morning. Watched through six to twelve months or more, improvement was not always easy to determine, but as the conditions were carefully noted before the procedure was determined the estimate as to improvement is quite unbiassed. In a few cases " not improved " the conditions were distinctly worse. 96 Annual Report of the London County Council, 1911. Breathing exercises. Slightly enlarged tonsils. Adenoids ? Mouth breathing. Improved. Not improved. Improved. Not improved. Improved. Not improved. Ordinary school routine 5 6 — 12 4 12 Special attention by teachers 4 2 5 2 4 — In slighter cases of partial mouth-breathing there is evidently a tendency to recovery which may he aided by reasonable care and breathing exercises. The advice which is so often heard as having been given by the family doctor, that the child would " grow out of it " has therefore an element of truth, provided the child escapes without more serious damage or without becoming the victim of a slowly progressing hardness of hearing in later life. In Dr. Williams' observations of those children who had handkerchiefs, three times as many showed improvement when compared with those who were without handkerchiefs. In many schools the proportion with handkerchiefs is as low as 10 per cent., but this may be raised to 70 per cent, by teachers who establish " handkerchief drill." Dr. Wells has taken a series of children whose ages vary from 3 to 13 years of age, all scholars of Council schools, on whom he operated for tonsils and adenoids at the St. George's Dispensary, Blackfriars. The first 50 were operated on between 18 and 24 months before the last note taken and the second 50 between 12 and 18 months previously. In eliciting the symptoms before operation the parents were always asked to describe these as far as possible so as to avoid any suggestions being made, as to the existence of particular symptoms. Most of those recorded were, therefore, actually noticed by the parents and should be noticeable to an observant person. Certain other symptoms noticed at the time, apart from the throat, are also recorded. In several cases where the nasal septum was deflected, or the mucous surfaces of the turbinate bones either hypertrophied or atrophied, the conditions were found unchanged later. In one case, a girl of 13 had suffered nocturnal incontinence regularly till operation, after which it had only occurred once in twelve months. The chronic gastrointestinal catarrh, called mucous disease by Dr. Eustace Smith, which is common in these cases was present in twelve cases, but had disappeared when examined later. The symptoms noted by Dr. Wells before the operation and remotely after recovery from it, were as follows:— First series of 50 cases. Second series of 50 cases. Percentage presenting symptoms. 100 " adenoid " cases and symptoms noted. Before operation. A year and a haf later Before operation. One year later Before operation At least a yearlater. Subjective. Snoring 43 1 39 3 82 4 Mouth breathing 45 3 45 2 90 5 Frequent colds 29 3 34 5 63 8 Deafness 9 1 12 1 21 2. Noises in ears 3 — — — 3 — Aural discharge . 6 — 18 5 24 5 Nasal discharge 9 1 14 — 23 1 Speech defect . 4 2 2 — 6 2 Frequent sore throats 24 1 16 — 40 1 Cough . 5 1 4 1 9 2 Sickness . 2 — 1 — 3 — Mental dulness . 2 — 2 — 4 — Enlarged glands . 6 1 2 — 8 1 Night terrors 3 — 6 — 9 — Objective Hypertrophied tonsils 34 — 42 — 76 — Adenoids 50 — 50 — 100 — Deflected septum . 2 2 1 1 3 3 Turbinal hypertrophy 2 2 2 2 4 4 Atrophic rhinitis 1 1 — — 1 1 Mucous disease 6 — 6 — 12 - Satisfactory as these results appear it is to be remembered that they are the results of one skilled operator, and that from the small number of serious complications in the form of turbinate hypertrophies or rhinitis they probably represent an unconsciously selected class of cases sent from the schools to the dispensary, although Dr. Wells thinks his selection was quite unbiassed and that the results are chiefly due to the careful following up possible in the clinic. 96 Report of the Medical Officer (Education). 97 Allusion was made in last year's report to the serious risks of out-patient practice, the scandal of children suffering from shock and vomiting in the streets and being refused admission to public conveyances. An eminent surgeon, Mr. Stephen Paget, in a lecture* at St. Bartholomew's Hospital a dozen years ago, before any public treatment had come into discussion, alluded to the conditions : " There is generally slight shock at least among the ill-fed, thin, nervous children of a London out-patient department; they are faint and miserable for a day or even two days, and want nursing, and half the troubles that may follow the operation—otitis, bronchitis, even pneumonia—come because the child is not taken into the wards, but must be turned out again back into the slums." But, apart from the complications of the rough and ready treatment subsequent to operations in the out-patient room, and remembering that striking as are the results of adenoid operations in many cases, the remote results are not always so good, often there is still reason to doubt whether the operation was skilfully or efficiently performed. In an enquiry during the autumn by Dr. Pearson as to the results in children who had been operated on during the past ten years, the returns were so disappointing that it speedily resolved itself into seeking the reasons for such want of success. Children are not recommended for surgical treatment because they have adenoids, but because of symptoms which are the noticeable results, such as mouth-breathing, snoring respiration, nasal discharges, and associated deformities and defects. If the result of treatment leaves these conditions in existence it cannot be said to have been satisfactory. Merely to scrape a child's pharynx in a routine way is not sufficient for intelligent treatment, and yet many cases appear to go through this process. Two of the cases in Dr. Pearson's series had been operated on five times for adenoids and yet were not relieved as their noses were blocked by enormously hypertrophied turbinal bones. It is not merely that these hypertrophies are recurrences, but often also that they have not been treated at the time of operation. Just as the hundreds of medical certificates received of freedom from disease in children who were at the time obviously suffering from ringworm give evidence which cannot be gainsaid, so, although any surgeon knows how easy it may be to throw stones, it is almost impossible to resist the conclusion that there is want of care or skill on the part of many who operate for adenoids. In this enquiry each teacher was asked to ascertain what children had been operated on for adenoids. The children were then examined by the doctor, who analysed his notes with the following result:— Total number. Operative result. Of the satisfactory cases. Unsatisfactory. Satisfactory. Still mouthbreathers. Wholly satisfactory. After 1 operation 366 217 149 41 108 After 2 operations 26 15 11 7 4 After 3 or more operations 8 5 3 1 2 Numbers 400 237 163 49 114 Percentages 100 59 41 12 29 The cases were considered satisfactory when there was no evident or palpable obstruction to nasal-breathing. Among the 163 thus recorded 49 still retained the habit of mouth-breathing, although probably by training and breathing exercises as in Dr. Wells' cases this could have been removed. The other 237 were returned as unsatisfactory because the mouth-breathing was due to persisting but removable causes. These were nearly two-thirds of the cases operated on, and on the 237 children there had been 279 operations. The conditions which still remained after the operations were— Unsatisfactory results in 237 of 400 children operated on. Adenoids Hypertrophied tonsils. Deflected septum. Nasal polypi. Otorrhoea. Deafness. After 1 operation 63 48 99 61 4 14 10 After 2 operations 5 4 7 3 1 After 3 or more operations 4 2 3 — 1 2 3 Numbers 72 54 109 61 5 19 14 Percentages 18 13.5 27 15 1 5 5 * St. Bartholomew's Hospital Journal, 1900, p. 103. 12532 N 98 Annual Report of the London County Council, 1911. The places where operations were said to have been performed were— 400 cases (442 operations). Satisfactory. Unsatisfactory. Total. Large general hospitals 49 112 161 Children's hospitals 25 66 91 Provincial hospitals 34 51 85 Special nose and throat hospitals 10 8 18 Private operations 11 13 24 School clinics 29 19 48 Unknown 5 10 15 Totals 163 279 442 The adenoids here recorded were not sought for when other cause of obstruction was apparent. In absence of other cause the naso-pharynx was digitally examined and adenoids only recorded when they could be palpated. They were usually felt on the lateral walls and generally on the right. When median they often had a fibroid feel showing that they had been scraped. It is not sufficient that provision is made whereby a third of the children who preaent pathological conditions among the large numbers with enlarged tonsils and adenoids can be medically or surgically treated in a satisfactory way with the minimum expense of time and trouble. While one-third of the children in the schools present conditions which represent a struggle against factors of ill-health, the causes must be sought out and removed as a public task. It is not a mere academic enquiry which is now being suggested, but a fundamentally important one, which also lies at the roots of tuberculosis and other causes of chronic debility. The external factors are the various kinds of septic organisms which gain access to the mouth and nose. Each human being goes through a period of acquiring a certain proportion of immunity against various diseases. Provided the dose is small enough almost any disease is overcome, or rather its germs are overcome, without the disease ever becoming evident. To judge from immunity reactions tuberculosis has affected 95 per cent, of the population before the limits of school age are past, but unless the doses of infection are large and repeated, or the child is depressed by the results of other diseases, as measles or whooping cough, it soon overcomes the attacking tubercular germs. In large towns almost every one acquires permanent protection against measles at an early period of life by going through the disease. Threequarters of the population seem to have sufficient immunity to resist scarlet fever, the rest mostly acquire it by suffering an attack ; but there are a number of germs of comparatively low pathogenic powers, against which only temporary immunity seems to be acquired. The common " dirt" inflammations of the eyes and ears and fungoid rashes of the skin, so evident among debilitated children and invalids, afford examples. Catarrhal attacks, the common cold, the micro-organisms of which cause an enormous diminution in health annually, can be resisted easily in vigorous health, but are so constantly present that any slight departure from a condition of resistance, a few minutes chilling, a slight attack of indigestion, will give the opportunity for invasion. The protection can be raised in many people for months by swallowing at the right time a medicinal dose of the protective vaccine. In the case of young children improper clothing and the use of dumb-teats or baby comforters must be most potent contributions to the catarrhal invasions which ultimately lead to development of the enlarged lymphatic tissues in consideration. These catarrhal germs are practically accompaniments of civilisation, the " stranger's cold " of St. Kilda, and the only method of dealing with them is by dilution. Increased living room must be found not only in houses but in cities and in school rooms. The factors contributed by the child itself depend to some extent on its bodily constitution, as a matter of heredity. The children of a family resembling a mouth-breathing parent in other respects will often be mouth-breathers too, whilst the rest are like the other parent and normal; but the lack of resistance in the cellular elements can be induced or cultivated as can be seen in the large, soft, well clothed, scarcely exercised workhouse or institution children so apt to develop chilblains or to suffer from adenoids. The children in some suburban localities which have no near playgrounds, who are well fed and well clothed, but whose freedom is restricted to maintain the gentility of their parents, have been pointed out in previous years as suffering from similar debility and adenoid hypertrophies in excessive numbers. The want of personal hygiene which contributes materially to permanent damage of vision and hearing from slight dirt infections also is a factor in catarrhal conditions of the naso-pharynx. The mentally defective children learn mouth-breathing in large numbers because the natural channels are neglected. The children who do not use handkerchiefs are more often mouth-breathers than the others. Breathing exercises, where both inspiration and expiration are through the nose, and the mouth is kept shut for several respirations, should be an essential part of the infant school work. Handkerchief drill in the lower classes is also to be thought of in the ordinary school. The inculcation of cleanliness beyond the level of the cleansing schemes ought to be part of the school work, and when the want of cleansing opportunities and the need of the tonic influence of bathing are properly appreciated, school baths will be insisted on as part of the prophylaxis against the lymphatic debility that shows ultimately as adenoids and in tuberculosis; but although the school cannot directly prevent the chronic catarrh, and possibly sometimes tubercular infection, set up by the use of baby comforters, some restriction is necessary. Their action is wholly bad both mechanically and as conveyers of infection. Their sale should be restricted. Report of the Medical Officer (Education). 99 Lastly, the reserve powers of the child must be cultivated. The absolute necessity for free exercise and fresh air means the need for playground areas beyond those attached to the schools. The children will have to be enticed into playgrounds if they are to live in towns and maintain normal health ; houses will have to be pulled down in order to obtain the spaces required. To summarise, reaction to unhealthy environment is shown by the 30 per cent, of children who suffer from " tonsils and adenoids." Breathing drills call the attention of the teachers to the existence of the condition, and mouth-breathing due to catarrhal causes is diminished by the habitual use of the handkerchief. A considerable proportion of cases need surgical operation ; this may be extremely good in its results, but under the conditions in which it is at present carried out among elementary school children, is unsatisfactory in about two-thirds of the cases. Rational treatment, by preventing the ill-health of which these symptoms are the associates, would be the use of all means to prevent catarrhal attacks and all that serves to raise the child's reserve powers. The chief causes of catarrh in earliest life are the baby's comforter, ignorance and dirt. Room to live on the land is the principal need ; house room and all that it connotes ; school room ; free spaces of land for ventilation, pulling down buildings to provide opportunity of free play for children ; the provision of chances of cleanliness and the tonic effects of school baths. The expenditure of any sum of money on the health of children is of more national importance than its expenditure on the health of adults. Breast fed children. Bottle fed children. Teeth carious. Teeth oarioua Number examined. Number examined. Upper. Lower. Total. Upper Lower. Total. Entrants. Boys and girls (4—6) 123 118 152 270 55 61 83 144 Boys, aged 8 80 98 96 194 33 44 51 95 Girls, aged 8 157 193 220 413 53 90 97 187 237 607 86 282 Boys, aged 12 118 48 71 119 27 18 31 49 Girls, aged 12 209 86 153 239 65 42 59 101 327 358 92 I 150 The average number of obviously carious teeth in these various groups of children were— Age. Infants (4—6). 8 years old. 12 years old. Breast fed 2.20 2.56 1.09 Bottle fed 2.62 3.28 1.63 So that the advantage of soundness of teeth is greatest in the naturally fed children at every age. 19532 n 2 leeth. Attention has been drawn frequently to the vast mass of national inefficiency due to dental" disease originating and neglected during childhood. The conditions in existence are indisputable, 80 to 90 per cent, of the children suffer from steadily advancing caries. The chief causes of this widespread disease are still doubtful and the remedy is not to be sought entirely in the toothbrush or dental chair. These merely mitigate results of deeper origin associated with the difficult conditions of infancy in overcrowded rooms and frequently with artificial feeding. The nutritional conditions of the first few months of infant life are of the greatest importance. It has been shown in the Report for 1905 that years of high infant mortality correspond later with crops of children whose measurements are below the average, and this gives a clue as to why it is that the districts in large towns where there is high infantile mortality also show stunted populations. The occurrence of bad nutritional conditions, more particularly rickets and convulsions, has been associated with honeycombed teeth in later life, and slight cases of lamellar cataract. Indeed, it is stated that this last defect was noted as exceedingly rare in Australia until the advent of condensed milk, since which time it has become comparatively common. Dr. Pollock has followed up these lines in his school examination by enquiring of parents whether the children presented were breast fed or bottle fed, and tried to correlate this to the dental conditions found in the permanent teeth. It was not expected to find any material effect on the deciduous teeth, but the entrants aged 4—6, the 8 year old group and the 12 year old group were all recorded. He found— 100 Annual Report of the London County Council, 1911. These results are confirmed by investigations also carried out during the past year on dental conditions of about 1,500 elementary school children in Kiel. The school doctor noted 12 per cent, as apparently faultless in regard to the presence of caries. No such healthy dentition was seen in any child stated to have suffered from rickets. There was only 1 per cent, among the bottle fed and as many as 21.3 per cent, among the breast fed children who showed mouths free from obvious caries. These conditions ran through the various other analyses recorded, e.g., of children with very bad teeth, etc., confirming the observations in the London schools that the tendency to caries is probably largely a matter of structure of teeth partly due to heredity and to very early infantile conditions. During the spring of 1911 toothbrushes were distributed among the children of thirteen schools in the East End. Three of these schools were gone over six months later and the dentist reported that considerable improvement in the cleanliness of the teeth was noticeable. The schools he inspected were :— Farrance-street (B.) School.—300 brushes were distributed on 27th March, 1911, and when the school was visited on 26th October, 1911, 233 of the boys were still in attendance, 67 had left. Of these 233 boys 192, or 82.4 per cent., possessed brushes, all of which were in good condition, and most of them showed signs of recent use. The teeth on the whole were much above the average in cleanliness as compared with the teeth of the boys in adjacent districts, namely, Poplar, etc., where no brushes had been provided. Farrance-street (G.) School.—Brushes were distributed to 305 girls on 6th April, 1911, and when the school was re-inspected on 2nd November, 1911, it was found that 263 of the girls were still in attendance, and of this number 243, or 92.4 per cent., had their brushes. The teeth of the girls were exceedingly clean and well kept. Halley-street (B.) School.—109 boys received brushes on 29th March, 1911, and 80, or 73.4 per Cent., were produced on 7th November, 1911. The teeth of the boys were on the whole clean ; it was found that soot was very popular as a tooth powder. Three boys confessed to having lent their brushes to other members of the family in spite of the warning of the teachers. Cayley-street (B.) School.—253 brushes were distributed on 3rd April, 1911, and of the boys who received them there were 218 still in attendance at the school on 9th November, 1911. Of this number 195, or 89.4 per cent., produced the brushes. At this school also the condition of the teeth as regards cleanliness was on the whole good and much better than the average of adjacent districts. Some beginnings of treatment have been made. The most notable is the school dental clinic organised by Miss Margaret McMillan in Deptford. This was opened on 17th October, 1910, and during 1911 has been subsidised by the Council on the same terms as the hospitals—that is a capitation fee of 2s. and payment of the dentist's salary. The clinic serves for 63 schools in Deptford, Greenwich, Lewisham and Peckham, covering a roll of about 45,000 children. The children sent, however, are limited to the eight year old group. In the first three months of the year inspections of neighbouring schools were made by Mr. Wallis, who found that the inspections of the school doctors were insufficient as regards dentistry, only the worst cases being selected. Since then Mr. Benjamin North, the dentist at the clinic, has given one afternoon a week to school visits. He has examined 3,173 children of the age of eight, 1,634 boys and 1,539 girls, in 37 schools on 33 half days, averaging96 per session. Of these 79.5 per cent, boys and 79.2 per cent, girls needed dental treatment. Four fifths of the eight year old children require such treatment. The percentages are a little lower in the poorest schools, possibly due, as Mr. North suggests, to the survival of the fittest, the infant death rate among weaklings being very high in those districts, and possibly to the use of coarser food. The ill effects of decayed and sensitive teeth are, however, more marked among the poorer children, and the mouths are dirtier. Although the dentist examined eight year old children, the numbers at that age were only about a third of those treated. The school doctors notify many cases at other ages as requiring treatment, so that out of 2,318 treated 242 were below eight, 1,102 over eight, and 974 eight years of age. When the school inspection shows any child to require attention its parents are notified, and if they wish to take advantage of the public service, locally established in Deptford, an agreement to that effect is signed, and a promise given to pay is. This may be reduced by the Care Committee to one penny if the parents are poor, or as workpeople contribute to hospital funds. When the signed schedules have been returned to the school an attendance card fixing a time for attendance at the clinic is issued. About ten or eleven attendances are arranged for each session, and about eight attend, which just affords work as regards the eight year old children. With older children where much has to be done to each mouth this number would be too great. The cases who attend for medical treatment by the three doctors who work at the clinic, and cases to be operated on for adenoids or tonsils, often also require treatment for carious teeth or septic mouths before operation is justifiable. These cases are numerous and show the utility of dental and medical service being closely associated. During 1911 they numbered 262 extractions only, 593 fillings only and 1,463 extractions and fillings. The general work shows that 75 per cent, require some teeth extracting, and that only a quarter of the cases can have their mouths made healthy by filling the teeth. The new arrangement from the beginning of 1912 whereby childrem from six to eight are taken will ultimately greatly reduce the number of extractions required. 101 Report of the Medical Officer (Education). 101 Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Extractions Temporary teeth 119 300 325 193 515 185 281 13 268 323 447 343 3,312 Permanent teeth 52 70 25 25 60 43 38 2 49 40 48 25 477 Fillings Temporary teeth 24 14 22 16 37 24 34 — 38 102 126 91 528 Permanent teeth 169 262 342 196 414 224 398 18 458 434 311 283 3,509 Most of these 477 extractions of permanent teeth were hopelessly damaged molars of older children. Many were quite difficult operations where an anaesthetic was necessary and local anaesthetics were used, as general anaesthesia was forbidden. Arrangements have now been made for the use of nitrous oxide gas. The extractions are generally done on a Saturday morning. About 4,000 stoppings, nearly all amalgam with cement, were applied, and 87 per cent, to permanent teeth. This shows the good work of the clinic, as it means about 4,000 teeth made serviceable which otherwise would soon have been sensitive and lost. The parents who in most cases accompany the children are always instructed as to the probable results, and the educational effect of these talks is very useful, as a considerable number return. The sale of good brushes for 2d. in the schools has been most effective in maintaining healthy conditions in the mouths after treatment. Of the 2,318 children treated the condition of the mouth when first seen was noted as : clean 89, fairly clean 873, dirty 1,196, and very dirty 160. The dirty generally had a sensitive tooth preventing one side of the mouth being used for mastication, whilst the very dirty ones had septic roots or stumps requiring urgent removal. The dental surgeon at Deptford has tabulated the cases of decay in the teeth at different ages in both permanent and temporary teeth. For the temporary teeth the following table shows the need of early dental care ; even at six years of age 64 per cent, of the childrea sent have four or more teeth carious and by seven this reaches 74 per cent. Ages Numbers of Children. Percentage with number of carious temporary teeth. Percentage with decayed teeth. 1 2 3 4 5 6 7 8or more. 6 98 1.2 12.2 10.7 13.2 15.3 17.3 9.2 11.3 90.4 7 144 7.0 5.5 10.3 15.2 13.9 20.1 10.3 14.6 96.9 8 974 5.6 10.4 16.6 19.0 16.0 12.3 6.6 8.2 94.7 9 385 8.0 17.1 21.0 19.0 13.0 8.8 8.0 2.0 96.9 10 81 5.0 13.5 24.4 26.0 13.6 7.4 1.2 3.7 94.8 11 208 12.5 24.5 11.0 11.0 7.2 4.3 1.9 2.4 74.8 12 428 10.7 12.1 8.1 4.4 3.2 1.0 1.0 — 40.5 Mr. North thinks it will be necessary ultimately to examine the mouths of all children before six years of age, and then annually, to save an enormous amount of pain and sensitive teeth and the retardation which this causes in growth and development. In the case of the permanent teeth there is no natural cure by loss as in the case of the temporary teeth, and here a functionally damaged tooth is a loss for the whole of life, but even during school days this loss is extensive, the loss of the first four permanent molars being quite common, and in the column of four permanent teeth carious the increase is rapid with age, and it is an increase not only in numbers of teeth attacked but in extent of damage, for so many teeth become unsavable and have to be removed. Age Number of children. Percentages with numbers of carious permanent teeth Percentages with unsavable permanent teeth. . 1 2 3 4 1 or more. 1 2 3 4 1 or more. 6 98 6.2 4.1 2.0 1.0 13.3 — — 1.0 — 1.0 7 144 24.3 16.6 11.1 4.1 56.1 4.8 2.0 — — 6.8 8 974 28.0 24.8 11.4 7.7 71.9 7.6 3.2 .6 .7 12.1 9 385 27.2 30.6 12.4 10.9 81.1 10.7 5.2 1.3 1.5 18.7 10 81 22.2 35.9 14.8 18.5 91.4 12.3 10.0 6.1 3.7 32.1 11 208 13.S 23.8 26.4 27.0 93.5 22.6 22.1 7.2 5.3 57.2 12 428 9.3 22.6 22.4 35.2 89.5 27.8 25.4 9.8 10.0 73.0 102 Annual Report of the London County Council, 1911. Ringworm. Ringworm continues to be one of the plagues of school life. The first nurse appointed by the School Board was a " ringworm nurse." In 1906 it was shown that ringworm cases corresponded to a school absence involving a loss of fee grant of between £5,000 and £6,000 annually. This meant an average of 2,950 children out of school. Subsequently the Attendance Department ascertained that the average crop absent at any time was about 3,500 to 4,000. In recent years there have been about 6,000 new cases yearly. Last year there were 6,231 new cases. This was one of the diseases in which several years ago it was pointed out that the hospitals failed to supply the public wants; a disease soon to become comparatively rare when public remedy is provided, as its extermination is entirely a matter of cost. When the treatment scheme became established, an enquiry by the nurses who filled up a card for each case, showed 3,542 cases of which 446 were being treated by Roentgen rays. The report on ringworm in 1909 stated that " It will be interesting a year hence to determine the effect of the organised attempt now being made by the hospitals to deal with this nuisance, as hitherto they have failed to make any impression upon the prevalence of the disease." Now, two years later, the record can be continued, that the disease appears to be just as prevalent as it has been at any time in the past half dozen years, although some effect ought to be expected shortly. Favus, which is a more intractable disease, but of like nature to ringworm, prevailed in the East End so that a favus school for over 80 children was opened. This produced but little effect until radical treatment was resolved upon, Roentgen apparatus installed, and a cure insisted upon in every case. The disease was stamped out in a few months. The record for favus for 1910 is four cases and for 1911 also four cases. If ringworm is treated by the same assiduous method it can be almost as readily exterminated. At present ringworm is costing the Council not less than £7,000 per annum, in the service of doctors, nurses and hospitals and loss of fee grant entailed, and in spite of this cost no appreciable difference appears in its prevalence. The returns for the Michaelmas term show that of the 1,272 cases returned as cured, the average school absence amounted to 5.89 months, and in the last quarter the average is 5.93 months. Each case of ringworm as it becomes known has a special card made out and the school nurse follows up the case to the best of her ability. If any case is alleged to be under treatment by doctor, it thereby passes out of consideration. Cases said to be treated by a chemist or at home are offered X-ray treatment, but if refused no action is taken. This is the weak part of the scheme. Certain other cases are, however, followed up and treated under the Council's schemes. About 20 per cent, now coming under treatment are by Roentgen rays. So far, up to the end of 1911, there is, however, no noticeable diminution in the number of cases being reported. The nurses are most assiduous, and the laboratory renders all certainty possible in the diagnosis of cases. The certificates of medical men in regard to the ringworm specimens received at the laboratory are not now enumerated, as considerably over 90 per cent, were erroneous. During the year, 6,231 fresh cases have been reported. Of doubtful cases, in which specimens were submitted for microscopic examination, 2,926 specimens were examined. The ringworm fungus of various varieties was detected in 2.165. favus in 4. and no fundus could be found in 757 cases. The following table gives a conspectus of this work during the seven years in which it has been followed:— Year. Specimens submitted. Ringworm found. Favus found. No fungus found. ' Insufficient material. 1905-6 988 597 104 257 30 1906-7 1,578 1,094 84 336 64 1907-8 2,175 1,705 25 347 58 Mar. Dec.}1908 2,751 2,212 32 423 47 1909 3,019 2,343 37 568 45 1910 3,116 2,400 4 709 3 1911 2,926 2,165 4 757 Open-air schools. The only drawback to the radical treatment of ringworm is that it would have to be considered as a public nuisance, and every case compelled to be cured within a reasonable time. Further, it is so prevalent that the private schools or other educational institutions, not under oversight of the Council, or indeed any sanitary authority, might still keep up reinfection of the child population. Otherwise the disease can be rapidly made to disappear, and its present cost to the Council indirectly is so great that it would probably, on financial grounds alone, be justified in spending even £10,000 a year for several years in stamping out the disorder, although the cost required would not nearly reach this figure. The experimental open-air schools on the model of the Wald Schule of Germany have been fully described in previous reports. Two open-air schools were continued at Birley House and Shooter'shill (Shrewsbury House). They were opened in April, and during the first few days the weather was exceptionally severe, the temperature running between 40 deg. F. and 50 deg. F. during the day, and several degrees of frost being registered at night. In spite of the inclement weather the school was carried on as usual, the children taking refuge in the Doecker shed during the blizzards of snow, and although most of the children came from homes with stuffy atmosphere and where closed windows are the rule, none of them suffered any harm from the unusual conditions of their schooling. Some 103 Report of the Medical Officer (Education). ordinary colds in the head occurred, but there was no loss of attendance. During the late summer, with a long drought, much sunshine and a shade temperature daily exceeding 80 deg. F, for weeks, the energy and vitality of the children fell off, exercise had to be curtailed, and there was a slackening in the weights of the children partly due at Birley House to some attacks of enteritis. The autumn, on the other hand, was again wet, windy and unsettled, and on several occasions the old time "London Fog" reappeared. There were, however, no ill effects on the children's health, and the attendance was steadily maintained. The Doecker shed at Birley House has had moveable side windows arranged in case of inclement weather. Clogs have also been provided by charitable donations, and children with defective foot gear have used the clogs during school hours. At Birley House the children on admission presented a miserable and uncared-for appearance and as the weather was cold and windy, and many of them were suffering from common colds, it would be difficult to imagine a more wretched looking class. They came from very poor districts and most of them were badly clothed and dirty. They were poorly nourished, had carious and defective teeth and were anaemic. At an examination of candidates nominated by teachers for admission to these schools almost every child seen is in a grave condition. A large proportion recommended are suffering from such lung conditions as fibroid changes, collapse or bronchietasis, all the result of repeated and neglected attacks of bronchial catarrh in the past. Several had family histories or family environment of phthisis, and some had previously been under treatment for this disease. It is difficult to say which of the children are actively suffering from tuberculosis. Two only seemed to be suffering from phthisis, but this is the final stage of chronic infection. Phthisis nowadays in a school child almost means that it has never had a fair chance in life. There were several children with greatly enlarged cervical glands and one case of tubercular elbow joint. Of the 86 children first admitted 52 required dental treatment, and discharging ears were present in 6, defective vision 12, and for throat and nose defects 7 were noted as requiring immediate treatment. The chief difficulty in obtaining treatment was the apathy of the parents, and several children had to be told again and again before any attention was paid. As the children come from parts scattered over South London it was not easy for anyone to get actually in touch with the parents, and still more difficult to get the parents to spend time and money in coming to the school to be interviewed in regard to the provision of treatment. The conditions requiring medical treatment were all relieved except one or two cases requiring glasses. The dental cases were taken for treatment in batches either to the Deptford Clinic or St. George's Dispensary, but here the difficulty of taking the children came in and 31 remained untreated, some of them having been marked "urgent" The following table compares the physique of the children admitted to Birley House with certain children measured as standards in London schools in 1906:— Birley House. 1911. Weights. Heights. Kilos gain in 36 weeks. Average weekly gain kilos. Sex Age groups. Number in age group. Birley House. Average of all L.C.C. schools. Birley House. Average of all L.C.C. schools. Birley House. Standard children. Birley House in the summer and autumn. Standard children in the year. Boys 7 1 20.7 22.0 111.0 116.0 - - - - 8 3 2E.8 23.5 127.3 120.5 2.7 1.4 .07 .03 9 12 23.3 25.5 120.6 125.2 2.6 1.6 .07 .04 10 13 26.0 27.6 128.1 129.8 2.8 1.6 .07 .04 11 7 27.1 29.9 133.2 134.3 3.7 2.1 .09 .05 12 5 29.9 32.5 137.0 138.7 4.9 2.6 .13 .06 13 3 30.8 36.4 139.3 143.1 3.8 2.4 .10 .06 Girls 7 - - - - - - — — - 8 3 20.8 22.9 119.6 120.2 2.2 1.5 .06 .03 9 6 22.9 25.0 123.5 124.7 2.8 1.7 .07 .04 10 5 22.3 27.2 123.6 129.9 3.1 2.0 .08 .05 11 15 24.8 29.9 128.4 135.0 3.2 2.6 .08 .06 12 10 31.6 33.3 140.2 140.6 4.0 3.0 .10 .07 13 3 28.8 37.7 139.0 146.8 4.4 3.3 .12 .08 For reasons which will be given presently, it is doubtful whether in the comparisons given the gain in weight of the standard children is not considerably understated. The nutrition expressed in grammes weight per centimetre of height was calculated at the opening of the school and at the thirtysixth week and showed a marked increase all round. It is not set out in tabular form, as the transfer of several children from one age group to another in such small groups, makes this form of statement inaccurate. The haemoglobin percentages within the thirty-six weeks rose to be equivalent to those of 120 normal children taken in November and December at Goodrich-road, Heber-road, St. John's 104 Annual Report of the London County Council, 1911. North Cross-road, Dulwich and St. Anthony's (R.C.) Lordship-lane, Dulwich. The normal average being 55 boys gave 87.8 per cent. and 65 girls gave 88.9 per cent. At the opening of Birley House the boys and girls gave 81 per cent., which by the thirty-sixth week had come up to 88 per cent. In cases where there was a temporary fall this was ascribed either to the hot weather, or to teeth or other operations. There is probably a seasonal variation in haemoglobin content of the blood. The chest expansion on admission was boys 1.9 inches, girls 1.8 inches, at the thirty-sixth week boys 2 inches, girls 2.4 inches. In the case of some of the children this chest expansion was very poor, two of the girls only giving half-an-inch, and several of the children 1 inch on admission. The children at Shooter's-hill were of a similar type, but possibly even more anaemic than the children at Birley House, as 73 per cent. of the admissions were below 75 per cent. by the haemoglobinator test, whilst by the end of the year only 2 per cent. remained below this mark. The conditions of the children admitted were noted as— Tubercular disease of lungs 5 Doubtful tubercular pulmonary disease 5 Other lung and chest diseases 40 Otorrhœa 15 Enlarged tonsils 14 Adenoids 10 Cardiac diseases 5 Disease of the eyes 11 Enlarged glands (not obviously tubercle) 13 Tubercular glands 4 Chorea 1 Curvature of spine 5 Torticollis 1 General malnutrition 49 Probably the majority of these children were tubercular in the widest sense of the term, but only 14 were definitely assigned to this heading. Of these, 5 were cases of pulmonary tuberculosis; they increased in weight, were less anæmic, and gained in appearance of general health, but the lung condition did not improve except in one case in which no traces of active lung disease could be detected at the time of leaving school. The asthma cases seemed to have attacks just as frequently during attendance at the open-air school as previously. The great function of the open-air school is its stimulating effect on the merely debilitated child, it also enlarges the mental outlook, the child becomes happier and more interested in its work, preferring the open air to the classroom, and enjoying to the full this return to a more natural life. This can, however, be discussed later with the playground classes. Several of the children have been attenders at the open-air schools through successive years, and Birley House has remained in session through the winter, it is therefore possible now to review the cards of some of these habitues of the schools, who are obviously in very poor health and see how they stand in comparison with other or normal children. From the cards of children at Shooter's-hill the weights on admission and on closing the school have been taken and averaged. Figure 1 shows these weights for different groups of children who have been in attendance 2, 3, or 4 successive years. The numbers dealt with are quite low, but it was only a few who were available for this statistical comparison. In Figure 1, line A gives the average weights for two boys of the same age present for four successive years; B is the curve for six boys of various ages who were present for three succcessive years, and, C, the curves for Figure 1. Shooters' Hill Open Air School Weight of groups of children attending successive years. 105 Report of the Medical Officer (Education). eight hoys of various ages present the last two years. D, is the average values for 14 girls of various ages present in 1910 and 1911, E gives four girls present for three successive years, 1909, 1910 and 1911. The features of these composite curves are equally demonstrated by the curves either for children born in specific years, or for individuals. There is a rapid increase in weight whilst in attendance at the school, with a slackening or even loss of weight in the interval when the school was closed in the winter. Studying individual cases, the two boys born in 1900 who attended Shooter's-hill 1908— 1911, can be taken. Figure 2 shows their average weight by thick lines and heights by thin lines. The increase of weight was mostly during school time, with a retardation when the school was not held. The regularity of this alteration is seen through all the groups and in individuals, unless a child is actually going down hill from tuberculosis or has incidentally been thrown back by surgical operation or acute illness. Setting out the weights of the two boys recorded in Figure 2 as percentages of their weights on admission, and also their rate of gain for each period, as percentage of weight at beginning of the period, it is seen how regular these fluctuations are. Figure 2.—Shooter' Hill Open Air School Heights and weights, two boys born 1900, to shew seasonal variation, also London Elementary School standards without respect to season. — 1908. 1909. 1910 1911. Percentages School open. Open. Closed. Open. Closed. Open. Weights —P.C. 100 109 102 125 120 126 128 149 A.H. 100 108 98 118 123 133 131 140 Percentage gain weekly—P.C. +.60 —.28 + .85 —.20 +.26 +.07 +.70 A.H. +.53 —.38 +1.17 +.20 +.38 +.08 +.27 At first the effect of the open-air school as regards increase of weight seemed wonderful, children gaining at about double the rate of those in the ordinary schools. On the other hand, it is to be noticed, as seen in the Figures 1, 2 and 3, that whilst the increase of weight slackens in the winter period, there is, if anything, an acceleration of growth in height. This suggests a seasonal variation in growth of stature and increase of weight. Fortunately some years ago measurements had been made to ascertain standards for London school children; from these, annual rates of growth can be deduced. These rates, however, being annual, any seasonal variation is obliterated. Regular measurements of the same individuals at periods of a month are required in order to determine this seasonal variation if it exists, as it may be a factor of some importance in investigations in the future. At present, ignorance of the amount of such variation makes the comparison of the figures existing for growth of children in the open-air schools with that of normal children of doubtful value. The increase in weight of 12 children present during three successive years at Shooter's-hill amounts to 3.17 per cent. weekly, normal children at these ages growing at an average annual rate of .185 per cent. weekly. This comparison, however, includes two periods of the open-air school at the beginning and end which, with the existence of a seasonal variation, would be unjust. If the increase of weight is reckoned from the opening of the school in 1909 till its opening in 1911, the average is .257 per cent. weekly; if reckoned from the close of the school in 1909 till its close in 1911, the rate is .181 per cent, weekly. The mean of these gives. 217 per cent. weekly gain for the open-air children in two years as against a normal .185 per cent. gain. On the other hand, 30 normal boys in the ordinary school at Cator-street, during the 26 weeks, including the summer of 1911, gained weight at the rate of .326 per cent. weekly. Whilst at Kensal House, 10 weeks of the summer showed a rate of .48 per cent. against 10 weeks' winter rate .20 per cent. These considerations as to a seasonal variation of growth are borne out by a few observations which have been previously recorded elsewhere, although their interpretation has not always been taken as due to this supposed seasonal variation. Thus Wretlind, in Gothenburg, tried to show that children grew much faster during the three holiday months of summer than in the rest of the school year, which, indeed, was stated of the holiday school at Kensal House this year. Wahl, in Denmark, in an institution for girls weighing on 1st April and 1st October, found that the increase of weights of the summer half-year were one-third greater than in the winter six months. He noted somewhat similar growth in children who did not attend school. 12532 o 106 Annual Report of the London County Council, 1911. Malling Hansen, in the deaf and dumb institution at Copenhagen, weighed 72 boys daily for three years, and found a rapid increase in weight in summer and autumn, from the end of March till the middle of August, giving the chief increase of the year. Schmidt Monnard, further south at Halle, found two-thirds of the increase in weight was in August to October and one-fifth in November and December, the first six months of the year only accounting for a very small increase. It may, therefore, be taken that there is a seasonable variation in growth in weight, and that this accounts for a considerable amount of the increase noticed in the open-air schools. Now that schools are to be kept open through the winter, it will be possible to observe in some measure this variation, but such observation will scarcely suffice for the observation and determination of the standard seasonal variation in healthy children. A complete knowledge of any such variation is necessary before many problems which are now arising can be satisfactorily handled. Playground Classes. For the past year, Figure 3 shows the heights and weights of 49 children at Birley House, summed for the 14th, 24th, 34th, 52nd week of 1911, and 7th week of 1912, and the heights at approximately corresponding dates. There was a slackening here in the summer, chiefly due to prevalent enteritis resulting from intense heat, and after about the 44th week of the year the winter slackening in weight is noticeable, at the same period an accentuation in growth is obvious. This interesting subject is also referred to later in connection with Kensal House School. The playground classes described generally in previous years have been continued during 1911. Measurements of height and weight were taken in the playground classes of type A (central classes) and certain others, and at Cator-street, as already mentioned, a control measurement of children of the same ages in the ordinary classes of the school was made by observing 30 boys of various ages from 8 to 12, but of equal numbers at equal ages in the ordinary school classes. In 26 weeks the boys in the ordinary school presented an average weekly increase of .326 per cent. Those in the playground class, selected on account of debility, only gave about half this increase, namely, .154 per cent. weekly. The other classes of type A, that is central classes formed from delicate children selected from neighbouring schools as well, gave the following results:— Rochelle-street. Daniel-street. Turin-street. Weight. Numbers. % weekly increase. Numbers. % weekly increase. Numbers. % weekly increase. Ago. 9 — — 3 .400 — — 10 6 .661 7 .857 — 11 6 .262 5 .362 — 12 6 .237 3 .406 19 .212 13 3 .819 — — 12 .080 107 Report of the Medical Officer (Education). At the "Lawrence" the 20 children who got no school feeding were comparable with five who had meals and cod liver oil. The 20 "non-fed" showed an average weekly increase of .245 per cent. whilst the children on meals and oil showed. 252 per cent., a positive gain if their otherwise poor condition is remembered, but otherwise a difference of no signiflcance. At other playground classes chiefly type C, where the children are drawn from the particular school only and were in the playground for from 20 to 26 weeks, the following results were noted:— Weights, 1911 Gainsborough-road St. IV. (Boys). Queensmill-road. St. VI. (Boys). Ess.ex-street. St. IV. & V. (Girls). St. Paul's (Burdett-road), E. St. II. (Girls). Numbers. % weekly increase. Numbers. % weekly increase. Numbers. % weekly increase. Numbers. % weekly increase. Age 6 - - - - - - 8 .188 7 — — — — — — 17 .228 8 — — — — — — 6 .132 9 — — — — 7 .295 5 .131 10 — — 5 .273 9 .177 — — 11 1 .385 7 .166 8 .219 — — 12 4 .210 13 .160 9 .251 — — 13 30 .233 18 .213 3 .230 — — 14 3 .237 13 .090 — — — — The increase in weight in these playground classes is probably below the average rate except at Rochelle-street and Turin-street, where the children were specially selected by the doctor as being ill-nourished or diseased. At Turin-street the boys of 13 scarcely gained weight at all. As it was thought that possibly the fresh air and greater movement might have altered metabolism so that growth was accelerated, the weekly average percentage of growth in height was also taken out. On the measurements of 1906 the annual rates for normal children give a weekly height percentage at 9 of .077, at 10 of .077, at 11 of .065, but the open-air boys who did not gain weight so rapidly as the normal boys, at Cator-street, gave .094, whilst the indoor boys (normal conditions) gave .073. The other results were:— Percentage of height weekly increase April—Oct., 1911. Rochelle- Daniel-street. Turin-street. Gainsboro-road B. Queensmill-road B. Essex-street G. St. paul, Burdett-road,G. Age 6 — - — — — — .043 7 — — — — — — .047 8 — - — — — — .026 9 — .079 — — — .071 .040 10 .053 .099 — — .080 .079 11 .052 .079 — .042 .069 .071 12 .085 .119 .100 .039 .066 .095 13 .095 — .090 .080 .075 .080 14 — — - .011 .054 — — There is no obvious relation between the rates of growth in height and increase of weight in these various groups of children. Turning to other evidence of improved metabolism, there is the increase in haemoglobin content of the blood. The figures are difficult to set out statistically and yet give a just impression. It is best to say that nine out of ten children in the open-air schools or playground classes show a considerable gain in this respect. How much of this is due to seasonal variation it is also impossible to say, but enquiry on the subject is desirable. During the time in these classes there is a steady gain in vitality, as shown by the healing of ulcers and cure of eye and ear conditions. The first enthusiasm with which both the open-air schools and playground classes were received, amounted to an indirect condemnation of the school buildings and classrooms. Undoubtedly the cubic capacity of all elementary schools, and the amount of ventilation, is short of healthy requirements. The quantitative effects of the out-of-door schooling must, however, be somewhat discounted by the effects not hitherto noted of the seasonal variation in nutrition and growth which I have endeavoured to describe. At the same time the effects of bad ventilation in diminished metabolism show in the anaemia noticed in the spring. The effects of bad ventilation and gas lighting or stoves in giving off carbon monoxide, for which even in the minutest traces the blood has a powerful selective affinity, no doubt causes this to be a contributing cause of anaemia during the winter months. The increased brightness, the alertness and absence of fatigue poisoning referred to by all observers who handle these children, are conditions which must be reproduced in the classrooms. Actual space can be converted into potential space by greatly increased window opening. In future schools, practically the whole outer wall should disappear for the greater part of the year; this is the only choice between nearly doubling the school capacity and a costly system of mechanical ventilation separate from the scheme of heating. 13532 0 2 103 Annual Report of the London County Council, 1911. The playground classes, then, certainty aid the children by their frequent exercises, bring out their mental qualities and further their education without noticeably interfering with health; beyond this they help the children to maintain a struggle for health against the ill effects of home environment, want of air, want of rest, want of clothes and food. The open-air school, with its scheme of broken-up lessons and of rest and feeding, goes a little further than the playground class. The merely debilitated child gains considerably, but the main portion of the group of children who attend are not cured; perhaps only a minority can be said to be materially or permanently relieved. The children who run temperatures, the children with lung conditions and with tuberculosis can be dragged along through school life, but they do not pass out fit. The residential school of recovery first suggested seven years ago (Report, 1906, p. 44), is becoming, with increasing knowledge, an absolute necessity as an adjunct to the public educational 3ystem. Experience of one or two schools for 120 to 150 such children should now be obtained. Whether they are treated as educational institutions, which would be best, or as public health institutions, they are a necessity for the public provision for ailing childhood. As shown on p. 23, during the ten years I have been in charge of the medical supervision of London elementary schools a third of a million has been actually paid out for the education of children who died of tuberculosis before they were out of their' teens. If the expense of cripple schools and of hospital and other medical treatment is added, the cost of this disease in school children in London in that time ran into a round million of pounds. Yet, whilst the residential school of recovery would take the child out of its environment of darkness or dirt or even tubercular infection and restore it to as healthy a condition as possible, it cannot wipe out the results of a defective heredity, or entirely prevent the recurrence of effects on a return to the old environment. The causes of most of the debility and ill-health seen among school children are the social conditions arising from sweated land, bad housing and hopeless poverty. "Prevention is better than cure," wrote John Locke, "and much cheaper." If, however, prevention cannot yet be accomplished, then the symptoms must be relieved. The school of recovery has not yet been tried, but the open-air school and playground classes have beneficial effects on the few children who have attended them. Improved housing is necessary in the schools themselves, and on these lines a very considerable extension of arrangements for many more children is necessary in the near future. The novel idea of a tuberculosis school, weighed and considered for several years, has ultimately taken shape in Kensal House. Towards the end of 1907 attention was drawn to the action of the Paddington Dispensary for the Prevention of Consumption in their efforts o avoid the spread of tubercle among the school children. Some instructions regarding tubertular cases were issued to managers of the Paddington schools early in 1908. A scheme for a tuberculosis school was drawn up during the year, and submitted in February, 1909. A year later, March, c910, the Council agreed to open this school, which was done in March, 1911. Kensal House stands In its own grounds of over three-quarters of an acre in extent, abutting on the Paddington Canal. It ihas large rooms, and the premises are accessible from the whole district of Paddington and North Kensington. The accommodation used for school purposes is confined to the ground, first floor and garden. Provision was estimated for 120 children, but at the end of the year this was cut down to 90, owing to room being wanted for cooking. The school as first projected was for children suffering from or predisposed to tuberculosis, or in an environment likely to infect them, and for children who have been discharged from sanatoria. The children were to be watched and educated, especially in the value of cleanliness, fresh air and exercise, and the dangers of tubercular contagion. This is the only logical kind of tuberculosis school. The ideal could not be put to the test, as under the Act of 1899 the Board of Education could not recognise the school unless they were satisfied that every child admitted was actually suffering to such an extent from tuberculosis that it could not properly benefit from education in the ordinary elementary school. The idea of the school as an educational instrument for prevention in the case of those otherwise likely to become infected had to be abandoned, and it became an institution for helping those already invalided from the ordinary schools. To make the best of the circumstances an agreement was arranged with the Paddington Dispensary. The Committee of this institution was to take the premises, carry out all alterations and repairs necessary, pay all rent, taxes and other outgoings, provide gas and electric meters, and give the Council facilities for storing wood and coal. The Council to provide furniture, books and other equipment, pay for teachers, heating, lighting and cleaning, and if meals became necessary to provide service and preparation, whilst the Dispensary Committee found the cost of food. After a few weeks' work the occurrence of feverishness among the children called for notice. The reason was that this tuberculosis school differs from all others in admitting children who are suffering from active disease. Treatment in tubercular disease is mainly to obtain local rest, so that the tissues may not become invaded by the toxic poisons of the tubercle bacillus. This auto-intoxication has to be kept down whilst sufficient exercise is taken to sustain or improve physical condition. The cases of active tubercular bone or joint disease attending the cripple schools have local rest procured by immobilisation of the affected part in splints, or by the use of plaster jackets or supports, so that any noticeable amount of fever among these tubercular children is comparatively rare. In phthisis, or pulmonary tuberculosis, the lungs must move to keep up respiration and absolute local rest is impossible. A relative amount of rest is only procurable by general rest. Formerly this was accomplished by confining the patient to a bedroom, but now that the stimulating effect of fresh air is better appreciated, such patients pass much time in the open air, and are allowed gentle walking exercise so long as fever does not show. Any rise of temperature is taken as a guide to excess of exercise. In the children's wards of consumption hospitals or sanatoria, experience shows that a good deal of play is of advantage to spirits and health. Every now and then a child oversteps the mark, and so from day to day play has to be reduced for a time or even absolute rest prescribed. Kensal House Tuberculosis School. Report of the Medical Officer (Education). 109 No general experience had, however, been obtained of a tubercular school where the children had active, although not acute, disease. For those whose disease is in an active condition the tuberculosis school is more of a medical and remedial nature than educational, and schooling proper has, therefore, to be guided and varied according to the medical requirements shown by temperatures. Although it was not necessarily an open-air school yet the arrangements made at Kensal House were on the basis of such schools, and provided work, rest and play, but no feeding. Some of the children had not only a long walk twice daily between home and school, but repeated this in going also to and from dinner each day. Much rest had to be provided, and all physical exercise of a violent nature avoided. The games in such a school should be so regulated that any child reacting unfavourably can be withdrawn from undesirable exertion. The manual work also must not be too heavy. Medical supervision has to be continuous. There is a great advantage in the Paddington scheme in home conditions being known, and the source of infection, apparently almost always an adult, being traced. The child and all the members of its family are examined, and on admission to the school a very exact record of each pupil's condition is made. With such a population as London to work among each suspected child ought to be inspected under X-rays, as physical signs are rarely marked in these children, and without the knowledge of environment it would be very uncertain work to attempt positive diagnosis in the best cases for this educational treatment. Recent work in Mannheim, indeed, showed that 42 per cent. of the 236 children suspected in school of tuberculosis, failed to react to Von Pirquet's tuberculin test, and were consequently to be taken as free from this disease. The nurse records the temperature of each child morning and afternoon and the weight once a week. Children who show a morning temperature of 99 deg F. or more, rest on a couch for the rest of the day. An afternoon temperature of the same amount puts them on the resting list for next day. Children who reach 100 deg. F. are to remain in bed at home till seen by the dispensary doctor. At school the children are medically examined from time to time, the report cards gone over and the parents invited to be present and confer with the doctor. On 29th June, 1911, a report was received from the Board of Education dealing with the school, setting forward the idea that it should be conducted more on the lines of an open-air school, and complaining of the lack of opportunity for adequate meals. These two last points are of very considerable importance. It would probably be better to assimilate such a school to open-air school practice as much as possible. The question of feeding the children is of supreme importance and will be discussed later. The medical officer in reporting on the school could, therefore, only confirm the criticisms of the Board. The children attending had now been divided into three groups:— (i.) Those whose temperature in the preceding week had exceeded 99 deg. F. in the morning or 100 deg. F. in the afternoon. (ii.) Those above normal, but not above the limits of the first group. (iii.) Those never above normal (98.4 deg. F.). Badges were worn: blue, green (now replaced by red), and white, to distinguish the children of each group. The first group have to rest all day, and their education is confined to oral methods or silent reading. The second group can do ordinary lessons, but must be considerably restricted in physical exercise, drill, or play. The third group are the ordinary open-air school children. Were it not that being at home really means playing, sometimes, indeed, violently and excitedly, in the street, the first class of cases should not be in the school; they are only suitable for a school sanatorium. The home journey to and fro, till recently often duplicated in the dinner hour, was entirely harmful to them. Nevertheless, the oral teaching and silent reading in school do much to check the moral evils which may spring up through the negative features of the usual treatment. The provision of meals was much discussed. In many cases parents insisted on children, even with fever, going home to dinner. This was discouraged, with the approval of the Board of Education who still pressed for the provision of a suitable and substantial dinner for all the children, followed by a rest of two hours. The clashing of different authorities, often viewing the same subject from a different standpoint and with differing purpose, the intense interest which each authority took in this pioneer work, made it difficult to get smooth working. The Board of Education requirements, the Council's desire to meet them, and yet to aid the Dispensary Committee in carrying out their scheme, and this Committee's desire to work on certain definite lines in conformity with the rest of their general plan, led to numerous conferences and suggestions. It was finally decided that the medical work should be regarded as chief, the educational as subsidiary, and that medical treatment should be carried out in its entirety by the Dispensary Committee. The managers were also to take responsibility for feeding. In November the Board of Education considered it essential that the children should not be allowed to go home or to bring their own dinners, but that a satisfactory meal should be furnished at the school for all the children. This is now arranged. All children rest from 11.30 a.m., dinner has to be in two batches, boys 11.55 to 12.30, girls 12.30 to 1.5; all the children resting till 2 p.m. Each child, therefore, has one and a half hours' rest during the mid-day interval of school. The results of the school cannot yet be set out in figures or even in qualitative assertions. Probably they will not nearly come up to the first expectations with which the school was proposed. The records, however, have already enabled an indication of the seasonal variation in growth n weight already referred to on p. 17, to be obtained. On visiting the school in the tenth week of 1912, the nurse drew attention to the fact that since school feeding had begun the children were not increasing weight at anything like the rate they had done previously. This was probably, however, merely seasonal and not due to school feeding. 110 Annual Report of the London County Council, 1911. There is much variation in these children partly due to their disease; for instance, one 12 year old girl weighed 25.5 kilo., whilst her neighbour of the same age weighed 48.0 kilo. The normal for their ages being 32. The average weights were taken for children aged 9—13, of whom there was a full record, as below:— At 25th week. Age last birthday. Sex. Numbers analysed. 1911. 1912. 25th week. 35th. 45th. 50th. 5th. 10th. 9 Boys Girls 11 6 23.40 21.93 23.78 22.30 25.16 23.50 25.52 23.82 25.88 23.73 26.08 23.95 10 Boys Girls 6 7 27.45 26.56 28.25 26.88 29.59 28.14 30.29 28.63 30.79 28.81 30.91 28.88 11 Boys Girls 6 7 28.35 27.93 29.51 28.74 30.06 29.90 30.40 30.21 31.11 30.74 31.41 31.16 12 Boys Girls 6 7 33.73 32.11 33.95 33.11 35.45 34.73 36.13 35.06 36.43 35.93 36.90 36.44 13 Boys Girls 4 2 28.00 28.80 28.65 29.40 30.32 31.45 30.60 31.15 31.47 31.50 31.62 31.90 Totals Boys Girls 33 29 27.47 27.42 28.08 28.06 29.39 29.42 29.82 29.74 30.32 30.13 30.57 30.44 Average weights at different times of groups of children at Kensal House School. If the percentage rates of growth are calculated as weekly percentages for these periods they are very concordant throughout, as shown in the table:— Age at 25th week. Sex. 1911. 1912. Whole period 25th week to 59th week— 37 weeks. Normal children 52 weeks (annual). 25th to 35th week. 35 th to 45th. 45th to 50th. 50th to 57th 57 th to 59th 9 Boys Girls .15 .16 .60 .54 .14 .13 .15 .03 .08 .09 .301 .295 .161 .173 10 Boys Girls .29 .12 .55 .47 .15 .17 .17 .06 .05 .03 .304 .295 .161 .165 11 Boys Girls .41 .29 .16 .40 .12 .10 .25 .17 .10 .13 .299 .301 .163 .190 12 Boys Girls .05 .31 .46 .48 .20 .09 .08 .24 .12 .14 .295 .305 .161 .221 13 Boys Girls .25 .21 .60 .69 .10 .09 .28 .11 .05 .13 .305 .292 .233 .252 All the 62 children Boys Girls .22 .23 .47 .48 .28 .22 .24 .19 .16 .20 .300 .300 .170 .192 Kensal House children, weekly percentage growth in weight for different periods 1911.12. The last column for normal children in this table is from annual averages, and the group figures in the bottom row are for the same age distribution of boys and girls as in the Kensal House total figures. Since the above table was compiled the rate of growth from 10th to 14th week of 1912 for the same boys and girls is .11 and .12 per cent respectively. This means that in the 35th to 45th week of last year these children put on weight of ten times the rate they have done (with increased feeding at school) during March of this year. These figures for Kensal House along with the facts given under the open-air schools, demonstrate the existence of a seasonal variation in growth. This is of great importance, and must be accurately determined for normal children by a careful special enquiry yet to be made. The establishment of this school at Kensal House has been the means of bringing to light a new stratum among debilitated children, long suspected, but never definitely ascertained. The battle with tubercle has to be gone through by everyone in the first few years of life. In a community like London the maintenance of a high average of the public health actually depends on the 111 Report of the Medical Officer (Education). maintenance of some infection by the causes of disease. Those affected need never suffer malaise, but they acquire and maintain the amount of immunity required to prevent epidemics, and catastrophal outbreaks. Tubercle as an infection is probably more ubiquitous than measles and although everyone acquires it, yet few become diseased. Not more than three children in a thousand in school, present evident phthisis. Yet searching the families of adults suffering from tubercle, children are found coming from such an environment, who are themselves infected and the observations taken in the school have shown that the majority are seriously infected. Only long observation can determine how extensive this infection is, and whether the main factors contributing to serious or lethal disease are heredity, debilitated physique or infection. It is possible from the Registrar General's records to reconstruct the facts for London so far as fatalities are concerned, but it is yet impossible to even estimate how many of those infected seriously are able to recover. That, however can be left for the moment. Dr. Letitia Fairfield by taking the ten years 1900-09 in order to average infectious diseases,ascertained that the mortality for London as deduced from the figures of the Registrar General, and re-arranged by interpolation in years of life, give for the common infections (measles, whooping cough, scarlet fever and diphtheria) and for tuberculous disease, the following numbers of deaths. Ages. 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15-20 Tubercular diseases 2,732 1,777 1,343 995 880 715 545 415 354 408 430 478 506 4,490 imfectious diseases 7'183 4,763 3,097 1,650 l,50 863 503 330 190 134 90 60 45 180 By applying actuarial methods, these deaths can be shown to represent an amount of money paid out for schooling for the education of children who die before they are out of their teens. For the ten years the amount of schooling over five years of age given to tubercular cases came to 68,880 years, and for the infectious diseases deaths, 13,249 years of schooling. Taking the annual cost of education as £4 15s. per head annually, this represents £62,966 spent in educating children who die of infectious diseases and £327,185 on those dying of tubercular diseases in the period considered. This is money almost lost, as the children died before they had passed out of their teens, and therefore never made any adequate return for it. The estimate does not make any allowance for the cases who survive crippled or in chronic ill-health. If the deaths are so numerous it may be assumed that the ill-health without death is also extremely costly to the community. These children are from homes where generally an adult is infected They may, therefore, be assumed if anything to have something of hereditary tendency to want of immunity. A study is required of the sources of infection and particularly infection by non-relatives. The home is likely to be itself infected. The child even if normally able to resist infection is still almost continuously exposed to it, and frequently possibly in more massive doses than are usual. The maintenance of robust health is necessary in such surroundings if infection is to be avoided. Adult men from fatigue and possibly also dust encountered in their work, are the most liable to infection. When the bread-winner is affected, as is so commonly the case, the invariable rule is a slow sinking of the family into poverty. The children, already possibly of weak immunity by inheritance, from want of food, and the surroundings and pressure of this poverty, want of sleep, of play, of clothes, of cleanliness are reduced to conditions of health which make infection almost a certainty. If tubercle is an infection pure and simple, predisposed to by the debility of overwork, and the want of vitality due to bad housing, poor wages, and caused by infection from other persons in the community, it is the duty of the community to come to the aid of the sufferers, whether actually diseased, or in danger of disease, and relieve them fully and freely. But even if the tendency to tubercle be largely inherited, that inheritance in the case of the bread winner or child, is aggravated by the conditions of life imposed by low wages and scanty living room. It is in the public interest to do all that is possible to relieve the tubercular child and to aid its natural tendencies to recovery. The chief aid that can be given is nutritional by the supply of plenty of good food, and the stimulation of metabolism by fresh air. Mid-day dinners can hardly be said to be sufficient. What ever in any way interferes with this supply is a direct obstacle to the child's chances of a healthy life. In addition, freedom must be procured from continual infection and from the care and worry, which affects even the children, of a sinking home. For these children so definitely affected that they wear the blue badge in school, the Tuberculosis School is only better than nothing, for the others, it is insufficient for their needs. They ought to be removed from the town altogether, and from their homes, and live with plenty of space in residential convalescent schools or camps of recovery. Hitherto the school authority has not been able to do much against tuberculosis. Indeed the public health authorities have been very lax in regard to this disease, which is the chief single cause of disablement in adult life in this country. A great deal has been written and talked about the importance of tuberculous milk, and this has been enormously exaggerated as a factor in dissemination of disease, whilst the other contributory factors have been much neglected. The tubercular cow has, unfortunately, turned attention to itself, but it must be vanishingly small compared with the tubercular person as a cause of disease after the first year of life. Heredity from the past is almost unalterable in the present, but other conditions of debility notably the depressing factors, want of food, chronic fatigue, alcohol and the irritating factor of dust and infection are ail more or less within immediate control if the price or control is paid. The tuberculosis tax must be paid in money or lives. 112 Annual Report of the London County Council, 1911. Residential schools. Secondary and trade schools. Training colleges. Permanent service. References. Scholarships and candidates for teaching profession. In the schools, obvious tuberculosis is cared for, so far as crippling diseases are concerned in the invalid schools. The provision for many of these cases is incomplete and insufficient in that there are no residential schools. The dangerous variety of tuberculosis, where the patient becomes infective to others, exists in obvious conditions in about three per thousand of the children in school. There is the whole strata of the child population already described, struggling chronically against this disease, who, in spite of neglect probably will recover, but damaged for life. They need help of the kind of which the Kensal House school is a beginning, but the help must go much further than at Kensal House. The children known to be tuberculous from school inspections, have been listed. The names entered in 1910 numbered 564, and in 1911 were 1,228. As the mortality at school ages in London from tuberculous diseases recorded by the Registrar-General's returns, exceeds 500 a year, it is obvious that these school lists are very defective. The new tuberculous regulations and the coming of the Insurance Act will make effective following up of all tuberculosis cases a necessity. This following up is only possible by joint action of the Council and the borough councils. The final solution of what is tobe do ne in the case of poor tuberculous families is, however, a problem depending on the answer to many points which at present it would almost seem pedantic to discuss, but which are worth close and exhaustive investigation as they will affect millions of public expenditure in the near future. The treatment of ringworm at some of the residential schools might give rise to trouble. Arrangements have now been made to treat all suspicious cases at once with tincture of iodine, and to have any cases requiring it removed to the Metropolitan Asylums Board ringworm school, on the certificate of the medical officer. Cases of ophthalmia or trachoma occurring in residential schools ought also to be removed. The question was raised in connection with a boy with some eye trouble, who was brought from Mayford to Upton House to benefit by hospital treatment. The surgeon at the Royal London Ophthalmic Hospital, became suspicious of the development of trachoma, and it was proposed to send the boy to the ophthalmic school, but the Metropolitan Asylums Board stated that they were unable to arrange for his admission. The greatest difficulty in secondary and trade schools is in connection with the treatment of dental defects. The results are better in the girls' schools than in the boys' schools. Medical inspection reveals pupils suffering from septic conditions of the gums of which they were quite unaware, but the treatment obtained is often far from satisfactory. There is seldom any attempt to stop the teeth, and some dentists appear to have little appreciation of the aseptic aspect of the case. In some training colleges the number of dental deficiencies is excessive; it is attributable to extra county and particularly Welsh students who have neglected their teeth in early life, and who are either wearing false dentures in the training colleges or have to be advised to do so. Examination of Candidates. 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 5,975. They may be classified according as they are examined for the permanent service, under special references, or for the award of scholarships. The first division includes all who work on the staff of the various educational institutions; these are teachers and instructors, matrons, nurses, schoolkeepers and caretakers in all classes of educational establishments under the Council. The Appendix IX. 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 one year of leaving college. Of the 267 referred candidates 9 (5 male and 4 female) were referred a second time owing to the conditions not having been remedied, viz., 3 (1 male and 2 females) to a dentist; 5 (4 males and 1 female) to an oculist; and 1 female to an oculist and also for anaemia. Of the candidates referred a second time, 1 female was referred for two defects. In addition to the first examinations, 763 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. 115 of the Regulations with regard to the Education Service, and to teachers about to be superannuated. In addition, about 200 claims were received from teachers for exceptional treatment as regards sick pay, in respect of absences alleged to have been due to infectious illness contracted directly in the course of the teacher's employment. The medical examination of candidates for the Council's scholarships serves a triple purpose. It prevents unsuitable scholars from taking up awards; it is a factor in promoting the health and wellbeing of suitable scholars by insisting on the remedying of remediable defects; and it safeguards the Council against pecuniary loss due to the payment of grants to scholars who are physically unfit to take advantage of a scholarship, and whose ultimate breakdown is but a matter of time. The scholarships and awards granted by the Council fall 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— (а) 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. 113 Report of the Medical Officer (Education). The County 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 school 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 medical examination of junior county scholars 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 14 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 from 16 to 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 of the age of 18 and upwards who desire to pursue a course of study at an institution of university rank. Appendix X. shows the number of candidates examined and the conditions found. Of the 825 junior county scholars who were referred back for various defects, excluding those 28 whose scholarships were finally withdrawn, 197 (67 boys and 130 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 for— Want of cleanliness. (1) Vision. (2) Teeth. (3) Throat. (4) Ears. (5) Ringworm (6) Skin. (7) Nose. (8) Boys 3 30 5 26 - 1 2 5 Girls 74 35 3 17 2 3 - 1 Some of the scholars were referred again for more than one defect. Of the 97 supplementary junior county scholars who were referred back for various defects, one boy was referred again owing to defects of throat not having been remedied, and two girls were also referred for defects of vision and one girl for teeth. Of the 38 intermediate county scholars who were referred for various defects, 1 boy was referred again as he had not obtained satisfactory treatment for defective eyesight. The following table shows the nature of the defects of 28 junior county scholars who were rejected; one was rejected for two defects. Want of cleanliness (1) Vision. (2) Teeth. (3) Throat. (4) Nose. (5) Tuberculosis. (6) General health. (7) Boys 1 - 1 - - 1 1 Girls 21 1 - 1 1 1 - Two supplementary junior county scholars (girls) were rejected owing to unsatisfactory personal hygiene. Of the candidates passed as fit 93 junior county scholars, 8 supplementary junior county scholars, and 2 intermediate county scholars were accepted with defects that did not easily lend themselves to treatment but which would not interfere with their studies. 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 X shows the number of candidates examined in connection with each award, and the conditions found. 12532 P 114 Annual Report of the London County Council, 1911. Of the 177 who were referred, 25 (1 boy, 24 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. (1) Number referred a second time. (2) Referred for Want of cleanliness. (3) Vision. (4) Throat. (5) Teeth. (6) Nose. (7) Skin. (8) M. F. M. F. M. F. M. F. M. F. M. F. M. F. Borough Polytechnic 1 1 Cookery 2 2 Corset-making 2 1 1 Dressmaking 2 1 1 Laundry work 5 5 Millinery 2 2 2 Ready-made clothing (designing 6 3 1 1 1 and making of) Tailoring (ladies) 2 1 1 Upholstery 3 2 1 Waistcoat making 1 1 Some of the scholars were referred again for more than one defect. 9 candidates (7 boys, 2 girls) were rejected for reasons set out below. One of the candidates was rejected for two defects— Scholarship. (1) No. rejected (2) Reason of rejection. Want of cleanliness. (3) Throat. (4) Teeth. (5) Vision. (6) Sundry. (7) m. f. m. f. m. f. m. f. m. F. m. F. Artificers, boy 2 1 1 (Poor physique) Building 1 1 Cookery 1 1 (Heart disease) Furniture and cabinet making 1 1 Mercantile marine 2 1 1 1 Ready-made clothing (designing and making of) 1 1 Tailoring (ladies) 1 1 The Council has made provision for a number of awards of a special character which cannot well be classed as trade scholarships. Appendix X. shows the number of candidates examined and the conditions found. Of the 326 special scholarship candidates who were referred 79 junior domestic economy scholars (girls) were referred a second time owing to defects not having been remedied. The defects are indicated in the following table— Scholarship. (1) Number referred a second time. (2) Referred for Want of cleanliness. (3) Vision. (4) Throat. (5) Teeth. (6) Nose. (7) Anaemia. (8) Ears. (9) Domestio economy, junior 79 56 15 4 2 1 2 4 Some of the candidates were referred again for more than one defect. Forty-three (2 boys 41 girls) were rejected for reasons set out below. Some of the candidates were rejected for more than one defect. Scholarship. (1) Number rejected. (2) Reason of rejection. Want of cleanliness. (3) Heart. 4 Teeth. (5) Vision (6) Anaemia. (7) Sundry. (8) M. f. m. f. m. f. m. f. m. f. m. f. M. f. Art 1 1 1 cerebral trouble. Cripple 1 1 spinal caries. Domestic economy 41 35 1 4 1 1 tuberoulosis. Report of the Medical Officer {Education). 115 The Council's 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 handicrafts not less than 14 on the 31st July in the year of the award); 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 XIII. Of the 461 candidates who were referred, 35 (3 males and 32 females) were referred more than once for reasons indicated below— Awards. (1) Number referred a second time. (2) Referred for Want of cleanliness. (3) Throat. (4) Vision. (5) Anaemia. (6) Nose. (7) Hearing. (8) m. f. m. f. m. f. m. f. m. f. m. f. m. f. Bursars 1 12 1 4 3 3 1 1 Pupil teachers 2 3 1 Pupil teachers of handicraft 5 3 1 1 Student teachers 9 6 3 Training college students 6 3 1 2 Some of the candidates were referred again for more than one defect. Nineteen candidates (6 males, 13 females) were rejected for the reasons given in the subjoined table— Awards. (1) Number rejected. (2) Causes of rejection Want of cleanliness (3) Hearing. (4) Vision. (5) Heart. (6) Sundry. (7) M. f. u. f. M. E. u. f. M. f. m. f. Bursars 6 2 3 1 glands Student teachers 1 2 1 1 1 goitre Training college students 5 5 1 1 1 . . 1 bronchocele 1 systolic murmur and albuminuria 1 voice 1 laryngitis 1 paralysis 1 Grave's disease 1 tubercular nephritis It is a very great hardship indeed, that persons who have spent years in training for the teaching profession, may be finally rejected as unsuitable for superannuation on some medical condition which when the sheltered condition and the great expectation of life of teachers is considered, probably will not, on the whole affect a member of the profession as it would a member of the general community. Candidates for the teaching profession ought to have the option of medical examination as qualification for superannuation should they pass their examinations at a much earlier age, say, seventeen, and should not be rejected for intercurrent illnesses, which leave comparatively trivial defects, such as slight roughness of a heart valve, after years spent in training. There ought in any case to be definite rules formulated by the department as to the conditions which are acceptable or non acceptable. Personal Hygiene Schemes. The London County Council (General Powers) Act, 1907, and the Children Act, 1908, confer upon the Council as the Education Authority the power of conveying to suitable premises and cleansing children found to be verminous after the parents have been duly notified of the condition. To utilise the powers thus conferred, the Council has arranged for 24 cleansing stations to be opened ultimately, but pending the completion of these arrangements, the original scheme for securing the treatment of verminous heads has been continued with the success experienced in former years. The procedure of this scheme is as follows:— The school nurse examines all the children at a school and notes the condition of their heads, using strict precautions against contagion. The head teacher is then supplied with a white card for each child whose head requires cleansing. The card, which draws attention to the condition and contains directions for cleansing, 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 12532 p 2 Elementary Schools— Verminous Heads. 116 Annual Report of the London County Council, 1911. Elementary Schools— Verminous persons and clothing. details is filled up by the nurse for each child still unclean. 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 these children, who, if still unclean, are excluded. After exclusion the divisional superintendent takes out a summons under the Attendance By-laws; but if any child is properly cleansed before the hearing, it is re-admitted to school, examined by the nurse and the summons is not pressed, the circumstances being explained to the magistrate. The following table shows the result of the cleansing scheme as applied to heads (1911)— Departments(1) Number of Children Examined(2) Number Clean number verminous and white and white cards served (first notice) (4) Number of red Cards served (Final Warning)(5) Numberproposed by nurse for Excusion(6) Number Excluded for Prosecution(7) Number Prosecuted(8) Boys 873 852 21 8 3 3 — Girls 45,119 37,626 7,493 4,921 3,809 2,689 257 Infants 17,622 15,835 1,787 1,082 743 482 32 Mixed 5,662 5,148 514 324 260 202 25 Special 638 501 137 86 59 35 1 Totals 69,914 59,962 9,952 6,421 4,874 3,411 315 The parents of 315 children were prosecuted, and fines varying from 2s. 6d. to £1 imposed. The percentage of children found to be verminous to children examined, was 14.2 in 1911, as compared with 22.4 per cent. in 1910. The head cleansing scheme was commenced under the School Board. It still gives very good results in districts where the cleansing stations are not in operation. The hair nowadays is much better cared for, and this cleansing scheme is very useful among the better class children who could not be sent to the cleansing centres and would often remain infected if not dealt with under the scheme. Often a medical certificate is obtained that the child is free from infectious disease, sometimes indeed from all "traces of vermin ; " supported by these the parents are naturally indignant with the nurse's judgment which, however, is generally correct. The strictness shown towards scholarship candidates in respect of cleanliness of the head has reacted on the elementary and secondary schools. Only a very small proportion of scholarship children are rejected on this account and they are generally undesirable on other grounds. As stated above, the Council has decided to exercise the powers for the cleansing of verminous children conferred upon it by the London County Council (General Powers) Act, 1907, and the Children Act, 1908. Clause 3 of Section 122 of the Children Act provides that the local education authority may require the local sanitary authority to permit the use of premises and appliances erected for the cleansing of the person or the clothing of persons infested with vermin. In view of this clause the Council has entered into agreements with nine sanitary authorities (City, Stoke Newington, Hackney, Poplar, Bermondsey, Camberwell, St. Marylebone, Hampstead, Woolwich) and is negotiating with five others (Battersea, Greenwich, Westminster, St. Pancras, Southwark) for the use of such premises and appliances. The agreements stipulate inter alia that the sanitary authority shall cleanse children attending elementary schools who shall be sent to the station by the Council, usually at the rate of 2s. a head for any number of cleansings within one calendar month from the date of the child's first attendance. In addition to these arrangements the Council has five stations (Finch-street, "Chaucer," Bath-street, Fountain-road, Sedlescombe-road) and is adapting premises or negotiating for the use of premises in four other instances, viz., Frankham-street, Lauriston-road, Pakeman-street and Sirdar-road. The scheme adopted provides that the school nurse visits the school, examines all the children who are in a foul or filthy condition and supplies to the head teacher for each child a card drawing attention to the condition found. The card is placed in a sealed envelope and given to the children to take home. The school nurse forwards to the nurse in charge of the cleansing station to which the school contributes the names of the children concerned. After 48 hours, the nurse in charge of the cleansing station visits the school and examines all children who have had cards, and those cases not cleansed are separated from the other children. The divisional superintendent is asked to serve upon the parent or guardian a statutory notice requiring the parent or guardian properly to cleanse the child, and the medical officer of health for the district in which the child resides is notified so that the home may be dealt with under the London County Council (General Powers) Act, 1904, Part IV., if necessary. When 24 hours have elapsed after the serving of this notice, the nurse again examines the children, and conveys those still unclean to the cleansing station for compulsory cleansing. An opportunity is afforded to the children to attend at the cleansing station voluntarily. If a child again attends school in a verminous or foul condition after having been compulsorily cleansed at a station, the divisional superintendent is asked (1) to serve a second statutory notice requiring the parent or guardian properly to cleanse the child and (2) to take police court proceedings against the parents. A complete report on the scheme cannot be made until all the projected stations are working, as until the scheme is complete, separate stations are so overworked that the results in the individual schools are not satisfactory. But the definite improvement in schools which are well situated with regard to cleansing is more than can be expressed in figures of children cleansed. The children come better clad, and where, at the first glance almost, the nurses used to find all the garments infested with vermin, they DIPHTHERIA All Persons. Children attending Public Elementary Schools. DIPHTHERIA SCARLET FEVER All Persons. Children attending SCARLET FEVER 117 Report of the Medical Officer (Education). need now carefully to examine under-garments to discover the conditions. Still, the reports are that there is so much work that the nurses attached to the centres cannot fully cope with it. During the year 53 parents were fined amounts varying from 2s. to 10s., and costs. The work done by the nurses and the nine cleansing stations may be summed as under— Departments. Number examined. Number clean. Number verminous and card M.0.24 ge ved. Children returned clean. Number on whom statutory notices served. Number cleansed at L.C.C. stations. Prosecutions. (1) (2) (3) (4) (5) (6) (7) (8) Boys 84,581 79,196 5,385 1,909 3,476 2,006 96 Girls 83,239 78,187 5,052 1,550 3,502 1,856 120 Infants 68,453 65,398 3,055 1,102 1,953 810 22 Mixed 12,080 11,256 824 262 562 272 29 Special 3,239 2,662 577 153 424 265 18 Totals 251,592 236,699 14,893 4,976 9,917 5,209 285 The personal hygiene scheme in girls' secondary schools and kindred institutions has continued in operation during the past year. The scheme was applied for the first time to one boys' school during the last term of the year. The inspection is carried out by the two assistants to the superintendent of nurses, one working in institutions north and the other in institutions 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 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. In order to deal with obstinate cases, it has been decided that in the case of a scholarship holder, the scholarship should be withdrawn, and in the case of a fee paying pupil, the pupil should be permanently excluded from attendance at the institution, provided that at least four weeks shall have elapsed between the first and last occasions. Few cases are unsatisfactory at the second visit, and still smaller number at the third, but during the year 13 pupils (girls) were proposed for permanent exclusion from the institutions owing to unremedied defects in personal hygiene. The following table shows the conditions found during the past year. Examination. No. of Pupils. No. of verimous heads found. Percentage of unclean heads on the pupils examined. Boys. Girls. Boys. Girls. Boys. Girls. Spring Term, 1911 — 3,599 — 172 — 4.8 Summer Term, 1911 — 3,679 — 209 — 5.7 Autumn Term, 1911 98 4,288 12 366 12.3 8.5 Infectious Diseases. The principal zymotic diseases in relation to elementary schools are measles, diphtheria, scarlatina, and occasionally, out of all proportion to its numerical importance, small-pox. From year to year in this series of reports, various aspects of these diseases have been dealt with in relation to school work. So long ago as 1893, the Medical Officer of Health pointed out that the summer vacation might afford an indication for ascertaining the influence of school attendance on notifications of infectious diseases. Each year a table has been published in the Report of the Medical Officer of Health, in which, by the use of percentages, of one month over the preceding, the effect has been set out so as to be unmistakably manifest. It varies considerably in its extent from year to year. There is, undoubtedly, some diminution in the number of notifications of infectious disease occurring during the periods of infection concurrent with the school vacation. Considering what the popular idea is of schools as centres of disease, the effect is surprisingly small. But the reduction of notifications by no means postulates reduction of disease through this cessation of school attendance, nor does it prove that school is a factor of any importance in relation to the zymotic diseases. There are indeed, reasons, as I showed in a statistical paper in 1896, for regarding school attendance as protecting children from risks of infection in a similar way to which it protects them from risk of death by accident. The aim in London, in regard to infection, has been to make the school safer than the street. The holiday effect is a reduction which appears to amount to 15 or 20 per cent., but it has been already demonstrated by school enquiries in London, that during the vacation there is a reduction of 15 to 20 per cent. in the child population, and this exodus of children has frequently been noted by country medical officers of health as being the means of introducing infectious diseases locallv. Even this, however, is masked to some extent by a much more potent factor, for many cases are brought to knowledge entirely through the efforts of school officials. The notifications of diphtheria and scarlatina are considerably swollen by cases of sore throat sent home from school, which, as shown later account for about one-fifth of the cases of scarlatina, and in the case of diphtheria include also the carriers discovered by the bacteriological results of school investigations. Secondary schools and kindred in. stitutione— Verminous heads. Zymotic diseases and school. 118 Annual Report of the London County Council, 1911. In a general enquiry in the Battersea area of south-west London in 1909, and a subsequent investigation by Dr. Thomas, on the sources of infection in diphtheria cases, it was pointed out that there is a factor acting exclusively on school children which affects the notification of infectious disease during the school term—the system of visitation at the homes by the attendance officers whenever a child is absent, and the prosecution of the parents if satisfactory reasons for absence are not forthcoming. Possibly no other public service compares in efficiency and universality with this in its action on the whole population. Parents know that if they have no reasonable excuse, prosecution will follow; during school term, therefore, there is great pressure upon parents to seek medical advice in order to satisfy the visitors. This ceases with the holidays, and it is probable that numbers of mild cases are missed at these times, whereas they are frequently brought to light whilst the school visitors are active. In many of the 99 cases of diphtheria which Dr. Thomas investigated, it was found that the school attendance officer's visit preceded any notification, and this last was due to his demands for a doctor's certificate. The discriminative requirements of the school attendance officer explain the increase in the immediate notification of scholars as compared with younger children, without giving any clue as to the real incidence of disease on these two groups of children. The indirect function of the school attendance visitor as a sanitary officer, has not hitherto met with acknowledgment, but when it is recognised, several things appear in a clearer light—the sudden drop in notifications when school ceases, and the no less sudden increase when the attendance visitor resumes his duties then appear in the relation of cause and effect. So that there is the double effect of school attendance officer at the home, and of teacher, Figure 4.—London, 1900-09. Average weekly mortality, scarlatina and diphtheria, shewing absence of marked holiday effect. (See also Fig. 10.) nurse and doctor in the school, bringing to light numbers of cases when the schools are open, sufficient to account for any drop when they are closed, without postulating a school effect which there are no other facts to support. Were it not for these considerations, it would be exceedingly uncomfortable to think that the intricate and costly organisation which has been built up by which all the essential facta of the occurrence of each infectious case among elementary school children in London are daily registered and 119 Report of the Medical Officer (Education). watched, produces apparently no noticeable effect on the prevalence of such diseases as diphtheria or scarlatina. This, however, is to be expected when the effects of school attendance in respect to these diseases are fully examined. The enquiry alluded to above as to the causes of infection in each case of diphtheria notified in the heaviest week of 1909, showed that in only five per cent. could school infection come into consideration, and that there was not the slightest probability that it could possibly have had to do with any of the other cases. As regards scarlatinal cases, the Battersea enquiry completely negatived the theory of school influence. Measles from its nature is more likely to be disseminated by school attendance than either scarlatina or diphtheria. Unfortunately, the measles record, as will be shown a little later, is very defective, excepting as regards mortality. It is highly probable too, that in the future the effect of school attendance on measles among crowded populations will be shown to be less than is now credited. If the mortality figures of measles, diphtheria and scarlatina be set out as in Fig. 10, which takes the numbers each week in three weekly averages to equalise the varying times of fatalities in different cases, the holiday influence at Christmas is noticeable in the measles curve, but wanting in the others, although deaths are proportionately twice as numerous for diphtheria as in summer, and school influence should be more marked. In the summer the holiday effect on measles mortality is unmistakable, whilst it is difficult to notice any effect on the diphtheria or scarlatinal curves which is not fully compensated by t he reduction in child population. The holiday effect from migration is absent at Christmas. On mortality the effect of teacher and attendance officer is obviously negligible compared with their effect on notifications. The weekly deaths for diphtheria and scarlatina, summed for the decennium 1900-09, are set out in Fig. 4 in thin lines for diphtheria and thick for scarlatina. Holiday periods are indicated in black on the chart, and the portions of the curves subject to holiday influence are dotted. The insignificance of this reduction is such that if the whole effect be ascribed to school attendance, the effects of migration being neglected, the result of the month's closure affects the annual number of deaths from diphtheria by 7 or 8, and from scarlatina by about 6, that is about 1 per cent. of the yearly mortality. Thus, in respect of scarlatina and diphtheria the effect of school influence on the diffusion of these diseases is not great, even if the highest estimate ever put forward be accepted, without discount, but when discounted in the view of other known factors it becomes vanishingly small. Finally, to sum the general question, it cannot be too strongly insisted that under the conditions which have prevailed during the past ten years in London, the role of elementary schools in the diffusion of outbreaks of scarlet fever or diphtheria is so trivial that they may be neglected as factors compared with other causes, which hitherto have come in for little observation and but slight attempts at control. This long discussion of almost an academic nature, would have been out of place save for its bearing on any further expenditure through school efforts being thereby shown to be uneconomical, compared with expenditure in other directions for the repression of infectious disease. Taking scarlatina, diphtheria and measles as the chief infectious diseases of school life, it is found that they continue to vary apparently without reference to school attendance or school treatment. The variation is shown for the past half dozen years in the following table:— Disease. Year. Total numbers notified. Weekly mean. Percentage of school children to all persons. All ages. School children. All ages. School children. Scarlatina per cent. 1906 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 1911 10,484 4,640 202 89 44 Diphtheria 1906 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 1911 7,268 2,572 140 49 35 Measles 1906 18,899 - 365 - 1907 Nonnotifiable 26,179 - 503 - 1908 19,385 - 373 - 1909 20,145 - 387 - 1910 25,677 - 494 - 1911 31,905 - 614 - Scarlet fever remains practically on a level with last year's record, and is generally on the downward grade. The type, too, of the disease is exceedingly mild. Diphtheria on the other hand, continues to vary about a level, and this year is considerably above the last. The high incidence of measles is fully discussed later. Charts are given showing the weekly notifications of these diseases, and also the weekly 120 Annual Report of the London County Council, 1911. percentage variation from the mean. The number of schools under observation for the above diseases were measles 777, scarlatina 400, and diphtheria 204. The departmental distribution was as follows:— Disease. Boys. Girls. Mixed. Infants. Special, &c. Diphtheria 25 48 21 170 - Scarlet fever 83 122 35 318 1 Measles 19 25 21 769 11 The following table shows the number of school closures during 1911:— Department, Scarlet Fever. Diphtheria. Measles. Scarlet Fever and Measles. Scarlet Fever, Measles and Whooping Cough. Depts. Rooms. Depts. Rooms. Depts. Rooms. Depts. Depts. Boys' 1 - - - - - - - Girls' 1 — — — — - — — Infants' 1 1 1 2 *17 †113 1 1 Mixed — ■ - — - ‡1 - - *2 by order of the local sanitary authority, 1 by order of the school managers. †10 by order of the local sanitary authority. ‡By order of the local sanitary authority. The policy of excluding for varying periods unprotected children from infants' classes and departments has been continued. Unprotected children were excluded from 7 departments, and from 955 classrooms. All unprotected children under five years of age were excluded from 449 departments and those under six years of age in one instance from one department. In addition, all children under five years old were excluded upon 42 occasions, 35 of which were at the instance of the local authority as was also the case of all under six. On two occasions by request of the local authority, children under five years of age were excluded for diseases other than measles, one being for chicken-pox, and one for whooping cough. The general tendency of scarlatina seems to be diminution in frequency, but zymotics follow long periods of secular variation, thus diphtheria had become almost unknown when it broke out virulently in the south-eastern counties in 1857. Holland, which as shown on p. 127 for many years has had the lowest death rate from this disease, is now suffering severely. Within our own memories influenza appeared to have become extinct when a recrudescence afflicted humanity in 1890 with all the severity of a plague. When scarlatina cases now occur in a district, children with slight sore throats are excluded to a greater extent than would have been thought necessary half a dozen years ago, and accentuating the so-called holiday effect when the disease is more prevalent. It is not clear that in the interests of the public health it would be wise, if it were possible to attempt, to utterly stamp out every case. Both with scarlatina and diphtheria a certain amount of immunity in the population seems useful in preventing violent outbreaks. This theoretical idea has not, however, been considered in practice, but every effort has been made to keep the schools free from suspicious cases. The school authorities always act in co-operation with the local authority, to this end. At Winchester-street School, which stands about two hundred yards from the Caledonian and Pentonville-roads respectively, a prevalence of scarlatina caused special enquiries to be made in the autumn. There were altogether 132 children excluded from the school, which has an average attendance of 1,238 in the three departments. Of these exclusions 51 were sufferers, including 15 children who were excluded through having sore throats or other suspicious symptoms. One infant boy had a second attack within three months. The area in which these children live is nearly a square, bounded by York, Offord, Pentonville and Barnsbury-roads as shown in Figure 5. No cases occurred in the boys' or infants' department during the first four months of the year. In the girls' department there was an isolated sufferer in January, and a girl excluded as a home contact in March. Notifications, however, showed the disease scattered about the northern half of the district represented. Twenty-eight houses and seven schools were affected. The Winchester-street area, comprising the lower left quarter of the map, became invaded about May. The school invasion was characteristic of this disease. On May 11th a child living on the extreme north limit of the district was first absent from the infants' department suffering from scarlet fever, and on the same day three children, two of them sufferers, were notified from Classrooms A, D, and E of the girls' department. The first case in the house of the girl in Class A was an adult; the girl in Class E was excluded on account of a baby taken with scarlatina in the house; whilst for the girl in Class D the origin of the illness was not traced. Several children were excluded from the three departments on account of home infection, and during May 22nd to 26th five cases of sufferers occurred, again with characteristic school distribution. Three were in the boys' department, all in different classes, one was in the girls' department, and one in the infants' department. During June there were sixteen cases of exclusions for disease at home, but only two actual sufferers, one in the infants' department, and one in Class H of the girls' department. A considerable number of Scarlet Fever. 121 Report of the Medical Officer (Education). notifications were received from the other schools during this period. In July only one child was a sufferer, a girl (in classroom F of the girls' department not hitherto affected), but eleven contacts were excluded, of whom two were notified as sufferers after the holidays. After the holidays numerous cases continued both here and in adjoining schools, the district was generally infected, but there was no evidence of any school distribution in the way of successive cases occurring within a day or two in the same class. Thirty cases were notified from the school during September, October, and November. Of these 14 were cases excluded as suspicious with sore throats, but without other evidences of illness. The only instance raising a question of school influence and which led to detailed study of the outbreak was the absence from classroom D in the girls' department, of I. B., on September 18th, M. G., on September 19th, and C. L., on the 20th. But I. B. had been excluded in June on account of disease in the house. The illness there was that of a boy in the infants' school. They both remained out of school until the end of the summer holiday. The infant boy had a recurrence of the disease, and I. B. was also affected. In the case of C. L., a similar story was noted, as a baby was ill with scarlatina and the children had been excluded. M. G., who was absent the day before C. L.'s absence commenced, was a new case, the origin of which was not traced, but she lived in a house abutting on two others where cases of the disease had occurred, and which were again invaded in November, and house infection was as likely, if indeed not more probable, than school infection. The four cases which occurred in the boys' department were in Classes A, C, D, and E, respectively, and there was no suggestion of school infection. In the infants' department two cases occurred in the Classroom H in May, but they were separated by over a week interval, and both came from infected districts. In September seven cases (one sore throat) appeared separated in five classrooms. In October again there were four cases separated in four classes, but seven cases of Figure 5.—District distribution of scarlatina about Winchester-street in 1911. suspicious throat were also excluded, in one case exclusion had taken place for disease in the house the previous May, and two others were from one house. All cases_ of suspicious throats were treated as cases of disease, but three out of every four of the children rapidly recovered and no other case occurred in the house. So that it is doubtful whether they were scarlatinal, although at the time no other course was practically justifiable and they stand in our records as suspected scarlatina. The other schools in the district were also invaded by scarlatina, but their cases of disease were almost confined to residents of this area, as detailed later. , 122 Annual Report of the London County Council, 1911. The following were the schools affected and except Manchester-street their position is shown on the map and marked by the letters attached to the name. The average attendance is given for each, and the percentage of cases of scarlatina; in addition, separately given, is the percentage of children with sore throats treated as suspicious, and elsewhere than this table included as cases of fever. School. Average attendance Scarlet fever cases. " Sore throats," etc. Child contacts excluded. School, Average attendance Scarlet fever cases. " Sore throats," etc. Child contacts excluded. Cloudesley-street (C.S.) 340 .88 — 1.76 York-road (Y.R.) 1,100 1.82 — 4.90 Richard-street (R.S.) 1,079 1.49 .74 5.28 St. Thomas (S.T.) 445 .90 — 1.57 Thornhill-road (T.R.) 1,396 .57 .07 1.60 Risinghill-street (R.H.) 1,269 .71 .30 4.90 Vittoria-place (V.P.) 916 1.20 — 2.94 White Lion-street (W.L.) 874 .67 — 4.60 All Saints (A.S.) 314 .60 — 1.60 Winchester-street (W.S.) 1,238 2.91 1.20 6.50 Buckingham-street (B.S.) 1,143 1.75 .35 3.70 Manchester-street 1,235 .73 .11 2.30 Clifford-street (G.S.) 1,489 .33 - 1.21 Grand Total 12,838 1.16 .27 3.46 About five per cent, of the children in those schools had attendance affected. At Winchesterstreet in the centre of the district it was 10.6, the next four nearest schools 5.2, the rest 3.9, and, indeed, in the four most remote only 2.3 per cent, were affected by actual illness or exclusion as contacts. On the map sketched in Figure 5, each circle represents a house known to us as invaded during 1911 by scarlatina. Houses marked with a cross did not affect school children. The plain circle means that children from that house were excluded from Winchester-street, although no school children were sufferers. Houses marked with a dot in the centre indicate children, but not sufferers, excluded from other schools. Houses where school children were sufferers are marked by half black circle; in Winchester-street cases the division is horizontal, in other cases vertical. With the figures already given, and the evidence shown on this map, it can be seen that each of these schools had repeated introduction of the disease, but the only active part they seemed to take was in the discovery of early or mild cases, the " throat cases." Of these 35 were brought to light in school compared with 149 otherwise notified, nearly 20 per cent., which notification ceasing during holiday times forms a large factor in the supposed holiday influence on the disease deduced from statistical notification returns. Otherwise the schools are almost passive as regards a scarlatinal prevalence, and are only affected according to their proximity to an invaded district. When the proportions of children in boys and girls departments whose attendance was affected by the disease are examined, whilst the proportions of contacts excluded are almost identical, the number of sufferers among the girls is in considerable excess compared with boys. These facts suggest the factor of house exposure. The numbers were:— Departments. Average attendance. Numbers. Percentages. Sufferers. Contacts. Sufferers. Contacts. 12 Boys' departments 4,139 25 127 .59 3.05 12 Girls' departments 4,059 45 132 1.00 3.25 13 Infants' departments 4,510 113 195 2.46 4.34 1 Mixed department 130 1 1 — — 12,838 184 455 1.44 3-54 Total school ohildren affected 639 4.98 Although this enquiry is not full enough to establish, it is entirely confirmatory of the suggestion put forward in a previous report that perhaps eighty per cent, of the population may be regarded as comparatively immune to scarlatina as now prevalent, and that only the remaining twenty per cent, are likely to take it under the usual conditions of exposure. This comparative immunity is no doubt mainly inborn, and contributed to by conditions of good health. It explains the escape of schools, and the want of any marked influence of schools in distributing the disease. It also explains the strange but usual mode of invasion among a school population where the first few cases occur almost simultaneously in different departments and in different classes. The escape of the boys compared to the girls, the latter more exposed in the homes, and the excess of the less immune infants attacked all bear out the proposition. To demonstrate an inborn or family immunity would be exceedingly difficult, but on distributing 123 Report of the Medical Officer (Education). the cases in the district to the various houses and again on examining the occurrence in the houses, there is either this family tendency, or else a remarkable tenacity of infectiousness in the house or family. This point was dealt with some years ago, but is worth reverting to. In the district considered there were 225 houses ascertained to be invaded, 133 had school children sufferers, 78 had school children excluded but no school child suffering, and 14 had no school children affected. In the 133 with school children as sufferers there were also 197 children excluded as contacts. In 17 cases it was ascertained that the first sufferer in the house was not attending school. Of the 78 with 172 school children excluded but not suffering, the first case was ascertained in 42 instances, 33 being infants and 9 adults. Of the 14 houses with no school children affected 9 were cases of infants before school age, and 5 adults. As regards Winchester-street School, 62 houses were affected. In 14 the first case was a baby and in 3 an adult, in the remainder it was presumed to be a child of school age. 41 houses had the 51 sufferers attending Winchester-street and also 27 contacts excluded. These 51 sufferers included 15 excluded from school for " sore throats," more than a quarter of the sufferers, who, but for the school, would have been largely missed, 21 houses had no Winchester-street children as sufferers but had them excluded as contacts. The single house, however, did not always affect a single school, in one instance it affected seven schools. There were single exclusions of child contacts from houses in 41 cases, and single sufferers in school children in 59 cases, of whom 18 were " throats." There were 49 double exclusions either exclusions alone, 34 children, or sufferers alone 4, of whom a pair were " throats," or a sufferer and a contact paired, covering 60 children. In 123 instances three children were excluded, 16 sufferers and 53 contacts, and in 47 instances 4 or more were excluded. These groups of children went out of various schools in many cases. In 174 houses the children attended one school, in 32 two schools, in 5 three or more schools. In these 225 houses in this area there were 145 school children sufferers and 344 contacts, a total of 489 school children directly affected ; whilst in the schools shown in the area the children affected numbered 184 sufferers and 455 contacts, a total of 639 children affected. The difference of 39 sufferers and 111 contacts drawn by the schools from a much wider surrounding district shows how the disease outbreak was chiefly confined to the small area in question. The tendency of the disease to recur in families or cling to houses, discussed in a previous report, is shown in this district by separate house records and dates given below as compiled from the school notifications. House A. 18.7 Sufferer. 18.7 Sufferer 18.7 Contacts House B. 23.5 Contacts. 7.12 Contacts. House C. 3.4 Contacts. 9.10 suspicious " throat " case House D. 28.4 Contacts 7.6 Contacts. House E.; 11.5 Contacts. 26.9 Sufferer. 28.9 Contacts. House F. 20.6 Sufferer. 18.9 Sufferer. 22.9 Sufferer. 17.11 Contacts. 17.11 Sufferer. House G. 25.9 Sufferer. 25.9 Contacts 27.9 Sufferer. 26.10 Contacts. House H. 14.3 Contacts 25.9 Sufferer. 25.9 Contacts. House I. 28.7 Contacts. 29.8 Sufferer. House J. 19.5 Contacts. 7.11 Sufferer. 13.11 Contacte. House K. 4.4 Contacts. 27.10 Sufferer. 27.10 Contacts. 31.10 Sufferers. House L. 6.9 Contacts. 13.10 Contacts. House M. 20.2 Contacts. 5.9 Sufferer. 5.9 Contaots. House N. 24.4 Contacts. 1.6 Contacts. House O. 29.9 Sufferer. 7.11 Contacts. 1.12 Contacts, House P. 16.6 Sufferer; 16.6 Contacts. 12.7 Sufferer. 14.12 Sufferer. 14.12 Contaots. House Q. 19.7 Sufferor. 21.7 Contacts. 19.9 Sufferer. The most noticeable facts, on a general review of the district and the records, are the comparatively low infectivity of the disease, its want of severity which has been a feature now for many years, its domesticity in relation to houses and the absence of class infection in schools. It presents a sharp contrast to measles, which is infective days ere illness declares itself, and which formerly generally showed class infection, as it often does yet, whereas in scarlatina the child may be covered with a rash and yet apparently not infect. In many cases discovered peeling in school, sometimes in attendance (luring the whole course, as shown in previous reports, infection arising in the school from such cases is not only uncommon but a rarity. The reasons for the disease presenting an exacerbation commencing with comparative suddenness and ceasing almost as suddenly it is impossible at present to determine. It may depend to a considerable extent on such variable factors as atmospheric temperature, humidity, or prevalence of dust, but is almost certainly due to an accumulation of a certain proportion of non-immune persons in the community, who have not hitherto been tested by exposure to the infection and abundant opportunities of close contact. This want of immunity, and the exposure to risk of infection are the two great factors to be followed up. The first depends partly on inheritance and partly on depressed vitality from defective nutrition, poor ventilation, bad housing, and generally debilitating conditions during infancy. The second is also related to the want of living room which when seen in aggravated conditions is called overcrowding. With the school information alone these subjects cannot be followed out, but the enquiry is feasible and of value. It would require a continued watching for some four or five years of such a 124 Annual Report of the London County Council, 1911. district as this, whose population had been carefully noted in relation to age, and to the incidence of the disease. It would probably show that the control of zymotic disease by many of the measures at present adopted is largely imaginary and that general conditions which have not yet been determined are more effective factors on which to direct attack. That for children the opportunities for cleanliness, for play, for avoidance of fatigue, sufficient living room and sufficient playing room would give more promise of reducing zymotic death -rates than any further special measures which can be suggested at present. Diphtheria As shown in the table on p. 119, following on a period of quiescence there has been a considerable increase in diphtheria cases during the latter part of 1911. Dr. A. Newsholme years ago pointed out that such increase is to be expected during the winter after a hot and dry summer. The 45 schools under special observation were visited 60 times, and tube cultures taken from suspicious cases. As a result of the 1,305 cultures examined 100 children were excluded as infectious and another 74 as harbouring germs of a suspicious nature. Until this year cultures were taken from the throat only, but now the nostrils as well as the fauces are invariably examined, and in a considerable number of cases bacilli were detected in the nostrils when missed in the throat. The ears have also been occasionally tested and the work of Dr. Helen Hanson, referred to later, shows that they may be regarded as occasionally a possible source of danger. The persistence of diphtheria at Brixton-hill due to a carrier has been noted below, although as the girl is not yet free the history may have to be completed later. At Princess-road School diphtheria which had appeared in May, 1911, continued in spite of careful watching. It recurred in different classrooms of the three departments. There were 3 boys, 2 girls, and 35 infants sufferers, and 1 girl and 6 infants excluded on bacteriological tests, although only 2 infants were actually determined as carriers. The effect of school cleansing or disinfection was shown by the persistence of the .cases after closure and disinfection of the rooms. The contrast between the day school and residential school is apparent in the following record. In the spring and autumn of 1911 outbreaks of scarlatina and diphtheria respectively caused much anxiety at Brixton-hill Industrial School for Girls. The illnesses, however, were under control throughout. In the notes and records, the name of one child constantly recurs. The other children come incidentally, but the illness in the school seems to so centre round this child that she may be taken as an instance of the tendency to harbour infections which some few individuals present. R. C., aged 11, was removed to the South-Western Fever Hospital on December 28th, 1910, with scarlatina. Enquiries failed to detect the source of her infection, as she had been in school for a considerable time, and no new girls had been admitted for about a month. None of the officials could be connected with scarlatinal cases, and it was concluded that the infection may have been brought in by some of the Christmas parcels which the children receive. She was transferred later to the Gore Farm Convalescent Hospital, and returned to school on March 27th. She appeared in good health, save for a finger which was bandaged, and from which a sequestrum of bone was subsequently removed. After a week of quarantine she was returned to her dormitory, where 27 other children slept. Here, after three months of absence, she was made much of by her companions, of whom 12 were later notified with fever. On the evening of April 5th one child showed scarlatina. It was feared that others might be already infected and examination led to another girl being isolated the same night. During the next ten days 13 children were notified to have scarlet fever, most probably infected by R. C. Eight others were isolated as suspicious. Three further cases occurred on April 21st, and one on the 25th, probably infected from the secondary cases. As soon as suspicion fell on R. C. she was isolated, notified afresh, and removed to hospital. No blame could be attributed either to the school or hospital authorities for these " return cases " as every precaution which experience justified had already been taken. Many of the cases were so mild in nature that in the ordinary population they would have passed unnoticed. "Without the history of exposure to scarlatinal infection accurate diagnosis would have been impossible. One of those isolated as suspicious was only confirmed by the occurrence of peeling three weeks later. The constant vigilance and isolation of the suspects brought the outbreak to an end with the last case on April 25th. By the end of June all the children were back in school, and R. C. was apparently quite well. But the tale is not yet finished, for on July 28th a girl was isolated with a sore throat which might have been scarlatinal or diphtheritic, and on the 30th removed to hospital, where the provisional diagnosis of diphtheria was confirmed next day.* " Carrier " cases were sought for at once. Seven suspicious cases, one of which was R. C., were isolated. Germs of diphtheria were cultivated from them on July 31st and on August 1st, although otherwise they appeared in good health. By August 4th they were clear except R. C. A few other cases were detected, but rapidly cleared up. R. C. continued to give positive results, so that she was sent to hospital on August 16th. Four children in all went to hospital of whom only two presented symptoms of illness, the other two beiiu? " carriers." The " carriers " isolated numbered 25. Altogether 273 swabs were examined in the laboratory. Positive results, as indicated by the Klebs-Loeffler bacillus being present, were found in 63, doubtful diphtheroid organisms in 28, and the rest were negative as regards diphtheria. By August 30th all fear of spread of diphtheria was at an end, and the rooms were disinfected. This small outbreak is a good example of the diffusion of diphtheria, probably from the unsuspected carrier, B.C. It was controlled by repeated swabbing, and by isolation of the carriers and suspects. Although the isolation arrangements were severely tested, they were found sufficient. On each child returning from hospital she was isolated until three successive cultures taken on separate days, were found negative. The child was then bathed, the nose, throat and ears, as far as possible cleansed, and fresh clothing given before taking her school place. R. C. and another child returned from hospital on November 2nd. They were placed in isolation, and cultures from the throat found to be negative. As R.C. appeared to have been the source 125 Report of the Medical Officcr (Education). of trouble, before admitting her to class all treatment of the throat which might have interfered with the growth of organisms was intermitted, when almost at once, although the throat was doubtful, cultures from the nostrils were teeming with diphtheria. So also with the other child who had returned with II. C. She was returned to hospital on November 11th and her companion not clearing up was sent off on November 17th. The companion rapidly cleared, but four months later, R. C. is still in hospital, whilst the school itself appears free from disease. Cultures taken from her after Easter, 1912, still present the Klebs-Loeffler bacillus, which was found to possess virulency when tested on animals. Dr. Helen Hanson has investigated the frequency ot the diphtheria bacillus in the ear discharges found in children in elementary schools. There are many varieties of diphtheroid organisms found in secretions of eyes, ears, nose or throat, and actual diphtheria organisms have been isolated from pustules or sores about the face, but without actual tests for virulence by inoculations it is often impossible to be quite certain that the true diphtheria organism is present. In these cases, which were bacteriologically examined in detail by Dr. Ludwig Rajchman, the reactions were morphologically and by culture such that if taken from throat swabs they would have been diagnosed as diphtheria. Some cases are returned as suspicious in that though they gave most reactions they were not quite typical perhaps morphologically, or at least that without a virulence test to confirm the diagnosis it could not be positively returned as diphtheria. The schools where the enquiry was made were noted as follows :— Aural discharge and diphtheria. Name of School, Department. Approximate Roll. Number with Ear Discharges. Number with suspicion of Dipt). Bacilli. Positive finding of Dipli. Bacilli School history for past six months. B 313 15 1 1 0 boys, 2 girls sufferers. Aldenham-street G 309 15 3 1 I 300 2 — — Amwell-street M 500 4 — — j — B 229 6 Ann-street G 338 2 — — — I 287 C — — B 380 6 — — I girl, 1 boy, 1 infant suffered, 3 Buckingham-street G 386 3 2 1 infants contacts. I 503 8 — — Camden-street I 450 5 — 1 3 infants suffered. B 400 5 — — Detmold-ioad G 400 5 — — — I 400 6 — — llerbrand-street B 130 6 1 3 Numerous cases of tonsilitis, G 114 5 1 1 no diphtheria reported. B 232 3 — — 3 girls and 1 boy suffered, 3 boys High-s.treet (Stoke G 200 9 1 1 contacts. Newington) I 251 6 1 — B 200 1 — — 1 girl sufferer. Lancing-strcet G 275 4 — 1 I 174 2I—|— B 450 4 3 — 1 boy and 2 girls sufferers, 5 girls Manchester-street G 437 8 3 1 contacts. I ,425 5 — — Prospect-terrace B 331 5 1 — 2 girls home contacts. G 400 5 2 1 St. George-the-Martyr B 144 4 — 1 0 boys suffered. Totals 8,958 155 19 13i There was no connection traceable between previous diphtheria in the school or family and the occurrence of the bacilli in the aural discharge. In none of the cases traced back for six months had a case been recorded in the person or family of one of the diphtheria bearing discharging ears. There was just an indication of seasonal influence in that the spring cases showed 20 per cent, with diphtheria, the summer 34 per cent., and the autumn 22 per cent. The increasing number of cases of measles in the last half of 1910 was the prelude to an epidemic Moasles. outburst, long expected, but short and sharp, in the spring of 1911. Measles is certainly the most serious of the zymotics, accounting in this country for one quarter of the deaths in the second and third years of life. The only consolation is that it is selective and that the majority of the fatalities are probably among the best spared weaklings. The recent 1910-11 epidemic was not confined to London, although here the reduced prevalence during the past ten years, by increasing the proportion of persons liable to the disease, may have accentuated the suddenness and extent of the outbreak. Still the deaths from measles in 1911 were 126 Annual Report of the London County Council, 1911. 2,570, a number, as shown in Fig. 7, considerably exceeded in each alternate year of the nineties, viz., in 1890, 1892, 1894, 1896, and 1898. As regards mortality, the outbreak was not in any sense a record, indeed it just touches the mean mortality for the years 1841-1900. So far as incidence of cases is concerned, the numbers have not been precedented since the annual record has been fully kept for school cases. For 15 months previous to October, 1910, measles deaths had fallen to an average of 22.6 per week, against 38 weekly for the decennium 1900-1910, and 44 weekly for the Nineties, and 50 for the Eighties. During the summer and early autumn of 1910 a prevalence of German measles complicated the school observation which has always been maintained in recent years. With the autumnal rise in October, 1910, an increase in the case notifications coincided with an increased death rate. True measles was therefore in excess of the average, creeping about London, and raising the average weekly measles mortality to 86 for the next four months. In March, 1911, there was a sudden increase to a weekly average of 169, declining to 95 for April, and remaining below the normal since. The epidemic ceased more suddenly than it had begun. The margin of susceptible cases was reduced to between 15 and 20 per cent, of the children in the schools, averaging 18.4 per cent. In 1911 the weekly mortality from the beginning of September averaged 8 ; whilst the mean weekly incidence of the same period among school children was 61. These figures are much below the normal for the month. Figure 6 shows the progress of the epidemic in numbers of deaths weekly by the continuous line ; the dotted line giving the ten years' averages. Figuke is.- London. Weekly mortality from measles during 1910-11 outbreak, and averages for 1900-10. 127 Report of the Medical Officer (Education). The natural history of measles is not yet quite clear. Certain unknown factors aSect the prevalence of all the zymotics. To eliminate the effect of chance epidemics figures are taken for about 20 years from tables published by the Registrar-General. Rates per million living have been calculated for various countries and several diseases to show the variation in their relative prevalence. The zymptics affecting the same elements of the population are comparable with each other in the same country. 1887 to 1908. Deaths per million living. United Kingdom France. Prussia. Austria. Belgium. Holland. U.S.A. Measles 354 810 260 382 457 258 101 Scarlatina 135 171 275 511 158 31 104 Diphtheria 199 864 750 788 315 127 87 Tubercular consumption 1,425 - 2,160 3,470 1.368 1.608 12,627 In the case of the United Kingdom these figures can be still further sub-divided. Deaths per million living. United Kingdom. England and Wales. Scotland. Ireland. Measles 354 386 413 168 Scarlatina 135 149 141 71 Diphtheria 199 228 177 81 Tubercular consumption 1,425 1,343 1,780 2,165 Scotland and England with birth rates of 29.6 and 29.2 respectively are comparable, Scotland having the higher measles death rate, although children do not begin school till at least a year later than in England. The age and sex distribution of the Irish population, the low birth rate (only about 23.1), scattered and sparse child population, and possibly defective registration will account for the zymotic Figure 7.—London. Crude annual death rates for measles, scarlatina and diphtheria to shew secular variation 1885-1911. 128 Annual Report of the London County Council, 1911. rates being half those of Great Britain. National characteristics evidently make a great factor in this prevalence. These diseases vary secularly with time. Fig. 7 shows the death rates from the three chief school zymotics year by year for the past 25 years in London. It will be seen that these diseases show a diminished prevalence in recent years, although in measles this is least marked. As regards diphtheria especially, this may be due to the unknown causes hidden under the term " epidemic constitution," but probably is mainly due to increased spread of knowledge and care for the sick. The dotted part of the measles line gave an estimate in November of the 1911 measles death rate which actually was 570 as shown in the figure. There is very imperfect knowledge of the number of measles cases occurring, the ages of incidence, and the fatality rate. One attack gives great protection against future attacks. Of 24,256 cases compulsorily notified in Aberdeen in 1893-1902, only 2.46 per cent, were supposed to be second, and 0-05 per cent, third attacks. In attempting to set forth the incidence of cases at different ages, the relative protection of previous attacks has almost always been neglected. Many writers have fallen into errors and concluded that there is a lessened liability to attack at higher ages, a conclusion which is not justified by the experience of isolated communities, and only possible by neglecting the immunity already existing in the population. In London information as to the number of cases existing is frequently derived for public health purposes from second or third-hand reports furnished by school teachers, attendance officers, and others to the education and sanitary authorities. Another source of information is in the mortality returns. Unless a school child lives in a family where a case of measles develops, or a death from the disease occurs, there is little probability of the occurrence of cases of measles being known. Careful studies, inagurated by our Woolwich Enquiry of 1902-1906, have shown that at different seasons from one-third to three-quarters of the children entering school have suffered from the complaint. This proportion will vary from year to year and to very great extent. The following table shows the percentage case mortality (Aberdeen, 1893-1902) in Aberdeen, where notification was compulsory, the case mortalities of both measles and whooping cough were highest among very young children. Age years 1 2 3 4 5 6 7 8 9 I 10 11 12 Measles 13.9 10.0 3.4 1.6 .9 .7 .5 .5 4 .6 .2 .0 Whooping cough 12.5 10.1 3.3 2.2 1.6 .5 .7 .1 .3 .0 .0 .0 These mortality case rates for measles are taken over a large number of cases spread through several years, and whilst they are probably fair averages (3-3 per cent.) will err in excess rather than deficit, owing to the mild cases which are non-fatal and escape notification. The total mortality (3-3 per cent.) is justly comparable with the average of 3-5 per cent, found in Edinburgh, where notification existed from 1880 to 1901, and where there were 2,882 deaths among 82,544 cases known by notification. Taking the mortality returns given by the Registrar-General for London for 1909, an estimate, which will err on the low side, can be made for the probable number of cases at each age in London in that year by using the Aberdeen figures:— London, 1909, Measles. —1. —2. —3. —4. —5. —10. —15. Total. Actual deaths registered 513 997 416 187 125 106 17 I 2,361 Probable cases occurring 3,700 9,970 12,235 11,687 13,889 17,500 8,500 77,000 It must be remembered that these figures are merely an estimate which shows the probable ratios, but which as actual numbers may be liable to an error of 5 per cent, or 10 per cent. There is reason, however, to suppose that they understate the case for London at school ages. This gives 77,000 to 78,000 as a low estimate for the probable number of cases in London during 1909, but only 20,100 cases were notified through the schools. In 1910 there were 1,980 deaths, and 25,677 cases notified. The crude death rate was 440 per million living. In 1911 there were 2,570 deaths and 31,905 cases notified, corresponding to a crude death rate of 571 per million, a trifle below the mean annual rate for the sixty years 1841-1900. The number of cases coming to notice through notifications does not seem to be more than about one-third, even when followed almost hourly as in the recent outbreak. These facts are only partly explained by second or third cases in a family failing to be notified. This estimate is borne out by a very careful study of measles at St. Helen's by Dr. Paterson. He found that of 1,367 cases known through notification, 41 cases died, exactly 3.3 per cent, as in the Aberdeen returns. There were actually 170 cases of deaths from measles registered, which, at the Aberdeen case rates, would indicate the probable cases at 4,038. From this he deduced that only 33.8 per cent, of cases came to light by the school returns in St. Helen's. Figure 9 has been constructed on the basis of the returns at Aberdeen, Edinburgh and St. Helen's, to show the distribution of cases probably occurring during 1909, and the amount of actual knowledge of them obtained from the school returns in London. Mortality is discussed rather than case incidence, because for practical purposes this last, if a thorough knowledge of the cases could be got, would vary with the birth rate and the child population 129 Report of the Medical Officer (Education). more than any other factor. Practically every child suffers measles sooner or later under the crowded condition of life in English towns. The mortality varies with other factors which mostly reduce the opportunity for personal contact; thus, the urban counties present higher mortality rates than rural counties. The social condition, which in the higher ranks means better care for children and also relative isolation of young families, is such that probably the average age at which measles is contracted in the working classes is under five, whilst in middle or upper-class children it will approximate to seven or eight. The younger the family the higher the death rate is likely to be, and this as well as contact is a partial explanation of rates in one, two or three roomed houses. The Aberdeen figures; when analysed according to the number of rooms in the house, gave:— Rooms in house 1 2 3 4 5 All houses. Average number of inmates 4.1 5.2 5.8 6.2 - - Cases 1,067 11,464 6,779 2,046 2,675 24,031 Deaths 73 348 122 19 22 584 Case mortality per cent. 6.8 3.0 1.8 .9 .8 2.43 The disease depends on a contagium vivum, which has not been yet isolated. The infection does not cling to fomites or persist out of the body, so that any special disinfection of things or places is probably unnecessary. It has been demonstrated in carefully regulated institutions that, like the other infectious diseases, children with measles can be nursed in the same wards with other susceptible children without the latter running serious risk of infection, if strict aseptic precautions are maintained. The published returns of the City Hospital at Providence, U.S.A., show that in an isolation ward with no other precaution in regard to prevention of spread of infection than attention to strict surgical cleanliness, the following cases were treated between March 1st and December 31st, 1910:— Scarlet fever 38 Diphtheria 18 Measles 38 Other contagious diseases 71 Non-contagious diseases 25 190 Dr. Chapin states : " In the treatment of all the contagious diseases contact infection is avoided by strict asepsis, and air infection has been disregarded." No case of cross infection occurred in the ten months, and only one case of measles and one case of chicken pox developed among the 190 patients treated in this ward. The conveyance of the infection is probably almost always direct, by particulate emanations in coughing and speaking, and the radius of infection to be measured by a few feet. The adoption or discarding of general methods of disinfection by municipal authorities has not in any way affected measles mortality at Aberdeen, New York, Paris, Providence or other places where the case rates have been studied, and if demonstrated to be useless general disinfection is costly and wasteful. The sufferer from measles presents a latent period whilst the infection is multiplying in his body. The length and fixedness of this period suggest the evolution of some particular life cycle of an organism. After about the ninth day from exposure slight catarrhal changes appear about the mouth, nose and eyes, and thenceforward the child is highly infective. On the twelfth to the fourteenth day the rash has come out, then the infectivity rapidly diminishes. During recovery there is fine desquamation of the skin. Infectivity is usually assumed to last till all signs of desquamation are over. It has probably ceased before that, but the assumption of a month from the beginning of the illness is well over the margin of safety. Carriers, that is, cases infective themselves, but not suffering any malaise, have been looked for in vain. These cases may play a leading part in the diffusion of scarlatina and diphtheria, but the high proportion of children who actually suffer measles almost puts the question of carrier cases out of the field. The picture then of measles is of a disease very fatal during infancy, which every child suffers, and which confers almost complete immunity from further attacks. Its prevalence at any time varies according to the aggregation and proportion of children liable to be attacked, but also varies according to quite unknown factors with race, country and year. It is usually introduced into households by the children who go beyond the family circle, and who have hitherto escaped infection. Latent or carrier cases and second attacks are so rare as to be negligible, so far as administration is concerned. Years ago I was fortunate enough to be able to watch the spread of measles outbreaks in isolated schools, and concluded that the outbreak if unrestrained ran through a school and exhausted itself in three weeks, and that the apparent good effect of school closure was an entirely spurious result. The only general method formerly used was to close a school when the attendance had fallen by 40 or 50 per cent. As there is an incubation period of nearly a fortnight, and as cases are infectious for four or five days before ceasing attendance through indisposition, it was possible to reconstruct, from subse 130 Annual Report of the London County Council, 1911. quent knowledge, the events illustrating the spread of an outbreak. It then became evident that closure of schools was not the cause of the stoppage of an outbreak, but that this would have occurred spontaneously without closure. The futility of closure for measles is exemplified by the following diagram, which I made in connection with the closure of a school, which was carried out against my advice by a former medical Figuke 8.—Showing typical school outbreak of measles in reference to school closure. officer of health for Hampstead. When the question of closure was considered, seven cases were known and it was concluded from their distribution that a larger number were already infected : subsequent events showed that 88 additional cases had been already infected when the presence of the disease was first announced, and that nine cases more may have been subsequently infected. The day after these 113 cases had all ceased attendance the medical officer of health insisted on closure. No subsequent case occurred. This was not the result of the closure, but because no case in the school had become infected during a fortnight before the date when closure had been insisted on. From observation of classes it appears necessary for at least one-third of the children to be susceptible before measles spreads. Our analyses showed that whilst scarlatina, which is rarely school distributed on any extensive scale, usually presented itself as isolated cases in several classes, measles (more frequently school distributed) showed itself mainly in single classes. Before the recent epidemic measles outbreaks have been to some extent altered to approximate more and more to the scarlatinal type of distribution through the effect of our regulations in the past five years. The first case in an infant class is carefully watched for, and a list having been prepared of those who have not had measles, all these children are excluded from the class from the ninth till the fourteenth day after the last attendance of this first case. All infected children are thus excluded before being infectious to others in the class. The first crop of cases is frequently arrested, putting an end to the outbreak for the time being. If the first crop has not been arrested any further attempt to restrict the class outbreak is futile, and, as Fig. 8 demonstrates, closure is useless. Sometimes all children under five are excluded. If the list of children who have already suffered has been prepared there is no reason to exclude them, whatever their age. In the Woolwich enquiry, class closure was rigorously enforced on every possible occasion in the eastern portion of the borough, whilst there was no closure in the western portion. No difference resulted in the prevalence of the disease, but class closure cost a loss of 135 attendances per case notified, whilst individual exclusions cost 63 attendances, less than half. Experience showed that measles only spread in infants' schools, that the liability to extension existed when from 30 to 40 per cent, of the children were unprotected by previous attack, and ceased when only 15 to 20 per cent, remained susceptible. Children in the standards were not liable to school spread of the disease. Incidentally, this is suggestive as to the cause of the continued escape of the partially protected population from serious small-pox outbreaks. Rules were framed on these observations, viz. (1) to warn the parents of " unprotected " children in the class where a case of measles occurs, by means of advice cards describing symptoms, etc., to watch their children closely, (2) to exclude where necessary the " unprotected " upon the notification of the first case of measles, (3) to prevent intimate mixing and massing of children when the disease is prevalent, and (4) to allow children from houses where measles exists to attend boys' or girls' departments»if they themselves have already suffered measles. 131 Report of the Medical Officer (Education). Suggestions for the improvements of our regulations would be welcomed, but no practical hints for betterment are forthcoming from those who criticise the regulations now in force. Direct knowledge of measles cases is very incomplete, the lacunae can only be filled by some form of notification. The majority of measles cases are not attended by doctors. Notification by doctors, is therefore, wholly insufficient; if all cases were seen by doctors and notified, it would cost about £8,000 per annum to local authorities in London for fees alone. Immediate notification by the householder to the school should be required in the case of any illness of a suspicious nature in any child of school age. For children below school age the medical officer of health might be notified. Hospital provision for the worst cases might do something to reduce the chance of secondary septic infections, to mitigate the type of disease, and to diminish the death rate. In the case of measles it is unlikely that there would be the beneficial effect there is in diphtheria or scarlet fever, of preventing further spread in the family. No useful changes have been suggested in the regulations of the Education Authority in regard to school attendance. It is very urgent in this as in other zymotics that there should be no indirect inducements to teachers to keep infective children in school. The abolition of the epidemic grant since 902 has acted to some extent as a promoter of disease among school children. Figure 9.—The thick black curve shows the probable incidence of measles cases in the various years of life in London in 1909 as deduced from mortality returns. The thin curve shows the probable curve if school effect was permanently removed. The dotted curve gives the cases as known from school notification. 132 Annual Report of the London County Council, 1911. Raising the lower limit of school age is a favourite proposition with people who write or speak on measles. It has already been pointed out that Scotland, where the lower limit of school age is already higher than in England, suffers a greater mortality from measles. The contagion of measles is incurred by a young child, either (1) in the family from another member, or (2) beyond the family. In Figure 9 representing the probable distribution of measles cases at the earlier years of life in London during 1909, as deduced from the mortality returns, the effect (1) is shown by the ordinary form of curve rising to a peak and continued downwards in the thin curved line ; the further effect (2), shown by a hump super-imposed on the curve in the fifth year, probably illustrates the effect of contagion on entering school. It shows that children in their fifth year in about two-sevenths of the cases occurring in 1909 may be supposed to possibly contract measles directly at school. The number of cases in question represents between 5 and 6 per cent, of all the cases. If school was excluded, the curve would probably be as in the thin line lower before about six to seven years old and more after but the difference is probably not very great. If it is supposed that by excluding four year olds till their fifth birthday these cases of school contagion could be prevented, this would mean postponement of 5.2 per cent, of the cases, or taking the concrete example of 1909 in London it would be approximately 4,000 cases. As the case rate mortality at 4 to 5 is about 0.9 per cent., and at 5 to 6, about 0.7 percent., the saving of life would be the difference; that is 0.2 per cent., and for 4,000 cases this amounts to 8 cases. These avoided out of a total of 2,371 fatal cases for 1909 would mean affecting the measles mortality by .03 per cent. If all the four to five-year-old children were kept out of school until they were five, there would be a crop of fatalities from other causes such as deaths by violence in the homes or motor vehicles, etc., in the streets outweighing any gain in measles mortality. The indirect mortality through secondary infection of younger children in the home has to be considered. Measles is regarded in this report as the disease which more than any other shows school influence. For this purpose mere case notifications are unreliable, as the apparent school influence shown in scarlatina or diphtheria notifications demonstrates. The mortality returns, however, are Figure 10.—Deaths from measles, diphtheria, scarlatina, summed for ten years. Weekly deaths as mean of three weekly average. London 1900-1910. (Mies L. D. Fairfield.) Measles, dotted line; Diphtheria, thin continous line ; Scarlet Fever, thick line. shown in Diagram 10, taken from a recent paper by one of our school doctors, to differentiate between the school effect on these diseases. Both the summer and Christmas holidays show a prolongation of the depression in measles mortality, and no noteworthy effect on the mortality of scarlatina or diphtheria. This school effect is, however, a result of excluding all children from school; but schools cannot be entirely and constantly closed. The result of holding up the four to five year old children was 133 Report of the Medical Officer (Education). shown to be very small. The result of holding up all infants would, as far as direct school effects are concerned, not affect the measles mortality by 1 per cent., and after a few months, when stability had been assumed, with secondary infections of the younger children in the family going on as before, would probably scarcely have any measurable effect on the mortality of children under school age. No hope is therefore here held out of materially affecting measles mortality in London by school closure. The mortality of this disease must be attacked by other means, such as compulsory (parental) notification, some hospital isolation for bad cases, education of parents as to means of treating the disease, and probably also the adoption of more scientific (aseptic) treatment of actual cases and especially improvement in regard to habits of life, housing and space to live. On April 6th, 1911, shortly after the wave of measles had passed its height, a conference of representatives of various public bodies met at the County Hall and passed a series of resolutions, viz. :— (1) That a better organisation is desirable in London for the control of measles in schools. (2) That during a serious outbreak of measles, children under five years should be excluded from school attendance. (3) That compulsory notification of measles is desirable. (4) That the cleansing of the infants' departments and of the furniture, lower walls and floors thereof shall take place once a week. (5) That accommodation should be provided in the Metropolitan Asylums Board's hospitals for urgent non-pauper cases of measles. (6) That in the interests of public health the school regulations should provide that all children from houses infected with measles should be prohibited from school attendance. These resolutions were later reported upon by me as follows :— (1) It is difficult to see what better organisation can be found, as every practical means has been utilised to deal with the problem of controlling measles in elementary schools. It has been demonstrated that closure of schools is useless, that by warning parents upon the appearance of measles in a school, by excluding susceptible children in the class or classes affected, especially those under five years, and by impressing upon the school teachers the importance of watching for the first symptoms of the disease and for segregating the affected classes, it is possible to watch the course of an outbreak and to take proper measures to prevent or to limit the spread of the disease. By the present system an outbreak can be followed and dealt with in detail accordingly, whereas by resorting to the cruder method of school closure the source of knowledge of the incidence of cases would be cut off, and consequently it would be impossible for appropriate measures to be taken either by the school medical service or by the local public health authority. (2) Particular attention is paid to children under five, and unprotected children under five years are wholly excluded when such action is considered necessary as a protective measure. It has been pointed out that in view of the immunity conferred in almost every case by one attack of measles it is unnecessary to include in a general order for the exclusion of children in an affected class as a protective measure, those who are protected by a previous attack, whatever their age. (3) Notification would not be likely to decrease the actual incidence of the disease, but by removing cases to the hospital a milder type of illness might probably prevail in time, and thus be the means of reducing the mortality. Notification without removal would be of little avail except to enable the local medical officer of health to give advice in regard to sanitary precautions. Doubt might be expressed as to whether any benefits accruing from a system of notification would be commensurate with the considerable cost to the public which would be incurred. If notification is to be of any real value, it should be accompanied by the provision of hospital accommodation, at least for serious cases, or where inefficient or insanitary home conditions prevail; but this raises a larger question, and is referred to under resolution (5). There is, however, an increasing need for some measure being adopted whereby it shall be the statutory duty of every parent or guardian to notify any illness of a suspicious nature in a school child to the head teacher of the school where such child attends. In the case of children below school age the local medical officer of health might be notified. This would be a most salutary innovation, not only as regards the control of measles, but of other infectious illnesses, as it would enable health authorities to bring pressure to bear upon parents with a view to obtaining prompt medical advice and ensuring early diagnosis. Many years ago I elaborated a scheme of free diagnosis of illness in school children, but it had objections in cost and liability to abuse. (4.) Whilst it is quite desirable that the cleansing of the infants' departments and of the furniture, lower walls, and floors thereof should take place once a week, it is not at all likely to affect the epidemic distribution of such a disease as measles. (5) It would of course be desirable that urgent non-pauper cases could be acommodated and treated in the M.A.B. hospitals, but unless the disease were made notifiable there would be no compulsion to notify the cases, and consequently as a large proportion of the class referred to as non-pauper cases would probably not seek medical attendance and advice, the responsibility of deciding whether such cases should go to hospital would devolve to a considerable extent upon the local medical officer of health. Notification and removal to hospital could scarcely be dissociated, since notification without removal to hospital would hardly produce any practical benefits, whereas the latter would necessarily entail notification before the patient could be admitted. Measles is in its most infectious and dangerous stage during the first few days of illness, if therefore, isolation by removal to hospital is to be effective from a preventive point of view, it is imperative that the patient should be removed immediately the onset appears. In the recent epidemic only pauper cases of measles were admitted to the M.A.B. hospitals as a general rule, and these probably did not amount to more than 2 to 3 per cent, of the number of cases which actually occurred. 134 Annual Report of the London County Council, 1911. Removal to hospital in the case of measles would probably have scarcely any effect in preventing secondary cases arising as the complaint is most infectious in its very early stages, when it is characterised by catarrhal symptoms, and when, in most cases, the disease would not have been diagnosed. Consequently any susceptible contacts with the patient at that time would have become infected before removal to hospital. It is very probable, however, that the care and attention bestowed in hospital would have the ultimate effect of mitigating the type of the disease and preventing serious developments which so frequently ensue—such as suppurative eye and ear disease, broncho-pneumonia, or bronchitis, and the debility which often prepares the child's constitution for an invasion of tuberculosis. In this way hospital treatment might exert a salutary effect, and diminish the death-rate. The following quotation from the memorandum on measles issued by the Local Government Board during the recent epidemic may be of interest. " There are numerous cases of measles, the hospital treatment of which will increase the prospect of recovery. For most cases, however, it appears probable that domestic treatment will continue to be necessary, and that the greater scope for saving of life lies in more complete medical attendance, and in skilled nursing and supervision of patients treated at home." The question of expense is one to be considered as there is no doubt that as hospital treatment became more universally adopted, as in other zymotic diseases, a large amount of additional accommodation would be required and that for a considerable part of the time the accommodation would not be utilised, so that it would also be costly. The whole question of hospital accommodation, however, is a matter for the Metropolitan Asylums Board. (6) The existing rules in regard to measles seem sufficient to safeguard the health of school children, and of the public generally. There has been much criticism of the Council's rules on this subject, but no convincing arguments have been adduced to demonstrate that the attendance of children in senior departments, who have already had measles are a source of infection when a case of the disease occurs at home. It has already been stated that the infection does not cling to fomites or tend to persist out of the body, and the risk incurred in the conveyance of infection by means of an intermediary " carrier " is so infinitesimal as to be negligible as far as senior children are concerned, 90 per cent, of whom are probably immune by a previous attack. Further the practice of allowing protected children to attend school from infected houses is only followed in senior departments and not in infants' departments. * The L.G.B. approve of this principle and it is now being generally adopted by school medical authorities. The following passage appears in the L.G.B. Memorandum on Measles, previously referred to :— " Older children are usually permitted to attend the boys' and girls' departments of schools from families in which there is at the time a case of measles. There is no evidence that this practice leads to spread of infection, whether this result be due to the fact that the infective material is seldom carried in clothes, or to the fact that most of the children in these departments of schools are already protected." It may be added that in London, children are only allowed in such circumstances to attend senior departments if they have already suffered from the disease. One source of criticism which must be always remembered arises from the Education Authority having hitherto carried out a uniform plan of treatment of infectious disease among school children throughout London, whilst locally the regulations and treatment of children out of school varies with the activity and ideals of the borough sanitary authorities and their officers, so that the regulations of the Council may be criticised in one district as too drastic, whilst a neighbouring authority considers these same regulations require tightening up. Smallpox, In 1911 there were 70 cases ot smallpox received at the M.A.B. hospitals, 01 these 67 were from the Metropolitan area, 12 were cases attending Council schools, and 1 an evening student. Of the cases 46 were vaccinated, 9 of them being under 20 years of age. There were no deaths among them. Of the unvaccinated cases, numbering 22, death occurred in 9, 20 were under 20 years of age, with 8 deaths. In 2 cases the vaccination was doubtful and one died. For the whole number of cases the mortality per cent, of the vaccinated class was 2.2, and of the unvaccinated class 40.9, twenty times as great. Beginning with two cases of school children in one house in Stepney, notified on February 21st, two more in the same house were notified on the following day. The cause of the two which were apparently primary cases infected about February 1st was not ascertained. These four school children attended three schools whilst probably infectious, but no secondary cases resulted. One child, indeed, was in school for a week with the rash on her, and was summarily excluded by the medical officer of health for the district. Eight cases occurred, but none were notified in school children until March 2nd, when a child previously excluded for measles was notified as having developed the smallpox rash on February 24th. A boy attended an evening school on February 27th in an infectious condition, but no secondary case occurred. School investigations were carried out in Poplar, Hackney, and Camberwell. At Tredegarroad Infant Department a case was reported on March 7th, whose onset was the third or fourth of the month and the rash appeared on the sixth. On the ninth two other cases were reported from the same school. The school was at first thought to be a centre of infection, but enquiry showed this not to be the case. The children all lived in the same street and the mother of two of them had had a mild attack two or three weeks previously. Three weeks later a fourth case was notified from the same school. Five other unvaccinated children were in the home, and were all vaccinated at the shelter. No further cases occurred there. There were 62 children contacts with the various smallpox cases and distributed over 10 schools to which 60 visits were paid by the medical officers. 135 Report of the Medical Officer (Education). It is fortunate that there was no further spread. Although, judging from records of the vaccinated condition of the community, the amount of immunity to smallpox in the population is decreasing it appears to be sufficient yet to hinder an extensive epidemic. So long as the cases are not too numerous to be rapidly shut off by immune persons comparative safety exists. It is at present impossible to say whether it is cheaper to the community to deal with smallpox, as was done in the present epidemic, or to insist on abundant immunity through vaccination. The present method means an amount of watching, visiting, and examining of individuals which may be expected to get more frequent and greater as time goes on and the community becomes less immune. The school nurses and doctors who had not been vaccinated for seven years, were generally re-vaccinated, the results of the operation showing that they mostly enjoyed a fair amount of protection. In several schools arrangements were made through the managers for the vaccination by public officials of those children whose parents wished it. The first step was a circular signed by the head teacher issued to the parents or guardians of the children as follows : " I am advised by the Medical Officer (Education) that, as there is risk of your child having come in contact with smallpox infection, it is desirable to protect it as far as possible against the severity of the disease. If the child has not been vaccinated at all, this should be done to-day or to-morrow. If the child has not been vaccinated during the past seven years it would be better to have it re-vaccinated. Vaccination can be done to-day or to-morrow at the school for your child, if you will sign your name at the bottom as agreeing to this, and return the paper to me." A considerable amount of vaccination was thus indirectly brought about in the affected districts. At Drury-lane Day Industrial School three boys were known in June to have " bad eyes," there was nothing suspicious about any of them, but on June 12th another boy was noticed with slight conjunctivitis. On July 17th all the boys were examined, and two of the first three noted as still having " bad eyes." They then went to camp at Ramsgate. On August 14th, when examined, all appeared well. After returning from Ramsgate eye troubles began and by the end of the month 21 cases of acute catarrhal conjunctivitis, not of a very virulent type, had occurred. A week later 41 cases were being treated, 16 with prescriptions obtained at hospital, and 25 with perchloride of mercury solution, one three-thousandth dilution. Either a fresh source of infection had occurred or more probably some of the previous cases relapsed and became infective. The Koch-Weeks bacillus was found in discharges. It was necessary to treat the disease energetically, and a nurse and doctor were detailed for the purpose. At one time fifty cases were affected. All recovered without ultimate bad result, but it was the end of the year before all were free. Possibly some were kept suspect long after danger was over, and some others were still suspicious owing to the energetic treatment being continued. Instructions were issued to all concerned in school pointing out that this variety of ophthalmia is very contagious and difficult to distinguish from simple conjunctivitis, except by its infectivity, also that it is very obstinate and prone to recur in its later stages. Catarrhal Conjunctivitis. It is spread from person to person either directly through the discharges from eyes, nose or throat, or indirectly through the agency of some article which has come in contact with a sufferer, such as clothing, handkerchiefs, or towels, schoolbooks, pencils, rulers, possibly doorhandles, and so on. The strictest precautions must be carried out in details, to limit the spread from affected persons. The most insignificant error may serve to break down the quarantine and prolong the school invasion for months. The teacher must be able to recognise both early and late stages of the disease, and conscientiously carry out all precautions in every detail. Each morning, first thing, the children must file past the teacher, who must isolate a child with the slightest abnormality in the appearance of the eyes. Any child once isolated should remain " affected " until the doctor definitely certifies him free. The infected children must enter school separately, and must be kept out of all contact with the healthy at all times. They must be separated at meals, and arranged so that healthy and affected are seated with their backs to each other. The infected ones enter last and leave first. All utensils from the affected children must be placed in a boiling solution of strong soda. No serviettes or tablecloths are to be allowed at meals, and seats and tables are to be wiped over with a cloth soaked in a strong'disinfectant solution. Affected children must not enter any kitchen or service room, or in any way handle food, clothing, books or school apparatus. Separate washing and lavatory accommodation must be most strictly enforced. The towels used by patients must not be allowed to dry, but immediately dropped into disinfecting solution. No paper is to be allowed loose in any of the W.C.'s. These precautions were advised at Drury-lane, and, moreover, the affected children had their playtime separately and were not allowed to handle any playthings used by the others; no affected child was allowed to enter the classrooms or to touch any school apparatus or seat belonging to the healthy children; in the classroom used for the affected children all objects used were placed in a tub of disinfectant or else destroyed by burning; the desks and seats were daily wiped over by a cloth damp with strong disinfectant and the children did this themselves; all manual instruction was " out of bounds " for the affected; the teacher who had had anything to do with the affected children or their utensils, had to wash the hands before undertaking other duty; the children were treated in their classroom. The doctor saw them in the morning, and the nurse treated them night and morning. The children were instructed how to avoid the spread of infection when at home and were not allowed to loiter about the school. Defectives. The medical examinations of children with a view to admission to special schools still increase in number. These examinations and the examinations of cases presenting special difficulty which have taken place for the past ten years constitute a kind of " school clinic for more detailed examination," as Results of examinations 136 Annual Report of the London County Council, 1911. it is now becoming fashionable to term it. The increase is mainly in doubtful school cases and in invalids. The numbers of children returned under the four chief classes are tending to remain stationary from year to year, as shown in the diagram. Figure 11.—London, 1903-11. Showing annual classification of children examined foi admission to Special Schools. The results of these examinations so far as educational differentiation is concerned were as follows:— M.D. m.d. and P.D. P.D. Blind. Blind and Deaf. Myopes. Deaf. Deaf and M.D. Hard of Hearing. Industrial School. e.s. Imbecile. Invalid or Epileptic. Total. 1974 7 1246 103 2 90 120 4 9 29 2445 112 2176 8317* *Some of the hard of hearing and myopes in this table are also included under E. S. or invalids. The total number examined was 8,228. For many years lunatics and idiots have been distinguished, lunacy being a disorder of the mind in one who had previously been in full possession of his senses, while idiocy is a state of mental incapacity present from birth or from an early age. Imbecility, a lesser degree of mental defect, was first recognised officially by the Idiots Act of 1886. The establishment and control of schools under the Education Act of 1870 revealed a number of children unable to profit by the education offered to them. A committee of the Charity Organisation Society in 1876-7 recommended the foundation of special schools for imbeciles, while another committee of the same society in 1890-2 estimated that 1 per cent, of the children examined in the inquiry they set on foot were in need of special care and training. The first English day schools for the mentally defective were opened in Leicester and London in 1892, and were modelled to a large extent on the German special schools which had been in operation since 1867. The interest aroused by these schools and by the reports of committees of various societies led up to the special Departmental Committee on Defective and Epileptic Children, who reported in 1897 " that children exist who, on the one hand, are too feeble-minded to be properly taught in ordinary elementary schools by ordinary methods, and on the other hand, are not so feeble-minded as to be imbecile or idiotic." These, they pointed out, needed special educational treatment. The outcome of the labour of this committee was the adoptive Elementary Education (Defective and Epileptic Children) Act, 1899, under which children are at present admitted to special schools. The interest in the questions of national physique arising from the revelations of the South African War and the reports of the Committees on Physical Education (Scotland) and on National 137 Report of the Medical Officer (Education). Deterioration led to demands for further inquiry, culminating in the Royal Commission on the Care and Control of the Feeble-minded. Feeble-minded being a generic term used by American writers for the whole class of mentally defective persons in contradistinction to the English use of the term as given below. This Commission adopted a triple classification of the mentally defective into idiots, imbeciles and feeble-minded, the definitions being— An idiot is one so deeply defective in mind from birth or from an early age that he is unable to guard himself against common physical dangers. An imbecile is one who by reason of mental defect existing from birth or from an early age is incapable of earning his own living, but is capable of guarding himself against common physical dangers. A feeble-minded person is one who is capable of earning a living under favourable circumstances, but is incapable, by reason of mental defect existing from birth or from an early age, of competing on equal terms with his normal fellows or of managing himself or his affairs with ordinary prudence. These definitions appear to have received general acceptation, but a certain amount of confusion arises if they are regarded as in all respects identical and conterminous with those implied by the Act of 1899, in which the essential test is educability in certain schools or classes. The lower limit of this basis is rather more circumscribed, power of self-protection alone, even in proportion to the age, being scarcely sufficient qualification for admission to a special school, while the other tests laid down in the formal definition apply essentially to adults and not children. Yet, from the returns of the after-care committees, it would seem that the children in the special schools have not departed widely from the postulates of the Royal Commission, for if some have been able to manage their affairs with ordinary prudence, few have been able to compete on equal terms with their fellows from the ordinary schools. The distinction is of importance, as those who declare that mental defect is lifelong and incurable only use the later definition which excludes those who have materially benefited by their education. They have, however, to admit that they cannot diagnose the slighter case with certainty at an early age. The Act of 1899 would appear from the fact of requiring benefit from education to suggest the possibility of recovery or improvement, and although it excludes the backward it provides for those who suffer from retarded mental development, whether due to adverse factors, physiological or pathological. The special schools must necessarily contain a certain number of doubtful cases, some bordering on ineducability, others on backwardness ; but these are revised at regular intervals. The progress of the special schools in London from the medical aspect is recorded in my previous reports to the education authority, in which special problems and the difficulties arising therefrom have been discussed—• 1903.-—Over-age children in Standard I. Imbeciles and epileptics. 1904.—Word-blindness. The special treatment of backward children. 1905.—The distribution of mental qualities. Physiological variation in mental qualities. Intermediate schools. 1906.—Physical defects as a cause of backwardness. Classification of backward children. The associations of mental deficiency. 1907.—Development of articulatory capacity. Backwardness associated with physical defect. 1908.—A census of 5,000 children in the special schools to determine the number likely to do better in an intermediate school and the probable results of special school education on their subsequent wage-earning capacity. Moral defectives and permanent custodial treatment. Word-deafness. 1909.—The teaching of writing. The conduct of admission examinations. The use of observation classes. The use of the Binet tests of intelligence. The actual attainments of mentally defective children. 1910.—Combined mental and physical defects. A special enquiry by examination of the children in certain special schools was carried out in Tests the autumn, and the children were reported on both from a medical and educational point of view, and of mental ability. enquiries made to determine— (a) The number of children in these schools at present fit to be transferred to ordinary schools. (b) The number of children who would probably be fit for transfer before reaching the age of 13 years. (c) The number of children who are mentally defective within the meaning of the Elementary Education (Defective and Epileptic Children) Act, 1899, i.e., " not being imbecile, and not being merely dull or backward, are defective, that is to say, by reason of mental defect, are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable, by reason of such defect, of receiving benefit from instruction in such special classes or schools as are in this Act mentioned." (d) The number of children who— (i.) Are imbecile, (ii.) Are ineducable, (iii.) Have reached mental limit and cannot be expected to improve further by attendance at the schools. 138 Annual Report of the London County Council, 1911. Dr. Shrubsall, one of the assistant medical officers (Education), conducted each examination, which occupied about four times the amount of time usually given to the examination of a special school child. Dr. Shrubsall has dealt with the subject as thoroughly as school circumstances, without special laboratory provision, would permit. Before a child can be admitted to a special school he must be examined and certified as suitable by a medical officer specially recognised for the purpose by the Board of Education. These examinations are held at special centres. The children regarded as unfit for ordinary elementary schools are nominated on special forms by the head teachers, often on the advice of the school doctor, or in the case of those not in attendance at a school by the divisional superintendents. Most children are nominated between the ages of 7 and 10, that is, at the earlier stages of their stay in the senior departments. When arrangements have been made for the admission examination the teacher and the parents of the child are invited to attend, and their help is of great importance. Many parents are brought to realise on such occasions that their children are not all that they imagined, and in anv case it is desirable that they should know from personal observation that the child had been given every chance. At each admission examination the medical officer considers the present condition, the personal and, if necessary, the family history of the child. He has the statement of the facts noted by the teacher, and if the child has attended school for a reasonable time and with fair regularity, this statement may be regarded as definite experimental evidence of the extent to which the child has shown itself irresponsive to tuition. The medical officer generally verifies these statements and searches for any pathological explanation of the retardation revealed. The medical examination varies with the appearance of the child, which in some cases may at once reveal a definite defect or in others, as obvious idiocy, be such as to render further examination a waste of time. The doctor seeks to determine whether there are any defects of vision, hearing or other sense which have prevented the child from profiting by the instruction offered him, or any more general defect or ailment which may have exerted a retarding influence. He decides how far such defects are likely to be remediable and whether the child's condition is such that he may return to the elementary school while this treatment is being carried out or should be invalided from school attendance for a time to receive treatment, to be called up if desirable for a further examination after a period of from three to six months. Mental improvement can scarcely be expected until some time after the defect has been remedied, and in the past, when facilities for treatment were not easily obtained, some children were presented for re-examination who had actually deteriorated owing to the continued action of the primary cause of retarded mental development. Such children could not be educated in the elementary schools ; but this class, which we termed " spurious defectives," at one time common, has now nearly disappeared. The examination is extended in any direction suggested by the appearance or history of the individual, and includes the record of stigmata or deformities and any nervous ailment which might cause deficiency, or even contra-indicate an attempt at formal education. In addition some psychological and pedagogical elements are usually introduced. They serve more particularly to determine the question of educability and comprise tests of the power of attention and of response to stimuli. The most usual tests are selected from the response to simple commands, the power of recognising the nature and use of simple objects, colour matching and recognition, and the extent to which objects are recognised in pictures. The pedagogical tests serve as a slight check on the teacher's estimate when the application form for medical examination has been filled in, or to give the requisite data when all such information is lacking. The testa usually cover the power of reading, writing and counting. When examining children the aim of the medical officers is not to find out what the child knows or has learned, but the extent to which the ordinary channels of education are open and available. The amount of schooling the child has actually received is considered and, so far as the history relates, his physical condition. It is a common thing for teachers to report that, in spite of special attention, often extending over a period of one or two years, the child has not progressed. This may be regarded as expert evidence of unsuitability for ordinary school methods, and if such a child is found to be dull of perception or appreciation, and particularly if his attention is difficult to fix, he is deemed to be deficient and to require such a special form of education as the ordinary elementary school cannot at present supply. Whenever age permits, a border-line case, which might be an example of delayed evolution although in some senses defective, is returned for a period to the infants' department. One of the serious difficulties hitherto confronting the medical officers at admission examinations is the number of cases which have to be examined in a short space of time. This renders it sometimes impracticable to establish such friendly relations with the child as to persuade him to put forth his best efforts and reduces the number of tests it is possible to apply. The difficulty is lessened by devoting the maximum of time to the doubtful cases and passing the apparently obvious cases with considerable rapidity. This necessity renders the teacher's report of great importance, since at times it is from this alone that the child's attainments can be judged. The children are re-examined about three months from admission, and after that at intervals of from six months to a year. The medical officer looks at the teachers' reports and the children's exercise books and manual work. The examination, in the main, follows similar lines to that at admission, but there is more opportunity, as a rule, to go into details or to follow out any particular line of inquiry. Up to the age of about 12$, children deemed reasonably able to work in Standard II. have been returned to the ordinary elementary school. After this age they lose so much by association with children much below their age, and their presence being often regarded as harmful by the class teachers it has been considered that they benefit more in the special schools for elder children. Sucli children, who are some three to five^years behind their proper standard, are considered to come under 139 Report oj the Medical Officer (Education). the terms of the Act, at any rate up to the age of 14. Beyond that age when the children are big and strong and suitable opportunities for work are available, it is difficult in disputed cases to obtain the necessary legal sanction to enforce their continued school attendance, and in such border cases adequate medical support could not be given to any legal proceedings. In the enquiry the opportunity was taken of trying certain extended methods, and for a number of children, though in some instances with slight modifications of technique, the graded tests for developmental diagnosis associated with the names of Binet and de Sanctis were used. These are described later. •The children in each school were watched at manual work, play, physical exercises when these were in progress, and their behaviour in the street on their way to and from school was observed in addition to the special examination of each child. The schedule filled in for each child noted, in addition to any points of ordinary medical inspection— Attitude. , Evidences of motor disturbance. Emotional condition. Imitation of movements. Habits. Attention. Ability to carry out movements to command. Sensory perception and interpretation— Recognition and matching of colours. Differentiation of size and weight of objects. Response to a weight size illusion. Immediate and remote memory— The carrying out of two or more orders successively, though included in one command. The repetition of sentences or sets of numerals read to the child. Report on short paragraph read by the child himself. Writing of a short sentence or a few words said once or twice only to the child. Questions on matters of daily life, such as breakfast. The multiplication table. Memory in conjunction with powers or habits of observation— Questions on the destinations, etc., of trains, trams, omnibuses, etc., in the neighbourhood ; the prices of such articles as children fetch from shops, etc. General tests- Knowledge of left and right. Days of the week ; day before yesterday and day after to-morrow. Description of a picture. Description from memory of an object, e.g., a cat. Distinction from memory between two objects, e.g., a fly and a butterfly. Recognition of coins. Detection of absurdities. Educational tests— Reading and report of subject matter read. Response to written commands. Writing—transcription, dictation and spontaneous writing. Calculation—counting, simple sums, mentally or in writing; power of giving the correct change in a supposed transaction. The Binet and de Sanctis tests were tried on a smaller number, for which purpose specia' additional schedules were employed. In conducting the examinations every effort was made to set the children at their ease, and when necessary time was spent in casual conversation with this end in view. Any child who seemed to have been disturbed by any exceptional circumstances, such as the presence of onlookers, was re-examined on a subsequent occasion and the best results onlv recorded. The following analysis gives the detailed results of each test or observation on the schedules of the 209 children examined:— Age—7 8 9 10 11 12 13 14 15 South-grove — — — — — 13 29 21 10 Priory-road — 2 8 10 7 15 24 15 12 Offord-road 4 5 7 11 7 4 4 — 1 South-grove is a school entirely for elder boys, Priory-road comprises both an ordinary special school and one for elder girls. Offord-road is an ordinary special school from which the older boys are drafted elsewhere. A nervous poise and somewhat slack general attitude were noted in the majority, the attention was apt to wander in a large number, but in only five was it really difficult to arrest. In about 10 per cent, there was some definite over-action of the frontal muscles during mental effort, inertia was a marked feature in about the same proportion of cases. An absence of ready response to cheerful stimulation and a lack of buoyancy was noted, particularly in the mass observations of the children at 140 Annual Report of the London County Council, 1911. exercises or play. The listlessness of the girls dancing in comparison with that in an ordinary school was very evident. No child failed to imitate simple movements or to carry out a single command, but 13 failed to carry out a triple command, such as " Go and sit down in the middle desk, then take a ball from the box and put it on the table." It has been found that at such a test nearly all normal 4-year old children fail, about half the 5-year olds succeed, as do practically all 6-year olds. Of those that failed, 2 were aged 7, 3 aged 8, 2 aged 9, 4 aged 10, and 1 aged 12. No child failed to match a coloured ball from the first Froebel gift with the others remaining in the box. The six balls in this gift are coloured respectively red, green, blue, yellow, orange and purple. The orange was often called dark yellow, and the purple, Oxford blue, dark blue, or dark red; these were accepted as correct. Twelve children failed to recognise the whole six by name, although in many cases tested both by asking them the names, or if that failed asking them to indicate a particular coloured ball. The ages of the children varied from 8 to 15. The number of colours recognised was 1 only in 1 case, 2 in 4, 3 in 2, 4 in 4, and 5 in 1 case. Three children failed to pick out the largest wooden brick of a series, although it was quite four times the size of the next nearest in dimensions. This recurred even when the children were also asked the question by their class teacher. A series of similar pill boxes containing shot, and weighing respectively 3, 6, 9, 12 and 15 grams, were employed. The test was tried by two methods, in the one the child was given the 3 and the 15 gram box and asked which was the heavier, in the other he was asked to arrange them in order of weight. The former test was not tried with the older children, but if they had made any absurd arrangement they were given two adjacent boxes and asked which was the heavier. The results of the arranging test appear to have some relation to manual work with wood and metals, as shown in the following table— Number of errors. Eider boys' school. Other schools. Total. 0 16 14 30 1 3 9 12 2 1 9 10 3 2 9 11 4 2 21 23 24 62 86 Only 5 of the 30 in the second group who made three or more errors were below 11 years of age. On the other hand, 17 children appeared to have no idea or power of comparing weights at all, but guessed at random. Several of these preferred to hold both the weights being compared in the same hand at the same time, even after being shown how to compare another pair. The size weight illusion consisted in presenting to the child two boxes of identical weight but differing in size. To most normal individuals the smaller appears to be the heavier on handling. In the boxes used the larger had to be made three times the weight of the smaller before many would admit that it was actually heavier. The actual weight of each box was just over an ounce. Of the children in the special schools, 105 said the smaller box was the heavier, 2 that they were equal in weight, and 48 that the larger was the heavier. The response that the larger is the heavier is said to normal for very young children, so that its persistence to later life may be an example of delayed evolution, but the results, age for age, seem too irregular to allow of definite conclusions— Age. Smaller the heavier. Both equal. Larger heavier. 7 1 — 1 8 5 — 1 9 8 — 5 10 11 - 8 11 7 — 3 12 14 - 10 13 28 1 10 14 18 1 8 15 13 — 2 The relation to manual training, if any, is shown by the numbers over the age of 12. In the elder boys' school 35 selected the smaller box, 11 the larger, and 1 said they were of equal weight; in the other schools, 38 selected the smaller box, 19 the larger, 1 said they were equal. The diminution of the choice of the larger box with increasing age was, however, more marked in the elder boys' school. Immediate memory was tested by the performance of successive commands previously mentioned, a test only tried once or twice with each as it is affected by the influence of practice. A more interesting test was the report made by the child on a passage he had just read; this is influenced by the degree of difficulty experienced in the mechanical process of reading. Memory was also tested incidentally in the dictation since each child was told the sentence twice, and after the first few experiences was also asked to repeat it aloud, and was, if necessary, corrected before sitting down to write. The longest sentence used was " The dog saw the cat on the wall," but a third of the children were only able to recall five syllables or less under the strain of writing them down. 141 Report of the Medical Officer (Education). Remote memory was tested by the multiplication table, which was known parrot fashion up to about six times by nearly all the older children, and up to three or four times by some of the younger ones, but constant errors occurred at all ages by asking for a single pair, e.g., 5 by 7. It appeared, too, that a response might be obtained by asking for five sevens, when it entirely failed on asking for five times seven. The children in some infants' departments march to their classrooms from the playground to the inspiriting strains of " three threes are nine," etc., and mass repetition of the tables is in common use. It would seem as if this established an unbreakable association of the table as a thing to be sung as a whole and not used piecemeal. At any rate, it suggests a rather more frequent practice in dodging in the tables. Memory and observation were also required to answer question on the destination of the trams in neighbouring streets, and the companies whose trains ran through neighbouring stations. The answers of the boys in the elder boys' school, many of whom travel a distance, showed considerable local knowledge, but in the ordinary special schools blank ignorance was the rule, especially as to trains, even when the children passed the station every day. The girls showed a rather better knowledge of the contents of local shops, but were almost immeasurably behind the children in the ordinary elementary schools in this respect. The request to put the right hand on the left ear produced more incorrect than correct answers but the error was often corrected after a time or on a repetition of the command. Only 10 could not say which day to-day was. Of 18 children who knew the day of the week 11 were unable to give the name of either yesterday or to-morrow, 2 knew to-morrow but not yesterday and 5 yesterday but not to-morrow ; 33 who knew the preceding could not give the day before yesterday or the day after to-morrow. Some of the older children knew the date, but this and the actual day of the week was often only a matter necessitating a short memory as it is usually written down and often copied daily by each class. For the test of describing a picture the illustrations in the various readers and in a child's toybook were employed, save in a few cases in which to save time pictures hanging on the wall of the room were utilised. Strictly every child should be given the same picture as a test, but as it was necessary to examine more than one child at the same time this was impracticable, and it also appeared that the news of the picture used spread through the school in the case of the elder children. The results were classified according to the type of response. Some would mention the uame of one object in a picture only, e.g., " cat," adding no qualifying adjectives to the noun; others enumerated several objects, also without qualification ; other groups, instead of practically employing nouns as interjections, added a qualifying adjective or participle, e.g., " little boy," " girl running" ; a more advanced group employed a short sentence such as " boys playing soldiers " ; others used two or three such short sentences for each picture, while a few gave a continuous narrative, or at least employed longer sentences. The frequency of each type is shown in the following table, which shows a steady improvement with age, though the more elementary type never entirely disappears. This, like other tests, shows evidence of delayed mental evolution in the majority and of almost complete arrest at an early stage in a smaller number. Age—7 8 9 10 11 12 13 14 15 Total. Type of response — One name per picture 1 3 3 2 2 — 2 1 3 17 Enumeration of objects only —2 2 3 1 8 7 4 431 Enumeration plus descriptive adjective — — 2 2 1 4 7 1 5 22 Enumeration plus descriptive participle — 1 1 1 — 2 7 4 1 17 Single short sentence 1 2 6 5 5 7 8 9 3 46 Two or more short sentences — — 1 4 4 4 16 13 2 44 Continuous narrative or longer sentence „ — — 1 1 — 5 7 3 3 20\ 197 These results may be checked by a series of similar tests carried out two years ago in an ordinary school, from which it would appear that verbs are used in description between the ages of 7 to 8, short sentences at 8 to 9, and longer sentences 9 to 10. In a school in a good class neighbourhood where the children receive the benefit of reasonable home encouragement the age limits are lower. The continuous narrative or long sentence may be regarded as a point against educational incapacity at earlier ages and as evidence of benefit derived at a later age. In the test of description from memory of an object the children were asked to say all they knew about some common object such as a cat. The object had to be varied for the reasons mentioned above, especially as after the first day it was noted each child began " a cat is a very useful animal." This expression was not counted, but other objects substituted. It is possible that this expression was a test of remote memory, as on inquiry it was found to occur in a reader in use in some schools. The answers were marked from 1 to 7 according to the fulness of the account, the minimum mark being for " a cat is a cat." The best result was from a child who knew all about the habits of the house fly and the bluebottle fly, but this was because he was in the habit of fishing and used gentles as bait. He was not equally good on other objects, but this shows the importance of finding the subject in which 142 Annual Report of the London County Council, 1911. a child is interested, when naturally a better idea of his potentialities can be obtained. The results obtained were as follows :— Marks. Age— 9 10 11 12 13 14 15 Total. 1 — — — 2 1 2 1 6 2 1 — — 4 3 2 2 12 3 — 1 1 3 2 5 — 12 4 — 1 _ 2 3 3 — 9 5 1— 1— 1 1 1 5 6 — 1 2 — 2 2 1 8 53 This test, although useful, took so long that it was used only in these cases recorded, and in the series where Binet tests were utilised in full. A similar test was to ask for differences between two familiar objects, such as a fly, and a butterfly. Roughly, for two who succeeded three failed. Many children seemed to try to recall something they had heard rather than what they themselves had noticed. Many answers were absurd, but in a few cases unexpected power of observation came to light. Being different from ordinary school procedure the teachers thought the test likely to be confusing to the children. It is set down by Binet as one which eight-year-old children should pass. A simpler test involving every-day experience and also the effects of school instruction is the power of recognising coins. For this purpose a full series was used, but for the younger children the values under Is. only were employed, and even in the elder children cases of confusion between 2s. and 2s. 6d. were ignored in marking the result. Had these been included the results of the following table would have been reduced materially— Age—7 8 9 10 11 12 13 14 15 Total. Knowledge— Plus — 2 3 12 7 23 30 23 13 119 Minus 3 3 8 8 2 8 12 5 0 55 174 Ihe power of readiness in recognising absurdities was tested in a tew cases, but leu to such bad results that it was abandoned, save in the formal Binet series. The sentence was read over twice to the child who was told there was something wrong about it of the nature of a catch. The sentence chiefly used was " a man was walking along the street with his hands in his pockets and twirling his cane." This catch and others were detected by a few elder boys. The test is given as one for 11-year olds. Each child was tested with a series of readers until his upper limit was determined; when he had read a passage he was asked to say what he had been reading about. The type of reading, the frequency of errors, and the accuracy of the subsequent report was noted. The range varied from two-letter words in an infants' primer, or in some cases single letters, to a newspaper extract utilised by Binet, which corresponds roughly in difficulty to a Standard III. reader. The results were :— Age—7 8 9 10 11 12 13 14 15 Total. Reading capacity—Reads- No letters 1 — — — — — — — — 1 Letters uncertain 3 3 3 1 1 1 3 — 217 Some 2-letter words — 3 7 10 4 6 10 1 3 44 Some 3-letter words — 1 4 7 4 4 9 6 1 36 Infants' primer — — — 2 3 7 8 3 2 25 Standard I. reader — — — — 1 8 10 10 5 34 Standard II. reader — — 1 — — 1 4 1 — 7 Standard III. reader — — — — — — — 1 1 2 Newspaper extract — — — 1 1 5 13 14 9 43 209 Age—7 8 9 10 11 12 13 14 15 Total. Type of reading— Nil 1 — — — — — — — — 1 By letters 3 7 12 10 6 8 15 3 5 69 By syllables — — 2 6 4 3 10 6 2 33 Jerky or hesitant — — — 4 4 15 18 16 6 63 Straightforward — — 1 1 — 4 13 10 8 37 Expressive — — — — — 2 1 1 2 6 209 The jerky type of reading, in which each word is brought out as though an interjection expressive of pleasure or pain, is the characteristic of the special school boy in the main, though it is found in the infants' school and the lower standards. It is survival in the older defective children of a type 143 Report of the Medical Officer (Education). common at an earlier stage. Few seem to regard reading as a continuous process, so much mental effort being absorbed by the individual word. Persistent reversal of words, such as " on " reads as "no," or " was " as " saw " occurred in 19 cases, the age distribution being— Age—7 8 9 10 11 12 13 14 15 Number — 2 4 4 1 1 3 3 1 This is another example of the persistence of an infantile trait. It may be noted that no characteristic case of complete word-blindness appeared in the series, that is to say, so far as inability to reproduce the sounds of some words was concerned, for many, as will be seen, the words carried little meaning. The report on the matter read was tested wherever possible, the most interesting results being from those who could read a newspaper passage. The passage employed was that used by Binet and adapted by Goddard for use in New Jersey ; it is arranged to show the manner of marking the results— Three / houses / burned / London / September 5th / A serious fire / last night / destroyed / three houses / in the centre of the city / Seventeen / families / are without a home / The loss exceeds / £5,000 / In rescuing / a child / one of the. firemen / was badly / burned / about the hands / and arms. There are thus 22 ideas, and the child was marked according to the number he reproduced, correct reports only being counted. After a brief experience, this was made easier by leaving out the word serious, putting middle for centre, seven for seventeen, five thousand pounds for £5,000, and saving for rescuing. The original version had proved a complete stumbling-block in the matter of reading. Forty-three children, all but four of whom were in the elder boys' or girls' schools, were able to get through this piece of reading with more or less help, the number of points scored in the report being— 14 44 73 101 27 5782 111 386492 Note was also made of the numbers who made serious errors, such as " five thousand children were burned,'' four made one error each, two made two errors, and one three such errors. Binet reports that by the age of eight, the child is almost invariably able to read the text and recall at least two facts—that no child can report six or more ideas unless he can read the text within the minute, and that even the slowest reader can recall two items. The 169 remaining children who could not with any help read this passage (71 could not read sufficiently to test even with a primer) were tested with passages from such reader or primer as was within their limit, and were marked in a corresponding manner. None obtained one-third marks, most being between one-sixth and one-twelfth, while twenty, although able to read very simple sentences, could recall no facts at all contained therein. The results show about 60 of the 209 children examined as fit to learn from anything they read. In a few instances, the child was allowed to read the passage several times, but no great improvement was noted. The meaning to the child of matter he has read was also tested by noting the response to a written command. The child'was first asked if he knew what a letter was, such as would be brought by the postman, and on a favourable response being obtained he was further asked if he knew that such a letter might ask him to do something. He was then told that he would be given a piece of paper on which was written, as it might be in a letter, something which he was to do. If it said " lie down," he was to lie down, etc. He was then given a strip on which was typed a command, such as " sit down,"' " pick up a pen," " open the door," etc., and. the result noted. If he did nothing, he was asked if he could read the typing, and if he said " Yes," was told to do what it said. Many only read it aloud or tried to copy it. Finally, they were asked what does it say, e.g., " sit down," and on their replying, they were told, " Well, sit down." The effect of a second slip was then tried, and no case was entered as a failure without two or three attempts. With those that responded, four separate tests were tried, two being the commands as above mentioned, the third a question, as " What is twice two," or " What does a cat eat," and the fourth a more complex question, " If you had a shilling and spent fourpence, write down how much you would have left." The response to the last was often an oral and not a written answer, in which case the children were asked to read it through again, and see if they had answered it in the manner requested. A certain number responded correctly on the second occasion. Except for this fourth test, the words used were rarely of more than three or four letters, and were chosen with due reference to the reading capacity which had previously been ascertained. Several slips were needed to check against any leakage of information as to the questions asked. One boy on being shown a slip, on which was " Pick up a pen," promptly sat down, the proper response to a slip which had been used a little before. The results were— Response. Age—7 8 9 10 11 12 13 14 15 Tests I.-III.— Failed 4 7 14 15 9 9 25 9 9 Succeeded — — 1 7 5 22 31 27 14 Test IV. (arithmetical)— Some response — — — 1 — 7 16 1.9 9 Correct — — — - — 6 11 15 6 Incorrect — — — 1 — 1 5 4 3 144 Annual Report of the London County Council, 1911. There is a general relation between the accuracy of the result and the age of the child, but it will be noted that the performance of the 15-year-old group is behind that of the 14-year-old. This will be noted in several other tables, and gives evidence of the probable level of attainments of those who leave for suitable work at the end of their 14th year, while the corresponding difference to be noted between the 12 and 13 groups shows a level at which there are more returns to the ordinary elementary school. Writing was tested by transcription, dictation and spontaneous writing. In practice the dictation was tried first as, if this succeeded, the transcription test was unnecessary. It is a common experience to be told that a child can write, and on investigation to find that he can write his name and nothing else, sometimes not even a single component letter if asked for separately. Age—7 8 9 10 11 12 13 14 15 Total Result— Correct — — — — 1 6 7 7 6 27 Errors in spelling, words being often quite unintelligible — 2 12 10 9 20 44 28 10 147 Practically nil 4 5 2 3 3 1 — — — 18 The passage used for dictation varied in difficulty from " the cat was on the mat," to " two dogs saw the cat on the wall," or, as extreme efforts in good readers, " the horse pulled the cart "and " the cat caught the mouse." It is impossible to do justice to the children's efforts by any description. Such efforts as the following by 13-year-olds show the limits counted as mere errors in spelling. " Toos dag " = two dogs; " the huse grue the cr " = the horse drew the cart; while both " hte cat sro the bo " and " dok kat dn " are believed to mean " the cat saw the dog." " Cikice dit the cot and ma it nd " and " to gat leat the coi " are " the dog bit the cat on the tail " ; " god eta a om the nest " is the version given by a boy of nearly 14 in an older boys' school for " the dog saw the cat was on the mat." It will be noted that many smaller words are often omitted ; as mentioned above this dictation was also used as a test of immediate memory. Dictation reveals several defects which may perhaps be grouped as varieties of word blindness, but their study might throw some light on educational methods. The lesser grades of defectives show the influence of associations of sound and in some cases the methods employed for reading may have been responsible for the inability to spell, in other cases associations of the word not the word itself are used, as in the case of a 13-year-old, who wrote " obni" for box, A child may make considerable progress in reading, but by the results of his dictation show that the letters have little meaning to him. Sometimes even transcription is impossible ; thus, a boy of 13 copied '' the cat sat on the box " as " c hcghctscaanhtepz." He would seem to be attempting really to write the words spontaneously from an ill-adjusted aural memory, or from the words as he read them silently, the interpretation being c = a false start, hegh = the, ct = cat, sea = sat, an — on, hte = the, and pz = box. Such cases as these need much individual attention to obtain results and really require careful investigation in a way that can only be applied in some special observational centre rather than in the schoolroom. Spontaneous writing was tested by asking the child to write down the name of an object, such as a pen or a box held up before him or otherwise indicated. Remit. Age.—'7 8 9 10 11 12 13 14 15 Total. Correct — — 4 5 2 14 25 21 12 83 Spelling incorrect but intelligible at the time — — 3 4 4 7 10 0 4 38 Unintelligible — 1 4 5 2 6 11 7 5 41 Nil 4 6 3 0 5 I 5 1 — 31 193 Under the heading spelling incorrect but intelligible are included such as " the bwhl is ylao = the ball is yellow, from a child who had been shown a yellow ball, the response looked for being " ball" ; while the unintelligible include the written responses of children shown the ink who wrote " eonem " or " ther is haxse in the haxse pot." Calculation was tested by counting objects, counting money, giving change, and by little sums. In counting objects it appeared that 10 were unable to count four objects which should be done by 5-year-olds, and 15 were unable to count thirteen objects, which should be done by 7-year-olds. All these were under 11. In counting up the money it was first made certain that the children knew the value of all the coins, and if they failed at first a set of coins was counted over with them and later results noted; four or five coins only were employed, the denominations varying with the age and the results were as follows:— Age—7 8 9 10 11 12 13 14 15 Total. Correct — — 1 8 5 14 23 19 16 86 Incorrect 4 0 9 9 8 18 29 15 6 104 145 Report of the Medical Officer (Education). The results both of this test and the next improve with age and especially with the out of school occupations if by any chance they involve practical dealing with small sums. In the giving of change the results were:— Age—7 8 9 10 11 12 13 14 15 Total. Correct — — — 4 2 6 12 11 9 44 Incorrect 4 6 10 13 11 26 41 22 13 146 The children were given a few coins and then a coin, say 2s., was offered for an imaginary transaction to cost, say 6d., and the hand held out for the change. The results show a great falling off from those of counting alone ; they vary nearly directly with age, but are at their best at 14 +. To count the correct result the child must actually hand over the required amount, not merely say it. According to Binet, who is confirmed by Goddard and others, a few 7's, about one-third of 8's, and all 9 year olds should pass this test. The more advanced children were given simple sums either as mental or written arithmetic. Practically their limit was easy sums in the four simple rules and perhaps very easy addition or subtraction of money. The results appeared to be below their stated school performances, and the time taken was longer than that of very much younger normal children. The method of asking a child its age and then how old it would be in two, three, or more years, and how old it had been two, three or more years ago was tried in nearly every case. No case was counted as a failure in the following table unless it was unable to give its age plus or minus two years— Age. Age in two year's time. Age two years ago. Succeeded. Failed. Succeeded. Failed. 7 - 3 - 3 8 — 7 - 7 9 3 13 3 13 10 13 7 9 11 11 6 8 4 10 12 20 13 12 21 13 41 16 25 32 14 32 2 19 15 15 14 8 11 11 Total 129 77 83 123 The series of tests associated with the names of Binet and Simon were tried on 33 children, partly as a check on the other methods and partly to experiment with their suitability for adoption as a standard. Several isolated tests belonging to this series are included in the group already mentioned, but the standard required for success was not always the same, so that the accompanying table of results refers only to those in whom the series was worked through— Succeed. Fail. 7 8 9 10 11 12 13 14 7 8 9 10 11 12 13 14 (a) 3 years old. 1. Cognisance of real objects by name. 4 7 7 7 2 3 2 1 - - - - - - - - 2. Memory for 5 syllables 4 7 7 7 2 3 2 1 - - - - - - - - 3. Memory for 2 digits 4 7 7 7 2 3 2 1 - - - - - - - - 4. Recognition of objects in a picture. 4 7 7 7 2 3 2 1 - - - - - - - - 5. Knowledge of family name 4 7 7 7 2 3 2 1 - - - - - - - - (6) 4 years old. 6. Knowledge of own sex 4 6 6 7 2 3 2 1 — 1 1 - - - - - 7. Naming familiar objects 4 7 7 7 2 3 2 1 - - - - - - - - 8. Memory for 3 digits 4 6 7 5 2 3 2 1 — 1 — 2 — — — — 9. Comparison of 2 lines differing length 4 4 7 6 2 3 2 1 — 3 — 1 — — — — (c) 5 years old. 10. Comparison of weights 1 1 2 2 1 1 2 1 3 6 5 5 1 2 — — 11. Copying a square 2 6 6 3 2 3 2 1 2 1 1 4 — — — — 12. Replacing triangular blocks 2 5 5 1 2 2 2 1 2 2 2 6 — 1 — —• 13. Counting 4 objects 1 5 4 5 2 3 2 1 3 2 3 2 — — — — (d) 6 years old. 14. Knowing right from left 1 5 4 7 2 3 2 1 3 2 3 — — — - — 15. Memory for 16 syllables — — — — — — 4 7 7 7 2 3 2 1 16. Aesthetic judgment 2 6 5 7 1 3 2 1 2 1 2 — 1 - — — 17. Definition of objects by their use — 2 4 3 2 2 2 1 4 5 3 4 — 1 — — 18. Execution of triple order — 3 3 2 1 2 2 1 4 4 4 5 1 1 — — 19. Knowledge of own age 4 6 6 5 2 3 2 1 — 1 1 2 — — — — 20. Knowing morning and afternoon 3 2 5 6 2 2 2 1 1 5 2 1 —• 1 - - 146 Annual Report of the London County Council, 1911. Succeed. Fail, 7 8 9 10 11 12 13 14 7 8 9 10 11 12 13 14 (e) 7 years old. 21. Noticing missing feature in unfinished picture 1 - 1 2 1 1 2 1 3 7 6 5 1 2 — — 22. Knowing number of fingers 1 5 3 6 2 2 2 1 3 2 4 1 — 1 — — 23. Writing from copy — 2 2 5 2 3 2 1 4 5 5 2 — — — — 24. Copying diamond 1 5 3 4 1 3 2 1 3 2 4 3 1 — — — 25. Memory for 5 digits 1 2 3 2 1 2 1 1 3 5 4 5 1 1 1 — 26. Description of picture - 1 1 1 1 — 1 4 7 6 6 1 2 — — 27. Counting 13 objects 1 1 1 5 2 3 2 1 3 6 6 2 — 1 — — 28. Naming 4 coins — 1 — 3 1 2 2 1 4 6 7 4 1 — — (f) 8 years old. 29. Reading and report - - — — 1 1 — — 4 7 7 7 1 2 2 1 30. Counting money - - — 3 1 1 — — 4 7 7 4 1 2 2 1 31. Knowing 4 colours 1 2 3 3 2 3 2 1 3 5 4 4 — — — — 32. Counting backwards from 20 - - 1 — — 1 — 1 4 7 8 7 2 2 2 — 33. Writing from dictation - - - - - 1 - - 4 7 7 7 2 2 2 1 34. Differentiating objects from memory — 1 2 1 2 3 2 1 4 6 5 6 — — — — (g) 9 years old. 35. Knowing the date - - - - - - 1 — 4 7 7 7 2 3 1 1 36. Knowing the days of the week - 5 5 2 3 2 1 4 7 2 2 — — — — 37. Making change - — 1 — 1 1 — 4 7 7 6 2 2 1 1 38. Defining objects other than by use - - - - - 1 1 1 4 7 7 7 2 2 1 — 39. Reading and report - - - - - - - - 4 7 7 7 2 3 2 1 40. Arranging 5 weights in order - - — 1 1 1 — 1 4 7 7 6 1 2 2 — (h) 10 years old. 41. Reciting months - - - - - - - - -- 7 7 7 2 3 2 1 42. Naming 9 coins - — — 1 — 1 — 7 7 7 1 3 2 — 43. Sentence building - — — — — — — 7 7 7 — 3 2 1 44. Problem questions - - — 1 1 1 — 1 — 7 7 6 1 2 2 — (i) 11 years old. 45. Noting absurdities - - — 1 — 1 — — — — 7 6 2 2 2 1 (j) 12 years old. 46. Memory for 7 digits - - 1 — - — — — — 6 7 2 3 2 1 The results vary very closely with the age, though certain features iu which the influence of training plays a more important role show better results than the others. Such, for example, are the naming of colours and the recitation of the days of the week. Binet and Simon rate the intellectual status of a child as the oldest age for which he can pass all the assigned tests but one, but to the level thus determined a year may be added for every five tests passed which belong to a grade above the year in question. They consider he whose final rank is three years or more behind the normal for his age is mentally defective. The results of the present series were— Up to the normal for his age 1 (age 7) One year behind 1 (age 8) Two years behind 5 Three years behind 16 Four years behind 5 Five years behind 4 Six years behind 1 The children who were only a little behind presented the difficulty from the educational standpoint, they had not made or were unable to make any progress in reading and writing, which rendered it practically impossible to continue their instruction in large classes. Professor Binet has recently proposed a new series, or rather a re-adjustment of the ages for the tests in the former, and now considers that all these should be passed to give the intellectual age. Dr. Goddard, of New Jersey, has also recently published a list based on the foregoing, but modified according to his extensive experience, but by either of these schemes all the children would be appraised at five years, and if the test for that age at which all failed were omitted all would again fail with one of the tests appropriate to the age of eight, even if capable of passing the intervening grades. There can be no doubt of the high value of these tests, but on the one hand they take up too much time for general employment at admission examinations, and on the other hand it is very essential that the child should be in a thoroughly natural condition, which is not always the case on such an occasion. These tests are suitable to test the progress of the children in a special school, but though they may show the child's intellectual status they do not necessarily indicate his fitness for instruction under the conditions at present prevailing in the ordinary elementary schools. This may be an argument for a re-consideration of the methods of teaching backward children since the tests have received an international approval as an index of general intelligence, though modifications 147 Report of the Medical Officer (Education). may be needed in some details, and for some ages there is scarcely sufficient evidence of the normal standard. It would be desirable to obtain satisfactory evidence as to the normal level of children at each age in the London schools, and to work in practice from the deviations from the standard thus established. In the United States, on the Continent and at Sheffield, it has been found practicable to carry out such a series through the medium of school teachers who have received instruction in the technique of these tests and who have worked together sufficiently long to ensure a uniformity in their standard of marking. De Sanctis uses the following material: Five wooden balls painted in distinctive colours, three wooden pyramids, two wooden parallelopipeds, five wooden cubes all of the same size, 12 cubes of varying sizes, a small black cube, and a test card on which are painted triangles, squares, and rectangles to represent the outlines of the pyramid, cubes and parallelopipeds. The tests are— 1. The five balls are placed on the table and the observer says: " Give me a ball." The time taken in responding is noted on the stop watch. 2. The same five balls are again shown and the observer says: " Which ball did you give me ? " The time is again noted. 3. The five identical cubes, the three pyramids, and the two parallelopipeds are mixed up on a table screened from the child. A cube not very different in size is shown to the child, who is asked to pick out all the bits of wood on the table which look like it. The screen is then removed, and the time of the performance and any errors noted. 4. The child is shown the test card of forms and the small black cube, and is asked : " Look at this piece of wood. Is there anything on the card which looks like the piece of wood ? and if correct is directed to " pick out all the things that look like it." The time and errors are recorded. 5. The 12 cubes of various sizes are put on the table at different distances from the child, who is told, " Here are bits of wood like the things you were picking out on the card. Look at them carefully, and tell me how many there are, which is the biggest, and which is farthest away from you." The time taken and the errors are recorded. 6. All the test materials being concealed the child is asked four questions, each being answered before the next is asked. (a) " Are big things heavier or lighter than small things ? " (b) " How does it happen that small things are sometimes heavier than big things ? " (c) " Which looks bigger, a thing that is close by or a thing that is far away ? " (d) " When things are far away, do they just look smaller or are they really smaller ? " The times of response are recorded, and the answers taken down verbatim. De Sanctis considers that ability to pass Nos. 1 and 2 only indicates intellectual defect of a high degree, ability to pass Nos. 1 to 4 or 5 with many errors indicates a moderate defect, ability to pass Nos. 1 to 5, but not No. 6, indicates a slight degree of mental insufficiency, while ability to pass all in normal time indicates a normal intelligence. Yet even such a child may rate as " backward " pedagogically. Goddard, however, thinks training comes into play, and that a child with a good training may pass even No. 6 and yet be feeble-minded. The principle employed in these tests has in part been utilised, but not the exact method. The time taken was in all cases considerable, but it was not noted down exactly. The Froebel gifts, which contain coloured balls and a series of wooden blocks of various shapes and sizes were used. For test three a mixed assortment of wooden bricks was placed on the table, and the child given a brick and asked to pick out all that were like it. For test four a rough series of pencil sketches was used, and the test tried both by asking the child to indicate the outlines like a given brick and to pick out bricks like a given outline. No case was regarded as having failed unless unable to do either. For test five cubical bricks only were used, the largest being about eight times as big as the next largest. The distances apart were such as to render it clear which was the farthest off and which the nearest from the other side of the room without any difficulty. Each question was asked separately, following the American system. In the case of test six the children were allowed to try experiments by lifting objects and looking at similar objects close by and at a little distance. The tests were tried with 60 children, and the following table shows the one at which each first failed:— Test. Age. Total 7 8 9 10 11 12 13 14 15 1 .. - - - - - - - - - - 2 .. 1 — 1 - - - - - - 2 3 .. 2 1 3 3 1 — — - — 10 4 .. 1 1 — — 1 — — — — 3 5 .. — 5 7 4 2 3 3 2 1 27 6 .. - - - - - 4 5 3 3 15 57 Two children of 13 and one of 14 passed all the tests. These tests show results closely correlated with age, but seem to serve to point out the lower grades more particularly. 148 Annual Report of the London County Council, 1911. Manual work was noted in progress, and appeared to show results superior to any of the other school occupations. The teachers' estimate was taken of each case, but this may be expected to vary in standard in different schools and classes. The numbers in each category are fairly evenly distributed as between the senior and junior classes, but the standard naturally rises with age. In connection with the domestic economy studies it was stated that a considerable number of the children had to be given the same elementary instructions day after day, and that many of them seemed totally unable to adapt themselves to meet the slightest variations of routine or surroundings. This statement, indeed, sums up the whole position of the mentally defective child. The lack of all idea of correct movement, of grace or of sense of rhythm in comparison with the normal school child was constantly noted in connection with the physical exercises, and the children seemed listless and uninterested even in dancing movements to lively tunes. A similar slowness may be seen even in the process of getting the children away from school, they take longer to dress and do so in a more clumsy manner. Generally, however, the effect of a few years at school is shown in improved neatness, though the deficit from the ordinary school is always marked. Capacity for adaptation and consequent suitability for after school work does not run parallel with other school attainments. Several can carry out mechanical processes, such as simple reading, and yet, as they need to be told the same things every day, prove themselves entirely unfitted for domestic service or any but the roughest occupations. Whenever there appeared any medical indication, this was followed up, and the child was medically examined along the lines indicated, while throughout a watch was kept for any causes of so-called spurious deficiency, such as might arise from the presence of adenoids or minor defects of vision or hearing. In ten cases measures were suggested, though many showed the signs of past defects which had been remedied—some, unfortunately, late in life. A few children with defective vision had an unlucky habit of breaking their glasses. There was no evidence that any defects which would have prejudicially affected education had been overlooked, though some had taken a long time to secure treatment; most, if not all these, antedated the present facilities for obtaining such treatment. In the junior special schools the children seemed to divide almost automatically into two groups of higher and lower grade, the better results being obtained from the middle class or classes. The child who does not respond to special instruction often remains in the lower classes until of such age and size that promotion to the top class is essential, partly for purposes of discipline, but also because he loses by constant association with much younger children, and has shown so much improvement in handiwork as to necessitate more advanced occupations and instruction. This child is a great contrast to the former, and often it would seem that two or three years in the special school has only advanced his academic status by some six months. The general intellectual progress is very slow, and the child falls more and more behind his normal age grade. The child who, after admission to the special school, responds at once to the smaller classes, simpler curriculum, and more individual attention is rapidly promoted from the lowest class, and definitely advances up to a certain point, though much more slowly than his fellow in the ordinary school. Some of this group in the middle classes show a recovery both intellectual and educational; from these are recruited those who return to the ordinary school; others, while still perhaps falling behind the normal for their age, show a relatively greater advance in intellectual than in educational status, and appear to supply the bulk of the promotion to the schools for elderjboys or girls. In the latter schools, under a more stimulating and practical form of manual training, the intellectual side develops more rapidly, and in many a certain degree of recovery of lost ground in this respect undoubtedly takes place. When these elder boys or girls are tested only by their manual work or by'questions on general topics, they show much less evidence of defect or retardation than is evident when they are compared with the normal child of the same age, or even much younger, in ordinary school subjects. The volitional spontaneity of the child has to be taken into account since some of the lack of progress and development is due to an absence of desire to learn which may amount to more than passive resistance. The elder boys' schools, through the medium of their manual training re-act favourably on the volition. A boy sees that the work he does is really constructive, and so takes more interest. He learns to cobble boots or do something that some other boys of his acquaintance cannot, and his self-respect rises accordingly. He finds his new attainments open the way to a definite trade and to some extent realises their advantages. As he needs some knowledge of reading and arithmetic to apply to this more attractive occupation, an incentive to effort previously non-existent is brought into action which in some cases leads to rapid progress in the hitherto backward subject. Such children are likely to have been at all stages further behind academically than intellectually, but their lack of interest is a real defect of brain functioning, though the cure is a pedagogical rather than a medical problem. The brightening of the general intellect, resulting from the change to more congenial work, is sufficiently obvious to blind even some teachers to the more specialised educational deficiency, and in any case is a source of great difficulty when the question arises of giving evidence to enforce the attendance of a child over 14. If the child is fairly bright in appearance, and responsive to simple questions, and still more if he has obtained a situation and is said to be giving satisfaction, it is perhaps little wonder if the legal authority fails to be impressed by the evidence that in other respects his school status is only that of a child of 9 or 10. Yet were this child just under 14, few would argue that he should return to the elementary schools to be placed in Standard II. in the company of much younger children, where he would be a nuisance to the teacher and deteriorate afresh from the loss of the very practical work which had stirred up his dormant faculties. On the other hand, placed with bigger boys in Standard IV. or V. he would be unable to follow the readers or the arithmetic, would 149 Report of the Medical Officer (Education). lose most of the blackboard instruction, and would soon become discouraged and deteriorate. The return to the ordinary school means not only different and more rapid work, but instruction in larger classes and the loss of much of that individual instruction which had been available in the special school. Such a child is then clearly incapable of deriving benefit from the instruction in an ordinary elementary school, and is certifiable under the Act of 1899. When he is over 14 the circumstances are different; it is no longer a choice between two types of school, but between school and work. At some period between 14 and 16 the parents, if anxious that the child should go to work, will obtain a situation for him, or make some proposal for his employment. This proposal with a report of the teacher is submitted to the medical officer who examines the child. The question of exemption is then considered when the boy's intellectual status is markedly in front of his educational, save, perhaps, so far as manual training is concerned, the benefits to the three R's of a year or even a year and a half of extra schooling may be measured by an improvement in grade of perhaps a quarter of a year, perhaps even by none at all. His general intelligence and his manual dexterity and knowledge of some trade will naturally show a much greater advance. Should, however, an opportunity offer of his entering suitable and instructive employment, and he be able to take reasonable care of himself under more or less supervision, it is usual to state that he is fit to leave if suitable work be found. If when a child is examined with a view to exemption, his response is bright and he is able to pass a fair number of the general and educational tests mentioned above, or such others as may be preferred by the particular medical officer conducting the examination, it is necessary to state that satisfactory evidence could not be given to support any steps taken to enforce attendance. If, on the other hand, the tests are not passed satisfactorily, exemption may still be recommended if suitable work is available, but any necessary action to enforce attendance could be supported by evidence in court. It is perhaps well to be clear that facts which would amply justify certification under 14 are not necessarily adequate for children over that age. The suitability of the individual for the proposed employment is but rarely a matter for medical attention. The main problem before the medical officer in considering children under 14 at admission examinations, or at visits to the special school, is whether the child will benefit by education at one type of school but not at another. The question whether or no a child has failed to benefit by education in the ordinary school is primarily pedagogical, and the medical officers should be able to regard nomination for examination as definite evidence to that effect given by an expert. The standardisation of educational attainments qualifying for such nomination is also a purely pedagogical matter. In practice the medical officers have to be on the watch against the bias of individual teachers to prevent any unloading on to the special schools of children who are troublesome or unlikely to do credit to the education they receive, and for one cause or another, about three-fifths of the cases nominated are sent back to the ordinary elementary schools. The child, once nominated, it is the duty of the medical officer to ascertain whether the deficiency is due to any preventable cause, and, if so, to notify it in order that the necessary steps may be taken. Now that medical inspection takes place in all infants' departments, the number of such cases is likely to be reduced. The causes of spurious deficiency being excluded, the question of permanency of the defect and of retarded development have to be considered, together with a few specialised defects which have relatively little influence on the general intellectual status. Diagnosis depends on the summation of a number of almost intangible character observations of behaviour, movement, attitude and response which, however, make up a well-recognised whole. Some tests of a phychological nature are needed, included among which are those employed in the present investigation. The decision must depend on the interpretation of the relation found to exist between the intellectual and emotional status, on the one hand, and the educational on the other. Unfortunately, the psychology of education is as yet in a comparatively rudimentary state, in which much more experimental research is urgently needed, the only point on which there is general agreement is that the tests should be numerous and varied. Because a child fails at some one test involving the powers of attention, memory or perception, it does not follow that he will fail at another apparently involving the same factors. This renders evaluation difficult. In time, when a numerical expression of the norms for many tests has been determined, the matter will be much simplified. There is also the difficulty that the degree of reliability of each test has as yet to be ascertained, which can only be done by continued investigation of a group of children. It is in this direction that work such as that of Dr. Spearman and Mr. Abelson, described on page 63, is of value to the medical officers certifying under the Act of 1899. Until this standardisation has been completed by experimental research, it is only possible to use a number of tests and judge from the general result. Probably four cases out of five, if not a higher proportion, offer no special difficulty, the odd cases require prolonged investigation, spread over some weeks, to avoid the influence of chance variations. These doubtful cases could only be accurately diagnosed by the more detailed application of psychological methods such as are available at the psychological clinic in Philadelphia or in the training school where Goddard works at Vineland, New Jersey. Such investigations could be carried out in some central school with a staff specially trained in medico-psychological methods. Their labours, however, might be expected not only to decide on methods of diagnosis, but to throw a definite light on the psychology of teaching methods in general. It is possible that some children owe their extreme degree of retardation to the methods in use not being adapted to their needs. Reliability of methods of examination is of the utmost importance both for education and for the determination of the border line between the child who can be made a passable citizen and the one who needs permanent custodial treatment. This uncertainty as to reliability is the weak point in the tests of Binet and de Sanctis, which are the best graded series at present available. 150 Annual Report of the London County Council, 1911. Failing the existence of a sorting house, which has often been suggested in these reports already, doubtful cases, which have already been declared failures under ordinary methods, can only be admitted to special schools and the results determined by a method of trial and error. The results of this investigation, however, support the general accuracy of the diagnostic methods at present in use. The medico-psychological and educational tests adopted indicate that the children in the special schools may be classed as follows :— (a) Those far behind their normal grade both academically and intellectually ; undoubted defectives, many of whom will never be fit for any but the roughest work under strict supervision. It is probable that these children who approach the ineducable do better in schools at which special attention is paid to sense education. Those ceasing to progress in either direction are noted as ineducable, or as having reached their mental limit. Both terms must be understood in the sense that the children are unable to benefit to a reasonable degree by education in day special schools. The term " reached mental limit" is not very satisfactory, as it is possible that some children thus classified might improve under the conditions of life in residential schools or colonies, while others are fit for some work, though they are unlikely to make further progress in academic subjects. (b) Those behind their grade intellectually, but more so academically. These are the children who profit by special school education. (c) Those somewhat behind their grade intellectually but distinctly so academically. These are the disputable cases, one fraction being found in the special schools and another and larger in the ordinary schools. Somewhere within this group is the boundary of the merely backward. These are the suitable candidates for intermediate schools where such exist. In my annual report for 1908 it was estimated by a special investigation that at least some 900 children, one-fifth of the total in the special schools, would do better in such an intermediate school. In the present inquiry a somewhat similar proportion was found, but the number of children of the age of 11 and under examined was too small to admit of accurate deductions. Intermediate schools would serve as clearing houses, through which doubtful cases would pass before certification for special schools. In the schools for elder children a certain number improve from grade (b) to (c). (d) Children who are behind intellectually, but little behind academically. Few of these are in special schools, and those that are there owe the position rather to moral than educational defect. They are usually unreliable and cannot obtain employment after the school period. (e) There is also the group of undoubted moral defectives. Intellectual tests entirely fail to discover these children. There are many who answer intelligently when questioned about their daily life or school work, and yet whose actions show they are incapable of forming a moral conception or of conforming to the conditions of social life. Such seem to need continuous care in residential institutions. The children who pass from (b) to (c) and are able to undertake the work of Standard II. by 13 are those returned to the elementary school. It is not easy to say on which tests most stress should be laid, the opinion of the teacher must have great weight as must the educational tests of reading understandingly, dictation, and power of doing simple sums. If intermediate schools existed the prospect of successful return would be increased. In the investigation now recorded a child who could read a Standard II. reader straightforwardly, give some report of what he or she had read, who responded to written commands, could write four or five letter words nearly correctly from dictation, wrote down an intelligible answer spontaneously and could do a simple sum, was regarded as suitable for an elementary school, if not well over the age of 13, and provided the general tests had not indicated a very special degree of retardation. Any case over three years behind the grade in the Binet tests or who showed a corresponding level in the series more extensively tried, was regarded as likely to repay better a stay in an elder school until such period after 14, at which he might be deemed fit for suitable work. The distinction between cases recommended for exemption which were regarded as certifiable, and those not certifiable has been explained above. As a result the 209 children examined may be classified as follows— School. South-grove. Priory-road. Offord-mail. Total Fit for ordinary school 3 1 4 8 Probably fit by 13 — 9 4 13 Certifiable as defective under the Act 52 65 38 155 Imbecile — — — — Ineducable — — 2 2 Reached mental limit — 1 1 2 Fit to leave when suitable work is found 18 7 1 26 There were only 13 children under 13 at South-grove and all were well past their 12th birthday. The estimate for return to the ordinary school by the age of 13 was taken from 54 children of 10-12 at Priory-road and Offord-road, as it was felt that no reasonable forecast could be made of the prospects of the 26 who were under 10 and had not long been in the special schools. The proportion thought suitable for return has been a little higher than at routine examinations (3.8 per cent, as against 1.7 per cent.), part of which may be due to personal equation and part to the much greater allowance of time per child (6 to 7 per session as against 25 per session). It is clear that 151 Report of the Medical Officer (Education). a more complete examination at which the child has ample opportunity to become accustomed to the examiner demands an expenditure of time which would allow not only of a definite opinion, but of some contributions to the psychology of education. Certain psychological investigations were made in the schools by pupils of Dr. Spearman, with the permission of the Education Committee. The most important was presented as a thesis at the University of London by A. R. Abelson. It was on the Measurement of Mental Ability of backward Children. The work has extended over three years. Individual examinations were carried out on 131 children in 8 schools, 18 different tests being used. Only one test was used on any occasion. The work was always done in a separate room, quite free from any disturbance, and plenty of time was allowed for the observer and observed to get on friendly terms. The children examined were those who presented least evidence of defects, and who whilst they cannot make sufficient progress in the ordinary schools, yet advance considerably in the special school. Abelson designated them merely backward, but adds that these " backward children are of all mentally defectives the most interesting, since they are the most amenable to treatment." The main aim of the enquiry appeared to be the principles upon which practical tests of efficiency must be based. At the start 14 groups of tests were tried. The following nine were continued through the enquiry, namely :— Tapping test—to measure simple motor action. Crossing out rings test—to measure rapidity of motor co-ordination. Crossing out sets of dots—to measure one form of quickness of perception. Geometric figure test. Power of placing a pointer within certain geometric figures. Immediate memory for sentences, names and commissions. Discrmination of length. Interpretation of pictures. Only the last three of these tests, memory for commissions, discrimination of length and the interpretation of pictures have been commonly used by the medical officers in the estimation of mental deficiency. The whole of this work may, however, be regarded as an independent enquiry, as the methods of testing have been somewhat different, being more to measure the value of the tests, as well as to determine mental response. The teachers' estimates of the practical intelligence of the children, and their attainments in arithmetic and reading were compared with the results of the tests. The boys and girls were separately graded in order according to their success in each test and according to the teacher's estimate of intelligence, reading, and arithmetic. The correlation co-efficient was then determined for each pair of groups. Each test was repeated and its reliability tested by these methods of correlation. The degree of reliability of the finished results were found to be high. There was an even and appreciable correlation between the results of the tests in the case of the girls, the average being .32. In the case of the boys smaller and more fluctuating values were obtained, with an average of .26. This point was noted early in the investigation, so that after only four schools had been visited girls alone were examined. It thus seems far harder to estimate a boy's intelligence by a few tests than that of a girl. The distribution of mental attainments being apparently more even among girls. Neither reading nor arithmetic correlate highly with other performances. They are no better, indeed, if anything, worse, than an average single test. Nor do they go together, an observation made by both teachers and doctors long ago, although not quantitatively estimated. The teachers' estimates of intelligence correlated mostly with arithmetical capacity, memory for commissions and sentences, and reading ability, the commissions memory was closest with girls, and reading with boys. This, Abelson points out, probably gives a clue to the working of the teachers' minds rather than to the mental capacities of the children. His conclusions are that:— It is time to abandon too exclusive reliance on casual and intangible general impressions, especially when these have to be derived from a single brief interview. Certain conceptions, such as that individuals may be classified into distinct types according to their mental processes, are becoming obsolete. Methods of diagnosis should be checked by numerical estimates and correlation co-efficients. The results obtained give no support to the " faculty " theory in psychology, so that a report by an examiner that he had tested memory, observation, judgment, reasoning, muscular co-ordination and so forth, would arouse no confidence in the procedure, on the part of the author. Of the tests themselves, all tests alike proved untrustworthy when used alone, the cardinal principle must be to pool several independent tests. When the tests are properly constructed and suitably graded any one of them is just about as effective as another. Moreover, the apparent intellectuality of a test may be very misleading. An unquestionably defective child may perform a test almost incredibly well while perfectly normal children may meet with surprising failure. More fundamental is the principle that the tests should be thorough enough to give results of some constancy. It is best for children on the border line between normal and deficiency and at least over eight years old always to use the same tests and make allowance for age. This is the usual method of the medical officers. He thinks half an hour should be allowed for the examination and re-examination of each child, but his method would seem to require an even longer time. He concludes that the general nature of mental deficiency is a " general lowering of that class of performances which is characterised by the need of clear consciousness. . . . The reason for applying a large number of tests is not to gauge a number of different factors in ability, but merely to obtain multiple evidence as to this one factor, the general level." This conclusion, at present popular, must be 152 Annual Report of the London County Council, 1911. very tentatively accepted, it is a reversion to the undifferentiated work of the past, and even apparently only holds for a restricted class of case. The value of the enquiry, however, does not depend on this physiology or psychology, but on the determination of reliability in the tests. If his conclusion that one set of tests is as good as another is confirmed as seems not improbable, for this is a matter of mathematics and not of theoretical psychology, the slight deviations of procedure adopted by different medical examiners become of relatively little importance. The author does not seem to have arrived at any further conclusions as to the educability of the children from his tests than those derived from the simpler work of the medical officers. His work deals with the work of many children, whereas the medical officer's work for the purposes of certification under the Act deals only with the performance of an individual child. The enquiry, however, is a good illustration of the advancing accuracy which quantitative methods are bringing into the most elusive and incommensurable observations in school work, and also illustrates the difficulty of doing such work under school conditions. Easy treatment or oral teaching only in elementary schools. In connection with the medical examination of children suffering from defective eyesight or hearing it is sometimes found that there are children who are not sufficiently bad to be classed as " blind " or " deaf," and many of them who will eventually attend myope or hard of hearing classes when provided, are, for the present, required to remain in attendance at the ordinary elementary schools. For some time past these children have been recommended for " easy treatment," for " oral teaching only," or " to sit in the front row." and the following instructions have been issued in regard to such cases:— Visual Defects.—Children recommended for easy treatment. —These children usually suffer from a defect of one eye only or they have defective vision in both eyes of a moderate degree. With reasonable care school work should not cause strain of the eyes nor entail the risk of exaggeration of their visual defect. These children should sit in the front row of the class, sit upright and not be allowed to stoop over any literary work allowed them. Girls must do no sewing, but may learn knitting, provided it be taught by touch and not by sight. Boys and girls should be prohibited the use of books with small print or writing of any sort other than a bold large-lettered hand. # They should not join in exercises that involve the reading or writing of masses of numerals or geometrical figures. They may read or write in large type preferably for periods not exceeding 20 minutes without a break. They should not be allowed to stoop over their work, and, if it be possible, the writing should be done free-arm fashion on a blackboard or millboard set up on the desk. So far as school arrangements allow they should attend all the object lessons, demonstrations and oral lessons that are given in the school. Drill, dancing, games of all kinds may be freely indulged in. Home lessons of any sort should be prohibited. Children recommended for " oral teaching only."—These children suffer from some serious defect of vision such as gradually increasing short sight. When no place can be found for them in a special school they are admitted to the elementary school with a view to their gaining the educational advantage of school discipline and such general knowledge as can be given them in the oral lessons of the classes. The use of books, pens, paper, pencils and slates of any kind and for any purpose is to be prohibited and the child should be reminded at intervals by the teacher in a friendly chat that the prohibition is for his or her own benefit, and that they must do at home what they are trained to do at school. If the class arrangements permit they may be allowed to write or draw on the blackboard in large characters free-arm fashion. If a girl shows aptitude for handwork she may learn knitting by touch, but not by sight. Similarly, a boy may do the larger kinds of carpentry, but he must not use the rule or draw measured plans. For the most part these children may drill and dance, but they should be warned against using gymnastic apparatus or dumb-bells, for example, in connection with the Children's Happy Evenings Association. They should be cautious in the playground games. Aural Defects.—Children recommended " to sit in the front row."—These children suffer from slight deafness and it is essential that they should be allowed to sit in the front desks in the class. Other children who are recommended for admission to a hard of hearing class have to remain in the ordinary school until places can be found for them in a special class. These children must also sit in the front row. Speech. From time to time attention has been called to the need for special educational treatment of stammering, as from one to two per cent, of children present this defect. Girls show a proportion of about a half per cent, throughout school ages, whilst boys increase from about a half per cent, in the infant department to as high as three per cent, at twelve years of age and four per cent, among the Standard VII. boys. Family predisposition towards nervous defects, and particularly stammering, is the chief point noted about this functional error. The frequency of some shock or accident involving nervous strain is also marked where history can be obtained. Dr. Dick, who has been noting the varieties of speech defect, incidentally remarks on the number of children who, after passing through the standards, at the age of fourteen, when ready to leave school still express themselves in language so crudely formed and with such defective enunciation that they are hardly able to make themselves understood. A question has frequently to be repeated several times, and the listener must pay close attention to understand the child. He attributes this largely tq want of home training, and says that frequently a child has two languages, the mother tongue and 153 Report of the Medical Officer (Education). the school language. The improvement in articulation among the children of the special schools in the past half dozen years, however, shows what part the school can play in modifying or educating this function. He found 111 cases presented by the teachers among 6,216 ordinary school children, that is 1.8 per cent. Of these, 60 stammered or stuttered, 12 presented lalling or lisping, 26 backward speech, and 13 defects due to adenoids, deafness or other physical causes. Dr. Bellingham Smith, working in the East End, where there are many alien children, has analysed the nature of the defect present among 96 children (1.98 per cent.) chosen by the teachers from among 4,631 ordinary school children, of whom 1,843 were boys, 1,881 girls, and 907 infants. Of these children 3,816 were English and 815 were Jewish by parentage. He arranges his cases as follows :— (i.) Organic defects of the articulatory mechanism— Adenoids 10 : . Enlarged tonsils 4 Cleft palate 2 Hoarseness (from intra-laryngeal causes) 2 Enlargement of turbinals 1 (ii.) Functional defects of articulatory mechanism- Stammering and stuttering 44 Substituted speech (lisping, lalling, etc.) 24 Unclassified (lack of will 2, feeble voice 2, nasal tone 1) 5 (iii.) Central nervous defect— Congenital word blindness 1 Nerve deafness, post meningitic 1 Temporary aphasia 1 Not classified 1 Increased adenoid or turbinal growths, or enlargement of the tonsils rarely gives rise to defect of speech. This only occurs when the obstruction is almost complete, or the tonsils very large. Where adenoids have been left till structural changes occur in the articulatory cavities, these themselves may produce a permanent speech defect, even when the adenoids have been removed. The cause of the hoarseness noticed in two cases is often intra-laryngeal roughnesses or warts (papillomata), but it could not be definitely determined by the means at disposal in a school examination. The functional causes were commonest and stammering was the most frequent. Of these, 20 were Jewish, 2.4 per cent, of the number of Jewish children, and 24 " English," or 0.62 per cent, of " English " ; 30 boys, 1.6 per cent, and 10 girls, 0.53 per cent, with 4 infants (3 boys and a girl). The large foreign element made enquiry into the history and associated conditions difficult. Definite causes were only assigned by 13 ; of these one stammered after recovery from pneumonia, one after seeing a small brother killed, two after fright from other causes; two learned through sitting next to stammerers at school, seven had elder members of the family stammer, and the remaining 31 assigned no cause. The cases were classified— (a) The commonest stammer was the simple noisy stutter on the first consonantal sound —27 cases, 24 of these being only on the first word of a sentence, the others on any words. (b) The cases with silent struggling over words numbered 5. (c) A stuttering repetition of the first syllable occurred in 7 cases, 2 of which had much overflow of nervous effort. (d) A curious abrupt explosive kind of speech noticed in 3 cases. (e) Stridulous inspiration with commencing speech noted in 2 cases. As regards stammering, all these cases could sing perfectly. Although the voices were generally rather toneless, one was the best singer in the class. In 17 the defect was evident on conversation alone, in 27 on conversation and reading, and of these 18 read poetry better than prose. Parents or teachers described 19 as very nervous ; 9 were reputed much above the average in intelligence, whilst 4 were in arrear, although not actually mentally defective. One suffered with enuresis and 5 had other troubles. The stammering varied with health; 1 nearly cured relapsed after tonsilitis. The faulty function lies in incoordination of articulation with breath, and in the first variety of cases the children talk or read in a great hurry, almost with breathlessness. The fear that they may stammer if they stop leads them to place the breathing periods as far apart as possible and aggravates the condition. Regular breathing exercises, reading aloud and slowly, if necessary with the teacher, so that they learn when to fill their chests, cures the majority of these cases. They have to be taught to speak slowly, deliberately and from a full chest. In the second variety, silent stutter, no air escapes at all, whilst in the third the fault lies in the second element, so that the first syllable is repeated. In the fourth variety the chest is not empty, but voice comes with explosive fores, the over-action of the articulatory mechanism preventing slow escape. The fifth variety seems to mean approximation of the vocal cords during inspiration, so that a stridulus is produced on beginning to speak and the sentence is hesitating during the filling of the chest. It is not sufficient to attempt to remedy these cases in the ordinary school. The teacher must gain special experience and the children have special training. 154 Annual Report of the London County Council, 1911. Substituted speech—24 cases—mostly found in the infants' departments ; easy sounds being used for more difficult ones, for instance in 11 cases R was replaced by W or L, in 4 cases voiced and voiceless consonants were not distinguished but used interchangeably as B and P or T and D. In the worst cases, commonly called idioglossia, these rules are present, but sometimes there is no clue to the speech at all. These cases are usually inattentive, but gradually improve. Such bad cases are :— S. McH.—Girl, aged 5|. Speech fluent, but quite unintelligible. Considerable irritability at not being understood, hears well and understands all paid to her. Marked lack of attention when attempts are made to teach her sounds. Vowels pronounced perfectly, but B=P, soft C=TH., d=Kee or ee. K=tee. W=Ki-oo. Z=eth. Eight months later, after careful individual teaching, she read, recited well, and was intelligible, but still altered certain consonants, replacing s. by t., labial b by voiceless p, and so on. E. V.—Boy, aged 8. Quite unintelligible at present, said to be improving. Is very inattentive ; can produce sounds correctly, but introduces T or D for many consonants and quite irregularly , also interchanging b and d, fat= tat, bad=bab, very=derry, blink=derlink, bring=dring ; voioed and voioeless gutturals are also replaced by dental, and aspirants omitted ; y is transposed to 1. The unclassified defects are illustrated by— J. M.,a boy, aged 5£. Been 2 years in the schools, will not talk unless cajoled or threatened, cannot read the smallest words, never talks unless spoken to and then speaks with great distinctness. All his sounds are perfect. Intelligence apparently normal. S. P., a boy 6}, of Polish extraction, 14 months in school, for six months never uttered a word, sits motionless and inattentive. Can produce all the sounds perfectly and knows alphabet. If addressed, appears stone deaf, taking no notice of questions or directions, now talks a little to the teacher, but never to other children. He is said to talk at home. Hearing and understanding would appear to be perfect, and he seems otherwise normal, but there is apparently complete lack of desire for speech. J. M., girl, aged 12. At 4 years of age had an attack of encephalitis during which she lost the use of her limbs and speech. She could not speak till eight years of age ; now is bad at reading and speaking, having attained the standard of a six year old. There is no lack of intelligence in other respects, but her home surroundings are bad. Some few of these developmental defects which ultimately come right would well repay careful daily study and throw light on educational methods. They belong to the class of cases which require to be studied in a residential observational school, for which London has probably greater need than any other place, from the amount of material to be handled and classified here. The stammerers exceed in number those mentally defective for whom a comparatively expensive education is provided. They are, however, more valuable members of the community. They all require encouragement and suggestion by direct assertion, sympathy and patience till they overcome their difficulties. Their general health must be kept at the highest level. They could in the majority of case be cured of their defect in a few weeks, or perhaps months' time, and yet there is no provision for the treatment of such cases within reach of the elementary school children in London. The SemiBlind. The treatment of children too blind for ordinary schooling is included under the Education (Blind and Deaf Children) Act of 1893. It has usually been taken as including them in the ordinary blind teaching with Braille type and so on. This is educationally unsound, if it be taken that they are to be educated as if the eyes are of no use to them. The smallest amount of vision even if it only be the perception of direction of light is of some use in life. There is, however, a considerable amount of blindness of such a nature that ordinary schooling is largely lost, whilst education by the usual blind methods is still of less value for the purposes of later life, vision remaining of considerable use even in work. With the increased care of children these cases may be expected to diminish in number. Ten years ago a census of the causes of blindness was made in the blind schools. It has been regularly repeated since. Ophthalmia neonatorum accounted for 30 to 40 per cent. It is impossible yet to assert that this has materially diminished, as the proportion of semi-blind admitted has increased as a result of more careful examination. The 25 years' agitation of ophthalmologists has at last resulted in the Local Government Board making the disease notifiable, and it may be expected that blindness from this cause will drop to one-twentieth of its present amount in the next decennium. Cases of semi-blindness, too common at present from the sam e cause, will also diminish. The common cases of corneal scarring, due to phlyctenula, the results of ill-nutrition and want of houseroom and playground space, whilst they result in diminished wage earning power, seldom bring children into the category of blind. High myopia except in the purely congenital non-progressive cases which are too exceptional to base general treatment on, has been recognised as requiring special educational means. Any child coming into school with noticeable myopia requires most careful consideration, and a child who in the earlier years of school life presents several dioptres of myopia, should be taken out of the ordinary school. In any case the condition of the eyes may be expected to get worse, the myopia will increase during the whole period of growth. The most that can be done is to retard deterioration. The dangers pictured by German writers, and so often adopted by English writers and applied to myopia generally may be said to apply only to this special class. Whilst the so-called school myopia may be dismissed as a danger to vision, the danger of school or any near eye work for these juvenile myopes is considerable. The eyes appear weak in structure, " slack set up " as a Yorkshire weaver described them. Deterioration in such eyes to the extent of blindness is more common than in any other class. In my own experience it has occurred from haemorrhage or from detachment of the retina before full growth was accomplished. High Myopia classes. The High Myopia School, described in previous reports, was started experimentally. Tw others are about to be opened. The experience has merely confirmed our knowledge, and now th experience acquired of its success makes provision for this class of child an urgent necessity. . 155 Report of the Medical Officer (Education). The number of high myopes passed as requiring such treatment has been:— Year. For the Class at Boundary-lane. Invalided, treated as Blind, or allowed to remain in E.S. 1909 6 18 1910 6 40 1911 7 83 1912 (up to May 20) 2 80 Total 21 221 The cases submitted from ordinary school examinations or elsewhere as possibly suitable for Deaf treatment as deaf were further examined at the Head Office with the following results as regards educational treatment proposed:— Elementary school 53 „ front row of class 45 Hard of hearing class 9 Deaf 133 Mentally defective 11 Imbecile 3 Physical defect, cleft palate, etc. 5 Invalided or exempt 23 282 Of those advised for elementary school 38, and of those for front row 3 were cases with aural suppuration. The hard of hearing cases are few, not because there are few, but because there is little use referring them for treatment until centres are established. The analysis of the causes of deafness is of great importance from the public health standpoint. Certain cases must always occur, but the majority even including congenital and hereditary cases could be prevented. Mr. Yearsley has investigated the causes of the defect among 874 pupils of the Council schools for the Deaf. The records of other deaf schools are of comparatively little value, as generally they have not been made with a clinical or scientific purpose, and often it is doubtful whether they are wholly medical records. The records dealt with here are, however, the result of a critical examination of the history of each child as given by its parents, or on its admission papers checked and controlled by a thorough physical and functional examination. For convenience the classification used by Mygind, in his well-known work on deaf mutism has been used, although a more complete classification is desirable. The first grouping of these 874 children is as follows :— Boys. Girls. Total. Percentage. I Congenital 186 177 363 41 II. Acquired 236 218 454 51 III. Doubtful 26 16 42 4.8 IV. Unknown 8 7 15 1.7 456 I 418 874 99.9 I.—Congenital cases.—The cases born deaf number 360 ; to these may be added 3 of true congenital aphasia, making 363 out of 874, or 41-5 per cent. Amongst the doubtful cases 23 are probably congenital and 1 is likely to be true congenital aphasia. The addition of these would raise the percentage of congenital cases to 44-3. Mygind writing in 1894, suggested that " Future investigators will perhaps prove that acquired deafness has a still greater preponderance in the causation of deaf mutism than we are authorised at present in believing." Here the majority of all cases are found to be acquired. II. The acquired cases.—Those which are beyond dispute number 454 or 51.94 per cent. If 18 of the doubtful cases which were probably acquired are added, the number is 472, or 54 per cent. Of these acquired cases the first group is Disease of the Brain and its coverings, constituting 18 per cent, of the acquired cases—viz.:— Meningitis 49 Convulsions 10 Fits 23 Brain fever 1 It is probable that all were meningitis cases, although the exact nature of the cause would not be definitely ascertained nearer than the classification given. One of the cases was definitely recorded as " tuberculous meningitis." 156 Annual Report of the London County Council, 1911. Acute infectious diseases account for one-third of the acquired cases. Epidemic cerebro-spinal meningitis, which is the most prevalent cause in America, is here only represented by one case. The older work of Mygind gave percentages as follows for statistics from various countries: Norway, 23.5 to 12.0; Pomerania, 26.8; Baden, 14.0; Denmark, 1.9; Mecklenburg, 1.5; Saxony, 11. Scarlet fever accounted for 39 cases, together with one where it was complicated with typhoid. Of these 40 cases (8.8 per cent.) in 35 there was suppuration, 3 had middle ear catarrh, and 2 internal ear disease. Scarlet fever used to be a very large factor in English statistics of deafness, but during the present generation the mildness of the disease has materially lessened the aural sequelae. Measles figures as follows, measles 61, measles and scarlatina 1, measles with meningitis 3, measles with pneumonia 6—a total of 71, or 15.6 per cent. Suppuration had resulted in 38 of these cases, whilst catarrhal disease 6 and internal ear disease 24, account for the rest. The diminished seriousness of scarlatina as a factor of deafness partly due to increased attention paid to it by public health authorities, and partly to reduced prevalence of serious forms shows up well when measles and scarlatina are compared as factors of acquired deafness. Here measles is twice as important as scarlatina, but in the older statistics of Mygind the opposite was always the case. He gives:— Ireland. Germany. Denmark. (Wilde) (Hartmann) 1 Scarlet fever 7.0 11.3 20.8 Measles 1.4 3.6 5.3 Diphtheria is given as the only cause in 10 cases, and in 4 as the cause combined with scarlet fever or measles. This makes 14, or 3.1 per cent. Suppuration had resulted in 11 of the cases. Pneumonia, now classed as an acute specific disease, is said to have been the cause in 13, or 2.9 per cent., 8 of which were due to suppuration and the rest to internal ear troubles. Other acute diseases figuring in the history as a cause were typhoid 2, influenza 3, whooping cough 5, mumps 1, and rheumatic fever 1 case. The majority of these last cases were due to nerve deafness. The constitutional diseases tubercle and syphilis are extremely prevalent in the community, but apart from the case of recovered tuberculous meningitis, which is a rarity, there was only one case in which tubercle could be assigned definitely as the cause. This was a case of old middle ear tuberculosis which had undergone more than a dozen operations. Considering the frequency of tubercle as an aural disease in very young children its absence in the deaf schools is remarkable and can only be due to its fatality. Our figures are borne out by other statistics which assign less than one per cent, to this cause. Congenital syphilis is responsible for an appreciable number of severe cases of acquired deafness in children. In addition there are a considerable number of cases which become affected in the last year or two of school life, and which, though too deaf for ordinary life, yet are not wholly deaf; these do not come into the deaf schools. All kinds of causes are assigned, " paralysis, nerves, run over, unknown, improper medical treatment," and so on. It is only by careful enquiry that a number of these cases are known, Castex, in Paris, publishes (1908) 18 out of 719, or 2.5 per cent.; Yearsley (1909) noted 17 of 225, or 7.5 per cent. There are 37 cases here assigned to this cause ; that is, 8.03 per cent, of the cases requiring education as deaf are definitely assigned to congenital syphilis. This alone is an argument for the sanitary control of this most serious disorder, which is so prevalent. Primary ear disease is disease of the ear not due to infectious fevers, constitutional or brain disease. The cases under this head may be classified as— (i.) Suppurative disease, not caused by the fevers. To render a child educationally deaf it must have considerable destruction of the middle ears or secondary implication of the internal ears. These cases numbered 51, or 11.25 per cent. The majority were due to naso-pharyngeal conditions, chiefly adenoids, and most were avoidable. (ii.) Middle ear catarrh numbered 41 cases, and of these 40, or 98 per cent., were due to adenoids. This shows the necessity of attention to preventative measures, as every one of these cases should have been avoided. (iii.) Otosclerosis is a remoter consequence which does not usually show before adult life, but which was the cause of deafness in a girl of eleven years of age. Other influences.—Undoubted causes were fright or shock 9, injuries such as blows or falls 66, where the deafness is directly caused 45, or secondarily through concussion of the brain 5, or meningitis 16. Three cases were assigned to the problematical cause burns. Other improbable causes were teething 8, four of which were probably due to congenital causes, meningitis, scarlatina, and catarrhal middle ear disease respectively. One case ascribed to diarrhoea was probably the result of adenoids, and associated mucous disease. Doubtful cases were 41, nearly 5 per cent, of all the children, and they were provisionally assigned as follows:— Probably congenital 23 „ congenital aphasia 1 „ middle ear suppuration 2 „ „ „ catarrh 14 Fever (nature not ascertained) 1 41 Causes were quite unknown in 15. 157 Report of the Medical Officer (Education). The congenital causes could probably be lessened in number by the application of eugenic principles, the most immediate of which would be the withdrawal of all support from adult " deaf and dumb " institutions, which, as Professor Graham Bell has suggested, are tending to develop a deaf mute variety of the human race. Of the other causes it is reasonable to suggest that all the cases of suppuration or middle ear catarrh due to adenoids, and half the cases of deafness due to scarlatina or measles could be prevented by prompt employment of preventative measures. This would give a saving of cases of the following nature:— Suppuration due to adenoids 51 Middle ear catarrh due to adenoids 40 Half the scarlatinal cases 20 Half the measles cases 36 147 It may be fairly estimated that these 147 cases out of the 454 acquired, one-third of the cases, or 32.4 per cent., could have been prevented. The need for provision for the education and care of epileptic children has been referred to Epilepy. annually since the first of these reports. The absence of this provision is a great gap in the educational system of London. The requirement is not great in bulk, but where it exists is intense, and can only be satisfactorily met by a residential institution. The family of an epileptic suffers severely, although, fortunately, the numbers of such families are not very great. Now the foreshadowing of legislative changes makes any authority hesitate before committing itself to the large capital expenditure needed to satisfy the requirements of this problem. Meanwhile tentative arrangements have been made for some cases to be taken at Chalfont and Lingfield. In view of the fact that 300 children in London are not receiving education on account of epilepsy a suggestion for a small home for the worst cases has been considered during the past year. In considering the establishment of such an institution it has to be remembered that epileptics show wide variations in the degree of their affection and in their mental condition. Some have a fit only at intervals of several months, while others may have many fits in the course of a single day. Some are highly intelligent and attain to a good standard of scholarship, while others are of the most vegetative type of imbecility. Some are placid, others violent, insane it may be for short periods, measured in minutes, or longer periods, days, months, or even years. An individual of any one type may, with apparent suddenness, change to another. As a consequence classification has always been a matter of difficulty, and on the Continent it has been found advantageous to establish large colonies in which there is provision for farm colonies and workshops for those able to labour, schools of various grades, homes for the more defective, places of restraint, almost cages, for the more violent imbeciles, and asylums for those temporarily insane. All these institutions being under one management classification and transfer are easy, so that the best means can be adopted for the present and future welfare of each individual. In the absence of a special authority to deal with the feeble-minded generally such provision is scarcely possible and the present problem is the case of the epileptic of school age, 7 to 16. A certain number who have fits of a mild type at rare intervals or who suffer only from the lesser grade of the affection known as petit mal are allowed to remain in the ordinary schools, or in the special schools if the epilepsy is associated with a degree of deficiency rendering instruction in the ordinary school impracticable. In these cases the teachers are warned of the inadvisability of endeavouring to push the children. In a number of instances, however, medical certificates are submitted showing that, in the opinion of the physicians on the staff of well-known hospitals, the children should be for long periods or even permanently excluded from work under the conditions prevalent in the Council schools. On the other hand there are also many cases in which it is suggested that some schooling should be attempted, but in which the fits recur with such frequency or violence as to cause a disturbance of school routine and discipline, rendering their presence most undesirable even apart from the effect on other non-epileptic children. Generally speaking, however, the epileptic children are also to a greater or lesser degree mentally deficient, either permanently or for a time after each fit. Experience has shown that accommodation can only be obtained for those slightly affected and who present little or no sign of mental defect, whereas it is the rather worse grade who are most in need of residential care. This is the more so as they not infrequently come from families of a poorer mental stock and do not receive that good home influence and training which is so important a part of education. In a small home in which no great amount of grading could be undertaken, it is necessary to assume that the children would be approximately of one level, neither the best for whom some accommodation would be available nor the worst who would need both more immediate attention and probably ought to have permanent custodial care at the expiration of the school period. A home for from 40 to 60 children could be filled with tfiose whose mental qualities would correspond to the intermediate grades of the special schools. It is wisest to assume that the fits will persist throughout the life of the individual, though in a considerable number great improvement will result. Education has, therefore, to be directed towards occupations which would involve no personal danger in the event of a seizure. Work on the water, about machinery or on scaffolding and the like is contra-indicated. The choice will generally be restricted to sedentary occupations, and though farm colonies play their part in the custodial treatment of adults, it may be doubted if it is of much avail to endeavour to lead a town bred 158 Annual Report of the London County Council, 1911. epileptic child back to the land. The general principle of life in such a school must be to secure a maximum of uniformity ; excitement o! every kind, overstrain in work, and irregularity in meals and sleep being avoided. If overstrain and worry are avoided education can continue along the ordinary lines, but longer intervals between lessons and probably shorter periods for each lesson would be advantageous. It may be found necessary to modify the instruction given to individuals should worry and recurrent seizures be found to follow any special subject. This has not been found a practical working difficulty in the German epileptic schools. Exercise is important, but this and games will require special regulation, or the excitement in the playground may be more harmful than the mental work in the schoolroom. Personal influence and supervision are the determining factors, so that the personality of the superintendent, teaching staff and, indeed, of all the officers is of manifold greater importance than any considerations of site or structure of building. As regards the epileptic seizures it will be necessary to bear in mind that from time to time children will suffer from these and may need immediate attention, so that a special couch will be needed in each room on which they can be placed during the attack and on which they may remain for a time. After the attack is over there is usually a period in which the individual is not quite responsible for his actions, so that he needs watching. It has been found that children can remain on the couches in the classrooms or recreation room without disturbing the rest of the class. The trouble caused in the ordinary or special schools arising from curiosity on the part of some children and nervousness on the part of other children and the teachers disappears in a home or colony where a fit is an hourly occurrence. As regards the structural arrangements these seizures have to be considered in two ways. A child may be seized anywhere, so that it is necessary that immediate and easy access to it may be always possible, which will necessitate special arrangements in regard to the desking of the classrooms and the construction of the bathroom, lavatories and offices. As the children are liable to fall, though usually after a warning, unnecessary furniture and sharp edges must be avoided, and facilities be available for keeping children from falling out of bed. All staircases must have doors at each landing and all windows be specially guarded. This is the more necessary, as in the post-epileptic condition children may wander about in a condition of sleep walking. The Board of Education are believed to discourage stairs in epileptic homes, but with proper precautions they have been found abroad to present no real difficulties or dangers, so that this can scarcely be enough to settle the design of a building if other considerations render a two or more storied edifice more desirable. The great German institutions have three or more stories to each building both for children and adults. It is also advisable that unbreakable materials be used in place of glass and earthenware to avoid danger from broken pieces. The sleeping accommodation must be arranged to admit of instant supervision and detection of seizures, and the beds and bedding must be of materials so arranged as to diminish the risk of suffocation. It is necessary to arrange for night supervision. How far this will be required may vary from time to time. With some it may be enough for an attendant to be immediately adjacent and able to hear any sound in the dormitory. At any given time some children will be unable to receive instruction and arrangements for their supervision in the recreation room or dormitories will be needed. There will be the usual risk of illness and infection, so that provision will be required for a sick room and isolation rooms. Probably dormitories of not more than 12 beds will be found the most convenient, though all numbers from 4 to 60 or more are provided in existing institutions. Too large a number increases the risk of disturbance of rest at night. Bathroom, lavatory and office accommodation should be on the same floor and within easy reach of the dormitories. Sufficient recreation room must be provided to avoid the excitement of large gatherings, but if one room is available for those " not in school," the other rooms could no doubt be adapted to multiple purposes. Two nurses will be necessary at any rate at the beginning, though their duties will doubtless become lighter as the teachers and others become more used to dealing with epileptics. All the officers will require ample off-duty hours, as this class of work involves much more strain than an ordinary school or even hospital, the unexpected being very trying. Ample playground space, preferably grass, covered with facilities for gardening and outdoor occupations is desirable, but in all the arrangements it must be remembered that no child or even group of children can be left long without supervision. Heart disease. The importance of rheumatism among young children, as an insidious and almost unnoticed disease, exerting a powerful debilitating effect in anaemia, probably also retarding normal mental development, and sometimes leading to serious disturbances of the heart mechanism which, however, may not be detected till long after, has lately been increasingly recognised. Dr. Norman, analysing his notes of children with respect to heart disease, found 9 boys (0.72 per cent.) among 1,235, and 28 girls (2.33 per cent.) among 1,198. In 2 of the 9 boys and 1 of the 28 girls a congenital malformation was diagnosed. A boy and a girl showed signs of the aortic valve being affected, otherwise all the cases were defects in action of the mitral valve. There were from three to four times as many defects among the girls as among boys and chiefly the elder girls. Dr. Hadfield has made a preliminary enquiry in N.E. London as to the prevalence of rheumatism, and provisionally suggests that larger numbers of children than is usually supposed pass through rheumatism or chorea without heart disease appearing during school life, or as he terms it, permanent heart disease. This may, however, not be a permanent escape, as after some years definite signs may appear, and in older scholarship or pupil teacher candidates the gradual development of definite valvular signs is noted occasionally in the changing heart sounds. He rejected cases of indistinct or doubtful heart affection from his figures. 159 Report of the Medical Officer (Education). The cases were noted separately where parents were present and confirmed the diagnosis by their history, as follows:— Heart condition. Boys 64 in 2,942. Girls 77 in 3,050. Total children 141 in 5,992. Unaffected. Affected. Unaffected. Affected. Unahected. Affected. Rheumatic fever— Parents present 9 5 7 2 16 7 „ absent 2 — — - 2 — Rheumatism- Parents present 14 3 14 6 28 9 „ absent — - 4 — 4 — Slight rheumatism— Parents present 5 - 6 1 11 1 „ absent 1 - — — 1 — Chorea— Parents present 7 1 16 1 23 2 „ absent 2 - 3 - 5 — Rheumatism and Chorea— Parents present 1 — 3 2 4 2 „ absent - — - — - — Heart disease alone— Parents present - 7 — 8 - 15 „ absent - 7 - 4 - 11 - 23 0.8 per cent. 24 0.8 per cent. 47 0.8 per cent. Dr. O. K. Williamson has also noted rheumatism and allied conditions, as well as heart disease. His results from 2,479 cases may be tabulated as follows:— Number. Signs of heart trouble. History of rheumatism Chorea. With joint swellings. Without joint affection. Bovs— Senior 776 7 +1 29 20 8+2 Infant 385 7+2 4 4 1+1 Girls— Seniori 931 19+8 34 25 12 + 4 Infant 387 2 + 1 4 - — These 2,479 gave 1.-9 per cent, showing some signs of heart trouble (1.5 per cent, boys and 2.3 per cent. girls), and in 1.4 per cent. of all the heart trouble was definite and indubitable. When ill-nourished and debilitated children are selected on this account rheumatism comes prominently forward, and heart disease is a striking part of the picture. Dr. Cardale examined particularly over 500 necessitous children—by this, meaning children fed at school. Of these 234 belonged to the Isle of Dogs, and 283 to the Homerton district, and he states that 181 were free from defect whilst 336 presented definite defects; slight temporary variations from health being excluded; 190 of the 336 defectives, or 56 per cent., presented what he regards as definite valvular affection of the heart, being about 36 per cent, of the necessitous children examined. In one school in the Isle of Dogs, 42 of the 60 being fed presented heart affection, temporary haemic murmurs being excluded from the reckoning. Probably it is the anaemia resulting from antecedent rheumatism that had most lo do with the selection of these cases for feeding, but the whole matter is worthy of very careful inquiry. The explanation of the frequency of heart disease given by Dr. Cardale is that a very large number of these children are neglected, poorly clothed, and badly shod; that their homes are often draughty, cold and damp ; the children run the streets at all hours of the evening and night exposed to cold and wet, and frequently during bad weather they sit in their wet clothes and boots. Attacks of acute and subacute rheumatism are common, especially those insiduous attacks, of the subacute variety, which are regarded as " influenza colds," and receive no treatment but may leave valvular mischief. Obviously rheumatism may be difficult to detect, but it is well worth a very careful study in relation to age incidence, sex, locality, and possibly school work, for a careful physician of the last generation wrote a book on chorea, in which he concluded that it was largely a school-produced disease. spinal curvatures, which we regard in London as mainly slight developmental defects only, run into serious disease in rare cases. Dr. Hirsch has carefully examined about 600 girls in Woolwich schools as regards these curvatures. The children were stood to toe a line, the hands hanging by the sides and the head held erect. The angles of the scapulae were then felt with the Spinal curvature 160 Annual Report of the London County Council, 1911. right and left thumbs respectively, and all cases in which one was higher than the other were put aside for further examination, when the spines of the vertebrae were marked out with a dermograph, and a plumb line fixed to a rod was dropped from the cervical vertebra; deviations were then recorded by a calliper gauge. Unfortunately a series at different ages could not be obtained, as children are only examined at certain age groups now. Those born in 1899 and 1903 were taken, and 3 39 per cent, of 383 girls born in 1903, and 6.25 per cent, of 240 born in 1899 were noted with scoliosis. The poorer the school the more curvature seemed to prevail. The cases were all mild except two, and a considerable proportion of them came under remedial treatment arranged by the Woolwich Branch of the Invalid Children's Association. Miss Dobbie, who has special knowledge of these defects, having spent much time both in the surgical diagnosis and treatment of orthopaedic cases and in the application of exercises to them, has made very careful notes on a considerable number of unselected children of the 8—9 and 12—13 year old groups, born in 1899 and 1903. She has analysed her records as follows:— Age group Sex Numbers examined Normal spines Kyphosis Lordosis Kypholordosis Lateral curves Knockknees Tendency to flat feet Slight Definite Slight Definite 8-9 B 412 per cent. 213 16 4 7 182 5 121 82 144 51.69 3.88 .97 1.69 44.17 1.21 29.36 19.90 34.95 G 384 per cent. 169 20 2 13 191 5 110 67 91 44.01 5.20 .58 3.35 49.73 1.30 28.64 17.44 23.43 12-13 B 363 per cent. 129 24 2 3 215 7 98 42 140 35.53 6.61 .55 .82 59.22 1.92 26.99 11.57 38.56 G 326 per cent. 100 24 4 12 202 9 91 56 102 30.67 7.36 1.22 3.68 61.96 2.69 27.91 17.17 31.28 Miss Dobbie also compared the older (12—13) group of children with reference to their vision, and obtained the following results, which do not seem to support the idea that spinal and ocular conditions are related:— Spinal condition. Sex. Numbers. Vision Vision fair. Vision bad. Vision. 6 6 6 6 6 6 9 12 18 24 Unequal Normal spines B. 129 62 31 10 1 2 23 per cent. 48.1 24.0 7.7 .7 1.5 17.8 G. 100 32 26 12 8 1 21 per cent. 32.0 26.0 12.0 8.0 1.0 21.0 Lateral curves B. 222 137 34 7 6 2 36 per cent. 61.7 15.3 3.15 2.7 .9 16.2 G. 211 96 68 17 7 1 22 per cent. 45.5 32.2 8.0 3.3 .5 10.4 Kyphosis lordosis, etc. B. 29 20 4 - 1 1 3 per cent. 69.0 13.8 — 3.5 3.5 10.3 G. 40 17 11 7 3 1 1 per cent. 42.5 27.5 17.5 7.5 2.5 2.5 Whilst these results from the primary schools are slight, they indicate that curvatures are not very serious, and they are in concordance with the more extensive investigation in secondary schools reported on last year. School Planning and Apparatus. Lighting. The reports on natural lighting of schools tabulated hitherto have dealt with schools as units and merely given the conditions of lighting as a general statement, good, fair or bad, according to the impression on the observer. Duriiv the years 1906-8 the returns showed for about 1,000 schools 68.5 per cent, returned as good, 9.4 per cent, fair, and 22.0 per cent, as bad in respect to lighting. With the modernising wave which swept over the schools about that time, many bad schools were either closed or structurally improved. The reports of some 1,300 schools during 1909-10 showed the natural lighting as good in 76.7, fair in 21.5, and bad in 1.8 per cent. The 22 per cent. badly lighted had now mostly passed over to fair or good. During the last period the artificial lighting cursorily recorded in a similar way showed 92.9 per cent, good, 5.6 per cent. fair, and 14 per cent. bad. These figures can only be taken as rough impressions 161 Report of the Medical Officer (Education). of schools as a whole. If separate class-rooms were taken as units, or if the separate place of eachchild was considered in reference to its lighting, this high percentage of satisfactory illumination would no longer be recorded. Until a couple of years ago the means of rapidly and accurately estimating local illumination was scarcely available for school purposes. Now several methods exist for measuring either (i.) the relative natural illumination of different parts of a room, which is the determination usually wanted; or (ii.) the absolute amount of illumination in foot candles on any surface, which is the measurement required for estimating the value of artificial illumination, or for scientific investigations. Before these convenient methods were available, it was recognised that apart from direct sunshine the natural lighting of parts of a room was always a definite fraction of the out-door lighting. To determine this relation the angular opening of the illuminating area of sky was measured. Recognising that reflections in the room play an important part in its illumination, this method is being abandoned. A better way is to use a portable arrangement by which the illumination on a small white surface in any position can be compared against an image of the sky, the brightness of which can be diminished to equality by means of the aperture of an iris diaphragm. This aperture in size measures the relative illumination of the spot and includes the effect of all indirect and reflected light. The last method is to measure the illumination in actual foot candles. A variety of handy instruments have been devised recently. Mr. Harman has used a candle photometer made in a very portable and cheap form. Dr. Williams uses an electric apparatus in the schools, and Dow's Lumeter is a reliable instrument which has recently become well known. With these means at disposal school illumination will now enter on a new phase. The lighting at any place can be stated as a fraction of daylight, or in definite foot candles. The physiological adjustment of the eye is such that it can bear an illumination by daylight which would be the cause of unmitigated glare by artificial light. Outside illumination is usually many hundred times as great as indoor natural lighting. It is generally stated as a thousand times greater than that of an average room. For this reason a relative photometer, such as that of Thorner, already mentioned, which measures by the aperture of an iris diaphragm the relative value of the illumination at various parts of a room in relation to the outside lighting, is the most convenient routine method of recording the natural lighting of a class room. The amount of light varies enormously in different school places. Figures 12 and 13 give measurements made by Dr. Williams in the absence of the figure 12.—Measurements of desk lighting in a schoolroom (lowest floor). Stippled desks are too dark for school work. children at two o'clock on a clear, bright, but sunless day in November in two wide class rooms of the same school—the top of the windows being 13 feet high. The light is shown to vary ten or twelve fold on the desks. Desks which are stippled in the diagrams do not exceed 2 foot candles, and are judged too dark for school work. The minimum illumination of a school place should be 2.5 foot candles. On 162 Annual Report of the London County Council, 1911. the desks when tilted to the reading position, the illumination was always reduced. This is of importance because it is not often considered, and yet is the condition under which books are read. The condition in these rooms Dr. Williams summed by saying that boys near the windows would have better light than in a well-lighted room at home, whilst those in the remote desks would have lighting more comparable to that of a basement or cellar dwelling. Any place where diamond-type cannot be easily read by a normal eye at half a metre distance has lighting certainly too poor for school purposes. Whilst the lighting of the separate places afEects the individual scholar, the illumination of the blackboard affects the whole class, and as a rule it is very poor. The contrast between the blackboard and the chalk requires to be good. For education the object on which the child concentrates Figure 13.—Measurements of desk lighting in similar room to Fig. 12, but two floors higher. its attention must have brilliant and clear definition not only in the psychological, but also in the physical sense. The colours and contrast of chalks have to be considered, especially by artificial light. Some colours are almost invisible at a short distance, and this is one of several objections to the Dale system of teaching reading. Measurements of the surface brightness of the best desks and of the moveable blackboards in a number of class rooms showed the blackboard, on an average, to have only one-fifth the amoimt of lighting on the desks. Variations ran between one-third and one-twelfth. The fixed blackboards were still more poorly lighted, especially in the infants' departments. Some of the bad rooms, had only about one-quarter of the lighting of well-lighted rooms. Two rooms compared for a week—one well, the other poorly, lighted—showed a difference of nearly one and a-half hours daily in the duration of artificial lighting. Where rooms are poorly lighted they may often be improved by comparatively slight alteration. Window cleaning will sometimes improve a school room by 40 per cent, in illumination. Borrowed light, as a rule, contributes very little to illumination for school purposes. A small window in the back wall is often of much use, particularly in illuminating the blackboard. The light green colour commonly used in the schools has a comparatively good reflecting power, but above five feet from the floor white should be used extensively, and woodwork should be white above that height. Dark dadoes have also to be avoided. It is, however, when the shadows of the children are considered that regulation of school class rooms becomes pressingly necessary. All ordinary school class rooms in which the children sit with their backs to the main source of daylight should now be strictly forbidden. A window surface in the wall behind the children is excessive if its area exceeds one-fifth the window area in the wall to the child's left side, although for ventilation and to aid blackboard illumination a window is advisable high up on the back wall and as remote from the lighting windows as possible. Glare may be the source of a considerable disturbance. It arises when any source of light throws a peripheral image on the retina stronger than the illumination of the objects whose images are central, 163 Report of the Medical Officer (Education). and for which the eye has been adapted. The protective strain thrown on these mechanisms of the eye is the usual cause of the ordinary glare by natural illumination, and is evident as a sensible and painful reflex to any one coming from a dark to a brightly lighted room. It is mostly caused in school by the use of certain forms of ribbed glass, or by badly set prism glass, or patterned glass which refracts small beams of light at low angles or nearly horizontally across rooms at about the level of the children's heads. These causcs of glare are now becoming rarer in schools. The other variety, seen mostly in secondary schools, is where an excessive amount of specular reflection occurs from surfaces of books or paper. This occurs mostly with artificial light or in rarer cases where the student faces the daylight. The windows behind the children still existing in older class rooms are a source of troublesome glare to many teachers, especially those with low degrees of astigmatism. Illumination has a very important bearing on the size of classrooms. Whilst the illuminating window should be as large as possible for the sake of lighting, it has, in winter at any rate, to be as small as possible for the sake of warmth and prevention of draughts. The best lighting value on the furthest part of the room is obtained by a window carried right to the ceiling. If this be 13 feet, which is about the most useful limit from ventilating considerations, then the furthest centre of a desk to be sufficiently illuminated will be 20 feet off the window ; this gives a limiting width for the ordinary class room of 22.5 feet. Artificial illumination of school rooms was discussed some years ago, and now is being considered by a committee of the Illuminating Engineering Society, so that it need not be further dealt with at present. The schools are most generally ventilated by natural means, which are the open doors, windows and Tobin's tubes provided, aided by wind, and by the heat produced by the warmth of open fireplaces, large low pressure water pipes, and the children's bodies themselves. Ventilation. fortunately the climate 01 London makes such arrangements tolerable tor a considerable part of the year, but they can scarcely be called hygienic. In hot weather ventilation fails and the rooms become almost unendurable, in cold either stuffiness or draughts have to be withstood. In respect to ventilation practically all the elementary schools are unsatisfactory if judged by the standard of what is attainable and desirable. Certain schools are ventilated mechanically and complaints of this ventilation are of regular recurrence. Some of them may almost be described as museums of mistakes, but speaking generally the ventilating arrangements are much below the capacity required, and it is too late to make effective improvements. The plenum system is the one adopted. It necessitates closed doors, or with open doors the short-circuiting and air-starvation of other parts of the building comes into effect. The conditions reported on in the Annual Report for 1904 still hold good. Neglecting as lacking confirmation the observations of Weichardt, which assert a powerful fatigue toxin in expired air, the conditions already mentioned for efficient ventilation are easily realisable. The nutrition of the body is partly aided by the excretion of moisture by the skin and mucous membranes, and by the removal of heat at the same time, which becomes late nt in evaporation. If there is any hindrance or slowing in the removal of this heat in the evaporationof the water from the skin, metabolism is interfered with, imperfect changes take place in the tissues, and feelings of malaise, fatigue and exhaustion result. This process of heat removal is carried on continuously and naturally, the air under the usual conditions being below the body temperature and not saturated with moisture. Such air coming in contact with the warm skin becomes heated, takes up quantities of moisture, and at the same time renders much heat latent by the evaporation. The heating of the air and absorption of aqueous vapour considerably reduces its specific gravity so that it rises, to be replaced by cooler and drier air, which again takes up heat and moisture, and thus a continuous circulation is kept up by each person, naturally ventilating themselves. If this air film is already considerably heated as in the plenum system, where the air carries the heat from the furnace to the rooms, and if the air is much moistened, then the process is interfered with, hindered and made slower. The air acts as if it were already used up, and malaise originates with fatigue and exhaustion. Although on the other hand, all the benefits of air flushing, are obtained in keeping down dust, and doing a little to dilute objectionable odours, or even infections from the persons or clothes of particular children, and chemical testing shows it to be very pure. The naturally ventilated school with its smaller air supply has many hygienic disadvantages, but not always, or so evidently, this drawback of heat accumulation in the body which results in the plenum school, where air is used for carriage of heat. If the air in a naturally ventilated school was kept in sufficient movement, it might be very foul and yet seem quite comfortable on most days. The ventilation of the class room has been so fully detailed in previous reports that it need not be further elaborated. The impossibility of getting sufficient air through a naturally ventilated room, and the evils of carriage of heat by the air in propulsion systems will have to be remembered. The whole subject, in view of the new ideal of classes of forty, requires very careful inquiry by the Council, as it is now purely a matter of space and cost, and rooms have been devised to take advantage of wind, and by supply of large amounts of heat to have some of the advantages of natural ventilation without the disadvantages of the mechanical. To what has been written in previous reports, which sum the whole problem, it may be added that on the ten square feet basis satisfactory natural ventilation of school classrooms is almost impossible, that in any mechanical system without a supply of 1,500 cubic feet per head per hour there will be complaints, and that they will persist whenever the greater part of the carriage of the heat to the rooms is by the air. Dr. Forbes has investigated the conditions of the water ot the swimming bath at Drury Lane Industrial School. The pool, which has been in use for sixteen years, is 20 ft. by 12 ft. Swimming baths. 164 Annual Report of the London County Council, 1911. The water has a depth of 5 ft. 4 ins. at one end and 4 ft. at the other. The bath-room is roofed in, and is ventilated on the North and East sides by wooden louvred shutters. Each Saturday it is emptied, scrubbed out, and sometimes acid is used to clean the tiles. On Monday mornings it is filled by 4,300 gallons of water. The temperature of 60° F. is generally maintained by blowing in steam, and in cold weather the temperature is raised to 70° F. Batches of a dozen boys, after having washed over with soap and water, are allowed to bathe daily, remaining in as long as half-an-hour. If the bath is used twice daily the water is renewed in the middle of the week as well. Specimens of the water were bacteriologically examined on a Monday, before the bath had been used, Wednesday, and Friday, and of the sediment left on emptying the bath on Saturday. On the Monday counts showed only about 100 organisms to the cubic centimetre—a satisfactorily low degree of bacterial contamination of the fresh bath water. The colonies obtained all appeared to belong to the Proteus group, and the presence of Bacillus coli could not be detected. On the Wednesday, the temperature, 70° F., was somewhat higher, so that the comparison with the other examinations would not be strict. The contamination was approximately 4,000 organisms to the cubic centimetre. Various cultures of the Proteus, notably Proteus Zenkerii, were obtained. Staphylococcus epidermidis albus and S. Pyogenes aureus, Sarcina lutea, Streptococci of the S. brevis fceculis type, and diplocci of normal saliva were determined. Flasks inoculated with 50 c.c., 20 c.c., 10 c.c., and 5 c.c. of water also yielded B. coli communis. On the Friday, the fifth day on which the water had been used but the temperature had not been raised above 60°, a contamination of about 1,200 organisms per cubic centimetre was determinedSome leptothrix and the organisms above mentioned were determined with the exception of B. coli communis. In the deposit from the surface of the bath after running off the water all these organisms were present, notably the Proteus and B. coli group. On reviewing the nature and numbers of organisms found at different times, it may be observed that they are such as would be most likely to occur, but the presence of B. coli communis and S. faculis suggest the possibility of the bath being a possible medium of infection in cases of epidemic enteritis, or even in the event of its being used by a typhoid carrier, the possible transfer of B. typhosus In addition, the presence of organisms commonly found in the mouth indicate the possibility of the transmission of infective conditions of the mouth and throat. The largely increased number of organisms found during the week when the bath was being used at a temperature of 70° F. instead of 60° F. also suggests more frequent renewal of the water under such circumstances. Seats and In the Report for 1909 the attitudes of children writing in class were discussed ; further desks. questions, however, in relation to the seats and desks for elementary school children were omitted. In large towns fitting and furnishing has to be controlled by the cost of materials and dearness of land. This does not concern the solution of problems which present themselves to the hygienist. He must consider first how to fulfil sanitary conditions, and having defined these requirements, they can be modified to practice, and the best compromise between economy and efficiency obtained. Space is the main requirement in school, or, indeed, in the lives of children in large towns. The minimum school space allowable by the Board of Education regulations has become the maximum permissible. Certain needs restrict, others would extend the dimensions of a class-room. The class must be well within range of the ordinary voice of the teacher. Normal children in quiet outside air respond to the forced whisper up to eighty feet, but one-third of the Whitechapel children under the best conditions obtainable in their schools fail with the test at twenty feet. It is, therefore, apparent that without straining the child's attention or the ordinary voice of the instructor, a greater distance from the teacher of about twenty to twenty-four feet would not be permissible. This gives a limit of twenty five feet for the length of an ordinary class-room. Such a distance also falls within the limits for visual acuity, allowing for the large percentage who fall short of normal vision. The width of the room will be determined by the range of effective daylight; this depends on the height of the windows, which again are restricted in extent by the requirements of heating and ventilation. Class-room height above fourteen feet may be taken as ineffective for ventilation, and if windows are carried close to the ceiling, there is a limit to the position of any sufficiently lighted desk of about 21 feet from the window. If a gangway is allowed next the remote wall, this gives a maximum width for the room of twenty-two and a half feet. The angle of lighting is commonly said to be insufficient when from a desk the top of the window subtends less than 25° with the horizontal. With a window 13 feet high this occurs at 22 feet on a desk 3 feet high. With a class room of the size 25 ft. by 22.5 ft. by 14 ft (=7,875 cub. ft.) the number of children who could be accommodated depends on the sufficiency of the ventilation. Under the present regulations of the Board of Education, such a room accommodates fifty-six children ; the exact number depending probably on the desking. Nearly all elementary class rooms present the exhausting bouquet d'enfant. School baths would do something to relieve this, but sufficient ventilation is more important. The British Association Committee on School Ventilation decided that 3,000 cubic feet of air per head per hour was advisable. If half that amount is taken as sufficient, then with seven changes an hour, which, unless mechanical ventilation is resorted to, is all to be relied on as possible in school under English climatic conditions, x the number of children who could be sufficiently ventilated would be x x 1500 = 7875 x 7, whence x = 37. The educational size of classes has recently been fixed for the next generation as forty, and this number may also be taken as the greatest number which could be instructed under healthy conditions in the class-room, whose limiting dimensions have already been fixed. Hygienic considerations of the maximum space therefore coincide with educational in limiting the class size to forty pupils. 165 Report of the Medical Officer (Education). This discussion of the size of the class room with 14 square feet area, aud approximately 200 cubic feet per pupil, may appear to set forth an excessive ideal to those whose conceptions have been based on the acceptance of the 10 square feet per head minimum of the Board of Education regulations, but the same regulations demand a much higher standard for secondary schools, where really the sanitary requirements should, if anything, be less than in the elementary school. A commentary on the whole matter is, however, offered by the School Law of the State of Minnesota, recently revised (1910), which runs " 146. No school room or class room, except an assembly hall, shall have a seating capacity that shall provide less than eighteen (18) square feet of floor space and two hundred and sixteen (216) cubic feet of air space per pupil, and no ceiling in buildings hereafter to be erected shall be less than twelve (12) feet from the floor." The Swiss regulations require 14 square feet. Our standard of 10 square feet was probably taken from the Prussian regulations of 1867. The arrangement of the forty children in the pattern class depends on the furniture used. They must be placed so that the teacher can see all faces. In the case of small children the teacher can overlook all, but with children in the standards further devices are necessary. To raise the teacher on a platform or dais restrains movement and on the part of the children means one of the most fatiguing of eye movements—that of continued raising of the eyes above the level. The teacher ought, therefore, not to be on any dais, but the desks should be raised on stepped flooring. The desks must be easy of access, the child should be able to stand up in its place, and the children in their places should be accessible to the teacher. i The desks should be simple, solid, easily repaired, and free from mechanisms which can injure fingers. All headings, footrests, and means of distracting attention by foot play or of making noise should be avoided. Sloping the gangways instead of using steps serves to diminish noise, dust and bustle. Almost any arrangement of the seats in the room will suit the primary requirement of being within reach of the teacher's voice and vision, but there is always a tendency if seats and desks are moveable to crowd them together, and sometimes a class is so crowded that three children are in the seats intended for two. Overcrowding must be made impossible ; therefore the seats should be fixed to the floor. Difficulties about cleansing may arise, but if footboards are avoided, cleansing is almost facilitated by the clear floor with merely plain standards screwed to it. The isolation and ventilation of the individual child is of the greatest sanitary importance, and the isolated seat for each is the first requirement which must be fulfilled. Isolation is needed to prevent dissemination of disease, not merely the acute infectious diseases, but grosser forms of sores, impetigo, scabies or lice, and to dilute the offensiveness of odours from decaying teeth, discharging ears, dirty clothes, and other kinds of uncleanliness, due to want of washing. Isolation is also required to effect sufficient ventilation. The condition of fatigue, so wasteful of educational effort, is largely due to insufficient elimination of heat and aqueous vapour. This ventilation is naturally accomplished by the continual movement of a thin film of air, rising along the skin surfaces as the result of convection produced by the body heat. The elimination of heat and moisture is a physiological necessity atjd most powerfully affects the metabolism of the body. The " dead alive " feeling even in the chemically pure air of mechanically ventilated rooms is due to the air being used to carry heat, and therefore perhaps already as " used up " in this respect as if it had been breathed. There must be a definite free air space of some inches between each child and its neighbour. This excludes all forms of dual desks as hygienically unsatisfactory. As regards isolation, the width of desk allowed to each child is of importance. At present with the Sheffield system in the schools 18 inches is allowed irrespective of the child's size ; 20 inches on dual desks. For the smallest children 18 inches is a minimum, but the lateral desk width should be allowed proportional to the size of the children, averaging 20 to 22 inches, and for the biggest children 24 inches. The best sizes have yet to be worked out in the schools. ' School habits, due to fatigue from continued muscular efforts as well as from toxic causes and bad ventilation, are of importance. Myopia and scoliosis are often credited with being the result of school-acquired habits. Our English experience is against such a doctrine, although there is no doubt that in those congenitally so disposed school conditions may aggravate either the shortsighted tendency, or the spinal curvature respectively. The control of the school habits which contribute to these results, will be much aided by hygienically designed seats and desks, but it is to the teachers' knowledge and watchfulness that the first place has to be assigned. The habit of a near working distance is most harmful of all school tricks, bending the head close to the work, cramping the chest, straining the eyes and twisting the spine. It is a complex attitude developed by the fatigue and strain of premature fine finger work and eye work in the infant schools. The design of most modern school furniture has been mainly directed to combat this habit, to make the children sit vertically when writing, and to keep their eyes far from the work. The prevention of curvature of the spine should be looked for by promoting good healthy tone instead of debility in the great muscle masses of the back in the growing child. The greater prevalence of these conditions among girls than among boys show that all the considerations of playgrounds, exercise and free space already urged in regard to the catarrhal conditions associated with lymphatic defects have weight here. In addition, attitudes fixed or maintained by muscular action of any kind are excessively fatiguing to children, and in the case of unsymmetrical attitudes the element of weight plays a considerable part in exaggerating tendency to deformity. The attitude which is most important is that for writing—it should be symmetrical; the child must sit upright. This is obtained bv the 166 Annual Report of the London County Council, 1911. proper relation of seat and desk dimensions to the size of the child. Seats adjustable to the individual child would be most advisable, but for their cost and the difficulty of securing proper adjustment. If, however, a knowledge of the sizes of the children in different classes is obtained, then the rooms can be fitted with stock sizes, always remembering that any error in size is preferable in the direction of largeness of the furniture rather than smallness. The smallest sizes should go on the left-hand file nearest to the windows, as the smallest children are not necessarily those most defective in hearing or vision. This avoids a big hard-of-hearing boy having to sit in a tiny seat in the front row. The space between the children should be so great that no attitudes with twisted spine are necessary to prevent copying. In the dual desk, as Dr. Dufestel, of Paris, suggests, the left-hand child always suffers. The pupil on the right presses back his comrade with his left shoulder, and the left child, having the right arm stiffened to write, seeks a new position with his left arm outside the desk. A back rest is necessary to prevent fatigue. For the writing position, which has been described before as the most important, the support should be low to fix the pelvis, so that the child sits vertically. For the resting or reading position the rest would be higher under the shoulder blades and sloped perhaps ten or twelve degrees backward; but then the child as it relaxes tends to slide forward on the seat. This position is generally assumed on the seat of a dual desk when it is pushed up against the desk behind which the child then uses as a back rest. Experience favours the low back rest, but a combined one would probably be worth experiment. The ideal arrangement is a single seat and desk for each child, but single desks have been refused recognition as necessary for elementary schools. The advantages of the single seat are, however, too great to be sacrificed, and so there has been recommended single seats with continuous desks, sometimes for convenience termed the Sheffield desks. These were described in the Annual Report for 1904, from which Fig. 14 is reproduced. If the forty children are arranged at desks with five seats to each, the class can be set out in four rows of two desks, with gangways at each wall and up the centre. Figuuk 14. To illustrate the Sheffield system of continuous desks with single seats. The dual desks used in most schools are of excellent pattern and dimensions, and probably as good as such a pattern of seat and desk can be, but they allow of crowding, not merely by undue approximation of desks, but by actually placing three children on one dual desk for some lessons. This appears a custom which only stringent regulation can prevent. Further, these dual desks necessitate two children of approximately equal size sitting closely in contact, and one of these at least in bad attitudes. They are noisy, and there are many accidents to fingers from the hinged tops. Cleansing of the rooms is always imperfect. Although provided in all sorts and sizes, they are not always intelligently used. Some rooms have only one size ; one room measured had twenty-five dual desks of nineteen differing varieties according to dimensions. Frequently they are too small for the children, who, if told to sit upright, find their knees touching the book shelf beneath. This serves as a test of the suitability of the desk in largeness for the child. Experiments have been made for some time with Sheffield desks. The opinions of those using them are still in suspense, although generally favourable. The great advantage here is the spacing of the children and the impossibility of overcrowding. Difficulties in school organisation are thereby raised, and some alterations in school methods necessitated. " Taking places," for instance, as a reward for industry is ruled out as an educational method, if seats of graduated sizes are to be used. These seats and desks have not, however, had the advantage of being fitted to rooms built to suit them. Other things being equal, rooms built for dual desks cannot be fitted with Sheffield desks with equal advantage if the 10 square feet basis is to be maintained. Eich desk should have stencilled on it the maximum and minimum heights of children for whom it is to be used. As already noted, the lateral desk width in use, 18 inches for each child, is too small for most. For older children the spacing between the seats becomes too restricted. The low back rest for writing attitudes, is sometimes complained of in these seats. The silence of the class, the accessibility of the seats, the absence of footrests, the cleanliness and simplicity of the seats and desks are their great advantage. They are issued at present in eight sizes ; the two smallest, 10 and 11 inch seats respectively, are for infant schools ; the others with seat heights increasing bv an inch from 13 inches are for the ordinary schools. 167 Report of the Medical Officer (Education). Remembering that children usually grow most rapidly about the middle third of the school year, and that it is better for the seats to err in the way of being too large, the seats should be fitted in classes to suit the various groups of children at about the eighth month of their school year, increase of height during the rest of the school year being small. With labelled desk sizes for children of various heights the children could be supervised as to their seats by a monitor. Each child in school should know its height and the size of seat it should occupy. The dimensions issued for Sheffield patterns are:— For infant For standards schools. Boys, girls, and mixed. Desk sizes 1 2 3 4 5 6 7 8 Inches 10 11 13 14 15 16 17 18 Seat heights Centimetres 25 27.5 32.5 35.0 37.5 40.0 42.5 45.0 Smallest child to be allowed — 100 112 120 122 132 142 152 Group heights of children to use them — 105-110 120 120-125 125-135 135-145 145-155 155 Height of biggest child to be allowed 105 112 125 130 137 147 157 — The heights recommended are generally smaller than those given by foreign writers and commissions, as allowance is made for the desk to suit about the eighth month of the school year, and it is better to exceed in size than be too small. For the distribution of these desks in class rooms the measurements of some 8,000 children taken in 1906 are useful. These children were distributed in percentages of those in each standard in the following height groups:— Height in centimetres, up to 104 105— 110— 115— 120— 125— 130— 135— 140 145- 150— 155— 160— 165— 170 Boys I. 3.6 11.3 25.7 25.5 19.5 8.0 4.1 1.6 .2 - - - - - - II. — 2.6 9.6 25.4 28.7 24.2 8.3 1.9 .3 .4 - - - - - III. — — 1.5 7.6 24.4 27.6 20.6 12.2 4.4 1.3 .2 — — — - IV. — — .1 2.3 10.2 22.5 30.0 19.6 10.4 2.7 1.0 — — — —. V. — .1 — .6 2.7 9.5 20.7 26.4 23.4 10.4 4.4 1.0 .3 .1 - VI. — — — .2 .5 1.7 11.6 22.6 24.7 19.5 12.3 4.8 .7 .9 .2 VII. — — — - .2 .6 4.5 10.4 21.4 24.5 18.4 10.5 4.4 3.2 .9 Girls I. 3.2 11.2 25.7 27.3 17.3 7.8 4.1 .8 - - - - - - - II. .3 1.5 10.2 26.4 30.8 18.8 7.8 2.3 .6 1.0 — — — - _ III. — .2 1.3 9.4 21.4 27.5 23.3 10.9 4.7 .9 .3 — — - - IV. — — .1 .2 5.8 19.4 29.3 21.0 11.8 5.9 2.9 .9 .1 - - V. — — .1 .1 1.7 7.8 16.9 25.0 20.5 15.7 8.0 4.0 — - - VI. — — — .2 .2 2.4 7.7 14.5 20.3 23.7 18.6 8.7 3.4 .7 - VII. - - - - - .5 2.7 5.2 10.0 21.9 22.5 22.5 11.6 2.3 .7 From these numbers the proportions of desks to each room can be estimated. The larger sizes are more numerous for girls than boys in the upper standards, but the difference is not very great and for practical purposes may be averaged as in the lowest part of the table. The numbers are given for a class of 40 in each case:— Desk size No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. Boys I. 27 9 4 - - - II. 14 11 13 2 - - III. 3 10 20 7 - - IV. 1 4 21 12 2 - V. — 1 13 20 6 - VI. — — 4 20 13 3 VII. — — 2 13 18 7 Girls I. 27 8 5 - - - II. 15 12 11 2 - - III. 4 9 20 7 - - IV. — 3 20 13 4 - V. — — 9 22 9 - VI. — — 5 14 17 4 VII. - - 1 6 18 15 All Children I. 27 9 4 - - - II. 14 12 12 2 - - III. 3 10 20 7 - - IV. — 4 21 12 3 - V. - — 10 22 8 - VI. — — 2 20 15 3 VII. — — 2 9 18 11 168 Annual Report of the London County Council, 1911. These would be places for single seats and desks. Stress has not hitherto been put on seats and desks, as the dimensions used are of good proportions, and if intelligently used the sizes sufficiently numerous. The provision of sufficient space is of more importance than the exact model and dimensions of the furniture. It should be fully realised that furniture alone will serve but little purpose unless the teachers are alert in inculcating good attitudes, and that good attitudes mean avoidance of fatigue and, therefore, increased educational efficiency. Miscellaneous. Physical The remedial exercises undertaken voluntarily and often out of school hours by the exercises, drill mistresses in girls' secondary schools have resulted in considerable modification of the physical defects. The pupils who present conditions suitable for such treatment are re-examined at regular intervals in the presence of the drill mistress ; more regular, frequent and persistent treatment would prove beneficial. The sitting and writing positions which play a considerable part in the production of spinal defects still give rise to difficulty. During the course of medical inspection, Dr. Tchaykovsky has demonstrated the effects of bad attitudes to the pupils by the use of a full length mirror, with beneficial results on the general carriage and deportment. The drill costume which has now been adopted as the school uniform in many schools and worn daily by practically all the children has got rid of much of the over-weighting by corsets and petticoats, and led to improvement in general posture. In some cases there is no provision of any sort of pavilion or covered shed in connection with the games ground, so that on rainy days the girls are obliged to travel considerable distances in wet boots and stockings. Considering the compulsory nature of games, it would be advantageous to insist on a change of footgear in wet weather, and to provide some sort of shelter for changing. A special feature of the Graystoke Place Training College is the daily health exercises, which are taken for fifteen minutes prior to the commencement of college work. Dr. Tchaykovsky notes the improvement which results in the students after a few terms. These daily health exercises have been worked out by Miss Hughes, the gymnastic instructress at the college, and the following short note is taken from her account:— The college work begins at 10 a.m. From 9.15 to 10 a.m. students come in three divisions (15 minutes each) for exercises. These are done in ordinary dress and are regarded as individual health work. There is no drill class element in it. Students take the same places each day, and the work is done quietly. They like it, and feel it a rest after their journey to college. This daily work gives the physical mistress opportunity of observing students more individually. It is also possible in connection with this work to give many hints about daily habits and more suitable ordinary clothing. The following exercises were given :— (1) Breathing.—(i.) Use of handkerchief. (ii.) Breathing through one nostril (to clear nasal passage). (iii.) Normal deep breathing in good position of the body. (2) Abdominal Press.—(General Corrective Figure Exercise). " Draw In." Abdominal muscles are gently contracted. " Relax." Abdominal muscles are gently relaxed. Jerky movement must be avoided. This movement is carried right up the spine, resulting in drawing back of the hips, straightening of the spine, flattening of the shoulder blades, expansion of the chest, and drawing back of the head. The result is an easy and well-balanced position of the body. The abdominal muscles become stronger and healthier, which with many girls has been a great help for constipation and indigestion, etc. (3) Dancing Step or Simple Dance.—For circulatory purposes and also pleasure. This is changed daily, and thus puts variety into the work. (4) Arm Movements.—Simple aesthetic movements are taken here, as the usual arm stretching movements are done in the ordinary training classes. (5) Corrective Movement.—Head bending. Trapezium movements for round shoulders. These are used at first, if necessary, in classes where there is a large proportion of round shoulders and poking heads. (6) Breathing. Relaxation exercises.—Students lie on the floor in complete relaxation, mental and physical, eyes shut. Normal rhythmic breathing is directed. This is not only physical rest, but mentally soothing. It has been useful to many girls suffering from sleeplessness and nerve strain. Closure of Stormont House for Mentally Defective Blind boys was practically an asylum in which numbers stormont of children generally with degenerative nervous diseases had become collected. It was scarcely worthy House School of consideration. as an educational institute and comparatively costly to maintain. On reviewing the cases several appeared fit for training in the ordinary blind or residential blind schools. The others were fit for such an establishment as Darenth or an asylum for mentally defective blind cases. The school was therefore closed, and the children disposed of to various institutions. The building is now being utilised as an industrial school for younger boys. Remand The Council being responsible for the medical supervision of residential special and industrial Homes, schools and places of detention, these institutions have now come into the responsibility of the school medical officer. In May, 1911, a conference was held between the officials of the department and the 169 Report of the Medical Officer (Education). various medical officers of these institutions. The duties of all were standardised 1o a uniform basis, a card system was decided to be the most useful form of records, and the question of a suitable scale of salaries considered. In these institutions the Council stands in loco parentis, and the whole care of the personal health and hygiene of the children has to be supervised. s. Places of detention from their very nature give rise to considerable difficulty. In 1897 by an order of the Local Government Board, children could be ordered by two justices, or a magistrate, to be taken under the Industrial Schools Act, 1866, to a workhouse or asylum of the district. The managers of the Metropolitan Asylums Board, after consultation with the Local Government Board, decided that it would be better to place the children so remanded in special homes. Under the Youthful Offenders Act, 1901, provision was made for this. The Act only gave the magistrate the power of sending the children to the remand homes after they had been brought before him, and after arrest children frequently had to be kept at police stations till their appearance before the magistrates. The Children's Act, 1908, made it compulsory that all children on arrest should be taken to remand homes. Children's courts were established. The London County Council was made the authority of the remand homes from the time the Act came into force, although actually they were not taken over till April, 1911, when the term " place of detention " was substituted for " remand home." The original scheme only admitted children from the sitting of the magistrates court, now they are admitted at any hour of the day or night. The duties of the medical officers to the homes originally were purely consultative, they were only called in by the Superintendent when deemed necessary. Children entered, were bathed and mixed with the other inmates at once. Latterly an endeavour has been made to keep all new admissions apart, until examined by the medical officer. Children on entering the home receive a warm bath and clean clothes. Boys have their hair cut at once if verminous, girls only on the doctor's order. Only those in contact with them can realise how untrained many of these children are in ordinary matters of decency. All children under fourteen spend school hours in the schoolroom. Older children are given occupation. Short periods of drill are also prescribed, although space is rather limited. In the evening between the last meal and going to bed, reading or games are allowed. Boxing occasionally, especially when a spirit of insubordination threatens to develop, helps to relieve excess of spirits. Since this was introduced there have been very few attempts to escape. The food is plain and wholesome, and the effect of a week's stay on the health of the children shows in their appearance. Those who stay longer generally gain in weight and healthy appearance. Corporal punishment is rare. Detention in the punishment room on low diet generally is sufficient. Acute illnesses are rare. Infectious illness occurred several times during 1911. The girls' section of the Pentonville home was closed twice for chicken-pox, one case of measles developed and a diphtheria carrier was detected and isolated for two months before free from infectiousness. The dirt infections, scabies, impetigo, pediculosis and ringworm are common. During the dusty season inflamed eyelids, and septic sores of hands or feet were very common. No attempt has yet been made to analyse the mental and physical conditions of these children, but this is a field which would well repay study, and each child should have a thorough record made and its finger prints taken, for future reference. Want ot occupation, according to Dr. Hawkes, seems one of the chief factors in bringing boys to the homes. The numbers increase with each year of life till school ages are past when they drop. School status. Infant schools. Senior (standard) schools. Left School. Ages —3 —4 -5 —6 —7 —8 —9 —10 —11 -12 -13 —14 —15 —16 Numbers admitted. 6 12 19 27 32 67 117 163 192 228 286 316 251 240 A few of the children with chronic complaints not fit- for a school are remanded again and again to the place of detention. These children should be sent to an infirmary or hospital, as the places of detention have few appliances or conveniences for treatment. The cases are, however, all treated and sometimes with very good results. In reference to hop picking Dr. Williams states that whilst children of all ages go, the majority are Hop picking, from 10 to 14 years of age. They are intellectually average children so far as the standard in the schools shows. The absence is 14 to 16 days as a rule. The mother only accompanies the children in four fifths of the cases, the father only in most of the others, or a few go with other relatives. The social position of the children appears much better than would be expected, and normally they are much cleaner than when returning from hop picking. None were much below average, and about one-fifth above in respect to nutrition. The children appear to distinctly gain in health as compared with those who do not have a holiday, but they practically all return verminous and there are many cases of septic affections such as blight, blepharitis, and impetigo. As the standard of cleanliness is raised in school, this annual incursion of children in a verminous condition, and many with septic conditions will have to be provided for, and the nurse sees all children who have been " hopping " at her first visit after their return to school. The dust from a ventilator in one of the classrooms at Gifford-street was examined bacterioDust. logically by Dr. Forbes. The ventilator is in a wall facing east and overlooking the backs of dwelling 170 Annual Report of the London County Council, 1911. houses. The large numbers ol moulds and excess of B. subtilis made it difficult to estimate other organisms. Exceedingly small numbers of staphylococci probably the ordinary skin S. albus epidermidis and a diplostreptococcus, probably from saliva, were found, but no diphtheroid organisms and no B. coli communis. These experiments take much time, and the constant routine of medical inspection hardly allows the pursuit of other enquiries. Dr. Malcolm, however, apart from his official time, has made a commencement by investigating the organisms in the air, and in the dust of three classrooms at various times during the session in Christ Church, Deal-street (mechanically ventilated) and the " Davenant." Gelatine plates were exposed for a quarter of an hour for various times in front of the classes. No B. Coli were found even on plates exposed for three quarters of an hour. The number of organisms in a gramme of dust that fell was wonderfully alike in the three schools. Excepting moulds and sarcinse and a few organisms, amounting to 100 but not to 1,000 in a gram, which resembled B. Coli but were not typical, and the spores of B. Welschii none of any interest were identified. One slide showed some organisms with a diphtheroid appearance, but neither cultures nor stains confirmed this. From what little has been done the dust of schools does not appear to be very dangerous, but from the pathogenic point of view the whole bacteriology of the schoolroom requires investigation as to the mode of distribution of recognisable organisms, their conveyance from school to home and vice versa, and as to the reality of any possible disease dangers from this source. Feeding. Under the Education (Provision of Meals) Act, 1906, which is administered by the Board of Education, the Board have intimated in relation to the Annual Reports for 1910 that in future annual reports of school medical officers for areas in which the Provision of Meals Act has been put in operation they will look for a section dealing with the working of the Act. It was necessary for this purpose to get an idea of the actual working of the feeding centres and during the autumn of 1911 the school doctors inspected those provided in their respective districts. The reports received were very varied. The effect of feeding seems very indefinite. In a few cases marked improvement has been noticed. The strictness about admitting ill-nourished children makes it difficult to compare these children with others. They are generally very poor and compare unfavourably with those not fed at school. In a few places the provision of meals, the ordering and superintendence appear excellent. The meals given at the cookery centres are much better than those given anywhere else. In one-fifth of the feeding centres the conditions required material improvement, to make the giving of these meals an educational function, and to impress the hygiene of proper eating and cleanliness on the children. There is need for dining accommodation at some of the secondary schools. Ill-nutrition and deficiency of nervous energy is frequently attributable to the strain of the journey home for a hurried meal in the dinner hour. For scholars, especially, this is of great importance as the meal obtained is often insufficient or unsuitable and under these circumstances no pupil, however clever, can take proper advantage of the scholarship without detriment to health. The advisability of a midday meal at school is urged by the teachers, but too often their efforts are in vain. Racial charIn the autumn of 1910 an enquiry was begun at the Jews' Free School, in association with acteristics. observers from the Galton Eugenics Laboratory. The physical and mental characteristics of the children being noted fully in school, the family and social conditions were being investigated by social workers. The whole facts were then to be analysed in the laboratory under the direction of Professor Karl Pearson. Owing to the requirements of the Board of Education this valuable work was interrupted before sufficient had been done to be of use, but it is now to be resumed, partly at private cost. Meanwhile Dr. Gordon Holmes has analysed the cards of 797 children in other schools, and born in 1899 or in 1903. With the help of the teachers they were separated into two groups, according to whether the home was described as good or bad. Good being satisfactory conditions of home life, whilst bad meant that from poverty or otherwise the homes were unfavourable. This last category included children whom the teachers thought unable to get sufficient nourishment and those receiving meals at feeding centres. These groups were then separated into those children of Jewish and nonJewish descent, and the physical condition estimated by average heights and weights were taken out and set forth in the following table:— E. London, 1911. Born in 1899. Born in 1903. Stepney. Numbers Average Average Numbers, Average Average Numbers. Weight Height. Weight. Height. Non-Jewish— Good 75 29.73 132.94 69 22.72 119.34 Bad 82 28.65 130.81 71 21.85 115.28 Boys Jewish— Good 47 30.68 134.23 41 22.83 120.21 Bad 22 29.27 133.90 16 22.12 116.50 Non-Jewish— Good 38 29.89 136.50 51 20.92 116.15 Bad 46 28.00 132.98 98 20.70 115.01 Girls Jewish— Good 33 30.57 138.42 58 22.13 117.82 Bad 40 30.60 135.90 10 21.30 115.40 171 Report of the Medical Officer (Education). The standards of good and bad homes had to be left to the personal judgment of the teachers, but in Stepney the Jewish families are much better off than those of other races in the same district; and it is probable that the Jews classed as bad are almost as well off as the " Christians " classed as good. The abundance of garments worn by those of alien descent may, indeed, make some little difference in weight. The precocity of the Southern races has to be remembered, aud although at these particular ages they are the heavier and taller, they probably do not maintain the advantage into adult life. The capacity for learning, like that for assimilating nourishment, has probably a very considerInattention, able seasonal variation about which at present we know nothing. Inattention is, however, ever present, and it may be regarded as a symptom of causes preventing learning or as a defect in itself. The whole matter of inattention in school should be investigated not superficially, but in an intensive way. Teacher and school inspector would have to collaborate with the doctor, and the work begun in the school folllowed up in the labaratoty, till the whole problem is unravelled. For such a laboratory, a very necessary adjunct to the school work in London, not only for normal but abnormal children, although often recommended, there is as yet no provision. The investigation of inattention will be a slow business, it will not make much show on paper, but it will be an enquiry of extreme value to the educationist. Dr. Langmead has made a preliminary enquiry, and although his results are too few to be of value, and the regulations make it almost impossible to find time to continue the work, yet the method tried was found useful. The teachers were asked to select all the children in whom they observed any difficulty of fixing attention. Those considered to be in any way mentally defective were then eliminated. There remained apparently normal but inattentive children, who were then examined by the doctor. He noted the child's name, age, and standard. Particular attention was paid to its general status as determined by clothes and cleanliness, recorded as very good, average, or bad. The hours of sleep were ascertained, the time of retiring, and of getting up. Any work out of school hours was enquired into, also the vision, hearing, general bodily constitution, such as washing, anajmia, and so on. The presence of enlarged tonsils or adenoids was ascertained, and a general remark made as to any evidences of nervous instability, excitability, fidgetiness, and so forth. A neurotic disposition appears the chief cause of lack of attention among the children examined. In a few no adequate cause could be determined. In several as noted below various causes seemed to contribute. Notes were taken ot 28 girls at Baltic-street, a very poor school, and 9 boys at Rosebery-avenue. The cases were numbered girls 1—28, boys 29—37. Factors of inattention. Girls. (Case numbers.) Boys. Neurosis— (1, 3, 4, 5, 11, 18, 22, 27) = 8 (8, 35, 36) = 3 Overwork and fatigue— (1, 2 (?), 6, 9, 13, 25 (?)) = 6 (31, 37) = 2 General bad health — (6, 7, 9, 11, 20, 22, 24, 26) = 8 — = 0 Defect of vision— (12, 15, 16, 17, 22) =5 — = 0 Defect of Hearing— = 0 (31 (?), 34) — 2 Insufficient Sleep— (13, 16, 24 (?)) =3 (31, 37) =2 Mental defect— (14, 17, 19,21, 23, 28) = 6 — = 0 Indeterminate— (8) = 1 (30, 32, 33) = 3 It is noteworthy that although only in five was visual defect assigned as a cause of inattention it was sub-normal in 23 of the 37. The girls do much housework, and most of them had nervous tricks and movements. 172 CHAPTER XXXV. Public Health. Powers and duties of the Council. Many important duties devolve on the Council in relation to public health. These duties are set forth in various Acts of Parliament, the principal Act being the Public Health (London) Act, 1891. This Act authorises the Council to deal with offensive businesses, to make orders adding to the list of infectious diseases notifiable under the Act, and to license slaughterhouses, cowhouses and knackers' yards. The Council is also empowered to take proceedings with respect to nuisance caused by a sanitary authority in removing, treating or disposing of house or street refuse, and to act in default when a sanitary authority fails to carry out its statutory duties. The Act also empowers 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; (b) for regulating the removal or carriage of offensive or noxious matter or liquid and as to the removal and disposal of refuse, etc., as to water-closets, earth closets, privies, cesspools and receptacles for dung. The Council is also required under the 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. The Council is authorised by section 6 of the London County Council (General Powers) Act, 1908, to contribute any sum towards the salary of a health visitor appointed by a metropolitan borough council not exceeding one-half of the salary. In addition to the powers which the Council possesses under the Public Health (London) Act, 1891, to deal with offensive businesses, section 9 of the London County Council (General Powers) Act, 1908, authorises the Council to make by-laws for regulating the conduct of the businesses of a fish curer, vendor of fried fish, and rag-and-bone dealer. The supervision of common lodginghouses under the Common Lodging Houses Acts, 1851 and 1853, a duty at one time carried out by the police, has, since 1894, devolved upon the Council. By the London County Council (General Powers) Acts, 1902 and 1907, the Council is authorised to license common lodging-houses, to require the appointment of a resident deputy in each house ; to make by-laws for regulating the conduct of such house and to cause any inmates who may be verminous to be cleansed compulsorily if necessary. In addition the Council licenses seamen's lodging-houses and enforces the by-laws made by it under section 214 of the Merchant Shipping Act, 1894. Further, under part VIII. of the London County Council (General Powers) Act, 1903, the Council is authorised to license premises for receiving horses for slaughter or dead horses. Powers with regard to safeguarding the purity of London's milk supply are given under various Orders and Acts, and are as follows:—Under the Dairies, Cowsheds and Milkshops Orders of 1885, 1886 and 1899, the Council has power to secure proper lighting, ventilation, cleansing, drainage and water supply of cowsheds and dairies and the sanitary condition of milk stores and milkshops. The Orders also forbid, under penalties, the use for human food of milk from a diseased cow, or from a cow with tubercular disease of the udder; under part V. of the London County Council (General Powers) Act, 1904, the Council is empowered to seize and slaughter, on payment of compensation to the owner, any cow in a London cowshed suspected of tuberculosis of the udder ; under part IV. of the London County Council (General Powers) Act, 1907, the Council is authorised to take within and outside the county 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 affected with tuberculosis of the udder, to prohibit the sending into London of further supplies of milk. The Act also contains provisions for the isolation of cows suffering from tuberculosis of the udder and for notice to be given of such cows to the Council's medical officer. In addition to the duties enumerated above, part IV. of the London County Council (General Powers) Act, 1904, and part III. of the London County Council (General Powers) Act, 1909, authorises 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 accommodation for the storage of food. Smallpox. Early in 1911 an outbreak oi smallpox occurred 111 London. On 2lst February three cases were removed to hospital from the Mile End Infirmary, and subsequently other cases were notified in the Borough of Stepney. In addition to the occurrences in Stepney cases occurred in Westminster, Bethnal Green, Hackney, Deptford and Poplar. The total number of cases reported was 62, of which 10 proved fatal. Experience in previous outbreaks had shown that slight cases are sometimes mistaken tor cases of chicken pox, with the result that infected patients have not been isolated so early as would have been the case had the real nature of the disease been at once recognised. In these circumstances the Council decided to make chicken pox a notifiable disease for three months, and further to apply to that disease Sections 68 and 70 of the Public Health (London) Act, 1891. These sections impose restrictions on persons suffering from ar infectious disease as regards exposure in public places and conveyance in public conveyances. Typhoid fever. Investigation was during the year made into an outbreak of typhoid fever which occurred in the Metropolitan Borough of Finsbury during the month of September. Attention was called to the suspicion which has from time to time fallen on various articles of food as the cause of Public Health. 173 outbreaks of this disease in London during the past 20 years. There were two articles of food to which suspicion attached, viz., ice-cream and fried fish, and it is interesting to note that of the 56 persons attacked by the disease 21 had recently consumed ice-cream, while no fewer than 52 had partaken of fish. The report strikingly illustrates difficulties which may be encountered in discriminating between suspected articles of food. On 31st January, 1911, 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, 1911, the notification of all cases of cerebro-spinal fever (epidemic cerebro-spinal meningitis) occurring within the Comity 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 occurring 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, an 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. During the year 1911,101 cases were notified, making a total of 642 cases since notification became compulsory in 1907. A conference between representatives of the Council and the metropolitan borough councils on various matters affecting public health was convened by the Council and held on 6th April at the County Hall. Representatives appointed by the Corporation of the City of London, the metropolitan borough councils, the Metropolitan Asylums Board and the Local Government Board attendee?. The undermentioned subjects were considered and resolutions passed thereon: (1) houses let in lodgings; (2) pulmonary tuberculosis; (3) measles; (4) water supply to tenement houses; (5) places where food is prepared and exposed for sale ; (6) notification of Births Act, 1907 ; (7) chapels of rest. In 1904, 1905, 1907, 1909 and 1910 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 17th February, 1911, 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 parsons 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 7,038 persons in common lodging-houses and for 704 persons in casual wards. Following the practice adopted in previous years, the report was printed and placed on sale.* During the year, the Royal Commission appointed to inquire into the relations of human and animal tuberculosis made its final report. The conclusions arrived at by the Commissioners were (1) that man must be added to the list of animals notably susceptible to bovine tubercle bacilli; (2) that other mammals and man can be reciprocally infected with tuberculosis, that bovine animals are not completely immune to the human tubercle bacillus, and adult human beings can be infected with the bovine type, even the pulmonary form of this disease in man being sometimes caused by the bovine tubercle bacillus; and (3) that " there can be no doubt that a considerable proportion of the tuberculosis affecting children is of bovine origin," and that " a considerable amount of the tuberculosis of childhood is to be ascribed to infection with bacilli of the bovine type, transmitted to children in meals conisting largely oi the milk of the cow." The report indicates the need for more ample powers than are now possessed by the Council for the exclusion of tuberculous milk from London, and the desirableness of the continual exercise of existing powers until the subject can be dealt with in a comprehensive manner by Parliament. Under a general order dated 15th November, 1911, the Local Government Board issued a further series of regulations in relation to the notification of pulmonary tuberculosis. These regulations complete the system of notification inaugurated in 1908, and every medical practitioner (with certain exceptions) is now required to notify every case of pulmonary tuberculosis occurring in the course either of his public or private practice. During the year under review the reports presented to the Council on the administration of Part IV. of the London County Council (General Powers) Act, 1907, showed that between the date of the coming into operation of the Act and 31st December, 1911, 7,896 sampes of milk had been examined, with the result that 850, or 10.8 per cent., proved tuberculous. The milk came from 28 different counties. During the year 3,029 samples were taken, of which 316 were found to be tuberculous. The Council's veterinary inspector has visited for inspection purposes, since the Act came into operation, 1,622 farms and inspected 44,307 cows, of which number 574, or 1.3 per cent., were found to be affected with tuberculosis of the udder. During the year 503 farms were visited and 15,510 cows were examined, of which 91 were found with tuberculous udders. The owners of the animals affected undertook that the use for human consumption of the milk should be discontinued immediately. 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 18 animals have been seized and slaughtered under the Act, and compensation amounting to £194 has been paid, the post-mortem examination showing in each case that the udder of the animal was tuberculous. Jiejiort by the Medical Ojjicer, submitting the rtsall of a census of homeless persons taken oil the night of 17th February, 1911 (No. 1417). Price 2d. Cerebrospinal fever. Health conference. Census of homeless persons. Royal Commission on Tuberculosis. Public health (tuberculosis) regulations. Milk. 174 Annual Report of the London County Council, 1911. Infant life protection. Powers and duties of the Council under the Midwives Act, 1902. Supervision of midwives. Investigation of charges against midwives. Suspensions—con victions. Number of midwives practising in London. Notification of provisions of the Midwives Act. The Council administers (except in the City of London) Part. I. of the Children Act, 1908, and has delegated its powers in respect of this Part of the Act to the Public Control Committee. A staff of 2 male and 8 female inspectors is employed under the direction of the chief officer of the public control department upon this work. The duties of the Council under the Act include the institution of inquiries as to persons who undertake the nursing and maintenance of infants, the fixing of the number of infants which may be kept in a dwelling as to which notice has been given, and the appointment of infant protection visitors to inspect places where infants are kept. The Council is required to satisfy itself as to the proper maintenance of the infants, and may arrange for the removal from a notified house of an infant improperly kept. Notice has to be given to the Council in cases where one infant is received, and the age limit of infants is 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. Offences under Part I. of the Act are punishable by imprisonment for a term not exceeding six months, or a fine not exceeding £25, and the fines are paid to 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 December, 1911, these numbers had risen to 2,539 and 3,257 respectively. Under section 2 (2) of the Act the Council, in cases where any infants have been placed out to nurse by any philanthropic society, 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. The Council approved 17 societies for this purpose, but during 1911 three of these were, at their own request, relieved of the obligations which they had undertaken in the matter, in addition to one previously released. 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 within 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 ar offence ; f (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 giv3 due notice to 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. 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 anv 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 1911 there were 76 cases of puerperal fever in the practice of midwives, and 100 inquests were held in which midwives were concerned, 11 being on the bodies of women, and 89 on the bodies of children. A case of puerperal fever also occurred in the practice of an uncertified person, and inquests were held on the bodies of three children who were attended at birth by women who had not been certified by the Central Midwives Board. Charges of malpractice, negligence or misconduct on the part of six midwives were investigated during the year, with the result that the Central Midwives Board were informed that in five instances prima facie cases (negligence and misconduct, 2 cases ; misconduct, 2 cases ; negligence, 1 case) had been established, the charge in the sixth case not being sustained. The names of the midwives charged with misconduct were removed from the roll, but the Board had not during the period covered by this report, announced its decision with regard to the remaining charges. During 1911 the Central Midwives Board announced its decisions with regard to two certified midwives against whom charges had been brought during the preceding year, the name of one of the midwives charged with misconduct being removed from the roll, while the other midwife was censured. It was not found necessary during the year to suspend any midwife from practice, but a midwife in the County was convicted of having performed an illegal operation and was sentenced to five years' penal servitude, her name being subsequently removed from the roll of midwives. During the year ended 31st December, 1911, 557 midwives notified to the Council their intention of practising within the County during the year; and, in addition to these, 12 notices were received from persons who had acted as mid waves on specific occasions, and 34 notices from midwives who intended to practise within the County during periods shorter than a year. 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 or 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 Public Health. 175 assistance in cases of emergency being exempted from the operation of the sectior. It appeared desirable that the provisions of the snb-section should be known as widely as possible, and with this object the Council on 8th February, 1910, decided to give notice by public advertisement of the altered state of the law. •The publicity thus given to the provisions of the section did not, however, entirely deter uncertified persons from practising as midwives, for it became necessary during the year 1911 to institute legal proceedings against 19 women for infringing the law in this respect. Convictions resulted in 18 instances, fines amounting to a total of £35 18s., with £12 3s. costs, being inflicted in 15 cases ; while three of the women were bound over not to repeat the offence, one being also ordered to pay 18s. 6d as costs of the proceedings. In the remaining case the summons was dismissed. In addition to these prosecutions, letters explaining the alteration in the law were addressed to 35 women. In January, 1911, a woman whose name had been removed from the roll of midwives attended a woman in childbirth, and her patient having died, an inquest was held upon the body with the result that th2 midwife was committed for trial on a charge of manslaughter, and at the hearing of the charge was convicted, and sentenced to four calendar months' imprisonment, with hard labour. The Central Midwives Board having invited the Council to express its view as to the desirableness of deleting from sub-section 2 of section 1 of the Midwives Act, 1902, the words "habitually and for gain," the Council informed the Board that it appeared desirable that, in any amendment of the Midwives Act provision should be made for the omission of these words. On 21st June, 1911, the Privy Council approved a new series of rules which had been framed by the Central Midwives Board. The rules came into operation on 1st July, and the Council sent a copy to each practising midwife in the county. The accounts of the Central Midwives Board showed an adverse balance for the year 1910, and the Council was called upon in May, 1911, to pay a sum of £76 15s. lOd. as its proportion of this deficit. The Metropolitan Borough Council of St. Marylebone made application to the Council for a contribution of one-half of the salaries of health visitors appointed by the borough council. The Council decided, as in previous cases, to make the contributions asked for subject to the condition, among others, that the contributions should be dependent on 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. Up to the present time twelve metropolitan borough councils have appointed health visitors. Applications were received for licences to keep and use, as common lodging-houses, 3C6 premises in the County of London, and licences were granted in respect of 304 of these premises, one application being withdrawn and one refused. Two licensed keepers were fined £5 with 8s. costs for having infringed the Council's by-laws. During the year licences to keep seamen's-lodging houses have been granted in respect of 36 premises Legal proceedings were instituted in 5 instances for keeping unlicensed seamen's lodging-houses. In each case a conviction followed and fines amounting to £44, with £4 7s. costs, were inflicted. During the year 375 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 259 were anonymous. The practice adopted is, in the case of signed complaints, to forward the complaint to the sanitary authority and to take no further action unless the complainant appeals again to the Council. In the case of anonymous complaints, the purport of the complaint is sent to the medical officer of the district, and, unless an intimation is received that action has been taken, an inspection is subsequently made, and, if then found necessary, a further communication is sent to the sanitary authority concerned. In pursuance of the authority conferred upon the Council by section 19 of the Public Health (London) Act, 1801, in three cases certain premises were removed from the register, the right to carry on (1) fat-melting, (2) tallow melting, and (3) tripe boiling thereat having lapsed. The number of slaughterhouses, cowhouses and knackers' yards licensed during the year was 242 slaughterhouses, 189 cowhouses, and 4 knackers' yards. There was one appeal against the decision of the Committee not to grant renewal of licence in respect of a cowhouse; one appeal in respect of a slaughterhouse; and one in respect of a knacker's yard. In each case the Committee's decision was confirmed. Draft by-laws relating to the businesses of a vendor of fried fish, fish curer and rag and bone dealer have been approved provisionally by the Local Government Board, and the observations of the Secretary of State for the Home Department are now awaited. The Hampstead Metropolitan Borough Council called attention to an appeal (Kershaw v. Brooks) by the borough council, which came before the Divisional Court by way of special case from the decision of a metropolitan police magistrate, dismissing certain summonses issued under the by-laws as to drainage and as to deposit of plans made under section 202 of the Metropolis Management Act, 1855, and the Metropolis Management Acts Amendment (By-laws) Act, 1899. The question for decision was as to the person liable for an infringement of the by-laws. The Borough Council summoned the responsible person actually carrying out the work, and the summonses were dismissed by the magistrate on the ground that they should have been issued against the person who ordered the work to be done. The divisional court sustained the decision of the magistrate. The Hampstead Borough Council also suggested that the by-laws should be amended to provide that the builder or contractor in control of the works should be responsible in cases of breaches of the by-laws, and as most of the borough councils were in favour of the amendment, the Council made by-laws (which were duly confirmed by the Local Government Board) dealing with the point. Practice of uncertified persons. Amendment of Midwives Act. Rules of Central Midwives Board. Accounts of Central Midwives Board. Health vieitor-i. Com men lodginghouses. Nuisances. Offensive businesses— knackera' yards, slaughterhouses, cow. houses and dairies. Drainf ge by-law?. 176 Annual Report of the London County Council, 1911. Diseases of animals. The Diseases of Animals Acts, 1894 to 1910, 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 Act relating to foreign animals. The powers of the Council are exercised by the Public Control 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. * Outbreaks. (a) This disease was scheduled in 1904. (h) This disease was scheduled as regards London in 1909, the Order coming into force on 1st June, 1909. Details were given in the last annual reportf of the reasons which actuated the Council in urging the Board of Agriculture and Fisheries to amend the Glanders or Farcy Order of 1907, 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 eases 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. As a result, the Board suggested that the Council should confer with the local authorities of districts adjacent to London upon the question generally, and as to the " desirability of the formation of a joint committee under section 39 of the Diseases of Animals Act, 1894, for the purposes of administering the Glanders or Farcy Order of 1897 throughout the whole of the police area and the City of London." A conference was accordingly convened with representatives of the Corporation of the City of London, the councils of the home counties and the authorities of other areas adjacent to London. The conference was not in favour of adopting the suggestion of the Board as to the establishment of a joint committee, but resolutions were passed approving the Council's proposals to amend the Order of 1907. The decisions of the conference were conveyed to the Board of Agriculture and Fisheries who subsequently intimated that it was prepared to amend the Order in accordance with the Council's proposals, with the exception of that relating to maintenance of control for a longer period over animals in whose cases the mallein test had not produced definite results. The following table shows the number of animals attacked by glanders in London and tlu 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. 1902 1,604 58 85 36 39 2,073 77 1903 1,915 118 102 18 52 2,499 76 1904 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 68 1907 1,385 33 44 21 32 1,921 71 190.S 1,730 144 97 18 36 2,421 71 1909 1,272 92 90 29 84 1,753 72 1910 597 26 64 33 24 1,014 58 1911 281 66 35 15 11 504 55 Total ... 13,402 841 821 257 431 18,923 70 t Annual Report of the Council, 1910, vol. iii., p. 187. lne prevalence ot contagious disease in animals in London during the year 1911 and certain preceding years is shown by the following statement:— Disease. Number of animals attacked by disease. 1904-5. 1905 6. 1906-7. 1907-8. 1908-9. 1910. 1911 Glanders, including farcy 1,713 1,382 1,332 1,490 1,704 597 281 Typhoid in swine 11 36 9 35 3 4* 8* Pleuro-pneumonia — — -- - — Sheep-scab.. — — — - Anthrax 4 3 9 13 63 35 12 Rabies — —. (a)Epizootic lymphangitis 126 10 (fc) Parasitic mange — — — 384 978 Public Health. 177 Compensation amounting to £3,358 8s. was paid by the Council iii rcspcct of horses slaughtered during the year. 19 infringements of the Order were detected, and in one case legal proceedings were taken, a penalty of £2 12s. 6d. being inflicted. During the year the Board of Agriculture issued the Parasitic Mange Order, 1911 (to come into force on 1st January, 1912). The Order extends to the whole of Great Britain tho provisions of the several local Orders which have been in operation for dealing with this disease and revokes such Orders, including the London (Parasitic Mange) Order of 1909. Tho terms of the new Order are practically identical with those of the revoked Orders, but it contains certain new provisions:—(a) parasitic mange is included in the list of diseases to which the Animals (Notification of Disease) Order of 1910 applies, so that veterinary surgeons and practitioners will be required to give notice of the existence or suspected existence of this disease met with in their private practice, to the local authority, which is required to pay a sum of 2s. 6d. for each notification ; (b) the cleansing and disinfection of infected places and articles, and the methods to be employed in such cleansing are provided for in the Order ; (c) in addition to making it an offence to fail to give notice of the existence of disease, or to move an animal placed under a detention notice without the consent of the local authority, the new Order makes it illegal to expose an affected animal for sale or to move such an animal along a highway or thoroughfare, except with the written authority of an inspector of the local authority, or to cause such an animal to be conveyed by vessel or railway. The Board of Agriculture during the year also issued the Swine Fever Order, 1911, intended to give effect to certain recommendations of a departmental committee appointed by the Board to inquire into swine fever. The new Order provides, among other things, that movement licences are in future to be available for eight days instead of for six as hitherto, that pigs moved for slaughter under a licence issued under the Swine Fever (Regulation of Movement) Order need not be conveyed in a vehicle, and that vehicles, crates, etc., used for the conveyance of swine must be thoroughly cleansed and disinfected after use. A further Order, issued by the Board in the course of the year was the Wandsworth District (Swine Fever) Order of 1911. The order, which came into force on 9th December, 1911, applied only to a small district in the south of Wandsworth, and was issued in consequence of outbreaks of swine fever in that district. Similar restrictions were placed on the movement of pigs into the district as are imposed by the Swine Fever (Regulation of Movement) Order, 1908, but it was provided that swine should only be moved out of the district for immediate slaughter if a movement licence had been issued on the owner's declaration, and if marked as provided for in the Order. Power was also given to an inspector of the Board of Agriculture or of the Council to apply the provisions of the Order to any premises in the neighbourhood by the service of a notice on the occupier. 12532 Y Parasitic mange. Swine fever. 178 The whole of the sewage of the County of London is dealt with by the Council, but 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. The sewage collected by the local sewers, which are vested in the metropolitan borough councils, 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 Londonbridge. 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 solid matters in suspension 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 1911 :— Powers and dutie3 of the Council. Main Drainage. The Council is charged by statute with the responsibility for the provision and maintenance of an efficient main drainage system for the Administrative 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 London, 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. Met opolitan main drainage area. The area drained by the system and the resident population thereof (1911) are approximately follows— Sq. miles. Persons. North—County of London 50 2,683,060 Out-county districts 29 773,239 South—County of London 67 1,839,901 Out-county districts 3 40,001 149 5,336,201 Treatment and disposal of sewage. Sewage treated Sewage daily average Barkmg. gallons. 63,375,886,303 173,632,565 Crossness, gallons. 51,040,331,100 139.836.524 Total, gallons. 114,416,217,403 313,469,089 Lime used .. .. ..— Proto-sulphate of iron used Sludge sent to sea Sludge, weekly average .. Refuse intercepted at gratings tons. 12,557-75 2,751744 1,686,500 32,432-7 3,335 tons. 10,751 2,921-2 893,500 17,182-7 1,587 tons. 23,308-75 5,672-944 2,580,000 49,615-4 4,922 .From the above figures it will be seen that at the Barking outfall one ton of sludge was extracted from an average of 37,601 gallons of sewage treated, as compared with 33,620 gallons in the preceding year; while at the Crossness outfall the average quantity of sewage treated to producc one ton of sludge was about 57,124 gallons, as compared with 51,737 gallons in the preceding year. The total quantity of sewage treated at the outfalls was more, by 7,284,605,707 gallons, than the flow in the previous year, while the quantity of sludge sent to sea was less by 93,000 tons, or about 1,790 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 eighteen 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. . Main Drainage. « 179 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 2,580 trips to and from the deposit area in the Black Deep ; the distance travelled being about 258,000 miles. The vessels are insured for £108,000. 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 mddle-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 Scrubbs-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. 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 £3,772,500 was prepared, it is anticipated that their inclusion in the scheme will not cause this estimate to be exceeded. They are (i.) the enlargement of the Crossness pumping station, roughly estimated to cost £120,000 ; and (ii.) the extension of the southern high-level sewer No. 2 from Catford to Nun he ad. The necessity for increasing the pumping power at Crossness arises from the fact that in connection with the main drainage extension scheme, the discharging capacity of the outfall sewers has been doubled, and when, in times of storm, these sewers are full, the pumping power at the outfall is quite inadequate. A new engine-house is to be erected, and the tender, amounting to £63,690, submitted by Dick, Kerr and Co., Ltd., has been accepted for the work. The new engine-house will be constructed to accommodate eight main driving steam engines and centrifugal pumps, but, in the first instance, only one half of the machinery, roughly estimated to cost £22,000, will be installed. The southern high-level sewer No. 2, which was constructed as part of the extension scheme above mentioned, extends from Catford to Crossness, and its gradient is such that the contents of the sewer do not have to be pumped. It is now proposed to extend the sewer from Catford to Nunhead and thus intercept the Effra branch sewer and convey to Crossness sewage from West Norwood, Dulwich, Peckham Rye, which, under existing conditions, has to be pumped on arrival at the outfall. The construction of the new length of sewer is being carried out by Messrs. Wm. Underwood and Bros., at the contract price of £88,398 14s. 9d. There is no separate system of sewers in Londor 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 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 ^ Storm relief Main diain- ageextmsion scheme. 180 » Annml Report of the London County Council, 1911. All works specifically referred to above have been completed with the exception of the sewer from Holloway-road to the Thames. Further borings and other preliminary work in connection with the proposal that the outlet of this sewer should be at Shadwell instead of the Tower were carried out during the year. Certain other works, not specifically mentioned above, were provided for in the estimate of the cost of the flood prevention scheme. One of the most important of these was the enlargement of the storm water pumping station on the Isle of Dogs. The existing plant consists of two steam-driven reciprocating pumps, and it is proposed that the station shall be extended so as to accommodate two centrifugal pumps driven by gas. The cost is roughly estimated to amount to £30,000. The two schemes referred to above included the undermentioned works which had for their object specifically or incidentally the relief of sewers in the Metropolitan Borough of Wandsworth— (i.) the Wandsworth and Battersea relief sewer ; (ii.) the Falcon-brook pumping station, and (iii.)the southern low-level sewer No. 2. Owing, however, to the very large development of building operations in the borough since the schemes were prepared, it is considered essential that other large works must be undertaken, and the Council on 7th November, 1911, agreed to the following proposals :— Estimated cost. 1. To construct a relief sewer from the junction of Balham road and Tooting Bec-road to the river Graveney £28,000 2. To improve certain portions of the waterway of the river Graveney 5,750 £33,750 It is also proposed to carry out extensive works for the relief of the area in the valleys of the rivers Wandle and Graveney. The details of these works have not yet been settled, but the expenditure involved will probably be considerable. The payments on capital account up to 31st March, 1912, in connection with main drainage extension and flood relief works amounted to £3,703,358 15s. 8d. In addition to the County of London, several neighbouring 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 :— r(i.) Hornsey, 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 the . (iii.) Wood Green 1 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. (vi.) Willesden, under the Willesden Sewerage Act, 1896, and the London County Council (General Powers) Act, 1908. (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 London 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 London 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. Under the provisions of the Willesden Sewerage Act, 1896, the sewage and drainage of the portion of the district of Willesden draining naturally towards London are received into the London main drainage system, and in the London County Council (General Powers) Act, 1908, authority was obtained for dealing in the same manner with the sewage and drainage of the remaining portion of the Willesden district which drains towards the river Brent. The Act, in addition to restricting the quantity of sewage and rainfall which might be discharged into the London sewers, provided— (1) That the Willesden Council should construct all sewers and works necessary to convey the sewage and drainage to the county boundary. (2) That the Council should construct, at the expense of the Willesden Council, a sewer from the county boundary to the middle-level sewer No. 2. (3) That the Willesden Council should pay (a) a differential rate of l|d. in the £, calculated on the rateable value of the Brent area, in addition to the proportion of the county rate levied by the Council each year which is applied for main drainage purposes; and (b) a capital sum of £40,000 in respect of discharged capital outlay on main drainage works. Cost o? new works. Drainage of out-county districts Main Drainage. 181 The works referred to in (1) and (2) were completed during the year under review and the discharge of sewage and drainage from the Brent area into the London main drainage system commencec on 30th September, 1911. From the date of the first discharge, there became due from the Willesder Council, the above-mentioned sum of £40,000, and this sum, together with interest thereon at the ratx of 3-£ per cent, per annum, is to be paid to the Council in one hundred half-yearly instalments o: principal and interest combined. The rate referred to in (3) also became due as from 30th September 1911, The sewer from the county boundary to the Council's middle-level sewe: No. 2 was constmctec of larger dimensions than would have been necessary had it been intended to use the sewer solelj for the conveyance of Willesden sewage, the reason being that it was considered desirable that tlx sewer should be utilised as a means of relief in times of storm for the district through which it passed Instead, therefore, of the whole cost of the sewer being defrayed by the Willesden Urban Districl Council, it was decided to divide the cost as follows: Willesden, £18,944 2s. 2d.; London, £9,782 lis. lOd. 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. Fahr., which either alone, or in combination with "thei 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 necessary in only one case during the year to institute legal proceed-'ngs in respiCt of the contravent.on of the above-mentioned section, and in this instance a penalty of £10 10s., with £10 10s. costs was imposed. 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. 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 previoa. consent of the Council is prohibited. During the year 13 licences to build over sewers were granted. The principal works of repair, etc., undertaken during the year, and the expenditure sanctioned therefor in each case were as follows :— Barking Outfall.—Alterations to effluent discharging channel and provision of sewage recording gauges, £1,000 (continuation of work for which expenditure of £2,000 was sanctioned in 1910) ; new dolphin to pier, £1,000; cleansing old reservoir, £500; alterations to sludge delivery pipe, £450 ; repairs to river wall, £440. Deptford Pumping Station.—Repairs to condensing water pipe, £500; painting buildings and engines, £500. Repairs to sewers.—Ravensbourne and Sydenham, £1,250 ; Fleet (Guildford-street branch), £1,000 ; Fleet (St. John-street branch ), £1,000 ; Smith-street, £1,000 ; Ratcliff-highway, £1,000 ; Northern outfall, £700 ; Northern low-level No. 1 (new penstock at Harwood-terrace, Fulham), £500 ; Countess-creek (flap valve for storm-water outlet,) £500. Repairs to sludae vessels.—£3.250. Illegal discharges into sewers. Building over sewers. Repairs, etc. Works completed or in progress. The following is a statement of works or contracts connected with the main drainage and flood relief schemes which have been completed, or are in progress. North of the Thames. £ s. d. Main Drainage Extension Scheme. 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 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 1 182 Annual Report of the London County Council, 1911. South of the Thames. Main Drainage Extension Scheme and, additional ivorks in connection therewith. 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 „ 2—Contract price 22,796 6 3 Southern high-level sewer, No. 2— Section E —Completed at cost of 361,223 5 4 „ (extension)—Contract pricc 88,398 14 9 Deptford pumping station— Erection of additional engine house (exclusive of machinery)—Completed at cost of 46,330 0 0 Machinery, etc. 29,380 10 0 Crossness pumping station— Erection of additional engine house—Contract price 63,689 18 5 Machinery—Estimated cost 22,000 0 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 ilaims for compensation payable by the Council of purchasing and fixing machinery, etc., or of jmploying the necessary supervising staff, etc. Section 69 of the Metropolis Management Act, 1855, provides that no new local sewer shall be made without the previous approval of the Council. Local sewers. The subjoined table shows the total length and sizes of the local sewers, the construction o which was sanctioned by the Council during the year. Size. North of Thames, feet. South of Thames, feet. Total length, feet. 4 ft. by 2 ft. 8 in. 1,605 1,605 4 ft. by 2 ft. 6 in. 150 150 3 ft. 3 in. by 2 ft. 2 in. 260 260 1 ft. 6 in. 1,013 462 1,475 1 ft. 3 in 2,545(') 3,193(>)(') 5,738 1 ft 2,675(3) 6,976(fi) 9,651 9 in. .. .. 7,026(*)(') 8,970(8) 15,996 6 in. 167 665(9) 832 Total 16,181 20,526 36,707 (1) Including 495 feet in lieu of existing sewers. (2) „ 18 feet „ „ „ (3) „ 578 feet „ „ „ (4) „ 1,250 feet „ „ „ 6) „ 1,560 feet reconstruction. (o) „ 820 feet „ (") „ 365 feet „ (R) „ 185 feet „ (°) „ 205 feet surface water sewer. 183 CHAPTER XXXVII. Housing of the Working Classes. 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-classes 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 access 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, aright 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 classes, 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 working classes are acquired under statutory powers other than the Housing Acts, e.g., in connection with the carrying out of public improvements, 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. Under Parts I. and II. of the Housing of the Working Classes Act, 1890, the Council has completed 13 schemes involving the displacement of 16,639 persons of the working classes, and in lieu of the old houses which it has caused to be demolished, has provided new dwellings capable of accommodating 15,010 persons. In the last Annual Report* details were given of the scheme under Part I. of the Act of 1890 with regard to the Tabard-street and Grotto-place areas, Southwark, and the Crosby-row area, Bermondsey, about 17 acres in all, involving the displacement of 4,552 persons of the working class and' entailing an expenditure of £473,300 gross, £387,700 net. The inspector appointed by the Local Government Board for the purpose held a local inquiry into the scheme on 26th, 27th and 28th April and 3rd and 4th May, 1911, and subsequently made a detailed inspection of the areas in company with representatives of various parties interested. Arising out of the inquiry, a communication was received from the Board stating that, subject to certain observations contained in the letter, it proposed to make an Order confirming the scheme. The Board was satisfied as to the correctness of the official representations in respect of all the properties comprised therein with only three exceptions, and the Board proposed to modify the scheme by excluding these three plots from the unhealthy area, and including them as neighbouring lands, the inclusion of which was necessary for making the scheme efficient. The result was very satisfactory from the Council's point of view. The Board decided to accede to an application made by the Council to modify the scheme by the exclusion of St. Stephen's vicarage, which was erected only a few years ago. As regards the rehousing accommodation to be provided, the Board expressed the opinion that in addition to the block dwellings for 2,450 persons proposed to be erected round the open space which is to be laid out on the Tabard-street area, the Council should provide as many cottages as could conveniently be erected on the detached portion of the area between Law-street and Little Hunter-street. In the event of this land being ear-marked for the erection of cottages, the estimate of the net cost of the scheme would be increased by £8,500, making a net total of £396,200. Although the Council was still of opinion that its original proposals for rehousing were sufficient, it was recognised that the question was a debatable one, and in all the circumstances the Council thought it should not raise any objection to the proposal of the Local Government Board to require a small increase in the amount of the rehousing accommodation to be provided. * Annual Report of the Council,' 1911, vol. iii., pp. 191-2 Powers and duties of the Couucil. Action taken under Parts I. and II. of the Act of 1890. Tabardstreet, etc., scheme. 184 Annual Report of the London County Council, 1911. Closing and demolition orders. Among the persons to he displaced by the scheme are a number of street traders (costermongers and the like), who at present keep their barrows, etc., in the cul-de-sac roads, courts and alleys opposite their dwellings. A suggestion being made by the Board that provision for the storage of barrows and carts should be made, the Council replied that it saw no difficulty in providing sheds on the Tabardstreet area for the convenience of street traders, but that stabling accommodation did not appear to be required. k'1 With regard to the proposed open space, which is to be about 5| acres in extent, the Board considered that the cost of acquiring the land was properly part of the cost of the improvement scheme, and that the retention and use of the land in question as an open space was an essential part of a scheme for rehousing in tenement blocks. The Board was of opinion, therefore, that the cost of acquiring the land proposed to be used for the open space should be borne as part of the cost of the improvement scheme, i.e., charged to the Dwelling House Improvement Fund and constituted a special county expense to which the City would not contribute. The Board, however, agreed that the cost of laying out and maintaining the open space should be charged to the general county account out of which expenditure on parks is met. The order of the Local Government Board confirming the scheme had not been received by the end of the year under review. Particulars are now available of the action taken by the metropolitan borough councils under sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909, for dealing, by way of closing and demolition orders, with those dwelling houses which have been represented to them as being "in a state so dangerous or injurious to health as to be unfit for human habitation." Closing and demolition orders were a part of the procedure authorised by the Housing of the Working Classes Act, 1890, but whereas under that Act a closing order could only be made by a Court of Summary Jurisdiction on the application of a local authority, the power to make such an order is by the Act of 1909 entrusted to the local authorities, subject to a right of appeal to the Local Government Board by any owner of the dwelling house in respect of which the order is made. The figures given in the following table, which are taken from a memorandum dated 9th November, 1911, issued by the Local Government Board, indicate the action taken during the year ended 31st March, 1911, so far as the information could be obtained, and for comparison the corresponding figures are also given for the year ended 31st March, 1910, during which the new procedure was in force for about four months, and for the year ended 31st March, 1909, during the whole of which the old procedure was in force— Number of houses iu respect of which representations were made to the metropolitan borough councils Number of houses made fit for human habitation or closed or demolished voluntarily without the issue of a closing order Number of houses in respect of which closing orders were made Number of houses in respect of which closing orders were determined Number of houses in respect of which orders for demolition were made Year. 1910-11. 1909-10. 1908-9. 1,389 83 223 3 2 82 19 3d — — 21 8 5 Information not available — Capital expenditure on clearance. Rehousing in connection with improvements, etc. The amount expended on capital account by the late Metropolitan Board of Works and the Council up to 31st March, 1912, in respect of the clearance of insanitary areas (exclusive of the cost of erecting new buildings), amounted to £3,422,677 18s. 6d., 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 £2,515,937 17s. 5d. In carrying out public improvements other than schemes under the Housing Acts, involving a statutory obligation to rehouse, the Council has displaced 12,244 persons of the working classes, and has provided accommodation in new dwellings for 12,902 persons in lieu of that destroyed. During the year the Local Government Board approved modification schemes releasing the Council from the obligation, under the approved schemes for rehousing persons displaced by the construction of Rotherhithe-tunnel, to erect dwellings on the Albion-street and Clarence-street sites, Rotherhithe, and the second portion of the London-street site, Rateliff. Re-housing accommodation for 1,990 persons had already been provided, as against accommodation required to be provided under the approved rehousing schemes for 2,842 persons, leaving an obligation outstanding to erect further dwellings on 'the three sites mentioned. Having regard to the large number of empty tenements in the vicinity, the Council contended that adequate accommodation for those persons of the working class not already provided for in the dwellings erected by the Council was available in the districts affected, and the Board concurred in this view. During the year the Local Government Board released the Council from rehousing obligations as regards 176 persons of the working classes displaced from properties over which com- Housing of the Working Classes. 185 pulsory powers of acquisition had been obtained for purposes of the education service ; and the Council also decided that special rehousing schemes were not necessary in respect of the displacement of 333 persons from certain other properties acquired for similar purposes, there being no statutory obligation to rehouse these people. On 12th December, 1911, the Council considered as to the course to be pursued with regard to the impending displacement of 1,529 persons of the working class from properties, in various parts of the County, over which compulsory powers of purchase for purposes of the education service were obtained in the parliamentary session of 1911. By section 3 of the Housing of the Working Classes Act, 1903, and the schedule thereto, the Council was under obligation, before it could enter into possession of these premises, to submit to the Local Government Board a scheme for rehousing the persons of the working classes to be displaced unless the Board should decide that such a scheme was not necessary. The displacements which called for special consideration were those from the sites at Nicholas-street, Hoxton (526 persons) ; Scawfell-street, Haggerston (172 persons) ; and Ranelaghroad, Westminster (265 persons). Inquiries were made as to the amount of accommodation suitable for occupation by persons of the working classes and publicly advertised as to-let in the neighbourhood of the several sites and, as a result, it was found that in almost every instance the number of vacant rooms in the vicinity was many times greater than the number of rooms to be demolished on the respective sites. The Council thought there was little doubt that the families who were to be displaced would experience little difficulty in finding fresh accommodation within a short distance, and in all the circumstances, having particular regard to the large amount of accommodation which has been, and is being, voluntarily provided by the Council under Part III. of the Housing of the Working Classes Act, 1890, it was decided to ask the Local Government Board to release the Council from the rehousing obligation. The Council has provided three model lodging-houses for men containing altogether 1,856 cubicles, viz. : Parker-street House and Bruce House, Drury-lane, and Carrington House, Deptford. Although committed to the policy of itself undertaking the erection and management of dwellings when under specific obligation to secure rehousing 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-classes apart from such obligations. However, 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, 1911, 2,405 cottages, with accommodation for 17,831 persons, had been completed on these estates, making a total accommodation for 21,899 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 1909 and 1910 the Council reconsidered its policy in regard to the land which it had acquired under Part III. 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 decided on 26th July, 1910, to take steps with a view to the disposal of a substantial proportion of the White Hart-lane Estate, Tottenham. This 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 would 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 is about 177 acres in extent, and the Council thought that it should also 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. 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 these two portions of the estate, and to the proceeds of any such sale being utilised in or towards the development of other lands under Part III. of the Act of 1890. In the result the Board, after a public inquiry had been held, gave its consent to the sale of the northern (detached) section, but the Board considered that sufficient grounds had not been adduced for the sale of any part of the southern portion of the estate and declined, therefore, to comply with the Council's application in this respect. Notwithstanding this decision, the Council was still of opinion that the White Hart-lane estate was too large for development exclusively for the purposes of Part III. of the Act, The estate 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 t>f 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 12532 z Common lodginghouses. Action taken under Pait III. of the Act of 189D. White Hartlane estate. 186 Annual Report of the London County Council, 1911. 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 1912 to enable it to develop any part of the estate on the lines of a garden suburb, and not solely for the accommodation of the working classes, and further to authorise the leasing of separate plots of land on the estate for the erection of better-class houses on the condition that the plans of the houses to be erected should be subject to the approval of the Council. The development of the other portion of the 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 48£ acres to be developed. Cottages have been erected on about 29 acres, and 3J 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 (10J acres), 304 cottages, containing accommodation for 2,454 persons, have been erected. Preliminary arrangements have been made for the provision of a row of 14 shops along the frontage to Lordship-lane, between Waltheof-avenue and Kevelioc-road; but it is proposed in the first instance to erect five shops only at the end of the plot next Waltheof-avenue. If this experiment proves successful no time will be lost in arranging for the erection of the remaining nine shops to complete the block. Administrative buildings are about to be erected on the estate, and it is proposed to provide in connection therewith a small meeting hall for the convenience of the tenants. There is at present no public building in the immediate vicinity which the inhabitants can hire on reasonable terms, and the Council feels that in an estate of this size, occupying a somewhat isolated position, some provision should be made to afford the tenants an opportunity of enjoying the ordinary social amenities of suburban life. 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 £11,970 10s. 2d. on 31st March, 1912, up to which date a sum of £9,788 3s. 8d. 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 most of the roads have been finished and the footways paved, the remainder of the work being carried out as the cottages are completed. About 3$ 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, 1911, 410 cottages, capable of accommodating 3,276 persons, had been completed on this section, and others were in course of erection. The development of the Totterdown-fields estate, Tooting (38£ acres) has now been completed, with the exception of a small amount of work of finishing certain roads. The total number of cottages erected on the estate is 1,229, in addition to four shops, providing accommodation for 8,788 persons. Particulars of the cottages and the rents charged are given in Appendix XIX. The capital expenditure upon the estate has been as follows :—Land, £44,934 ; fencing, £638 ; roads, sewers and development, £33,119 ; buildings, £315,756 ; estimated outstanding liabilities, £1,484 ; total, £395,931. The annual gross rent receivable is £29,341, and the actual surplus for 1911-12 as shown in the accounts is £843. Further progress has been made with the development of the Norbury estate, Croydon (28| acres). Roads and sewers have been constructed on about 16£ acres of the estate, and the cottages already built cover about 15 acres. The work of finishing the roads on this estate is being carried out by the Croydon Corporation. Up to 31st December, 1911, accommodation for 3,207 persons had been provided in 430 cottages. Further cottages are in course of erection on the portion of the estate on which roads have been formed, and plans for the development of the remainder of the estate are in course of preparation. 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. Roads and sewers have been constructed on the western section, and Ducane-road has been widened to 50 feet in front of Wormwoodscrubs prison and extended along the southern boundary of the estate to Old Oak Common-lane. The total estimated cost of the work, including incidental expenses is £8,671. During the year contracts were let for the erection of 121 cottages, 26 cottage flats and 5 shops, the total of the contract sums, added to the cost of articles to be bought direct and other incidental expenses, being estimated at £30,860. Plans of additional cottages for erection on the western section were in course of preparation at the end of the year. The irregular boundary where the estate adjoins Wormwood-scrubs has been adjusted by a mutual exchange of land, and a 40-feet road will be constructed along the new boundary line, half the land required for the purpose being taken from the open space and half from the housing estate. A temporary school is about to be erected on the estate and the question of allocating a site for the provision of permanent school accommodation is under consideration. Two additions to the estate were made during the year. Five cottages, some stabling and vacant land of a total area of about half an acre, situated in Old Oak Common-lane, adjoining the estate, were purchased by the Council for the sum of £700, with the object of facilitating the development of the estate, and the widening of Old Oak Common-lane. The Council also acquired about an acre and a quarter of vacant land abutting on the housing estate Lord Swaythling'f gift. Totfcerdown Fields estate. Norbury estate. Old Oak estate. Homing of the Working Classes. 187 and Wormwood-scrubs, for the purpose of constructing an outlet from the eastern section of the estate in the north-west corner. The purchase price amounted to £1,500, in addition to certain expenses incurred by the vendor, which the Council agreed to pay. The portion of this land not required for the proposed new road will, owing to its shape and position, probably be found more suitable for addition to the open space than for a building site, and the land has accordingly been conveyed partly for housing purposes and partly for an open space. During the year the Council considered a suggestion that a scheme should be introduced to enable working men to buy their own houses on easy terms. The only power which the Council has at present of advancing money to enable persons to acquire the ownership of the houses in which they reside is conferred by the Small Dwellings Acquisition Act of 1899. The number of loans granted by the Council under this Act has been very few, and this is probably due to the fact that the cost of property in London may almost be said to prohibit working-class people from acquiring houses under the terms of the Act, whereby a considerable sum of money has to be found by the applicant, the advance by the local authority being limited to four-fifths of the amount which, in the opinion of the local authority, is the market value of the ownership. The Council felt, therefore, that in order to make a successful scheme which would appeal to the working classes it would be necessary to advance practically the whole of the sum required for the purchase of the house. The Council would, of course, require to be fully safeguarded against financial loss, and it was thought that this object could best be secured and the most advantageous terms offered to the prospective purchaser by applying the proposal to some of the estates which the Council had purchased under Part HI. of the Act of 1890. As regards the nature and extent of the interest in the property to be acquired by the purchaser, the Council thought that, in preference to disposing of the freehold, a lease should be granted for a term of years. Parliamentary sanction to this course was necessary, and the Council therefore on 7th November, 1911, resolved to apply to Parliament in the session of 1912 for powers to enable it to grant on such terms as should it think fit to persons of the working classes, leases for any period not exceeding 99 years of houses provided by the Council in pursuance of the provisions of the Housing Acts. The scheme which has been provisionally approved by the Council provides for payment of a ground rent to be made by the lessee throughout the term of the lease, and for the cost to the Council of erecting the buildings to be repaid by the lessee during the first 15, 20 or 25 years, at his option, in the form of a weekly rent covering principal and interest. The rate of interest to be charged under the scheme is to be, as nearly as possible, the rate, either estimated or actual, at which the Council can raise money by the issue of stock after allowing for the expenses in connection therewith and all other charges, that ie to say, such rate of interest as will entail no loss to the Council. In order to bring the scheme within the reach of the working classes it was essential that the initial payment should be made as small as possible, and as the Council would retain the freehold of the property and a considerable amount of control, it was thought to be sufficient if the lessee were required to pay a sum of £5 as deposit and in part payment, on taking up the lease. The legal costs and other expenses are, in the first instance, to be paid by the Council, and the ground rent is to include an amount sufficient to cover these and other incidental expenses. The prospective lessee will have to satisfy the Council that he has a bona-fide intention of residing in the house ; but the scheme provides that he may, with the Council's consent, subsequently let the house to an approved tenant, the necessity for such consent and approval to apply only during the repayment period. The lessee is to be allowed to transfer the lease at any time subject, during the repayment period, to the Council's consent, which is not to be unreasonably withheld. As, however, it might not always be possible for the lessee to find a suitable assignee, the Council felt it essential that it should have power to accept a surrender of the lease and to make a payment to the lessee in consideration of such surrender. The charges to the lessee will be fixed as low as possible without involving a charge upon the rates. The task of managing the Council's dwellings, which on 31st December, 1911, contained accommodation for 53,811 persons, is one of considerable magnitude, and a special department has been established for the purpose. Dwellings capable of accommodating 2,468 persons were completed during the year 1911 at an approximate cost for buildings and plans of £74,790. The erection of new cottages designed to accommodate 2,328 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 £81,469. 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 the dwellings erected by the Council do not fulfil Ihese 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 fcr the purpose. 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 * 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 1910 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 12532 wnrkiny-class accommodation. Leasing [of cottage* to tenant?. Dwellings provided by the Council. New working class accommodation. 188 Annual Report of the London County Council, 1911. History of housing question. 1910 shows that the number of rooms in new dwellings provided during the year in the County of London was 6,950, the number of rooms in dwellings demolished 3,992, and that the net addition to the number of rooms was therefore 2,958. The figures in respect of the adjoining districts were 25,179, 4,268 and 20,911 respectively. The average rents for each room at which the new dwellings were let or to be let were during 1910, 3s. Id. in the central districts of London, 2s. 7Jd. in the outer districts of London and 2s. Hd. in the extra-London districts. The Council has published a history of the housing question in London up to the year 1900*, and an account of the Council's housing work since that date is in course of preparation. 1 * The Housing Question in London, 1855-1900 (No. 503.) 189 CHAPTER XXXVIII. Housing Accounts—Memorandum by the Comptroller {Mr. H. E. Haward). These accounts (see Appendix XVI.) relate to all the dwellings and lodging houses erected or owned by the Council. The dwellings are provided either (a) under the Housing of the Working Classes Act, 1890 (Parts I., II. and III.), or (b) under Improvement Acts. The results of the year 1911-12, after interest and sinking fund charges have been met, are shown by the Revenue Accounts (details on pages 24 and 25) to be as follows— Dwellings— £' s. d. Housing of the Working Classes Act, 1890 . Surplus 5,472 16 3 Improvement Acts Surplus 2,859 18 9 Surplus on dwellings 8,332 15 - Estates in Course of Development Deficiency 4,949 6 5 Net surplus on all dwellings a d estates ... 3,383 8 7 For the year 1910-11 there was a net deficiency on all dwellings and estates of £1,398 0s. Id., made up of a surplus on dwellings of £4,428 2s. 5d., and a deficiency on estates in course of development of £5,826 2s. 6d. 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 (6) dwellings erected under Part III. of the Act to provide accommodation for persons of the working classes/apart from any displacements. Dwellings erected under Parts I. and II. represent, therefore, compulsory provision for rehousing under statutorj 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 financia 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 :— Housing Accounts and Statistics. £ s. d. art i. Surplus 5,278 8 2 „ ii . Surplus 264 12 11 5,543 1 1 „ iii.—Dwellings Deficiency 70 4 10 Net surplus on dwellings 5,472 16 3 Part iii.—Estates in course of development Deficiency 4,91/9 6 5 Net Surplus for Housing Act 523 9 10 The deficiency on dwellings under Part III. includes £1,567 12s. 3d. 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. The gross rental for the year' from dwellings under the Housing Act was £159,037 0s. 2d. Deducting therefrom allowances for empties, caretakers' quarters and amounts irrecoverable, the net rental amounted to £143,929 4s. 7d., exclusive of £450 8s. 3d. for interest on cash balances. The amount of rent irrecoverable was £149 9s. 4d., or only 0'10 per cent, of the gross rental. The total loss of income due to "empties" was £13,888 6s. 6d., or 8'73 per cent, of the gross rental, as against 10 32 per cent, in 1910-11. Of this loss £5,575 occurred on four estates, viz.: Carrington House (£3,323, or 43'13 per cent, of gross rental), Hughes Fields Dwellings (£398, or 3107 per cant.), Hughes Fields Cottages (£579, or 28"10 per cent.), and Preston's-road Estate (£1,275, or 31.84 percent.). On two other estates the loss from empties was more than 10 per cent, of the gross rental. Summary of results of year He using Act, 1890. Results of year. Income. 190 Annual Report of the London County Council, 1911. The total expenditure on dwellings was £138,907. 1910-11, Per cent, of gross rental. 1911-12. Per cent, of gioss rental. £ Working Expenses—- £ 8,984 6.12 Supervision and collection of rent 9,543 6.00 21,689 14.78 Rates and taxes (less tax on interest on debt recovered).. 25,984 16.34 7,972 5.43 Lighting, heating, water and insurance 8,044 5.06 246 0.17 Stores and incidentals 322 0.20 14,125 9 .63 Repairs and renewals (transfers to fund) 14,711 9.25 53,016 36.13 58,604 36.85 Debt Charges— Interest (gross) Land £11,683 Buildings 55,506 63,618 43.35 67,189 42 .25 Sinking Fund — Land .. £2,252 Buildings 10,862 12,450 8.48 13,114 8.25 129,084 87.96 Total Expenditure 138,907 87 .35 16,388 11.17 Net deductions from gross rental (empties,etc.) 15,108 9.50 1,279 0.87 Surplus on dwellings (excluding interest on cash balances) 5,022 3.15 146,751 100.00 Gross rental 159,037 100.00 Repairs and Renewals Fund. Estat s in course of development. Sir Samuel Montagu (Lord Sway tilling) Gift Fund. [ 4 Special Fund for Acquisition of Lands under Part III. of Housing Act, 1890. Capital expenditure on Dwellings and Estates. A statement is appended (pages xliv. and xlv.) showing the percentages on gross rental of the several items of income and expenditure for each estate. 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 accumulations of the fund. The credits to this fund during the year exceeded the expenditure thereout by £2,374 2s. lid. The amount standing to the credit of the fund on 31st March, 1912, was £41,909 6s. 9d, of which £38,899 5s. lOd. was invested. 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 1911-12 was £4,949 6s. 5d., and the aggregate amount raised in the rates to 31st March, 1912, is £74,895 14s. 2d. This amount includes the annual instalments of sinking fund to redeem debt. 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, 1912, to £11,970 10s. 2d., of which £1,938 7s. Id. was invested in India Bills, maturing 1st December, 1912. A sum of £9,788 3s. 8d. had, up to 31st March, 1912, been applied to the purposes of the gift. 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 acquisition 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, 1912, to £54,041 19s. 6d. 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 £23,014 13s. 6d. has been applied to meet expenditure on tbis estate. The balance available on 31st March, 1912, for future expenditure on this estate is thus £31,027 6s., of which £20,250 is invested. The total expenditure on capital account on the dwellings and estates up to the 31st March, 1912, amounted to £2,191,630 12s. Id. The Summary of Financial Results shows the apportionment of this figure as between land and buildings. The capital expenditure during the year 1911-12 amounted to £55,554 19s. • 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 ohargeable against the dwellings. Expenditure. Housing of the Working Classes—Accounts. 191 Appendix XVIII. shows the estimated commercial value and housing value in respect of al sites utilised for the erection of working class dwellings under Parts I. and II. of the Act, whethe: the dwellings have been erected by Dwellings Companies or by the Council. As regards sites sole to Dwellings Companies, the aggregate commercial value at the time of disposal is estimated ai £472,100, and the aggregate housing value as represented by cash received from Dwellings Companie; 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 a £465,803, and the housing value charged to dwellings accounts to £163,361, the difference of £302,44i being charged against the clearance schemes. The statement on page^ xlix. shows the capital expenditure on the clearance of insanitary area: under Parts I. and II. of the Housing of the Working Classes Act, 1890, as distinct from the ex penditure on dwellings. The net capital expenditure to 31st March, 1912, under both parts of th» Act for clearance schemes, amounted to £2,515,937 17s. 5d. The capital expenditure during the yea 1911-12 amounted to £2,422 lis. Id. Dwellings under Improvement Acts. These dwellings were erected in pursuance of statutory obligations to provide rehousinj 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 unfavourabL financial result was from the first anticipated ; these are shown under a separate head. The result of the year's working of Dwellings under Improvement Acts is a net surplus of £2,859 18s. 9d., as compared with £2,551 19s. lid., in 1910-11. The gross rental for the year from dwellings was £56,256 12s. 8d. Deducting therefron allowances for empties, caretakers' quarters, and amounts irrecoverable, the net rental amounted te £52,863 19s. lid., exclusive of £183 6s. Id. for interest on cash balances. The amount of rent irrecoverable was £72 17s. lid., or only 013 per cent, of the gross rental. The total loss of income due to " empties " was £2,753 3s. Id., or 4 89 per cent, of the gross rental, as against 5.19 per cent in 1910-11. The greater part of this loss occurred on three estates, viz.: Hughes Fields Dwellings (£199, or 3107 per cent, of gross rental), Brightlingsea Buildings (£220, or 20 21 per cent.), and Swanlane Dwellings (£952, or 23 05 per cant.), which account for £1,371. On two other dwellings the loss from empties was more than 10 Der cent, of the otoss rental. The total expenditure on dwellings was £50,187. 1910-11. Per cent, ogross rental 1911-12. Per cent, of gross rental. £ Working Expenses— £ 4,254 75.6 Supervision and collection of rent 4,371 7.77 8,857 150.5 Rates and taxes (less tax on interest on debt recovered) 8,643 15.36 2,584 4.60 Lighting, heating, water and insurance 2,544 4.52 78 .14 Stores and incidentals 86 0.15 5,428 9.65 Repairs and renewals (transfers to fund) 5,253 9.34 21,201 37.70 20,897 37.14 Debt Charges— Interest (gross)— Land £3,515 Buildings 21,010 24,517 43.60 24,525 43.60 Sinking Fund— Land 657 Buildings 4,108 4,758 8.46 4,765 8.47 50,476 89.76 Total Expenditure 50,187 89-21 3,523 6.26 Net deductions from gross rental (empties, etc.) 3,393 603 2,236 3.98 Surplus on dwellings (excluding interest on cash balances) 2,677 4-76 56,235 100.00 Gross rental 56,257 100 00 The amount standing to the credit of this fund on 31st March, 1912, was £19,880 16s. 7d., of which £19,103 4s. 2d. was invested. The credits to this fund during the year exceeded the expenditure thereout by £438 8s. 9d. The total expenditure on capital account up to the 31st March, 1912, in respect of Dwellings under Improvement Acts amounted to £743,306 0s. 2d. The Summary of Financial Results shows the apportionment of this figure as between land and buildings. The capital receipts exceeded the expenditure during the year 1911-12 by £340 0s. 4d. 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. Appendix XVIII. shows the estimated commercial value and housing value 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 commeicial value at the time of disposal Capital Expenditure on Clearance Schemes. Results of year. Income. Expenditure. Repairs and Renewals Fund. Capital expenditure on Dwellings. 192 Annual Report of the London County Council, 1911. 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 improvement.". Financial Results of all Dwellings and Estates to 31s£ March, 1912. The total financial results on all dwellings and estates from April, 1894 (the date of the opening of the first block) to the 31st March, 1912, apart from contributions from or to rates, are as follows— Dwellings—■ Housing of the Working Classes Act, 1890— £ s. d. Part I surplus 34,060 13 2 Part II Part III surplus deficiency 2,967 27,757 9 18 3 7 surplus 9,270 3 10 Estates in course of development deficiency 74,895 H 2 Total under Housing Act deficiency 65,62b 10 4 Dwellings— Improvement Acts surplus 8,053 7 7 Net aggregate deficiency... 56,972 2 9 Contributions from Tramways Account 1,054 14 2 Net contributions from Rates ... 55,917 8 7 56,972 2 These results are arrived at after (a) charging interest on capital outlay, (b) making full prevision for repairs and renewals, and (c) 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, 1912, amounted to £201.828 19s. 2d. (exclusive of £13,684 16s. 3d., proceeds of sales). Housing Statistics—Memorandum by the Housing Manager (Mr. S. O. Burgess). Accommodation. Financial results. Empties; transfers ; rents irrecoverable, & *. The new buildings completed and opened between 1st April, 1911, and 31st March, 191'2, comprise 3'25 cottages, providing accommodation for 2,280 persons. 7 cubicles and 10 sheds were also provided. Up to 31st March, 1912, a total of 6,428 tenements in block dwellings, and 2,844 cottages, or a total of 9,272 lettings, containing 26,291 rooms; and 1,856 cubicles in lodging houses, affording accommodation altogether for 54,141 persons, had been provided and opened by the Council. The gross rent receivable for the year 1910-11 was £202,986 0s. 0d., and for the year 1911-12, £215,294 0s. 0d., being an increase of £12,308 0s. Od. 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 £7,699 0s. 8d., which, after adding interest on cash balances (£663 14s. 4d.) gives a total net surplus of £8,332 15s. Od., or 3*87 per cent, of £215,294 Os. 0d., the gross rent receivable for the year. The interest and sinking fund charges amount to 50'90 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 £25,638 5s. Id., and the total sum now set aside in thin fund in respect of dwellings in occupation amounts to £192,276 Os. lOd. The expenditure for the management of the estates, including repairs, rates and taxes, water, lighting, etc., amounts to o6'93 per cent, of the gross rental. During the year the sum of £19,964 has been transferred to the repairs and renewals account, the unspent accumulations on which, with the interest earned during the year (£1,919 5s. 4d.), now amount to £61,850 3s. 4d. The total addition to the fund was 9-97 of the gross rental. The loss of rent by empties (including the amounts lost at the opening of the new buildings —325 lettings) is equivalent to 7"73 per cent, of the gross rental. During the year 3,026 tenants left the dwellings. This is equivalent to 3263 per cent, of the total number of tenements, as compared with 35*0 percent in 1910-11. Of the 3,026 tenants who removed, 327 tenants, or 10'8 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 2,699 tenants, or 89-2 per cent., gave notice to the Council and left to suit their own convenience. A total of 6,223 applications for accommodation on the Council's estates (excluding lodging houses) were dealt with, and 681 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. Of the 6/223 applications received, 3,350 or 53'8 per cent, were suited with accommodation. 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 Housing of the Working Classes—Statistics. 193 vacation, but the amount of £222 7s. 3d. or '10 per cent. (2s. Od. 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, 1912, is 1,750. The usual annual enumeration of tenants of the Council's dwellings was taken in March, 1912,' and showed that the rooms (excluding lodging houses), available for letting, were actually occupied by 32,610 persons, or an average of 1'24 persons per room. The birth rate for the year amounted to 27'5 per 1,000, and the death rate (exclusive of the three men's lodging houses) to 8*5 per 1,000. As in previous years, a careful examination of the enumeration returns 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 12, or 13 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. A sum of £19,071 3s. 8d. (8*86 per cent, of the gross rental) has been spent in repairs to' the buildings during the year. These repairs include external painting at 26 blocks of tenements, 32 blocks of cottage flats and 379 cottages, whitening the soffits and cleaning or painting walls of 152 staircases, comb graining and varnishing the woodwork of 652 tenements, and cleansing repairs at 6,771 tenements. The whole of these repairs have been executed by direct labour employed in the housing department. During the year 36 small fires occurred in the dwellings. The damage was in every case slight, and the total cost of reinstatement, amounting to £21 14s. -d., was covered by the Council's insurance fund. 12532 aa Rehousing. Census of tenants. Repairs. Fires. appendixes. 125^3 AA 2 APPEN DIX 1. ii TABLE SHOWING PROCEEDINGS OF LONDON SANITARY AUTHORITIES UNDER THE FACTORY AND "WORKSHOP ACT, 1901. iii Premises, Particulars, Class, &c. City of London Battersea. Bermondsey. Bethnal Green. Camberw^ll. Chelsea. Deptford. Finsbury. Fulham. Greenwich. Hackney. Hammersmith Hampstead. Holborn. Islington. Kensington. Lambeth. Lewisham. Paddington. Poplar. i | St. Marylebone. 1 I St. Panoras. Shoreditch. South wark. i Stepney. Stoke Newfngton. Wandsworth. City of Westminster. Woolwich. 1. Inspections. Factories (including factory laundries) 4,329 579 218 261 321 3 148 1,190 132 87 28 904 103 148 460 140 10 87 130 83 33 122 298 121 114 37 708 237 80 Workshops (including workshop laundries) 5,547 1,314 132 3,568 2,414 875 379 1,932 470 352 2,058 1,614 922 746 1,772 2,378 400 1,490 2,313 817 3,788 1,016 2,862 992 5,108 172 3,059 4,246 322 Workplaces (other than outworkers' premises) 1,122 1,716 164 881 700 —a 283 320a 342 53a —a 704 2,190 2,486 838 244 13 316 40a 1,523 952 236 558 3,629 231a 16a 1,875 4,304 83 Total (Inspections) 10,998 3,609 514 4,710 3,435 878a 810 3,442a 944 498a 2,086a 3,222 3,215 3,380 3,070 2,762 423 1,893 2,483a 2,423 4,773 1,374 3,718 4,745 5,453a 225a 5,646 8,789 485 2. Defects Found. Nuisances under the Public Health Acts. Want of cleanliness 1,080 51 38 415 46 12 167 225 63 88 120 75 93 65 465 155 64 146 18 506 116 64 193 726 627 16 219 807 65 Want of ventilation 79 4 1 37 — 6 2 31 — 2 42 1 8 6 21 31 1 — — 4 6 2 1 33 79 — 9 257 18 Overcrowding 16 1 1 2 5 5 — 13 2 — l3 — 3 6 18 12 12 5 5 2 8 — 7 12 48 — 3 44 10 Want of drainage of floors 2 4 4 5 — — 11 — 1 1 24 3 — 50 7 — 1 — — 1 — •— 7 5 2 — 31 — Other nuisances 1,503 71 128 426 47 36 181 587 — 36 96 1 173 51 81 399 43 226 47 5 175 — 4 52 875 316 16 253 754 41 Insufficient 32 10 4 7 5 — 3 18 — 21 1 2 2 2 9 15 — 2 — — 5 7 5 l6 Z4 4 10 89 — Sanitary Unsuitable 3,166 87 5 203 35 — 77 247 15 l6 62 48 11 53 437 52 146 40 16 — 20 5 56 37 115 36 104 410 17 accommodation Not separate for sexes 91 4 — — 1 — — 40 — — 1 — 3 15 4 9 7 — 3 — 12 5 8 2 29 — 3 37 3 Offences under the Factory it Workshop Act. Illegal occupation of underground bakehouse (s. 101) — — — 1 — — — — 1 — ù — 1 — — 2 — — — — — — — — 1 — — — — Breach of special sanitary requirements for bakehouses (ss. 97-100) — 32 3 18 — 7 — — 4 53 — 95 — — — 37 — 40 — — 8 32 — — 44 — 13 — — Other offences (excluding offences relating to outwork) 2 — — 5 — — — — — — — — — — — — — — — — — 3 — — — — — — — Total (defects found) 5,969 262 184 1,118 144 66 430 1,258 84 217 336 418 175 228 1,403 363 456 281 47 687b 176 122 322 1,708b 1,288 74 614 2,429 154 3. Homework. Outworkers' Lists (s. 107). Received twice" in the year from employers Number of List 1,440 76 86 178 148 56 71 246 26 24 406 56 128 128 260 110 28 70 116 140 120 42 88 146 322 47 124 264 52 Outworkers. correspouding thereto Contractor 2,882 48 12 — 62 277 16 456 8 165 33 70 101 178 302 117 8 — 16 91 246 176 74 — — 52 6,708 — Workmen 13,542 332 770 3,318 1,739 486 506 4,700 78 4,575 88 234 603 5,202 890 304 171 501 2,749 1,426 8 1,239 1,178 4,531 371 390 1,066 Received once" in the year from employers Number of List 75 8 10 12 21 2 5 61 2 — 59 12 6 7 138 18 28 16 9 5 11 9 16 13 18 — 6 75 3 Outworkers, corrosponding thereto] Contractors 74 4 — — 8 1 — 38 — 57 — 6 3 9 4 — — — 3 — 8 8 — — — — — 1,107 — Workmen 341 31 86 155 95 4 13 525 4 622 22 13 24 220 306 964 49 21 30 136 18 257 80 97 — 10 86 Number of addresses of outworkers received from other Councils 686 334 3,351 133 663 240 3,507 284 2,932 306 964 297 2,100 2,755 1,135 696 408 550 67 Number of addresses of outworkers forwarded to other Councils 16,405 160 1,822 590 331 89 2,477 118 1,219 788 251 354 1,635 1,348 851 169 251 3,357 171 Prosecutions Failing to keep lists or permit inspection thereof — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Failing to send lists — — — — — — 1 — — — — 11 — — — — — — — — — — — — — Outworkers' Premises. Number of inspections of outworkers ri remises — 610 3,487 1,202 112 194 585 290 320 1,853 128 — 170 1,6,33 152 133 1,410 2 2,735 677 4,443 — 404 975 405 Outwork in unwholesome premi se s (s. 108) Instances 5 101 41 — — — 16 5 720 5 — — 139 2 — 16 — — — — 107 — 698 — 27 323 24 Notices served — 5 101 13 — — — 16 5 452 5 — 75 2 — 16 — — — — 107 — 698 — 29 657 24 Prosecutions — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — Outwork in infected premises (ss. 109, 110) Instances _ — — — — — — — 4 6 — — — — — — 47 9 12 — — 17 — — — 12 47 — 15 55 Orders made (s. 110) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Prosecutions (ss. 109, 110) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Workshops. orkshops on the Register at the end of 1911. Bakehouses (c) 28 74 76 92 167 33 70 60 70 61 27 61 34 32 249 93 214 89 60 89 76 175 70 107 175 24 128 85 36 Laundries 3,802 48 40 2,121 57 22 9 1,900 43 22 98 1,009 7 12 106 168 112 66 1,381 29 3,010 74 27 63 27 188 144 34 14 Other workshops 442 653 1,679d 667 194 e 357 195d 944 d 417 1,130 2,090 1,445 885 d 821 801a d 1,686 1,109 2,951d 3,136 1,418 2,729 149e Total (number of workshops on the Register) 3,830 564 769 2,213 1,903< I 722 273 1,960 470 278d 1,069 1.070d 458 1,174 2,445 1,706. 1,211 d 975 1,441 919 3,086d 1,935 1,206 3,l21d 3,338 212 1,690 2,848 199e 5. Other Matters. Matters notified to H.M. Inspector of Factories. Failure to affix abstract of the Factory and Workshop Act 1s. 1331 113 28 — 20 24 — 20 66 — 15 60 — 35 13 168 47 — 24 46 23 29 — — 8 67 6 28 91 1 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 38 2 — 50 10 8 3 45 3 1 31 14 1 26 19 17 9 3 23 5 25 18 29 34 168 — 5 100 1 Reports (of action taken)sent to H.M. Inspector 38 — — 53 3 8 4 45 3 1 31 14 1 26 15 16 9 3 17 5 18 18 9 8 132 — 5 100 1 Other 37 — — 4 11 — 20 50 — — — 33 7 1 — — — 3 — 4 — — 2 1 36 2 — 9 — Underground Bakehouses (s. 101). Certificates granted during 1911 — — - — — — — — — — — — — — — — — — — In use at Ihe end of 1911 22 31 26 66 28 23 34 49 16 5? 32 21 21 94 75 72 20 55 25 68 132 40 40 59 19 46 69 15 (a) Excluding inspection# of restaurant kitchens, etc (b) Including defects in horaeworkers premises. (c) Including bakehouses not in use during the year. (d) Includes workplaces other than places where food is prepared. (e) Including workplaces. iv Annual Report of the London County Council, 1911. Appendix 11. APPENDIX II. CASES OF TYPHOID FEVER OCCURRING IN OR ASSOCIATED WITH AN AREA IN FJNSBURY, AUGUST AND SEPTEMBER, 1911. No. Date of onset of illness. Date of notification. Sex. Age. Milk—Whether obtained from Z or not. Ice-cream. Fried fish. Remarks. 1 Aug. 19th. Aug. 31st F 14 No From stalls, not from Y. The girl is said to have washed up glasses at one of these stalls Occasionally from X. The onset in these three cases may have been earlier. When seen September 15th they had been ill 3 or 4 weeks. Case 3 belonged to same family as cases 8 and 9 2 End of Aug. Sept. 2nd M 11 99 •\T From Y From X 3 99 „ 5th M 16 Yes From Y From X. 4 99 „ 5th M 12 No From Y From X 5 Aug. 27th „ 5th F 16 99 Very doubtful if from Y within incubation period From X 6 „ 30th „ 5th M 9 Yes Not from Y for some months prior to illness From X (habitually) Brothers 7 „ 29th „ 6 th M 13 " Not from Y for some months prior to illness 'From X (habitually) 8 End of Aug. „ 6th F 21 99 No ice cream From X sister of No. 3. 9 " „ 6th F 42 99 No ice cream From X Mother of Nos. 3 and 8 10 Aug. 28th. „ 7th F 11 No From stalls—wafers, but not ice cream From X 11 Sept. 3rd „ 7th M 15 99 From Y From X It is doubtiui it this boy had typhoid tever. Member of same family as cases 13, 23, 38, 49. 12 Aug. 28th „ 7th M 10 99 Same history as that given'by his brother. See No. 14 From X Brother of No. 14 13 Sept. 2nd „ 7th F 12 99 From Y From X Member of same family as cases 11, 23, 38, 39 14 End of Aug. „ 7th M 13 99 From stalls, not known to buy from Y From X Brother of No. 12. 15 Sept. 3rd. „ 8th M 11 Yes Possibly from Y, but doubtful if within incubation period. From X At wnitstaoie uuiy z/—Aug. l0th. Does not think he had ice cream after this. 16 Aug. 31st „ 8th F 8 99 No. (Not from Y within incubation period.) From X Sister of No. 42 17 Sept. 5th „ 8th M 17 Not from Y From X (frequently) 18 Aug. 28th „ 8th F 12 No From Y From X 19 „ 29th „ 8th F 13 99 From stalls and from Y From X 20 „ 31st „ 8th M 10 99 From stalls. Sometimes from Y From X (frequently) 21 „ 27th „ 8th M 13 99 From Y on Sundays. " A long time ago." " All the family had it." From X about once a week 22 Sept. 3rd „ 9th F 15 99 Doubtful if in incubation period. Occasionally from Y About 4 times a week from X. Last time during latter part of Aug., when she and her sister had penny bits of plaice Sister of No. 50 23 „ 7th „ 9th M 9 99 From Y From X Member of same family as cases 11, 13,38, 49 24 Aug. 26th „ 9th F 24 99 From Y From various sources; but not, it is said, from X Sister of No. 44. Away from London during a part of month preceding onset. 25 „ 15 or earlier „ 9th F 7 99 Very doubtful if from Y. Doubtful if any ice cream within the incubation period Father says from X occasionally Doubtful case. Tuberculosis. Returned 26 „ 30th „ 9th F 21 from Brighton 3 weeks before illness. 27 Sept. 4th „ 9th F 9 • 99 99 No ice cream From Y From X From. X; Mother sends her to buy for ) sisters and self and sometimes for the rest of the family. Sister of No. 35 28 29 Aug. 28th „ 29th 9th „ 9th F M 5 25 99 Yes Possibly From Y. Two half-pint glasses full purchased every Sunday he was at home. Wife and children all ate it as well as patient himself From X i From U and V, not from X Patients are sisters. Probably not typhoid fever 30 „ 19th „ 9th M 7 Possibly from Y From Y, just after Bank Holiday Not from Y. Father is an ice-cream vendor From a stall. Not from Y From Y (2 or 3 times weekly) From X FromX From X From X (once or twice a week) From X Mother buys for family once a week. Patients are brothers 31 „ 30th „ 9th M 14 No 32 End of Aug. „ 10th F 5 99 33 Sept. 2nd „ 10th M 26 34 „ 3rd „ 11th J.TJ, M 19 99 " Knew No. 47. Also No. 17 and No. 3. No. 11 does not know them. Fish from X 3 times between Aug. 10th and 31st, generally in middle of week. Last time one week after Bank Holiday. 35 Aug. 29th „ 11th M 13 99 From Y. From X (2 or 3 times weekly until a week before he became ill) From X 3 or 4 times a week for supper Probably from X Brother of No. 26 36 37 Sept. 7 th „ 2nd „ 11th „ 11th M M 16 8 99 99 From Y From stalls. Not from Y for some months 38 „ 8th „ 11th M 7 99 From Y From X Doubtful case. Member of same famly as cases 11, 13, 23 and 49. 39 Beginning Sept. „ 11th F 17 Yes From Hampstead-heath. From Y some From X (habitually) 40 Sept. 4th „ 12th M 5 months ago, but not since July From Y t7w.tvy "v 41 „ 10th „ 12th F 8 No On Saturdays and Sundays from Y jd rom a From X (twice a week). She or her 42 „ 4th „ 12th M 18 Yes No ice cream brother fetches it. From X Brother of No. 16. to Early in Sept. „ 12th F 16 1 From Y 3 months ago—not since From X. Frequently, last time 4 weeks before Sept. 15th. 44 Aug. 30th „ 12th M 14 No Doubtful if in incubation period From various sources ; but not, it is said, from X Brother of No. 24. Away from London during a part of month preceding onset. 45 Sept. 4th „ 13th M 25 Yes Not from Y From X. Some plaice about a fortnight before he was taken ill 46 „ 10th „ 15th F 15 No From stalls; not, frnm Y From X 47 „ 5th „ 16th M 20 " From stalls ynot from Y From Y From X 48 „ 4th „ 18th M 16 99 No ice cream From X 49 „ 10th „ 19th F 42 99 99 No ice cream rrom X (once a week) From X Member of same family as cases 11, 13, 23 and 38 v No. Date of onset of illness. Date of notification. Sex. Age. Milk— Whether obtained from Z. or not. Ice-cream. Fried fish. Remarks. 50 Sept. 5th Sept. 19th F 13 No From Y (occasionally) From X about 4 times a week Sister of No. 22 51 „ 10th „ 20th F 24 99 Not from Y Has fried fish at work but not at home unless her mother gets it. 52 „ 4th „ 21st F 19 99 No—not within incubation period From X frequently Ice cream on August 7th from Y, not since. 53 „ 17th „ 25th M 3 99 From a stall; not from Y None Not typhoid fever—Pneumonia. 54 „ 26th F 4 None None 99 99 99 99 55 Aug. 23rd Sept. 5th F 9 From stalls—wafers but not ice cream From X 56 „ 26th „ 6th F 12 Not from Y Probably from X Usually bought a $d. worth of potatoes only, without fish 57 Latter part of Aug. „ 7th or a day or two later M 23 No ice cream Occasionally from X 58 Sept. 2nd „ 9th M 15 From Y frequently From X Occasionally from X. The "big ones" (i.e., Nos. 17, 3, ,47) "mostly went there." No. 34 confirms this. 59 Latter part of Aug. „ 11th F 17 Yes Probably from X 60 Sept. 1st ,, 21st F 16 No ice cream ... In Ramsgate Aug. 8-15, about. Ate cockles there. Bought apples in London but no fish or ice-cream. 61 Sept. 3rd. M 31 From Y on one occasion only, about 3 weeks before Sept. 3rd Occasionally from X At Margate during last week in August. 62 Sept. 6th or 7th F 18 Never from Y Generally from W, but possibly also from X., as she passes the shop on her way from work. Annual Report of the London County Council, 1911. vi vii. Appendix III APPENDIX III. SUMMARY OF REPORTS ON 638 SCHOOL BUILDINGS INSPECTED BY SCHOOL DOCTORS, 1911. Departments. Sanitation. Lighting. Heating. Ventilation. Furniture. Artificial. Natural. Good. Fair. Bad. Good. Fair. Bad. Good. Fair. Bad. Good. Fair. Bad. Good. Fair. Bad. Good. Fair. Bad. 448 Boys' dep artments 387 56 5 417 30 1 351 87 10 392 53 3 382 64 2 401 46 1 466 Girls' 411 52 3 433 31 2 364 92 10 404 57 5 407 58 1 419 47 — 575 Infants' „ 513 55 7 529 41 5 440 119 16 507 63 5 508 63 4 522 53 - 150 Mixed ,, 131 17 2 137 12 1 120 29 1 137 13 - 138 12 — 137 13 — 1,639 Departments in 1911 1,442 180 17 1,516 114 9 1,275 327 37 1,440 186 13 1,435 197 7 1,479 159 1 88% 11% 1% 92% 7% 1% 78% 20% 2% 88% 11% 1% 88% 12% 0% 90% 10% 0% 1,019 Departments in 1910 906 85 28 952 52 15 785 221 13 890 122 7 849 162 8 868 145 6 89% 8% 3% 93% 5% 2% 77% 22% 1% 87% 12% 1% 83% 16% 1% 85% 14% 1% viii. ix. Annual Report of the London County Council, 1911. Appendix IV. APPEN DIX IV. MEDICAL EXAMINATION OF SCHOOL CHILDREN, 1911. SUMMARY OF DEFECTIVE CONDITIONS REPORTED BY SCHOOL DOCTORS. CHILDREN AGED 8-9 YEARS. Divisional Superintendent's area. (Constituent borovghs). Cleanliness. Clothing. Nutrition. Teeth. Eyes. Throat and nose. Ears. Speech. Heart. Lungs. Skin. Glands. Rickets. Deformities. Nervous complaints. Anæmia. Tuberculosis (not pulmonary). Other defects. Number — of children examined. Good. Average. Bad. Good. Average. Bad. Good. Average. Bad. Good. Average. Bad. Defective vision and Squint. Disease. Adenoids. Tonsils. Diseases of nose. Other defects. Deafness. Discharging. Other defects. Stammering and stnttring. Other defects. Valvular lesion. Other defects. Phthisis. Other defects. Ringworm. Other defects. 1. Chelsea (Chelsea, Fulham, Hammersmith, Kensington) Boys 3,684 1,955 1,334 395 1,464 1,824 396 1332 1,914 438 1,715 1,170 799 257 66 321 372 34 23 55 66 13 17 6 49 66 46 104 17 78 136 56 62 26 61 16 116 53% 36% 11% 40% 49% 11% 36% 52% 12% 46% 32% 22% 7.0% 1.8% 8.7% 10 .1 % .9% 6% 1.5% 1.8% 4%********************** '5% ■2% 1-3% 1.8% 1.2% 2.8% .5% 2.2% 3.7% 2.5% 1.8% .7% 1.8% .3% 3.9% Girls 3,513 1,946 1,177 390 1,548 1,627 338 1,286 1,850 377 1,638 1,100 775 273 53 270 379 28 17 55 67 11 5 59 69 34 66 12 50 160 33 74 31 85 18 116 55% 34% 11% 44% 46% 10% 36% 53% 11% 47% 31% 22% 7.8% 1.5% 7.7% 10.8% .8% .5% 1-6% 2.9 .3% .1% .1% 1.7% 2.0% 1.0% 2.9% .3% 1.4% 4.6% .9% 2.2% .9% 2.4% .5% 3.3% 2. Paddington (Paddington, St. Marylebone, City of Westminster) Boys 2,162 1,119 857 186 1,013 1.005 144 641 1,220 301 778 996 388 159 27 82 136 22 9 39 26 2 5 6 13 17 5 27 3 24 78 15 22 11 40 1 51 52% 40% 8% 47% 46% 7% 30% 56% 14% 36% 46% 18% 7.4% 2.2% 3.8% 6.3% 1.0% .4% 1.8% 1.2% 1% .2% .3% .6% .8% .2% 1.2% .1% 1.1% 3.6% .7% 1.0% .5% 1.9% - 2.4% Girls 1,955] 1,056 637 262 991 837 127 705 1,018 232 779 838 338 150 17 64 150 9 4 31 26 1 3 7 15 31 9 17 12 19 62 11 20 5 26 3 46 54% 33% 13% 51% 43% 6% 36% 52% 12% 40% 43% 17% 7.7% .9% 3.3% 7.7% .5% .2% 1.6% 1.3% .1% .2% .4% .8% 1.6% .5% .9% .6% 1.0% 3.2% .6% 1.0% .3% 2.3% .2% 2.4% 3. St. Pancras (Hampstead, Holborn, St. Pancras) Boys 2,383 1,361 785 237 1,094 1,011 278 936 1,132 315 1,155 840 388 133 26 49 115 21 21 43 34 3 4 2 21 4 7 31 4 19 44 17 14 4 34 5 59 57% 33% 10% 46% 42% 12% 39% 48% 13% 49% 35% 16% 5.6% 1.1% 2.1% 4.8% .9% .9% 1.8% 1.4% .1% .2% .1% .9% .2% .3% 1.3% .2% .8% 1.8% .7% 6% .2% 1.4% .2% 2.5% Girls 2,440 1,428 789 223 1,211 1,025 204 1,054 1,127 259 1.172 937 331 144 16 32 120 12 5 25 37 3 1 3 21 7 11 30 7 11 16 1 15 3 44 2 36 59% 32% 9% 50% 42% 8% 43% 46% 11% 48% 38% 14% 5.9% 7% 1.3% 4.9% .5% .2% 1.0% 1.5% .1% - .1% .9% .3% .5% 1.2% .3% .5% .7% — .6% .1% 1.8% .1% 1.5% 4. Islington (Islington, Finsbury) Boys 3,576 1,702 1,556 318 1,279 1,884 413 779 2,202 595 1,456 1,433 687 310 59 271 385 12 12 96 72 - 20 9 50 53 25 79 20 54 428 118 86 20 110 4 59 48% 43% 9% 36% 53% 11% 22% 61% 17% 41% 40% 19% 8.7% 2.6% 7.6% 10.8% .3% .3% 2.7% 2.0% — .6% .3% 1.4% 1.5% .7% 2.2% .6% 1.5% 12.0% 3.3% 2.4% .6% 3.2% .1% 2.6% Girls 3,159 1,554 1,259 346 1,247 1,671 241 922 1,831 406 1,329 1,251 579 276 48 203 285 9 8 80 61 6 6 10 54 61 25 55 10 36 318 44 82 22 80 2 50 49% 40% 11% 39% 53% 8% 29% 58% 13% 4.2% 40% 18% 8.6% 1.5% 6.4% 8.9% .3% .3% 2.5% 2.9% .2% .2% .3% 1.7% 2.9% 8% 1.7% .3% 2.2% 10.0% 1.4% 2.6% .7% 2.5% .1% 1.6% 5. Hackney (Hackney, Stoke Newington, Shareditch) Boys 3,4 l5 1,809 1,282 324 1,493 1,537 385 1,010 1,971 434 1,744 1,281 390 306 71 258 310 31 33 98 86 8 7 8 38 33 5 76 22 86 198 95 39 21 117 9 100 53% 38% 9% 44% 45% 11% 29% 58% 13% 51% 38% 11% 9.0% 2.2% 7.6% 9.1% .9% 1.0% 2.9% 2.5% .2% .2% .2% 1.1% 1.0% .2% 2.2% .6% 2.5% 5.8% 2.5% 1.1% .6% 3.4% .3% 2.9% Girls 3,196 1,625 1,202 369 1,466 1,470 260 1,077 1,779 340 1,807 1.063 326 292 65 179 305 13 28 82 73 8 5 3 33 36 4 52 14 85 158 35 30 32 124 7 74 51% 38% 11% 46% 46% 8% 34% 56% 10% 57% 33% 10% 9.1% 2.0% 5.6% 9.5% .4% .9% 2.6% 2.3% .3% .2% .1% 10% 1.1% .1% 2.6% .4% 2.7% 4.9% 2.1% 2.9% 1.0% 3.9% .2% 2.3% 6. City and Stepney (City of London Stepney) Boys 3,179 854 1,810 515 638 2015 526 673 2,122 384 1,300 1,339 540 492 91 186 282 28 10 40 33 3 13 6 25 11 7 46 14 52 81 16 24 13 46 5 43 27% 57% 16% 20% 63% 17% 21% 67% 12% 41% 42% 17% 15.0% 2.9% 5.9% 8.9% .9% .3% 1.3% 1.0% .1% .4% .2% .8% .3% .2% 1.4% .4% 1.6% 2.5% .5% 8% .4% 1.4% .3% 1.4% Girls 3,021 866 1.591 564 674 1.969 378 765 2,009 247 1,258 1,270 493 489 65 164 260 23 4 40 44 4 4 4 26 6 13 41 5 74 50 2 23 22 42 4 49 29% 53% 18% 22% 65% 13% 25% 67% 8% 42% 42% 16% 16.0% 2.0% 5.4% 8.6% .8% .1% 2.3% 2.5% .1% .1% .1% .9% .2% .4% 1.4% .2% 2.4% 1.7% - .8% .7% 1.4% .1% 2.6% 7. Poplar (Poplar, Bethna Green) Boys 2,819! 1,001 1,510 332 797 1,698 354 815 1,685 349 1,533 976 340 475 81 219 245 17 40 71 63 14 11 32 45 17 17 64 10 71 126 31 45 23 43 5 82 35% 53% 12% 28% 60% 12% 29% 59% 12% 54% 34% 12% 17.0% 2.8% 7.7% 8.6% .6% 1.4% 2.5% 2.2% 5% .4% 1.1% 1.6% .6% .6% 2.2% .4% 2.5% 4.4% 1.1% 1.6% .8% 1.5% .2% 2.9% Girls 2,762 922 1 389 451 873 1,626 263 894 1,555 313 1,532 937 293 479 91 224 260 15 25 93 74 12 5 19 50 30 14 65 4 118 106 37 49 23 60 4 67 34% 50% 16% 32% 59% 9% 33% 56% 11% 55% 34% 11% 17.3% 3.3% 8.1% 9.4% .5% .9% 3.4% 2.7% .4% .2% .7% 1.8% 1.1% .5% 2.4% 1% 4.3% 3.8% 2.3% 1.8% .8% 2.2% .1% 2.4% 8. Greenwich (Greenwich, Lewis ham, Woolwich) Boy. 3,081 1,430 1,471 180 1,154 1,733 194 1.145 1,684 252 1,250 1,318 513 197 63 221 277 29 18 89 44 15 9 4 21 8 3 18 4 44 55 5 34 19 46 7 71 46% 48% 6% 38% 56% 6% 37% 55% 8% 40% 43% 17% 6.4% 2.0% 7.2% 1 QQ 9.0% .9% .6% 2.9% 1.4% .5% .3% .1% .7% .3% .1% .6% .1% 1.4% 1.8% .2% 1.1% .6% 1.5% .2% 2.3% Girls 3,048 1,631 1,215 202 1,253 1,637 158 1,283 1,522 243 1,302 1,248 498 222 69 188 288 33 6 80 51 9 6 4 20 5 9 8 5 50 37 7 26 29 46 6 62 53% 40% 7% 41% 54% 5% 42% 50% 8% 43% 41% 16% 7.3% 2.3% 6.2% 9.2% 1.1% .2% 2.6% 1.7% .3% .2% .1% .7% .2% .3% .3% .2% 1.6% 1.2% .2% .9% 1.0% 2.5% .2% 2.9% 9. Camberwell (Camberwell, Deptford) Boys 2,979 1,436 1,361 182 1,167 1,541 271 1,040 1,733 206 1,198 1.273 508 263 33 190 252 19 47 48 47 9 9 15 28 18 12 44 6 43 131 29 57 16 51 6 102 48°/ 46% 6% 39% 52% 9% 35% 58% 7% 40% 43% 17% 9.0% 1.1% 6.4% 8.5% .6% 1.6% 1.6% 1.6% .3% .3% .5% .9% .6% .4% 1.5% .2% 1.4% 4.4% 1.0% 1.9% .5% 2.7% .2% 3.4% Girl 3,003 1474 1,293 236 1,371 1.427 205 1,185 1,645 173 1,179 1,393 431 338 57 153 262 19 24 48 49 11 2 7 29 30 11 29 7 37 123 16 44 14 62 5 56 49% 43% 8% 46% 47% 7% 39% 55% 6% 39% 47% 14% 11.3% 1.9% 5.1% 8.7% .6% .8% 1.6% 1.6% .4% - .2% 1.0% 1.0% .4% 1.0% .2% 1.2% 4.1% .5% 1.5% .5% 2.2% .2% 1.9% 10. Walworth (Bermondsey, Southwark) Boy s 3,082 1,149 1,656 277 854 1,879 349 845 1,951 286 1,244 1,286 558 367 64 237 282 27 53 59 76 14 7 13 36 75 14 88 10 91 233 22 40 19 109 3 158 37% 54% 9% 28% 61% 11% 28% 63% 9% 40% 42% 18% 12.0% 2.1% 7.7% 9.2% .9% 1.7% 2.9% 2.5% .5% .2% .4% 1.2% 2.4% .5% 2.9% .3% 3.0% 7.6% .7% 1.3% .6% 3.5% .1% 5.1% Girls 3,011 1,258 1,375 378 961 1,745 305 925 1,799 287 1,296 1,208 507 434 64 233 315 15 40 66 69 18 6 7 58 64 8 90 4 96 234 34 46 18 124 7 196 42% 46% 12% 32%, 5.8% 10% 31% 60% 9% 43% 40% 17% 14.4% 2.1% 7.7% 10.5% .5% 1.3% 2.2% 2.3% .6% .2% .2% 1.9% 2.1% .3% 3.0% .1% 3.2% 7.8% 1.1% 1.5% .6% 4.1% .2% 6.5% 11. Lambeth (Lambeth) Boys 2,036 1,236 699 110 1,140 774 122 825 1,049 162 959 739 338 169 41 159 191 36 17 38 34 6 2 3 16 13 5 27 4 26 42 39 12 13 66 4 67 61% 34% 5% 56% 38% 6% 40% 52°/ 8% 47% 36% 17% 8.0% 2.6% 8.0% 9.0% 1.8% .8% 1.9% 1.7% .3% .1% .1% .8% .6% .2% 1.3% .2% 1.3% 2.1% 2.9% .6% .6% 3.2% .2% 3.3% Girl s 1,963 1,242 591 130 1,227 669 67 980 860 123 992 706 265 192 37 141 220 26 6 49 35 5 — 4 22 25 6 15 5 28 44 15 19 16 54 3 51 63% 30% 7% 62% 34% 4% 50% 44% 6% 51% 36% 13% 9.8% 1.9% 7.2% 11.2% 1,3% ,3% 2,5% 1,8% .3% - .2% 1.1% 1.3% .3% .8% .3% 1.4% 2.2% .8% 1.0% .8% 2.7% .2% 2.6% 12. Wandsworth (Wandsworth, Battersea) Boys 4,073 2,336 1,463 274 2,095 1,686 292 1,183 2,460 430 1,549 1,827 697 265 46 220 365 18 14 146 33 8 14 6 39 7 14 37 9 58 140 34 10 15 17 1 52 57% 36% 7% 52% 41% 7% '29% 60% 11% 38% 45% 17% 6.5% 1.1% 5.4% 9.0% .4% .3% 3.6% .8% .2% .3% .1% 1.0% .2% .3% .9% .2% 1.4% 3.4% .8% .2% .4% .4% — 1.3% Girs 3,893 2,289 1,288 316 2,149 1,496 248 1,43 2,070 392 1,523 1,692 678 227 1.0% 194 370 24 13 107 65 6 2 2 36 12 12 23 8 80 121 15 29 13 12 5 55 59% 33% 8% 55% 39% 6% 37%, 53% 10% 39% 44% 17% 7.1% 1.0% 5.0% 9.5% .6% .3% 2.7% 1.7% 2% .1% .1% .9% .3% .3% .6% .2%, 2.1% 3.2% .4% .7% .3% .3% .1% 1.4% London County Boys 36,499 17,388 15,781 3,330 14.188 18,587 3,724 11,224 21.123 4,152 15,88 14,472 6.146 3,393 668 2,413 3,212 294 297 822 614 95 118 110 381 322 160 641 123 646 1,692 477 445 200 746 60 960 48% 43% 9%/ 39% 51% 10% 31% '58% 11% 43% 40% 17% 9.3% 1.8% 6.5% 8.8% .8% .8% 2.2% 2.7% .3% .3% .3% 1.0% .9% .4% 2.8% .3% 1.8% 4.6% 2.3% 1.2% .5% 2.9% .2% 2.6% Girs 34,964 17,291 13,806 3,867 14.971 17,199 2,794 12,507 19,065 3,392 15,807 13,643 5,514 3,564 620 2,045 3,206 226 180 756 651 94 45 75 42.3 376 156 491 93 684 1,429 250 457 228 759 66 858 40% 40% 11%, 43% 49% 8% 36% 54% 10% 45% 39% 16% 10.2% 1.8% 5.9% 9.2% .6% .5% 2.2% 1.9% .3% .1% .2% 1.2% 1.1% .4% 1.4% .3% 2.0% 4.1% .7% 1.3% .7% 2.2% .2% 2.5% 12532 BB 2 X. xi. Annual Report of the London County Council, 1911. Appendix V. APPEN DIX V. MEDICAL EXAMINATION OF SCHOOL CHILDREN, 1911. SUMMARY OF DEFECTIVE CONDITIONS REPORTED BY SCHOOL DOCTORS. CHILDREN AGED 12—13 YEARS. ("LEAVERS.") Divisional Superintendent's area. (Constituent boroughs). Cleanliness. Clothing. Nutrition. Teeth. Eyes. Throat and Nose. Ears. Speech. Heart. Lungs. Skin. Glands. Rickets. Deformities. Nervous complaints. Anaemia. Tuberculosis (not pulmonary). Other defects. Number of children exam ined. Good. Average. Bad. Good. Average. Bad. Good. Average. Bad. Good. Average. Bad. Defective vision and squint. Disease. Adenoids. Tonsils. Disease of Nose. Other , defects. , Deafness. Discharging. Other defects. Stammering and stuttering. Other defects. Valvular lesion. Other defects. Phthisis. Other defects. Ringworm. Other defects. 1. Chelsea (Chelsea, Fulham, Hammersmith, Kensington) Boys 3,693 2,210 1,154 329 1,678 1,670 345 1,686 1,677 330 1,931 1,247 515 373 42 173 321 37 17 68 51 6 26 9 52 26 26 42 8 49 70 46 117 18 73 8 86 60% 31% 9% 46% 45% 9% 46% 45% 9% 52% 34% 14% 10.1% 1.1% 4.7% 8.7% 1.0% .5% 1.8% 1.4% .2% .7% .2% 1.4% .7% .7% 1.1% .2% 1.3% 1.9% 7.2% 3.2% .5% 2.0% .2% 2.3% Girls 3,447 1,962 1,124 361 1,526 1,630 291 1,588 1,514 345 1,902 1,127 418 341 49 152 281 18 28 70 66 2 11 2% 61 40 40 53 11 47 56 39 124 29 74 7 61 57% 33% 10% 44% 47% 9% 46% 44% 10% 55% 33% 12% 9.9% 1.4% 4.4% 8.2% .5% .7% 2.0% 1.9% .1% .3% .2% 1.8% 1.2% 1.2% 1.5% .3% 1.4% 1.6% 1.1% 3.6% .8% 2.1% .2% 1.8% 2. Paddington (Paddington, St. Marylebone, City of Westminster) Boys 2,386 1,234 901 251 1,105 1,047 234 940 1,165 281 1,133 917 336 154 15 82 202 15 15 51 41 3 16 3 36 16 7 14 1 33 64 8 36 9 47 99 52% 38% 10% 46% 44% 10% 39% 49% 12% 48% 38% 14% 6.5% •6% 3.4% 8.5% .6% .6% 2.1% 1.7% .1% .7% .1% 1.5% .7% .3% .6% — 1.4% 2.7% .3% 7.5% .4% 2.0% .1% 4.1% Girls 2,173 1,127 719 327 1,115 885 173 1,015 984 174 1,112 807 254 170 22 70 165 5 10 40 37 3 6 1 30 32 6 14 2 20 28 10 53 10 42 - 55 52% 33% 15% 51% 41% 8% 47% 45% 8% 51% 37% 12% 7.8% 1.0% 3.2% 7.6% .2% .5% 1.8% 1.7% .1% .3% - 1.4% 1.5% .3% .6% .1% .9% 1.3% .5% 2.4% .5% 7.9% - 2.5% 3. St. Pancras (Hampstead, Holborn, St. Pancras) Boys 2,391 1,462 683 246 1,198 911 282 1,078 995 318 1,281 774 336 249 26 38 128 24 20 54 46 1 6 2 25 8 22 15 3 23 14 6 12 4 35 1 52 61% 29% 10% 50% 38% 12% 45% 42% 13% 54% 32% 14% 10.4% 1.1% 1.6% 5.4% 1.0% .8% 2.3% 1.9% - .2% .1% 1.0% .3% .9% .6% .1% 1.0% .6% .3% .5% .2% 1.5% — 2.2% Girls 2,314 1,313 829 172 1,104 1,052 158 1,023 1,055 236 1,198 873 243 252 18 29 138 9 3 46] 38 1 - 3 43 10 14 15 4 16 22 2 21 7 41 6 32 57% 36% 7% 48% 45% 7% 44% 46% 10% 52% 38% 10% 10.9% .8% 1.3% 6.0% .4% .1% 2.0% 1.6% - - .1% 7.9% .4% .6% .6% .2% .7% 1.0% .1% .9% .3% 1.8% .3% 1.4% 4. Islington (Islington, Finsbury) Boys 3,328 1,598 1,435 295 1.065 1,857 406 893 1,985 450 1,445 1,418 465 426 49 187 383 23 20 88 53 2 11 4 42 64 21 65 12 52 354 73 78 .13 52 3 52 48% 43% 9% 32% 56% 12% 27% 60% 13% 43% 43% 14% 12.8% 1.5% 5.6% 11.5% .7% .6% 2.6% 1.6% .1% .3% .1% 1.3% 7.9% .6% 2.0% .4% 1.6% 10.6% 2.2% 2.3% .4% 1.6% .1% 1.6% Girls 3,303 1,654 1,270 379 1,344 1,713 246 1,153 1,801 349 1,584 1,301 418 441 _ 26 188 362 23 6 90 37 4 7 7 5 106 104 24 42 11 39 283 51 161 9 70 - 71 50% 38% 12% 41% 52% 7% 35% 55% 10% 48% 39% 13% 13.0% .8% 5.7% 11.9% .4% .2% 2.7% 1.1% .1% .2% .2% 3.2% 3.1% .7% 1.3% .3% 1.2% 8.6% 1.5% 4.9% .3% 2.1% — 2.7% 5. Hackney (Hackney, Stoke Newington, Shoreditch) Boys 3,298 1,616 1,234 448 1,333 1,573 392 1,201 1,751 346 1,836 1,134 328 396 34 209 297 11 26 125 77 7 19 2 46 44 8 51 8 57 54 15 27 14 117 5 56 ' 49% 37% 14% 40% 48% 12% 36% 53% 11% 56% 34% 10% 12.0% 1.0°/o 6.30% 9.0% .3% 8% 3.8% 2.3% 2% .6% .1% 1.4% 1.3% .2% 1.5% .2% 1.7% 1.6% .5% .8% .4% 3.5% .2% 1.7% Girls 3,246 1,572 1,174 500 1,464 1,503 279 1,371 1,571 304 1,998 1,017 23 J 413 51 188 303 5 15 141 87 .2% 3 - 55 39 2 51 4 42 56 12 39 24 134 3 48 49% 36% 15% 45% 46% 9% 42% 49% 9% 62% 31% 7% 12.7% 1.6% 5.8% 9.3% .2% 5% 4.3% 2.7% .2% .1% - 1.7% 1.2% .1% 1.6% .7% 1.3% 7.7% .4% 1.2% .7% 4.1% .1% 1.5% 6. City and Stepney (City of London, Stepney) Boys 3,269 888 1,868 513 625 2,083 561 904 2,046 319 1,634 1,257 378 650 70 152 289 25 23 51 64 1 19 - 43 15 9 30 10 43 22 12 16 19 30 6 43 27% 57% 16% 19% 64% 17% 28% 62% 10% 50% 38% 12% 19.9% 2.1% 4.7% 8.8% .8% .7% 1.6% 2.0% - .6% - 1.3% .5% .3% .9% .3% 1.5% .7% .4% .5% .6% .9% .2% 1.3% Girls 2,913 983 1,578 352 792 1,880 241 1,052 1,710 151 1,537 1,094 282 600 47 142 270 14 8 41 46 4 5 2 37 19 6 13 4 34 15 11 33 13 45 7 1 26 34% 54% 12% 27% 65% 8% 36% 59% 5% 53% 38% 9% 20.6% 1.0% 4.9% 9.3% .5% .3% 1.4% 1.6% .1% .2% .1% 1.3% .7% .2% .4% .1% 1.2% .5% .4% 1.1% .4% 1.5% .2%, .9.% 7. Poplar (Poplar, Bethnal Oreen) Boys 2,974 996 1,536 442 836 1,680 458 1,009 1,683 282 1,493 1,133 348 445 58 152 219 36 31 59 73 3 14 13 55 32 18 28 4 51 36 3 50 16 42 4 63 33% 52% 15% 28% 57% 15% 34% 57% 9% 50% 38% 12% 15.0% 2.0% 5.1% 7.4% 1.2% 1.0% 2.0% 2.5% .1% .5% 4% 1.8% 7.7% .6% .9% .1% 1.7% 1.2% .1% 1.7% .5% 1.4% .1% 2.1% Girls 2,892 981 1,357 554 972 1,625 295 1,204 1,441 247 1,579 1.030 283 472 80 4.9% 259 35 31 75 62 11 3 6 55 29 15 28 1 55 32 4 49 13 71 3 58 34% 47% 19% 34% 56% 10% 42% 50% 8% 55% 36% 9% 16.3% 2.8% 4.9.% 9.0% 1.2% 1.1% 2.6 2.1% .4% .1% 12% 1.9% 1.0% .5% 1.0% 1'9% 7-7% ■7% 7-7%, ■4% 2*5% •7% 2.0% 8. Greenwich (Greenwich, Lewisham, Woolwich) Boys 3,232 1,575 1.466 191 1,210 1,766 256 1,441 1,612 179 1,481 1,309 442 357 37 120 264 16 13 80 50 3 17 1 29 11 4 6 3 23 17 8 30 13 20 5 45 49% 45% 6% 37% 55% 8% 45% 50% 5% 46% 40% 14% 11.0% 1.1% 2.7% 8.2% .5% .4% 2.5% 1.5% 1% .5% - .9% .3% .1% .2% .7% .7% .5% .2% .9% .4% .6% .2% 1.4% Girls 3,119 1,648 1,291 180 1,378 1,613 128 1,541 1,411 167 1,586 1,159 374 384 46 136 274 5 12 82 53 16\ 5 4 15 9 1 6 — 36 13 3 49 16 25 4 27 53% 41% 6% 44% 52% 4% 50% 45% 5% 51% 37% 12% 123% 15% 4.4% 8.8% .2% .4% 2.6% 1.7% .5% .2% ..1% .5% .3% - .2% - 1.2% .4% .7% 1.6% .5% .8% .7% .9% 9. Camberwell (Camberwell, Deptford) Boys 3,191 1,623 1.366 202 1,249 1,653 28S 1,217 1,822 152 1,607 1,192 392 395 45 \ 199 285 41 67 58 47 4 13 7 47 25 14 14 5 40 32 24 55 14 54 3 91 51% 43% 6% 39% 52% 9% 38% 57% 5% 51% 37% 12% 12.4% 1.4% 6.2% 8.9% 1.3% 2.10% 1.8% 1.5% .1% .4% .2% 1.5% .8% .4% .4% .2% 1.3% 1.0% .8% 1.7% .4% 1.7% .1% 2.9% Girls 3,161 1,594 1,317 250 1,485 1,519 157 1.390 1,622 149 1,744 1,142 275 491 49 5.2% 9.1% 1.1% 34 51 39 2 6 7 34 27 18 22 9 29 43 19 62 28 56 4 58 50% 42% 8% 47% 48% 5% 44% 51% 5% 55% 36% 9% 15.5% 1.6% 5.2% 9.1% 1.1% 1.1% 1.6% 1.2% .1% .2% .2% 1.1% 9% .6% .7% .3% .9% 1.4% .6% 2.0% .9% 1.8% .1% 1.8% 10. Walworth (Bermondsey, Southwark) Boys 3,120 1,185 1,657 278 857 1,897 366 1,003 1,813 304 1,456 1,214 450 436 55 287 368 51 74 103 87 12 13 6 35 52 22 61 6 65 84 36 57 21 68 10 131 38% 53% 9% 27% 61% 12% 32% 58% 10% 47% 39% 14% 14.0% 1.8% 9.2% 11.8% 1.6% 2.4% 3.3% 2.8% .4% 4% .2% 1.1% 1.7% .7% 2.0% .2% 2.1% 2.7% 1.2% 1.8% .7% 2.2% .3% 4.2% Girls 3,171 1,440 1,391 340 1,121 1,798 252 1,199 1,763 209 1,751 1,115 305 562 55 281 406 .21 65 92 75 10 2 6 41 72 8 36 7 52 115 24 43 24 126 7 171 45% 44% 11% 35% 57% 8% 38% 56% 6% 55% 35% 10% 177% 77% 8.9% 12.8% .7% 2.0% 2.9% 2.4% .3% .1% 2% 1.3% 2.3% .3% 1.1% .2% 1.6% 3.6% .% .8% 4.0% .2% 5.4% 11. Lambeth (Lambeth) Boys 2,164 1,459 604 101 1,343 712 109 970 995 199 1,094 756 314 272 27 121 237 47 20 64 43 7 8 5 27 17 15 26 3 29 55 7 36 18 64 7 48 ' 67% 28% 5% 62% 33% 5% 45% 46% 9% 51% 35% 14% 12.6% 1.2% 5.6% 11.0% 2.2% .9% 3.0% 2.0% .3% .4% .2% 1.2% .8% .7% 1.2% .1% 13% 2.5% .3% 1.7% .8% 3.0% 2.3% .2% Girls 2,090 1,377 575 138 1,374 610 106 1,169 792 129 1,217 630 243 245 30 118 243 31 10 45 1 2 2 33 28 9 13 2 17 37 6 46 38 67 2 45 66% 28% 6% 66% 29% 5% 56% 38% 6% 58% 30% 12% 11.7% 1.4% 5.6% 11.6% 1.5% .5% 2.2% 2.4% - .1% .1% 1.6% 1.3% .4% .6% .1% .8% 7.8% 3% 2.2% 1.8% 3.2% .7% 2.2% 12. Wandsworth (Wandsworth, Battersea) Boys 3,908 2,241 1,394 273 2,017 1,567 324 1,501 1,969 438 1,821 1,447 640 356 38 166 289 14 12 100 47 4 12 5 46 22 10 29 7 64 92 11 22 14 13 3 58 57% 36% 7% 52% 40% 8% 39% 50% 11% 47% 37% 16% 9.1% 1.0% 4.2% 7.4% .4% .3% 2.6% 1.2% .1% .3% .1% 1.2% .6% .3% .7% .2% 1.6% 2.4% .3% 6% .4% .3% .1% 1.5% Girls 3,736 2,305 1,132 299 2,078 1,406 252 1,491 1,924 321 1,861 1,346 529 338 27 4.1% 8.8% 18 10 90 42 4 5 2 62 30 15 8 3 47 61 9 21 10 14 6 39 62% 30% 8% 55% 38% 7% 40% 51% 9% 50% 36% 14% 9.0% .7% 4.1% 8.8% .5% .3% 2.4% 1.1% .1% .1% .7% 1.7% .8% .4% .2% .1% 1.3% 1.6% .2% .6% .3% .4% .2% 1.0% London County Boys 36,954 18,087 15,298 3,569 14,516 18,416 4.022 13,843 19,513 3,598 18,21213,798 4,944 4,509 496 1,886 3,282 340 338 901 679 53 174 57 483 332 176 381 70 529 894 249 536 173 615 57 824 49% 41% 10% 39% 50% 11% 37% 53% 10% 49% 37% 14% 12.% 1.3% 5.1% 8.9% .9% .9% 2.4% 1.8% .1% .5% .2% 1.3% .9% .5% 1.0% .2% 1.4% 2.4% .7% 7.5% .5% 1.7% .2% 2.2% Girls 35,565 17,956 13,757 3,852 15,753 17,234 2,578 15,196 17,588 2,781 19,069 12,641 3,855 4,709 500 1,763 3,320 208 227 863 633 64 55 45 572 439 158 301 58 434 761 190 701 221 765 49 691 50% 39% 11% 44% 49% 7% 43% 49% 8% 54% 35% 11% 13-3% 1.4% 5.0% 9.3% .6% .6% 2.4% 1.8% .2% .2% .1% 1.6% 1.2% .4% .8% .2% 1.2% 2.1% .5% 2.0% .6% 2.2% .1% 1.9% xii. xiii. Appendix VI. Annual Report of the London County Council, 1911. APPENDIX VI. MEDICAL EXAMINATION OF SCHOOL CHILDREN, 1911. SUMMARY OF DEFECTIVE CONDITIONS REPORTED BY SCHOOL DOCTORS. INFANTS ("ENTRANTS.") Divisional superintendent's area. (Constituent boroughs.) Number of children examined (boys and girls). Cleanliness. Clothing. Nutrition. Teeth. Eyes. Throat and Nose. Ears. Speech. Heart. Lungs. Skin. Glands. Rickets. Deformities. Nervous complaints. Anaemia. Tuberculosis (not pulmonary). Other defects. Li J2 Good. Average. Bad. Good. Average. Bad. Good. Average. Bad. Good. Average. Bad. Defective vision and squint. Disease. Adenoids. Tonsils. Diseases of nose. Other defects. Deafness. Discharging. Other defects. Stammering and stuttering. Other defects. Valvular lesion. Other defects. Phthisis. Other defects. Ringworm. Other defects. 1. Chelsea 4,092 2,204 1,528 360 1,749 1,969 374 1,486 2,167 439 2,527 932 633 176 156 496 542 41 23 65 140 4 16 13 51 48 42 154 13 113 326 123 5( 29 178 12 151 (Chelsea, Fulham, mersmith, Kensington) 54% 37% 9% 43% 48% 9% 36% 53% 11% 62% 23% 15% 4.3% 3.8% 12.7% 13.2% 1.0% .6% 1.6% 3.4% .1% .4% .3% 1.2% 1.2% 1.0% 3.8% .3% 2.8% 8.0% 3.0% 1.4% .7% 4.3% .3% 3.7% 2. Paddington 3,093 1,768 1,071 254 1,632 1,290 171 1,229 1,614 250 1,755 910 428 135 73 231 396 22 19 50 90 7 7 7 26 26 17 94 6 55 325 39 38 19 68 6 110 (St. Marylebonc, ton, City of Westminster) 57% 35% 8% 53% 42% 5% 40% 52% 8% 57% 29% 14% 4.4% 2.4% 7.5% 12.8% .7% .6% 1.6% 2.9% .2% .2% .2% .8% .8% .5% 3% .2% 1.8% 10.5% 1.3% 7.2% .6% 2.2% .2% 3.6% 3. St. Pancras 2,689 1,609 889 191 1,289 1,187 213 1,210 1,156 323 1,493 872 324 111 91 96 160 28 19 46 78 6 9 6 10 16 23 77 4 54 70 38 30 29 101 6 62 (St Pancras, Hampstead, Holborn) 60% 33% 7% 48% 44% 8% 45% 43% 12% 56% 32% 12% 4.1% 3.4% 3.6% 6.0% 1.0% .7% 1.7% 2.9% .2% .3% .2% .4% .6% .9% 2.9% .1% 2.0% 2.6% 1.4% 7.7% 1.1% 3.8% .2% 2.3% 4. Islington 3,583 1,874 1,446 263 1,387 1,845 351 1,290 1,862 431 2,104 1,034 445 168 159 397 528 17 21 68 132 7 16 36 31 72 33 155 13 101 517 179 87 23 142 13 75 (Islington, Finsbury) 52% 41% 7% 39% 51% 10% 36% 52% 12% 59% 29% 12% 4.7% 4.4% 11.1% 14.7% .5% .6% 1.9% 3.7% .2% .4% 1.0% .9% 2.0% .9% 4.3% .3% 2.8% 14.4% 5.0% 2.4% .6 4.0% .3% 2.1% 5. Hackney 3,442 1,688 1,473 281 1,550 1,638 254 1,201 1,868 373 2,336 785 321 178 143 456 450 80 33 82 192 21 8 19 45 40 6 151 14 154 309 129 42 35 181 7 128 (Hackney, Stoke ton, Shoreditch) 49% 43% 8% 45% 48% 7% 35% 54% 11% 68% 23% 9% 5.2% 4.2% 13.2% 13.1% 2.3% 1.0% 2.4% 5.6% .6% .2% .6% 1.3% 1.2% .2% 4.4% .4% 4.5% 9.0% 3.7% 1.2% 1.0% 5.3% .2% 3.7% 6. City and Stepney 2,926 998 1,529 399 827 1,697 402 992 1,659 275 1,631 877 418 196 155 266 342 34 14 40 103 7 11 13 13 9 9 82 11 147 120 44 29 27 46 14 47 (City of London, Stepney) 34% 52% 14% 28% 58% 14% 34% 57% 9% 56% 30% 14% 6.7% 5.3°/ 9.1% 11.1% 1.2% .5% 1.4% 3.5% .2% .4% .4% .4% .3% .3% 2.8% .4% 5.0% 4.1% 1.5% 1.0% .9% 1.6% .5% 1.6% 7. Poplar 3,289 1.238 1,606 445 1,029 1,882 378 1,278 1,693 318 2,193 835 261 245 200 346 313 34 75 69 166 24 10 39 64 20 22 120 13 170 253 104 46 32 81 7 119 (Poplar, Bethnal Green) 38% 49% 13% 31% 57% 12% 39% 51% 10% 67% 25% 8% 7.5% 6.1% 10.5% 9.5% 1.0% 2.3% 2.1% 5.0% .7% .3% 1.2% 1.9% .6% .7% 3.6% .4% 5.2% 7.7% 3.2% 1.4% 1.0% 2.5% .2% 3.6% 8. Greenwich 3,657 1,931 1,517 209 1,513 1,940 204 1,490 1,903 264 2,118 1,120 419 121 123 363 392 34 12 78 94 8 14 11 21 12 7 52 14 96 84 25 51 39 61 3 87 (Greenwich, Lewisham, Woolwich) 53% 41% 6% 41% 53% 6% 41% 52% 7% 58% 31% 11% 3.3% 3.4% 9.9% 10.7% .9% .3% 2.1% 2.6% .2% .4% .3% .6% .3% .2% 1.4% .4% 2.6% 2.3% .7% 1.4% 1.1% 1.7% .1% 2.4% 9. Camberwell 3,787 1,890 1,627 270 1,663 1,838 286 1,677 1,873 237 2,118 1,275 394 240 123 357 450 52 79 46 137 17 6 18 36 21 7 107 7 107 196 49 86 22 110 8 126 (Camberwell, Deptford) 50% 43% 7% 44% 49% 7% 44% 50% 6% 56% 34% 10% 6.3% 3.2% 9.4% 11.9% 1.4% 2.1% 1.2% 3.6% .4% .2% .5% 1.o% .6% .2% 2.8% .2% 2.8% 5.2% 1.3% 2.3% .6% 2.9% .2% 3.3% 10. Walworth 4,066 1,521 2,090 455 1,202 2,386 478 1,369 2,279 418 2,357 1,173 536 234 218 708 633 72 74 100 209 26 15 32 43 83 17 232 16 175 469 121 60 33 180 22 281 (Bermondsey, Southwark) 37% 52% 11% 29% 59% 12% 34% 56% 10% 58% 29% 13% 5.8% 5.4% 17.4% 15.6% 1.8% 1.8% 2.5% 5.1% .6% .4% .8% 1.1% 2.0% .4% 5.7% .4% 4.3% 11.5% 3.0% 1.5% .8% 4.4% .5% 6.9% 11. Lambeth 2,377 1,515 733 129 1,364 901 112 1,286 957 134 1,505 608 264 95 96 229 293 43 27 49 77 12 1 8 18 19 9 83 5 48 132 29 21 25 86 6 72 (Lambeth) 64% 31% 5% 57% 38% 5% 54% 40% 6% 63% 26% 11% 4.0% 4.0% 9.6% 12.3% 1.8% 1.1% 2.7% 3.2% .5% — .3% .8% .8% .4% 3.5% .2% 2.0% 5.6% 1.2% .9% 1.1% 3.6% .3% 3.0% 12. Wandsworth 3,879 2,477 1,205 197 2,314 1,371 194 1,284 2,255 340 1,718 1,614 547 121 69 353 465 19 22 45 92 16 7 14 29 11 14 49 18 73 158 1 33 20 12 29 4 47 (Wandsworth, Battersea) 64% 31% 5% 60% 35% 5% 33% 58% 9% 44% 42% 14% 3.1% 1.8% 9.1% 12.0% .5% .6% 1.2% 2.4% .4% .2% .4% .7% .3% .4% 1.3% .5% 1.9% 4.1% .9% .5% .3% .7% .1% 1.2% London County 40,880 20,713 16,714 3,453 17,519 19,944 3,417 15,792 21,286 3,802 23,855 12,035 4,990 2,020 1,606 4,298 4,964 476 418 738 1,510 155 120 216 387 377 206 1,356 134 293 2,959 913 566 325 1,263 108 1305 51% 41% 8% 43% 49% 8% 39% 52% 9% 58% 30% 12% 4.9% 3.9% 10.5% 12.1% 1.2% 1.0% 1.8% 3.7% .4% .3% .5% .9% .9% .5% 3.3% .3% 3.2% 7.2% 2.2% 1.4% .8% 3.1% .3% 3.2% xiv. Annual Report of the London County Council, 1911. APPENDIX VII. A.—CHILDREN PRESENTED BY SCHOOL TEACHERS FOR SPECIAL EXAMINATION ("SPECIAL AND URGENT CASES") AND "ENTRANTS" INSPECTED. Department. Number examined or inspected. Eyes. Throat and nose. Ears. Speech. Heart. Lungs. Skin. Glands. Rickets. Deformities. Nervous complaints. Anaemia. Tuberculosis (not pulmonary). Other defects. Defective vision and squint. Disease. Adenoids. Tonsils. Disease of nose. Other defects. Deafness. Discharging. Other defects. Stammering and Stuttering. Other Defects. Valvular lesion. Other defects. Phthisis. Other defects. Ringworm. Other defects. Boys' 5,840 1,315 298 581 569 88 69 401 481 27 57 51 111 60 73 108 46 238 192 44 111 112 154 24 328 Girls' 7,260 1,749 368 801 879 103 81 494 492 36 25 42 178 126 113 137 34 288 238 64 182 179 292 43 450 Infants' : Examined "Entrants " inspected 6,151 96,791 1,066 704 1,161 1,191 154 89 341 610 58 36 71 67 46 52 174 56 394 565 118 130 97 329 50 34 Total, Examined "Entrants" inspected 19,251 96,791 4,130 1,370 2,543 2,639 345 239 1,236 1,583 121 118 164 356 232 238 419 136 920 995 226 423 388 775 117 1,119 B .—ADMINISTRATION OF MEDICAL INSPECTION, 1911. Department. Number of children examined (inspected). Parents present. Total defects found (excluding dental). Advice cards issued. Examination sessions held. Time given to examination and inspection. Number. Per 100 children examined. Number. Per 100 children examined in detail exclusive of urgent and special cases. Number. Per 100 children examined. Number. Average number examined. Doctors. Nurses. Teacher. Total. Per child. Total. Per child. Total. Per child. Total. Per child. Boys' 79,293 45,364 57% 42,461 50% 28,746 36% 9,785 (a) hours. minutes. hours. minutes. hours. minutes. hours. minutes. Girls' 77,789 47,314 61% 42,853 50% 28,482 37% 23,047 4.6 28,760 5.7 22,854 4.6 74,661 14.9 Infants' 47,031 (96,791) 32,920 70% 35,613 68% 20,888 44% Total 204,113 (96,791) 125,598 62% 120,927 54% 78,116 38% 9,785 (a) 23,047 4.6 28,760 5.7 22,854 4.6 74,661 14.9 (a) During the spring and summer terms 96,791 "Entrants" were inspected in addition to those examined in detail. In the autumn term all Entrants were examined. The average number of children dealt with in each session including children merely inspected was 30.7 ; but in 225 sessions in which all were examined in detail, the average number dealt with in each session was 22.6. XV APPENDIX VIII. DEFECTS FOUND AND REFERRED FOR TREATMENT UNDER COUNCIL'S SCHEME, 1911. (Including cases from special schools.) Area. Average number on roll, year ended 31.3.1911. Defects. Area. Average number on roll, year ended 31.3.1911. Ears, throat, nose, adenoids. Defects. Ears, throat, nose, adenoids. Eyes. Ringworm. Total. Eyes. Ringworm. Total. Battersea 19,176 1,044 488 16 1,548 Lambeth, N. 8,778 657 289 35 981 Bermondsey 17,134 996 534 8 1,538 Lewisham 22,666 1,147 681 28 1,856 Bethnal Green, N.E. 14,648 1,004 655 4 1,663 Limehouse 11,069 440 464 9 913 Bethnal Green, S.W. 13,428 454 724 13 1,191 Marylebone, E. 4,127 167 100 23 290 Bow and Bromley 16,362 870 604 4 1,478 Marylebone, W. 9,649 489 351 30 870 Brixton 8,742 485 271 22 778 Mile End 7,218 459 451 4 914 Camberwell 19,931 1,062 794 24 1,880 Newington, W. 9,920 535 296 10 841 Chelsea 8,712 462 313 23 798 Norwood 10,837 1,029 597 53 1,679 City of London 2,982 139 204 — 343 Paddington, N. 13,427 526 331 43 900 Clapham 21,144 899 482 21 1,402 Paddington, S. 4,662 236 112 8 356 Deptford 17,014 1,042 631 26 1,699 Peckham 15,616 541 551 40 1,132 Dulwich 11.037 323 275 31 629 Poplar 14,541 736 724 5 1,465 Finsbury, C. 9,927 531 391 6 928 Rotherhithe 14,498 1,135 691 4 1,830 Finsbury, E. 6,050 334 172 3 509 St. George, Hanoversquare 4,112 142 75 11 228 Fulham 27,957 1,292 732 48 2,072 Greenwich 19,023 996 539 44 1,579 St. George-in-the-East 11,680 356 618 5 979 Hackney, C. 9,360 373 263 5 641 St. Pancras, E. 10,227 532 362 11 905 Hackney, N. 11,836 409 282 21 712 St. Pancras, N. 9,210 148 229 25 402 Hackney, S. 20,909 870 662 20 1,552 St. Pancras, S. 5,050 206 183 7 396 Haggerston 10,875 707 491 10 1,208 St. Pancras, W 8,333 312 235 30 577 Hammersmith 16,727 832 448 59 1,339 Southwark, W. 11,145 738 373 10 1,121 Hampstead 6,938 180 70 41 291 Stepney 15,256 679 627 3 1,309 Holborn 6,938 240 179 10 429 Strand 3,395 121 52 3 176 Hoxton 11,350 542 392 16 950 Walworth 12,609 565 481 46 1,092 Islington, E. 13,005 612 496 41 1,149 Wandsworth 36,872 1,686 965 155 2,806 Islington, N. 13,501 614 424 30 1,068 Westminster 6,378 179 73 4 256 Islington, S. 11,682 686 409 29 1,124 Whitechapel 16.120 690 853 10 1,553 Islington, W. 11,350 662 352 27 1,041 Woolwich 23,717 1,074 661 62 1,797 Kennington 12,625 547 370 20 937 Total 729,452 35,614 24,562 1,341 61,517 Kensington, N. 13,762 738 399 38 1,175 Kensington, S. 4,215 144 91 7 242 12532 Appendix VIII. xvi. Annual Report of the London County Council, 1911. APPENDIX IX. RE-INSPECTION, 1911. Electoral area. Total number of children re-inspected. Abstract of re-inspection returns relating to two selected schools in each electoral area. Children on rolls Dec., 1911. Total number of defects found in 1911. Number of children re-inspected. Total defects reinspected. Defects referred for treatment. Defects in children not traced. Defects not treated. Defects treated. Results of treatment. Under Council's scheme. Teeth. Not under Council's scheme. Still requiring treatment. Not requiring treatment. At hospital, dispensary, or Centre. Privately. Satisfactory. Unsatisfactory. Still under treatment. Battersea 2,870 2,904 242 168 200 119 57 24 12 51 7 67 63 98 21 11 Bermondsey 1,098 2,174 546 127 144 92 20 32 7 26 8 97 6 71 15 17 Bethnal Green, N.E. 939 1,611 310 99 144 82 42 20 — 106 6 25 7 23 2 7 Bethnal Green, S.W. 574 2,703 389 86 92 49 36 7 5 60 1 26 — 16 4 6 Bow and Bromley 594 2,637 535 163 182 96 80 6 10 118 3 49 2 26 15 10 Brixton 813 1,943 367 82 106 53 28 25 2 50 5 24 25 16 1 32 Camberwell 430 2,428 280 90 106 49 30 27 12 35 1 46 12 37 8 13 Chelsea 760 909 175 90 126 49 46 31 20 36 4 40 26 33 15 18 City of London 530 1,001 78 122 142 46 93 3 7 98 5 18 14 19 1 12 Clapham 2,329 1,686 158 112 131 66 54 11 8 32 1 65 25 66 18 6 Deptford 1,364 2,296 389 117 141 83 58 – — 63 4 72 2 46 20 8 Dulwich 847 2,327 225 132 153 95 44 14 23 71 3 35 21 41 7 8 Finsbury, Central 1,143 1,965 141 121 141 84 30 27 8 52 3 69 9 46 14 18 Finsbury, East 728 2,150 1,230 158 185 114 31 40 38 61 5 67 14 • 32 13 36 Fulham 2,882 2,275 326 157 173 115 41 17 36 89 4 37 7 19 4 21 Greenwich 1,663 2,023 289 149 168 140 3 25 22 41 1 100 4 49 16 39 Hackney, Central 1,060 2,119 462 132 148 101 33 14 21 58 3 60 6 47 9 10 Hackney, North 708 2,135 265 118 129 117 3 9 12 73 7 32 5 18 10 9 Hackney, South 1,398 2,465 442 135 169 101 39 29 3 93 8 56 9 40 8 17 Haggerston 670 2,681 385 101 107 86 12 9 15 50 2 36 4 24 — 16 Hammersmith 1,747 1,735 291 133 145 130 4 11 10 87 9 36 3 25 3 11 Hampstead 562 1,903 238 113 120 76 28 16 5 59 2 38 16 31 2 21 Holborn 870 1,284 139 85 101 75 15 11 4 34 5 53 5 40 11 7 Hoxton 374 2,107 378 103 110 59 29 22 12 52 3 40 3 33 2 8 Islington, East 1,448 2,330 250 118 133 107 16 10 19 70 3 34 7 30 5 6 Islington, North 1,166 3,281 340 105 114 93 8 13 — 55 8 45 6 36 5 10 Islington, South 1,029 1,992 269 82 98 76 10 12 7 33 5 45 8 37 3 13 Islington, West 1,540 2,472 218 114 133 70 35 28 26 57 4 32 14 34 4 8 Kennington 1,173 1,689 360 128 171 104 27 40 24 65 7 73 2 50 4 21 Kensington, North 1,461 2,462 429 161 174 142 25 7 19 95 — 53 7 39 9 12 Kensington, South 651 1,247 294 113 118 76 23 19 21 19 12 60 6 53 10 3 Lambeth 1,349 1,231 225 125 149 86 51 12 21 63 2 50 13 46 3 14 Lewisham 1,103 1,917 296 86 107 61 29 17 4 49 3 39 12 39 1 11 Limehouse 1,023 2,118 490 110 125 49 41 35 16 44 — 60 5 44 13 8 Marylebone, East 448 1,856 214 79 95 54 31 10 – 69 — 24 2 13 7 6 Marylebone, West 1,050 1,997 273 131 138 106 17 15 4 79 5 42 8 32 9 9 Mile End 266 2,258 373 89 105 85 14 6 15 64 3 20 3 7 4 12 Newington 474 2,334 529 121 142 106 19 17 14 49 — 69 10 49 6 24 Norwood 987 2,491 651 142 191 149 24 18 12 52 3 97 27 109 9 6 Paddington, North 1,302 2,739 246 86 96 64 9 23 8 24 4 52 8 43 2 15 Paddington, South 545 2,216 397 87 96 66 11 19 11 26 1 49 9 28 8 22 Peckham 894 2,096 319 86 101 46 49 6 3 55 6 32 5 18 4 15 Poplar 1,268 1,797 464 110 162 126 18 18 31 102 — 21 8 7 4 18 Rotherhithe 959 2,183 363 118 132 102 12 18 15 51 — 63 3 38 13 15 St. George, Hanoversquare 402 1,239 187 91 125 46 37 42 12 44 — 48 21 35 8 26 St. George-in-the-East 1,269 2,006 384 100 117 91 13 13 27 23 5 56 6 24 20 18 St. Pancras, East 990 2,032 272 88 109 84 – 25 22 35 5 41 6 26 7 14 St. Pancras, North 516 3,442 254 103 114 88 12 14 24 48 1 35 6 26 3 12 St. Pancras, South 543 1,755 198 94 107 41 25 41 13 45 1 36 12 15 3 30 St. Pancras, West 1,056 2,218 225 101 122 56 46 20 37 54 3 23 5 16 2 10 Southwark 997 2,032 409 113 143 67 37 39 13 65 4 54 7 32 3 26 Stepney 1,408 2,073 325 97 129 82 42 5 3 84 3 33 6 24 3 12 Strand 520 682 82 90 94 59 10 25 2 35 6 43 8 23 9 19 Walworth 1,193 2,010 295 155 179 110 41 28 10 107 3 53 6 30 11 18 Wandsworth 3,244 2,720 226 81 91 65 18 8 9 65 — 7 10 4 7 6 Westminster 902 1,695 87 90 96 40 44 12 1 62 6 20 7 19 4 4 Whitechapel 1,888 2,320 276 104 125 68 48 9 5 71 8 32 9 21 5 15 Woolwich 1,735 2,143 231 131 145 100 25 20 13 68 7 39 18 36 7 14 Total 63,752 120,534 18,731 6,522 7,639 4,842 1,723 1,074 753 3,422 218 2,668 578 1,979 434 833 xvi Appendix X. APPENDIX X. TRAINING COLLEGES, PUPIL TEACHER CENTRES, SECONDARY AND TRADE SCHOOLS—DEFECTS NOTED ON MEDICAL EXAMINATION. Institutions. Number of Pupils. Defects. Roll. Returns analysed. Two or more defective teeth Vision. Throat and Nose. Ears. Heart. Lungs Anæmia. Nutrition. Cleanliness. Back. General physique. Various. Defective Suitable glasses. Unsuitable glasses. Strain. Hearing. Discharge. Round. Curvature. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) Training Colleges. Avery-hill 280 100 — – 17 – 2 2 — — — — 7 — — 12 1 — 2 Clapham 240 100 7 — 19 3 1 1 — 2 — — 13 3 — 5 1 — 3 Fulham 157 100 5 10 17 3 2 — —. — — — 21 8 — 18 10 — — Graystoke-place 144 100 7 1 10 7 4 1 — — — — 14 5 — 19 2 — 2 Islington 233 100 24 — 26 2 — — — 1 — — — — — 1 3 — — London Day 294 200 13 39 67 10 2 9 1 — — 1 14 5 3 8 8 5 — Moorfields 159 100 14 28 18 2 3 2 — — 2 — 18 — 1 14 7 4 7 Pupil Teacher Centres. Mile End 128 54 10 13 8 4 1 1 — — — — 6 — 5 2 4 2 4 Secondary Schools. Bermondsey 138 100 14 1 11 5 — 3 — — 1 2 18 13 1 22 6 — 1 Brockley 133 67 8 8 — 1 — 1 — — 3 — — — — — — — — Chelsea 200 100 11 5 12 — 2 2 — 4 3 — 5 3 — 10 — — 2 Clapham 470 100 12 1 11 3 2 4 — 1 2 — 2 4 2 4 2 — 2 Dalston 242 100 18 23 14 2 1 5 — 1 5 2 5 2 12 19 16 3 8 Eltham 230 100 15 9 6 3 1 5 1 1 4 — 5 1 1 6 1 — 2 Forest-hill 120 100 12 5 15 2 5 4 2 — 6 — 6 6 2 8 3 — 5 Fulham 300 100 22 5 8 11 7 1 — 1 2 12 10 4 31 11 — 1 George Green's 354 188 48 20 8 3 2 11 2 1 4 11 6 3 14 1 — 1 Hackney 250 100 12 21 20 – — 3 1 1 2 — 5 4 16 11 5 5 3 Hackney Downs 440 100 13 3 7 5 1 7 3 2 1 — — — — 1 6 — 5 Holloway 215 101 9 — 5 — — 4 — — — — — — 2 — 1 — — Kentish Town 212 100 13 27 15 2 1 13 2 — 2 — 12 12 7 11 13 15 6 Paddington 197 190 21 18 14 5 2 — 3 — — — 18 8 3 19 2 1 — Peckham 187 100 12 3 5 5 3 2 1 — — — 15 11 — 30 8 — 2 Putney 320 100 12 5 6 4 3 — 1 2 2 — 3 2 — 3 1 — — St. Marylebone Grammar School 122 100 29 5 10 4 1 2 — 1 — — 1 — — — 8 — 4 St. Pancras 94 94 10 17 9 4 — 3 1 1 1 1 13 2 27 9 4 — 3 Stockwell 200 100 5 1 21 2 — 1 — — 3 — 4 5 2 6 1 — — Sydenham 120 100 11 1 16 — 1 1 — — 1 — 6 4 — 5 — — 1 Trade Schools. Beaufoy Institute 85 84 7 6 4 – — 1 — 1 — — — — 1 — — — — Central School of Arts and Crafts 47 47 6 – 2 – — 1 3 — — — — — — — 2 — 1 Hammersmith School of Arts and Crafts 70 66 8 3 8 2 2 — 1 — 1 — 4 2 — 2 — — — Norwood 29 29 4 — 2 2 — 2 1 1 1 — 7 4 — 9 4 — — Paddington 111 106 10 6 3 2 5 2 2 — — — 7 4 2 20 9 — 3 Queen-square, Bloomsbury 160 100 10 7 4 5 — 1 3 — 1 1 25 4 — 15 11 — — School of Building 51 51 1 8 6 4 1 2 — 1 1 3 2 1 — — 1 — — School of Engineering 88 84 22 7 1 1 — 6 4 1 — — — 1 — 1 — — Shoreditch 230 200 53 28 21 6 1 13 5 5 3 — 6 3 39 15 11 10 6 School of Photo Engraving and Lithography 14 14 2 2 1 – – 1 1 — 1 — — 1 — — 2 — — Hackney Institute 82 67 15 4 4 2 — 1 4 2 1 — — — — — 2 — 2 12532 cc 2 xviii. Annual Report of the London County Council, 1911. APPENDIX XI. NUMBER OF CANDIDATES EXAMINED FOR THE PERMANENT SERVICE AND THE CONDITIONS FOUND. Status. No. Examined No. of Examinations. Fit. Vaccination. Referred Back. Rejected. Withdrawn prior to examination or not yet reported. Not vaccinated. No marks. Want of cleanliness. Teeth. Vision. Heart. Vaccination. Sundry. For one defect. For two or more defects. Total. 1 2 3 4 5 6 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. 306 663 413* 815* 307* 661* 5 1 ... — 1 77 95 21 56 1 — 4 1 3 6 92 135 7 12 99 147 2 3 20 11 Nurses, matrons, etc. — 8 — 9 — 7 ... ... ... — 1 — 1 ... ... ... — 2 ... — 2 ... — 1 Schoolkeepers, caretakers, etc. 42 — 66† — 44† — ... ... ... 14 — 2 — ... ... 4 — 18 — 1 — 19 — 1 — 3 — Total 348 671 479*† 824* 351*† 668* 5 1 ... — 1 91 96 23 57 1 — 4 1 7 6 110 137 8 12 118 149 3 3 23 12 * In the case of 23 males and 12 females the figures for the first examination were included in the report for the 12 months ended 31st December, 1910. † In 6 cases the figures of the first examination were included in the report for the 12 months ended 31st December, 1910. xix. Appendix XII. APPENDIX XII. NUMBER OF COUNTY SCHOLARSHIP CANDIDATES EXAMINED AND THE CONDITIONS FOUND. Scholarships. N umber 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 11 12 13 h 15 16 17 Junior County 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. 863 837 1,293 1,423 859 809 98 116 17 25 34 237 50 53 195 161 144 125 1 1 36 22 276 340 89 (4 for 3) (1 for 4) 120 (17 for 3) (1 for 4 365 460 4 24 ... 4 Supplementary Junior County Intermediate County 122 146 166 200 121 142 18 13 ... 3 5 23 4 1 25 26 14 22 ... ... 4 1 36 34 8 19 44 53 ... 2 1 2 92 83 122 92 92 83 ... 2 ... ... ... 1 3 1 16 5 10 3 1 ... 1 1 27 7 2 (1 for 3 2 29 9 ... ... ... ... Senior County Totals 35 13 44 16 33 13 1 1 ... ... ... 1 ... ... 8 1 3 1 ... ... 1 10 3 1 ... 11 3 ... ... 2 ... 1,112 1,079 1,627 1,731 1,105 1,047 117 132 17 28 39 262 57 55 244 193 171 151 2 1 42 24 349 384 100 (4 for 3) (1 for 4) 141 (18 for 3) (1 for 4) 449 525 4 26 3 6 XX. Annual Report of the London County Council, 1911. APPENDIX XIII. NUMBER OF TRADE 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 vaccinated. No marks. Want of cleanliness. Throat. Teeth. Vision. Sundry. For one defect. For two or more defects. Total. l 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ... 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. Apprenticeships, dressmaking ... 10 ... 13 ... 10 ... ... ... 2 ... ... ... ... ... 3 ... ... ... ... ... 3 ... ... ... 3 ... ... ... ... Artificers, Boy 12 ... 12 ... 7 ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 3 ... ... ... 3 ... 2 ... 3 ... Beaufoy Institute 30 ... 38 ... 28 ... 2 ... 2 ... 1 ... ... ... 7 ... ... ... 1 ... 9 ...... 1 ... 10 ... ... ... 2 ... Borough Polytechnic 22 ... 29 ... 23* ... 3 ... 4 ... 1 ... 1 ... 4 ... ... ... 2 3 ... 2 (1 for 3) 5 ... ... ... ... ...... Book production 7 ... 8 ... 7 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... Building and allied trades 24 ... 35 ... 23 ... ... ... ... ... 5 ... ... ... 8 ... ... ... 2 ... 7 ... 4 ... 11 ... 1 ... ... ... Cookery 13 10 15 14 10 10 ... ... ... ... ... ... ... 1 3 1 1 1 ... ... 4 1 ... 1 4 2 1 ... 2 Corset-making ... 10 ... 19 ... 9 ... 3 ... ... ... 5 ... ... ... 4 ... 2 ... ... ... 5 ... 3 ... 8 ... ... ... 1 Dressmaking ... 60 ... 89 ... 60 ... 10 ... ... ... 8 ... 4 ... 15 ... 2 ... 2 ... 24 ... (1 for 3) 3 ... 27 ... ... ... ... Engineering 41 ... 50 ... 41 ... 4 ... ... ... ... ... 2 ... 5 ... 4 ... ... ... 7 ... 2 ... 9 ... ... ... ... ... Froe place 1 4 1 5 1 4 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... Furniture 22 ... 29 ... 20 ... 1 ... ... ... 2 ... 1 ... 1 ... ... ... ... ... 8 ... ... ... 8 ... 1 ... 1 ... Laundry work ... 15 ... 31 ... 15 ... 1 ... ... ... 5 ... ... ... 5 ... 1 ... ... ... 11 ... ... ... 11 ... ... ... ... Mercantile marine 5 ... 7 ... 3 ... ... ... ... ... ... ... ... ... 2 ... ... .... ... ... 2 ... ... ... 2 ... 2 ... ... ... Millinery ... 17 ... 27 ... 17 ... 2 ... ... ... 1 ... 1 ... 7 ... 1 ... ... ... 6 ... 2 ... 8 ... ... ... ... Photography ... 9 ... 13 ... 9 ... 2 ... ... ... 1 ... 1 ... 2 ... 1 ... 1 ... 2 ... 2 ... 4 ... ... ... ... Ready-made clothing, designing and making of ... 30 ... 54 ... 28 ... 7 ... 1 ... 12 ... 2 ... 9 ... 6 ... ... ... 13 ... (2 for 3) 7 ... 20 ... 1 ... 1 Shoreditch Technical In- stitute 3 ... 5 ... 3 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... Silversmithing 6 ... 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tailoring, ladies' ... 29 ... 45 ... 27 ... 1 ... ... ... 3 ... 2 ... 11 ... 4 ... 1 ... 10 ... (1 for 3) 5 ... 15 ... 1 ... 1 Upholstery ... 27 ... 45 ... 26 ... 3 ... ... ... 9 ... ... ... 10 ... 5 ... ... ... 10 (2 for 3) 6 ... 16 ... ... ... 1 Waistcoat making ... 10 ... 17 ... 10 ... 3 ... ... ... 3 ... ... ... 3 ... 1 ... ... ... 5 ... 1 ... 6 ... ... ... , ,, Woodcarving... 7 ... 7 ... 6 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... Total 193 231 242* 372 178* 225 11 32 6 3 10 47 4 11 36 71 11 24 5 4 47 91 9 (1 for 3) 30 (6 for 3) 56 121 7 2 9 4 * In the case of 1 male the figures for the first examination were included in the report for the 12 months ended 31st December, 1910. Appendix XIV. APPENDIX XIV. 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 vaccinated. No marks. Want of cleanliness. Throat. Teeth. Vision. Sundry. For one defect. For two or more defects. Total. l 2 3 4 5 6 7 8 9 10 l1 12 13 14 16 16 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 10 10 11 15 9 10 ... ... ... ... ... ... ... ... ... 3 1 ... ... 2 1 5 ... ... 1 5 1 ... ... ... Blind 4 3 4 3 4 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cripple 8 8 8 8 7 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Deaf 1 9 1 9 1 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Junior Domestic Economy ... 580 ... 948 ... 513 ... 56 ... 7 ... 178 ... 23 ... 130 ... 63 ... 21 ... 231 ... 84 (12 for 3) (2 for 4} ... 315 ... 41 ... 26 Science 16 ... 19 ... 16 ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 3 ... ... ... 3 ... ... ... ... ... Trust Fund 5 4 6 5 5 4 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 1 ... ... 1 1 ... ... ... ... Totals 44 614 49 98S 42 547 ... 56 ... 7 ... 179 ... 23 3 133 2 63 23 5 237 ... 84 (12 for 3) C2 for 4) 5 321 2 41 26 xxi. xxii. APPENDIX XV. 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. Sundry. For one defect. For two or more defects. Total. l 2 3 4 5 6 7 8 9 10 11 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. Bursars 56 328 80 459 54 320 2 17 ... ... 2 17 1 2 11 59 11 43 1 15 2 16 22 93 3 28 (3 for 3) 25 121 ... 6 2 2 Domestic economy training ... ... ... 11 ... 9 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ...... 2 ... ... ... 2 ... ... ... ... Pupil teachers 59 132 71 185 59 132 ... 3 ... ... ... 10 ... 1 7 28 6 11 ... 2 1 4 10 39 2 8 (1 for 3) 12 47 ... ......... ... ... Pupil teachers, handicraft 9 ... 16* ... 1O* ... 2 ... ... ... ... ... ... ... ... ... 1 ... 2 ... 1 ... 4 ... ... ... 4 ... ... ... ... ... Student teachers 60 315 59 390 59 311 ... 1 ... ... ... 22 1 ... 16 33 3 13 ... 2 1 3 21 63 ... 5 21 68 1 2 ... 2 Training college students 214 501 277 598* 206 492* 3 15 2 2 1 8 ... 4 55 53 13 32 2 4 3 9 59 81 7 (1 for 3) 14 (1 for 3) 66 95 5 5 3 6 Totals 398 1,285 503*1 ,643* 388* 1,264* 7 36 2 2 3 57 2 7 89 174 34 100 5 23 8 32 116 278 12 (1 for 3) 55 (5 for 3) 128 333 6 13 5 10 Annual Report of the London County Council, 1911. * In the case of 1 male and 2 females the figures for the first examination were included in the report for the 12 month3 ended 31st December, 1910. xxiii. APPENDIX XVI. WORKING CLASS DWELLINGS ACCOUNTS. 12532 D D xxiv. Annual Report of the London County Council, 1911. APPENDIX WORKING CLASS DWELLINGS Housing of the Working Classes—Accounts. XXV. XVI. ACCOUNTS, YEAR ENDED 31st MARCH, 1912, A.-HOUSING OF THE WORKING 2)r. CLASSES ACT, 1890. Cr. EXPENDITURE. INCOME. REVENUE ACCOUNT. PART 1. PART 1. Working Expensbs and Debt Charges— Boundary-street Estate (Bethnal Green and Shoreditch)— £ s. d. Income— Boundary-street Estate (Bethnal Green and Shoreditch;— £ s. d. Tenements (including laundry) £21,015 19 3 Tenements (including laundry) £22,905 17 2 Automatic gas supply 2,601 12 5 23,617 11 8 Automatic gas supply 2,962 15 Cable-street Dwellings (Stepney) ... 2,708 3 5 Cable-street Dwellings (Stepney) ... 25,868 12 2 Shelton-street Dwellings (Holborn) ... 1,441 16 - Shelton-street Dwellings (Holborn) ... 2,921 3{ 6 Millbank Estate (Westminster)—Proportion ... 5,320 — 5 Millbank Estate (Westminster)—Proportion ... 1,522 1] 3 Church way Dwellings (St. Pancras) ... 3,188 5 10 Churchway Dwellings St. Pancras) ... 6,535 11 5 Hardy Cottages, Trafalgar-road, Greenwich ... 838 13 5 Hardy Cottages, Trafalgar-road (Greenwich) 3,869 7 6- Duke's-court Dwellings (Westminster)—Proportion ... 1,525 19 5 Duke's-court Dwellings (Westminster)—Proportion ... 794 8 ... York-street Dwellings Westminster)—Proportion ... 990 18 1 York-street Dwellings (\\ estminster)— Proportion ... 1,804 10 11 Preston's-road Estate (Poplar) —Proportion ... 813 10 - Preston's-road Estate (Poplar)—Proportion ... 1.128 11 3 St. Luke's Dwellings (Finsbury)— Wenlake Builldings ... 1,671 19 5 St. Luke's Dwellings (Finsbury)— Wenlake Buildings ... 550 2 4 Chadworth Buildings ... 2,868 12 4 Chadworth Buildings ... 1,893 15 6 Clerkenwell and Holborn Dwellings — Mallory Buildings (Finsbury) ... 772 4 1 Clerkenwell and Holborn Dwellings — Mallory Buildings (Finsbury) ... 889 19 14 Nigel Buildings, etc. (Holborn) 5,590 4 Nigel Buildings, etc. (HolborH) ... 5,656 16 5 Webber-row Dwellings (Southwark) 3,959 19 8 Webber-row Dwellings (Southwark) ... 4,605 11 ... 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) ... ... ... 1,053 4 10 Brook-street Dwellings (Stepney) ... 957 19 6. Goldsmith's-row Cottages (Shoreditch) ... 478 17 6 Goldsrnith's-row Cottages (Shoreditch) ... 452 11 6 Hughes-fields Cottages (Greenwich) ... 2,128 3 2 Hughes-fields Cottages (Greenwich) ... 1,451 18 7 ... 58,967 19 7 ... 63,981 10 9 Surplus carried to Appropriation Account ... 5,278 8 2 Interest on cash balances ... 264 17 ... ... 64,246 7 9 ... 64,246 7 9 PART II. PART II. Working Expenses and Debt Charges— Cranley Buildings, Brooke's-market (Holborn) ... £ 242 s. 5 d. 9 Income— Cranley Buildings, Brooke's-market (Holborn) ... £ 280 s. 16 d. 6 Borough-road Dwellings (Southwark) ... 1,748 12 8 Borough road Dwellings (Southwark) ... 1,788 8 6 Cobham Buildings, Green-street and Pocock-street (Southwark) ... 1,027 4 2 Cobham Buildings, Green-street and Pocock-street (Southwark) ... 1,113 15 ... Ann-street Dwellings (Poplar) ... 1,879 1 6 Ann-street Dwellings (Poplar) ... 1,901 5 6 Sylva Cottages, Mill-lane (Deptford) ... 406 14 7 Sylva Cottages, Mill-lane (Deptford) ... 465 10 ... Surplus carried to Appropriation Account ... 5,303 264 18 12 8 11 Interest on cash balances ... 5,549 18 15 16 6 1 ... 5,568 11 7 ... ... 5,568 11 7 PART III. PART III. (a) Dwellings. Working Expenses and Debt Chargks— £ s. d. (a) Dwellings. Income — £. s. d. Parker-street House (Holborn) ... 3,092 9 5 Parker-street House (Holborn) ... 3,211 1 1 Carrington House (Deptford) ... 5,862 11 2 Carrington House (Deptford) 4,294 18 11 Dufferin-street Dwellings (Finsbury) ... 574 1 1 Dufferin-street Dwellings (Finsbury) ... 595 2 6 Green-street and Boyfield-street Dwellings (Southwark) ... 1,613 14 5 Green-street and Boyfield-street Dwellings (Southwark) ... 1,741 1 ... Millbank Estate (Westminster)—Proportion ... 818 14 10 Millbank Estate (Westminster;—Proportion 978 12 9 Holmwood Buildings, 97, Southwark-street (Southwark) ... 346 14 1 Holmwood Buil lings, 97, Southwark-street (Southwark) ... 333 10 ... Totterdown-fields Estate (Wandworth) ... 24,106 13 9 Totterdown-fields Estate (Wandsworth) ... 24,949 17 6 Preston's-road Estate (Poplar)—Proportion ... 2,723 4 1 Preston s-road Estate (Poplar)—Proportion ... 2,116 12 4 Hughes-fields Dwellings (Deptford and Greenwich)—Proportion ... 1,124 16 9 Hughes-fields Dwellings (Deptford and Greenwich)-Proportion ... 861 4 10 White Hart-lane Estate (Tottenham, Wood Green and Edmonton) ... 14,693 17 3 White Hart-Jane Estate (Deptford and Greemwich (Proportion) ... 14,804 13 10 Wessex Buildings, Wedmore-street (Islington) ... 3,825 9 4 Wessex Buildings, Wedmore street (Islington) 3,972 ... 6 Norbury Estate (Croydon) ... 8,451 8 3 Norbury Estate (Croydon) ... 8,871 ... 3 Caledonian Estate (Islington) ... 4,954 13 5 Caledonian Estate (Islington) ... 5,281 6 6 Briscoe Buildings (Lambeth) ... 2,433 13 4 Briscoe Buildings (Lambeth) ... 2,386 13 6 Old Oak Estate ... 12 17 2 Interest on cash balances 74,397 166 18 15 4 2 Deficiency carried co Appropriation Account ... 74,564 70 13 4 6 10 74,634 18 4 ... 74,634 18 4 12532 DD 2 xxvi. xxvii. Annual Report of the London County Council, 1911. Housing of the Working Classes—Accounts. HOUSING OF THE WORKING CLASSES ACT, 1890-continued Dr. EXPENDITURE. INCOME. " REVENUE PART III.—continued. (b) Estates in Course op Development. ACCOUNT—continued. PART III,—continued. (h) Estates in Course of Development. Express and Debt Charges- £ s.. d. Income £. s. d. Totterdown-fields (Wandsworth) 265 1 7 White Hart-lane (Tottenham, Woo I Green and Edmontion 318 10 4 White Hart-lane (Tottenham, Wood Green and Edmontion 3,018 7 7 Old Oak (Hammersmith ... 46 10 9 Norbury (Croydon) 488 1 4 ... . Old Oak (Hammersmith) 945 ... 5 364 19 1 4,717 -£ 11 Less—Interest on overdrawn cash balances ... 97 4 7 Supervision 500 ... ... Deficiency carried to Appropriation Account (below) 267 4,949 14 6 6 5 5,217 11 5,217 ...- 11 APPROPRIATION ACCOUNT. £ s. d. £. s. d. £. s. d. Special County Account for contribution to Rates, as contra ... ... 523 9 10 Amount brought from Revenue Account— Surplus— Part I 5,278 8 2 Part II 264 1 12 11 Less—Deficiency—Part III.— 5,543 1 1 Dwellings £70 4 10 Estates in course of development (above) ... 4,949 6 5 5,019 11 3 523 9 10 523 9 10 523 9 10 REPAIRS AND RENEWALS FUND. £ s. d. £ s. d. £. d. £. s. d. Actual Expenditure— Part I 6,716 19 - Balance—1st April, 1911— Part I 20 699 13 9 Part II. 444 3 - Part II 2 698 8 4 Part III 6,466 15 5 13,627 17 5 Part III 16,197 1 9 Expenses of Investment — Transfers from Revenue Account 39,595 14,710 3 13 L0 1 Parti I. 5 4 9 Dividends on investments and interest on cash balances- Part II 2 12 3 Part I 615 19 4 Part III 2 12 2 Part II. 90 2 5 Balance—31st March, 1912 (of which £38,899 5s. lOd. is invested) carried to 10 9 Part III 595 14 9 1,301 16 6 20,615 3 3 2,944 15 6 Part III.—Including £16,004 6s. 9d. invested 18,409 8 - 41,969 6 9 55,607 13 5 55,607 13 5 CAPITAL ACCOUNT PART 1. £. .s d. PART 1 £. s. d.. Erection of Dwellings— ... 66 8 3 Balance carried to Capital (Aggregate) Account •• 69 17 ... Clerknwell and Holborn Dwellinges- Nigel (late Union) Building 1 8 .. Webber-row Dwellings ... ... 2 .. 9 69 17 69 17 .. xxviii. xxix. Annual Report of the London County Council, 1911. Housing of the Working Classes—Accounts. Dr. HOUSING OF THE WORKING CLASSES ACT.1890 —continued. Cr EXPENDITURE. INCOME. CAPITAL PART III. Schemes for the erection of lodging (A) Acquisition and ACCOUNT—continued. PART III. houses for the working classes. Laying-out of Sites. £ s. d. White Hart-lane, Tottenham, Wood Green and Edmonton—Sir Samuel Montagu (Lord Swaythling) Gift Fund Account to meet expenditure during year on public garden £ s. d £ s. d. White Hart-lane, Tottenham, Wood Green and Edmonton 2,999 1 1 Norbury, Croydon 2,249 9 5 ... 18 5 Old Oak, Hammersmith 7,010 6 ... Old Oak Estate—Acquisition of Lands Fund Account to meet expenditure during year 5,060 6 ... Totterdown-fields, Wandsworth 2,108 2 2 13 376 19 8 Totterdown-Fields Estate, Wandsworth 2,108 3 2 White Hart-lane Estate, Tottenham, Wood Green and Edmonton 4,621 _ ... Norbury Estate, Croydon 333 ... ... Consolidated Loans Fund for proceeds of sales, contra— Old materials 43 10 - Old Oak Estate, Hammersmith 1,950 - ... 9,012 3 2 Lest—Expenses of sales 9 - - 34 10 Balance carried to Capital (Aggregate) Account (below) 696 7 11 Sales of old materials — White Hart-lane Estate 26 14,073 7 7 Old Oak Estate 17 10 - Less—Expenses of sales—Old Oak Estate 43 9 10 ... 34 10 ... 14,107 17 7 14,107 17 7 (B) Working Class Dwellings. £ s. d. £ s. d. £ s. d. Totterdown-fields Estate, Wandsworth 13,111 14 8 Old Oak Estate—Acquisition of Lands Fund to meet expenditure during year 13,640 17 11 Add—Value of site appropriated for dwellings White Hart-lane Estate, Tottenham, Wood Green and Edmonton Add—Value of site appropriated for dwellings 2,108 3 2 18,963 7 2 4,621 - - 15,215 23,584 17 7 10 2 White Hart-lane Estate, Tottenham, Wood Green and Edmonton—Sir Samuel Montagu (Lord Swaythling) Gift Fund Account to meet additional expenditure on cottages erected on the Tower-gardens section 2,200 - Norbury Estate, Croydon Add—Value of site appropriated for dwellings 19,199 9 11 333 - - 19,532 9 11 Sale of land—Parker-street House—Moiety of cost of party wall Balance carried to Capital (Aggregate) Account 15,840 8 13 6 11 3 Old Oak Estate, Hammersmith Add—Value of site appropriated for dwellings 11,690 13 11 1,950 - 13,640 13 11 56,181 9 11 Briscoe-buildings, Brixton-hill, Lambeth 45 19 5 Caledonian Estate, Islington 2 4 7 72,02 2 3 10 Consolidated Loans Fund for proceeds of sale, contra—Land 8 6 3 72,030 10 1 72,030 10 1 CAPITAL (AGGREGATE) ACCOUNT. £ s. d. £ s . d £ s. d. Balance—1st April, 1911- Balance—31st March, 1912, carried to Balance Sheet 2,191,630 12 1 Part I 883,598 3 7 Part II 80,014 6 7 Part III.— Estates in course of development 120,242 12 4 Dwellings 1,052,220 10 7 2,136,075 1 3 Expenditure in 1911-12— Part I. 69 17 - Part III.—Dwellings 56,181 9 11 Less—-Part III.—Estates in course of development (above) 56,251 6 11 696 7 11 55,554 19 - 2,191,630 12 1 2,191,630 12 1 LOAN CONSOLIDATED ACCOUNT. STOCK (Moneys raised.) £ s. d. £ s. d. Balance —31st March, 1912, carried to Balance Sheet 2,023,311 5 8 ... • 2,023,311 5 8 XXX. xxxi. Annual Report of the London County Council, 1911. Housing of the Working Classes—Accounts. HOUSING OF THE WORKING Dr. EXPENDITURE. CLASSES ACT, 1890—continued. INCOME. Cr. SINKING FUND ACCOUNT (Accumulating). [Transactions of the Consolidated Loans Fund £ s. d. is request of Dwellings under the Housing Act, 1890. £ s. d. £ s. d. Balance—31st March, 1912, carried to Balance Sheet 135,897 - 1 Balance—1st April, 1911 118,147 16 9 A mount provided during year for redemption— Sinking Fund instalments provided out of Revenue in 1911-12 13,770 3 11 33 Interest on accumulations of Sinking Fund 3,935 15 10 Proceeds of sales 17,706 42 7 16 1 3 135,897 - 1 135,897 - 1 SIR SAMUEL MONTAGU [Contribution of £10,000 from Sir Samuel Montagu (Lord Swaythling) CONTRIBUTION (LORD SWAYTHLING) GIFT FUND. to be utilised in connection with the White Hart Lane Estate. ACCOUNT. £ s. d. £ s. d. £ s. d. Balance—31st March, 1912 (including £1,938 7s. 1d. invested in India Bills), carried to Balance Sheet 11,970 10 2 Balance—1st April, 1911 11,841 3 Dividends on investment 93 15 ... Interest on uninvested portion 35 14 11 11,970 10 2 129 9 11 11,970 10 2 OUTLAY ACCOUNT £ s. d. £ is. d. 7,587 b 3 £ s. d. Capital Account for amount transferred to meet expenditure during year on the White Hart-lane Estate— Laying out public garden 9,788 3 8 Erection of Cottages—Tower Garden section 2,206 18 5 9,788 3 8 9,788 3 8 ACQUISITION OF [Transfer of £50,000 from the Thames Embankment Extension and Improvements at Westminster Account tinder sec. 66 of the amount has been charged a sum of £6,441 1s. 6d. in respect of the proportion of expenditure on the Millbank site relating CONTRIBUTION LANDS FUND (PART III). L.C.C. (General Powers) Act, 1903, in respect of rehousing accommodation provided on the Millbank Estate. Against this to the improvement. The balance of £13,558 18s. 6d. with interest thereon is available for the purposes of the fund.] ACCOUNT £ s. d. £ s. d. £ s. d. Expenses of investment 30 14 3 Balance—1st April, 1911 51,798 7 9 Balance—31st March, 1912 (including *£20,250 invested), carried to Balance Sheet 54,041 19 6 Dividends on investment 2,217 6 9 *Victoria Government 4 per cent. Loan, 1883, Inscribed Stock (1913) £10,125 Dominion of Canada 4 per cent. Debentures (1st October, 1912) .. .. 10,125 Interest on uninvested portion 56 9 3 20,250 2,273 16 ... 54,072 13 9 54,072 13 9 OUTLAY ACCOUNT. Balance—1st April, 1911 4,313 13 7 Balance:—31st March, 1912, carried to Balance Sheet 23,014 13 6 Capital Account for amount transferred to meet expenditure during year on Old Oak Estate— Acquisition and laying-out of site 5,060 6 ... Erection of Dwellings 13,640 13 11 18,700 12 11 • 23,014 13 6 23,014 13 4 12532 ee xxxii. xxxiii. / Annual Report of the London County Council, 1911. Homing of the Working Clasees-Accounts. HOUSING OF THE WORKING Dr. CLASSES ACT, 1890- continued Cr. BALANCE SHEET. 31ST MARCH, 1912. Liabilities. £ s. d. £ s. d. Assets and Capital Outlay. £ s. d. Loans raised and outstanding—Consolidated Stock—Cash— Capital Outlay- Metropolitan— Part I. 883,668 ... 7 2½ per cent. 239,315 1 3 Part II. 80,014 6 7 London County— 2½ per cent. 191,232 3 1 Part III.—Dwellings 3per cent 1,155,903 7 - Kstates in course of development 1,108,402 ... 6 3½ per cent. 436,860 14 4 119,546 4 5 2,023,311 5 8 Lett Proceeds of sales (Part III.-Dwellings and estates in course of development) 2,191,630 16 3 London County Bills (proportion) 142,033 12 7 12,684 16 3 2,165,344 13 3 Sir Samuel Montagu (Lord Swaythling) Gift Fund-Outlay Account 2,178,94 9,78 19 3 10 8 Sundry Creditors 1,536 19 9 Acquisition of Lands Fund—Outlay Acconnt 2,188,733 23,014 19 13 6 6 Special Accounts— Sir Samuel Montagu (Lord Swaythling) Gift Fund—Contribution Account Acquisition of Lands Fund (Part III.)—Contribution Account 11,970 10 2 2,211,748 13 - 54,041 19 6 66,012 9 8 Sinking Fund Assets- Loans to local authorities and other investments 135,897 .. 1 Repairs and Renewals Fund Sundry Debtors Part I. 20,615 3 3 1,597 18 4 Part II. 2,944 15 6 Norbury Estate- Ballast, etc. 300 9 .. Part III. 18,409 8 - 41,969 6 9 Appropriation Account (after taking into account net contributions from Rates amounting to £65,625 10s. 4d. _ _ Investments on Special Accounts at Cost PriceRepairs and Renewals Funnd £38,899 5 10 Sir Samuel Montagu (Lord Swaythling) Gift Fund—£2 000 India Billes Acquisition of Lands Fund (Part III.) [Market value at 31st March, 1912, £20,175] 1,938 7 1 Fxcess of Assets and Capital Outlay over Liabilities— Stock cancelled—Cost 26,285 13 10 20,250 Sinking Fund balance £135,897 - 1 Lets— Proceeds of sales, deducted from capital Cash in Hand— 61,087 12 11 outlay (contra) 12,684 16 3 Revenue Accounts 123,212 3 10 149,497 17 8 Special Accounts—* Sir Samuel Montagu (Lord Swaythling) Gift Fund £243 l9 Acquisition of Lands Fund (Part III.) 10 600 14 2,885 4 7 5 9 10,844 14 2 2,424,361 12 1 13,729 18 9 • Loans raised and outstanding .. .. £2,105,344 18 3 2,424,361 12 1 Sinking Fund balances .. .. 135,897 - 1 - Net Debt 2,0?9,447 18 2 • B—DWELLINGS UNDER IMPROVEMENT ACTS. Note.—For statutes under which these dwellings have been erected, see Appendix XX.. paye lxviii. DITURE. INCOME REVENUE ACCOUNT. Workinc. Expenses and Debt Charges— £ s. d. Income— £ s. d. Battersen Bridge Dwellings (Battersea) 985 7 10 Battersea Bridge Dwellings (Battersea) 1,003 7 3 Cotten-street Dwellings (Popular) 1,023 11 2 Cotton-street Dwellings (Poplar) 1,001 10 6 Durhanm Buillings, York-road (Battersea0 1,554 8 4 Durham Buildings, York-road (Battersea) 1,217 18 3 Durham Buildings, York-road (Battersea) 508 13 1 Duke's-court Dwellings (Westminster)—Proportion 601 10 4 Duke's-court Dwellings (Westminster)—Proportion 330 6 2 York-street Dwellings (Westminster)- Proportion 376 10 4 York-street Dwellings (Westminster)—Proportion 2,322 9 5 Herbrand-street Dwellings (Holborn\ 2,758 17 3 Herbrand-street Dwellings (Holborn) 5,823 3 Bruce House, Kemble-street (Westminster) 2,75 7,478 6 8 Brice House, kemle-stree(Westminster0 9,226 18 — Millbank Estate (W estnnnster)—Proportion 11,335 2 6 Millbank Estate (Westminster) Proporttion 11,753 17 1 0 Bourne Estate (Holborn) 13,015 8 11 Bourne Estate (Holborn) 3,944 8 5 Swan-lane Dwellings (Bermondsey) 3,143 13 11 Swan-lane Dwellings (Bermondsey) 1,433 16 8 Valette Buildings (Hackney) 1,513 19 6 Valette Buildings (Hackney) 562 8 5 Hughes-tields Dwellings (Deptford and Greenwich) Proportion 430 12 5 Hughes-fields Dwellings (Deptford and Greenwich)—Proportion Bearcroft Buildings (Fulham) 745 2 8 Bearcroft Buildings (Fulham) 834 ) 6 Dwellings on sites compulsorily appropriated for rehousing, on the working og which a deficiency was anticipated owing to the character or situation of the site. 983 9 5 Council Buildings (Poplar) 758 13 — Council Buildings (Poplar) 1,705 6 9 Westview, Armitage and Collerston Cottages (Greenwich) 1,291 6 - Westview, armitage and Collection Cottages Greenwich 1,090 7 5 Idenden Cottages (Greenwich) 1,108 15 — Idenden Cottages (Greenwich) 1,364 12 10 Barnaby Buildings, Leroy-street (Bermondsey) 1,336 15] 8 Barnaby Buildings,Leroy-street (Barmondsey (1,000 10 10 Brightlingsea Buildings, Ropemaker's-fields (Stepney) 847 8 6 Brightlingsea Buildings, Ropemaker's-fields (Stepney) 1,278 - 1I Bekesbourne Buildings (Stepney) 1,216 5 9 Bekesbourne Buildings (Stepney) 706 8 8 Darcy Buildings, London-fields (Hackney) 702 4 — Darcy Buildings, London Fields (Hackmey) 843 19 5 Wandsworth-road Dwellings (Lambeth) 893 7 6 50,187 7 3 Surplus carried to Appropriation Account 2,859 18 9 Interest on cash balances 52,863 183 19 6 11 1 53,047 6 - 53,047 6 - APPROPRIATION ACCOUNT. £ d. £ 2,991 s. 14 d. 9 Amount brought from Revenue Account—Surplus 2,859 1 9 General County Account for contribution to Rates tamways AocountFORntribution to meet one-third of deficiency for year on Hughes-fields (Deptford) Dwellings, in respect of the rehousing of persons displaced by the Greenwich generating station 131 16 — 2,991 14 9 2,991 14 9 REPAIRS AND RENEWALS FUND. £ s. d. Actual Expenditure 5,443 6 3 Balance-1st April, 1911 £ 19,442 s. 7 d. 10. Expenses of investment 2 12 3 Transfers from Revenue Account 5,253 6 11 Balance—31st March, 19X2 (of which £19,103 4s. 2d. is invested), carried to Balance Sheet 19,880 16 7 Dividends on investments and interest on cash balances 631 - 4 25,326 15 1 25,326 1 1 xxxiv. xxxv. Annual Report of the London County Council, 1911. Housing of the Working Classes—Accounts. xxxvi. xxxvii. Annual Report of the London County Council, 1911. Housing of the Working Classes—Accounts. DWELLINGS UNDER IMPROVEMENT ACTs-CONTINUED. Cr. EXPENDITURE. | INCOME. CAPITAL ACCOUNT. £ s. d. £ s. d. p j Erection of Dwellings— Southampton-row improvement — Bourne Estate—proportion 14 13 2 Erection of Dwellings— Rotherhithe Tunnel— St. John-street, Clerkenwell, improvement— Bourne Estate—proportion 3 10 5 previous years on the proposed second part of site, not proceeded with 59? 16 7 Bourne Estate—proportion 3 9 6 Central-street, St. Luke, widening Bourne Estate—proportion 9 18 7 Holborn to Strand improvement— Bourne Estate—proportion 86 2 7 Bruce House 136 2 222 4 7 253 16 3 Balance—31st March, 1912, carried to Capital (Aggregate) Account (below) 340 - 4 593 16 7 593 16 7 CAPITAL (AGGREGATE) ACCOUNT. £ s. d. £ s. d. Balance—1st April, 1911 743,646 - 6 Balance—-31st March, 1912, carried to Balance Sheet 743,306 - 2 Deduct—Year 1911-12—-Capital receipts in excess of expenditure (above) 340 4 • 743,306 743,306 - 2 * LOAN ACCOUNT. CONSOLIDATED STOCK (Moneys raised.) £ s. d. £ s. d. Balance—31st March, 1912, carried to Balance Sheet 736,127 13 9 Balance—1st April, 1911 736,127 13 9 SINKING FUND ACCOUNT (Accumulating). (Transactions of the Consolidated Loaus Fund in respect of Dwellinas muter Imiprovement Acts) £ s d. Balance—31st March, 1912, carried to Balance Sheet 46,200 10 3 £ s. d. Balance—1st April, 1911 £ s 40,051 1 . d 2 Amount provided during year for redemption— Sinking Fund instalments provided out of Revenue in 1911-12 ... 4,765 5 - Interest on Accumulations of Sinking Fund 1,383 12 10 6,148 17 10 46,200 10 3 46,200 9 39 3 xxxviii. xxxix. \ Annual Report of tJie London County Council, 1911. Housing of the Worlcing Classes—Accounts. DWELLINGS UNDER IMPROVEMENT ACTS—continued. Dr. _ Cr. BALANCE SHEET. 31st MARCH, 1912. £ s. d. £ s. d. Assets and Capital Outlay*. Liabilities. Loans raised and outstanding Capital Outlay, including £8,614 19s. 8d. for Drake Buildings, Hughes Fields (rehousing in connection with Tramways) £ 743 306 s. d. 2 Metropolitan— 2£ per cent. 61,838 16 2 Less—Proceeds of sales—Disposal of right of light (Bourne Estate) 1,000 - London County— 742,306 . 2 31,665 8 5 2½ per cent. 3 per cent. 592,060 5 Sinking Fund Assets—Loans to Local Authorities and other investments 46,200 10 3 3½ per cent. 50,563 4 2 736,127 13 9 Sundry Debtors 536 4 1 London County Bills (proportion) 47 15 2 *736 175 8 11 Repairs and Renewals Fund Investment AccoUNT) (Marlet va;ie at 31st March, 1919, £ 17,755) 19,103 4 2 Sundry Creditors 421 17 3 Repairs and Renewals Fund 19,880 16 7 Cash in Hand 663 5 7 Appropriation Account (after taking into account net contributions to Rates and from Tramways Account, amounting to £8,653 7s. 7d.) - - Excess of Assets and Capital Outlay over Liabilities— Stock cancelled (cost) 7,130 11 3 Sinking Fund balance £46,200 10 3 Less—Proceeds of sales, deducted from capital outlay (contra) 1,000 — - 45,200 10 3 52 331 1 6 808,809 4 3 808,809 4 3 • Loans raised ami outstanding ... £736,175 8 11 Lw—Sinking Fund balances 46,900 10 3 Net Debt .. 689,974 1 8 8 xl. xli. Annual Report of the London County Council, 1911. Housing of the Working Classes—Accounts. C—DWELLINGS UNDER THE HOUSING OF THE WORKING Dr. CLASSES ACT. 1890. AND IMPROVEMENT ACTS COMBINED. Cr. EXPENDITURE. INCOME, REVENUE (Apportionment calculated ACCOUNT. on basis of accommodation). Millbank Estate (Westminster)— £ s. d. £ s. d. Millbank Estate (Westminster)— £ s. d £. d Working expenses and debt charges 15,365 13 3 Income 18,849 6 8 Housing of the Working Classes Act, 1890— Part I. (page 6) 5,320 5 Less—Credited to the following accounts— Housing of the Working Classes Act, 1890— Part I. 6,535 11 5 Part III. (page 6) 818 9 226 14 18 10 Part III 978 12 9 — 15,365 13 3 Dwellings under Improvement Acts 11,335 2 6 — 18,849 6 8 Duke's-court Dwellings (Westminster) — £ s. .d. Duke's-court Dwellings (Westminster)— £ s. d Working expenses and debt charges Less—Charged to the following accounts— 2,034 12 6 Income 2,406 1 3 Housing of the Working Classes Act, 1890—Part I. 1,525 19 5 1,804 10 11 Dwellings under Improvement Acts 508 13 1 2,034 12 6 Dwellings under Improvement Acts 601 10 4 2,406 i 3 - - - York-street Dwellings (Westminster)— £ s. d. Working expenses and debt charges 1,321 4 3 Income 1,504 15 Less—Charged to the follow ing accounts— Housing of the Working Classes Act, 1890—Part I. 990 18 1 Less—Credited to the following accounts— Dwellings under Improvement Acts 330 6 2 1,321 4 3 Housing of the Working Classes Act, 1890—Part 1. Dwellings under Improvement Acts 1,128 376 11 3 3 9 1,504 15 - _ - Preston's-road Estate (Poplar)— £ s. d. Preston's-road Estate (Poplar1)— £ (i Working expenses and debt charges Less—Charged to the following accounts— Housing of the Working Classes Act, 1890— Part I. 813 10 3,536 14 1 Income Less—Credited to the following accounts— Housing of the Working Classes Act, 1890— 550 9 2,666 4 14 8 Part III 2,723 4 1 3,536 14 1 Part III 2,116 12 4 —2,666 14 8 - - - Hughes-fields Dwellings (Deptford)— £ s. d. v j Working expenses and debt charges . 1,687 5 2 Income 1,291 17 3 Less Charged to the following accounts- Housing of the Working Classes Act, 1890—Part III 1,124 16 9 Less—Credited to the following accounts— Dwellings under Improvement Acts 562 8 5 1,687 5 2 1,291 17 3 H. E. Haward, Comptroller, xlii. xliii. Annual Re-port of the London County Council, 1911. Housing of the Working Classes—Accounts. d—details of revenue account, WORKING CLASS DWELLINGS ACCOUNTS YEAR ENDING 31st MARCH, 1912. Dwellings. Income. Expenditure. Result of Year's Working, 1911-12. Surplus ( + ). Deficiency (-). m Gross Rental. Deductions. Maintenance and Management. Debt Charges, transferred to Consolidated Loans Fund. Total. (Columns 13 and 18.) Empties. Caretakers' Quarters. Amounts recoverable. Total. Net Rental. Supervision and Collection of Rent. Rates and Taxes. (i) Lighting, Heating, Water and Insurance. Stores and Incidentals Transfer to Repairs and Renewals Fund. Total. (1) Interest (gross). 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. 1.—Housing of the Working Classes Act, 1890, £ 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) 23,432 19 - 361 - 6 141 16 - 24 6 1 2 7 22,905 7 2 1,547 - 7 4,040 4 10 1,285 7 11 9 9 5 2,105 - - 8,987 2 9 1,899 9 6 7,919 13 5 405 4 7 1,804 9 _ 12,028 16 6 21,015 19 3 + 1,889 17 11 Do. Automatic Gas Supply 2,962 1 5 - - 6 - - - 527 - 2,962 15 - 167 - 2,008 13 4 - 14 - 150 - - 2,326 7 4 222 9 - 52 16 1 275 5 1 2,601 12 5 + 361 2 7 Cable-street 2,971 6 6 24 8 - 25 - - - 15 - 50 3 - 2,921 3 6 133 14 11 590 1 3 105 19 5 - 315 - - 1,144 lo v 112 14 - 1,158 16 7 25 14 9 266 2 6 1,563 7 10 2,708 3 5 + 213 _ 1 Millbank (proportion) 1,568 8 - 21 2 3 24 16 6 - 10 - 45 8 9 1,522 9 3 63 2 11 265 2 3 59 — 7 - 10 - 144 - - 532 b 9 153 — - 578 15 b 36 11 4 141 3 6 909 10 3 1,441 16 — + 81 3 3 6,600 4 9 33 5 1 30 6 7 1 1 8 64 13 4 6,535 11 5 311 1 9 1,112 12 9 208 16 5 - 609 10 11 2,242 1 10 335 3 b 16 4 62 15 5 450 .3 4 3,077 18 7 5,320 - 5 + 1,215 11 - Churchway 3,915 19 - 17 9 6 27 9 - 1 10 - 46 11 6 3,869 7 6 200 6 1 696 9 3 120 3 11 - 345 _ _ 1,361 19 3 277 17 6 1,248 17 5 53 3 4 246 8 4 1,826 6 7 3,188 5 10 + 681 1 8 Hardy 881 - - 63 - 17 - - 6 1 - 86 12 - 794 8 - 33 - - 140 8 2 25 12 6 - 126 - - 325 - 8 32 10 - 398 4 9 6 4 4 76 13 8 513 12 9 838 13 5 — 44 5 5 Duke's-court (proportion) 1,823 8 9 2 1 5 16 13 4. 3 11 18 17 10 1,804 10 11 87 8 11 296 4 9 54 19 1 1 — 188 5 _ 626 18 V 136 10 — 611 9 7 26 2, 5 122 1H 10 899 _ 10 1,525 19 5 + 278 i -} 6 York-street (proportion) 1,146 4 6 1 8 8 16 13 4 - 12 9 17 13 3 1,128 11 3 11 171 19 4 35 18 7 - 101 5 _ 362 14 4 101 5 - 42' 2 19 13 1 83 5 6 628 3 9 990 18 + 137 13 York-street (proportion) Preston's-road (proportion) 826 3 5 263 12 3 10 4 11 2 14 9 11 276 1 1 550 2 4 40 6 6 122 14 6 25 5 6 - 106 13 - 294 19 6 47 12 4 389 15 4 8 19 2 72 3 8 518 10 6 813 10 — 263 7 8 St. Luke's— 1,934 18 6 16 6 6 24 16 6 - 41 3 - 1,893 15 6 98 2 11 332 3 10 60 13 6 - 176 _ _ 667 _ 3 175 - - 672 10 5 31 15 7 125 13 2 1,004 19 2 1,671 19 5 + 221 16 1 Chadworth 3,408 11 - 325 4 6 22 4 6 16 10 - 330 19 - 3,077 12 - 150 8 4 477 19 7 92 8 1 - 271 - - 991 16 - 260 - ~ 1,338 1 9 50 16 11 227 17 8 1,876 16 4 2,868 12 4 + 208 19 b Clerkenwell and Holborn— 914 9 11 - 19 - 23 11 - - 24 10 889 10 11 37 - _ 103 17 10 22 1 7 - 63 - _ 225 19 5 60 15 - 402 14 9 10 5 11 72 9 _ 546 4 8 772 4 1 + 117 15 10 Mallory 6,050 2 - 324 7 54 18 - 14 4 - 393 5 7 5,656 16 5 271 4 8 910 15 9 198 2 5 - 473 - - 1,853 2 10 545 12 6 2,643 14 10 92 9 7 455 - 7 3,736 17 6 5,590 - 4 + 66 16 l Webber-row 4,937 8 - 275 7 6 61 8 6 4 19 - 331 17 4 605 11 - 246 13 11 903 3 7 142 - - 1 - 424 - - 1,716 1/ 316 i; 1,591 18 1 61 19 5 272 7 2 2,243 2 2 3,959 19 8 + 645 11 4 63,373 19 1 1,729 12 9 496 18 2 28 7 - 2,254 17 11 61,19 1 2 3,440 2 11 10,164 7 8 4,445 3 8 11 13 5 5,597 13 11 28,059 1 7 4,454 6 10 21,832 17 10 891 15 10 , 4,469 12 - 31,643 12 6 55,307 14 1 1+ 5,811 7 1 rwlline. nn .it™ rnmnnlfiorilv aoDroDriated for rehousing, on the working of which a deHciencv was anticipated owing to the character or situation of the site. Brook-street 1,019 11 9 39 13 12 - 2 6 61 121 3 957 19 6 40 3 9 184 19 _ 41 11 2 1 145 - _ 411 13 11 55 10 - 47C 3 2 12 4 5 103 13 4 641 10 11 1,053 4 10 — 95 4 Goldsmith's-row 486 2 3 12 9 9 19 12 - 1 9 - 33 10 9 452 11 6 19 _ _ 87 1 10 15 8 1 — 54 - - 175 9 11 30 - - 2K 14 11 7 1 11 52 10 9 303 7 7 478 17 6 — 26 6 Hughes-fields (cottages) 2,058 18 2 578 3 1 ' 17 - - 11 6 6 606 19 7 1,451 18 7 60 - - 316 17 3 58 - 11 — 225 - - 659 18 2 ~ 4 11 26 8 - 258 - 1 1,468 fa - 2,128 3 2 — 676 4 7 3,564 12 2 630 16 7 56 4 - 15 2 - 702 2 7 2,862 9 7 119 3 9 588 18 1 115 - 2 — 424 - - 1,247 2 " 197 2 - i,7f>e 3 - 45 14 4 414 4 2 2,413 3 6 •3,660 5 6 — 797 15 11 Interest on cash balances - - - - - - — - — + 264 17 _ 66,938 11 3 2,360 9 4 553 2 2 43 9 - 2,957 _ 6 63,9b 1 10 9 3,559 6 8 10,753 5 9 4,560 3 10 11 13 6,<121 13 11 24,906 3 7 4,651 8 10 23,581 - 10 937 10 2 4,883 16 2 34,061 16 - 58,967 19 7 + 5,278 8 2 Part II. 290 4 9 8 - - - 9 280 16 6 19 2 3 50 12 0 9 8 5 29 - 108 3 5 22 10 88 13 2 4 10 5 18 8 9 134 ?. 4 242 5 9 + 38 10 9 Cranley 1,874 9 59 17 3 - - 86 6 1,788 8 6 98 16 7 351 10 10 59 18 7 — 168 - - 678 6 - 162 10 - 725 7 6 32 3 11 150 5 3 1,070 6 8 1,748 12 8 + 39 15 10 Borough-road 1,134 12 20 8 - - 9 - 20 17 - 1,113 15 _ 80 1 2 221 4 10 35 1 5 — 106 - - 442 7 b 68 5 - 422 14 7 12 19 2 80 18 — 584 16 9 1,027 4 2 + 86 10 10 Cobham 2,141 2 213 14 12 - 6 10 6 239 17 - 1,901 5 6 113 18 7 456 6 3 61 2 4 — 251 — - 882 7 2 73 9 — 756 13 4 14 1 1 152 10 11 996 14 4 1,879 1 6 + 22 4 Ann-street 470 11 6 4 1 6 - 1 - - 5 1 6 465 10 - 19 - 90 10 3 12 17 3 — 49 - - 171 7 6 S3 15 - 162 18 10 6 11 - 32 2 3 235 7 1 406 14 7 + 58 15 5 Sylva - - - - - - — — - — + 18 16 1 Interest on cash balances 5,911 19 6 307 9 6 45 15 - 7 19 6 361 4 - 5,549 15 6 330 18 7 1,170 4 11 178 8 - — 603 - - 2,282 11 6 360 9 - 2,156 7 b 70 5 7 434 5 2 3,021 7 2 5,303 18 8 + 264 12 11 Part iii. Dvellings. (a)3,268 1 7 43 15 6 13 5 - - 57 6 3,211 1 1 867 11 8 345 14 11 432 11 10 64 5 2 376 - - 2,086 3 7 110 9 10 704 17 4 24 19 1 165 19 7 1,006 5 10 3,092 9 5 + 118 11 8 Parker-street House b) 7,704 13 5 (e) 3,322 17 6 86 5 - - 12 3,409 14 6 4,294 18 11 1,478 15 9 589 7 11 772 8 2 111 13 9 657 - - 3,609 5 7 74 5 - 1,811 15 10 14 8 3 352 16 6 2,253 5 7 5,862 11 2 —1,567 12 3 Carrington House 632 13 - 9 15 6 22 17 9 4 17 3 37 10 6 595 2 6 6. 19 1 122 16 6 24 7 4 — - - 335 2 11 55 8 138 18 2 12 12 10 31 7 6 238 18 2 574 1 1 + 21 1 fa Dufferin- street 1,794 3 - 30 6 - 22 4 6 - 11 6 53 9 - 1,741 1 _ 101 15 _ 348 2 11 60 10 9 — 188 - - 706 8 8 115 16 — 623 10 10 30 — 8 137 18 3 907 5 9 1,613 14 5 + 127 6 7 Millbank (proportion) 988 6 5 4 19 7 4 10 10 - 3 3 9 13 8 978 12 9 46 11 8 165 9 6 31 0 4 91 0 6 334 12 ~ 67 li 9 335 11 4 12 14 3 67 19 6 484 2 10 818 14 10 + 159 17 11 Holmwood 388 5 3 36 9 3 18 6 - - 54 15 3 333 10 _ 12 68 16 _ 12 19 3 1 10 - 61 - - 156 5 3 12 18 9 144 15 11 2 15 1 29 19 1 190 8 10 346 14 1 — 13 4 1 Totterdown-Fields 28,654 19 9 (/)3,594 17 - 65 4 6 45 - 9 3,705 2 3 24,949 17 6 1,075 17 3 4,544 5 1 621 11 6 - 1J - 2,500 - — 8,742 12 10 2,464 6 4 10,479 12 10 457 - 1 1,963 1 8 15,364 _ 11 24,106 13 9 + 843 3 9 Preston's-road(proportion) 3,178 15 3 1,012 3 3 39 8 7 10 11 1 1 062 9 11 2,116 12 4 155 3 2 493 6 9 97 4 11 410 7 - 1,156 1 10 183 3 11 1,137 10 9 34 9 6 211 18 1 1,567 2 3 2,723 4 1 — 606 11 9 Hughes-fields(dwellings) (proportion) 1,282 - 398 8 8 11 6 8 11 8 10 4 2 861 4 10 47 5 4 180 1 3 42 17 6 147 6 8 417 10 9 28 IV 1 569 1 4 5 7 11 103 19 8 707 6 _ 1,124 16 9 — 263 11 11 White Hart-lane 16,636 2 - (f)1,767 5 9 54 15 9 9 6 8 1,831 8 2 14,804 13 10 755 1 4 3,525 3 2 416 11 7 2 9 2 1,502 — 6,201 5 3 1,501 18 1 5,713 8 9 265 16 3 1,011 8 11 8,492 12 - 14,693 17 3 + 110 16 7 Wessex 4,165 3 6 168 7 6 23 10 6 1 5 - 193 3 - 3,972 _ 6 2,17 1 2 749 19 7 136 16 4 394 - - 1,497 17 1 3S4 5 4 1,574 6 2 73 11 7 295 9 o 2,327 12 3 3,825 9 4 + 145 11 o Norbury 9,365 - (f)439 4 11 51 17 6 2 15 - 16 11 8,871 a 1 398 8 4 1,427 16 6 380 19 7 — 852 - - 3,059 4 b 938 10 3 3,640 2 4 166 15 2 646 16 1 5,392 3 10 8,451 8 3 + 419 1 4 10 Calednian 5,589 16 6 272 19 - 30 1 6 5 9 6 308 10 - 5,281 6 6 29C 14 2 1,043 12 3 183 2 8 K 117 18 10 526 - - 2,161 7 11 491 6 - 1,865 3 7 98 15 2 338 - 9 2,793 fa 6 4,954 13 5 + 326 13 1 Briscoe 2,539 - 9 118 18 3 27 9 - 6 - - 152 7 3 2,386 13 6 13.1 18 1 455 13 4 92 10 - 254 — - 938 1 6 241 9 2 1,022 5 9 45 3 - 186 14 - 1,495 11 11 2,433 13 4 — 46 19 10 Old Oak - - - 5 - - 11 12 2 12 17 2 12 17 2 — 12 17 2 Interest on casli balances — - — - - — - + 166 15 2 86,18 9 5 11,220 7 8 471 2 7 98 - 10 11,789 11 1 74,397 18 4 5,652 7 - 14.060 5 8 3,305 16 9 310 8 1 8,085 14,710 19 13 2 1 31,414 16 8 6,671 3 2 29,761 11 1,244 8 10 5,543 8 9 43,220 1 8 74,634 18 4 — 70 4 10 Total for dwellings 159,037 - 2 13,808 6 6 1,069 19 9 149 9 4 15,107 15 7 143,929 4 7 9,541! 12 3 25,983 16 4 8,044 8 7 322 1 6 58,603 11 9 11,683 1 55,506 9 2 2,252 4 7 10,861 10 1 / 80,303 4 10 138,906 16 7 + 5.472 16 3 Part III. - 67,189 10 2 13,113 14 8 Estates in course op development. - - - - - - 14 18 4 - 9 11 - - 14 8 5 230 - - - • - 280 265 11 7 — 265 11 7 Totterdown-flelds 319 16 - - - 1 5 3 1 5 3 318 10 9 —- 84 14 4 - 51 10 1 - - 33 4 3 2,581 9 8 - 470 2 2 - 3,051 11 10 3,018 7 7 — 2,699 16 10 White Hart-lane - - - - - 26 1 10 - — — 10 - - 1 — 462 8 2 - 51 14 2 - 514 2 4 488 1 4 — 488 1 4 Norbury (c) 49 4 - - 3 10 - 10 (c) 46 8 4 - 31 12 11 - 121 10 - - - 89 17 1 720 3 1 - 135 _ 3 - 855 3 4 945 fa — 898 1 1 Old Oak - - - - - 50C -- _ - - - - 500 - - — - - 500 _ — 500 Suprvision - - - - - — - - - - - - - — 97 4 7 Interest on cash balances 361 14 4 - — 4 15 3 4 15 3 364 19 1 1 50C - - 157 7 5 173 10 10 14,710 13 1 516 3 5 4,044 1 - 656 16 7 - 4,700 17 6 5,217 11 — 4,949 6 5 159,406 14 6 13,888 6 6 1 069 19 9 154 4 7 15,112 10 10 144,294 3 8 ,10,04 2 1 3 25,826 8 11 8,044 8 7 49 o 12 4 59,119 Id 2 15,727 1 11 55,506 9 2 2,909 1 2 10,861 10 1 85,004 2 4 144,123 17 6 + 523 9 10 Total-Housing of the Working Classes (h) Act, 1890 £71,233 11 1 £ 13. 770 11 3 ii.—Improvement Acts £ 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 1,105 8 80 15 3 20 19 - 6 6 102 - 9 1,003 7 3 41 1 114 - - 42 19 1 - 129 - — 327 - 1 43 17 6 508 — 8 8 7 11 98 1 8 658 7 9 985 7 10 + 17 19 5 Cotton-street 1,190 0 15 6 166 9 6 1 20 18 6 1 17 - 189 5 - 1,001 10 6 60 1 9 244 18 5 34 10 9 - 142 - - 481 10 11 40 fa - 412 8 3 8 4 - 81 3 - 542 - 3 1,023 11 2 — 22 8 Durham 1,531 6 6 295 1 8 I 16 7 - 2 - - 313 8 3 1,217 18 8 64 19 8 138 5 5 56 18 - - 195 - - 455 3 1 80 6 6 843 16 — 15 11 10 159 10 11 1,099 5 3 1,554 8 4 — 336 10 1 Duke's-court (proportion) 607 16 3 16 1 5 11 2 - 7 4 6 5 11 601 10 4 29 3 - 98 14 11 18 6 8 - 62 lb — 208 19 7 45 10 — 204 9 L0 8 14 1 40 19 7 299 13 6 508 13 1 + 92 17 3 Yofk-street {proportion) 382 2 1 6 - 10 10 5 11 2 - 4 3 5 17 9 376 3 9 17 17 1 57 6 6 11 19 6 - 33 15 - 120 18 1 33 lo ~ 141 6 10 6 11 - 27 15 3 209 8 1 330 6 2 + 45 17 7 Herbrand-street 2,782 18 16 6 22 4 6 - 19 9 24 1 3 2,758 17 3 142 8 8 462 12 - 90 6 6 - 266 - - 961 6 9 236 5 - 906 3 7 45 17 2. 172 16 11 1,361 2 8 2,322 9 5 + 436 7 Bruce House id) 7,709 9 1-1 ?, (q) 130 8 6 106 - - - 236 8 6 7,473 5 8 2,122 1 11 744 5 2 954 16 11 85 14 3 577 - - 4,483 18 3 331 2 6 1,653 - 8 56 2 5 298 19 2 2,339 4 9 6,823 3 - + 650 2 8 Millbank (proportion) 11,447 13 7 52 12 1 1 17 5 112 3 1 11,335 2 6 539 10 11 l,929 14 7 362 3 5 - 1,057 3 7 3,888 12 6 581 6 4 3,867 6 9 108 17 5 780 15 — 5,338 5 6 9,226 18 - + 2,108 4 6 Bourne 13,466 6 2 305 1 7 3 114 13 6 30 9 6 451 3 13,015 8 11 648 18 - 2,024 19 - 436 8 5 - 1,056 - - 4,166 5 5 1,430 - - 4,941 13 7 271 17 8 944 1 2 7,587 12 5 11,753 17 0 + 1,261 11 1 Swan-lane 4,130 - 952 2 6 19 12 - 15 12 10 987 7 4 3,142 13 8 178 11 2 712 6 3 146 1 7 - 470 - — 1,506 19 - 177 4 6 1,871 15 5 28 16 9 359 12 9 2,437 9 5 3,944 8 5 — 801 14 9 Valette 1,684 4 18 6 139 1 6 23 10 6 3 7 - 165 19 - 1,518 19 6 76 8 10 287 8 8 56 5 6 - 151 - - 571 3 - 112 10 - 615 12 3 19 1 4 115 10 1 862 13 8 1,433 16 8 + 85 2 10 Hughes-fields (dwellings) (proportion) 641 6 4 4 5 13 5 14 5 210 12, 1 4 30 12 5 23 12 8 90 - 8 21 8 9 - 73 13 4 203 l5 5 14 8 6 284 10 9 2 14 — 51 19 9 353 13 - 562 8 5 — 131 16 - Bearcroft . 879 9 V _ 22 - - 23 10 6 - 45 10 6 834 6 6 34 - - 154 11 4 26 15 6 80 - - 295 6 10 26 5 - 356 - 4 4 9 - 63 1 449 15 10 745 2 8 + 89 3 10 47,559 9 If 2,352 17 1 437 59 19 4 1 2,849 1 9 8 1 44,709 16 6 3,978 14 3 7,059 2 11 2,259 - 7 85 14 3 4,293 6 11 17,675 18 11 3,152 15 10 16,606 4 11 585 4 7 3,194 6 9 23,538 12 1 41,214 11 - + 3,495 5 6 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 801 6 6 40 7 - 2 6 6 42 13 6 758 13 - 53 16 10 167 17 6 30 14 4 - 100 - - 352 8 8 18 12 7 492 4 9 4 4 7 115 18 10 631 - 9 983 9 5 — 224 16 5 Westview, etc. 1,314 19 6 22 13 6 1 - - 23 13 6 1,291 16 - 53 2 195 18 4 38 15 5 - 177 - - 464 15 9 34 9 1 968 17 2 7 4 2 230 — 7 1,240 11 - 1,705 6 9 — 414 9 Idenden 1,138 16 6 6 7 - 22 4 6 1 10 - 30 1 6 1,108 15 - 46 - - 187 10 9 32 18 LI - 124 - — 390 9 8 45 — — 513 17 - 11 13 5 129 7 4 699 17 9 1,090 7 5 + 18 7 7 Barnaby 1,435 5 - 74 7 - 20 18 6 3 15 10 99 1 4 1,336 3 8 71 2 7 314 12 3 43 6 7 - 142 - - 571 1 5 97 - 7 573 9 4 18 4 2 104 17 4 793 11 5 1,364 12 10 — 28 9 2 Brightlingsea 1,089 18 - 220 4 6 19 12 _ 2 13 - 242 9 6 847 8 6 39 1 2 196 16 6 38 18 7 - 124 - - 398 16 3 33 15 - 474 17 5 6 7 1 86 15 1 601 14 7 1,000 10 10 — 153 2 d Bekesbourne 1,247 7 6 7 2 - 22, 4 6 1 8 3 30 14 9 1,216 5 9 63 12 7 223 - 10 43 18 9 - 133 - - 463 L2 2 36 8 - 658 12 - 7 2, 112 b 814 8 9 1,278 - 1 — 61 15 2 Darcy 745 5 6 20 13 _ 22 4 6 - 5 - 43 2 6 702 4 - 29 - - 132 1 26 18 7 - 71 - - 258 19 7 42 3 9 335 11 4 7 18 11 61 15 1 447 9 1 706 8 8 — 4 4 8 Wands worth-road 924 4 - 8 12 _ 22 4 A — 30 16 6 893 7 6 37 - - 166 3 5 29 3 5 - 89 - - 321 6 0 54 12 - 386 3 9 11 2 72 7 .522 12 7 843 19 5 + 49 8 1 8,696 16 6 400 6 _ 129 8 6 12 18 7 542 13 1 8,154 3 5 392 15 2 1,584 - 7 284 14 7 - 960 - - 3,221 10 4 362 1 - 4,403 11 3 72 5 10 913 7 10 5,751 5 11 8,972 16 3 — 818 12 10 Interest on cash balances — - - — — — - - - — + 183 6 1 56,256 6 12 8 2,753 3 1 566 11 9 72 17 11 3,392 12 9 52,833 19 11 4,37 1 5 8,643 6 2,543 15 2 85 14 3 5,253 6 11 20,897 9 3 3,514 16 10 21,009 16 2 657 10 5 4,107 14 7 29,289 18 - 50,187 7 3 + 2,859 18 9 (i) £24,524 13 - £4,765 5 - (a) Including £20 18s. l0d. miscellaneous receipts for baths, storage of parcels, etc. cottages handed over on completion. (a) Excluding £514 6s. 4d., as in liote (e). recovered, the interest, hitherto shown net, b-ing the gross figures this year (see note k). (b) Including £3b 7s. 9d., as in note (a). (c) Including (h) Local wages of caretakers, etc., £4,205 3s. 7d.; central {k) Legal expenses in respect of appeal against assessment £4 lis. 6d., sale of top spit, etc. (d) Including £70 I9s. 7d., as in note (a). (e) Excluding £1 10?. 4d., rebate on weekly tickets. (/) Including new office, £5,g37 8s. 8d. (i) Local wages of caretakers, etc., £2,399 13s. 3d.; central office, £1,971 16s. 2d. (J) After deducting tax on interest on debt of certain tenements, (I) Tax on interest recovered is deducted from rates and taxes (col. 9). See note (j). xliv. xlv. Annual Report of the London County Council, 1911. Housing of the Working Classes—Accounts. E.-PERCENTAGES ON GROSS RENTAL OF THE SEVERAL ITEMS OF INCOME AND EXPENDITURE IN RESPECT OF DWELLINGS IN THE DETAILED REVENUE ACCOUNT. Dwellings. Income. Expenditure. Result of Year's Working (excluding interest on cash balances). Gross Rental. Empties. Deductions. Maintenance and Management. Transfer to Repairs and Renewals Fund. Debt Charges. Caretaker's Quarters. Amounts irrecoverable. Total. Net Rental. Supervision and Colection of Rent. Rates and Taxes. (c) Lighting, Heating, Water and Insurance. Stores and Incidentals. (e) Interest (gross). Sinking fund. Total (cols. 13 and 18) Surplus. Deficiency. Total. Land. Buildings. Land. Buildings. Total. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1.—Housing of the Work ing Classes Act, 1890. Part I. £ % % % % % % % % % % % % % % % % % % % Boundary-street (including laundry) 23,433 1.54 ..61 .10 2.25 97.75 6.60 17.24 5.49 .04 8.98 38.35 8.10 33.80 1.73 7.70 51.33 89.68 8.07 -— Do. (automatic gas supply) 2,963 - - -— 100.00 5.64 19.86 78.52 7.50 7.50 - 1.78 9.28 91.15 12.20 - Cable-street 2,971 •82 .84 .03 1.69 98.31 4.50 16.94 38.53 .87 8.96 91.15 5.16 - Shelton-street Millbank. 1,568 1.34 1.58 .02 2.90 97.10 4.03 16.86 9.01 57.99 91.93 5.17 - 6,600 .50 .46 .02 .98 99.02 4.71 17.79 Churchway 3,916 .45 .70 .04 1.19 98.81 5.11 15.95 2.92 14.31 34.78 3.69 45.25 .71 8.71 95.29 5.03 Hardy 881 7.16 1.93 .75 9.84 90.26 3.75 16.25 1,824 .13 .92 .01 1.04 98.96 4.79 16.25 Duke's-court .14 1.45 .05 1.54 98.46 4-67 15.00 York-street Preston's-road 826 31.84 1.24 .33 33.41 66.59 4.88 14.85 3570 St. Luke's— .85 1.28 - 2.13 97.87 5.07 17.16 314 — 9.11 34.48 906 34.82 1.65 6.51 52 04 86.52 12.35 — Wenlake Chadworth 3,409 9.54 .65 -48 9.71 90.29 4.41 14.02 2.71 7.95 29.09 7.63 39.26 1.49 6.68 55.06 84.16 6.13 Clerkenwell and Holborn— 915 .10 2.58 - 2.68 97.32 4 .05 11.36 2.41 — 6.89 24.71 6.64 44.04 1.12 7.92 59.72 84.43 12.89 — Mallory 6,050 5.36 .91 .23 6.50 93.50 4.48 18.29 30.63 Webber-row 4,937 5.58 1.24 .10 6.72 93.28 5.00 18.14 1,020 3.89 1.92 .23 6.04 93.96 3.94 18.14 40.38 10.17 9-3o Brook-street 486 2.57 4.03 .30 6.90 93.10 3.91 17.91 11..11 36.10 98.51 Goldsmith's-row 2,059 28.10 .83 .55 29.48 70.52 2.91 15.39 10.93 32.05 12.53 71.31 i 103.36 Part II. 290 3.24 - - 3.24 96.76 6.59 17.45 3.25 — 9.99 37.28 7.75 30.54 1.56 6.35 46.20 83.48 13.28 Cranley 1,874 3.20 1.40 4-60 95.40 5.27 19.50 3.09 9.34 38.98 6.02 37.26 1.14 7.13 51.55 90.53 7.63 Borough-road 1,135 1.80 — .04 1.84 98.16 7.05 21.31 Cobham 2,141 9.98 .92 .30 11.20 88.80 5.32 19.23 2.74 7.17 34.63 86.43 12.49 Ann-street 471 .87 - .21 1.08 98.92 4.04 Part iii. 1.75 98.25 26.54 10.58 13.24 1.97 11.51 63.84 3.38 21.56 •76 5.08 30.78 94.62 3.63 Parker-street House 3,268 1.34 .41 - 44.26 98.25 19.19 7.65 10.01 1.45 8.53 •96 23.51 •19 29.24 76-09 -.- 20.35 Carrington House 7,705 43.13 1.12 — 44.26 55.74 9.64 19.41 3.85 8-85 21.96 Dufferington House 633 1.55 3.61 .77 5.93 94.07 6.12 19.40 34.76 Dufferin-street and Boyfield-street 1,794 1.69 1.24 .03 2.96 97.04 4.71 16.74 3.16 9.24 33.85 6.87 33.95 1.29 6.88 48.99 82.84 16.18 Millbank 988 .50 .46 .02 .98 99.02 Holmwood 388 9.39 4.71 - 14.10 85.90 3.09 17.72 3 34 2.17 •39 15.71 40.25 3.33 8.60 37.29 36.57 •71 7.72 49.05 89.30 3.40 Totterdown-fields 28 655 (a)12.54 .23 .16 12.93 87.07 3.76 15.86 3,179 3184 1.24 .33 33.41 66.59 4.88 15.52 Preston's-road 1,282 31 07 .88 .89 32.84 67.16 3.69 14.04 .01 Hughes-fields Dwellings 16,636 (a)10.62 .33 .06 11.01 88.99 4.54 21.19 White Hart-lane .57 .03 4.64 95.36 5.21 18.01 3.28 9.46 35.96 9.22 37.80 1.77 7.09 55.88 91.84 3.52 Wessex 4,165 .55 .03 5.27 94.73 4.25 15.25 4.07 9.10 32.67 10.02 38.87 1.78 6.91 57.58 90.25 4.48 — Norbury .54 .10 5.52 94.48 5.20 1 18.67 38.66 .1.77 6.05 88.64 — Caledouian 5,590 2,539 4.68 1.08 .24 6.00 94.00 5.35 17.95 3.64 10.01 36.95 9.51 40.26 1.78 7.35 58.90 95.85 1.85 Briscoe - - - - - Old Oak Total for Housing of the Working Classes Act, 1890 159,037 8.73 .67 .10 9.50 90.50 6.00 16.34 5.06 •20 9.25 36.85 7.35 34.90 1.42 6.83 50.50 87.35 3.15 - II—Improve ment Acts. Battersea-bridge 1,106 7.31 1.89 .03 9.23 90.77 3.71 10.31 3.89 — 11.67 29.58 3.97 45.96 .76 8.87 59.56 89.14 1.63 Cotton-street 1,191 13.98 1.76 .15 15.89 84.11 5.04 20.57 5.24 55-10 1-02 10.42 71.78 101.50 1,531 19.27 1.07 .13 20.47 79.53 4.24 9.03 10.32 7.49 33-64 49.30 83.68 608 .13 .92 .01 1.04 98.96 4.79 16.25 382 .14 1.45 .05 1.54 98.46 4.67 15.00 2,783 .10 .80 .04 .86 99.14 5.12 16.62 3.25 9*56 3455 8.49 4.29 32-56 21-44 1.65 6.21 48.91 83.46 15.68 — 7,710 (B)1.69 1.38 — 3.07 96.93 27.53 9.65 5.08 33-78 •95 46.63 Millbank 11,447 .50 .46 .02 .98 99.02 4.71 16.86 3.24 7.84 30.94 10.62 36-69 2.02 1 701 56.34 87.28 9.37 Boourne 13,467 2.27 .85 .23 3.35 96.65 4.82 15.04 Swan-lane 4,130 23.05 .47 .38 23.90 76.10 4.32 17.25 Valette 1,685 8.25 1.40 .20 9.85 90.15 4.54 17.06 334 8.96 11.49 33 .90 32.56 2.25 j 44.37 •42 811 5515 87.71 5.05 20.55 Hughes-flelds Dwellings 641 31.07 .88 .89 32.84 67.16 3.69 14.04 3.04 909 33.57 2.98 40.46 •51 7.17 51.12 84-69 10.14 Bearcroft 880 2.50 2.67 — 5.17 94.83 3.87 17.57 Council 801 5.04 - .29 5.33 94.67 6.72 20.95 3.83 — 12.48 43.98 2.32 61.43 .53 14.47 78.75 122.73 — 28.06 Westview, Armitage and Collerston 1,315 1.72 - .03 1.80 98.20 4.04 14.90 Idenden 1,139 .56 1.95 .13 2.64 97.36 4.04 16.47 Barnaby 1,435 5.18 1.46 .26 6.90 93.10 4.96 21.92 Brightlingsea 1,090 20.21 .24 22.25 77.75 3.58 18.06 3.57 — 11..38 36.59 43.57 7.96 — 14.05 Bekesbourne 1,247 .57 1.78 .11 2.46 97.54 5.10 17.89 3.52 10.67 37.18 52 81 4.95 Darcy 745 2.77 2.99 .03 5.79 94.21 3.89 17.72 3.16 9.53 5.91 41.78 1.03 7.83 56.55 91-32 5.34 Wandsworth-road 924 .93 2.41 — 3.34 96.66 4.00 17.98 Total for Improvement Acts 56,257 4.89 1.01 .13 6.03 93.97 7.77 15.36 4.52 •15 9.34 3714 6.25 37.35 1.17 7.30 52.07 89.21 4.76 - Total for dwellings 215,294 7.73 .76 .10 8.59 91.41 6.46 16.09 4.92 •19 9.27 36.93 7.06 35.54 1.35 6.95 50.90 87.83 (d)3.58 - (a) See note (/) on page 24. (b) Excluding 6 67 for rebate on weekly tickets. (c) After deducting income tax on interest on capital outlay, the interest hitherto shown net being now stated gross (cols. 14 and 15). (d) Percentage ou surplus of £7,699 Os. 8d., which excludes interest on cash balances amounting to £633 14s. 4d. (e) Se3 Note (e) xlvi. xlvii. Annual Repart, of the County Council, 1911. F—SUMMARY oF FINANCIAL RESULTS. Dwellings. Borough. Accommodation persons) * Persons in occupation 31st March, 1912. Date of opening. Aggregate Capital Expenditure to 31?t March, 1912. Aggregate Balanc on Revenue Account, 1st Apri e Result of Year's Working. , Surplus (+) Deficiency (—) (page 25, col. 20). Aggregate Bnlance on Revenue Account, 31at .March, 191 Surplus (+) Deficiency (— Accumulation of Sinking Fund to 31st March 1912, (excluding pro ceeds of Sales. s d Unspent Accumulation on 1st April, 1911. Repairs and Renewats Fund. Transfers froL Revenue Account(pag 1911-12 Land. Buildings. Total. 1911. Surplus (+) Deficiency (—). u Actual Expenditure Uitfercnce,beir further amout Unspent Accumulation on 31st March, 1 2 3 4 5 6 7 9 10 11 12 13 zd, 14 15 16 17 1 —Housing of the Working Classes Act. 1890 Part I. £ s. d. £ s. d. £ s. d. £ s. d. £ . s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ . s. d. £ s. d. Boundary-street Bethnal Green and Shored itch 5,380 4,555 1895-1900 62,010 275,526 6 - 337,536 6 - + 19,651 12 3 + 2,25 1 - -f 21,90 2 1 41,85 7 1 0 11 17,106 12 6,Of .1 13 u 6,7 16 19 69 s. 5 d 1 I 1 16,411 s 6 d. 11 Cable-street Stepney 798 bl3 1896, 1901 3,660 - - 37,592 8 7 41,252 8 7 + 1,509 19 8 + 213 - 1 + 1,722 19 9 5,677. 14 5 Shelton-street Holborn 284 222 1896 5,100 - - 19,292 7 5 24,392 7 5 + 241 10 9 + 81 3 3 + 322 14 - 3,843 13 8 Millbank (proportion).. Westminster (City) 1,536 1,044 1899-1902 11,906 12 - 70,390 13 1 82,297 5 1 + 11,820 12 5 + 1,215 11 - + 13,036 3 5 6,953 3 4 Church way St. Pancras + 6,7] 4 1 i 3 + 68 1 Hardy Greenwich 306 220 1901 1,000 - - 12,298 9 13,298 9 — 968 15 8 - 44 5 5 - 1,013 1 1 1,013 11 1 Duke's-court (proportion) Westminster 458 363 1902 4,200 19,193 16 1 23,393 16 1 + 2,435 6 1 + 278 11 6 + 2,713 17 7 1,696 6 6 York-street (proportion) Westminster (City) 293 219 1903 3,000 - 12,950 6 7 15,950 6 7 + 1,018 10 7 + 137 13 2 + 1,156 3 9 965 - 1 Preston's-road (proportion) Poplar 269 136 1904 1,433 14 1 11,412 17 5 12,846 11 6 — 2,160 15 8 - 263 7 8 - 2,424 8 4 687 14 7 St. Luke's— Wenlake Finsbury 496 348 1905 5,000 - - 19,774 2 7 24,774 2 7 + 1,305 19 - + 221 16 1 + 1,527 15 1 1,146 13 - Chandworth Finsbury 720 551 1907 8,000 — - 35,813 10 6 46,813 10 6 + 484 12 7 + 203 19 3 + 693 12 3 1,510 2 9 Clerkenwell and Holborn— Mallory Finsbury 164 118 1906 1,620 — — 11,479 2 3 13,099 2 3 + 551 12 4 + 117 15 10 + 696 8 2 505 2 2 Nigel, etc, Holborn 1,260 872 1908 14,550 - - 71,277 2 2 85,827 2 2 + 29 7 8 + 66 16 1 + 96 3 9 2,167 13 6 Webber-row Southwark 1,143 764 | 1906-7 9,750 - - 43,041 8 1 | 52,791 8 1 + 2,775 18 4 + 645 11 4 + 3,421 9 8 1,850 15 4 Dwellings on sites compulsonly appropriated for rehousing, on the working of which a deficiency was anticipated owing to the character or situation Brook-street Stepney .. 308 235 1894,1900 1,800 - - 15,314 - 9 17,114 - 9 — 1,855 2 7 - 95 5 4 - 1,950 7 11 2,560 7 5 Goldsmith's-row Shored itch 144 100 1895 1,000 - - 7,128 11 8,128 8 11 — 517 10 1 - 26 6 - - 543 16 1 1,403 8 8 Hughes-fields cottages Greenwich 666 374 1895 3,720 - - 35,750 1 39,476 1 1 — 9,367 15 - 676 4 7 - 10,043 19 7 6,919 19 4 Part II. 2,277 8 11 603 - -- 444 3 - 158 17 - 2,436 5 11 Cranley Holborn 60 46 1897 750 - - 3,017 10 3,767 8 10 + 578 11 5 + 38 10 9 + 617 2 2 435 8 - Borough-road Southwark 400 291 1900 5,000 - - 24,014 4 1 29,014 4 1 + 883 12 6 + 39 15 10 + 923 8 4 2,666 - 9 Cobham Southwark 279 214 1900 2,100 - - 13,007 1 5 15,107 1 5 + 1,216 11 5 + 86 10 10 + 1,303 2 3 1,284 8 7 Ann-street Poplar 630 439 1901-2 2,260 - ~ 23,812 4 8 26,072 4 8 — 850 4 10 + 22 4 - - 828 - 10 1,871 13 2 Syiva Deptford 144 101 1903 1,000 — - 5,053 7 7 6,053 7 7 + 495 6 9 + 58 15 5 + 554 2 2 380 4 4 Part III. Dwellings. Parker-street House Holborn 345 344 1893 3,750 - - 23,159 9 - 26,909 9 - + 456 17 4 + 118 11 8 + 575 9 - 4,810 17 4 14,595 14 3 8,085 19 2 6,466 15 5 1,619 3 9 16,214 18 Carrington House Deptford 803 459 1903 2,200 - - 54,936 17 7 57,136 17 7 — 10,581 2 11 1,567 12 3 + 12,148 15 2 3,450 9 1 Duffer in-street Finsbury 174 147 1892 1,900 ~ - 4,714 10 11 6,614 10 11 — 127 10 2 + 21 1 5 - 106 8 9 1,318 11 1 Green-street and Boyfield-street Southwark 418 236 1897 3,860 - - 21,074 18 4 24,934 18 8 + 1,859 11 5 + 127 6 7 + 1,986 18 - 3,308 9 5 Millbank (proportion) Westminster (City) 230 156 1899-1902 2,411 - - 10,540 5 3 12,951 19 8 + 1,650 9 5 + 159 17 11 ! + 1.810 7 4 1,100 11 9 Holmwood Southwark 72 39 1900 450 - - 4,777 13 6 5,227 13 6 — 278 12 3 - 13 4 1 - 291 16 4 484 11 6 Totterdown-fields Wandsworth 8,788 4,329 1903-11 76,772 4 3 316,015 5 9 392,787 10 - + 518 19 7 + 843. 3 9 + 1,362 3 4 15,565 14 2 Preston's-road (proportion) Poplar 1,035 524 1904 5,516 5 11 33,552 19 10 39,069 5 9 — 5,404 14 3 606 11 9 - 6,011 6 - 2,138 14 2 Hughes-flelds-dwellings (proportion) Deptford and Greenwich 440 293 1904 855 6 8 16,374 12 9 17,229 19 5 — 1,611 16 3 — 263 11 11 — 1,875 8 2 854 - 6 White Hart-lane Tottenham, Wood Green and Edmonton (U.D.C.) 5,889 2,541 1904-12 44,754 169,145 14 - 213,899 14 - — 5,008 19 10 + 110 16 7 — 4,898 3 3 5,428 7 4 Wessex Islington 1,050 730 1904-5 11,818 13 2 46,060 9 11 57,879 3 1 — 1,321 15 9 + 146 11 2 - 1,175 4 7 3,133 3 7 Norbury Croydon .. 3,325 1,558 1906-12 26,476 - - 123,174 2 8 149,650 2 8 — 1,317 11 9 + 419 14 10 - 897 16 11 2,605 3 9 Caledonian-road . Islington .. 1,384 984 1906 15,763 12 7 53,192 - 8 35,122 9 9 + 148 19 9 + 326 13 1 + 475 12 10 3,040 18 5 Briscoe Lambeth 718 342 1906 7,154 7 2 27,968 2 7 35,122 9 9 — 1,501 15 1 —. 46 19 10 - 1,548 14 11 1,409 6 9 Old Oak Hammersmith - - - † †32 13 7 †32 13 7 - — 12 17 2 — 12 17 2 - - - Total—Dwellings — 25,205 — 361,092 10 3 1,710,991 17 7 5 2,072,084 7 8 + 13,474 12 5 + 5,022 8 - + 18,497 _ 5 139,944 19 4 33,979 5 2 14,710 13 1 13,627 17 5 1,082 15 8 35,062 10 10 Interest on cash balances • • * + 2,538 9 6 + 450 8 3 + 2,988 17 9 Dwellings in course of erection— + 16,013 1 11 + 5,472 16 3 + 21,485 18 2 — — — — Part I. — 6,613 17 1 - 6,613 17 1 Part III. — — 5,601 17 3 — 5,601 17 3 — — — 12,215 14 4 — 12,215 14 4 Dividends (less expenses of investment) and interest (Repairs and Renewals Fund) 361,092 10 3 1,710,991 17 5 2,072,084 7 8 + 3,797 7 7 + 5,472 16 3 + 9,270 3 10 — • - — 5,615 8 8 — 1,29 7 3 1,291 7 3 6,906 5 1 Part III. Estates in course of development .. ‡§ 119,546 4 5 ‡ § 119,546 4 5 — 69,946 7 9 — 4,949 6 5 74,895 14 2 9,552 18 4 480,631 1 8 1 1,710,98 1 7 5 2,191,63( 1 2 1 — 66,149 - 2 + 523 9 10 — 65,625 10 4 149,497 17 8 1 39,595 3 1 5 14,710 13 1 12,336 10 2 2,374 2 1 41,969 6 Add—Net c ontributio ns rom r ates to 3 St March 1912 (pag e x viii) •• 65,625 - 10 4 II- -Improvement Acts, £ s. d. £ s. d. s. d. £ £ (\ Battersea Bridge . Battersea 286 205 1901 1,350 - - 15,704 68 5 17,054 7 8 + 489 19 8 + 17 19 5 + 507 19 1 1,300 12 11 Cotton-street Popular 36 220 1901 1,400 - - 12,768 12 5 14,168 12 - — 465 7 11 - 22 _- 8 — 487 8 7 1.160 17 3 Durham . Battersea .. 536 265 1904 2,380 - - 24,684 13 - 27,064 13 - —3,301 3 5 336 10 1 - 3,637 13 6 1,493 12 6 Duke's-court (proportion) . Westminster (City) 152 120 1902 1,400 - - 6,397 18 5 7,797 15 5 + 811 15 6 + 92 17 3 + 904 12 9 565 8 ' York-street (proportion) . Westminster (City 97 73 1903 1,000 - - 4,316 15 5 5,316 15 5 + 339 10 - + 45 17 7 + 335 7 7 321 13 11 Herbrand-street Holborn 680 502 1904 7,000 - - 26,659 2 2 33,659 2 2 + 2,964 7 10 + 436 7 10 + 3,400 15 8 1,927 4 1 Bruce House Westnubster (City) 708 708 1906 8,830 0 0 2 47,105 4 5 55,935 4 5 + 3,593 9 10 + 650 2 8 + 4,243 12 6 2,010 7 8 Millbank (proportion) Westminster (City) 2,664 1,810 1899-1903 20,630 10 2 122,083 15 7 142,734 6 1 + 20,543 17 9 + 2 108 4 6 + 22,652 2 3 10,871 6 2 Bourne Holborn 2,642 1,854 1902-4 44,090 149,345 5 193,345 17 7 + 6,920 15 5 + 1 261 11 1 + 8,182 6 6 12,059 7 5 Swan-lane Bermondsey 1,270 957 1902-4 5,000 55,870 60,870 5 — 8,044 7 6 801 14 9 — 8,846 2 3 3,403 19 - 18,1 72 11 1 21,172 1 1 Valette Hackney .. 416 276 1905 3,000 18,172 11 1 21,172 11 1 + 741 2 7 + 85 2 10 + 826 5 5 923 2 3 Hughes-fields (dwellings) (proportion) Deptford and Greenwich 220 146 1904 427 13 4 8,187 6 4 8,614 19 8 — 805 18 2 131 16 937 14 2 426 19 10 16,998 6 1 5,443 3 189 19 4 16,808 6 1 Bearcroft Fulham 220 121 1906 700 9,562 19 - 10,262 19 - 22c — 300 18 5 b 89 3 10 — 211 14 7 350 Dwellings on sites compulsorily appropriated for rehuousing, on the working of which a deficiency was anticipated owing to the character or situation of the site Council Popular 240 159 1894 621 - - 16,307 7 17,041 7 2 — 4,377 3 10 - 224 16 5 - 4,602 _ 3 3,045 14 7 Westview, etc Green wich 464 316 1894 1,148 9 3 32,807 14 11 33,456 4 2 — 8,092 11 7 414 - 9 - 8,506 12 4 5,956 12 11 Idenden Greenwich 400 254 1896 1,500 17,156 10 1 19,391 17 1 — 874 - 8 - 18 7 7 — 855 13 1 2,978 1 1 Barnaby Bermondsey 400 303 1904 2,875 16,516 17 1 19,391 17 1 — 159 3 8 - 28 9 2 — 187 12 10 982 - 9 Brightlingsea Stepnev .. 340 200 1904 1904 1,000 13,671 5 10 14,671 5 10 — 1,387 5 9 153 2 4 - 1,540 8 1 748 - 1 Bekesbourne Stepney 380 250 1907 1,120 17,076 9 10 18,195 9 10 — 241 4 - - 61 1 5 2 - 302 19 2 620 8 7 Dary Hackney 190 138 1904 1,250 - ~ 9,741 12 3 10,991 12 3 — 169 17 1 - 4 4 8 174 1 9 573 19 2 Wandsworth-road Lambeth 236 148 1905 1,560 11,343 1 3 12,903 1 3 + 230 1 11 - 49 8 1 + 279 10 - 611 3 1 Total—Dwellings in occupation • • — 9,016 - 108,212 12 9 635,093 7 5 743,306 - 2 + 8,415 18 6 2,676 12 8 8 + 11,092 11 2 52,331 1 6 16,998 6 3 5,253 6 11 5.443 6 3 189 19 2 16,808 6 11 Interest on cash balances .. •• *• + 1,274 18 1 + 183 6 1. + 1,458 4 2 — Dwellings in course of erection + 9,690 16 7 + 2,859 18 9 + 12,550 15 4 • • — 3,897 V 9 — — 3,897 7 9 — — Dividends (less expenses of investment) Repairs and Renewal Fund - - + 5,793 8 10 +, 2,859 18 9 + 8,653 7 7 2,444 7 628 8 1 628 8 1 3,072 9 8 108,212 12 9 635,093 7 5 743,306 - 2 + 5,793 8 10 + 2,859 18 9 + 8,653 7 7 52,331 1 6 19,442 7 10 5,253 e 11 4,814 18 2 438 8 9 19,880 16 7 Deduct—Net contributions to rates, after deducting contributions from Tramways Account, to 31st March, • The accommodation is arrived at generally by calculating two persons to room. The census taken in March, 1612. showed an 1912 (pagexlvii) 8,653 7 7 - - - Deduct—Net contributions to rates, after deducting contributions from Tramways Account, to 31st March, ♦ The accommodation is arrived at geneially by calculating two persons to a 100m. The census taken in March, 1 £12. showed an average of 1 32 persons per room. † After deducting expenditure of £14,373 8s. -d. met cut of the Acquisition of Lands Fund—Land, £1,950 ; Buildings, £12,423 £s. -d. ‡After deducting expenditure of £8,41 £s. d. as in note†. Š White Hart-lane, £82,254 14s. £d; Norbury, £5,299 12s. 3d.; Old Oak, £31,991 17s. 8d. 12532 GG xlviii Annual Report of the London County Council, 1911. G.-REPAIRS AND RENEWALS ACCOUNT-DETAILS OF INVESTMENTS.[/$$$] Name of Stock. Amount of Stock. Cost Price. Market Value on 31st March, 1912. Housing of the Working Classes Act, 1890. Dwellings (Improvement Acts). * Total. Part. I. Part II. Part III. Total. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ London County Consolidated— 2J per cent 24,570 14 9 12,693 9 1 1,000 _ _ 1,603 16 9 15,297 5 10 5.702 14 2 21,000 _ _ 17,261 3 per cent. 12,246 9 8 1,000 - - 500 - - 4,500 - - 6,000 - ~ 5,000 ~ — 11,000 ~ - 10,379 Now South Wales Government— 31/2 per cent. Inscribed (1918) 11,148 17 2 3,000 - - 500 - - 4,000 - - 7,500 ~ — 3,500 ~ — 11,000 - - 10,954 Dominion of Canada— 3 J per cent. Registered (193050) 13,026 4 1 3,000 — - 5,500 - * 8,500 - 4,500 - 13,000 - 12,587 London, Brighton and South 6 per cent. Consolidated Guaranteed 1,500 ~ ~ 801 400 10 — 400 10 1,602 400 10 2,002 10 1,911 20,494 9 1 2,400 10 - 16,004 6 9 38,899 5 10 19,103 4 2 58,002 10 - *53,092 •Housing Act, 1890 .. £35,337 Improvement Acts .. 17,755 53,092 H-STATEMENT AS TO CONTRIBUTIONS FROM AND TO RATES. Year. Housing of the Working Classes Act, 1890. Dwellings (Improvement Acts). Total. Part I. Part II. Part III. Dwellings. Estates in Course of Development. Contributions from Rates. £ s. d. £ s d £ s d £ s d £ s d. £ s. d 1894-5—1910-11 3,16 17 6 30,509 9 9 71,336 16 3 5,097 5 4 110,111 8 10 1911-12 70 4 10 4,949 6 6 5,019 11 3 3,16 17 6 30,579 14 7 76,286 2 8 5,097 5 4 115,131 - 1 Contributions to Rates. 1894-5—1910-11 31,95 2 6 2,702 16 4 2,821 16 _ l,390 8 6 11,813 12 4 50,678 15 8 1911-12 5,27 8 2 264 12 11 . 2,991 14 9 8,534 15 10 37,228 10 8 2,967 9 3 2,821 16 - l,390 8 6 14,805 7 1 59,213 11 6 Net Contributions— From rates 27,757 18 7 74,895 14 2 To rates 34,060 13 2 2,967 9 3 9,7 08 1 9 Proportion of deficiency on Hughes-fields (Deptford) Dwellings, Drake Buildings, allocated for rehousing persons displaced by the Generating Station, Greenwich— To 31st March, 1911 922 18 2 1911-12 131 16 - 1,054 14 2 Net contributions from Rates and Tramways Account— Housing of the Working Classes Act, 1890 65,625 10 4 Less—Dwellings under Improvement Acts 8,653 7 7 - 56,972 2 9 † In respect of Norbury Brickfield. Housing of the Working Classes — Accounts. xlix. APPENDIX XVII. STATEMENT OF CAPITAL EXPENDITURE ON CLEARANCE SCHEMES UNDER THE HOUSING OF THE WORKING CLASSES ACT. 1890. 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. Clearance Scheme. Date of Act sanctioning Scheme Capital Expenditure to 31st March, 1912. Gross. Receipts applied to Capital Expenditure. Net. (a) Housing of the working Classes Act, 1890. £ s. d. £ s. d. £ s. d. Part I. 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. George - the 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. Marylebonc 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 - flelds, Deptford „ 91,978 3 5 8,083 5 0 83,894 17 7 Cable-street, Shadwell 1887 46,390 10 6 5,155 8 2 41,235 2 4 Shelton-street, St. Giles 79,553 13 6 11,134 12 9 68,419 _ 9 Boundary-street, Bethnal Green 1891 353,439 8 5 74,442 7 0 278,997 - 7 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 — Ayiesbury - place, Clerkenwell, and Union-buildings, Holborn .. I900 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 " 120,719 7 10 13,860 11 6 106,858 16 4 Webber-row, Wellington-place and King's Bench-walk, Southwark 106,742 14 ~ 10,293 9 96,449 5 — Nightingale-street, St. Marylebone t 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 Crosby-row, — 659 11 4 — 659 11 4 Bermondsey General — 449 3 7 — 449 3 7 Total for Part I 3,255,251 18 - 866,173 17 0 (a)2,389,078 - 2 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 - plice, 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 15,600 — — — 15,600 — — Norfolk-square, Islington » 3,986 19 8 — 3,986 19 8 Total for Part II 167,426 - 6 40,566 3 3 (a)126,859 17 3 Jotal for Parts I. and II. 3,422,677 18 6 906,740 1 1 2,515,937 17 5 (a) Before deducting proceeds of sales carried to Consolidated Loans Fund. 12632 gg 2 !• Annual Report of the London County Council, 1911. APPENDIX XVIII- STATEMENT AS TO THE COMMERCIAL AND HOUSING VALUES OF SITES UTILISED FOR THE ERECTION OF WORKING CLASS DWELLINGS. Statement shewing difference between the commercial value and the housing value of sites (a) sold by the Metropolitan Board of Works ',o Dwellings Companies and others, with the' obligation to erect dwellings for the working classes thereon, or (b) acquired or appropriated bv the Council for the erection of wortcing class dwellings. Note.—The figures in the column headed " Commercial value," except in the few instances where actual cost is given, represent the estimate of 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 site as cleared land free from all restrictions. The figures in the column headed " Housing value " represent in statement (a) the sums actually received from Dwellings Companies and others for the sites restricted to the erection of working class dwellings and in statement (b) the estimated housing value as determined by the Council on the advice of the Valuer, and charged to the capital accounts of the dwellings. (a) Sites sold by the Metropolitan Board of Works to Dwelling Companies and others, with the obligation to erect dwellings for the working classes thereon. ' (6) Sites acquired or appropriated by the Council for the erection of working class 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 Accounts, page 28, col. 6.J Difference charged to clearance scheme or improvement (cost of writing down value of cleared site). Housing of the working Classes Act, 1890. Part I.— Clearance Schemes. £ £ £ housing of the working classes ACT, 1890. Part i. £ £ £ | Boundary-street 131,670 62,010 69,660 J Cable-street 8,500 3,660 4,840 ! Shelton-street 24,465 5,100 19,365 Whitechapel and Limehouse 73,000 24,900 48,100 Millbank •16,202 11,907 4 295 Goulston-street and Flower and Dean-street, Whitechapel .. 80,000 32,106 47,894 Churchway 25,000 8,550 16,'450 Elizabeth-place, King-street and Mint-street, St. Gcorge- 27,000 12,300 14,700 ! Hardy 4,000 1,000 3,000 the-Martyr, Southwark Duke's-court 1 • ftl- 1 Q1 ( 4,200 Bedfordbury, St. Martin - in - the - Fields 15,000 7,886 7,114 York-street f 61,101 1 3,000 | 53,981 Great Wild-street, St. Giles - in - the - Fields 35,000 15,840 19,160 1,434 1,434 Nil. Pear Tree-court, Clerkenwell 12,000 5,925 6,075 St. Luke's—Wenlake 25,900 5,000 20,900 Whitecross - street, St. Luke 105,000 36,882 68,118 Do. Chadworth 20,800 8,000 12,800 High-street, Islington . 11,000 5,650 5,350 Clerkenwell and Holborn — Mallory 10,000 1,620 8,380 Old Pye-street, Westminster 40,000 20,410 19,590 Do. Nigel, etc 53,000 14,550 38,450 Bowman's-buildings, St. Marylebone 16,500 10,000 6,500 28,500 9,750 18,750 Essex-road, Islington 30,000 13,306 16,694 1 Parker-streett 14,035 3,750 10,285 Wells-street, Poplar 12,000 5,000 7,000 6,000 3,050 2,950 3,600 1,800 1,800 Tabard-street, Newington 7,000 4,200 2,800 Goldsmith's-row •4,794 1,000 3,794 Hughes-fields, Deptford 2,600 1,460 1,140 Hughes-fields 7,760 3,720 4,040 Total for Clearance schemes 472,100 198,915 273,185 Part. II. 1,500 750 750 Borough 8,146 5,000 3,146 Cobham 6,466 2,100 4,366 Ann-street 2,850 2,260 590 Sylva 2,166 1,000 1,166 ♦Carrington House 3,834 2,200 1,634 Street Improvements. 465,803 163,361 302,442 §Dwellings under Improvement Acts. Metropolitan Street Improvements Act, 1872— Battersea-bridge 4,000 1,350 2,650 Bethnal Green-road 11,500 *7,220 4,280 Cotton-street 2,500 1,400 1,100 Old-street to Oxford-street (Clerkenwell-road and 38,400 10,860 27,540 Durham 5,000 2,380 2,620 Theobald's-road) Duke's-court \ ( 1,400 ) Willow-walk, Great Eastern-street 26,305 14,272 12,033 York-street J 20,668 I 1,000 18,268 Metropolitan Board of Works (Various Powers) Act, 1876— Herbrand-street 41,836 7,000 34,836 Appold-street (Sun-street), Shoreditch 2,100 1,250 850 Bruce House 63,000 8,830 54,170 Metropolitan Street Improvements Act, 1877— •201,469 44,000 157,469 Camberwcll and Peckham 1,500 600 900 •27,901 20,651 7,250 Charing-cross-road and Shaftesbury-avenue 77,000 •33,715 43,285 6,850 5,000 1,850 Gray's Inn-road (including Elm-street, Acts of 1884 22,730 14,335 8,395 Valette 8,600 3,000 5,600 and 1887) •428 428 Jamaica road and Union-road .. 10,700 5,300 5,400 Bearcroft 2,229 700 1,529 Kentish Town-road 2,500 2,300 200 Marshalsea-road (Southwark Bridge-road) 4,200 1,900 2,300 Council 3,000 621 2,379 Tooley-street 20,000 •10,000 10,000 Westview, Armitage and Collerston 4,900 1,148 3,752 Metropolitan Street Improvements Act, 1883— Idenden 4,400 1,500 2,900 Green-street, Bethnal Green 3,500 2,030 1,470 Barnaby 6,100 2,875 3,225 Upper-street, Islington 2,500 950 1,550 Brightlingsea 4,100 1,000 3,100 Hampstead, High-street 2,500 1,500 1,000 Bekesbourne 2,350 1,120 1,230 Metropolitan Board of Works (Various Powers) Act, 1885— Rosebery-avenue 30,000 24,775 5,225 Darcy Wandsworth-road 2,350 •4,596 1,250 1,560 1,100 3,036 Total for Street Improvements 255,435 131,007 124,428 .^it- 416.277 108,213 308,064 Total 727,535 329.922 397.613 882.080 271,574 610,506 * Wholly or partly based on the capitalisation of annual ground rents. * Actual cost of site purchased for re-housing purposes. + Erected as a lodging house under Part III., but provides accommodation in connection with Shelton - street Scheme. t Erected as a lodging house under Part III., but provides accommodation in connection with Mill - lane, Deptford, Scheme. § For Statutes under which these dwellings are erected, see page 28. APPENDIX XIX. A.— Number of Tenements Comprised in the Dwellings in Occupation on 31st March, 1911, together with Particulars of the Dwellings Opened between that date and 31st March, 1912. Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total tenements. Total rooms. Cubicles. Number of persons provided lor. Shops. Workshops. Stables Sheds. Cupboaids 1 room 2 rooms. 3 rooms 3 rooms with additional small bearoom. 4 rooms 5 rooms 6 rooms Total number of tenements, etc. in occupation on 31st March, 1911 191(a) 3,459 3,634 273(6) 915 472(c) 3 8,947 25,141 1,84? 51,856 102 97 12 192 17 Dwellings opened during the year 1st April, 1911, to 31st March, 1912 — Norbury Estate — Croydon Newbands - road Dec., 1911 ) & Mar. 1912 1 •• 25 3 28 87 174 2 " •• •• Northborough - road July & ) Aug., 1911' 4 26 30 116 232 •• Norton-gardens Sept., 1911 4 18 22 84 •• 168 •• •• •• •• •• Tylecroft - road June, 1911 16 4 20 64 128 • • •• •• 49 51 100 351 702 2 Totterdown Fields— Wandsworth Church-lane Aug., 1911 11 41 88 Coteford - street June to ) Aug., 1911) 48 12 1 61 196 380 Cowick - road June & 1 Aug., 1911 1 48 8 1 57 180 352 Lessingham - avenue May & ) Aug., 1911) •• 27 27 108 216 . . . . 96 20(b) 40 156 528 1,036 (b) These cottages are reckoned as containing 4 rooms, accommodating 7 persons. (c) Five of these tenements contain 1 small room, reckoned as accommodating 1 person only. Housing of the Working Classes—Statistics. li. lii. Annual Report of the London County Council 1911. (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 4 rooms, accommodating 7 persons. (c) Five of these tenements contain 1 small room, reckoned as accommodating 1 person only. (d) These cottages contain 4 rooms with a small additional bedroom, each reckoned as containing 5 rooms accommodating 9 persons. (e) Seven of these lettings contain 1 small room and each is reckoned as accommodating one person only. A.—Number of Tenements Comprised in the Dwellings in Occupation on 31st March, 1911, together with Particulars of the Dwellings Opened between that date and 31st March, 1912 — (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 additional small bedroom. 4 rooms? 5 rooms 6 rooms White Hart-lane— Tottenham Benington-road , . April, 1911 . . 20 .. .. 20 80 160 Risley-avenue Nov., 1911, to Feb., 1912 J •• •• 6 • • 41 2(d) • • 49 192 •• 382 •• •• •• •• •• 6 61 2(d) 69 272 542 Total number of cottages, opened during year to 31st March, 1912. | •• 151 20(6) 152 2(d) • • 325 1,151 •• 2,280 2 •• •• •• •• Alteration to cottage flats at Totterdown Fields Estate. Additional cubicles and sheds brought into charge :— + 1 —1 —1 —2 " Bruce House , , Nov., 1911 , , , , 7 7 Briscoe-buildings April & "I Sept., 1911) .. . •• •• •• •• •• •• •• 10 •• •• •• 1 150 20(6) 152 2(d) • • 325 1,150 7 2.285 2 •• •• 10 Total number of tenements, etc, open on 31st March, 1912.. 191(a) 3,460 3,784 293(6) 1,067 474(e) 3 9,272 26,291 1,856 54,141 104 97 12 202 17 Housing of the Working Classes -Statistics„ liii. B.— A.CCOMMODAT I ON PROVIDED IN ALL THE COUNCIL'S DWELLINGS OPEN ON 31ST MARCH, 1912. 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 room? 6 rooms nn-street - dwellings— Poplar Adelaide-buildings Sept., 1901 .. 25 15 . . .. . . 40 95 190 Melbourne-buildings Nov., 1902 .. 30 10 . . .. .. • • 40 90 .. 180 Sydney-buildings 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 Bekesboume-buildings Stepney July, 1907 , . 45 20 . . 10 ., s • 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 Boundarv-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 •• •• •• <i Marlow - buildings '' March, 1897 12 17 5 34 129 258 6 17 Shiplake - buildings '' March, 1897 25 I 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 A 20 62 124 Wargrave-buildings '' May, 1899 45 15 60 135 270 Cookharn-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 •• 5 17 jiv. Annual Report of the London County Council, 1911. Housing of the Working Classes—Statistics. , lv. b—accommodation Provided in all the Council's Dwellings open on 31st March, 1912—[continued). Dwellings. Metropolitan Borough. )ate opened. Number of tenements c»f Total tenements Total rooms. ubicles. Number of persons provided for. Shops. Work shops. Stables Sheds. Cup boards 1 room. 2 rooms. 3 rooms. 3 rooms with small additional bedroom. 4 rooms 5 rooms 6 rooms Beurne - estate— Holborn 55 125 250 Denys-buildings Oct., 1902 •• 40 15 15 • * ,, * * 55 125 250 Frewell - buildings Jan., 1903 40 5 • * 55 115 230 Scrope-buildings Jan., 1903 50 * * 55 125 250 Skipwith-buildings Feb., 1903 40 15 • * * * 55 115 230 25 Ledam-buildings March, 1903 50 5 * * * * 30 60 120 25 Shene-buildings May, 1903 50 97 * * 127 355 710 Redman-buildings Oct., 1904 11 oi 21 105 301 602 23 Radclifi-buildings June, 1904 5 25 48 537 1821 2642 23 50 16 306 167 48 Union-buildings area— Holborn 10 40 120 240 Buckridge-buildings Oct., 1908 10 20 20 90 * * * * 45 145 290 Kirkeby-buildings Aug., 1908 10 15 1 * * 71 183 366 15 14 Iianey-buildings.. April, 1908 4 29 29 1 1 71 182 364 Nigel-buildings Dec., 1907 11 20 11 630 1260 15 15 69 96 46 1 Brightlingsea -buildings Stepney Sept., 1904 5 20 35 5 65 113 170 359 •• 340 718 10 Briscoe-buildings Lambeth Oct., 1906.. 10 (0 30 Brook-street-dwellings— Stepney 20 40 100 200 Beaehcroft-building3 .. Sept., 1894 18 18 54 108 Cranford - cottages July, 1900 20 38 58 154 308 Cable-street dwellings— Stepney 50 130 260 Bewley-buildings March, 1896 20 30 * * 50 130 260 Dellow-buildings March, 1896 20 30 • * 40 69 139 Lowood-buildings May, 1901 (a)11 29 * * 40 69 139 Chancery-buildings May, 1901 (a)11 29 • • • * • • 180 398 798 22 98 60 Caledonian-estate— Islington 30 90 180 Burns-buildings July, 1906.. 30 30 30 90 180 Scott-buildings July, 1906.. 70 170 340 Wallace-buildings July, 1906.. 40 30 ' ' 66 166 332 Knox-bui1,dings July, 1906.. 36 26 30 76 176 352 Bruce-buildings.. Oct., 1906.. 0 40 ou - * * 272 692 1384 6 116 140 Chadworth-buillings.. Finsbury April, 1907 58 68 10 136 360 720 19 Churchway-dwellings— St. Pancras 80 180 360 Wellesley-buildings March, 1901 60 aft 20 10 • * 60 128 256 . Seymour-buildings July, 1902 2 20 4 40 108 . . 216 Somerset-buildings Aug., 1902 ~ 416 882 2 124 50 4 Cobham-buildings Southwark .. Oct., 1900 (a) 39 20 •• •• •• •• 60 139 * " 279 Cntton-street-dwellings— Poplar 25 25 50 125 . . 250 Montreal-buildings Sept., 1901 5 15 20 55 • . 110 Toronto-buildings Sept., 1901 70 180 860 30 40 Council-buildings, Poplar .. Poplar April, 1894 30 6 20 6 •• •• •• 50 12 120 30 •' 240 60 Cranley-buildings Holborn Oct., lo97 15 40 95 190 Darcy-buildings Hackney July, 1904 29 23 4 56 87 174 12 12 Dufierin-street dwellings Finsbury April, 1892 Duke's-court dwellings— Westminster 35 15 50 115 230 Fletcher-buildings April, 1902 May, 1902 10 15 5 10 40 95 190 Beaumont-buildings 25 15 40 95 190 Sheridan-buildings Aug., 1902 180 805 610 /0 75 GO Durham-buildings Battersea July, 1904 .. 56 52 •• •• • • 108 268 536 East Greenwich cottages— Greenwich 12 8 4 24 64 128 Collerston-cottages june, 1894. 12 8 16 36 112 224 Armitage-cottages • * 6 8 18 56 112 W estview-cottages Aug.,1894 78 282 464 80 20 28 1 44 Goldsmith's-row-cottages Shoreditch . Sept., 1895 •• 8 12 5 25 72 Green-street and Boyfield- Southwark street (late Gun-street] dwellings— 6 36 72 144 Albury-buildings June, 1897 6 18 6 30 60 120 Clandon-buildings 12 6 18 42 84 Merrow-buildings AUg.,1897 Aug 1897 1 17 18 35 70 •• 8 aug.,1897 418 8 * 13 71 18 102 209 Hardy-cottages Greenwich . July, 1901 51 •• •• 51 153 •• 306 Herbrand-street-dwellings— Feb 1904 50 , , .. 50 100 200 Coram-buildings 4 20 30 10 .. 60 110 220 Dickens-buildings . 4 20 30 ) # # 50 130 260 •• Z 0 3 Thackeiav-buildings 160 840 680 28 H 20 100 40 (a) One of the one-roomed tenements in each of these buildings contains abed recess, and is reckoned as accommodating three persons. 7c9zi w W Ivi. Annual Re-port of the London County Council, 1911. Housing of the Working Classes—Statistics• lvii. B.—Accommodation Provided in all the Council's Dwellings open on 31st March, 1912—(continued). Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total tenements Total rooms. Cubicles. Number of persons provided for. Shops. Workshops. Stables Sheds. Cupbeards. 1 room. 2 rooms 3 rooms. 3 rooms with small additional bedroom 4 rooms 5 rooms 6 rooms Holmwood-buildings.. Southwark .. April, 1900 12 4 16 36 .. 72 Hughes-fields-cottages Greenwich .. Jan., 1895 71 61 2 134 333 666 H ughes-fields-dwellings— Drake-buildinjs Deptford Sept., 1904 10 30 . . 40 110 220 1 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 Idenden-cottages Greenwich Aug., 1896 50 50 200 400 Mallory-buildings Finsbury .. j July, 1906 1 15 17 33 82 164 5 Millbank estate— Westminster Hogarth-buildings May, 1899 . . 21 22 10 i 54 153 306 Millais-buildings June, 1900 15 10 25 60 120 Leighton-buildings July, 1900 15 10 25 60 120 Romnev-build ings 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 Mulread y-build ings 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-buildings 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— Croydon Bavant-road May, 1906.. 8 9 16 6 39 154 .. 299 Bulkeley-road Feb., 1908.. . . 16 20 36 164 312 Newlands-road May, 1906.. 55 16 8 8 87 301 586 2 Northborough-road April, 1906 30 103 12 145 562 1124 Norton-gardens Oct., 1910 .. 4 . . 22 26 100 200 Palmers-road Feb., 1906 6 8 2 16 6 126 Tyliecroft-road .. June, 1910 42 38 20 100 358 678 139 85(a) 177 48 449 1705 3325 • 1. • Preston's-road estate— Poplar • St. Lawrence-cottages .. March, 1904 .. 14 •« 14 42 84 J Ottawa-buildines March, 1904 #. 25 25 . , 50 125 250 a Baffin-buildings March, 1904 .. 20 5 . . . . 25 55 110 Ontario-buildings Aug., 1904 .. 25 25 . . 50 125 250 Hudson-buildings July, 1904 .. 20 5 25 55 110 Winnipeg-buildings Sept., 1904 25 25 50 125 250 Quebec-buildiilgs Sept., 1904 25 25 50 125 250 140 124 264 652 1304 Shelton-street-dwellings— Holborn Aldwych-buildings 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 3 45 11 4 63 142 284 20 Swan-lane - dwellings— Bermondsey Winchelsea - buildings 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 , 0 255 635 1270 Sylva - cottages Deptford March, 1903 24 24 72 144 Totterdown-fields estate— Wand sworth Blakenham-road Aug., 1903 . . 26 8 34 110 220 Church-lane May, 1905 . . 11 16 27 124 248 Coteford-streer June, 1903 165 82 1 # # 248 827 1572 Cowick-road May, 1903 . . 48 228 8 1 # . 285 816 1624 Deiinton-road Aug., 1903 159 64 67 23 313 1116 2168 Franciscan-road Jan., 1907.. 41 41 205 410 4 Lessingham-avenue May, 1903 . . 18 113 95 226 981 1962 Ruislip-street Mav, 1903 . . 29 4 # . 33 103 206 Okeburn-road Oct., 1909 .. 54 54 216 378 48 625 208(a) 205 175 1261 4498 8788 4 Valette-buildings Hackney Mav, 1905 39 34 7 80 208 416 Wandsworth-road-d wellings— Lambeth Lennox-buildings May, 1905 3 17 20 . . . , , . 40 97 194 Clere-cottages May, 1905 7 7 21 .. 42 B S 17 37 47 118 236 ^ (a) These cottages are reckoned as containing 4 rooms, accommodating seven persons. HJl 2 12532 lviii. Annual Report of the London County Council, 1911. 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. (а) Three of these tenements also contain a bed recess, and each is reckoned as accommodating three persons. (б) These cottages are reckoned as containing 4 rooms, accommodating seven persons. (c) Five tenements in Mawdley-buildings contain 1 small room, reckoned as accommodating one person only. (d) Two cottages contain 4 rooms with a small additional bedroom, each reckoned as containing 5 rooms, accommodating 9 persons. (e) Seven of these lettings contain 1 small room reckoned as accommodating one person only. B.—Accommodation Provided in all the Council's Dwellings open on 31st March, 1912-^(continued). Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total tenements Total rooms. Cubicles. Number of persons provided for. Shops. Workj shops. Stables. Sheds. Cupboards. 1 room. 2 rooms. 3 rooms. 3 rooms with smal additiona bedroom 4 rooms 5 rooms |6 rooms Webber-row estate— Southwark Delarch-buildings Nov., 1906 • • 20 25 .. 45 115 230 Overy-buildings Nov., 1906 20 25 • > .. 45 115 230 A1 gar-buildings Dec., 1906.. 20 25 45 115 230 Dauncy-buildings Jan., 1907.. 20 25 .. 45 115 230 Mawdley-buildings March, 1907 3 13 16 3 5 (e) 40 114 223 10 - 3 93 116 3 5(c) 220 574 1143 10 Wenlake-buildings Finsbury March, 1905 25 46 15 86 248 496 Wessex-buildings Islington Oct., 1904 5 140 80 225 525 1050 White Hart-lane estate— Tottenham Awlfield-avenue May, 1909.. 16 11 27 119 238 Balliol-road July, 1910 29 .. 29 87 174 Benington-road Feb., 1911 32 32 128 256 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 .. 10 97 59(d) 166 713 1424 Shobden-road March, 1907 22 15 37 163 326 Siward-road Feb., 1907.. 46 46 138 276 Spigurnell-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 .. 39 162 324 224 272 237(d) 733 2945 , 5888 York-street dwellings— Westminster Stirling-buildings June, 1903 5 20 15 . . , . , . 40 90 . . 980 Siddons-buildings June, 1903 5 10 20 5 40 105 210 10 SO 35 5 SO 195 390 Bruce House Westminster , July, 1906.. 708 708 3 Carrington-house Deptford Nov., 1903 .. . . . . , . , . . # . . 803 803 3 Parker-street-house .. .. Holborn Jan., 1893 •: •• • • •• •• • • •• •• 345 345 2 Totals .. 191(a) 3,460 3,784 293(6) 1,067 474(e) 3 9.272 26,291 1,856 54,141 104 97 12 202 17 dousing of the Working Classes—Statistics. lii. C.—Rents Charged at the Council's Dwellings. Dwellings Borough. Rent per week of tenements. Rent per night of cubicles. Rent per week of workshops. Rent per week of stables. Rent per week of sheds. Rent per week of cupboards. Gross rent per annum on 31st March, 1912. I room. 2 rooms. 3 rooms. 8 rooms with small additional bedroom. 4 rooms. 5 rooms. 6 rooms. Ann-street-dwellings Poplar 5/_ to 6/- 6/6 to17/6 .. £ S. d; 2,129 8 - Barnaby-buildings Bermondsey 5/6 & 6/- 7/6 & 8/- . . •• •• * * .. 1,427 8 - Battersea - bridge - buildings Battersea 4/- 4/9 to 5/6 6/3 to 7/- . , 3d. 963 6 - Bearcroft-buildings Fulham 5/9 to 7/- 8/6 to 9/6 .. 3d. 876 17 - Bekesboume-buildings .. Stepney , , 5/- to 6/- 6/6 to 7/6 .. 8/- & 8/6 .. . , 1,240 4 - Borough-road-d wellings 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 13/- 10/6 to 14/- 12/6 3/6 to 6/6 6d. 3d. 23,024 17 - Bourne estate (including shops) Holborn 4/6 to 6/- 7/6 to 8/6 9/6 to 11/- • • 1 l/-to 13/- .. 3d. 13,384 10 - Bnghthngsea-buildings .. Stepney 3/6 & 4/- 5/- & 5/6 6/6 to 7/6 •• 8/- & 8/6 .. .. . . . . 1,082 18 - Briscoe-buildings Lambeth . . 6/6 & 7/- 7/6 to 8/6 10/-toll/6 3d. 2,527 4 - Brook-street-dwellings .. Stepney . . 5/6 7/-to 8/- m # .. 1,014 - - Bruce-house (including shops) Westminster •• •• •• 6d., 7d., 1/-&1/2 • • •• 7,709 14 2 Cable-street-dwellings .. Stepney 4/6 & 5/- 5/6 to 6/6 7/6 . . 9 # 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 7,704 13 5 Chadworth-buildings (including shops) Finsbury 6/- to 7/- 8/- to 9/- 10/-to11/- 1/- 3,393 10 - Churchway-d wellings St. Pancra3 .. 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 .. 741 - - Dufferin-street-dwellings Finsbury 2/3 to 2/9 4/6 to 5/- 6/6 & 7/- 1/6 1/- 629 4 - Duke's-court-dwellings .. Westminster.. v- . 6/6 8/6 10/6 2,418 - - *Durham-buildings Battersea 3/6 to 4/9 4/9 to 5/6 1,344 4 - 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 Boyfield- street (late Gun-street) dwellings Southwark .. 4/6 & 5/- 6/6 & 7/- 8/6 .. .. .. •. .. 1,783 12 - * At these buildings the local rates are paid by the tenants. lx- Annual Report of the London County Council, 1911. C.—Rents Charged at the Council's Dwellings.—(continued). Dwellings: Borough. Rent per week of tenements. Rent per night of cubicles. Bent per week of workshops. Rent per week o stables Rent per week of sheds. Rent per week of cupboards Gross rent per annum on 31st March, 1912. 1 room. 2 rooms. 3 rooms. rooms witli small additional bedroom. 4 rooms. 5 rooms. 6 rooms. 1 £ s. d. Hardy-oottages Greenwich .. 6/- to 7/- 876 4 - Herbrand-street -dwellings Holborn 3/6 & 4/- 6/- & 6/6 8/- & 8/6 .. .. 3d. " ! 2,767 14 - Holmwood-buildings Southwark .. 8/- & 9/- 11/6 } 386 2 - Hughes-fields-cottages Greenwich .. 5/- & 5/6 6/- to 6/6 7/- f .. 2,044 18 - Idenden cottages Greenwich .. 8/6 & 9/- 1,131 - - Mallory-buildings Holborn 5/- 6/- to 7/- 8/6 to 9/6 910 16 - 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 ,. 10,490 14 - Parker-street-house (ineluding shops) Holborn 6d. 3,268 1 7 Preston's-road-estate Poplar 4/6 & 5/- 6/6 to 8/- 3,983 4 - Raleigh, Drake and Ben- Greenwich bow-buildings (Hughesfields-dwellings) and Deptford 5/- & 5/6 6/- & 6/6 7/- & 7/6 • • 1,913 3 4 Shelton-street-dwellings Holborn 5/- 6/6 to 8/- 9/6 11/- & 11/6 . . 4/6 to 6/- 1,554 16 - S wan-lane-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 6/6 to 9/- 9/-&10/- 9/- to 11/— 10/6 to 13/6 * * 29,341 4 - Union-buildings (including shops) Holborn 4/6 & 5/- 7/- to 8/- 9/- to 10/- 10/6 to 11/6 12/- 4d. 6,013 12 8 Valette-buildings Hackney 6/6 & 7/- 8/6 & 9/- . . 10/6 1,675 14 - 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 4,906 8 - 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/- 17,461 12 - York-street-dwellings Westminster.. 4/6 6/6 j 8/6 . •• 10/6 •• •• •• •• 1,519 6 - Total .. £ 213,589 16 2 lxi. Housing of the Working Classes—Statistics. lxi- D.— Accommodation Provided in the Council's Dwellings, and the Gross Rent per annum on 31st March, 1892, and each subsequent Year. Year. Tenements. Rooms. Cubicles. Persons provided for. Gross annual rent. 1892 56 87 — 174 £ s. d. 629 4 - 1893 56 87 324 498 3,577 12 - 1894 56 87 324 498 3,577 12 - 1895 358 871 324 2,066 8,119 11 8 18% 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 3,525 321 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 12, 80 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 31,343 129,129 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 23,578 1,846 49,003 194,019 15 1911 8,947 25,006 1,849 51,856 207,340 17 4 1912 9,272 26,291 1,856 54,141 213,589 16 2 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, 1911. Duiing year 1911-12. Total. Ann-street-dwellings Poplar 25 25 Bekesboume-buildings Stepney 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 £ 13 Herbrand-street-dwellings Holborn 91 91 Millbank estate Westminster.. 174 174 Preston's-road-d wellings Poplar 8 8 Swan-lane-dwellings Bermondsey .. 186 186 Russell-court-dwellings Westminster.. 323 323 Webber-row estate Southwark .. 12 12 Wenlake-bu'.ldings Finsbury 41 41 Totals 1,756 1,756 lxii. lxii. Annual Report of the London County Council, 1911. F.— Number of Lettings effected, the number of Tenants who Vacated their Tenements and the number of Tenants who were Transferred to other Tenements in the Council's Dwellings during the Year 1911-1912. ! Dwellings. Metropolitan Borough. Number of tenements Number of lettings effected. Number of vacations, excluding transfers. Number of Transfers not included In number of letting! or racatloM Tenant's notice. Council's notice. Total. Percentage. Ann-street-dwellings Poplar 135 72 70 7 77 57 11 Barnaby-buildings Bermondsey 80 37 35 1 36 45 7 Battersea-bridge-buildings Battersea 69 41 43 4 47 68 3 Bearcroft-buildings Fulham 40 15 12 1 13 32 1 Bekesboume-buildings .. Stepney 75 20 14 4 18 24 2 Borough-road-dwellings .. Southwark .. 84 32 30 2 32 38 3 Boundary-street-estate .. Bethnal-green 1,044 305 224 78 302 29 105 Bourne-estate Holborn 537 145 116 30 146 27 61 Brightlingsea-buildings .. Stepney 65 29 28 3 31 48 4 Briscoe-buildings Lambeth 113 64 58 4 62 55 18 Brook-street-dwellings .. Stepney 58 30 30 3 33 57 2 Cable-street-dwellings .. Stepney 180 43 44 2 46 26 13 Caledonian-estate Islington 272 147 123 7 130 49 41 Chadworth-buildings Finsbury 136 41 39 2 41 30 7 Churchway estate St. Pancras .. 180 56 55 1 56 31 18 Cobham-buildings Southwark .. 60 28 26 2 28 47 1 Cotton-street-dwellings .. Poplar 70 46 40 7 47 69 3 Council buildings, Poplar Poplar 50 30 24 4 28 56 5 Cranley-buildings.. Holborn 12 6 8 .. 8 67 1 . Darcy-buildings Hackney 40 14 13 1 14 35 4 Dufferin-street-dwellings Finsbury 56 8 6 3 9 16 3 Duke's-court dwellings .. Westminster 130 11 9 2 11 9 5 Durham-buildings Battersea 108 39 72 4 76 70 24 East Greenwich-cottages Greenwich .. 78 26 28 1 29 37 1 Goldsmith's-row-cottages Shoreditch .. 25 9 10 .. 10 40 4 Green-street and Boyfieldstreet dwellings Southwark .. 102 33 26 4 30 30 3 Hardy-cottages Greenwich .. 51 25 25 2 27 53 2 Herbrand-street-dwelJings Holborn 160 9 8 1 9 6 31 Holmwood-buildings Southwark .. 16 7 6 1 7 44 Hughes-fields-cottages .. Greenwich .. 134 56 42 - 7 49 37 7 Hughes-fields-dwellings .. Deptford 120 81 69 6 75 63 11 Idenden-cottages .... Greenwich .. 50 9 9 1 10 20 3 Mallory-buildings Finsbury 33 4 4 4 12 Millbank-estate Westminster 895 199 187 13 200 22 41 *Norbury estate Croydon 449 213 103 2 105 23 47 Preston's-road estate Poplar 264 130 109 24 133 50 17 Shelton-street-dwellings.. Holborn 63 12 12 1 13 21 3 Swan-lane-dwellings Bermondsey 255 102 85 10 101 39 28 Sylva-cottages Deptford 24 8 7 1 8 33 • • *Totterdown-fields-estate.. Wandsworth 1,261 513 343 48 391 31 88 Union-buildings Holborn 227 57 46 9 55 24 7 Valette-buildings Hackney 80 41 41 1 42 52 3 Wandsworth - road - dwellings Lambeth 47 11 11 • • 11 23 2 Webber-row-estate Southwark .. 220 78 80 2 82 37 10 Wenlake-buildings Finsbury 86 25 24 24 28 1 Wessex-buildings.. Islington 225 102 95 2 97 43 10 *White-Hart-lane estate .. Tottenham .. 733 308 177 11 188 24 20 York-street-dwellings Westminster 80 33 33 2 35 44 •• Totals 9.272 3,350 2,699 3-27 3,026 33 681 * New cottages were opened at these estates during the year. Ixiii. Housing of the Working Classes—Statistics. Ixiii. Percentage of Total Outgoings for Maintenance on the Rent Receivable for the last Five Years. Dwellings. Metropolitan Borough. 1907-8. 1908-9. 1909-10 1910-11. 1911-12. (b) Ann-street-dwellings Poplar 40 42 45 45 41 Barnaby-buildings Bermondsey.. 39 43 44 43 40 Battersea-bridge-buildings Battersea 37 39 40 39 30 Bearcroft-buildings Fulham 21 21 21 23 34 37 Bekesboume-buildings Stepney (a)37 39 39 39 36 37 Borough-road-dwellings Southwark .. 39 41 42 41 036 38 Boundary-street estate Bethnal-green 41 41 42 42 331 Bourne estate Holborn 34 35 35 35 037 58 Brightlingsea-buildings Stepney 38 40 41 40 39 39 Bruce house Westminster 54 55 54 58 040 39 Briscoe-buildings Lambeth 27 34 41 40 Oo40 O39 Brook-street-dwellings Stepney 41 43 43 44 39 47 Cable-street-dwellings Stepney 42 42 41 41 35 Caledonian estate Islington 26 36 37 37 Ol 25 Carrington house Deptford 50 48 47 47 31 Churchway-dwellings St. Pancras .. 36 37 37 37 39 Clerkenwell & Holborn-dwellings 40 Mallory-buildings Holborn (a)25 (a)32 { 30 37 Union-buildings 34 32 25 Cobham-buildings Southwark .. 39 42 43 43 31 3Q39 Cotton-street-dwellings Poplar 36 41 44 44 40 Council-buildings, Poplar Poplar 43 41 45 47 44 Cranley-buildings Holborn 38 39 40 41 37 35 Darcy-buildings Hackney 35 38 40 IX 38 53 35 Dufferin-street-dwellings Finsbury 56 57 59 58 53 Duke's-court-dwellings .. Westminster.. 37 38 37 36 00 34 Durham-buildings Battersea 38 39 39 40 ot 30 East Greenwich-cottages Greenwich .. 40 41 41 40 <j\j 35 Goldsmith's-row-cottages Shoreditch .. 41 41 42 41 OU Green-street and Boyfield-street (late Gun-street) dwellings Southwark .. 39 42 43 42 00 QQ Hardy-cottages .. Greenwich .. 39 41 40 40 oy 37 Herbrand-street-dwellings Holborn 36 37 37 37 3/> Holmwood-buildings Southwark .. 42 45 49 48 0 j 40 Hughes-fields-cottages Greenwich .. 35 36 42 34 39 Hughes-fields-dwellings Deptford 38 38 39 36 Ou 33 Idenden-cottages Greenwich .. 36 37 38 37 00 34, Millbank estate .. Westminster.. 36 36 36 36 32 34. Norbury estate Croydon («)36 32 (a)34 (a)35 (a) 33 Parker-street house Holborn 69 68 \ / 67 \ / ^ 69 64 Preston's-road-dwellings Poplar 37 38 41 40 36 Shelton-street-dwellings Holborn 35 37 37 37 34 St. Luke's-dwellings— Wenlake-buildings Finsbury (o)34 34 j 38 37 34 Chadworth-buildings 32 32 29 Swan-lane-dwellings Bermondsey.. 36 41 43 43 36 Sylva-cottages Deptford 37 37 40 4r> 36 Totterdown-fields estate Wandsworth. . («/34 («)33 (ci)35 U (33 ('031 Valette-buildings .. ;. Hackney 35 37 38 37 34 Wandsworth-road-d wellings Lambeth 37 38 39 38 35 Webber-row estate Southwark .. 35 38 40 39 35 Wessex-buildings.. Islington 26 39 39 39 35 36 White Hart-lane estate .. Tottenham .. (*)28 («)27 (u)24 (a)25 fa)37 York-street-dwellings Westminster.. 35 35 35 V / 34 32 (a) New buildings were opened during this year. (b) After deducting income tax on interest on capital outlay from maintenance outgoings. Formerlysube tax was deducted from debt charges. 12532 lxi'v. Ixj'v. Annual Report of the London County Council, 1911. H.—Population of the Council's Dwellings According to the Enumeration taken in March, 1912. 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 135 315 439 78 72 Barnaby-buildings Bermondsey 80 200 303 59 56 Battersea-bridge-buildings Battersea 69 143 205 32 41 Bearcroft-buildings Fulham 40 110 121 24 18 Bekesboume-buildings Stepney 75 190 250 37 36 Borough-road-dwellings .. Southwark .. 84 200 291 50 54 Boundary-street estate Bethnal-green 1,044 2,690 4,555 845 808 Bourne estate Holborn 537 i 1,321 1 854 291 272 Brightlingsea-buildings Stepney 65 170 200 31 54 Briscoe-buildings Lambeth 113 359 342 58 59 Brook-street-dwellings Stepney 58 154 235 44 42 Bruce-house Westminster.. 708 708 708 . . . . Cable-street-dwellings Stepney 180 398 613 100 75 Caledonian estate Islington 272 692 984 169 176 Carrington-house Deptford 803 803 459 . , . . Chadworth-buildings Finsbury 136 360 551 102 85 Churchway-dwellings St. Pancras .. 180 416 592 79 86 Cobham-buildings Southwark .. 60 139 214 33 37 Cotton-street-dwellings Poplar 70 180 220 35 36 Council-buildings, Poplar Poplar 50 120 150 30 27 Cranley-buildings Holborn 12 30 46 12 4 Darcy-buildings Hackney 40 95 138 25 20 Dufierin-street-dwellings Finsbury 56 87 147 23 16 Duke's-court dwellings Westminster.. 130 305 483 82 60 Durham-buildings Battersea 108 268 265 39 54 East Greenwich-cottages Greenwich .. 78 232 316 74 58 Goldsmiths'-row-cottages Shoreditch .. 25 72 100 10 11 Green-street and Boytield-street (late Gunstreet) dwellings Southwark .. 102 209 336 58 63 Hardy-cottages Greenwich .. 51 153 226 57 55 Herbrand-street-dwellings Holborn 160 340 502 92 86 Holmwood-buildings .. Southwark .. 16 36 39 4 4 Hughes-fieldscottages Greenwich .. 134 333 374 83 75 Hughes-fields-dwellings Deptford 120 330 439 104 87 Idenden-cottages Greenwich .. 50 200 254 50 44 Mallory-buildings Finsbury 33 82 118 13 18 Millbank estate Westminster.. 895 2,215 3,010 478 494 Norbury estate Croydon 449 1,705 1,558 284 252 Parker-street-house Holborn 345 345 344 , , # , Preston's-road estate Poplar 264 652 660 136 122 Shelton-street-dwellings Holborn 63 142 222 41 32 Swan-lane-dwellintrs Bermondsey 255 635 957 158 170 Sylva-cottages Deptford 24 72 101 20 16 Totterdown-fields estate Wandsworth 1,261 4,486 4,329 793 758 Union-buildings Holborn 227 630 872 133 146 Valette-buildings Hackney 80 208 276 48 42 Wandsworth-road-dwellings Lambeth 47 118 148 26 19 Webber-row estate Southwark .. 220 574 764 116 135 Wenlake-buildings Finsbury 86 248 348 44 37 Wessex-buildings Islington 225 525 730 116 121 White Hart-lane estate Tottenham .. 733 2,945 2,541 500 477 York street dwellings .. Westminster.. 80 195 292 39 48 Totals .. 11,128 28,147 34,221 5,755 5,758 kv Housing of the Working Classes—Statistics. lxv 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, 1912. Dwellings. Metropolitan Borough. Erysipelas. Measles. Scarlet Fever. Typhoid. Diphtheria. Chickenpox. Ann-street-dwellings Poplar 2 1 Barnaby-buildings. Bermondsey ... 1 ... . • • . ... liattersea-bridge-buildings Battersea 3 ... ... 4 Bearcroft-buildings Fulham 1 ... Bekesboume-buildings Stepney 1 • Borough-road-dwellings Southwark ... • •• 2 ... Boundary-street estate Bethnal-green 1 11 u Bourne estate Holborn 1 1 2 Brightlingsea-buildings Stepney ... ... ... Briscoe-buildings ... Lambeth ... 1 2 Brook-street-dwellings Stepney 1 ... ... Cable-street-dwellings Stepney 4 1 •.. Caledonian estate ... Islington • • • 1 ... Chadworth-buildings Finsbury • •• 1 2 2 Churchway-buildings St. Pancras ... 1 1 4 • •• Cobham-buildings ... Southwark ... ... Cotton-street-dwellings Poplar 2 ... Council-buildings Poplar ... Cranley-buildings Holborn ... Darcy-buildings Hackney ... Dufferin-street-dwellings Finsbury ... ... Duke's-court-dwellings Westminster... ... 1 4 Durham-buildings Battersea 2 ... East Greenwich-cottages Greenwich 2 2 Goldsmith's-row-cottages Shoreditch ... 1 ... ... ... Green-street and Boyfield-street (late Gunstreet) dwellings Southwark ... ... 1 ... Hardy-cottages Greenwich ... 3 ... ... Herbrand-street-d wellings Holborn • • * 1 . . • ... Holmwood-buildings Southwark ... 1 ... Hughes-fields-cottages Greenwich ... 2 1 ... Hughes-fields-dwellings Deptford 2 1 Idenden-cottages Greenwich ... 2 ... ... Mallory-buildings Finsbury 1 1 Millbank estate Westminster... 13 (a) Norbury estate Croydon 1 6 Preston's-road estate Poplar 2 1 Shelton-street-dwellings Holborn 2 2 i Swan-lane-dwellings Bermondsey ... 3 1 ... Sylva-cottages Deptford .. • • •• ... (a)Totterdown-fields estate Wiindsworth... 4 5 ... Union-buildings Holborn 2 1 2 Valette-buildings Hackney 1 ... 1 ... Wandsworth-road-dwellings Lambeth ... • • . Webber-row estate Southwark ... ... ... 3 ... Wenlake-buildings Finsbury 1 1 2 Wessex-buildings Islington 1 ... ... (a)White Hart-lane estate Tottenham ... 4 3 ... York-street-dwellings Westminster... ... ... 2 ... Totals 3 25 60 6 52 18 (a) New cottages at these estates were opened during the year. 12532 2 lxvi. lxvi. Annual Report of the London County Council, 1911. L.— Particulars of Births and Deaths in the Council's Dellings during the Year ended 31st March, 1912.(a) Dwellings. Borough. Births. Deaths. Occurring in the dwellings. Occurring in institutions. Total. Ann-street-dwellings Poplar 25 6 3 9 Barnaby-buildings Bermondsey 8 1 2 3 Battersea-bridge-buildings Battersea Bearcroft-buildings Fulham 5 1 1 2 Bekesboume-buildings Stepney 15 1 2 3 Borough-road-dwellings Southwark 8 1 1 Boundary-street estate Bethnal-green 124 19 11 30 Bourne estate Holborn 52 12 10 22 Brightlingsea-buildings Stepney 8 2 2 4 Briscoe-buildings Lambeth 5 .. Brook-stieet-dwellings Stepney 10 6 6 Bruce-house Westminster .. 35 35 Cable-street-dwellings Stepney 24 • 4 2 6 Caledonian estate Islington 29 7 3 10 Carrington house Deptford 25 25 Chadworth-buildings Finsbury 18 2 2 Churchway estate St. Pancras 18 2 3. 5 Cobham-buildings Southwark 6 3 1 4 Cotton-street-dwellings Poplar 8 3 3 Council-buildings, Poplar Poplar 6 1 1 Cranley-buildings Holborn 2 .. Darcy-buildings Hackney 2 Dufferin-street-d wellings Finsbury 6 3 1 4 Duke's-court-dwellings .. Westminster 8 7 1 8 Durham-buildings Battersea 12 1 1 East Greenwich-cottages Greenwich 3 1 1 Goldsmith's-row-cottages Shoreditch Green-street and Boyfield-street • (late Gun-street) dwellings Southwark 17 4 4 Hardy-cottages Greenw ich .. 9 Herbrand-street-dwellings Holborn 12 2 1 3 Holmwood-buildings Southwark 1 1 1 2 Hughes-fields cottages Greenwich Hughes-fields-dwellings Deptford 11 1 2 3 Idenden-cottages.. Greenwich 4 2 2 Mallory-buildings Finsbury 2 .. Millbank estate Westminster 71 20 15 35 Norbury estate Croydon 64 2 3 5 Parker-street house Holborn .. 9 9 Preston's-road dwellings Poplar 24 11 1 12 Shelton-street-dwellings Holborn 6 1 1 Swan-lane-dwellings Bermondsey 38 5 .. 5 Sylva-cottages Deptford Totterdown-fields estate Wandsworth 94 27 4 31 Union-buildings Holborn 21 3 2 5 Valette-buildings Hackney 8 .. .. Wandsworth-road-dwellings Lambeth 5 Webber-row estate Southwark 15 8 2 io Wenlake-buildings Finsbury 7 1 . • l Wessex-buildings Islington 19 5 5 White Hart-lane estate Tottenham 66 23 ,, 23 York-street-dwellings Westminster 3 2 3 5 Totals 899 186 160 346 (a) The particulars comprised in thie table for estates within the County have been supplied by the Medical Office of Health, and for estates outside the county by the registrars of the districts. lxvii. Housing of the Working Classes—Statistics. lxvii, M.—Occupations of the Tenants. Nature of occupation. No. Nature of occupation. No. Nature of occupation. No. Agent 84 Farrier 37 Pensioner 73 Artist and draughtsman 25 Fireman 42 Platelayer 20 Attendant 116 Fitter and plumber 131 Police constable, sergeant and Florist 14 detective 349 Baker and confectioner 75 Flusher and sewerman 10 Polisher 47 Barman 30 Foreman 76 Porter 339 Basket and brush maker 10 Furrier 11 Postman 127 Boilermaker 15 Bookbinder 54 Gardener and park keeper .. 24 Railway worker, guard and Bootmaker 101, General dealer and hawker .. 48 signalman 31 Boxmaker 34 Glazier and glassworker 22 Brass finisher 27 Hairdresser 37 Bricldayer, mason and Hat and cap maker 32 Salesman Sin Zoo 17 terer 65| Horsekeeper 32 oawyer .. 11 l/IK Butcher 65 Housekeeper 48 Seaman and coastguard CI 1. * J... ^ 1 - i. 140 1q Butler .. 21 onipwTignt iy CABDRIVER 17' Independent 165 Silversmith and goldsmith .. Soldier Ol 15 vauuiivci Cabinet maker.. 208 Inspector 47 Sorter and Post Ofiice Worker 72 Carman, carrier and coachman 235 Instrument maker 52 Steward 20 Carpenter and joiner.. 15L Stevedore 38 Carpet planner 18 Jeweller.. 11 Stoker 58 Cellarman 18 Journalist 16 Storekeeper 43 Charwoman and cleaner 272 Superintendent and caretaker 63 9,q Labourer .... 549 Checker 1 1 Lamplighter 17 Tailor and tailoress 205 Chemist and analyst.. . 1i 19 r Laundry worker 13 Teacher 43 Cigar and cigarette maker .. 1*1 OTTrrrrvi o n o t~w i /> nnT/> nWArl/or 14 O 29 Leather worker 46 Telegraphist 32 Clergyman diiu. tiiuitiiwuiivci Clerk 495 Theatre worker 21 Coachbuilder 30 Machinist 71 Timekeeper 22 Commercial traveller 118 Manager and manageress 31 Tinsmith 22 Commissionaire 52 Mechanic 26 Turner .. 28 CAMPOI 124 Messenger 69 VUIIIUUSIUUI • • « • • • flnn n lip.tnr 111 Metal worker 39 TTm nrplln Qiirl dtipL'TYiflliPV 12 Uvuvi ■ • • • • • Cook .. .. 80 Milkman and dairyman 18 U ill u I diet aiiu Ouii/hiiiwivci. • . TTnliol sterer 29 Costermonger .. 24 Miscellaneous 175 V UUvlOUvlvl • • • • • • Crane driver 17 Musician and artiste .. 30 Waiter and valet 125 Cutter .. 25 \T Waitress 11 25 Newsagent 18 Warehouseman 194 Distemper and papernanger.. 20 No occupation 171 Watchmaker 15 Domestic servant tlrpaamti l,ror 26 93 Nurse 34 Watchman 25 L/lcoolllclKtl Waterman, boatman, and Electrician 76 Omnibus and motor driver .. 204 lighterman 54 Engine driver 26 Wheelwright 16 Engineer 115 Packer 115 Wireman and linesman 19 Engraver 13 Painter and decorator 139 Woodcarver 19 APPENDIX XX. STATEMENT SHOWING STATUTES UNDER WHICH DWELLINGS UNDER IMPROVEMENT ACTS 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 Dwellings L.C.C. (General Powers) Act, 1897—Long-lane and Tabard-street widening. Durham Buildings L.C.C. (General Powers) Act, 1898—York-road, Battersea, Improvement and L.C.C (Tramways and Improvements) Act, 1901—Red Lion-street to Tooting High-street Improvement. Duke's-court Dwellings | L.C.C. (Improvements) Act, 1899—Holborn to Strand Improvement. York-street 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 .. j- L.C.C. Thames Tunnel, (Rotherhithe and RatclifE) Act, 1900. Brightlingsea Buildings Bekesbourne Buildings Darcy Buildings \ L.C.C. (Improvements) Act, 1900—Mare-street (Hackney) ImproveJ ment. 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 Palaceroad and High-street widening. kviii. Annual Report of the London County Council, 1911.