43/3 London County Council. Council LCC 21 ANNUAL REPORT OF THE COUNCIL 1912. VOL. III. PUBLIC HEALTH (INCLUDING THE REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER, 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., Agents for the sale of the Publications cf the L ondon County Council. No. 1612. Price 2s. 6d., post free 2s. 10d- 1000—21.2.14—18820 C.1349B. CONTENTS. Chapter XXXII. page Public Health Reports—Report of the County Medical Officer of Health and School Medical Officer for the year 1912—Part I. (Vital Statistics and Administration) 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 and enteritis—Erysipelas—Puerperal fever— Influenza, bronchitis and pneumonia—Phthisis—Cancer—Cerebro-epinal fever—Poliomyelitis —Anthrax—Glanders and hydrophobia in man—Leprosy—Meteorology— B—Administration.—Dairies, cowsheds and milkshops—Offensive businesses—Nuisances—Housing of the Working Classes—Underground rooms—Overcrowding—Houses let in lodgings—Death rates in Council's dwellings—Common lodging houses—Seamen's lodging houses—Cleansing of Persons Act, 1897—Vermin inquiry—Water supply to tenement houses—Revenue Act, 1903—Factory and Workshop Act—Places where food is prepared for sale—Inspection of food—Shelters—Mortuaries—National Insurance Act—Homeless persons—Sanitary officers —Inspection of theatres, music halls, etc.—Rag Flock Act, 1911—Water supply—Intercepting traps—Equalisation of Rates Act—Midwives Act 55 Public Health Reports (continued)—Special reports submitted during 1912 by the Medical Officer of Health 91 I.—Census of homeless persons II.—Sanitary staffs of City Corporation and metropolitan borough councils III.—London Life Table, 1901-1910 Chapter XXXIII. Public Health Reports (continued)—Report of the County Medical Officer and School Medical Officer for the year 1912—Part II. (Education) Introductory Note.—Medical Inspection and Treatment—Government grant—Development during year—"Following up "—After-care—Infectious diseases—Cleansing and personal hygiene schemes 20 Medical Inspection (Elementary Schools)—Results of inspection under the headings of the several ailments found—Comparison of age groups—Condition of school children with reference to environment and social status—Early tuberculosis and X-ray examination ... ... ... 123 Medical Inspection (Training Colleges, Secondary, and Trade Schools) 130 Medical Treatment—Development of scheme—Hospitals, treatment centres—Progress made during 1912—Dental treatment 37 Re-Inspection 41 Education (Provision of Meals) Act 142 Physical Exercises for Children Suffering from Defects 142 Infectious Diseases—Amendment of regulations—Scarlet fever and diphtheria—Measles—Whooping cough and chickenpox—Ophthalmia—Ringworm—Favus—Exclusions from school—Places of detention—Residential, industrial and special schools145 Open-Air schools—Birley House—Shooter's Hill 160 Playground Classes 164 Examination of Candidates—For the permanent service—Teachers and county scholars 175 Personal Hygiene Schemes.—Verminous heads—Verminous persons and clothing—Children's Country Holiday Fund 178 Flea Prevalence, 1909-12 183 Schools for Defective Children.—Mentally defective—Physically defective—Deaf and partially deaf—Blind, partially blind, and myope 184 Visual Defects of Children Referred for Treatment 201 Sizes of Types in School Books, etc 205 Industrial Residential Schools, and Places of Detention 210 Miscellaneous.—Children out of school on account of illness—Instruction in swimming—School journeys—School buildings—Playgrounds—School gardens—Health of teachers 210 ii. PAGE Chapter XXXIV. 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 216 Chapter XXXV. Main Drainage 223 Chapter XXXVI. Housing of the Working Classes 226 Chapter XXXVII. Housing Accounts and Statistics.-—Memorandum by the Comptroller (Mr. H. E. Haward) submitting Housing Accounts for the year ending 31st March, 1913—Memorandum by the Housing Manager (Mr. S. G. Burgess), submitting Housing Statistics for the year ended 31st March, 1913 231 Appendixes. I.—Proceedings of sanitary authorities under the Factory and Workshop Act .. .. ii. II.—Percentage of total tenements and overcrowded tenements in each metropolitan borough iv. III.—Training college, secondary and trade schools—Defects noted on medical examination vii. IV.—Number of candidates examined for the permanent service and the conditions found viii. V.—Number of Scholarship candidates examined and the conditions found .. .. viii. VI.—Number of candidates examined for the teaching profession and the conditions found ix. VII.—Dietary tables (residential and industrial schools and places of detention) x. VIII.—Tables of menus for necessitous school children xiii. IX.—Conditions of agreement with hospitals, etc. xv. X.—List of hospitals and centres and provisions made for treatment xviii. XI.—Attendances of parents at medical examinations xix. XII.—Results of medical inspection (clothing, nutrition, cleanliness and teeth) in London boroughs xx. XIII.—Medical inspection of school children—Summary of defects (London boroughs) xxi. XIV.—Medical inspection of school children—Summary of defects (whole county) xxvi. XV.—Re-inspection 1912 xxvii. XVI.—Re-inspection 1912—Council scheme ailments only xxviii XVII.—Housing accounts— A.—Housing of the Working Classes Act, 1890 xxx. B.—Dwellings under Improvement Acts xi. C.—Dwellings under the Housing of the Working Classes Act, 1890, and Improvement Acts combined xivi. D.—Details of Revenue Account—• I.—Housing of the Working Classes Act, 1890 xiviii. II.—Dwellings under Improvement Acts xiviii. E.—Percentages on gross rental of the several items of Income and Expenditure in respect of dwellings in D 1. F.-—Summary of Financial Results— I.—Housing of the Working Classes Act, 1890 iii. II.—Dwellings under Improvement Acts iii. J.—Details of Repairs and Renewals Fund iiv. H.—Contributions from and to rates iiv. iii. page XVIII.—Capital expenditure on clearance schemes under the Housing of the Working Classes lv. Act, 1890 XIX.—Commercial and housing values of sites utilised for the erection of Working Class Dwellings 1vi. XX.—Statutes under which dwellings under Improvement Acts have been erected lvii XXI.—Housing Statistics— A.—Number of tenements in the Council's working-class dwellings Iviii. B.—Accommodation in the Council's working-class dwellings 1x. C.—Rents charged in the Council's working-class dwellings lxvi. D.—Accommodation provided and gross rent per annum on 31st March, 1892, and each subsequent year lxviii. E.—Number of persons re-housed (improvement and clearance schemes) lxviii. F.—Lettings effected, tenants transferred or who vacated, 1912-1913 lxix. G.—Percentage of total outgoings on rent receivable for the last five years.. lxx. H.—Population of the Council's dwellings according to a census taken in March, 1913 lxxi. J.—Cases of infectious disease removed from the Council's dwellings, 1912-1913 lxxii. K.—Births and deaths in the Council's dwellings, 1912-1913 lxxiii. L.—Occupations of the Council's tenants lxxiv. Diagrams. facing page Part I. Diagram A.—Marriages, 1851-1912 5 B.—Births, 1851-1912 5 „ C.—Deaths among males (all causes compared with that from phthisis) 7 „ D.—Deaths (all causes), 1841-1912 10 „ E.—Infantile Mortality, 1858-1912 13 „ F.—Smallpox (mortality), 1841-1912 20 „ G.—Measles (mortality), 1841-1912 24 „ H.—Measles and Whooping-cough (monthly deaths), 1891-1912 24 „ I.—Scarlet Fever (mortality), 1859-1912 26 „ K.—Scarlet Fever (admissions to hospitals of Metropolitan Asylums Board, percent, of total notified cases in London), 1890-1912 26 „ L.—Scarlet Fever (monthly notified cases and case-mortality), 1891-1912 26 „ M.—Diphtheria and Croup (mortality), 1859-1912 29 „ N.—Diphtheria (admissions to hospitals of Metropolitan Asylums Board, per cent, of total notified cases in London), 1890-1912 29 „ O.—Diphtheria (monthly notified cases and case-mortality), 1891-1912 29 „ P.—Whooping-cough (mortality), 1841-1912 33 „ Q.—Typhus (mortality), 1869-1912 35 „ R.—Enteric Fever (mortality), 1869-1912 35 „ S.—Enteric Fever (weekly notified cases, 1912, and 1890-1912) 35 „ T.—Enteric Fever (monthly notified cases and case-mortality), 1891-1912 35 „ U.—Enteric Fever (relative decrease in London, Belfast, and S.W.Germany) 38 „ V.—Diarrhoea and Enteritis (deaths under 2 years of age 1862-1912) 42 „ W.—Phthisis (mortality—males and females), 1851-1912 46 Part II. Diagram A.—Scarlet Fever Notifications, 1912 146 „ B.—Diphtheria Notifications, 1912 146 „ C.—Scarlet Fever and Diphtheria in 30 selected schools 154 „ D.—Measles (deaths, 1840-1912), weekly averages 155 „ E.—Measles (deaths, notified cases and estimated cases), 1906-12 in weekly periods 155 iv. page Diagram G.—Seasonal prevalence of fleas, 1909-12 183 „ H.—Prevalence and degree of myopia at various age periods 201 „ J.—Age incidence of errors of refraction 205 Special Reports. London Life Table, 1901-1910— (a) Population at risk and deaths, 110. (b) Values of px, ls, and mx, 112. (c) Values of Ex and m, 113. Map. F.—Area served by cleansing stations 181 London County Council. ANNUAL REPORT OF THE COUNCIL, 1912. CHAPTER XXXII. REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH (Dr. W. H. IIAMER) FOR THE YEAR 1912. Part I.—General. A—Vital Statistics. The mean temperature of the air during 1912 was 0 9 degrees above the average of the preceding 65 years. The greatest excess over the monthly average occurred in December, March, February and May, the temperature being below the average in August, September, October and, slightly so, in June. The rainfall during the year was very slightly above the average, the excess being greatest in August and the deficit greatest in April. The total number of persons enumerated in London at the Census of 2nd April, 1911, was 4,521,685. This figure was remarkable, inasmuch as it denoted a decrease on the result of the enumeration taken in 1901, amounting to 0.3 per cent, of the total population. During the hundred years from 1801 to 1901 there had been a continued growth in numbers from 959,310 to 4,536,267, though it is necessary to mention that the rate of increase had Since 1881 declined from 17.4 per cent, to 7.3 per cent. Attention has in previous years been drawn to the gradual decentralisation of the London population, but whereas in 1901 only eight of the twenty-nine sanitary districts showed a loss on the figures obtained at the previous census, in 1911 only nine boroughs, and those farthest removed from the centre, showed a gain in numbers. Associated with the decline in London, it is to be observed that the rate of increase in the population of the outer ring was as much as 33.5 per cent., and the rate of increase in all the counties surrounding or adjacent to the metropolis was maintained or exceeded, except in the case of those counties to the east, namely Essex and Kent, where there was a noteworthy reduction in the rate of increase of 13.8 and 6.9 per cent, respectively. The rate of increase for the whole of England and Wales was 10.9 per cent. Further notes on the statistics of population will be found on page 2, but it may be here mentioned that the Registrar-General estimates the total number of persons living in London at the middle of the year 1912 as 4,519,754. As regards the density of population, London, covering an area of 74,816 acres, is pre-eminent among administrative counties with 38,680 persons to the square mile. For the whole of England and Wales the proportion is 618 persons to the square mile. In 1911, with 573,265 occupied houses, London averaged 7.89 persons to each house, as against 7.93 persons in 1901. The number of uninhabited dwellings was 33,006. The average number of persons to each family in all dwellings, was 4.37, but taking into consideration ordinary dwelling houses only, it was 4.24. The marriage-rate again showed an increase on the rate of the previous year, being 18.6 persons married in every 1,000 persons living. The rate, which was as high as 20.6 per 1,000 in the decennium 1851-60, reached a minimum of 16.9 per 1,000 in 1908. Since 1909 there has been a slow but constant increase, and in 1912 the rate was higher than in any year since 1899. The birth-rate (24.5) was the lowest recorded in London since the institution of civil registration. Since 1903 the decline has been continuous, the total diminution in rate amounting to 4.3 per 1,000 living. England and Wales in the same period shows a diminution in rate of 4.7 per 1,000 living. The rate in the several London boroughs shows considerable variation, Finsbury, Shoreditch, Bethnal Green, Stepney, Poplar and Bermondsey having the highest rates, ranging from 5.5 to 7.8 above the mean London rate per 1,000 living. The question of the steady fall in the birth-rate in this and other countries, the influence of migration and other causes, such as the incidence of mortality on special age groups, is discussed on page 6. In 1912 the death rate from all causes, 13.6 per 1,000 living, and the infant mortality rate, 91 per 1,000 births, were both the lowest yet recorded in this series of reports. The decrease in the all causes death rate as compared with that obtaining in the decennium 1901—10 represents a saving to the community of 10,065 lives, equivalent to 487,455 years of life capital. Concerning the principal epidemic diseases, it is to be noted that the death rates from small-pox, measles, whooping cough, scarlet fever, diphtheria, and enteric fever were all below the annual average of the preceding 5 years, as was also the death rate from phthisis; the notifiable infectious diseases, moreover, showed a diminished prevalence. In the section of the report relating to enteric fever, reference is made to recent experience in South-West Germany, and the deductions drawn therefrom are contrasted with the experience of the disease in Belfast and London. (See pages 35-40). Opportunity has been taken in the present report to include a new extended life table for London, based on the mortality experience of the decennium 1901-10. This table shows the expectation of life for each sex at each year of age. The first extended London life table was published as an appendix to the report of the Medical Officer of Health for the year 1901. This life table was based on the mortality experience of the decennium 1891-1900. The method adopted in the construction of the first life table has been followed in the case of the present table, in order that the results obtained may be strictly comparable. Compared with the earlier table, the present table shows that the expectation of life at birth has increased in the case of males by 5.76 years, and in the case of females by 6.08 years, and 18820 a 2 Annual Report of the London County Council, 1912. it is interesting to observe that a comparison of the recently published life table for Salford for the period 1901-10, with the corresponding table for 1891-00, shows similar improvement, the increase in the expectation of life at birth being 6.97 years for males and 7.85 years for females. In the administrative section of the report it is to be noticed that the numbers of licensed cowhouses, slaughter-houses and offensive trades continue to diminis. The annual reports of medical officers of health of the several boroughs contain little reference to serious nuisance and complaints of smoke nuisances appear to be less frequent. A large amount of inspection has been carried out under the Housing, Town Planning Act, 1909, and regulations under this Act dealing with underground rooms have been made by some ten authorities. As regards overcrowding it may be noted that according to the census returns there has been a slight increase of 0.04 per cent, in the percentage of the total population living in overcrowded tenements of one to four rooms. It should, however, be pointed out that the standard adopted by the Census Office is perforce an arbitrary one, and is based on the assumption that tenements are overcrowded where they contain an average of more than two persons to a room. This does not correspond with the statutory definition of overcrowding based on a measurement of cubic space per head. Indeed, during the last intercensal period there has undoubtedly been considerable improvement as regards the conditions of occupation of tenemented dwellings. Moreover, from the information supplied by medical officers of health, from 3,000 to 4,000 overcrowded dwelling rooms are dealt with annually, and although there may be relapse in some cases, the tendency has certainly been to a reduction in the absolute number. Common lodging-houses again show a reduction in numbers and in authorised accommodation, although as far as can be judged from the various censuses undertaken by the Council, the number of inmates varies but little. The accommodation, however, has always been in excess of the use by some thousands of beds. Seamen's lodging-houses show but little variation. A considerable amount of work is now being done in London in connection withthe Cleansing of Persons Act, 1897, and the sections of the Council's General Powers Acts dealing with cleansing. Details are given of the number of cleansings, both of the person and of rooms. (See pages 71-2). On the night of the 9th February, 1912, the seventh enumeration of homeless persons was undertaken by authority of the Public Health Committee. As is pointed out on page 79, the numbers obtained were some 1,500 less than in 1910, when the figures reached a maximum; the full text of the report is included in chapter XXXIIa. Some notes on sanitary officers in London are contained on page 79, and the eleventh return which has been prepared on this subject was published during the year under review, and is reproduced in chapter XXXIIa. Population. The population of the Administrative County of London estimated to the middle of the year 1912 was 4,519,754. On 2nd April, 1911, the date of the last census, the enumerated population was 4,521,685, comprising 2,126,341 males and 2,395,344 females in 1,033,861 families. The difference to be observed in the proportions of the sexes is not peculiar to London, for throughout England and Wales the preponderance of females has, on the whole, steadily increased. Indeed, in all the principal European States there is an excess of females over males, although, with the exception of Norway, in relatively smaller proportions than in England and Wales. The ratio per 1,000 of females to males in England and Wales was 1,068, while in London it was 1,127. Residential counties in which large numbers of domestic Servants are employed and to which the unoccupied classes (preponderantly female) resort for residence, such as Sussex, Surrey, Middlesex and the Isle of Wight, ranged from 1,130 to 1,256 females per 1,000 males, whilst in the mining counties such as Monmouthshire, the proportion of females to males was as low as 908 to 1,000. The census populations of London boroughs in 1901 and 1911 and the mid-year populations in 1912, 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 (middle of year 1912). Metropolitan borough. Census Population 1st April, 1901. Census Population 3rd April, 1911. Estimated Population (middle of year 1912). Paddington 143,976 142,551 142,362 Shoreditch 118,637 111,390 110,430 Kensington 176,628 172,317 171,746 Bethnal Green 129,680 128,183 137,985 Hammersmith 112,239 121,521 122,750 Stepney 298,600 279,804 277,315 Fulham 137,289 153,284 155,402 Poplar 168,822 162,442 161,597 Chelsea 73,842 66,385 65,397 Southwark 206,180 191,907 190,017 Westminster, City of 183,011 160,261 157,248 Bermondsey 130,760 125,903 125,260 St. Marylebone 133,301 118,160 116,155 Lambeth 301,895 298,058 297,550 Hampstead 81,942 85,495 85,966 Battersea 168,907 167,743 167,589 St. Pancras 235,317 218,387 216,145 Wandsworth 231,922 311,360 321,881 Islington 334,991 327,403 326,398 Camberwell 259,339 261,328 261,591 Stoke Newington 51,247 50,659 50,581 Deptford 110,398 109,496 109,377 Hackney 219,110 222,533 222,986 Greenwich 95,770 95,968 95,994 Holborn 59,405 49,357 48,026 Lewisham 127,495 160,834 165,249 Finsbury 101,463 87,923 86,130 Woolwich 117,178 121,376 121,932 London, City of 26,923 19,657 18,695 London 4,536,267 4,521,685 4,519,754 3 Report of the County Medical Officer—General. The proportion of the London population at different ages, all ages being taken as 10,000, in the last eight censuses is shown in the succeeding tables. Males. Age period. 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 + 1841 1,249 1,053 974 904 1,024 1,827 1,324 861 478 231 66 9 1851 1,324 1,096 969 895 977 1,764 1,306 868 489 238 66 8 1861 1,383 1,142 1,000 917 937 1,640 1,303 874 500 228 68 8 1871 1,385 1,136 1,005 940 945 1,661 1,230 883 505 239 64 7 1881 1,383 1,158 999 955 980 1,653 1,237 822 506 234 66 7 1891 1,252 1,135 1,035 992 975 1,676 1,237 870 496 253 71 8 1901 1,157 1,028 969 976 1,015 1,735 1.310 911 554 257 80 8 1911 1,103 1,016 936 909 898 1,710 1,382 1,006 619 321 89 11 Females. age period. 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 + 1841 1,131 948 860 934 1,166 1,927 1,313 850 495 269 92 15 1851 1,171 975 869 913 1,062 1,855 1,310 894 548 289 99 15 1861 1,212 1,009 893 930 1,035 1,754 1,310 887 562 295 99 14 1871 1,222 1,021 904 947 1,027 1,727 1,257 903 563 311 103 15 1881 1,230 1,048 925 976 1,035 1,705 1,232 856 569 305 105 14 1891 1,136 1.028 946 988 1,055 1,728 1,231 880 553 326 113 16 1901 1,034 929 885 973 1,088 1,828 1,296 912 589 325 124 17 1911 972 909 847 887 993 1,805 1,391 1,006 641 386 140 23 Females per 1,000 Males at Each Age-Period. Age period, 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 + 1841 1,034 1,028 1,008 1,178 1,298 1,205 1,133 1,127 1,182 1,328 1,600 2,001 1851 1,005 1,009 1,018 1,157 1,234 1,193 1,138 1,169 1,270 1,375 1,700 2,244 1861 1,003 1,011 1,021 1,161 1,264 1,224 1,150 1,161 1,285 1,480 1,684 2,128 1871 1,003 1,022 1,022 1,144 1,236 1,182 1,162 1,163 1,267 1,482 1,814 2,303 1881 999 1,016 1,040 1,147 1,187 1,159 1,118 1,171 1,263 1,464 1,777 2,344 1891 1,012 1,010 1,019 1,111 1,207 1,150 1,110 1,129 1,243 1,435 1,784 2,395 1901 999 1,010 1,019 1,115 1,199 1,179 1,106 1,118 1,187 1,414 1,750 2,348 1911 993 1,008 1,020 1,099 1,245 1,189 1,133 1,126 1,166 1,357 1,775 2,459 Age and sex distribution of the population. The following table shows the mean annual rate of "natural increase" of the population per 1,000 living in certain periods from 1886 to 1912:— With a view to a proper understanding of this table it may be well here to state that the observed rate of increase in the population is dependent upon two causes (i) the difference between the numbers of births and deaths described as "natural increase," and (ii) the difference in the numbers of emigrants and immigrants generally referred to as "the balance of passenger movement." The rate of natura increase, therefore, is the rate that would obtain in a population whose numbers are undisturbed by migration. Period. Annual birth-rates per 1,000 living. Annual death-rates per 1,000 living. Annual rate of natural increase per 1,000 living. London. Greater London. (a) England and Wales. London. Greater London. (a) England and Wales. London. Greater London. (a) England and Wales. 1886-1890 32.106 31.97 31.44 19.69c 18.68 1889 12.41 1329 12.55 1891-1895 30.766 30.46 30.48 . 19.82c 18.49 18.71 10.94 11.97 11.77 1896-1900 29.666 29.31 29.27 18.51c 17.23 17.69 1115 12.08 11.58 1901-1905 28.55b 28.57 28.15 1641c 15.14 16.03 12.14 13.43 12.12 1906-1910 26.526 26.28 26.22 14.88c 13.72 14.68 11.64 12.56 11.54 1906 27.656 27.52 27.17 15.75c 14.66 15.44 11.90 12.86 11.73 1907 26.896 26.75 26.40 1534c 1418 15.07 11.55 12.57 11 33 1908 26.716 26.53 26.70 14.64c 13.56 14.78 1207 12.97 11.92 1909 25.836 25.58 25.78 14.99c 13.76 14.60 10.84 11.82 1118 1910 25.546 25.02 25.04 13 69c 12.44 13.49 11.85 12.58 11.55 1911 24.786 24.42 24.37 l5.04c 13.83 14.60 9 74 10.59 9.77 1912 24.486 23.84 23.82 13.55c 12.25 13.29 10.93 11.59 10.53 Natural increase of the population. (a), (6) and (c), for footnotes see next page. 4 Annual Report of the London County Council, 1912. Rates of natural increase in large English towns. The following table enables comparison to be made of the rates of "natural increase" of the London population with those of the principal towns of England in the period 1907-11, and in the year 1912. Town. 1907-11. 1912. Town. 1907-11. 1912. London 11.2 (b c) 10.9 (b c) Bradford 4.6 5.0 Greater London 12.1 11.6 Hull 13.4 13.3 Liverpool 12.2 11.5 Newcastle-on-Tyne 13.3 12.7 Manchester 10.4 9.4 Nottingham 10.0 9.3 Birmingham 12.6 12.1 Stoke-on-Trent .. 15.5 Sheffield 13.9 13.4 Portsmouth 12.2 10.8 Leeds 9.4 9.0 Salford 11.5 9.9 Bristol 9.9 8.1 Leicester 10.5 8.7 West Ham 15.5 15.3 Rates of natural increase in foreign towns The factors affecting the rates of natural increase in the different localities to which reference is made, probably tend more to vitiate accurate comparison when the populations concerned are of different nationalities, and this should be borne in mind in connection with the following table showing the rate of increase in London and certain foreign towns (d):— Town. 1907-11. 1912. Town. 1907-11. 1912. London 11.2 (bc) 10.9 (b c) Stockholm 9.1 6.8 Paris 0.6 0.5 St. Petersburg 4.2 4.6 Brussels 3.0 3.1 Berlin 7.2 6.0 Amsterdam 11.3 12.1 Vienna 5.5 3.7 Copenhagen 11.9 10.8 New York 11.1 12.1 The natural increase during the period 1907-11 in New York is probably understated, owing to incomplete registration of births prior to 1908. It will be noticed that the excess of births over deaths in 1912 is above the average of the preceding five years in Brussels, Amsterdam, St. Petersburg, and New York. These rates can only be regarded as approximate, and in making comparison of one town with another it should be borne in mind that full correction for births and deaths in institutions might considerably modify the rates of some of the towns. Marriagerates— London. Marriages. The number of marriages in the Administrative County of London in 1912, was 42,227 (365 days) giving an annual rate of 18.6 persons married per 1,000 living. The marriage-rate in successive periods has been as follows— Period. Marriage-rate per 1,000 persons living. Period. 0 Marriage-rate per 1,000 persons living. 1851-1860 20.6 1904 17.5 1861-1870 20.3 1905 17.5 1871-1880 19.1 1906 17.9 1881-0890 17.6 1907 17.9 1891-1900 17.8 1908 16.9 1901-1910 17.5 1909 16.9 1910 17.3 1901 17.7 1911 17.8 1902 18.0 1912 18.6 1903 17.8 (а) Greater London is the administrative area of the Metropolitan and City police. (б) For the purposes of these rates the births in the principal lying-in institutions have been distributed to the district to which they belong. (c) These death-rates are fully corrected for institutions, by the exclusion of deaths of persons not belonging to, but occurring in, institutions situated within London, and by the inclusion of deaths of persons belonging to London, but occurring in London institutions situated outside the Administrative County. Since the year 1910, the deaths have been further corrected by the inclusion of non-institutional deaths of London residents occurring in the outer Ring of Greater London. (d) All rates in this report relating to foreign towns are calculated upon figures published by the Registrar- General. Diagram A Marriages. diagram B. Births. 5 Report of the County"Medical Officer—General. Marriages of minors. The accompanying diagram (A) shows the marriage-rate in each year since 1850, in relation to the mean marriage-rate of the period 1851-1912. In the year 1912 among males 31 per cent, married were under 21 years of age, and among females 113 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:— Period. Marriages of minors per cent, of total marriages. London. England and Wales. Males. Females. Males. Females. 1851-1860 2.8 11.9 5.7 18.0 1861-1870 3.6 14.6 6.8 20.4 1871-1880 4.7 16.9 8.0 22.0 1881-1890 5.5 18.9 6.8 20.8 1891-1900 4.7 16.5 5.4 17.5 1901 4.4 15.0 5.0 16.0 1902 4.0 14.0 4.7 15.4 1903 3.8 13.7 4.6 15.2 1904 3.7 13.9 4.6 15.3 1905 3.6 13.0 4.4 14.7 1906 3.5 12.9 4.3 14.6 1907 3.2 11.8 4.1 14.2 1908 2.9 11.3 4.0 14.0 1909 3.1 11.1 4.0 13.7 1910 2.9 10.8 3.8 13.3 1911 3.1 10.9 3.9 13.3 Births. The number of births in the Administrative County of London in 1912 (52 weeks) was 110,353, giving a birth-rate of 24.5 per 1,000 persons living per annum. The male births numbered 56,509 and the female 53,844, there being, therefore, 1,049 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 1912 is the lowest recorded rate in London since the institution of civil registration. 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 1904 28.5a 1861-1870 35.4 1905 27.9a 1871-1880 35.4 1906 27.6a 1881-1890 33.2 1907 26.9a 1891-1900 30.2a 1908 26.7a 1901-1910 27.5a 1909 25.8a 1910 25.5a 1901 28.9a 1911 24.8a 1902 28.7a 1912 24.5a 1903 28.8a Birth-rates — London. The corresponding figures for England and Wales, which show a similar decline to that noted in London, are as follows:— Period. Birth-rate por 1,000 persons living. (a) Period. Birth-rate per 1,000 persons living. (a) 1851-1860 34.1 1904 28.0 1861-1870 35.2 1905 27.3 1871-1880 35.4 1906 27.2 1881-1890 32.4 1907 26.5 1891-1900 29.9 1908 26.7 1901-1910 27.2 1909 25.8 1910 25.1 1901 28.5 1911 24.4 1902 28.5 1912 23.8 1903 28.5 Birth-rates— England and Wales. (a) See footnote (6), page 4. 6 Annual Report of the London County Council, 1912. The decline in the birthrate. The cause of the steady fall in the birth-rate in recent years has been the subject of great controversy. It must suffice here to say that there is much to be said in favour of the view that the fali is, in the main, a natural one and represents the adjustment brought about by the ordinary laws which affect movement and growth of population. The birth-rate in most of the countries of Europe attained a maximum in the seventies, and it has since declined. There have been conspicuous contrasts, it is true, presented by the crude birth-rates of one and another European country, and even if these crude rates be corrected by employment of what has been described as the "correct method of stating fertility," it is still found that Italy and Austria in a less degree, and France in a more conspicuous degree, have fallen behind other European countries since 1881. The method of correcting crude rates just referred to, however, while it takes into account the age of the wife at marriage, does not make similar allowance for the age of the husband, nor does it have regard to variations affecting the reproductive capacities of both parents resulting from changes of the population brought about by emigration or immigration, and possibly in other ways. In the case of France, it is true, there has been but little migration from or into the country, but there has been noteworthy interchange as between country and town, and study of the influence of these "migrations interieures" as they are termed by M. Cauderlier (Les Lois de la Population, p. 188) carries with it conviction as to the large importance, in its effect upon the birth-rate of such migration. France is, it is affirmed, the country in which this "migration interieure" is most active. In departments such as Lozere, les Landes, la Haute Saone, l'Ariege, it is, allowing for the size of the populations concerned, more than double the amount of the emigration from Germany or England. M. Cauderlier (loc. cit. p. 188) argues that "migration interieure" operates as follows The birth-rate is higher in the towns because of the excessive proportions of married women of the reproductive ages (there were 158,000 married women per million inhabitants, from 15 to 50 years of age in the department of the Seine as against 139,000 in France as a whole). Fecundity, however, is lower in the towns (Seine 116, France 146, Basses Alpes 214, per 1,000 married women). The excessive proportion of married women in the towns, he says, is due to the fact that immigrants are in the main single persons eligible for marriage, or people recently married. Thus persons of reproductive ages are leaving a centre of high for one of low fecundity. In France, too, other and still more important influences of a very special character have undoubtedly been at work ; thus, no study of the declining birth-rate in France can be complete, which does not take account of the Napoleonic wars in the early years of the last century; of the famine, and political crises ; and in later years, of the effects of the Crimean, Italian and Franco-German wars, of the taxation imposed to pay off war debt, and finally of financial difficulties and disasters, such as those caused by the silkworm disease, or the invasion of phylloxera. Another writer upon the French birth-rate, M. Levasseur, states that, between 1791 and 1813, 41/2 million Frenchmen entered the imperial armies, and he computes that some 1,800,000 of these yielded up their lives in Napoleon's campaigns. This loss, of many of the best of its young adult males, may quite possibly have had a very serious effect, lasting for many years upon the country's birth-rate. Even in the last war (1870-71), it is stated, that 139,000 Frenchmen were killed, and 143,000 wounded. In this country there has been no such disastrous loss by war or famine, indeed, the Irish famine of 1847, drove many thousands of peasants over here, and thus actually helped to raise the English birth-rates from the fifties to the seventies. There has, however, in this country as in France, been large internal migration from the country to the towns ; and there has of course in England been also much emigration and immigration, sometimes more of one, sometimes more of the other, but the qualities qua birth-rate of the incoming and outgoing populations have been by no means identical. The effect, produced by this interchange, upon the phthisis deathrate has been discussed elsewhere ("Influence of Migration upon the Phthisis death-rate." Proc. Roy. Soc. Med., Epidemiological Section, 1913), but it may here be noted that the movement in question must also have had its influence upon the birth-rate. For many years this country was especially favourably circumstanced, in that it was able to send away in considerable numbers its less desirable sections of population, and with these may be included from a hygienic standpoint, persons going abroad for the sake of their health; England is now, however, having its consumptives returned on its hands from America and the Colonies, and it is losing at the present time, in addition to those who are " unfit," a considerable number of its more active and enterprising young men and women. In discussing the phthisis death-rate, in the above-mentioned paper, the migration of young women from the country into the towns, and into England itself from Scotland and Ireland, was especially referred to. It was noted, in this connection, that the writers of the Census report, of 1891, had gone somewhat astray in dealing with this phenomenon, and had been led to deduce, from their figures, the existence of a widespread tendency of women over 25 to understate, and of girls under 20 to overstate their ages. In the last Census volume considerable modification of the position previously taken up is made, and the larger part played by movement of population in the matter is emphasized. It is moreover, important to bear in mind in this connection, that it is the quality as well as the quantity of this migration that specially affects the question of birth-rate. M. Cauderlier has a few instructive sentences on selection (in respect mainly of age) as it affects immigrants into Paris. He says children and old people are not easy to move. Those who come alone are single men or single women; those who come two at a time are man and wife, two brothers or two friends; when there are three, one of them may be a child; and where four come two may be children; but it is rare for a family, in which there are three or more children, to come to Paris, such a family is already established in the provinces and remains there. Special reference may here be made to some charts which M. Cauderlier gives in his book. He shows (p. 261) curves of mortality for English males at different ages. In 1881, and 1891, the curve given is the familiar one, which has a maximum at age 0-5, falls to a minimum at 10-15, and then shows a -Diagram C.- ENGLAND and WALES. Death-rates among males in certain age-groups in successive decennia from all causes compared with the death-rates from phthisis. 7 Report of the County Medical Officer—General. steady rise throughout the succeeding 5 year and 10 year age-periods. But, in earlier years (in 1851 and 1861 for example) the rise of mortality from the minimum at 10-15 is at first quite steep, and then after 25 years of age becomes markedly less steep, rising again of course in steepness as later ages are reached. This marked increase of incidence of mortality on males aged 15-25, in England, becomes greatly exaggerated (p. 265) in the case of France, and more especially is this observed in years of war (e.g., 1871) ; it remains, however, still noticeable in the curve for France even as late as 1892. The raised mortality at ages 15-25, in the earlier years, has in fact, in England, in 1881 and 1831, been completely smoothed away, and this phenomenon closely corresponds with all that is known as to the excessive incidence of phthisis upon young adults in the fifties and sixties, the great extent of migration in those and in succeeding decades, and the shifting of the high incidence of phthisis to later age-periods in more recent decades (loc. cit). The less marked smoothing away of the excessive incidence upon young adults, in later decades in France, may correspond with the lesser disposition of the French to leave their own country. A similar phenomenon is apparent in curves constructed from the figures of decennial periods. Thus on the accompanying diagram " C " the curves relating to the death-rate from all causes, especially for the earlier decennia, while exhibiting generally concavity (viewed from above) show convexity, at the ages 15 to 25. The lower part of the diagram relating to death rates from phthisis, exhibits a similar tendency to development of a convex protruberance at the same age periods in the earlier decennia, and this convexity becomes smoothed away in later decennia as in the case of the death-rates from all causes. (See also, note on the behaviour of the curve showing female death-rates, London Life Table, 1901-1910, appended to this chapter.) M. Cauderlier's curves are referred to here because of their great interest in connection with the birth-rate. They clearly show that a distinctly excessive number of deaths must be associated with the age period 15-25, in 1851 and 1861, in England, and it is also recognised that persons of those ages yielded a specially excessive number of births. It has been suggested elsewhere (vide supra) that migration has markedly affected the death-rates and the question arises, therefore, whether it may not have played some part in determining variations of the birth-rate. It seems indeed probable that were it possible, in addition to the corrections which have been deemed essentially necessary for a " correct method of stating fertility," to make full corrections for delayed age at marriage as it affects males, and for alterations produced in the population as a whole by loss of some sections and addition to it of other sections, very considerable change in the crude birth rates would be brought about. The fact might perhaps emerge, that correction for all these natural factors tending to influence the birth-rate, yielded true birth-rates presenting relatively small variations from one year to another. In such event it would be unnecessary to go outside natural causes for explanation of the recent decline of the birth-rate. 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. s Town. 1907-11. 1912. Town. 1907-11. 1912. London 25.9a 24.5a Bradford 19.6 19.4 Greater London 25.7 23.9 Hull 29.4 27.7 Liverpool 31.6 29.6 Newcastle-on-Tyne 29.4 26.9 Manchester 28.0 25.4 Nottingham 26.1 23.7 Birmingham 29.0 26.2 Stoke-on-Trent . . 31.3 Leeds 25.3 23.2 Portsmouth 26.1 23.7 Sheffield 29.9 27.6 Salford 29.2 26.4 Bristol 23.7 21.4 Leicester 23.9 22.1 West Ham 30.8 29.4 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. Birth-rates in foreign towns- Town. 1907-11. 1912. Town. 1907-11. 1912. London 25.9a 24.5a Stockholm 23.8 21.0 Paris 18.0 16.8 St. Petersburg 29.0 26.5 Brussels 17.0 16.6 Berlin 22.7 20.4 Amsterdam 24.1 23.3 Vienna 22.4 19.1 Copenhagen 26.9 24.9 New York 27.5 26.2 (a) See footnote (6) page 1. Annual Report of the London County Council, 1912. The diagram (B.) facing page 5 shows the London birth-rate in each year since 1850, in relation to the mean birth-rate of the period 1851-1912. 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. Birth rates in London sanitary districts. The following table shows the birth-rate in the several sanitary districts per 1,000 persons in the period 1907-11 and in the year 1912:— Metropolitan borough. Births, 1912 (52 weeks). (a) Birth-rate per 1,000 persons living. (a) 1907-11. 1912. Paddington 3,021 22.2 21.3 Kensington 3,326 19.4 19.4 Hammersmith 2,880 25.4 23.5 Fulham 4,213 29.2 27.2 Chelsea 1,229 20.9 18.8 Westminster, City of 2,348 16.4 15.0 St. Marylebone 2,243 21.3 19.4 Hampstead 1,281 15.7 14.9 St. Pancras 5,367 25.7 24.9 Islington 8,213 25.6 25.2 Stoke Newington 1.033 20.4 20.5 Hackney 5,266 24.4 23.7 Holborn 902 19.8 18.8 Finsbury 2,575 31.3 30.0 London, City of 185 12.5 9.9 Shoreditch 3,562 32.4 32.3 Bethnal Green 3,902 32.4 30.6 Stepney 8,533 33.8 30.9 Poplar 5,045 31.8 31.3 Southwark 5,587 30.7 29.5 Bermondsey 3,872 31.9 31.0 Lambeth 6,952 25.4 23.4 Battersea 4,258 26.8 25.5 Wandsworth 6,757 23.6 21.0 Camberwell 6,422 25.5 24.6 Deptford 2,896 28.3 26.6 Greenwich 2,391 25.9 25.0 Lewisham 3,356 22.7 20.4 Woolwich 2,738 25.0 22.5 London 110,353 25.9 24.5 It will be seen from the above table that the birth-rates of the several sanitary districts vary greatly, ranging when the rates for the year 1912 are compared, from 9.9 in the City of London, to 32.3 in Shoreditch. Notification of births Under the Notification of Births Act, 1907, the London County Council receives particulars of the births which have been notified to the medical officers of health of the several sanitary districts in London, and from the information thus received the following table has been prepared:— Metropolitan borough. Total births notified (corrected for institutions). Stillbirths (corrected). Births less stillbirths (corrected). Births registered (corrected). Excess of registered over notified births (corrected). Paddington 4,157 85 4,072 3,021 — 1,136 Kensington 3^244 94 3,150 3,326 + 82 Hammersmith 2,467 45 2,422 2,880 + 413 Fulham 3,422 63 3,359 4,213 + 791 Chelsea 1,004 22 982 1 229 + 225 Westminster, City of 1,670 34 1,636 2 348 + 678 St. Marylebone 2,499 86 2,413 2,243 — 256 Hampstead 1,257 23 1,234 1,281 + 24 St. Pancras 5,069 125 4,944 5,367 + 298 Islington 7,644 246 7,398 8,213 + 569 Continued on next page. (a) See footnote (i) page 4. 9 Report of the County Medical Officer—General. Metropolitan borough. Total births notified (corrected for institutious). Stillbirths (corrected). Births, less stillbirths (corrected). Births registered (corrected). Exces3 of registered over notified births (corrected). Stoke Newington 933 23 910 1,033 + 100 Hackney 5,513 145 5,368 5,266 — 247 Holborn 825 19 806 902 + 77 Finsbury 2,564 42 2,522 2,575 + 11 London, City of 179 8 171 185 + 6 Shoreditch 3,500 98 3,402 3,562 + 62 Bethnal Green 3,870 110 3,760 3,902 + 32 Stepney 8,723 240 8,483 8,533 — 190 Poplar 4,704 106 4,598 5,045 + 341 Southwark 5,987 129 5,858 5,587 — 400 Bermondsey 3,763 12 3,751 3,872 + 109 Lambeth 7,244 174 7,070 6,952 — 292 Battersea 3,522 75 3,447 4,258 + 736 Wandsworth 4,810 99 4,711 6,757 + 1,947 Camberwell 5,766 160 5,606 6,422 + 656 Deptford 3,008 75 2,933 2,896 — 112 Greenwich 2,469 67 2,402 2,391 — 78 Lewisham 3,449 105 3,344 3,356 — 93 Woolwich 2,618 63 2,555 2,738 + 120 London 105,880 2,573 103,307 110,353 + 4,473 The number and percentage of still-births and of multiple births notified in 1912 (uncorrectec for institutions) is shown in the following table:— Metropolitan borough. Total births notified. Stillbirths. Per- centage still born. Multiple births. Percental of mothers Delivered o more than one child at a birth Twins. Triplets. Total born. Cases. Stillborn. Cases. Stillborn. One- both. One. Two. Three Paddington 3,911 77 1.97 57 7 2 — — — — 114 1.48 Kensington 3,022 92 3.04 34 1 — — — — — 68 1.14 Hammersmith 2,357 41 1.74 — — — — — — — — — Fulham 3,288 62 1.89 — — — — — — — — — Chelsea 956 21 2.20 8 1 — — — — — 16 0.84 Westminster, City of 1,492 29 1.94 16 1 — — — — — 32 1.08 St. Marylebone 4,128 129 3.13 41 2 — 1 — — — 85 1.03 Hampstead 1,218 18 1.48 4 — — — — — — 8 0.33 St. Pancras 4,618 118 2.56 51 4 — — — — — 102 1.11 Islington 7,264 230 3.17 101 10 3 2 — — — 208 1.43 Stoke Newington 907 22 2.43 8 — — — — — — †16 0.89 Hackney 5,427 142 2.62 56 8 — 3 — — — 121 1.10 Holborn 1,182 30 2.54 18 — — — — — — 36 1.55 Finsbury 3,357 78 2.32 51 6 — 1 1 — — 105 1.57 London, City of 172 8 4.65 — — — — — — — — Shoreditch 3,277 89 2.72 30 1 1 — — — — 60 0.92 Bethnal Green 3,830 107 2.79 41 7 — — — — — 82 1.08 Stepney 8,706 239 2.75 110 1 2 6 1 — — 238 1.35 Poplar 4,699 106 2.26 71 4 2 — — — — 142 1.53 Southwark 5,964 129 2.16 76 8 2 — — — — 152 1.29 Bermondsey 3,756 12 0.32 23 1 — 1 — — — 49 0.64 Lambeth 7,203 174 2.42 84 8 — — — — — 168 1.18 Battersea 3,503 74 2.11 38 4 — — — — — 76 1.10 Wandsworth 4,780 98 2.05 41 1 — — — — — 82 0.86 Camberwell 5,753 160 2.78 74 7 3 — — — — 148 1.30 Deptford 3,006 75 2.49 36 6 — — — — — 72 1.21 Greenwich 2,465 66 2.68 14 — — — — — — 28 0.57 Lewisham 3,445 105 3.05 34 4 — — — — — 68 1.00 Woolwich 2,615 62 2.37 19 — — — — — — 38 0.73 London 106,301 2,593 2.44 1,136 92 15 14 2 — — 2,314 1.09 Still-births and multiple births in 1912. Deaths. The number of deaths in the Administrative County of London in 1912 (52 weeks) was 61,100 giving an annual death rate of 186 per 1,000 of the estimated population. 18820 10 Annual Report of the London County Council, 1912. Death-rates all causes 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 1903 15.4a 1851-1860 23.7 1904 16.5a 1861-1870 24.4 1905 15.6a 1871-1880 22.5 1906 15.8a 1881-1890 20.3 1907 15.3a 1891-1900 19.2a 1908 14.6a 1901-1910 15.7a 1909 15.0a 1910 13.7a 1901 17.2a 1911 15.0a 1902 17.4a 1912 13.6a The death-rate in each year since 1840 in relation to the mean death-rate of the period 1841-1912 is shown in diagram (D) 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. The columns showing "death-rates corrected for age and sex distribution" have been obtained by multiplying the crude death-rates by the "factors for correction" published by the Registrar-General in the Annual Summary for 1912. Town. Estimated Population (middle of 1912). Crude death-rate per 1,000 persons living. Death-rate per 1,000 persons living (corrected for age and sex distribution). Comparative mortality figure. 1907-11. 1912. 1907-11. 1912. 1912. England & Wales 36,539,636 14.53 13.29 14.22 13.01 1,000 London 4,519,754 14.72 13.56 14.72 13.56 1,042 Liverpool 762,021 19.40 18.14 20.03 18.73 1,440 Manchester 723,531 17.64 16.04 19.05 17.32 1,331 Birmingham 850,947 16.46 14.05 17.18 14.66 1,127 Sheffield 466,408 16.12 14.23 16.96 14.97 1,151 Leeds 447,746 15.96 14.17 16.91 15.01 1,154 Bristol 359,432 13.86 13.33 13.63 13.11 1,008 West Ham 291,900 15.30 14.14 15.70 14.51 1,115 Bradford 289,609 15.02 14.35 15.85 15.14 1,164 Hull 282,988 16.02 14.40 16.11 14.48 1,113 Newcastle-on-Tyne 269,196 16.14 14.17 16.99 14.92 1,147 Nottingham 262,574 16.18 14.43 16.33 14.56 1,119 Stoke-on-Trent 237,159 18.66 15.83 19.90 16.88 1,297 Portsmouth 236,731 13.98 12.89 13.82 12.74 979 Salford 232,734 17.78 16.51 19.07 17.71 1,361 Leicester 229,294 13.44 13.38 13.82 13.76 1,058 Death-rates in large English towns. London had therefore (comparing the corrected death-rates) in the quinquennium 1907-11 a lower death-rate than any of these towns except Bristol, Portsmouth, and Leicester, and was in ]912 lower than all except Bristol, and Portsmouth. The following table enables comparison to be made of the crude death-rate of London with that of several foreign towns:— Town. 1907-11. 1912. Town. 1907-11. 1912 London 14.7a 13.6a Stockholm 14.7 14.2 Greater London 13.6 12.3 St. Petersburg 24.8 21.9 Paris 17.4 16.3 Berlin 15.5 14.4 Brussels 14.0 13.5 Vienna 16.9 15.4 Amsterdam 12.8 11.2 New York 16.4 14.1 Copenhagen 15.0 14.1 Death-rates In foreign towns. It will be seen from the foregoing table that in the quinquennium 1907-11 the London death-rate was exceeded by the death-rates of Paris, Copenhagen, St. Petersburg, Berlin, Vienna, and New York, and in 1912 was, in addition, exceeded by that of Stockholm. (a) See footnote (c) page 4. Diagram D. - Deaths (all causes) - 11 Report of the County Medical Officer—General. The following table shows the mean death-rates obtaining in London at the several age-periods and for each sex in the decennium 1901-1910 and in the year 1912. Age-period. Males. Females. Mean deathrate 1901-1910. Death-rate 1912. Difference per cent. Mean deathrate 1901-1910. Death-rate 1912. Difference per cent. 0— 53.61 36.72 —31.51 45.71 30.87 —32.47 5— 3.47 3.10 —10.66 3.48 2.85 —18.10 10— 1.99 2.05 + 3.02 2.04 1.90 — 6.86 15— 2.88 2.72 — 5.56 2.40 2.32 — 3.33 20— 3.81 3.43 — 9.97 2.77 2.50 — 9.75 25— 5.72 5.20 — 9.09 4.19 3.68 —12.17 35— 10.97 9.90 — 9.75 8.12 7.12 —12.32 45— 19.37 18.63 — 3.82 13.93 12.93 — 7.18 55— 35.00 35.46 + 1.31 25.90 23.91 — 7.68 65— 69.10 67.86 — 1.79 54.62 51.24 — 6.19 75— 140.88 145.77 + 3.47 119.76 117.41 — 1.96 85 and upwards 290.54 253.54 —12.73 258.54 252.18 — 2.46 All ages 16.98 15.18 -10.62 14.34 12.56 —12.35 Death-rates in London— age and sex distribution. It will be seen from this table that the rate of mortality in 1912 was considerably lower than that of the period 1901-1910 at each age-period of life and for each sex, except among males aged 10-15, 55-65, and 75-85. In previous annual reports it has been shown that a more accurate estimate of the effect on the community of fluctuations of mortality could be obtained by the use of a Life Table, the method adopted being similar to that employed by Dr. Tatham in a report on the health of greater Manchester for the period 1891-3. The advantages of this method and the formula used are set out in some detail in the London Life Table appended to the annual report for 1901. It will be seen from the description therein contained that in order to apply this method of comparison it is necessary in the first place to ascertain from the Life Table the mean future lifetime of males and females in groups of ages corresponding to those age-groups to which the deaths relate. The following table shows the results thus obtained from the London Life Table, which has been newly calculated on the basis of the mortality in the years 1901 1910, and is appended to this report. Fluctuations of mortality. Age-group. Mean future lifetime, 1901-1910. Males. Females. Age-group. Mean future lifetime, 1901-1910. Males. Females. Years. Years. Years. Years. 0— 54.43 58.24 35— 25.90 29.04 5— 52.88 56.72 45— 19.18 21.72 10— 48.47 52.38 55— 13.34 15.16 15— 44.02 47.93 65— 8.60 9.70 20— 39.72 43.52 75— 5.15 5.74 25— 33.52 37.06 85 + 2.93 3.22 In the following table the number of deaths occurring in the year 1912 at each age-period and for each sex is compared with the number of deaths which Would have occurred had the death-rates of the period 1901-1910 been maintained in the year 1912. The number of lives gained in the latter period is also shown, and the figures in the last column of the table express this gain in terms of "life-capital," these being obtained by applying the mean future lifetime figures given in the preceding table to the number of lives gained at each age-group:— Age-group. Deaths calculated according to mean death-rates of 1901-1910. Deaths occurring in the year 1912. Gain (+) or loss (—) of lives in the year 1912, by fluctuations of mortality. Gain (+ ) or loss (—) of "life capital" in the year 1912 by fluctuations of mortality. Males. 0— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— 85 and upwards All Ages—Males 12,604 751 397 558 729 2,085 3,232 4,155 4,619 4,727 2,664 653 37,174 8,632 671 408 527 656 1,895 2,918 3,997 4,679 4,642 2,756 570 32,351 +3,972 + 80 — 11 + 31 + 73 + 190 + 314 + 158 — 60 + 85 — 92 + 83 +4,823 +216,196 + 4,230 — 533 + 1,365 + 2,900 + 6,369 + 8,133 + 3,030 — 800 + 731 — 474 + 243 + 241,390 (Continued on next pane.) 18820 B 2 12 Annual Report of the London County Council, 1912. Age-group. Deaths calculated according to mean death-rates of 1901-1910. Deaths occurring in the year 1912. Gain ( +) or loss (—) of lives in the year 1912, by fluctuations of mortality. Gain ( +) or loss (—) of "life capital" in the year 1912 by fluctuations of mortality. Females. 0— 10,668 7,205 + 3,463 +201,685 5— 759 621 + 138 + 7,827 10— 415 387 + 28 + 1,467 15— 511 493 + 18 + 863 20— 660 595 + 65 + 2,829 25— 1,816 1,595 + 221 + 8,190 35— 2,711 2,376 + 335 + 9,728 45— 3,363 3,122 + 241 + 5,235 55— 3,987 3,681 + 306 + 4,639 65— 5,069 4,756 + 313 + 3,036 75— 4,020 3,941 + 79 + 453 85 and upwards 1,429 1,394 + 35 + 113 All Ages—Females 35,408 30,166 + 5,242 + 246,065 Total—Persons 72,582 62 517 + 10,065 +487,455 It will be seen from the preceding table that during the year 1912, compared with the decennium 1901-1910, there has been a saving of 10,065 lives, representing a gain to the community of 487,455 years of "life-capital." Death-rates in London boroughs. The following table shows the crude death-rates, and tne death-rates corrected lor differences in the age and sex constitution of the population of the several sanitary districts during the year 1912, and for the period 1907-11 (a). Area. Factor for correction for age and sex listribution. Crude death-rate per 1,000 persons living. Corrected deathrate per 1,000 persons living. Corrected comparative mortality figure (London, 1,000). 1907-11. 1912. 1907-11. 1912. 1907-11. 1912. England, and Wales 0.9790 14.58 13.29 14.22 13.01 966 959 London 1.0000 14.72 13.56 14.72 13.56 1,000 1,000 Paddington 0.9941 13.38 12.33 13.30 12.26 904 904 Kensington 0.9957 13.66 13.00 13.60 12.94 924 954 Hammersmith 0.9884 14.58 13.12 14.41 12.97 979 956 Fulham 1.0340 14.08 12.81 14.56 13.25 989 977 Chelsea 0.9513 15.56 14.55 14.80 13.84 1,005 1,021 Westminster, City of 1.0540 12.78 12.38 13.47 13.05 915 962 St. Marylebone 1.0198 14.78 13.83 15.07 14.10 1,024 1,040 Hampstead 1.0572 9.66 9.82 10.21 10.38 694 765 St. Pancras 0.9971 15.54 14.60 15.49 14.56 1,052 1,074 Islington 0.9749 14.62 14.32 14.25 13.96 968 1,029 Stoke Newington 0.9512 12.44 12.11 11.83 11.52 804 850 Hackney 1.0066 13.76 12.10 13.85 12.18 941 898 Holborn 1.0034 16.60 15.30 16.66 15.35 1,132 1,132 Finsbury 0.9887 19.56 18.77 19.34 18.56 1,314 1,369 London, City of 1.0419 15.34 13.46 15.98 14.02 1,086 1,034 Shoreditch 1.0331 19.00 18.13 19.63 18.73 1,334 1,381 Bethnal Green 1.0397 17.26 15.31 17.95 15.92 1,219 1,174 Stepney 1.0433 16.90 15.23 17.63 15.89 1,198 1,172 Poplar 0.9898 17.24 16.35 17.06 16.18 1,159 1,193 Southwark 1.0060 18.16 16.70 18.27 16.80 1,241 1,239 Bermondsey 0.9976 18.44 16.80 18.40 16.76 1,250 1,236 Lambeth 0.9804 14.76 13.31 14.47 1305 983 962 Battersea 1.0098 13.80 12.22 13.94 12.34 947 910 Wandsworth 1.0045 11.60 10.17 11.65 10.22 791 754 Camberwell 0.9883 14.06 12.89 13.90 12.74 944 940 Deptford 0.9879 15.06 13.13 14.88 12.97 1,011 956 Greenwich 0.9837 14.18 13.10 13.95 12.89 948 951 Lewisham 0.9826 11.04 10.40 10.85 10.22 737 754 Woolwich 1.0249 12.72 11.60 13.04 11.89 886 877 It will be seen from the foregoing table (comparing the corrected death-rates) that in the quinquennium 1907-11, Shoreditch (19.6) had the highest rate and Hampstead (10.2) the lowest, in the year 1912 Shoreditch (18.7) had the highest, and Wandsworth and Lewisham (10.2) the lowest The death-rates in each of the four quarters of the year 1912, were as follows: first quarter, 15.3; second quarter, 12.4; third quarter, 11.5; and fourth quarter, 15.0 per 1,000 persons living. (a) All death-rates in this report relating to metropolitan boroughs are fully corrected for institutions (see footnote (c), page 4). 13 Report of the County Medical Officer—General. The following table shows the corrected death-rates from all causes in each metropolitan borough during the last seven years:— Metropolitan borough. Corrected death rates. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Paddington 12.9 14.0 12.8 13.6 12.5 13.3 12.3 Kensington 14.2 14.2 13.5 14.0 12.6 13.6 12.9 Hammersmith 15.0 14.6 14.3 14.8 12.7 15.4 13.0 Fulham 15.7 15.2 14.7 14.4 12.9 14.9 13.2 Chelsea 15.8 15.3 15.1 15.4 13.6 14.7 13.8 Westminster, City of 13.8 13.9 13.6 14.2 12.4 13.1 13.0 St. Marylebone 15.7 15.6 14.9 15.6 13.7 15.4 14.1 Hampstead 10.6 10.3 9.7 10.4 10.2 10.2 10.4 St. Pancras 16.5 15.6 15.4 15.9 14.8 15.5 14.6 Islington 15.0 14.9 13.6 14.6 13.5 14.5 14.0 Stoke Newington 11.5 11.4 12.3 11.5 11.2 12.4 11.5 Hackney 14.0 14.3 13.9 13.6 12.8 14.4 12.2 Holborn 18.4 17.8 17.0 16.5 15.9 15.7 15.3 Finsbury 21.1 19.1 19.1 20.2 18.3 19.6 18.6 London, City of 16.7 15.5 16.6 18.0 13.7 15.7 14.0 Shoreditch 20.5 21.3 18.2 19.9 17.6 20.7 18.7 Bethnal Green 20.0 18.2 17.9 17.9 16.2 18.9 15.9 Stepney 19.7 17.6 18.6 17.5 15.9 18.1 15.9 Poplar 17.9 17.2 16.2 16.8 15.9 18.7 16.2 Southwark 19.1 19.1 17.5 18.3 17.5 18.5 16.8 Bermondsey 19.8 18.1 18.6 18.9 17.7 18.4 16.8 Lambeth 15.5 15.1 13.9 14.9 13.4 14.6 13.0 Battersea 14.3 14.4 13.3 14.5 12.8 14.4 12.3 Wandsworth 12.8 12.3 11.5 12.0 10.2 12.0 10.2 Camberwell 15.2 14.4 13.4 14.3 13.0 14.1 12.7 Deptford 16.7 14.6 14.5 14.5 15.0 15.4 13.0 Greenwich 14.6 13.8 14.0 13.9 13.3 14.5 12.9 Lewisham 12.1 11.5 11.2 10.5 9.8 11.1 10.2 Woolwich 14.4 13.7 12.7 13.4 12.0 13.1 11.9 London 15.8 15.3 14.5 15.0 13.7 15.0 13.6 Corrected death-rates, all causes, 1906-12. Infantile Mortality. The deaths of children under one year of age in the Administrative County of London during 1912 (52 weeks) numbered 10,056, being in the proportion of 91 per 1,000 births. The proportion in successive periods has been as follows:— Period. Deaths under one year of age per 1,000 births. Period. Deaths under one year of age per 1,000 births. 1841-1850 157a 1903 130b 1851-1860 155a 1904 145b 1861-1870 162a 1905 130b 1871-1880 158a 1906 131b 1881-1890 152 1907 116b 1891-1900 159b 1908 113b 1901-1910 126b 1909 108b 1910 103b 1901 148b 1911 129b 1902 140b 1912 91b Deaths of infants per 1,000 births. The accompanying diagram (E.) shows the infantile mortality in each year since 1857 in relation to the mean infantile mortality of the period 1858-1912, and also the infantile mortality in each year after exclusion of the deaths from premature birth, which cause of death would in all probability be affected in greater degree than the deaths under any other heading by the more complete registration of recent years. (a) The registration of births was not made compulsory until the beginning of 1875; before that year many births were probably unregistered. (b) See footnotes (b) and (c), page 4 14 Annual Report of the London County Council, 1912. 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. 1907-11. 1912. Town. 1907-11. 1912. London 114a 91a Bradford 130 99 Greater London 108 86 Hull 135 101 Liverpool 145 125 Newcastle-on-Tyne 127 101 Manchester 143 121 Nottingham 150 117 Birmingham 144 112 Stoke-on-Trent 170 128 Sheffield 134 106 Portsmouth 110 82 Leeds 136 101 Salford 142 128 Bristol 111 103 Leicester 129 110 West Ham 125 104 London had therefore in the period 1907-11 a lower infantile mortality than any of these towns except Bristol and Portsmouth. In 1912 the London rate was below that of all except Portsmouth. It should, however, be pointed out that the comparative rates given in the above table, which shows the deaths of infants under one year of age per 1,000 births, are not fully corrected for births in institutions except with regard to the rates for the Administrative County of London, as shown in heavier type. The figures, therefore, are not strictly comparable, but afford a rough method of approximating the relationship of the several infantile mortality rates in the instances given. Deaths and death rates of infants in London boroughs. 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 1907-11 and for the year 1912 (a):— Metropolitan borough. Deaths under one year of age, 1912 (52 weeks). Deaths under one year of age per 1,000 births. 1907-11. 1912. Paddington 296 107 98 Kensington 303 120 91 Hammersmith 259 120 90 Fulham 396 116 94 Chelsea 84 109 68 Westminster, City of 197 97 84 St. Marylebone 209 103 93 Hampstead 79 70 62 St. Pancras 472 106 88 Islington 712 108 87 Stoke Newington 74 87 72 Hackney 421 109 80 Holborn 72 113 80 Finsbury 294 134 114 London, City of 15 98 81 Shoreditch 439 149 123 Bethnal Green 375 134 96 Stepney 897 125 105 Poplar 541 130 107 Southwark 587 130 105 Bermondsey 431 137 111 Lambeth 601 110 86 Battersea 358 109 84 Wandsworth 513 97 76 Camberwell 535 104 83 Deptford 259 119 89 Greenwich 201 111 84 Lewisham 236 87 70 Woolwich 200 94 73 London 10,056 114 91 It will be seen from the foregoing table that in the period 1907-11 and in the year 1912 Shore" ditch (149 and 123 respectively) had the highest infantile death-rates and Hampstead (70 and 62 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 approximately as follows:—First quarter 96; second quarter 83; third quarter 81; fourth quarter 105. (a) See footnotes (b) and (c), page 4. 15 Report of the County Medical Officer—General. Infantile mortality in London boroughs, 1901—1911:— 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908 1909. 1910. 1911. Paddington 129 125 111 129 118 105 109 102 100 96 127 Kensington 157 144 138 144 139 132 129 118 111 106 133 Hammersmith 163 138 133 148 130 137 116 120 120 99 146 Fulham 153 149 130 152 145 135 121 116 108 106 125 Chelsea 138 138 135 152 112 132 121 109 106 102 109 Westminster 131 129 115 115 106 111 102 102 96 84 103 St. Marylebone 138 139 130 133 128 119 101 101 101 99 108 Hampstead 102 86 87 110 92 78 71 68 74 61 78 St. Pancras 146 139 127 143 127 124 106 108 101 102 112 Islington 137 130 122 124 121 125 115 102 102 94 127 Stoke Newington 111 111 116 113 119 103 100 94 79 63 102 Hackney 138 121 121 146 132 120 111 115 101 98 119 Holborn 150 163 121 140 118 117 123 112 103 105 115 Finsbury 161 171 152 160 144 160 130 133 131 123 156 City of London 171 129 135 104 142 104 94 91 109 59 124 Shoreditch 195 172 167 186 163 163 149 139 141 146 170 Bethnal Green 151 153 140 155 147 156 135 131 129 122 151 Stepney 164 149 139 157 142 135 117 132 119 112 144 Poplar 165 151 151 151 151 151 124 123 129 118 157 Southwark 164 164 145 171 145 145 136 132 120 117 144 Bermondsey 167 154 156 171 146 154 123 145 139 125 156 Lambeth 148 136 135 147 124 132 119 103 108 93 123 Battersea 160 124 131 144 128 125 114 106 107 98 124 Wandsworth 131 126 109 122 117 122 99 97 86 77 122 Camberwell 138 135 122 142 122 130 114 104 100 94 109 Deptford 143 133 134 143 119 145 106 122 102 122 142 Greenwich 134 141 129 143 122 121 97 122 100 108 128 Lewisham 130 123 92 123 93 114 88 87 74 80 104 Woolwich 130 124 106 136 102 110 111 95 82 85 97 London County 148 140 130 145 130 131 116 113 108 103 129 Infantile mortality in London boroughs. 1901-11. The reports of Medical Officers of Health of the several sanitary districts of the Administrative County for the year 1912 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 1912. 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. 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 of death of infants under one year of age. Common Infectious Diseaees— Small-pox — — — — — — — — — — Chicken-pox — — — — — — 2 — 1 3 Measles — 1 1 3 5 10 18 118 225 371 Scarlet Fever — — — — — 1 1 4 4 10 Diphtheria and Croup — — 1 1 2 6 9 11 23 49 Whooping-cough 1 — 2 7 10 93 80 126 130 429 Diarrhœal Diseases— Diarrhœa, all forms 2 6 8 11 27 153 233 124 86 596 Enteritis (not tuberculous) 4 12 17 13 46 179 205 107 65 556 Gastritis, Gastro-intestinal Catarrh 3 5 5 3 16 42 19 9 8 78 Wasting Diseases— Premature Birth 1,373 187 142 88 1,790 1,944 25 4 3 1,976 Congenital Malformations 158 47 29 22 256 326 40 16 15 397 Atelectasis 133 14 3 5 155 171 3 — 1 175 Injury at Birth 92 5 4 4 105 107 3 1 1 112 Atrophy,Debility, Marasmus 250 108 107 76 541 935 268 119 62 1,384 Causes of death of infants under one year of age. (Continued on next page.) 16 Annual Report of the London County Council, 1912. Cause of death. 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 Deaths under one year. Tuberculous Diseases— Tuberculous Meningitis — 1 - 1 2 16 39 55 52 162 Abdominal Tuberculosis — 1 l — 2 16 24 17 21 78 Other Tuberculous Diseases — 2 3 2 7 19 35 38 34 126 Erysipelas 1 — 3 — 4 13 2 3 2 20 Syphilis 8 10 19 15 52 126 34 7 5 172 Rickets — — — 1 1 1 2 10 11 24 Meningitis (not Tuberculous) 3 3 1 3 10 24 32 36 33 125 Convulsions 86 50 18 20 174 253 52 38 31 374 Bronchitis 9 29 35 44 117 318 148 130 114 710 Laryngitis — 1 — — 1 1 4 6 2 13 Pneumonia 11 21 21 30 83 296 281 292 317 1,186 Suffocation, overlaying 69 10 8 14 101 212 72 10 7 301 Other causes 150 51 34 20 255 379 133 101 80 693 Total (All Causes) 2,353 564 462 383 3,762 5,461 1,764 1,382 1,333 10,120 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. 1912. 52 weeks. Deaths in 1912 in excess or defeat of the corrected average for 1905-11 Diminution in 1912 Excess in 1912. Small-pox - - - - - - 1 - - - Chicken-pox 3 3 5 3 10 4 5 3 1 — Measles 389 420 400 333 503 391 531 371 22 — Scarlet Fever 34 18 35 24 20 10 6 10 9 — Diphtheria and Croup 52 59 53 67 60 30 53 49 - - Whooping-cough 623 502 746 469 524 602 424 429 83 — Diarrhœa 3,423 4,468 1,790 2,709 1,849 1,536 4,443 1,230 1,430 — Enteritis (not tuberculous) Gastritis, Gastro-intestinal Catarrh Premature Birth 2,423 2,208 2,299 2,197 2,122 2,086 1,970 1,976 37 — Congenital Malformation. 547 613 645 705 667 657 472 397 19 — Atelectasis 175 175 Injury at Birth 99 113 117 110 113 108 123 112 — 9 Want of Breast-milk 2,281 2,130 1,922 1,843 1,825 1,682 1,738 1,384 379 — Atrophy,Debility Marasmus Tuberculous Meningitis 273 241 239 259 203 179 211 162 49 — Abdominal Tuberculosis 192 225 153 168 145 129 99 78 67 - Other Tuberculous Diseases 284 246 264 255 188 142 148 126 73 - Erysipelas 64 50 52 35 48 32 26 20 20 - Syphilis 271 233 226 229 216 186 172 172 29 - Rickets 79 67 58 51 45 54 38 24 27 - Meningitis (not tuberculous) 300 302 210 246 170 174 183 125 82 - Convulsions 803 660 603 520 495 475 428 374 147 - Bronchitis 1,276 1,043 1,284 982 960 843 847 710 239 - Laryngitis 25 23 15 18 15 13 17 13 4 - Pneumonia 1,490 1,335 1,629 1,431 1,334 1,442 1,334 1,186 130 - Suffocation, overlaying 462 417 421 417 322 321 261 301 42 - Other causes 1,004 1,009 979 885 852 751 804 693 132 - Total 16,397 16,385 14,145 13,956 12,686 11,847 14,509 10,120 Net diminution 3,012 Number of births (a) 125,939 124,880 121,408 122,898 116,559 115,190 111.738 110,353 17 Report of the County Medical Officer—General. The total deaths among children under one year of age from "all causes" at certain age periods in 1912 may be compared with similar figures included in the Annual Reports for the preceding seven years as follows:- 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 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 2,374 617 571 508 4,068 6,669 3,035 2,485 2,320 14,509 1912 2,353 564 462 383 3,762 5,641 1,764 1,382 1,333 10,120 Deaths of infants at certain age periods, 1905-12. 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 1906 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 1912 21.3 5.2 4.3 3.6 34.1 51.1 16.8 13.4 13.1 91.7 With a view to comparing the rates of mortality from the several groups of diseases in tbe years 1905-12 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 14.07 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 1912 91.7 3.4 3.9 11.2 36.6 3.3 4.5 6.4 10.8 11.6 The following tables, which are based upon the figures in the table on page 15, show the number of survivors at the beginning of each of five periods in the first twelve months of life, and the probability (a) These rates are based upon the deaths as 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. 18820 c 18 Annual Report of the London County Council, 1912. of living through each period, per 100,000 born in the year 1912. For the purpose of comparison, the corresponding figures for the preceding seven years are shown. Age-period. X Number living at the beginning of each of five periods in the first year of life. l * 1912 1911. 1910. 1909. 1908. 1907. 1906. 1905. 0—1 month 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 1—3 months 96,615 96,384 96,523 96,458 96,422 96,122 96,292 96,112 3—6 „ 94,925 94,074 94,609 94,409 94,179 93,851 93,826 93,587 6—9 „ 93,338 91,418 92,761 92,416 91,977 91,760 91,095 91,068 9—12 „ 92,108 89,246 91,214 90,826 90,279 90,080 88,926 89,000 0-1 year 90,918 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 1912, 1911. 1910. 1909. 1908. 1907. 1906. 1905. 0—1 month .96615 .96384 .96523 .96458 .96422 .96122 .96292 .96112 1—3 months .98251 .97603 .98017 .97876 .97674 .97637 .97439 .97373 3—6 „ .98328 .97177 .98047 .97889 .97662 .97772 .97089 .97308 6—9 „ .98682 .97624 .98332 .98280 .98154 .98169 .97619 .97729 9—12 „ .98708 .97762 .98427 .98304 .98271 .98246 .97826 .97936 0—1 year .90918 .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. 0-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total under 1 Year Paddington 69 18 19 7 113 168 50 39 38 295 Kensington 91 21 20 5 137 193 43 41 28 305 Hammersmith 69 11 14 13 107 153 49 37 22 261 Fulham 92 18 21 6 137 225 77 44 49 395 Chelsea 18 3 6 5 32 55 14 8 8 85 Westminster, City of 53 7 9 9 78 112 34 29 20 195 St. Marylebone 58 10 7 7 82 110 42 28 29 209 Hampstead 25 4 2 — 31 49 11 8 711 79 St. Pancras 133 25 28 17 203 282 64 49 77 472 Islington 190 41 25 24 280 413 121 81 95 710 Stoke Newington 20 10 6 3 39 50 6 10 7 73 Hackney 95 38 16 20 169 267 73 49 37 426 Holborn 13 6 2 1 22 28 15 15 12 70 Finsbury 42 8 10 10 70 133 53 39 65 290 London, City of 3 — — — 3 6 1 2 1 10 Shoreditch 86 22 21 10 139 231 78 77 65 451 Bethnal Green 73 21 19 15 128 203 70 48 54 375 Stepney 203 36 37 33 309 482 192 146 126 946 Poplar 116 29 17 21 183 296 103 70 74 543 Southwark 104 32 20 27 183 272 114 97 104 587 Bermondsey 92 14 12 11 129 216 88 68 61 433 Lambeth 135 43 33 33 244 350 96 1 91 61 598 Battersea 78 23 22 19 142 205 62 42 44 353 Wandsworth 148 29 28 26 231 337 79 50 50 516 Camberwell 108 37 22 18 185 274 109 83 85 551 Deptford 63 18 13 12 106 141 35 45 37 258 Greenwich 58 15 8 9 90 124 23 27 26 200 Lewisham 57 16 15 12 100 138 41 28 26 233 Woolwich 61 9 10 10 90 128 21 31 21 201 London 2,353 564 462 383 3,762 5,641 1,764 1,382 1,333 10,120 19 Report of the County Medical Officer—General. With a view to the consideration of the effect of "social condition (a)" on the rates of infantile mortality at different periods during the first year of life, the following table has been prepared, in which the rates of infantile mortality obtaining for groups of districts can be compared:— Infantile mortality in relation to "social condition"—1912. Age-period. Group of boroughs in order of " social condition." I. II. III. IV. V. Under 1 week 17.6 22.9 20.4 21.5 22.1 1-2 weeks 4.2 5.7 5.4 5.1 4.5 2-3 „ 3.5 4.8 3.7 4.4 4.4 3-4 „ 2.5 2.9 3.6 3.7 3.5 Under 1 month 27.8 36.3 33.1 34.7 34.5 0-3 months 40.0 51.6 48.8 51.4 56.4 3-6 „ 11.0 12.4 15.1 15.8 21.4 6-9 7.9 10.5 11.4 12.6 16.9 9-12 „ 7.9 9.2 10.1 13.5 16.5 0-12 months 66.8 83.7 85.4 93.3 111.2 Infantile mortality and "social condition," 1912. 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 I. taken as 100. Children aged 0-3 months. Children aged 3-6 months. Children aged 6-9 months. Childron aged 9-12 months. Children under 1 year. 1905-11. 1912. 1905-11. 1912. 1905-11. 1912. 1905-11. 1912. 1905-11. 1912. I. 100 100 100 100 100 100 100 100 100 100 II. 114 129 129 113 143 132 165 117 126 125 III. 119 122 132 138 150 145 175 127 132 128 IV. 124 129 144 144 165 159 186 171 140 140 V. 130 141 174 195 194 214 235 210 159 166 The figures for the period 1905-11 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 1912 are in general agreement with those for the period 1905-11. • 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 1912 (52 weeks) was 3,498, giving an annual death-rate of 0.79 per 1,000 persons living. (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. 18220 c 2 20 Annual Report of the London County Council, 1912. Deaths from epidemic diseases in in London boroughs. The following table shows the deaths from the principal epidemic diseases (excluding pyrexia, typhus, diarrhoea and enteritis), and the death-rates per 1,000 persons living in each of the sanitary districts of the County in 1912, and the death-rates for the period 1907-11:— Metropolitan borough. Deaths, 1912 (52 weeks). Death-rate per 1,000 persons living. 1907-11. 1912. Paddington 61 0.75 0.43 Kensington 66 0.74 0.39 Hammersmith 67 0.98 0.55 Fulham 139 1.11 0.90 Chelsea 44 0.80 0.68 Westminster, City of 72 0.43 0.47 St. Marylebone 83 0.75 0.71 Hampstead 34 0.43 0.40 St. Pancras 172 0.98 0.79 Islington 264 0.95 0.81 Stoke Newington 8 0.70 0.16 Hackney 75 0.90 0.34 Holborn 40 0.75 0.84 Finsbury 177 1.50 2.06 London, City of 4 0.39 0.21 Shoreditch 191 1.76 1.74 Bethnal Green 140 1.46 1.09 Stepney 314 1.45 1.13 Poplar 203 1.62 1.26 Southwark 225 1.32 1.18 Bermondsey 167 1.56 1.34 Lambeth 203 0.90 0.69 Battersea 118 1.02 0.71 Wandsworth 149 0.78 0.46 Camberwell 167 0.89 0.64 Deptford 72 1.13 0.67 Greenwich 84 0.98 0.87 Lewisham 74 0.58 0.46 Woolwich 85 0.74 0.69 London 3,498 1.00 0.79 It will be seen from the foregoing table that the death-rate from these diseases in the period 1907-11 was highest in Shoreditch (1.76) and lowest in the City of London (0.39), and in 1912 was highest in Finsbury (2.06) and lowest in Stoke Newington (0.16). The death-rates from these diseases during each of the four quarters of the year were as follows: First quarter, 0.60; second quarter, 0.85; third quarter, 0.65; and fourth quarter, 1.01 per 1,000 persons living. Smallpox and Vaccination. Smallpox death-rates in London. The death-rate from samllpox in successive period have been as follow:- 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 0035a 1909 0.000a 1910 — 1901 0.051a 1911 0.002a 1902 0.285a 1912 0.000a The smallpox death-rate in each year since 1840 in relation to the mean death-rate during the period 1841-1912 is shown in diagram (F). (a) See footnote (c) page 4. 21 Report of the County Medical Officer—General. 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 1912 6 0.001 Smallpox— notified cases and case rates, 1890-1912. It will be seen from the following table that in the quinquennium 1907-11 and in the year 1912 only one of the under-mentioned towns, namely, Bristol, had an appreciable death-rate from small-pox Town. 1907-11. 1912. Town. 1907-11. 1912. London 0.00(a) 0.00(a) Bradford - - Greater London 0.00 o.oo Hull o.oo — Liverpool — — Newcastle-on-Tyne o.oo — Manchester — 0.00 Nottingham o.oo — Birmingham o.oo — Stoke-on-Trent — — Sheffield o.oo — Portsmouth — — Leed — — Salford — - Bristol 0-01 0.01 Leicester — — West Ham — — Smallpox death-rates in large English towns. The following table shows that of the undermentioned towns, Paris and St. Petersburg are the only towns which had an appreciable death-rate from smallpox during the last six years:— Town. • 1907-11. 1912. Town. 1907-11. 1912. London 0.00(a) 0.00(a) Stockholm - - Paris 0.01 0.00 St. Petersburg 0.13 0.06 Brussels 0.00 — Berlin o.oo o.oo Amslerdam — — Vienna — — Copenhegen — — New York o.oo 0.00 Smallpox death-rates in foreign towns Of the six cases notified in London, four proved to be true small-pox, in the other two cases the diagnosis was not confirmed. The details of the true cases are as follows:— (1) J. A., aged 52 years, residing in Woolwich, was a winchman on s.s. "Delhi," wrecked on 14th December, 1911. He was at Tangier on 26th and 27th December, where probably he was infected. He was notified on 15th January, 1912, and died the same night at South Wharf receiving station. This was the only fatal case. (2) M. A. D., aged 40. A lodger in the same house as J. A. Rash appeared 29th January, 1912. Patient removed to hospital the following day. (3) F. D., aged 41. Husband of Case No. 2. Rash appeared 1st February, 1912. Removed to hospital the same day. Both these patients were unprotected by vaccination, but both were very mild cases with no symptoms but the rash. Smallpox in London. (a) See footnote (c) page 4. 22 Annual Report of the London County Council, 1912. (4) J. S., aged 47. Seaman. Fell down engine-room steps on his ship at Bilbao on 10th February, 1912, and was taken to hospital. Remained in hospital at Santander until 10th March. Afterwards he shipped in s.s. "Saxone" to Ardrossan, travelled to Glasgow, and went by train to Leith. Here he joined the s.s. "Fione," which arrived at Free Trade Wharf in the River Thames on 25th March. He had no premonitory symptoms, but the rash appeared on the 28th March. He was removed to South Wharf the following day. In addition to these cases, M. F., aged 22 years, an Indian servant on the s.s. "Colaba," lying in the Royal Albert Dock, was, on the 25th March, removed to the Seamen's Hospital, Greenwich, and was certified to be suffering from small pox. He was afterwards taken to South Wharf, where the diagnosis was confirmed. Three other cases on ships entering London were detained by the Port of London sanitary authority and removed to the hospital at Denton. Vaccination returns. The following table shows the proportion of children born in London 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 1911 20.8 The percentage of children born who were exempted by "conscientious objection" certificates in and since the year 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; 1911, 15.8. N umber 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. 1904. 1905. 1906. 1907. 1908. 1919. 1910. 1911. 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 23.3 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 66.7 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 15.3 48.3 Chelsea 17.3 14.9 16.0 13.4 14.9 13.9 10.0 8.9 13.0 14.3 16.9 19.8 19.3 20.0 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 25.2 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 13.2 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 21.2 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 29.4 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 25.1 Hackney 49.0 38.6 40.4 38.5 26.1 25.5 26.9 28.2 36.8 33.2 34.4 39.0 43.8 49.1 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 24.5 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 25.2 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 39.1 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 34.2 (Continued on next page.) 23 Report of the County Medical Ofjicer—General. Metropolitan Union. 1898. 1899. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 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 15.4 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 38.1 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 38.1 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 33.2 Marylebone, St. 18.0 20.9 17.7 14.6 12.5 10.8 10.4 10.8 12.1 12.7 12.9 14.5 15.7 16.2 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 53.4 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 20.2 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 45.6 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 56.5 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 48.6 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 39.4 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 58.8 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 28.7 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 34.0 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 16.5 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 19.9 Woolwich 10.2 8.3 7.5 9.8 9.7 7.1 7.2 6.6 9.3 15.0 23.2 23.9 28.8 28.9 London 34.4 28.7 26.8 25.2 22.1 21.7 20.2 20.1 22.7 25.8 28.8 30.7 34.1 36.6 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 1912 (52 weeks') numbered 1,799, as compared with 2,570 in 1911 (52 weeks). The death-rates from this disease per 1,000 persons living in 1912 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 1910 0 0.44a 1901 0.43a 1911 0.57a 1902 0.51a 1912 0.40a Measles death-rates in London. 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 has also been worked out. 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 1904 4.49a 1861-1870 4.18 1905 3.38a 1871-1880 3.65 1906 3.83a 1881-1890 4.74 1907 3.58a 1891-1900 4.82a 1908 3.OOa 1901-1910 3.92a 1909 4.73a 1910 4.00a 1901 3.71a 1911 5.18a 1902 4.49a 1912 3.68a 1903 4.02a Mortality among children at ages 0-5. (a) See footnote (c) page 4. 24 Annual Report of the London County Council, 1912. The death-rate in each year since 1840 in relation to the mean death-rate of the period 1841-1912, calculated on the population at all ages, is shown in diagram (G). The monthly deaths from measles in relation to the mean of the period 1891-1912 is shown in diagram (H). Deaths and death-rates from measles in London boroughs. The following table shows the deaths in 1912 (52 weeks) and the death-rates from measles, in 1907-11 and 1912 in each of the sanitary districts of the County:— Metropolitan borough. Deaths, 1912 (52 weeks). Death-rate per 1,000 persons living. 1907-11. 1912. Paddington 31 0.32 0.22 Kensington 27 0.31 0.16 Hammersmith 29 0.43 0.24 Fulham 65 0.46 0.42 Chelsea 22 0.37 0.34 Westminster, City of 37 0.13 0.24 St. Marylebone 40 0.28 0.35 Hampstead 11 0.14 0.13 St. Pancras 95 0.44 0.44 Islington 151 0.43 0.46 Stoke Newington 5 0.26 0.10 Hackney 19 0.37 0.09 Holborn 25 0.26 0.52 Finsbury 129 0.72 1.50 London, City of 2 0.10 0.11 Shoreditch 116 0.91 1.05 Bethnal Green 91 0.69 0.71 Stepney 170 0.75 0.61 Poplar 112 0.74 0.69 Southwark 139 0.68 0.73 Bermondsey 102 0.88 0.82 Lambeth 97 0.37 0.33 Battersea 55 0.47 0.33 Wandsworth 50 0.33 0.16 Camberwell 81 0.40 0.31 Deptford 28 0.51 0.26 Greenwich 28 0.42 0.29 Lewisham 11 0.13 0.07 Woolwich 31 0.31 0.25 London 1,799 0.45 0.40 In the distribution of measles mortality throughout the year 1912, the highest death-rates obtained in Finsbury (1.50) and the lowest in Lewisham (0.07). For the period of 1907-11, Shoreditch (0.91) had the highest measles death-rate, and the City of London (0.10) the lowest. The death-rates for this disease in London in each of the four quarters of the year 1912 were as follows: first quarter, 0.18; second quarter, 0.38; third quarter, 0.33; and fourth quarter, 0.70 per 1,000 persons living. 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 1907-11, 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 1912 was exceeded by all except Sheffield, Leeds, Bradford, Stoke-on-Trent, and Portsmouth. Measles death-rates in large English towns. Town. 1907-11. 1912. Town. 1907-11. 1912. London 045 0.40 Bradford 0.21 0.17 Greater London 0.39 0.32 Hull 0.39 0.53 Liverpool 0.48 1.15 Newcastle-on-Tyne 0.36 0.61 Manchester 0.49 0.68 Nottingham 0.41 0.62 Birmingham. 0.47 0.67 Stoke-on-Trent 0.56 0.23 Sheffield 0.81 0.39 Portsmouth 0.34 0.40 Leeds 0.27 0.36 Salford 0.56 1.06 Bristol 0.23 0.44 Leicester 0.38 0.42 West Ham 0.65 0.85 25 Report of the County Medical Officer—General. Medical officers of health derive their information as to the occurrence of cases of measles mainly from the teachers of elementary schools, though it is observed that the public are applying in increasing numbers for disinfection after the termination of cases of illness from this cause and thus bring to light many cases which Would not otherwise have become known. Most of the reports show the number of cases made known from these sources and the following table has been compiled from the material thus made available. Measles in London. Metropolitan borough. No. of cases. Metropolitan borough. No. of cases. Paddington 1,374 Shoreditch 754 Kensington 485 Bethnal Green 849 Hammersmith 487 Poplar †1,114 Fulham 783 Bermondsey 730 Chelsea 233 Lambeth 1,595 Westminster 468 Battersea 706 St. Marylebone 484 Wandsworth 1,095 Hampstead 429 Deptford 221 St. Pancras *1,951 Greenwich 586 Islington 1,377 Lewisham 351 Hackney 769 Woolwich 775 Holborn 202 Finsbury 625 * Patients, contacts and suspects. † Houses under observation. As mentioned in Part II. (Education) of this report, the incidence of measles in London declined considerably in 1912 as compared with 1911, but it should be noted that in the early part of the latter year there was exceptional prevalence. It is worthy of remark that the decline observed in 1912 has been maintained during the current year. Medical officers of health throughout London generally are devoting much attention to the question of the high mortality from this disease, and in this connection the reports contain references to the work of sanitary inspectors and health visitors, and to the distribution of pamphlets and instructions to parents. That these educative influences are having an effect upon the parents there can be little doubt, and it is mentioned that in Kensington 159 cases had, when visited, already received medical attention. In Hampstead the percentage not medically treated was 22, whilst in Holborn a doctor was in attendance in 84 out of 99 cases visited. Considerable use has been made of the Metropolitan Asylums (Measles) Order of the 30th May, 1911, providing that non-pauper cases of measles may be received in the hospitals of the Board on the certificate of the medical officers of health of London sanitary districts. Though admission is restricted to children of the poorest class and to urgent cases for whom there is no suitable provision at home, 4,314 cases were admitted during the year. The deaths numbered 414, giving a mortality rate of 9.6 per cent., as compared with 13.9 per cent. in 1911. This high death-rate is, of course, mainly due to the class of cases received. In the reports relating to Paddington and Finsbury tables are given of the age incidence of cases and deaths for the year 1912 and the period 1903-12 respectively. The comparison is interesting inasmuch as the first-mentioned borough had in 1912 a death rate from this cause well below the mean for London, whilst Finsbury had the highest rate. In the following table the number of admissions to the Metropolitan Asylums Board hospitals and the deaths for the same age groups are also shown, though regard must be paid to the fact that "notified cases" and "admissions" cannot be held to be comparable terms and to the further consideration that the admissions to the Metropolitan Asylums Board's hospitals form a selected class naturally subject to a high rate of mortality. Age groups 0— 1— 2- 3— 4- 5-15 Paddington— Notified cases, 1912 93 166 152 173 222 747 Deaths, 1912 11 12 6 2 1 — Finsbury— Notified cases, 1903-12 333 679 644 808 1,183 2,385 Deaths, 1903-12 168 331 114 73 21 27 M.A.B. hospitals— Admissions, 1912 404 1,042 779 697 566 781 Deaths, 1912 82 196 62 43 22 9 18820 D 26 Annual Report of the London County Council, 1912. The medical officers of health of Paddington and Hampstead show the number of houses in which multiple cases occurred during the year. The particulars are as follows:— Metropolitan Borough. Number of houses in which one or more cases occurred. One case. Two cases. Three cases. Four eases. Five cases. Six cases. Seven cases. Eight cases. Nine cases. Paddington, 1912 400 191 108 36 15 3 3 1 - 1911 377 196 97 36 13 2 — — — Hampstead, 1912 166 65 30 7 3 — — - - 1911 323 47 17 4 - — — — — Scarlet Fever. The cases of scarlet fever notified in the Administrative County of London during 1912 (52 weeks) numbered 11,312, compared with 10,483 in 1911 (52 weeks). The number of deaths registered from this cause was 159 in the vear 1912 (52 weeks), compared with 172 in 1911 (52 weeks). Scarlet fever death-rates. The scarlet fever case-rates, death-rates and case-mortality for 1912 and preceding periods are shown in the following table:— Period. Death-rate per 1,000 persons living. Case-rate per 1,000 persons living. Casemortality per cent. 1861-1870 1.13 — a — a 1871-1880 0.60 — a — a 1881-1890 0.33 — a — a 1891-1900 0.19b 4.8 3.8 1901-1910 0.10b 3.9 2.7 1901 0.13b 4.1 3.2 1902 0.12b 4.0 3.1 1903 0.08b 2.8 2.9 1904 0.08b 3.0 2.7 1905 0.12b 4.3 2.8 1906 0.12b 4.5 2.6 1907 0.14b 5.7 2.5 1908 0.12b 4.8 2.5 1909 0.08b 3.8 2.2 1910 0.05b 2.3 2.0 1911 0.04b 2.3 1.6 1912 0.04b 2.5 1.4 The death-rate in each year since 1858 in relation to the mean death-rate of the period 18591912 will be seen on reference to diagram (I). It will be observed that the death-rate of 1912 was the lowest recorded in London. The monthly case-rate and case-mortality in each of the years 1891-1912 in relation to the mean of the whole period is shown in diagram (L). It will be seen from the following table that in the period 1907-11 the London scarlet fever deathrate was exceeded by that of Liverpool, Manchester, Birmingham, Sheffield, West Ham, Stoke-onTrent, Salford and Leicester. In 1912 it was exceeded by all except Bristol, Bradford, Hull and Salford. Town. 1907-11. 1912. Town. 1907-11. 1912. London 0.09b 0.04b Bradford 0.05 0.04 Greater London 0.08 0.03 Hull 0.04 0.00 Liverpool 0.23 0.11 Newcastle-on-Tyne 0.07 0.13 Manchester 0.14 0.07 Nottingham 0.04 0.09 Birmingham 0.16 0.18 Stoke-on-Trent 0.18 0.12 Sheffield 0.11 0.07 Portsmouth 0.07 0.12 Leeds 0.07 0.09 Salford 0.23 0.04 Bristol 0.04 0.03 Leicester 0.10 0.05 West Ham 0.13 0.06 Scarlet fever death-rates in large English towns. 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 1912. It will be seen that at " all ages " the case-rate was highest among females, while the fatality was higher among males. (a) The Infectious Disease (Notification) Act came into force in 1889. (b) See footnote (c) on page 4. Diagram I. Scarlet Fever. Diagram K. Scarlet Fever. N1umber ofadmissions to Hospitals of the Metropolitan Asy/ums Board percent of total cases notified in London. /890-/9/2 Diagram L. Scarlet Fever. 27 Report of the County Medical Officer—General. In the age-groups adopted for the purposes of this table, the greatest incidence of attack was upon males and females aged 4-5 years. The greatest incidence of death was upon males aged 4-5 and females aged 2-3. The fatality was highest among males and females under 1 year of age, if the obviously abnormal fatality among females aged 45-55, due to the smallness of the figures, is disregarded. Age-period. Males. Females. Notified cases. Deaths. Casemortaiity per cent. Rates per 100,000 living. Notified cases. Deaths. Casemortality per cent. Rates per 100,000 living. Cases. Deaths. Cases. Deaths. All Ages 5,265 81 1 5 248 4 6,047 85 1.4 253 4 0— 62 5 8.0 126 10 54 4 7.4 112 8 1— 197 11 5.6 439 24 188 8 4.2 423 18 2— 354 10 2.8 745 21 380 21 5.5 809 44 3— 483 10 2.1 1,035 21 490 11 2.2 1,043 23 4— 583 13 2.2 1,276 28 593 5 0.8 1,301 11 5— 2,198 24 1.1 1,021 11 2,586 27 1.0 1,192 12 10— 819 4 0.5 413 2 1,026 3 0.3 507 1 15— 293 1 0.3 152 1 275 1 0.4 130 0 20— 120 2 1.7 63 1 183 1 0.5 77 0 25— 125 1 0.8 34 0 213 2 0.9 49 0 35— 24 — — 8 — 44 1 2.3 13 0 45— 6 — — 3 — 13 1 7.6 5 0 55 & upwards 1 — — 0 — 2 — — 1- Scarlet fever cases and deaths by age and sex, London. The following table shows the scarlet fever cases, deaths, case-rates, and death-rates for the year 1912 and the case-rates and death-rates for the period 1907-11 in the several sanitary districts. Metropolitan borough. Notified cases, 1912 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1912 (52 weeks). Death-rate per 1,000 persons living. 1907-11. 1912. 1907-11. 1912. Paddington 269 3.32 1.89 3 0.07 0.02 Kensington 304 2.19 1.77 5 0.03 0.03 Hammersmith 333 3.23 2.72 4 0.07 0.03 Fulham 485 3.33 3.13 6 0.08 0.04 Chelsea 126 2.84 1.93 2 0.05 0.03 Westminster, City of 238 2.59 1.52 4 0.05 0.03 St. Marylebone 259 3.04 2.24 11 0.09 0.09 Hampstead 107 2.66 1.25 1 0.04 0.01 St. Pancras 597 3.33 2.77 5 0.09 0.02 Islington 811 3.30 2.49 9 0.07 0.03 Stoke Newington 90 2.94 1.78 — 0.09 - Hackney 515 4.38 2.32 8 0.09 0.04 Holborn 114 2.48 2.38 — 0.06 - Finsbury 157 3.31 1.83 5 0.11 0.06 London, City of 33 2.21 1.77 — 0.03 - Shoreditch 153 4.02 1.39 5 0.13 0.05 Bethnal Green 283 5.19 2.22 2 0.19 0.02 Stepney 929 5.31 3.36 13 0.13 0.05 Poplar 314 5.05 1.95 3 0.15 0.02 Southwark 500 3.63 2.64 6 0.09 0.03 Bermondsey 418 4.38 3.35 8 0.15 0.06 Lambeth 596 3.85 2.01 9 0.09 0.03 Battersea 462 4.40 2.76 6 0.07 0.04 Wandsworth 812 3.43 2.53 11 0.06 0.03 Camberwell 634 3.66 2.43 8 0.07 0.03 Deptford 404 4.63 3.70 6 0.08 0.06 Greenwich 439 4.07 4.59 9 0.06 0.09 Lewisham 457 3.95 2.77 6 0.07 0.04 Woolwich 472 6.10 3.88 4 0.09 0.03 Port of London 1 London 11,312 3.80 2.51 159 0.09 0.04 Scarlet Feve in London boroughs. 18820 D2 28 Annual Report of the London County Council, 1912. It will be seen that the scarlet fever death-rate was, in the period 1907-11, highest in Bethnal Green (0.19), and lowest in Kensington and the City of London (0.03); in the year 1912, St. Marylebone and Greenwich (0.09) had the highest death-rate, and Hampstead (0.01) the lowest, exclusive of Stoke Newington, Holborn and the City of London, where no deaths occurred. The scarlet fever death-rates obtaining in London in the four quarters of the year 1912 were as follows: first quarter, 0.02, second quarter, 0.04, third quarter, 0.04, and fourth quarter, 0.04 per 1,000 persons living. During the year 1912 the diminished prevalence of scarlet fever observed in the years 1910 and 1911 was maintained. The mortality rate, moreover, is quite remarkably low, and in most of the reports comment is made upon the prevailing mild type of the disease. One or two medical officers state that there are indications of increased prevalence, and this view has been borne out by the behaviour of the disease, during the last quarter of the current year. In commenting upon the disease in Bermondsey Dr. Brown writes: "The form of the disease is very mild and it is possible that this is one of the causes of the increase. Many cases seem to have no rash, or if one occurs it is so slight that it is liable to be missed." This evidence is supported by other observers. In some of the reports record is made of the attempts to trace the cause of infection. For instance, in Paddington of 260 definite cases, 18 were believed to have been infected outside the borough; in 6 cases the disease was contracted in hospitals where the patients were being treated for other complaints, and 14 were "return" cases. The medical officer of health of Kensington states that in 84 cases inquiry elicited a definite history of contact with previous cases ; 19 cases were due to infection in school; 12 were due to contact with persons recently discharged from hospital; 5 were contacts of missed cases; and 6 were infected outside the borough. In Chelsea there was only 1 "return" case, after an interval of 7 days. In Marylebone, of 259 cases, 17 were traced to a previous case in the same family; 6 to cases in the same house, 17 to cases in the neighbourhood. Holborn had 105 cases, of which 23 were secondary cases in the same house and of these, again, 11 were "return" cases. In Finsbury there were 23 cases arising from previous infection, 2 of them from mild unrecognised cases; 4 were infected by playfellows; 4 by friends and 9 cases developed in hospital attended for other causes. 43 cases in Bermondsey were analysed and 29 were traced to previous cases in the same house or family, or among neighbours, 11 were, attributed to school infection, and there were 3 "return" cases. In Wandsworth there were 39 "return" cases and in Greenwich 5. In the case of the latter borough it is mentioned that 10 patients were discharged from hospital still suffering, 8 from chronic rhinorrhcea, and 2 from intermittent rhinorrhoea. In Woolwich 37 were due to "return" cases, 36 to other inmates of the house, 7 to friends and neighbours, 32 to school attendance, 5 to fever hospitals, and 6 to other hospitals. The number of dwellings in which multiple cases occurred is shown as follows:— Metropolitan borough. Number of houses. One case. Two cases. Three cases. Four cases. Five cases. More than five cases. Paddington 178 29 8 - - - Fulham 247 49 8 - 3 - Westminster 182 17 4 1 - - Hampstead 77 5 3 - - - Islington 592 78 15 2 1 - Holborn 68 8 4 1 - - Thus of 1,580 houses invaded, multiple cases occurred in 236 or 14.3 per cent. In 1911, the number of houses in which multiple cases occurred was 14.6 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:— Year. Percentage. Year. Percentage. 1901 5.6 1907 6.8 1902 4.7 1908 5.8 1903 6.4 1909 6.9 1904 6.7 1910 9.5 1905 5.4 1911 8.7 1906 4.9 1912 6.4 Scarlet fever —diagnosis not confirmed. Diphtheria. The cases of diphtheria (including membranous croup) notified in the Administrative County of London in 1912 (52 weeks) numbered 7,101, compared with 7,385 in 1911 (52 weeks). The number of deaths was 452 in 1912 (52 weeks), compared with 612 in 1911 (52 weeks). Diagram M. Diphtheria. Diagram N. Diphtheria. Number ofadmissions to Hospitals of the Metropolitan Asylums Boardpercent of total cases notified in London. 1890-1912 TMI CITY Of LONDON LITHOGRAPHIC CO. HARP ALLEY, LONDON,E.C Diagram O. Diphtheria. 29 Rejport of the County Medical Officer—General. 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 1912, 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 1912 0.10b 1.6 6.4 Diphtheria death-rates in London. The death-rate in each year since 1858 in relation to the mean death-rate of the period 18591912 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 1891-1912 in relation to the mean of the period is shown in diagram (0). If the London diphtheria death-rate be compared with the death-ratea of the following large English towns it will be seen that in the quinquennium 1907-11 the London rate was exceeded by that of all except Sheffield, Nottingham and Leicester, and in 1912 was exceeded by the rates of all except Sheffield, Hull, Nottingham and Leicester. Town. 1907-11. 1912. Town. 1907-11. 1912. London 0.14b 0.10b Bradford 0.15 0.20 Greater London 0.14 0.10 Hull 0.18 0.07 Liverpool 0.16 0.14 Newcastle-on-Tyne 0.17 0.11 Manchester 0.16 0.13 Nottingham 0.12 0.10 Birmingham 0.16 0.12 Stoke-on-Trent 0.31 0.25 Sheffield 0.10 0.10 Portsmouth 0.27 0.53 Leeds 0.18 0.21 Salford 0.35 0.14 Bristol 0.15 0.13 Leicester 0.06 0.09 West Ham 0.19 0.12 Diphtheria death-rates in large English towns. The following table shows the diphtheria cases, deaths, case-rates, and death-rates for the year 1912, and the case-rates and death-rates for the period 1907-11, in the several sanitary districts:— Metropolitan borough. Notified Cases, 1912 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1912 (52 weeks). Death-rate per 1,000 persons living. 1907-11. 1912. 1907-11. 1912. Paddington 254 1.11 1.79 6 0.09 0.04 Kensington 180 1.20 1.05 6 0.12 0.04 Hammersmith 176 1.62 1.44 13 0.17 0.11 Fulham 233 2.51 1.50 15 0.20 0.10 Chelsea 89 1.66 1.36 5 0.13 0.08 Westminster, City of 160 1.03 1.02 11 0.09 0.07 St. Marylebone 149 1.03 1.29 8 0.09 0.07 Hampstead 161 1.00 1.88 17 0.09 0.20 St. Pancras 550 1.50 2.55 25 0.12 0.12 Islington 517 1.52 1.59 39 0.13 0.12 (Continued on next page.) Diphtheria cases, deaths and deathrates in London boroughs. (a) The Infectious Disease (Notification) Act came into force in 1889. (h) See footnote (c), page 4. 30 Annual Report of the London County Council, 1912. Metropolitan borough. Notified Cases, 1913 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1912 (52 weeks). Death-rate per 1,000 persons living. 1907-11. 1912. 1907-11. 1912. Stoke Newington 55 1.35 1.09 - 0.06 - Hackney 252 1.53 1.13 12 0.13 0.05 Holborn 89 1.13 1.86 7 0.10 0.15 Finsbury 144 1.81 1.68 13 0.19 0.15 London, City of 17 1.13 0.91 1 0.07 0.05 Shoreditch 139 1.64 1.26 19 0.17 0.17 Bethnal Green 220 1.76 1.72 12 0.16 0.09 Stepney 363 2.05 1.31 26 0.19 0.09 Poplar 253 1.64 1.57 17 0.20 0.11 Southwark 283 1.56 1.49 27 0.17 0.14 Bermondsey 218 1.94 1.75 16 0.13 0.13 Lambeth 336 1.19 1.13 29 0.15 0.01 Battersea 232 1.74 1.39 15 0.14 0.09 Wandsworth 428 1.61 1.33 19 0.10 0.06 Camberwell 318 1.38 1.22 21 0.13 0.08 Deptford 169 1.85 1.55 11 0.14 0.10 Greenwich 254 2.35 2.65 15 0.14 0.16 Lewisham 436 2.22 2.65 27 0.17 0.16 Woolwich 424 2.19 3.49 20 0.13 0.16 Port of London 2 London 7,101 1.60 1.58 452 0.14 0.10 It will be seen from the foregoing table that in the period 1907-11 the diphtheria death-rate was highest in Fulham and Poplar (0.20) and lowest in Stoke Newington (0.06); in the year 1912, Hampstead (0.20) had the highest death-rate, and Paddington and Kensington (0.04) the lowest. The diphtheria death-rates in London in each of the four quarters of the year 1912 were as follows: first quarter, 0.12; second quarter, 0.09 third quarter, 0.09; and fourth quarter, 0.10. 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 1891-1912 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 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 Paddington 104 77 73 117 74 66 91 98 68 44 88 65 61 63 47 72 61 59 87 69 73 114 Kensington 78 60 68 63 86 70 67 49 51 74 53 54 60 67 52 57 74 78 69 74 78 67 Hammersmith 195 164 87 72 77 67 49 58 58 85 75 68 85 111 146 134 94 97 108 112 99 91 Fulham 61 58 78 126 139 99 109 145 135 178 175 130 122 132 139 156 212 152 145 139 125 95 Chelsea 138 110 83 107 143 184 107 79 61 74 54 77 80 54 51 130 118 117 98 102 77 87 Westminster, City of 58 91 57 53 61 53 59 67 50 59 52 67 61 52 48 69 44 64 93 76 56 65 St. Marylebone 70 81 88 78 64 66 53 64 47 59 73 76 103 58 72 63 53 55 63 88 70 82 Hampstead 105 96 73 53 61 84 47 65 48 74 70 50 61 43 55 67 69 43 38 49 108 119 St. Panoras 89 95 103 83 90 64 76 78 79 93 149 152 132 95 88 69 80 78 98 99 119 162 Islington 152 119 86 103 70 106 73 60 68 70 102 112 81 66 74 75 75 91 89 119 111 101 Stoke Newington 83 113 97 77 70 70 52 59 34 111 105 82 46 75 110 52 120 72 37 86 95 69 Hackney 131 147 135 108 93 89 122 152 106 107 167 139 145 163 122 99 127 99 81 70 86 72 Holborn 52 89 79 61 66 61 104 102 46 70 105 86 53 51 58 69 62 54 62 74 106 118 Finsbury 118 82 130 81 86 112 170 163 93 74 110 101 77 94 103 118 86 105 125 139 124 106 London, City of 59 130 60 49 51 74 71 60 68 89 95 158 63 102 47 44 65 76 62 82 72 58 Shoreditch 124 89 131 95 80 97 103 80 103 111 103 84 77 101 110 71 101 105 112 96 96 80 Bethnal Green 154 230 181 168 143 114 144 100 89 115 133 105 110 206 165 110 116 122 97 117 96 109 Stepney 106 132 112 123 157 150 128 93 89 107 106 111 108 176 154 118 135 131 139 118 113 83 Poplar 191 148 214 159 179 133 141 105 83 141 137 118 149 252 207 85 113 109 88 88 107 100 Southwark 71 72 116 113 86 106 102 151 207 141 101 111 102 88 106 114 110 78 89 121 94 95 Bermondsey 68 60 84 126 80 99 97 90 177 133 94 92 79 94 91 147 129 112 105 137 124 111 Lambeth 88 97 91 83 88 74 83 103 121 104 65 68 67 68 105 79 56 65 86 90 83 72 Battersea 144 123 132 122 97 81 125 178 116 70 59 74 109 85 80 92 110 123 116 111 81 88 Wandsworth 74 83 84 79 60 51 100 114 99 74 76 132 125 98 92 114 117 115 84 77 100 85 Camberwell 69 65 67 112 140 180 154 102 156 130 125 113 82 65 66 77 80 86 97 86 82 77 Deptford 72 68 86 153 225 113 141 132 121 111 144 103 243 111 94 156 150 107 121 98 92 98 Greenwich 60 43 84 85 137 189 82 105 122 89 73 81 127 100 107 240 138 132 115 144 203 168 Lewisham 48 74 82 70 57 122 85 127 170 126 87 129 121 59 77 101 105 176 170 117 130 168 Woolwich 32 68 66 66 81 96 91 86 100 115 69 91 91 85 161 182 120 173 150 117 119 221 London 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Diphtheria case rates, London boroughs, 1891-1912. Report of the County Medical Officer—General. 31 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 1912. At "all ages" the fatality was higher among males, and the incidence of attack and of death were also slightly higher among males than among females. In the age-groups adopted for the purposes of this table the greatest incidence of attack was upon males and females aged 4-5 years; the greatest incidence of death was upon males and females aged 1-2 years. Diphtheria cases and deaths by age aDd sex —London. Ihe fatality was greatest among males and females under one year of age, if the obviously abnormal rate among females over 55 years of age, due to the smallness of the figures for one year, is disregarded. Age-period. Males. Females. Notified Cases. Deaths. Case mortality per cent. Eates per 100,000 living. Notified Cases. Deaths. Case mortality per cent. Hates per 100,000 living. Cases. Deaths. Cases. Deaths. All Ages 3,347 224 6.7 158 11 3,754 236 6.3 157 10 0— 106 26 24.4 216 53 79 22 27.7 164 45 1— 241 40 16.5 537 89 182 33 18.0 409 74 2— 286 21 7.3 602 44 271 29 10.6 577 61 3— 352 38 10.7 754 81 308 29 9.4 655 61 4— 381 24 6.3 834 53 374 27 7.2 820 59 5— 1,227 56 4.5 570 26 1,431 72 5.0 659 33 10— 417 11 2.6 210 6 493 13 2.6 244 6 15— 136 1 0.7 71 1 162 3 1.8 77 1 20— 68 3 4.4 36 2 158 — — 67 — 25— 81 1 1.2 22 0 197 2 1.0 46 0 35— 36 1 2.8 12 0 65 2 3.1 20 1 45— 9 1 11.0 4 0 18 — - 7 - 55 & upwards 7 1 14.2 3 0 16 4 24.9 6 1 During the year 1912 both the incidence and mortality of diphtheria were lower than in 1911, though in both Kensington and Hampstead the medical officers of health have to record a distinctly increased prevalence. In the report relating to the latter district the high infectivity of the disease is commented upon. Some of the reports refer also to the persistence of the "carrier condition" in certain individuals; for example Dr. Stevens refers to particular instances in which positive results were obtained at a considerable interval after the first swabbing. This persistence has for some time received the attention of the medical superintendents of the Metropolitan Asylums Board hospitals, and in the medical supplement to the report of the Board for 1912 is included an article by Dr. J. D. Rolleston, of the Grove Hospital, on the treatment of "diphtheria carriers" with bouillon cultures of staphylococcus pyogenes aureus. The experiments carried out showed that the treatment was successful in cases in which the fauces were involved, but unsuccessful where the nose only was affected. The method of treatment must be conducted with caution, firstly, because it entails some discomfort to the patient, and secondly because if used in the early stages of the disease there is danger of infection of the deeper tissues by the pyogenic organisms. The conclusion, however, is that in view of the futility of most other methods in ridding the throat of diphtheria bacilli the application of staphylococcus cultures is worthy of trial. In Part II (Education) of this report, the detailed history is given of a carrier of diphtheria bacilli in whom the condition has continued to be demonstrated for a period of nearly three years. In the same report comment is made upon the association of scarlet fever and diphtheria in 30 selected schools. Diphtheria in London. The result of inquiry into the source of infection is shown in some of the reports as follows: In Paddington, of 233 cases 6 contracted the disease in hospital, 6 were imported, and 6 were "return" cases. In 43 cases the symptoms were so trifling as to cause them to be regarded as "carriers," 14 of them occurred among the patients and staff of a children's hospital, and 18 among children specially examined in school. Dr. Sandilands, in the report relating to Kensington, thus classifies the source of infection in 51 cases: In residential institutions other than schools or hospitals, 11 cases; in schools, 9 cases; in hospital wards, 10 cases; from a case previously notified in a patient's home, 8 cases; from unrecognised cases, 3; and from sources beyond the borough, 8 cases. There were also 2 "return" cases. In Marylebone, of 147 cases, 14 were infected at home, 9 from a case in the same family, 5 from another family in the same house. There were in Finsbury, 148 true cases of the disease, and of these 15 were infected by members of the same family, 3 by missed cases, 9 cases were attributable to hospital infection, 3 to playfellows, 2 to visits to the country, and 6 followed an attack of measles. The result of inquiries in Shoreditch showed that in 8 cases there was a previous history of sore throat in the same house, 9 cases were infected outside the borough, 45 by playfellows and neighbours, and 62 patients were children attending school. In Woolwich it is noted that in 71 cases other inmates of the house were involved, in 47 cases there was history of school infection, in 13 cases neighbours and friends were suspected, 3 cases were attributed to general hospitals, and 9 to the fever hospital. There were 9 "return" cases. 32 Annual Report of the London County Council, 1912. In several of the reports there are references to the number of houses in which more than one case of the disease occurred. This information is given in the following table:— Number of houses. Metropolitan borough. One case. Two cases. Three cases. Four cases. Five cases and upwards. Westminster, City of 141 3 1 1 — Fulham 200 11 3 — — Hampstead 100 17 7 — — Islington 402 24 10 4 1 Holborn 58 6 1 — — Wandsworth 317 29 4 4 3 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, one making mention of the fact that no applications were received, whilst 14 refer to the supply of anti-toxin for curative and prophylactic purposes. 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 530 94 Shoreditch 45 18 Kensington 340 52 Bethnal Green 133 38 Fulham 216 56 Stepney 103 21 Chelsea 160 44 Poplar 228 78 Westminster, City of 157 19 Southwark 188 32 St. Marylebone 160 31 Bermondsey 596 52 Hampstead 247 68 Lambeth 497 55 St. Pancras 317 127 Battersea 554 135 Islington 435 137 Wandsworth 808 233 Stoke Newington 128 43 Deptford 313 71 Hackney 258 63 Greenwich 1,590 240 Holborn 51 18 Lewisham 531 244 Finsbury 89 22 Woolwich 1,231 320 London, City of 6 2 Bacteriological diagnosis. It will be seen from diagram (N) that the proportion of cases of diphtheria removed to the hospitals of the Metropolitan Asylums Board was about the same as in the preceding year. Cases notified as 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 1912 13.8 Diphtheria —diagnosis not confirmed. Whooping-cough. The deaths from whooping-cough in the Administrative County of London during the year 1912 (52 weeks) numbered 970, as compared with 1,038 in 1911 (52 weeks). Diagram P. Whooping- Cough . Report of the County Medical Officer—General. 33 The death-rates from this disease in 1912 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 1904 0.33a 1851-1860 0.88 1905 0.33a 1861-1870 0.88 1906 0.27a 1871-1880 0.81 1907 0.40a 1881-1890 0.69 1908 0.21a 1891-1900 0.50a 1909 0.28a 1901-1910 0.32a 1910 0.30a 1901 0.35a 1911 0.23a 1902 0.41a 1912 0.21a 1903 0.36a Whooping cough— death-rates. The following table shows the death-rates from whooping cough in London per 1,000 children living at ages 0-5 years. The rates are shown for each decennium from 1851 and for the several years from 1901 to 1912. 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 1904 3.01b 1861-1870 6.53 1905 3.01b 1871-1880 6.02 1906 2.47b 1881-1890 5.34 1907 3.64b 1891-1900 4.21b 1908 2.00b 1901-1910 2.95b 1909 2.56b 1910 2.83b 1901 3.14b 1911 2.15a 1902 3.64b 1912 2.02a 1903 3.23b Whoopingcough deathrates— children 0-5 years. The death-rate in each year since 1840 in relation to the mean of the period 1841-1912 is shown in diagram (P), while the deaths in each month since 1890 in relation to the mean monthly deaths of the period 1891-1912 are shown in diagram (H), facing page 24. It will be seen from the following table that in the quinquennium 1907-11 the London whoopingcough death-rate was exceeded by that of all the undermentioned towns except Bristol, Bradford, Hull, Nottingham, Portsmouth and Leicester; while in the year 1912 it exceeded that of Leeds, Bristol, Bradford, Hull, Newcastle and Leicester. Town. 1907-11. 1912. Town. 1907-11. 1912. London 0.28a 0.22a Bradford 0.22 0.05 Greater London 0.26 0.21 Hull 0.27 0.09 Liverpool 0.43 0.36 Newcastle-on-Tyne 0.41 0.15 Manchester 0.36 0.41 Nottingham 0.28 0.27 Birmingham 0.36 0.39 Stoke-on-Trent 0.34 0.30 Sheffield 0.32 0.41 Portsmouth 0.21 0.22 Leeds 0.31 0.12 Salford 0.38 0.55 Bristol 0.24 0.19 Leicester 0.17 0.21 West Ham 0.41 0.43 Whoopingcough deathrates in large English towns. (a) See footnote (c), page 4. (6) 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. 18820 E Whooping Cough in London boroughs. 34 Annual Report of the London County Council, 1912. The following table shows the whooping-cough deaths and death-rates for the year 1912 and the death-rates for the period 1907-11 in the several sanitary districts:— Metropolitan borough. Deaths, 1912 (52 weeks). Death-rate per 1,000 persons living. 1907-11. 1912. Paddington 20 0.24 0.14 Kensington 24 0.25 0.14 Hammersmith 17 0.27 0.14 Fulham 45 0.33 0.29 Chelsea 14 0.22 0.21 Westminster, City of 16 0.12 0.10 St. Marylebone 19 0.26 0.16 Hampstead 4 0.12 0.05 St. Pancras 44 0.30 0.20 Islington 57 0.28 0.18 Stoke Newington 3 0.25 0.06 Hackney 33 0.26 0.15 Holborn 7 0.27 0.15 Finsbury 29 0.42 0.34 London, City of 1 0.14 0.05 Shoreditch 47 0.49 0.43 Bethnal Green 32 0.35 0.25 Stepney 96 0.33 0.35 Poplar 64 0.45 0.40 Southwark 49 0.34 0.26 Bermondsey 36 0.35 0.29 Lambeth 55 0.25 0.19 Battersea 40 0.31 0.24 Wandsworth 61 0.26 0.19 Camberwell 51 0.26 0.20 Deptford 25 0.35 0.23 Greenwich 30 0.31 0.31 Lewisham 24 0.19 0.15 Woolwich 27 0.19 0.22 London 970 0.28 0.22 It will be seen from the foregoing table that in the period 1907-11 the highest whooping-cough death-rate was that of Shoreditch (0.49),and the lowest were those of Westminster and Hampstead(0.12); in the year 1912, Shoreditch (0.43) again had the highest death-rate and Hampstead (0.05) the lowest. The whooping-cough death-rates in London in each of the four quarters of the year 1912 were as follows : first quarter, 0.25; second quarter, 0.31 ; third quarter, 0.16; and the fourth quarter, 0.13. Generally the reports of medical officers of health contain but slight reference to whooping cough. In two boroughs, however, the disease has been made notifiable for a period of five years, in Lambeth from 1st January, 1913, and in Greenwich from 1st June, 1912. During the year the Local Government Board issued the Metropolitan Asylums (Whooping Cough) Order of the 9th August, 1912, giving power to the Asylums Board to admit to their hospitals non-pauper cases of whooping cough on the certificate of the medical officers of health of London sanitary districts, similarly to non-pauper cases of measles to which reference has already been made. 1,731 cases of whooping cough were admitted to the Board's hospitals in 1912, and there were 146 deaths, giving a fatality rate of 8.47 per cent. As with measles, the high death-rate is due to the fact that the cases form a selected class. The association of whooping cough and measles is commented upon, the two diseases being co-existent in 147 cases admitted to hospital during 1912. In the case of both diseases, moreover, it is pointed out that the most frequent complications are broncho-pneumonia and otitis. Typhus death rates, London. Typhus. There were no deaths from typhus in the Administrative County of London during the year 1912. The death-rates from this disease in successive periods have been as follows:— Period. Death-rate per 1,000 persons livimg. 1871-1880 .055 1881-1890 .008 1891-1900 .001a 1901-1910 .000a 1901 .001a 1902 — 1903 .001a 1904 — 1905 — 1906 - 1907 — 1908 — 1909 — 1910 — 1911 — 1912 — (a) See footnote (c) page 4. Diagram Q. Typhus. Diagram R. Enteric Fever. Diagram S. Enteric Fever. Notified Cases THE CITY OF LONDON LITHOGRAPHIC Co. HARP ALLEY LONDON, E.C Diagram T. Enteric Fever. Report of the County Medical Officer—General. 35 The death-rate in each year since 1868 in relation to' the mean death-rate of the entire period 1869-1912 is shown in diagram (Q). During the year 3 cases of typhus fever were notified as having occurred in London, one each in Finsbury, Shoreditch, and Bermondsey. All the patients died. Accounts of the cases are given in the respective annual reports of the medical officers of health and are here summarised. Typhus suspected cases. Finsbury.—A married woman, aged 39 years, who worked as a laundress ironer in a Holloway laundry, suffered from an illness which was notified as typhoid fever. After her admission to hospital, in May, she was suspected to be suffering from typhus, a suspicion which was confirmed by a postmortem examination. She died thirteen days after the symptoms of disease were first observed. The source of her illness could not be traced, and no further cases occurred in the borough. Shoreditch.—A commercial traveller out of employment, aged 50 years, began to be ill on 14th October. His illness was marked by a severe shivering fit. He was admitted to the Shoreditch Infirmary on 16th October, was delirious on the 17th, a rash appeared on the 18th, he became unconscious and had a series of fits and convulsions and died the following day. His temperature was continuously between 104 and 105 degrees Fahrenheit. The eruption, which resembled that of measles, was distributed generally over the trunk and limbs, and was to be seen on the face. The Medical Officer of Health states that a physician of great experience in typhus fever who saw the body shortly after death, was of opinion that the disease was not typhus, and suggested that the eruption was to be associated with convulsions sometimes met with in persons with kidney disease. Marked evidence of chronic kidney disease was found at the post mortem examination, but it was also noticcd that the eruption was distinctly petechial in character and persisted after death. The patient's wife and two children were kept under observation at the borough council shelter, but no further cases occurred and the source of infection could not be traced. Bermondsey.—This case, that of a lighterman notified on October 5th, was seen by Dr. Brown, the medical officer of health on October 3rd. The rash was fairly typical of typhus, and the man seemed very ill. His mental condition was clear. He earned good wages, had a very good home, and there was a total absence of the usual concomitants of the disease, namely, poverty, dirt, and overcrowding. He was removed to the South-Western Hospital, where he died. Dr. Brown states that it is difficult to be absolutely certain whether the case was a genuine one, but arguing by the process of exclusion it was impossible to come to any other diagnosis. Enteric Fecer. The number of cases of enteric fever notified in the Administrative County of London during 1912 (52 weeks) was 704, compared with 1,022 in the year 1911 (52 weeks). The deaths from this disease numbered 117 in 1912 (52 weeks), compared with 144 in 1911 (52 weeks). The case-rates and death-rates per 1,000 persons living and the case-mortality per cent. in 1912 and preceding periods were as follows:— Period. Death-rate per 1,000 persons living. Case-rate per 1,000 persons living. Case-mortality per cent. 1871-1880 0.24 —a —a 1881-1890 0.19 —a —a 1891-1900 0.14b 0.8 17.4 1901-1910 0.06b 0.4 15.3 1901 0.11b 0.7 15.6 1902 0.12b 0.7 15.8 1903 0.08b 0.5 15.7 1904 0.06b 0.4 15.1 1905 0.05b 0.3 15.1 1906 0.06b 0.4 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 1912 0.03b 0.2 16.6 Enteric fever death-rates and caserates, London. The death-rate in each year since 1868 in relation to the mean death-rate of the period 1869-1912 is shown in diagram (R). The notified cases in each week of 1912 may be compared with the average weekly notifications of the period 1890-1912 on reference to diagram (S). The monthly case-rate and case-mortality in each of the years 1891-1912 in relation to the mean of the whole period is shown in diagram (T). Enteric fever. During the year 1912 there appeared a very important report, on Typhoid Fever in South West Germany, giving the results obtained in the campaign against this disease instituted 9 years previously by Robert Koch. The report is profoundly interesting, for the point of view is one which differs Comparison of experience obtained in South-west Germany, with that of this country. (a) See footnote («), page 26. (b) See footnote (c), page 4. 18820 E 2 36 Annual Report of the London County Council, 1912. markedly from that held prior to 9 or 10 years ago, and it is very elaborately illustrated in a volume of more than 600 pages. Robert Koch was led to believe that typhoid fever was due to an organism the natural habitat of which was the human body; indeed, he held that, as one of his followers expresses it in the present report, this species of organism must necessarily become extinct provided only the possibility of its growth in that body be removed. Acting upon this belief, the school of Koch, in 1903, set about exterminating typhoid fever root and branch in South West Germany; the design being not merely to isolate the sick, but over and above this to search for all persons harbouring the specific bacilli, and to disinfect or destroy all the infective material produced by these so-called healthy carriers. This plan was carried out by establishing 11 bacteriological stations for the purpose of examining the blood and excreta of suspected persons, and upwards of a quarter of a million examinations have been made. The individuals supplying material which gave positive results have been kept under close watch, and subjected to severe restrictions, until such time as they were declared on bacteriological evidence to be free from suspicion. The report shows the remarkable perseverance with which this scheme has been put into execution, and it details some of the difficulties encountered, more especially in connection with obtaining the necessary material for examination. In illustration of the uncompromising way in which the plan has been followed up, it may be sufficient to refer to the case (mentioned on page 304 of the report) of a chronic carrier of typhoid bacilli, who was under the necessity of changing her place of abode three times within a single year, because those dwelling in the houses she inhabited would not tolerate her presence on account of the smell of the disinfectants she had been required to use. The results of the nine years' work lend, the official reporters claim, support to the view that the campaign has been largely successful, for there has been a distinct decline of typhoid fever in South West Germany, and this decline, it is noted, has been a more marked one than that recorded in Prussia during the same period; but there was some slight recrudescence of typhoid in 1910 and 1911, in the area of the campaign itself, and this increase is admitted to constitute a warning that much still remains to be done. There are not wanting, moreover, scattered throughout the reports, indications that as a matter of fact far less has been achieved than it had been anticipated would be accomplished. In the sections of the volumes which deal with dysentery and paratyphoid fever, almost complete failure is practically admitted, but then, it is argued (p. 94), typhoid fever itself stands on an entirely different footing, for man alone constitutes the medium ("Vegetationsort") for development of the bacillus typhosus, whereas paratyphoid bacilli are widely distributed, not in the human species only, but in other animals and in the outer world. This consideration is held to explain the fact that there has been an actual increase of paratyphoid fever coincidently with rigorous practice of campaign methods. Again, the occurrence of the seasonal peak of typhoid is felt to constitute a difficulty from Koch's point of view. The writers of the reports find that this peak is more markedly developed when the statistical material is obtained from rural than from urban areas, and they also find that the cases which contribute to the heightened autumnal prevalence are not the "secondary" cases, but, in the main, the unexplained cases; the "contact wave" lags behind that produced by the cases of admittedly unknown origin, and the fact must, therefore, be admitted that the riddle of typhoid may largely lie in the mysterious circumstances which give rise to this last-named group. The decision as to whether a case is "explained" or "unexplained" depends, however, largely, the reporters admit, upon the personal equation of the observer, but even at the lowest estimate the unexplained cases are half the total number. There are, moreover, various curious circumstances associated with these "unexplained cases"; there is their tendency to occur in small groups, in connection with which suspicion as to infected food supplies often arises (p. 184); there is their special development in industrial and mining centres, and their possible association, even in individual instances in those centres, with imported food supplies. Particularly noteworthy, moreover, is the comparatively slight incidence of typhoid fever upon the rural areas, for, at first sight, it might be thought that in them the conditions were specially inimical, means of water supply and excrement disposal being as a rule extremely faulty, though on the other hand there are few strangers and the inhabitants prepare their own food. When such sparsely inhabited areas do become involved, the disease sometimes persists in them, and yet, on the other hand, there is the fact (p. 25), especially difficult of explanation from the stand-point of Koch, that nearly half the districts yielding cases of typhoid in some numbers in the course of a year are districts newly involved during that year. All these peculiarities are passed in review, and so, also, is the question of incidence upon doctors, nurses, laundry-maids, etc., which it transpires is smaller than had been anticipated; more than, once too, there is mention of the inconceivability of any important role in dissemination being played by the fly. On p. 481 a very weighty piece of caution is given, to the effect that, altogether apart from the particular source suspected in any given instance, there are other possibilities which should not be allowed to pass altogether out of mind. In all this it is seen how difficulties, which cannot be brushed aside, present themselves to the painstaking and methodical observers who write these reports. Perhaps the most interesting of all the contributions is that of Dr. Demuth, of the Bavarian Pfalz. This observer again and again insists that the behaviour of the disease in the area he is concerned with has to no inconsiderable extent been influenced by the general measures of improvement which were undertaken in the seventies, eighties and nineties of the last century, in obedience to the teaching of that earlier day. He is able to give a chart, showing typhoid fever prevalence in the Pfalz from 1876 onwards, and he deduces (p. 398) from his figures the conclusion that, already in 1903, typhoid fever had shown clear evidence of decline, although no special measures, of the kind now deemed necessary, had at that time been undertaken; he adds, however, that acceleration of this decline dates from 1904, the year of the newly undertaken preventive measures. All through the reports one cannot fail to be impressed with the evidence presented to the effect that a large amount of attention has been, Report of the County Medical Officer—General. 37 and is still being, devoted to nuisance removal, to improved methods of excrement disposal, to bettering of water supplies, and so forth; in various sections of the reports the millions of marks expended, and the details of changes effected, etc., etc., are all set out. Again, on page 374, the remark is made that the greater care exercised during recent years with regard to food supplies may have had influence in lessening prevalence of typhoid. Speaking generally, however, one fails to detect that the beneficial effect of these measures has been fully appraised in considering the causes of the decline of the disease. This remark is not, however, applicable in the case of Dr. Demuth. In his report he alludes to the ground water theory of Pettenkofer, and recalls the belief entertained 40 years ago, in the innocuousness of recently voided excreta, and the need for certain changes to be brought about in them, outside the human body, before they become potent for harm; changes supposed to be effected in suitable soils, given appropriate conditions of impurity and moisture. It was in the light of this theory of the mode of spread of typhoid, that the sanitary measures of the latter half of the last century were undertaken, measures which Dr. Demuth evidently thinks have not been without effect. It is interesting to note in this connection a very curious remark made by von Drigalski, who contributes a paper to the volume, and who, unlike Dr. Demuth, looks upon the older teaching with complete disfavour. If, he observes, the typhoid organism grew in the soil, agricultural labourers must, as a class, be held to be as much exposed to danger as nurses in hospitals or workers in laboratories, and he adds that, in times of epidemic prevalence, it will, at least, be admitted that multitudes of typhoid germs must finally lose their virulence in the soil of the churchyard. This institution of a comparison of the relative risks of two kinds of employment is very instructive, particularly when considered in the light of the actual figures at von Drigalski's disposal. Table 20, p. 471, shows noteworthy incidence upon those engaged in agriculture, and this would, of course, be expected, in view of the fact that the total population (of upwards of 2,000,000) dealt with, includes a considerable number of persons thus employed. Only three doctors and two disinfectors, on the other hand, were attacked; one of the doctors inoculated himself, accidentally, when engaged in experimenting, and he died. This incidence is certainly not a heavy one, even on the two years' figures to which Table 20 relates, and apparently the three doctors mentioned represent the total number attacked during the longer period of years (4¼) to which von Drigalski refers. Five workers in the bacteriological institutes suffered, i.e., at the rate of about one a year; the total number of workers (which must, however, have been considerable) is not given. There are, moreover, references to typhoid fever in nurses; thus Klinger (p. 239) recorded 32 nurses attacked among 842 female sufferers (in whom the source of infection was believed to have been discovered), i.e., between 3 and 4 per cent. There are, again, no means of determining whether or no this percentage is in excess of the percentage of nurses to adult women generally. On p. 247 there is a further reference to nurses, and it is stated that women constituted 78 per cent. of the total number of nursing attendants attacked; the proportions of males and females in the total numbers at risk are again not forthcoming. Altogether the data available for assessing the special risk to attendants on the sick do not admit of any precise statistical analysis being made. The case cannot, however, be a convincing one, for the statement appears (p. 200) that attendants on the sick were specially careful, and for that reason they, as a rule, escaped. A soil theorist might conceivably find quite as much in support of his thesis in the evidence cited by von Drigalski, as that writer believes that he himself finds in support of his own contact theory. It has already been noted that the fly hypothesis, which has found so much favour of late years in this country and in America, is not regarded very seriously by the German reporters. Thus (p. 272) the fact is referred to that the laboratories, in summer time, were invaded by large numbers of flies, and, had conveyance of infection by these insects constituted a real danger, it would have been anticipated, von Drigalski thinks, that many mishaps would have been recorded. Again, a tendency to accept too readily evidence held to incriminate a water supply is commented upon. Thus, on p. 21, it is rather naively noted that cases in one family or house, which might be ascribed to contact, are oftentimes wrongly attributed to water, merely because the available supply is one which cannot be regarded as above criticism ; and yet supplies of this kind, it is added, are not uncommonly met with in rural districts. The writer goes on to hint that, in his opinion cases, which are really due to contact are in a similar way, often on quite insufficient grounds, held to be due to infected milk supplies. Again, on p. 16, the general absence of association between outbreaks of the disease and areas of common milk supply is commented upon. In tracing contact infection, however, apparently everything counts; blood, stool and urine samples from all persons living in the same surroundings as a patient must be examined, and this means (p. 186) not merely dealing with members of the same family, but with those dwelling in the same street or even in the same district; such extension of the scope of enquiry becomes it is, however, reluctantly agreed, in the case of towns of 15 or 20 thousand inhabitants, a counsel of perfection; the bacteriologist finds himself adrift on a shoreless sea; he may, nevertheless, console himself, if a carrier cannot be found, by concluding (p. 185) that it was a mere occasional disseminator of bacilli who was at fault, and that he had ceased to void the germs at the time when the sample was submitted for examination. Moreover, a positive result is satisfactory (p. 322) a negative result is held to prove nothing; or, as an American writer, Dr. Overlander (Boston Medical and Surgical Journal, 13th July, 1913), expresses it, there is a definite method by which we may determine whether a person is a typhoid carrier, but there is no definite method by which we may determine that a person is not a typhoid carrier. The German observers, working on the lines indicated, do not hesitate to attribute four-fifths of their cases of known origin to contact. They calculate, p. 292, that their methods, if fully put into execution, would reveal 4,300 new chronic carriers of typhoid fever, each year, among the German population, and they are not in any way inclined to discount the value of such discovery by the consideration that a large number of these persons would give no history of having ever suffered from typhoid fever at all. 38 Annual Report of the London County Council, 1912. In this summary of the German reports, no reference has hitherto been made to the special bacteriological questions, which, indeed, occupy the major portion of the volume. The description of the technique employed, and the careful account given of certain anomalous cultural and serological peculiarities observed in dealing with particular strains of typhoid bacilli are, however, full of interest. Part IV., written by Dr. Rimpau, which deals with paratyphoid fever and dysentery, appears especially deserving of close attention. There occurs (p. 562) a remarkable discussion of the question whether discovery of the presence of a chronic carrier of paratyphoid bacilli, in the near neighbourhood of a sufferer from paratyphoid fever, warrants the conclusion that the latter was infected by the former. Dr. Rimpau says the two may have been infected quite independently of one another, or both may have been infected from one and the same common source, one person developing the disease, the other merely becoming a healthy carrier. Finally, he says, the possibility must be kept in mind that the sick person may have excreted bacilli before his illness developed, and that the healthy carrier may thus have been infected by him, instead of his having been infected by the healthy carrier. The bearing in mind of these possibilities, in the case of typhoid fever and the typhoid fever bacillus, might tend perhaps to reduce somewhat the large proportion of carriers of that disease, attributed to contact in these German reports. Dr. Rimpau, moreover, gives (p. 544-546) a full account of the special difficulties encountered by reason of the occurrence of paratyphoid bacilli in the excreta of healthy persons, and also in persons presenting symptoms of very various character, food poisoning, influenza, liver disorders, and scarlet fever. On p. 546 he refers to the fact that in swine fever an organism, which closely resembles the paratyphoid bacillus, is commonly found, but that it is not this organism, but a "filterpasser," that is now regarded as the cause of the disease. Dr. Rimpau speculates as to the possible bearing of this last-mentioned view upon the anomalous and perplexing bacteriological results which he has to record in reporting upon paratyphoid fever. * These German reports have been referred to in some detail, as they illustrate very copiously a particular modern point of view. Thus, if the analytical statement of all the German cases be examined, it transpires that, out of a total of 10,149, in 5,254 of which a source of infection was recorded, no fewer than 4,202 cases were ascribed to contact, 399 to water, 309 to milk, 141 to other foods, 39 to laundry work, 103 to nursing the sick, 5 to soil infection, 26 to direct excretal contamination, and 11 to laboratory infection. The absence of references to shell fish is very remarkable, but the large number ascribed to contact can perhaps be understood, in the light of the explanations which have been collected from the reports, of the principles upon which such ascription has oftentimes been based; in this large series of 10,000 cases, it will be noted that the laboratory and nurse sufferers assume proportions to the total numbers which cannot greatly exceed the percentages of laboratory workers and of nurses respectively, in the total populations at risk. It is very instructive to compare the experience gained in South West Germany with that forthcoming from towns like London and Belfast. In all three there has been marked decline of typhoid fever in recent years, as will be seen on reference to diagram U. In Belfast this decline has been attributed by Dr. Darra Mair to disuse of cockles from a neighbouring sewage polluted foreshore. Contact infection Dr. Mair relegates to quite a subsidiary place, while he left no role at all for the healthy carrier to perform. In South West Germany the influence of shell fish is practically ignored, though there is an isolated mention of fish ("Seebarsch"), in connection with some cases of paratyphoid fever (p. 571); the part played by the healthy carrier, however, is deemed, as has been seen, to be one of extremely great importance. In London the methodical examination of excreta, on the lines practised in Germany, has only been carried out in a few localities, and in them a good deal of difficulty has been experienced in obtaining the necessary material. Much careful work has been undertaken by London medical officers of health, who have endeavoured to trace sources of infection in individual cases, and the series of reports, to which the present report belongs, has contained a summary year by year of the results which have been obtained. Only one outbreak of typhoid fever, that of 1895 in Plumstead, has been traced in recent years to milk in Lonndon. Sir Shirley Murphy reported in 1894, and again later, upon the relation of typhoid fever prevalences to floods; several cases, moreover, have been ascribed to contact infection, and this has been more particularly the case since the trend of thought in Germany has influenced opinion over here. There have, further, been a large number of cases attributed to food infection; the kind of food implicated being, as a rule, shellfish, fried fish and, in some instances, ice cream or watercress. Many of these foods, have moreover, been of a kind which would bring them within the category of "trash bought in the streets," to adopt the description applied by Dr. Niven, of Manchester, some years ago to certain materials sold in the poor quarters of that town. There is a remarkable point about the London sufferers, and here, at any rate, there is agreement with observations made among the sufferers in South West Germany (p. 223 of the German report): those attacked, as a rule, have belonged to the poorer classes. In the case of London it has not perhaps been so much the classes which are quite the lowest in the scale, the A and B of Mr. Charles Booth's classification, as the classes just above them, C and D, that have been affected. Londoners in these classes, it has been found, consume, as a rule, more than one of the varieties of food which have from time to time fallen under suspicion, and, in particular oubreaks, question has arisen as to which, if any, of the kinds of food referred to has been concerned in causing spread of infection. Thus, in 1911, two prevalences of typhoid fever were developed almost simultaneously in London, the one prevalence (which was somewhat widespread all over the town) affected only persons who had recently been at Ramsgate and had partaken of cockles there, the other (a more extensive but strictly localised prevalence) was traced to the consumption of fish from a fried fish shop. It is noteworthy that several of the sufferers, in this last-named prevalence, had also partaken of ice cream obtained from a particular vendor, but careful analysis of all the facts clearly showed that fish and not ice cream was at fault. Similarly, in other outbreaks, question has from time to time arisen as between mussels, and fish, watercress and fish, and so forth. Report of the County Medical Officer—General. 39 The first outbreak attributed to fried fish occurred in 1900, and a smaller prevalence was reported in 1903. Study of the behaviour of the disease in the light of these occurrences then led to the conclusion, that fish had probably been responsible for some, at any rate, of the excessive and widespread incidence observed in London in 1898, 1899 and 1900. At this time, moreover, a large amount of attention was being directed to the possibility of infection by shell fish, more particularly by oysters, and the fall in prevalence of typhoid which followed in the early years of this century was very generally attributed to the alterations which were effected, at about this time, in the conditions under which shell fish were stored and manipulated. There can be no question as to the value of the improvements carried out in this connection, which resulted from the reports of Newsholme and others as to individual cases of disease attributed to oyster eating, and which were further stimulated by the reports on the occurrence of two considerable outbreaks, which were traced by Bulstrode to oysters in 1903, and by the same writer's detailed and exhaustive enquiries into the whole subject of the shell fish-industry. The attention of the market authority, supplying London with fish and shell fish, was thus closely directed to the possibility of risk from consumption of infected shell fish and fish, and the medical officer of health of the City has referred, year by year, in his reports to this subject. In 1908 and again in 1910 and 1911 further fish outbreaks were reported, in East London, and it was now clear that these outbreaks were especially associated with the consumption of immature plaice; increasing attention was given as the result of these occurrences to the whole subject of fish inspection. It appears probable that the precautions taken have had a share in producing the general decline in prevalence which is observable and it is particularly worthy of note that while the excess of typhoid fever in London in the last quarters of 1910 and 1911 was almost entirely due to infected fish, the years 1909, 1912 and 1913 exhibited practically no corresponding autumnal increase at all. The question which must now arise is whether the theory, broached by Koch in 1903, has stood the test of experience, and whether the evidence of contact infection, adduced in Germany, can be held to outweigh evidence incriminating water, milk, shell fish and fish which has by slow degrees been accumulated in this country. It is possible, though the great authority of Murchison was against the view, that direct case-to-ease infection plays some part in promoting spread of typhoid fever, but it certainly cannot, on the evidence to hand, be held to merit anything like the importance attached to it by the more extreme contagionists; indeed, if it did possess this importance, it would be necessary to assume that the typhoid fever caused by water, milk, shell fish and fish was not the same disease as that described by the Germans, for there has been a conspicuous absence of spread from case to case, after considerable outbreaks of typhoid fever caused by water or food materials. How, then, can the German results be explained? The ascription of so many cases to contact infection may perhaps be understood from consideration of the following passage (p. 183) from the German volume. "If a case of typhoid fever cannot be ascribed to infection from another case in its neighbourhood, and, if the search for a healthy bacillus carrier fails, inquiry must be made as to other possible sources of infection (food, water, soil, etc.). In such case also, however, in the light of the experience gained in South West Germany, a human being excreting bacilli is the cause of the mischief, and it is only the intervention of an intermediary substance which removes the instance in question from the category of ordinary contact infection. A sharp distinction cannot, of course, always be drawn between 'contact infection' and 'indirect transference,' for investigation is, as a rule, only made 14 days after the commencement of the illness, and the probable date of the actual infection itself was presumably 14 days earlier still, making an interval of 4 weeks. Neither the patient nor his friends are able after such an interval, not having made any precise observation at the time, to render assistance in discriminating as to whether personal contact or transference (for example, by means of washing or foodstuffs) has been in question. It is, therefore, possible that a number of those cases which are classed as contact cases are really and truly instances of 'indirect infection.' " This frank statement, taken together with that made, on page 441, to the effect that a far greater danger to the town dweller than can be ascribed to contact infection is that of infection conveyed by food materials, practically gives the case away so far as direct contact is concerned, and, if this be admitted, the problem becomes one of determining the relative importance of the parts played, in "indirect infection," by manipulation of food, immediately prior to its consumption, on the one hand, and by exposure of food to contamination in the gathering ground, foreshore, or estuary, on the other. The German reports themselves, in the evidence they yield of grouping of cases, of failure of spread in the absence of new importations, and of comparatively slight incidence upon those specially brought in contact with the sick, all confirm similar evidence obtained in this country, which tells strongly against the view that mischief is done at a comparatively late stage in the history of the distribution of the water or food. It only remains to add that the campaign in South West Germany has not proceeded, no campaign ever has, on the lines originally intended; on the contrary, first one and then another new position has been taken up. Koch anticipated that clear evidence of spread from the sick would be forthcoming, but his followers have tacitly admitted their failure to discover this class of evidence by their appeal to the healthy carrier; Koch expected to find "house incidence" and "street incidence," but the facts actually recorded, here, are difficult of explanation from the contact point of view; again, he said it would be found that the child population constituted an ever-present menace, inasmuch as they were harbourers of infection (he had already surmised that this might be the case in malaria), but this suggestion, too, has been a particularly unfruitful one. Koch's followers have invoked the influence of "regional immunity," brought about as the result of previous attacks, but all the facts which have been forthcoming appear to discredit this hypothesis also. It has become necessary, in fact, to place entire reliance upon the healthy carrier; and healthy carriers proving to be numerous far beyond anticipation, 40 Annual Report of the London County Council, 1912. the question has really become—What degree of importance should be attached to the demonstration of the presence of typhoid bacilli in the blood or excreta of a particular individual? And here the question has been complicated, in one sense, by the discovery of "enrichment methods" of cultivation; for the bacillus can now be demonstrated under conditions in which a few years ago it would have been hopeless to attempt to find it. It is true that in dealing with the hitherto generally recognised vehicles of infection, water, milk, etc., few positive results have been obtained; von Drigalski was only successful in finding the bacillus in one sample of water, and in this instance no cases of illness resulted from drinking the supply in question. But, on the other hand, the bacillus has been found under the most unexpected circumstances, e.g., in collections of pus or in gallstones years after an attack, or indeed in the absence of any history of an attack of typhoid; again, it has been found in the excreta, in numerous instances, where no history of previous attack of typhoid is forthcoming. One method after another of isolating bacilli from the blood and excreta has been recommended, better and better results being claimed for each new departure made, until at length one of the German reporters writes (p. 525), "It is not so much the method employed that matters, it is rather the practical experience gained of it, and the patience of the observer that count." All this has undoubtedly tended to excite criticism, and in the minds of many to cast doubt upon the position taken up by Koch; but two considerations, in particular, indicate that some modification of his view is necessary. In the first place there are the difficulties presented by the case, in many ways so closely parallel to that of the typhoid bacillus and typhoid fever, of the paratyphoid bacillus and paratyphoid fever. The German writers fully admit the difficulties presented in the case of the latter. Reports from all the stations, it is said, agree (p. 95), that it is quite common to meet with paratyphoid bacilli in healthy persons, who have not been exposed to the infection of paratyphoid fever; and, again, so variable are the conditions associated with the presence of paratyphoid bacilli, that we are told (p. 543) paratyphoid fever cannot be regarded as a clinical term, but must be locked upon as an ætiological one. It is difficult to define the ætiological role of a bacillus which anyone may excrete and which is not necessarily (even when it does occur in a sick person) associated with any particular kind of disease. In the second place, bacteriological theory has undergone a remarkable change during the last five years. The demonstration of the secondary role played by a number of supposed causal organisms, and the proofs gradually accumulating of the liability of bacteria to undergo so-called "mutation," have done much to render unsettled ideas as to the criteria which should be held to delimit a bacterial species. To all this development of knowledge large and important contributions have been made by German bacteriologists, and the campaign in South West Germany, if it has not done much to throw any direct light on the spread of typhoid fever, has at least contributed materially to growth of knowledge concerning the typhoid and paratyphoid bacilli. Enteric fever in London boroughs. The following table shows the enteric fever cases, deaths, case-rates ana death-rates for the year 1912, and the case-rates and death-rates for the period 1907-11 in the several sanitary districts— Metropolitan borough. Notified cases, 1912 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1912 (52 weeks). Death-rate per 1,000 persons living. 1907-11. 1912. 1907-11. 1912. Paddington 15 0.24 0.11 1 0.03 0.01 Kensington 15 0.22 0.09 4 0.03 0.02 Hammersmith 11 0.24 0.09 4 0.04 0.03 Fulham 26 0.26 0.17 8 0.04 0.05 Chelsea 10 0.21 0.15 1 0.03 0.02 Westminster, City of 17 0.24 0.11 4 0.04 0.03 St. Marylebone 11 0.21 0.10 5 0.03 0.04 Hampstead 10 0.23 0.12 1 0.04 0.01 St. Pancras 29 0.27 0.13 3 0.03 0.01 Islington 49 0.27 0.15 8 0.04 0.02 Stoke Newington 3 0.21 0.06 — 0.04 — Hackney 27 0.31 0.12 3 0.05 0.01 Holborn 12 0.35 0.25 1 0.06 0.02 Finsbury 8 0.43 0.09 1 006 0.01 London, City of 2 0.30 0.11 — 0.05 — Shoreditch 14 0.46 0.13 4 0.06 0.04 Bethnal Green 30 0.48 0.24 3 0.07 0.02 Stepney 56 0.34 0.20 9 0.04 0.03 Poplar 36 0.39 0.22 7 0.08 0.04 Southwark 39 0.27 0.21 4 0.04 0.02 Bermondsey 37 0.31 0.30 5 005 0.04 Lambeth 61 0.21 0.21 13 0.04 0.04 Battersea 21 026 0.13 2 0.03 0.01 Wandsworth 69 0.21 0.21 8 0.03 0.02 Camberwell 29 0.21 0.11 6 0.03 0.02 Deptford 9 0.24 0.08 2 0.05 0.02 Greenwich 11 0.23 0.11 2 0.05 0.02 Lewisham 26 0.19 0.16 6 0.02 0.04 Woolwich 20 0.14 0.16 2 0.02 0.02 Port of London 1 London 704 0.27 0.16 117 0.04 0.03 Report of the County Medical Officer—General. 41 It will be seen that among the several sanitary districts in the period 1907-11 the enteric fever death-rate was highest in Poplar (0.08), and lowest in Woolwich and Lewisham (0.02); in the year 1912, Fulham (0.05) had the highest enteric fever death-rate , while six districts had a death-rate of 0.01 only and in Stoke Newington and the City of London there were no deaths. The death-rates from enteric fever in London in each of the four quarters of the year 1912 were as follows : first quarter, 0.03 ; second quarter, 0.02 ; third quarter, 0.03; and fourth quarter, 0.03. The following table shows the notified cases, deaths, ease-rates, death-rates and fatality of enteric fever at the several ages and for each sex in London during the year 1912. The case-rate, deathrate 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 15-20 and females aged 10-15, and the greatest incidence of death was upon males aged 20-25 and females 35-45. Euteric fever cases aiul deaths byage and sex, Loudon. 35-45. The fatality was greatest among males aged 25-35 and females aged 35-45. Age-period. Males. Females. Notified Cases. Deaths. Casemor tality per cent. Rates per 100,000 living. Notified Cases. Deaths. Casemor tality per cent. Rates per 100,000 living. Cases. Deaths. Cases. Deaths. All Ages — 370 71 19.1 17 3 334 52 15.5 14 2 0— 1 - 1 11.1 8 1 — - 11.0 4 0 1— 2 - — - 2— 3 - 1 - 3— 7 - 3 — 4- 5 2 5 1 5— 41 2 4.9 19 1 41 2 49 19 1 10— 44 3 6.8 22 2 43 4 9.2 21 2 15— 57 8 14.0 30 4 31 5 16.0 15 2 20— 42 13 30.8 22 7 46 5 10.8 19 2 25— 82 17 20.6 23 5 71 11 15.4 16 3 35— 53 16 30.0 18 5 51 12 23.4 15 4 45— 21 6 28.4 10 3 31 7 22.5 13 3 55 & upwards 12 4 332 5 2 11 5 45.2 4 2 In the reports of medical officers of health there is no mention of any considerable local prevalences of enteric fever during the year; in fact, in the whole of the administrative county only 704 cases were notified in 1912, as compared with 1,022 during 1911. Most of the reports contain notes on the probable origin of infection so far as this could be learned by inquiry. Thus, of 386 cases occurring in 17 boroughs 51, or 13.2 per cent., were supposed to have been contracted outside the borough, mostly at the seaside or abroad. In 1911 the proportion was 19.3 per cent. of 471 cases, and in 1910 was 15.7 per cent. of 733 cases. Mention is made in particular cases that special articles of food, such as shell fish, fried fish, water-cress and ice cream were consumed shortly before the onset of illness. Some of the reports contain notes upon particular cases. Thus in Paddington, one patient, a child one year old, was deemed to have been infected by his mother, who was found to be a " carrier." The mother had suffered from an attack of enteric fever some eighteen months previously while in India. In Finsbury the first case was that of a patient who had been medically treated for " influenza and debility," who kept at his work during the course of his illness and died while being removed to hospital. He had stayed in the country before his illness became acute, but the source of infection could not be traced. Three patients had eaten shell-fish obtained at the seaside from polluted estuaries, although in one case there was a distinct warning to visitors pointing to the fact that the water was sewage polluted. Dr. Alexander gives a statement of supposed causes and predisposing influences in all the cases occurring in Poplar so far as the information could be obtained. Among the cases, two had been bathing in the River Thames, one had been staying in the country for ten days where well water was used, and one had eaten unsound fruit thrown away as refuse ; a group of 4 cases occurred in one family, but there was no history of the source of infection. Dr. R. K. Brown gives a table of 7 cases occurring in Bermondsey as an illustration of the way the disease spreads from person to person, and of the mischief a wrongly diagnosed case may cause. A woman was first attacked, but her complaint was diagnosed as rheumatic fever with pneumonia and she was nursed at home. A month later her husband was notified as suffering from enteric fever, and about the same time his sister was stated to have pneumonia. Three weeks later a brother had pneumonia, and three weeks after this another sister was diagnosed as having the same complaint. Within the next ten days or so a second and third brother had been notified as suffering from enteric fever. Dr. Brown suggests that all the cases were probably of the same nature. There was a second small family outbreak in Bermondsey, but all the other cases were sporadic. In Woolwich, too, Dr. Davies states that of 6 cases occurring in one family, the first was the mother, who was treated in a general hospital for pneumonia ; on her return home her four children developed enteric fever ; the mother, as the result of bacteriological examination, was notified and removed to a fever hospital, but was discharged too soon, giving rise to a " return " case in the person of her husband. Two other cases in Woolwich, are said to have resulted from infection by a " carrier " case of long standing, a girl who had been in India, where she had had " fever " some two or three years ago. 18820 F 42 Annual Report of the London County Council, 1912. Enteric fever— diagnosis not confirmed. Cases certified to be 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 1907 29.1 1901 25.4 1908 28.1 1902 21.2 1909 37.9 1903 24.2 1910 24.8 1904 26.3 1911 34.2 1905 29.7 1912 40.8 1906 25.2 Diarrhœa and Enteritis. The deaths at all ages from diarrhoea and enteritis in the administrative County of London during 1912 (52 weeks) numbered 1,774, as compared with 6,162 in 1911. Of these, 1,190 occurred during the first year of life, and 181 in the second year. In each quarter the deaths numbered 305, 314, 748 and 407 respectively. In diagram V the death-rate from diarrhoea 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 1862-1912. Diarrhœa and Enteritis deaths and death-rates in large English towns. The following table shows that the London death-rate in 1912 from diarrhoea and enteritis among infants under two years of age per 1,000 births was higher than the death-rate of any of the undermentioned large English towns, except Liverpool, Manchester, Stoke-on-Trent and Salford. Town. Deaths. Death-rate per 1,000 births. Town. Deaths. Death-rate per 1,000 births. London 1,371 12.42 Bradford 25 4.47 Greater London 1,865 10.58 Hull 83 10.60 Liverpool 454 20.42 Newcastle-on-Tyne 48 6.65 Manchester 260 14.18 Nottingham 76 12.25 Birmingham 230 10.36 Stoke-on-Trent 126 17.02 Sheffield 137 10.72 Portsmouth 56 9.99 Leeds 102 9.84 Salford 91 14.84 Bristol 56 7.30 Leicester 45 8.89 West Ham 101 11.79 Diarrhœa deaths in London boroughs. The deaths and death-rates from diarrhoea and enteritis among infants under two years of age for the year 1912 in each of the sanitary districts of London, are shown in the following table :— Metropolitan borough. Deaths 1912 (52 weeks). Death-rate 1912 per 1,000 births. Paddington 43 14.23 Kensington 37 11.12 Hammersmith 29 10.07 Fulham 33 7.83 Chelsea 8 6.51 Westminster, City of 38 16.18 St. Marylebone 26 11.59 Hampstead 1 0.78 St Pancras 37 6.89 Islington 90 10.96 Stoke Newington 3 2.90 Hackney 60 11.39 Holborn 8 8.87 Finsbury 44 17.09 London, City of 4 21.62 Shoreditch 94 26.39 Bethnal Green 48 12.30 Stepney 153 17.93 Poplar 68 13.48 Southwark 104 18.61 Bermondsey 67 17.30 Lambeth 98 14.10 Battersea 50 11.74 Wandsworth 73 10.80 Camberwell 65 10.12 Deptford 29 10.01 Greenwich 25 10.46 Lewisham 26 7.75 Woolwich 10 3.65 London 1,371 12.42 Report of the County Medical Officer-General. 43 It will be seen from the foregoing table that the death-rate in 1912 from diarrhoea and enteritis per 1,000 births was highest in Shoreditch (26.39) and lowest in Hampstead (0.78). The death-rates in London in each of the four quarters of the year 1912 were as follows: first quarter, 7.56; second quarter, 7.51; third quarter, 22.92; and fourth quarter, 11.93. Erysipelas. The deaths(a) from erysipelas in the Administrative County of London during 1912 (52 weeks) numbered 152, as compared with 202 in 1912 (52 weeks). ErysipelasAge distribution of deaths, London, 1912. 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. 19 6 2 3 6 6 17 19 20 33 21 152 Erysipelas cases and deaths, 1891-1912. 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 1894 6,080 1.40 221 0.05 1895 5,660 1.30 179 0.04 1896 6,436 1.43 207 0.05 1897 5,794 1.31 184 0.04 1898 5,169 1.16 165 0.04 1899 5,606 1.25 213 0.05 1900 4,762 1.06 182 0.04 1901 4,604 1.02 171 0.04 1902 5,536 1.20 183 0.04 1903 4,372 0.97 183 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 1.07 202a 0.04a 1912 4,098 0.91 152a 0.03a Erysipelas case-rates in London boroughs. The number of cases of erysipelas notified and the case-rate for the year 1912, together with the case-rate for the period 1907-11, in the several sanitary districts are shown in the following table:- Metropolitan borough. Notified Cases, 1912 (52 weeks). Case-rate per 1,000 persons living. 1907-11. 1912. Paddington 117 0.77 0.82 Kensington 116 0.76 0.68 Hammersmith 102 0.64 0.83 Fulham 115 0.80 0.74 Chelsea 30 0.61 0.46 Westminster, City of 92 0.52 0.59 St. Marylebone 89 102 0.77 Hampstead 44 0.47 0.51 St. Pancras 189 0.80 0.88 Islington 186 0.73 0.57 Stoke Newington 33 0.61 0.65 Hackney 210 1.29 0.94 Holborn 47 0.80 0.98 Finsbury 144 1.61 1.68 (a) See footnote (c) page 4. (b) See footnote (b) page 33. 18820 F2 41 Annual Report of the London County Council, 1912. Metropolitan borough. Notified Cases, 1912 (52 weeks). Case-rate per 1,000 persons living 1907-11. 1912. London, City of 14 0.61 0.75 Shoreditch 148 1.24 1.34 Bethnal Green 192 1.67 1.50 Stepney 342 1.59 1.24 Poplar 198 1.18 1.23 Southwark 265 1.31 1.40 Bermondsey 164 1.16 1.31 Lambeth 223 0.72 0.75 Battersea 133 0.96 0.80 Wandsworth 207 0.67 0.64 Camberwell 216 0.92 0.83 Deptford 191 1.49 1.75 Greenwich 98 1.07 1.02 Lewisham 103 0.58 0.63 Woolwich 90 0.79 0.74 Port of London - London 4,098 0.96 0.91 Erysipelas cases by age and sex, London, 1912. The following table shows the age and sex distribution of the notified cases of erysipelas in 1912- Sex. Under 1 year. 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75 and upwards All Ages. Males 56 110 74 71 86 68 217 359 358 241 145 57 1,842 Females 52 95 94 69 137 135 273 367 435 310 206 83 2,256 Persons 108 205 168 140 223 203 490 726 793 551 351 140 4,098 The table shows that the number of females exceeds the number of males attacked, and it should be noted that the attack rate among females is higher, 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 1912 (52 weeks) attributed to puerperal fever(b) numbered 159, as compared with 142 in 1911 (52 weeks) and 161 in 1910 (52 weeks). Puerperal fever cases and deaths, London, 1891-1912. 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.(c) 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 142a 1912 380 159a (a) See footnote (c) page 4. (b) Including deaths from puerperal septicæmia and puerperal pyæmia. (c) See footnote (b) page 33. 45 Report of the County Medical Officer-General. Puerperal fever caserates and death-rates, London, 1891-1912. If these cases and deaths arc considered in relation to the total population and total births the following rates are obtained- Year. Case-rate per 1,000 living. Case-rate per 1,000 births. Death-rate (a) per 1,000 living. Death-rate (a) per 1,000 births. 1891-1895 0.07 2.17 0.06 1.97 1896-1900 0.06 2.03 0.05 1.50 1901-1905 0.06 2.10 0.04 1.44 1906-1910 0.06 2.27 0.04 1.36 1891 0.05 1.64 0.05 1.65 1892 0.08 2.55 0.07 2.37 1893 0.09 2.98 0.08 2.65 1894 0.06 1.92 0.05 1.60 1895 0.05 1.76 0.05 1.56 1896 0.06 2.04 0.05 1.66 1897 0.06 1.98 0.05 1.61 1898 0.05 1.86 0.04 1.39 1899 0.07 2.45 0.05 1.57 1900 0.05 1.81 0.04 1.29 1901 0.06 1.94 0.04 1.41 1902 0.07 2.35 0.04 1.52 1903 0.05 1.79 0.04 1.30 1904 0.06 2.12 0.04 1.54 1905 0.06 2.32 0.04 1.45 1906 0.07 2.39 0.04 1.50 1907 0.06 2.09 0.03 1.25 1908 0.05 1.86 0.03 111 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 1912 0.08 3.44 0.04b 1.44b An account of cases of puerperal fever occurring in the practice of midwives will be found on page 87. Influenza, Bronchitis and Pneumonia. The deaths(b) attributed to influenza, which in 1911 numbered 496 (52 weeks), rose to 534 in 1912 (52 weeks). The deaths from bronchitis numbered 5,479 in 1912, as compared with 5,203 in 1911. In 1912 there were 5.337 deaths attributed to pneumonia. as compared with 5,618 in 1911. Influenza, bronchitis and pneumonia death-rates, London, 1890-1912. 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 7,901 171 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 496b 0.11b 5,203b 1.15b 5,618b 1.25b 1912 534b 0.12b 5,479b 1.22b 5,337b 1.18b (a) See footnote (b) page 33. (b) See footnote (c) page 4. 46 Annual Report of the London County Council, 1912. Influenza — seasonal distribution, 1891-1912, The distribution of deaths (a) from influenza throughout the year (b) for each of the years 1891 to 1912 is shown in the following table:- No. of weeks. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 (c) 1912 (c) 1— 4 9 1,308 52 272 59 37 40 244 66 1,016 57 77 141 67 94 56 291 87 61 112 61 56 5— 8 7 637 96 96 164 58 55 368 259 298 75 224 103 62 119 44 186 276 90 151 77 101 9-12 8 119 162 69 1,343 61 94 193 430 130 134 298 89 74 119 98 104 424 430 98 57 67 13—16 29 42 180 56 257 50 121 140 302 172 102 89 54 62 75 129 81 209 257 64 51 32 17—20 770 33 125 32 106 50 96 61 121 105 81 58 46 40 56 105 48 94 85 41 39 46 21—24 1,044 22 72 27 35 33 54 51 82 57 30 35 37 21 38 40 41 36 46 16 15 22 25—28 242 15 49 19 28 17 26 25 42 16 21 20 25 17 16 21 25 28 34 11 11 9 29—32 51 7 23 17 14 15 18 27 27 12 18 7 18 5 4 20 14 15 15 9 10 14 33-36 32 9 23 20 17 10 13 10 11 11 11 16 6 9 11 15 18 12 10 17 6 15 37—40 13 6 18 14 15 12 19 17 19 15 12 13 17 24 22 18 19 21 15 29 17 16 41—44 15 20 28 29 22 27 29 46 55 17 23 35 13 92 39 35 42 30 31 25 40 48 45—48 35 18 152 41 47 56 35 49 61 55 44 65 44 98 44 86 39 45 56 75 46 39 49—52 81 28 546 58 49 56 71 52 342 46 56 . 99 51 138 52 228 59 57 86 75 66 70 Phthisis. The deaths from phthisis, fully corrected for institutions, in the Administrative County of London during 1912 (52 weeks) numbered 6,069, including acute miliary tuberculosis, as compared with 6,084 in 1911 (52 weeks. Phthisis death-rates, London, 1851-1912. 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 1904 1.67c 1861-1870 2.84 1905 1.45c 1871-1880 2.51 1906 1.50c 1881-1890 2.08 1907 1.46c 1891-1900 1.79c 1908 l.39c 1901-1910 1.49c 1909 1.40c 1910 1.25c 1901 1.65c 1911 1.35cd 1902 1.61.c 1912 1.35cd 1903 1.57c The phthisis death-rate since 1850 (corrected for differences in the age constitution of the population) in relation to the mean death-rate of the period 1851-1912 (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. Since the year 1910 the deaths from phthisis have been more fully corrected (d) than in previous years, and the increased incidence of phthisis shown in the last two years 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 for differences in the age and sex constitution of the population of the various sanitary districts. The factors for correction, also shown in the table, have been calculated by applying the 1911 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 in England and Wales during the decennium 1901-1910:- Metropolitan borough. Factor for correction for age and sex distribution. Crude death-rate. Corrected death-rate. Comparative mortality figure. (London 1,000.) 1907-11. 1912. 1907-11. 1912. 1907-11. 1912. London 0.9628 1.36 1.35 1.31 1.30 1,000 1,000 Paddington 0.9198 1.08 0.87 0.98 0.80 748 616 Kensington 0.9217 0.99 1.07 0.92 0.98 702 754 Hammersmith 0.9510 1.20 1.35 1.14 1.28 870 985 Fulham 0.9779 1.32 1.35 1.29 1.32 985 1,015 Chelsea 0.9151 1.47 1.30 1.35 1.19 1,030 915 Westminster, City of 0.8422 1.28 1.17 1.08 0.98 825 754 St. Marylebone 0.8932 1.33 1.26 1.19 1.13 908 869 Hampstead 0.9021 0.70 0.64 0.63 0.58 481 446 St. Pancras 0.9322 1.60 1.58 1.49 1.47 1,137 1,131 (a) See footnote (6), page 33. (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 4. (d) Including miliary tuberculosis, which would probably bo 2 per cent. of the total cases. 47 Report of the County Medical Officer—General. 47 Metropolitan borough. Factor for correction for age and sex distribution. Crude death-rate. Corrected death-rate. Comparative mortality figure. (London 1,000.) 1907-11. 1912. 1907-11. 1912. 1907-11. 1912. Islington 0.9573 1.29 1.35 1.24 1.30 947 1,000 Stoke Newington 0.9329 1.01 0.87 0.94 0.81 718 623 Hackney 0.9730 1.27 1.36 1.24 1.33 947 1,023 Holborn 0.8577 2.20 2.07 1.88 1.77 1,435 1,362 Finsbury 0.9976 2.14 1.92 2.14 1.92 1,634 1,477 London, City of 0.8219 1.63 1.98 1.34 1.63 1,023 1,254 Shoreditch 1.0270 1.85 2.10 1.90 2.15 1,450 1,654 Bethnal Green 1.0436 1.64 1.69 1.71 1.77 1,305 1,362 Stepney 1.0282 1.68 1.68 1.73 1.73 1,321 1,331 Poplar 1.0222 1.39 1.51 1.42 1.54 1,084 1,185 Southwark 0.9786 1.94 1.87 1.90 1.83 1,450 1,408 Bermondsey 1.0123 1.82 1.75 1.85 1.77 1,412 1,362 Lambeth 0.9548 1.47 1.37 1.40 1.31 1,069 1,008 Battersea 0.9829 1.29 1.17 1.27 1.15 969 885 Wandsworth 0.9627 0.91 0.93 0.88 0.89 672 685 Camberwell 0.9902 1.28 1.30 1.27 1.29 969 992 Deptford 0.9820 1.32 1.35 1.30 1.32 992 1,015 Greenwich 1.0040 1.17 1.41 1.18 1.42 901 1,092 Lewisham 0.9693 0.77 0.70 0.75 0.68 573 523 Woolwich 0.9781 1.28 1.05 1.25 1.03 954 792 It will be seen from the foregoing table (comparing the corrected death-rates) that among the several sanitary districts in the quinquennium 1907-11, Finsbury (2.14) had the highest phthisis death-rate and Hampstead (0.63) the lowest; in the year 1912, Shoreditch (2.15) had the highest death-rate, the lowest obtaining in Hampstead (0.58). The death-rates from phthisis in London in each of the four quarters of the year 1912 were as follows: first quarter, 1.52 ; second quarter, 1.21: third quarter, 1.18; and fourth quarter; 1.47. Phthisis- Corrected death-rates in London boroughs, 1906-1912. The following table enables comparison to be made between the phthisis death-rates in the several sanitary districts for each of the years 1906-1912, inclusive. These death-rates are corrected for differences in the age and sex constitution of the various populations, 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. Metropolitan borough. Corrected Phthisis death-rates. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Paddington 1.08 1.00 0.97 1.07 0.82 1.12 0.80 Kensington 1.23 1.04 0.98 0.91 0.80 0.85 0.98 Hammersmith 1.21 1.18 1.21 1.08 1.05 1.20 1.28 Fulham 1.22 1.31 1.28 1.32 1.11 1.43 1.32 Chelsea 1.52 1.50 1.26 1.48 1.16 1.33 1.19 Westminster, City of 1.18 1.15 1.07 1.16 0.98 102 0.98 St. Marylebone 1.43 1.33 1.01 1.24 1.05 1.31 1.13 Hampstead 0.63 0.66 0.74 0.61 0.59 0.55 0.58 St. Pancras 1.76 1.57 1.52 1.59 1.32 1.47 1.47 Islington 1.21 1.31 1.25 1.26 1.17 1.19 1.30 Stoke Newington 0.95 0.86 1.02 0.86 0.94 1.02 0.81 Hackney 1.32 1.17 1.27 1.25 1.15 1.36 1.33 Holborn 2.11 2.12 1.77 1.89 1.84 1.79 1.77 Finsbury 2.19 2.41 2.25 2.36 1.81 1.86 1.92 London, City of 1.38 1.57 1.32 1.37 1.14 1.31 1.63 Shoreditch 2.11 2.13 2.07 1.82 1.58 1.89 2.15 Bethnal Green 2.35 2.03 1.67 1.64 1.53 1.70 1.77 Stepney 1.93 1.68 1.76 1.89 1.51 1.82 1.73 Poplar 1.63 1.41 1.48 1.37 1.49 1.35 1.54 Southwark 2.12 2.10 1.96 1.90 1.88 1.67 1.83 Bermondsey 2.01 1.91 1.91 1.81 1.80 1.80 1.77 Lambeth 1.36 1.54 1.45 1.44 1.24 1.35 1.31 Battersea 1.33 1.29 1.27 1.32 1.16 1.31 1.15 Wandsworth 0.96 0.92 0.91 0.90 0.80 0.85 0.89 Camberwell 1.29 1.34 1.16 1.29 1.23 1.33 1.29 Deptford 1.30 1.43 1.19 1.34 1.28 1.25 1.32 Greenwich 1.32 1.15 1.28 1.15 1.12 1.17 1.42 Lewisham 0.82 0.91 0.85 0.79 0.55 0.63 0.68 Woolwich 1.39 1.28 1.29 1.27 1.12 1.31 1.03 London 1.43 1.40 1.33 1.34 1.20 1.30 1.30 48 Annual Report of the London County Council, 1912. PhthisisMortality and '' social condition." The following table shows the mortality from phthisis during the year 1912 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. 0.77 0.71 545 II. 1.06 1.00 767 III. 1.32 1.25 958 IV. 1.45 1.41 1,080 v. 1.79 1.83 1,400 London 1.31 1.30 1,000 Results obtained from the notification of Phthisis during 1912 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 more than twice that in the highest group. During the year 1911 the system of compulsory notification of pulmonary tuberculosis was completed and it was in operation during the whole of 1912. This scheme was begun on the 1st January, 1909, as the result of the Public Health (Tuberculosis) Regulations, 1908, issued by the Local Government Board on the 18th December of that year. These regulations provided for the notification of cases of pulmonary tuberculosis by Medical Officers of Poor Law Institutions, District Medical Officers, Superintending Officers of Poor Law Institutions and Relieving Officers. The respective duties of these officers in connection with notification are prescribed in Articles IV to VIII of the Regulations. Further Regulations were made on 22nd March, 1911, extending the system of notification to cases occurring among the in-patients or out-patients at hospitals or other similar institutions for the treatment of the sick which are supported wholly or partially otherwise than by the contributions of the patients (or of their relatives or guardians) and otherwise than from rates and taxes. These Regulations are described as the Public Health (Tuberculosis in Hospitals) Regulations, and came into force on 1st May, 1911. A further stage in the system of notification of pulmonary tuberculosis was reached by the issue of the Local Government Board Order of the 15th November, 1911. This Order provided that from the 1st January, 1912, every Medical Practitioner should notify within 48 hours every case of pulmonary tuberculosis occurring in the course of his public or of his private practice", but it relieved the medical practitioner of the duty of notifying a case which had to his knowledge already been notified to the proper authority. The Order was not a consolidating Order but supplemented and to some degree extended the Poor Law and Hospital Regulations. Thus, from the 1st January, 1912, a complete system of notification of pulmonary tuberculosis has been in force. The results for the year, however, cannot be regarded as representative inasmuch as a large number of old cases among the general population were notified for the first time. This consideration does not perhaps hold to the same extent as regards the notifications under the Poor Law Order, inasmuch as this Order had been longer in operation. From the returns supplied by medical officers of health of the several metropo litan boroughs, corrected as far as possible for duplicate notifications within each borough, it appears that 21,873 persons were notified during 1912. Probably this figure exceeds the true number because, owing to removals, it is possible that some cases have been notified from more than one borough. The percentage of cases distributed in age periods is as follows:- Ages 0-5, —15, 25, —35, —45, -55, —65, —75, -85 Percentage 2.32, 14.94, 16.02, 44.45 19.74 2.53 It will be observed that the case incidence increases with each age period up to 35 years, after which it falls. In some of the boroughs the normal curve of case incidence is disturbed and a considerably greater proportion of cases is notified at earlier ages particularly from 5-15 years, the school attending age. attending age. The following table gives the percentages of notifications and deaths of cases at this age period in the several boroughs. Sanitary district. Percentage at ages 5-15 years. Sanitary district. Percentage at ages 5-15 years. Notified cases. Deaths. Notified cases. Deaths. Battersea 17.5 3.2 Kensington 18.3 1.1 Bermondsey 18.5 7.1 Lambeth 8.2 2.8 Bethnal Green 4.0 3.4 Lewisham 10.5 1.8 Camberwell 15.2 3.8 Paddington 29.4 .9 Chelsea 8.3 - Poplar 19.7 3.2 Deptford 16.7 4.1 St. Marylebone 28.1 2.7 Finsbury 20.5 2.5 St. Pancras 7.9 1.8 Fulham 27.1 1.9 Shoreditch 9.1 1.4 Greenwich 18.3 2.2 Southwark 8.2 2.9 Hackney 10.7 2.7 Stepney 14.2 3.5 Hammersmith 12.1 3.0 Stoke Newington 2.0 2.2 Hampstead 13.1 3.1 Wandsworth 10.4 4.3 Holborn 5.7 4.2 Westminster 7.2 4.4 Islington 8.8 2.4 Woolwich 33.7 1.6 (a) See footnote (a) page 19. (b) See footnote (c), page 4. Report of the County Medical Officer-General. 49 When attention is directed to the percentages of deaths occurring at this period great variation will be noted as might be expected from the small number occurring at this age in a single year, yet those in boroughs which have a high case incidence at 5-15 years are without exception below the average for the county. On comparing the notification under the different orders it appears that the majority at this age period were from hospitals, dispensaries, and similar public institutions and were notified under the Tuberculosis (In Hospitals) Order. It is perhaps easier for children to attend at hospitals than adults, so that it might be expected that the proportion would be highest in those boroughs where the facilities for hospital attendance are the greatest. This, however, is not entirely the case since boroughs such as Bethnal Green and Holborn both well served by hospitals, present a very small proportion of notifications at this age, while Woolwich, from which access is less ready, presents a very high proportion. The factor of special interest in the areas whence come some of the high frequencies of tuberculosis at the age period 5-15 years, is the presence of special dispensaries for diagnosis and treatment, which seek out contacts and encourage their attendance for examination. It is probable that they may find it easier to secure the examination of the younger individuals and indeed it appears from the report of the Central Fund for the Promotion of Tuberculosis Dispensaries in London, that 34 per cent. of those they examine are under the age of 15 years, whereas the proportion at this age of the whole population was 28.8 per cent. The disparity between the indication from the death rate, the Poor Law notification and notification from general practitioners shows that there are in different areas different standards of what constitutes notifiable tuberculosis. The percentage of patients with pulmonary tuberculosis at the age group 5-15 years attending the Hospital for Consumption, Brompton, was 5.4 in 1842-1848 and 5.3 in 1902-1908, figures which show remarkable constancy and may be regarded as indicating the proportions whose condition attracted attention, and it will be noted that changed methods over the course of years had little influence on the proportions. It must be remembered that many under 12 years of age might go to Children's Hospitals. Some indications are given in the reports of medical officers of health as to the nature of treatment received by the patients in the cases notified. While the bulk of the cases notified under the Poor Law Order receive indoor institutional treatment in the infirmaries, or, in some instances where beds are at the disposal of the guardians, in sanatoria, the majority of the patients notified from hospitals and private sources are treated at home. Thus, in St. Marylebone, of 155 cases notified under the Poor Law Order, 109 were treated in the infirmary; of 448 notified under the Tuberculosis Order, 35 were admitted to hospital or infirmary, and 393 were treated at home ; while of 107 notified from other medical sources only three received residential institutional treatment. Some idea of the range of residential treatment at present available is indicated by a return from the City of Westminster, which shows that 331 cases were distributed as follows:-Sanatoria, 73; convalescent homes, 26; boarded out, 11; consumption hospitals, London 16; consumption hospitals, seaside, 18; homes for the dying, 7; general hospitals, 31; Poor Law infirmaries, 149. Returns from seven metropolitan boroughs show the percentage proportion of fatal cases treated in different institutions to have been-Infirmaries, 40.8 ; hospitals, etc., 13.1 ; at home, 46.1. The duration of illness of the individuals notified has been indicated in some cases, from which it would appear that approximately the average duration of illness prior to notification has been 2½ years, while in the fatal cases recorded during the year the average duration of illness prior to death has been a little under 2½ years. This agrees closely with the results derived from the records of the Brompton Hospital (1908) which indicated 2.6 years for males and 2.3 years for females as the average duration of illness of fatal cases in recent years, while the average duration for both sexes in the period 1842-1848 was 2 years. 1842-1848 was 2 years. The percentage of cases distributed according to the duration of symptoms has been tabulated so far as the information is available as follows:- Length of duration of symptoms. Notified cases for 8 boroughs, 1912. % Cases admitted to Hospital, 1907. % Cases at Hospital, 1848-1860. % Fatal cases 3 boroughs, 1912. % 2,639 fatal cases, Hospitals (recent). % 215 fatal cases, 1842-1848. % Under 1 year 41.5 37.1 49.7 43.5 41.5 41.0 1-2 years 16.8 21.0 27.3 21.4 32.6 30.0 2-3 ,, 11.4 13.6 23.0 11.2 12.2 13.0 3-4 ,, 6.9 8.2 4.7 3.7 [5.0 4-5 ,, 5.3 3.9 6.8 3.9 l3.0 5 years and over 18.2 13.1 12.4 6.1 The evidence afforded by this table would seem to indicate a considerable constancy in duration in spite of economic and medical changes. In the reports of the medical officers of Bethnal Green and Woolwich reference is made to patients who have been sent to sanatoria by the borough councils. The first-mentioned medical officer does not regard the results as a great success owing to the return of patients to unsatisfactory surroundings, while the latter thinks that from 4 to 5 months would be better than the usual period, from two to three months, spent at an institution, and indeed, recommends a period of from one to two years. Of 237 patients who have left the sanatorium within the last nine years, 107 are known to be dead, 15 to be alive but under treatment, and 75 to be at work or looking for work. 18820 G 50 Annual Report of the London County Council, 1912. An idea of the difficulty of keeping in touch with some patients on account of their migratory habits is given in some cases. Thus in Finsbury the length of time certain patients had resided at one address after being notified is given as follows:- Period. No. of cases. 0—1 week 3 1 week-1 month 30 1-3 months 24 3—6 ,, 38 6-12 ,, 53 1-5 years 155 Over 5 years 89 Many data of social and economic interest are accumulating and will be available when uniform systems of keeping records are in use. From data from Wandsworth and Marylebone the amount paid in rent by the families of patients is shown:— Weekly rent. No. of cases. Percentage. Under 5/- 188 14.3 5/ to 10/- 688 52.4 10/- to 15/- 283 21.6 15/-and over 153 11.6 Information as to the size of the dwelling shows that the greatest number of phthisical cases is to be found in two-roomed tenements thus: No. of rooms in tenement. Metropolitan borough. Wandsworth. Marylebone. Kensington. Finsbury. 1 63 136 160 105 2 59 291 345 156 3 159 105 138 97 4 163 43 180 5 and over 266 27 Dr. Thomas of Finsbury shows the number of persons to each bedroom and bed to instance the degree of overcrowding:— No. of persons in room. No. of instances where the room contained— One bed. •Two beds, Three beds. Four beds. 1 86 7 - - 2 133 23 — 1 3 38 37 1 — 4 7 34 — — 5 1 14 1 — 6 1 5 1 1 In Holborn 30 per cent. of the deaths from phthisis'during the last ten years were those of patients removed from common lodging houses,the death rate being 20 per 1,000 occupied beds. In 1912, of 95 deaths, 23 or 25 per cent. were removed to the infirmary from common lodging houses in the borough. Some information as to the working capacity of patients and the percentage of insured persons is given by Dr. A. E. Thomas, the medical officer of health of Finsbury:— Working capacity during 52 weeks preceding notification. Insurance. 32 per cent. not out of work at all 44 per cent. insured at onset of illness 25 per cent. out of work a few days 6 per cent. insurance had lapsed 16 per cent. out of work 1—3 months 9 per cent. belong to Friendly Societies 9 per cent. out of work 3—6 months 8 per cent. belonged to " Share out" Societies 18 per cent. out of work over 6 months 7 per cent. belonged to Trades Unions 1 per cent. belonged to Trades Unions (formerly) 25 per cent. definitely uninsured 51 Report of the County Medical Officer—General. As regards Stepney 26 per cent. of notified cases excluding children were insured, though the proportion of insured persons in the whole population is estimated to be 33 per cent. From the reports relating to Southwark and Bethnal Green the following data are obtained:— Males. Females, All persons. Insured 48.5 per cent. 23.1 per cent. 38.7 per cent. Uncertain 12.0 per cent. 8.1 per cent. 10.5 per cent. Uninsured 39.5 per cent. 68.8 per cent. 50.8 per cent. Reference to the action taken by the London County Council during 1912 with regard to securing treatment for persons in London suffering from tuberculosis will be found in the administrative section of this report under the heading National Insurance Act, 1911, page 78. Cancer. The deaths from cancer, fully corrected for institutions, in the Administrative County of London during 1912 (52 weeks), numbered 5,007. as compared with 4,746 for the 52 weeks of 1911. 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 1904 0.94a 1861-1870 0.48 1905 0.96a 1871-1880 0.55 1906 1.01a 1881-1890 0.68 1907 0.99a 1891-1900 0.85a 1908 1.02 1901-1910 0.98a 1909 1.04a 1910 1.03a 1901 0.88 1911 l.05a 1902 0.93a 1912 1.11a 1903 0.98a Cancer death-rates, London, 1851-1912. 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. 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 (Londoa 1,000). 1907-11. 1912. 1907-11. 1912. 1407-11. 1912. London 0.9634 1.03 1.14 0.99 1.10 1,000 1,000 Paddington 0.8542 1.20 1.23 1.02 1.05 1,032 955 Kensington 0.8117 1.16 1.36 0.94 1.10 952 1,000 Hammersmith 0.9363 1.05 1.13 0.99 1.06 998 964 Fulham 1.0723 0.99 1.00 1.05 1.07 1,065 973 Chelsea 0.8018 1.23 1.49 0.99 1.20 998 1,091 Westminster, City of 0.8484 1.17 1.44 0.99 1.22 1,002 1,109 St. Marylebone 0.8556 1.34 1.18 1.15 1.01 1,158 918 Hampstead 0.8657 1.00 1.26 0.87 1.09 877 991 St. Pancras 0.9362 1.17 1.21 1.10 1.13 1,109 1,027 Islington 0.9163 1.08 1.19 0.99 1.09 1,002 991 Stoke Newington 0.8235 1.24 1.18 1.02 0.97 1,030 882 Hackney 0.9594 0.99 1.00 0.95 0.96 960 873 Holborn 0.8425 1.08 1.33 0.91 1.12 921 1,018 Finsbury 0.9977 0.93 0.97 0.93 0.97 935 882 London, City of 0.78S3 1.23 1.71 0.97 1.35 976 1,227 Shoreditch 1.1342 0.85 0.82 0.97 0.93 980 845 Bethnal Green 1.1866 0.92 0.97 1.09 1.15 1,099 1,045 Cancer death-rates in London boroughs. Continued on next page. (a) See footnote (c), page 4. (b) The deaths upon which these rates are calculated, so far as the years 1911 and 1912 are concerned, are the deaths in England and Wales which have been allocated by the Registrar-General to London. Prior to 1911, the correction was limited to the Greater London area. The effect of this correction is, however, small, and results, as might be anticipated, in a slight increase of the death-rate, as will be seen on comparison with the rate shown in the preceding table, in which the less fully corrected rate is retained in order to ensure, as far as possible, comparability with years previous to 1911. 18820 G 2 52 Annual Report of the London County Council, 1912. Metropolitan borough. 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). 1907-11 1912. 1907-11. 1912. 1907-11. 1912. Stepney 1.2037 0.80 0.86 0.97 1.04 978 945 Poplar 1.0747 0.89 1.08 0.95 1.16 962 1,055 Southwark 1.0335 0.99 1.16 1.03 1.20 1,036 1,091 Bermondsey 1.0744 1.02 1.28 1.10 1.38 1,107 1,255 Lambeth 0.9193 1.15 1.31 1.06 1.21 1,067 1,100 Battersea 1.0112 0.96 111 0.97 1.13 982 1,027 Wandsworth 0.9552 0.98 1.08 0.93 1.03 941 936 Camberwell 0.9688 0.97 1.22 0.94 1.19 954 1,082 Deptford 0.9963 0.95 1.09 0.95 1.09 958 991 Greenwich 0.9895 0.90 0.98 0.89 0.97 901 882 Lewisham 0.9223 1.02 1.13 0.94 1.04 947 945 Woolwich 1.0321 0.93 1.01 0.96 1.05 968 955 It will be seen from the foregoing table (comparing the corrected death-rates) that in the quinquennium 1907-11 among the several sanitary districts, St. Marylebone (1.15) had the highest cancer death-rate, and Hampstead (0.87) the lowest, in the year 1912 Bermondsey (1.38) had the highest, the lowest obtaining in Shoreditch (0.93). Cancer death-rates —London boroughs, 1906-1912. The following table shows the corrected death-rate from cancer in each of the sanitary districts of London, annually for the last twelve years:- Metropolitan borough. Corrected Cancer death-rates. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Paddington 0.99 1.07 1.12 0.92 1.00 1.00 1.05 Kensington 0.82 1.00 0.89 1.01 0.83 0.98 1.10 Hammersmith 1.13 1.08 0.96 0.89 1.01 1.00 1.06 Fulham 1.02 1.14 0.84 1.02 1.06 1.21 1.07 Chelsea 0.99 0.82 0.86 1.01 1.14 111 1.20 Westminster, City of 0.86 0.83 1.02 1.03 0.96 1.12 1.22 St. Marylebone 0.92 1.05 1.16 1.16 1.15 1.21 1.01 Hampstead 1.01 0.74 0.92 0.87 0.89 0.92 1.09 St. Pancras 1.03 0.88 1.22 1.03 1.18 1.18 1.13 Islington 1.04 0.97 1.02 0.99 1.04 0.94 1.09 Stoke Newington 0.88 1.04 1.10 1.00 0.92 1.04 0.97 Hackney 0.81 0.88 0.97 0.94 0.98 0.98 0.96 Holborn 0.99 0.71 0.82 1.08 0.97 0.98 1.12 Finsbury 0.88 0.92 0.94 1.00 0.84 0.93 0.97 London, City of 0.98 0.94 0.98 1.01 0.97 0.93 1.35 Shoreditch 0.83 1.08 0.92 0.96 0.96 0.93 0.93 Bethnal Green 1.15 1.03 1.05 1.10 1.16 1.12 1.15 Stepney 1.18 0.93 0.97 0.88 1.00 1.06 1.04 Poplar 0.84 0.85 0.96 0.98 0.97 1.00 1.16 Southwark 0.96 1.00 0.97 0.99 1.03 1.14 1.20 Bermondsey 1.04 1.08 0.93 1.21 1.24 1.02 1.38 Lambeth 0.97 1.04 1.04 1.17 0.99 1.04 1.21 Battersea 1.03 0.96 0.92 1.10 0.87 0.01 1.13 Wandsworth 0.94 0.94 0.91 0.88 0.94 0.99 1.03 Camberwell 0.99 0.89 0.98 0.98 0.87 1.00 1.19 Deptford 1.00 0.72 0.88 0.95 1.02 1.16 1.09 Greenwich 0.81 0.85 0.98 0.89 0.90 0.84 0.97 Lewisham 0.89 0.91 0.90 0.92 0.93 1.03 1.04 Woolwich 1.02 0.96 0.81 1.02 0.89 1.10 1.05 London 0.97 0.95 0.98 1.00 0.99 1.03 1.10 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." These figures and those for the years 1910 and 1911, 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 48). Report of the County Medical Officer—General. 53 Cerebrospinal Fever. During 1912, 105 persons were certified to be suffering from cerebro-spinal fever and 4 deaths were attributed to this disease. The number of deaths in each year since 1901. has been as follows:— Deaths.(a) Deaths,(a) 1902 4 1908 12 1903 6 1909 15 1904 6 1910 10 1905 5 1911 9 1906 4 1912 4 1907 25 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, 115 in 1910, and 101 in 1911. In March, 1912, the Council extended the Order for another period of twelve months. The age distribution of the 105 cases notified in 1912 was as follows:— Sex. Cerebro-spinal fever—Age distribution of notified cases, 1912. 0- 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 13- 15 + All ages Males 13 6 3 2 4 1 — 1 2 1 5 2 12 52 Females 14 11 3 6 1 1 — 1 2 — 2 3 9 53 Persons 27 17 6 8 5 2 — 2 4 1 7 5 21 105 Two of the deaths were those of infants under one year of age, and the remaining two those of persons over five years of age. No cases were notified in Chelsea, Greenwich, Hampstead, Kensington, Stoke Newington. 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 105 cases notified, in 42 the final diagnosis confirmed the original diagnosis, in 11 this diagnosis was reversed, and in the remaining 52 the evidence was doubtful. Of the 42 cases verified on final diagnosis a post-mortem examination was made in 13 and bacteriological evidence was obtained in 17 ; 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. Anterior poliomyelitis. The Order making the disease notifiable became operative on 1st September, 1911, and during the remainder of that year 66 cases were notified. During 1912, 132 persons were certified to be suffering from anterior poliomyelitis. suffering from anterior poliomyelitis. The age distribution of the 132 cases notified during 1912 was as follows:- Sex. 0- 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 13- 15 + All ages. Males 3 24 19 8 6 1 1 2 1 1 2 — 7 75 Females 5 16 9 7 5 3 3 1 2 1 3 — 2 57 Persons 8 40 28 15 11 4 4 3 3 2 5 — 9 132 No cases of the disease were notified in Holborn, Kensington and Shoreditch. Of the 132 cases notified, in 61 the final diagnosis confirmed the original diagnosis, in 5 this diagnosis was reversed and in the remaining 66 the evidence was doubtful. Anthrax. Only one case of anthrax was notified during 1912. This case occurred in Fulham in the person of a poulterer regularly attending Smithfield Market. The part affected was the forehead, and the patient recovered. In addition, Dr. Thomas, the medical officer of health for Finsbury, records a case of anthrax occurring in a workman employed in a horse-hair factory in the borough. The illness was associated with the taking up of an old wooden floor of a storage room. The woodwork was well soaked with a resinous disinfectant before being disturbed and Dr. Thomas suggests that resinous disinfectants are not in practice effective for dealing with anthrax spores. (a) See footnote (c) page 4. 54 Annual Report of the London County Council, 1912. Glanders and Hydrophobia in man. Both these diseases are notifiable in London but no case was recorded during 1912. As regards glanders in man no case has been notified in London since March, 1910, and in this case the diagnosis was not confirmed. In the Annual Report of the Council for the year 1910, Vol. III, page 109, there appeared a report on the whole subject by Drs. J. M. Bernstein and W. H. Hamer including a brief statements of the main facts concerning the appearances presented by the disease in man and the means adopted for diagnosis. Appendix II. in the same report, moreover, presented a summary of the known facts relating to all the cases notified as occurring in the County of London for 18 years from 1893. As was pointed out at the time it is probable that the number of diagnosed cases did not include all the cases which occurred, although in 1909 there were nine and in 1908 seven notified cases. It was estimated by the chief officer of the Public Control Department that in London in 1907 there were about 700,000 horses, but the rapid development of motor traction has resulted in a large diminution of numbers. From omnibus and tramway stables alone it is estimated that from 45,000 to 60,000 horses have been disposed of, and including the obvious reduction in the number of horse drawn cabs and carriages, cartage waggons, and delivery vans it is probable that the total number of horses in the county would not at the present time exceed 300,000. In the report on human glanders to which reference has just been made it was pointed out that almost all the known cases of this disease occurred amongst persons working in direct association with horses, and it is possible that the reduction in the number of horses has been the direct cause of diminished prevalence of glanders in man. It must not, however, be overlooked that the fact that there are now fewer horses in London is due to the disposal of the larger studs formerly belonging to the companies dealing with the conveyance of persons and goods, and of horses belonging to the wealthier private owners. In all these cases special efforts were made to prevent the outbreak of disease. It is to the ever-increasing proportion of one-horse owners forming so large a class as to be almost beyond the control of the authorities that attention must be directed as a possible source of infection. As stated on page 111 of the Council's Annual Report of 1910-" These horses, often badly fed and overworked, and so offering little resistance to infection, are still liable to constitute a serious source of infection, both to other horses and to man." And again, "the men who own these horses would be, and in fact are, if they suspect themselves to be suffering from any infectious disease, very loth to draw attention to themselves and interfere with their freedom." Leprosy. In April, 1912, the London County Council received a communication from the Greenwich and otheT borough councils asking that leprosy be made a notifiable infectious disease and that sections 55 to 70 of the Public Health (London) Act, 1891, be applied. It was stated that between 20 and 30 persons suffering from the disease were known to be residing in different places in the metropolis. A reply was sent to the effect that the London County Council had not before it sufficient evidence to warrant the inclusion of leprosy in the list of notifiable diseases, but that having regard to the importance of the suggestion the matter had been brought to the notice of the Local Government Board. 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 1912 was 51.0 deg. Fahrenheit, which is 0.9 degrees above the average of the preceding 65 years. The rainfall during the year amounted to 24.87 inches, being 0.75 inches above the average of the preceding 65 years. the average of the preceding 65 years. The temperature and rainfall in each month of the year 1912 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 51 19 40.4 +2.0 18 3.03 + 1.15 February 60 19 43.6 +3.8 21 1.73 +0.25 March 62 31 46.9 +4.4 19 2.58 + 1.06 April 71 32 49.6 + 1.5 2 0.04 -1.53 May 83 36 57.0 +3.2 12 1.29 —0.63 June 84 42 59.4 -0.9 18 2.35 +0.31 July 90 48 61.6 +0.9 11 1.24 — 1.16 August 73 42 58.4 —4.5 26 4.27 + 1.93 September 69 37 53.7 —4.5 5 2.11 -0.04 October 66 29 48.2 —2.2 14 1.88 —0.90 November 57 29 43.8 +0.4 16 1.55 -0.67 December 57 26 45.7 + 6.1 21 2.80 +0.97 55 Report of the County Medical Officer—General. B—Administration. Dairies, Cowsheds and Milkshops. The Council received during the year 180 applications for cowhouse licences, all of which were granted. The number of applications for licences received during the last nineteen 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. Year. No. of applications received. No. of premises for which licences were granted. 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 1912 180 180 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. The following table relating to cowsheds has been thus prepared:— Metropolitan borough. Number of cowshed premises. Number of inspections by the sanitary authority, 1912. Number of prosecutions by sanitary authority, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. Battersea 2 — — 2 Frequent. — Bermondsey 3 — 1 2 18 — Bethnal Green 13 — — 13 37 — Camberwell 10 — — 10 130 — Chelsea 1 — — 1 9 — Deptford 2 — — 2 34 — Finsbury 3 — — 3 40 — Fulham 1 — 1 — 6 — Greenwich 4 — — 4 14 — Hackney 16 — 1 15 174 — Islington 5 — — 5 53 — Kensington 1 — — 1 45 — Lambeth 13 — 1 12 26 — Lewisham 13 — — 13 141 — Paddington 1 — — 1 4 — Poplar 14 — 1 13 41 — St. Marylebone 5 — — 5 50 — St. Pancras 7 — 1 6 104 — Shoreditch 7 — — 7 44 — Southwark 3 — — 3 36 — Stepney 32 — 1 31 65 — Stoke Newington 1 — — 1 2 — Wandsworth 12 — — 12 49 — Westminster, City of .. 1 — — 1 25 — Woolwich 17 — — 17 64 — Totals for 25 districts 187 — 7 180 — — Inspection of cowshed premises. 56 Annual Report of the London County Council, 1912. Section 5 of the London County Council (General Powers) Act, 1908, gives power to local sanitary authorities to remove from the register or to refuse to register the name of any person carrying on or proposing to carry on the trade of a dairyman or purveyor of milk upon premises which are in the opinion of the sanitary authority unsuitable for the purpose. These powers have been much used, with the result that the sale of milk in general shops has materially decreased in recent years. For instance, Dr. Lennane mentions that in Battersea the number of general shops where milk is sold has declined from 131 in 1908 to 60 in 1912. In Woolwich the number of such shops was reduced from 196 in 1905 to 117 in 1912. Associated with the reduction in numbers a considerable improvement has been effected in the conditions under which milk is sold as a subsidiary part of the business, and generally registration is refused in respect of premises retailing mineral oils, coal, or fish unless special precautions are adopted to prevent contamination, such as, to mention specific requirements, ventilated and lighted safes, or glass cases with swinging doors. Several of the reports of medical officers of health make mention of refusal of registration on the ground of unsuitability of the premises. Thus, in Kensington, one application was refused but afterwards granted on the applicant giving an undertaking that milk, cream, and other foods would not be stored in the basement as was at first proposed. In Lambeth 4 applications were refused; in Paddington, 1; in Stepney, 14; in Westminster and Woolwich, one each. Dr. Porter in the report relating to St. Marylebone states that 15 names were removed from the register on the ground of the unsuitability of the premises, and Dr. Thomas, the medical officer of health of Stepney, refers to the removal of 65 names for this cause. In the annual report for 1911 reference was made to the decision of the Court of Appeal in the case of Green v. Spiers and Pond. It will be remembered that the Lord Chief Justice decided that the defendants were not "carrying on the trade of purveyors of milk" within the meaning of the Order, and therefore they did not require to be registered. There is some discussion in several of the reports of medical officers of health of the importance of this judgment, which exempts from registration the small retailer who sells milk as a subsidiary part of his business. Dr. Collingridge mentions that already in the City of London advantage had been taken of this ruling. The Corporation of the City of London has therefore approached the Local Government Board with a view to an amendment of the Order in such a way as to make it applicable to all persons selling milk within the City, or, if it be considered necessary to except any class, clearly to define such exception. Milkshops. Inspection of milkshop premises. The following table shows the number of milkshop premises at the end of 1911 and 1912 in the metropolitan boroughs of London, the number of inspections and the proceedings taken. The table has mainly been compiled from information contained in the annual reports:— Metropolitan borough. Number of premises, (a) Number of inspections, 19112. Number of notices, 1912. Number of prosecutions, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. City of London 639 33 34 638 Not stated. Battersea 176 6 12 170 576 12 — Bermondsey 294 29 75 248 1,042 19 — Bethnal Green 256 12 25 243 607 51 3 Camberwell 614 22 24 612 1,353 22 — Chelsea 114 8 10 112 122 8 — Deptford 206 40 45 201 475 7 — Finsbury 260 37 55 242 224 40 2 Fulham 211 42 56 197 530 — — Greenwich 173 9 16 166 206 24 — Hackney 311 15 11 315 1,593 5 — Hammersmith. 347 44 58 333 655 25 2 Hampstead 103 1 4 100 453 26 — Holborn 177 17 10 184 759 5 — Islington 568 33 19 582 1,593 208 1 Kensington 196 16 8 204 1,362 19 1 Lambeth. 109 34 — 143 260 42 — Lewisham 158 31 26 163 491 6 — Paddington 120 3 3 120 168 — — Poplar 325 8 6 327 1,419 — — St. Marylebone 200 45 15 230 615 15 — St. Pancras 413 — — 413 1,050 — — Shoreditch 292 15 16 291 3,157 14 — Southwark 456 99 104 451 1,627 14 — Stepney 1,092 24 65 1,051 1,785 259 11 Stoke Newington 53 — — 55 67 — — Wandsworth 355 55 54 356 1,023 40 3 Westminster 382 33 16 399 940 73 — Woolwich 129 11 23 117 189 12 — Totals (7,578 553 615 7,516 — — — 11,151 169 175 1,147 (a) Figures in italics refer to persons registered. † The milkshop premises are being re registered under new regulations. 57 Report of the County Medical Officer—General. The Dairies, Cowsheds and Milkshops Order, 1899, provides that the milk from cows certified by a veterinary surgeon to be affected with tubercular disease of the udder shall not be (a) mixed with other milk, or (b) sold or used for human food, or (c) sold or used for the food of swine without having first been boiled. In 1904 this power was supplemented in London by additional powers, incorporated in the London County Council (General Powers) Act of that year, to remove any cow from any dairy, farm or cowshed in the County (elsewhere than in the City), if such cow is suspected to be suffering from tuberculosis of the udder, and if, upon slaughter, these suspicions are verified, a sum equal to threequarters of the agreed value of the animal (not exceeding £22 10s.) is payable by the Council. If, however, the cow is proved to be free from tuberculosis of the udder, the full agreed value (not exceeding £30), together with a further sum of £1, is payable by the Council. The cows in the London cowsheds have, since the date of the Dairies Order of 1899, been periodically inspected by the County Council's veterinary inspector, with a view to the detection of cows suffering from tubercular disease of the udder. Tuberculoeis of the udder in London cows. London County Council (General Powers) Act, 1904(Part V.) During the year 1912 there were six inspections of all the cows in the London cowsheds, and the results of the veterinary inspector's examinations are shown in the following table:— Details of Examination. 1st period, 13th Jan., 1912, to 7th Mar., 1912. 2nd period, 8th March to 26th April, 1912. 3rd period, 27th April to 26th June, 1912. 4th period, 27th June, to 10th August 1912. 5th period, 2nd Sept. to 25th Oct., 1912. 6th period, 26th Oct., to 29th Dec., 1912, Total number of cows examined 2,935 2,829 2,896 2,771 2,790 2,747 Affected with disease or defects of the udder 88 79 87 62 68 58 Affected with tubercular disease of the udder 4 1 14 1 2 0 Subjects of acute mastitis 14 11 10 8 5 12 Affected with chronic induration of the udder 20 26 25 23 21 15 Atrophy of one or more quarters 39 38 35 27 33 26 Injuries, abscesses, simple eruptions, strictures and obliterations of milk ducts 11 3 3 3 7 5 Tuberculous miik; London County Council (General Powers) Act, 1907. Part IV. The 22 cows suffering from tubercular disease of the udder were slaughtered, and the carcases, with the exception of the hides, 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. The hides were sold and the amounts received were paid into the County fund. Part IV. of the London County Council (General Powers) Act of 1907 empowers the County Medical Officer of Health or other duly authorised person to take, within and without the County, samples of milk produced or sold or intended for sale within the County; and, having obtained a justice's order, in company with a veterinary surgeon, to enter any dairy from which milk is being sold or suffered to be sold or used within the County, and to inspect the cows kept therein, and if the Medical Officer or such authorised person has reason to suspect that any cow is suffering from tuberculosis of the udaer ne 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 1912, 2,991 samples of milk were taken. The milk had been sent to London from the following counties: Bedfordshire, Berkshire, Buckinghamshire, Cambridgeshire, Cheshire, Derbyshire, Devonshire, Dorsetshire, Essex, Gloucestershire, Hampshire, Herefordshire, Hertfordshire, Huntingdonshire, Kent, Leicestershire, Lincolnshire, Middlesex, Norfolk, Northamptonshire, 18820 H 58 Annual Report of the London County Council, 1912. Northumberland, Nottinghamshire, Oxfordshire, Rutlandshire, Shropshire, Somersetshire, Staffordshire Suffolk, Surrey, Sussex, Warwickshire, Wiltshire, Worcestershire and Yorkshire, and from Ireland and Wales; 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 80 1 77 2 Berkshire 207 7 191 9 Buckinghamshire 151 3 147 1 Cambridgeshire 8 — 8 — Cheshire 32 3 27 2 Derbyshire 256 37 201 18 Devonshire 3 — 2 1 Dorsetshre 55 3 51 1 Essex.. 96 5 90 1 Gloucestershire 35 2 32 1 Hampshire 150 22 120 8 Herefordsliire 1 — 1 — Hertfordshire 55 5 50 — Huntingdonshire 1 1 — — Kent 45 9 33 3 Leicestershire 266 9 254 3 Lincolnshire 27 1 25 1 Middlesex 3 2 — 1 Norfolk 7 2 5 — Northamptonshire 170 4 159 7 Northumberland 1 — 1 — Nottinghamshire 33 3 30 — Oxfordshire 137 3 128 6 Rutlandshire 3 — 3 — Shropshire 17 4 13 — Somersetshire 165 12 149 4 Staffordshire 234 17 212 5 Suffolk 8 2 4 2 Surrey 60 9 48 3 Sussex 175 17 151 7 Warwickshire 90 8 81 1 Wiltshire 403 48 336 19 Worcestershire 10 2 8 — Yorkshire 1 — 1 — Ireland 3 — 3 — Wales 3 — 3 — Total 2,991 241 2,644 106 This table shows that out of 2,885 completed examinations of samples taken from churns consigned to London, 241 proved to be tuberculous, i.e., 8.4 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 2,877 samples of milk examined during the year 1911, of which 298, or 10'4 per cent., were found to be tuberculous. 59 Report of the County Medical Officer—General. The following table shows the number of farms visited, the number of cows inspected and the number of cows certified to have tuberculosis of the udder during the year:— County. No. of farms inspected. No. of cows inspected. No. of cows with tuberculous udders. Bedfordshire 2 41 1 Berkshire 2 61 — Buckinghamshire 6 218 1 Cheshire 2 83 — Derbyshire 54 1,536 14 Dorsetshire 3 99 3 Essex 2 77 — Gloucestershire 2 80 — Hampshire 14 836 6 Hertfordshire 1 80 Huntingdonshire 1 31 1 Kent 4 131 — Leicestershire 15 329 7 Lincolnshire 1 17 Northamptonshire 4 76 2 Nottinghamshire 2 73 — Oxfordshire 2 56 2 Shropshire 2 55 1 Somersetshire 22 576 3 Staffordshire 52 1,112 5 Surrey 3 151 1 Sussex (East) 10 409 3 Sussex (West) 17 737 2 Warwickshire 8 225 — Wiltshire 247 4,537 11 Worcestershire 1 14 — Total 479 11,640 63 Farms inspected in English counties. This table shows that 0.5 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. It will be observed that inspection was made of the cows at 479 farms and only 63 cows were certified to be suffering from tuberculosis of the udder. It should be borne in mind, however, that various circumstances prevent the discovery at every farm of a cow suffering from tuberculosis of the udder. In a number of cases, for instance, the farmer whose name was on the churn was found, on inquiry, not to have sent the milk into London on the date on which the sample was taken. In other instances, diseased cows had been removed before the inspector's visit; in others, again, a possible source of mischief was a cow having tuberculosis in some part other than in the udder. In nearly every case in which a tuberculous cow, or a cow suspected to be tuberculous, was found, the farmer undertook to withhold the milk of the suspected animal from London. Offensive Businesses. In the year 1912 the County Council received 235 applications for licences for slaughter-houses and granted 234. 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:— [####]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 1903 350 346 1893 538 529 1904 338 333 1894 518 506 1905 322 318 1895 497 485 1906 310 308 1896 478 470 1907 301 294 1897 460 460 1908 281 273 1898 442 429 1909 265 264 1899 419 411 1910 257 255 1900 405 393 1911 247 243 1901 384 381 1912 235 234 1902 371 362 Slaughterhouses. 18820 H 2 60 Annual Report of the London County Council, 1912. The number or 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, 1912. No. of notices, 1912. Licensed at end of 1911. Licence lapsed or refused in 1912. Remaining at end of 1912. Battersea 4 1 3 Bermondsey 1 — 1 19 — Bethnal Green 4 — 4 31 2 Camberwell 13 2 11 130 2 Chelsea 6 1 5 51 — Deptford 3 3 46 — Finsbury 3 — 3 90 — Fulham 3 — 3 — — Greenwich 4 — 4 65 — Hackney 21 — 21 311 3 Hammersmith 9 1 8 107 18 Hampstead 4 — 4 74 — Holborn 1 — 1 11 — Islington 30 1 29 1,599 — Kensington 10 — 10 268 — Lambeth 19 1 18 38 4 Lewisham 14 1 13 126 — Paddington 7 — 7 447 — Poplar 14 — 14 93 1 St. Marylebone 7 — 7 129 1 St. Pancras 17 1 16 555 — Shoreditch 6 1 5 15 — Southwark 6 — 6 29 — Stepney 6 6 18 — Stoke Newington 4 4 9 — Wandsworth 15 — 16 (b 329 6 Woolwich 12 — 12 49 3 Totals, 27 districts 243 10 234 4,549 40 Inspection of slaughter bouses. Offensive businesses. During the year the following authorised offensive businesses, other than that of a slaughterer of cattle, were discontinued : the business of a tripe-boiler in Lambeth; the businesses of tallow melter and soap-boiler in Wandsworth. Hence the number of scheduled offensive businesses declined from 74 to 71. The number of such authorised offensive businesses, except those in the markets under the jurisdiction of the City Corporation, was at the end of the year as follows:— Fat melters 15 Manure manufacturers 2 Tripe boilers 20 Soap boilers 10 Glue and size manufacturers 5 Tallow melters 4 Knackers 4 Gut manufacturers 3 Fellmongers 6 — Bone boilers 2 71 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 1912. No. of inspections, 1912. Metropolitan borough. No. on Register at end of 1912. No. of inspections, 1912. Battersea 2 Lambeth 2 8 Bermondsey 12 .194 Poplar 6 50 Bethnal Green 1 5 St. Marylebone 2 27 Camberwell 4 6 St. Pancras 2 3 Deptford 3 28 Shoreditch 1 6 Finsbury 1 5 Southwark 5 62 Greenwich 3 9 Stepney 7 40 Hackney 1 9 Wandsworth 3 60 Islington 6 87 — Total 61 (a) The seven slaughter-houses under the jurisdiction of the City of London Corporation are not licensed by the London County Council. (6) During the year the Council granted a licence to Messrs. Harrison, Barber & Co., to use part of their knackers' premises in Garratt Lane, Wandsworth, as a slaughter-house. 61 Nuisance Prom stable manure. Report of the County Medical Officer—General. 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. Other nuisances. Dr. Collingridge reports that in the City of London much progress has been made towards replacing the old-fashioned street gullies by properly trapped gullies of modern type and thus remedying a source of nuisance. Sewer emanations and smells from upcast shafts are mentioned in several of the reports as cause of complaint. During the year upwards of 42,000 complaints relating to various nuisances were investigated by the officers of the several borough councils, and the necessary action was taken-in each case. Some special nuisances are particularly referred to and the details are here summarised. In Bermondsey for some years past frequent complaint of effluvium nuisance has been received from the Neckinger school and surrounding neighbourhood. Dr. Brown, the medical officer of health, reports that the nuisance has its origin in three sources: (1) the dust destructor ; (2) the electric light undertaking; and (3) a local tannery. He comments unfavourably upon the association of the dust destructor with the electric light undertaking, which he states does not tend to quick and hygienic disposal of the refuse or to economical production of electric current. The low chimneys using forced draught produce large quantities of sulphur compounds, which find their way into the surrounding buildings. Dr. Brown suggests the separation of the two undertakings and the removal of the dust destructor to its old site in Rotherhithe, where the buildings still remain. He adds with regard to the nuisance from the tannery, that there are several other tanneries in the neighbourhood and that all tanneries produce offensive smells. In Camberwell a complaint was received under the Public Health Act, signed by ten inhabitant householders, as to nuisance caused by a factory. The business was that of cleansing oily and greasy cloths, and nuisance arose from the escape of steam from the drying chamber. Proceedings were taken in July, 1912, but the case was adjourned sine die, the borough council being allowed costs. In Greenwich there was nuisance from sewage flooding in certain houses due to the abnormal rainfall. The nuisance was remedied, but Dr. Annis points out that this was small satisfaction to the occupiers, who were compelled to have the floors of their houses taken up to clear up the debris remaining. Considerable difficulty has been experienced in Holborn in respect of fumes from oil engine exhaust pipes on the premises of an electric supply company. Other attempts to remedy the cause of complaint having failed, the company erected a chimney stack of ferro-concrete about 150 feet high for the discharge of the exhaust pipes. Since the completion of the work no complaints have been received. Dr. Allan mentions an instance of the difficulty of discovering the source of origin of effluvium nuisance. A sulphurous smell which invaded houses in several streets in Mayfair was only discovered after a fortnight's careful examination. It was found to be due to a steam exhaust pipe on club premises being taken into a chimney shaft at the wrong point. Other effluvium nuisances in Westminster were due to the burning of rubber dentures at a refining establishment, the damping of clinkers, and the improper use of a forced draught in a patent smoke preventing apparatus. A complaint of quantities of grit and fine ash was remedied by building a brick baffler in the flue, and frequent removal of the ash from the base of the chimney shaft. House refuse. There is generally little reference to complaint of non-removal of house refuse. Dr. Harris mentions that in Islington in 1891 some 10,000 requests were received for removal, whilst in 1912 there were only 47 applications. Throughout London the practice of at least one collection a week has been adopted, though there is an increasing tendency to the view that a more frequent collection is desirable. Arrangements for a bi-weekly collection have been made in Holborn and Poplar, and to a certain extent in Hackney, Lambeth and Paddington. In the City of Westminster a system of daily collection is in force throughout a large part of the area, and in other boroughs house refuse is collected daily from tenemented blocks of dwellings and certain prescribed portions of the district. Smoke nuisance. 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. Dr. Collingridge refers to the fact that while considerable reduction in the amount of smoke nuisance has been effected as the result of action under the existing statutory powers, difficulty is felt because it is necessary to prove that the smoke emitted is "black," as well as that the premises of the offenders are not used as a private dwelling house. With regard to Westminster, Dr. Allan records more nuisance from this cause than in previous years, due mainly to careless stoking, and the burning of wet sawdust, rags, and hospital dressings in the furnaces. The use of inferior coal owing to the strike of miners during the year is also suggested as a probable cause. Mention is made of smoke entering rooms from chimneys at too low a level. On several occasions during the year, moreover, the attention of the Port of London Authority was directed to smoke emitted from vessels on the Thames. 62 Annual Report of the London County Council, 1912. The following table, which is compiled entirely 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 287 12 12 — Battersea 80 32 3 — Bermondsey 47 (ohimneys) 16 — Bethnal Green 100 ( „ ) 24 26 3 — Camberwell — — 99 — — Chelsea — None — — — Deptford 12 — — 8 — Finsbury 66 6 14 — — Fulham — — — — — Greenwich 194 — — 4 — Hackney 1,521 — 40 — — Hammersmith 20 (premises) A number 8 16 2 Hampstead — 6 — — — Holborn 1ll — 5 1 — Islington 158 — — 13 — Kensington 304 — — 6 — Lambeth 19 18 As required — — Lewisham 228 — 5 — — Paddington 20 (premises) 5 — — — Poplar — 54 29 12 — St. Marylebone 1,386 10 6 1 — St. Pancras 710 — 8 — — Shoreditch 11 (premises) 9 16 — — South wark 87 23 14 5 — Stepney — 62 — 62 — Stoke Newington — 9 3 — — Wandsworth 192 55 — 50 — Westminster, City of 1,722 43(a) 142 8 — Woolwich 80 19 14 — — Housing, Town Planning Act, Section 17 Housing of the Working Classes. 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:— politan borough. No. of houses inspected. No. of houses dealt with under • Seotion 15. No. of representations, 1912. No. of closing orders, 1912. No. of houses, defects remedied without closing orders. No. of houses, defects remedied after closing orders No. of houses demolished. Remarks.[/##] Battersea 2 2 6 2 6 Bermondsey 23 23 19 29 Bethnal Green 664 362 1 188 18 Camberwell 87 19 1 Chelsea Deptford 2,479. 1 24 24 15 17 Finsbury 1,336 1 1 1 Fulham 44 44 3 8 other houses voluntarily closed. Greenwich 486 338 9 Continued on next page. (a) Complaints only. Report of the County Medical Officer—General. Metropolitan borough. No. of houses inspected. No. of houses dealt with under Section 15. No. of representations, 1912. No. of closing orders, 1912. No. of houses, defeots remedied without closing orders. No. of houses, defeots remedied after closing orders. No. of houses demolished. Remarks. Hackney 9 9 38 9 Hammersmith 749 274 Hampstead 579 1 underground room closed. Holborn 126 13 26 1 93 25 Islington 910 12 12 12 7 demolished, April,1913. Kensington 44 19 10 2 26 8 empty houses. Tenants evicted by owners. Lambeth 1,576 27 44 44 4 66 27 demolished voluntarily. 1 disputed ownership. Lewisham 1,058 16 2 14 Paddington 38 11 13 14 1 11 demolition orders. Poplar 168 21 21 7 St. Marylebone 1,586 1 2 914 1 5 basement rooms closed by magistrate. St. Pancras 245 245 Shoreditch 20 18 Southwark 21 36 1 Stepney 9 houses closed under the Act. Stoke Newington 561 Wandsworth 2,674 Defects dealt with under P.H. (L.) Act. Westminster, City of 17 13 9 7 4 voluntarily closed. Woolwich 48 9 5 4 6 Including 3 closing orders under Section 17 (7). Underground rooms. Some further information which cannot be put into tabular form is contained in some of the reports as to the working of the Housing Acts, and as to their uses and difficulties. For instance, Dr. Lennane mentions the fact that 21 underground rooms were closed by means of orders under Section 17 (7) of the Housing, Town Planning Act, 1909. In Fulham 3 houses were demolished during the year for which closing orders had been issued in 1911. In Hampstead in one case only was it necessary to issue a closing order, and that was in respect of an underground room. In Holborn, too, only one closing order was made. This order was not determined inasmuch as the owner undertook to use the premises for storage purposes. Dr. Sandilands discusses the hardship entailed under the Acts whereby an owner is faced with the problem of renovating houses, the expense of which would not be justified by the rents obtainable, or, alternatively, of being bound by a closing order to forego the opportunity of converting the houses into business premises and awaiting an order for demolition. In Kensington, therefore, no notices have been served where the owner undertakes that the houses shall not be again used for human habitation, and houses have been allowed to remain empty until they are required for other purposes. Dr. Dudfield mentions a defect in the machinery of the Housing Acts observed in Paddington. In certain instances, after the service of closing orders it was necessary to take proceedings against the tenants to compel them to quit. The owner did his best to persuade the tenants to remain, and when a house became vacant another family was put in occupation. Dr. Dudfield states that there appears to be no power in any of the Housing Acts to deal with such action on the part of the owner. Dr. Porter gives details of the circumstances leading to the closure of the 5 basement rooms in St. Maryle bone mentioned in the above table. These rooms formed the sleeping apartments of the staff of a large private hotel. Before the provisions of Section 17 (7) of the Housing, Town Planning Act came into force the owner had been advised to discontinue their use as sleeping rooms. He did not adopt this suggestion, but carried out certain improvements. Later, closing orders were made under the Act, but the borough council found it necessary to appeal to a magistrate for enforcement. Summonses were issued against the owner and his servants in order to cover any difficulty that might arise as to responsibility. As it happened, the owner alone appeared, and an order was made directing compliance. The use of the rooms was thereupon discontinued. In Stoke Newington the houses in several streets were inspected under the Act and the Housing (Inspection of District) Regulations, 1910, issued by the Local Government Board. All the defects found, however, were remediable under the procedure for the abatement of nuisances. In Westminster 4 underground rooms were closed under Section 17 (7.) With regard to Woolwich Dr. Davies states that considerable action has been taken under Section 17, that no difficulty has arisen, and apparently no hardship has been caused. No action has been taken in Woolwich under Section 15. 63 64 Annual Report of the London County Council, 1912. On the 4th April. 1912, formal representation was made by Dr. G. P. Bate of the area known as the Brady-street area, including 528 houses occupied by 3,058 persons. At the end of the year the question of an improvement scheme was still under the consideration of the Bethnal Green borough council and the London County Council. A petition signed by 57 persons was received by the Lambeth Borough Council during 1912 describing all the houses in Waxwell-terrace as being wholly insanitary and uninhabitable. It was found on inspection that the houses themselves were in fair condition, but were let out in tenements to persons of unsatisfactory habits. Several of the houses were afterwards reconstructed and re-arranged and let to a better class of tenant. The remaining houses were not in such a condition as to warrant closing orders, and no further action was taken. Underground Rooms. The number of underground rooms dealt with in 1912 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 113 90 Lambeth 9 9 Bermondsey — — Paddington 11 23 Bethnal Green — — St. Marylebone 199 199 Camberwell — — St. Pancras 435 * Chelsea — — Shoreditch 7 7 Deptford 2 2 Southwark — — Finsbury 24 24 Stepney 31 31 Fulham — — Stoke Newington 7 7 Greenwich 2 2 Wandsworth 52 52 Hackney 14 14 Westminster, City of 38 38 Hampstead 130 130 Woolwich 13 13 Holborn 17 17 Islington 31 31 Total 1,157 711 Kensington 22 22 *435 Under Section 17 (7) of the Housing and Town Planning Act, 1909, 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 ten authorities have been approved by the Local Government Board, these authorities being the metropolitan borough councils of Battersea, Fulham, Hampstead, Lambeth, Poplar, St. Marylebone, St. Pancras, Stoke Newington, Wandsworth and Woolwich. In the case of Kensington 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 eighth volume of the Report on the Census of 1911, deals with tenements, the classification of the people by the size of the family of which they are members and the number of rooms in the occupation of the family. In previous censuses similar inquiry was made as regards families occupying less than five rooms, but it was felt that the absence of any definition of the word room, must have led to some amount of understatement, more especially as in cases where the question remained unanswered, it had to be assumed that the tenement consisted of more than four rooms. In the census schedules of 1911 therefore, every occupier was for the first time required to state the number of rooms in the occupation of his family, and an attempt was made to define a room by adding to the schedule an instruction reading "Count the kitchen as a room, but do not count scullery, landing, lobby, closet, bath-room, nor warehouse, office, shop." In tabulating the returns, only private families have been included. It is stated in the report, however, that this limitation can have but little effect on the comparability of the figures, as it is extremely unlikely that many of the excluded tenements occupied by " non-private " families consisted of less than five rooms. * Time allowed to tenants to find room elsewhere. Report of the County Medical Officer—General. The statistics for the County of London are especially referred to as presenting considerable variations from those for the country as a whole, and it is pointed out that in each 1,000 tenements, 541 are of less than four rooms, 324 of from four to six rooms, and only 135 of more than six rooms. The corresponding figures for England and Wales are 255, 593, and 152 respectively. Again, comparing London with the country generally, tenements of one room form 13.5 per cent. of the total as against 3.2 and tenements of two rooms 19.2 per cent. as against 8.3. In the 1911 census opportunity was taken to tabulate the number of children under ten years of age in families and tenements of various sizes for the more important towns. With regard to London, tables are given showing that while children under ten years of age form 20.7 per cent. of the population of tenements of all sizes, they form 38.2 per cent. of the population of tenements where each room contains more than two occupants. Incidentally it is mentioned that in six instances, a single child was left alone in the tenement in the night of the census, in two instances 2 children, and in one instance 4 children were so left. The total number of families living in overcrowded tenements, that is, in tenements comprising rooms occupied by more than two persons each was found to be 121,638, including 758,786 persons of whom 289,802 were children under ten years of age. On this basis of overcrowding figures are given, which enable comparison to be made of the conditions existing at the time of the censuses of 1901 and 1911. This information has been used in the preparation of the following table, from which it will be seen that generally there has been a decrease during the last decennium in the percentage of the total population living in overcrowded tenements of one and two rooms, with a corresponding increase in the percentage living in overcrowded tenements of three and four rooms. The nett increase in the percentage of the total population living in overcrowded tenements of one to four rooms is 0.04. It is difficult to determine to what extent the increase shown in the overcrowding of three and four-roomed tenements is real in view of the revised form of schedule used in 1911 already referred to in the first paragraph. Expressed as a percentage of total tenements, the table also shows an increased use of tenements of one to four rooms in the census years 1901 as compared with 1891, and 1911 as compared with 1901 of 10.5 per cent., and 4.2 per cent. respectively. It may not be out of place here to mention that tenements of less than four rooms contain 43.3 per cent. of the private family population of Lon don, including 6.24 per cent. in single-roomed tenements, 15.84 per cent. in tenements of 2 rooms, and 21.2 per cent. in tenements of 3 rooms. As an interesting fact, it may also be noted that of the 1,023,951 private families enumerated in London, 95,724 or 9.3 per cent. consist of single persons in the proportion of 58,594 females to 37,130 males. The following table enables comparison to be made of the percentages of total tenements and of overcrowded tenements for the whole county in the several census years, 1891, 1901, and 1911. The details for each of the London boroughs for the two last-mentioned years only will be found in Appendix II. Tenement of Percentage of total tenements. Overcrowded tenements. (Tenements occupied by more than 2 persons per room.) Percentage of total population living in overcrowded tenements. 1891. 1901. 1911. Inc. ( + )orDec. (—) 1891. 1901. 1911. Inc. (+) or Dec. (—) 1891-1901. 1901 1911. 1891-1901. 1901-1911. 1 room 2 rooms 3 „ 4 „ 9.2 16.4 15.8 14.1 14.7 19 8 17.8 13.7 13.5 19.2 21.4 161 + 5.5 + 3.4 + 2.0 — 0.4 — 1.2 — 0.6 + 3.6 + 2.4 5.10 7.84 4.57 219 3.26 6.54 414 207 2.58 614 4.93 2 40 —1.84 —1.30 —0.43 —0.12 —0.68 —0.40 +0.79 +033 1.4 rooms 55.5 66.0 70.2 + 10.5 + 4.2 19.70 16.01 16.05 —3.69 +004 Study of the detailed tables forming Appendix II. of this report shows that increase in the percentage of overcrowded tenements of less than five rooms, comparing the years 1901 and 1911, was most marked in Shoreditch (4.10 per cent.), Fulham (2.78 per cent.), Finsbury (2.68 per cent.) and Camberwell (2.64 per cent.). The largest decreases occurred in Holborn (5.72 per cent.), St. Marylebone (3.37 per cent.), Westminster (2.92 per cent.), and the City of London (2.78 per cent.). In the annual report for 1901 attention was directed to the increase of overcrowding in the eastern districts. On the basis of overcrowding adopted in the tables, this increase is still to be observed except in the case of Stepney, where the proportion of overcrowded tenements has diminished during the decennium by 1.48 per cent. It should, however, be noted that the standard of overcrowding used in these tables is the arbitrary one of necessity used by the Census Office, and the application of the statutory definition of overcrowding based on a measurement of cubic space per head would undoubtedly give very different results. For the whole county, moreover, the average number of occupants per room, which declined between 1891 and 1901, still further declined between 1901 and 1911 for all tenements of less than five rooms. * These figures relate to the County of London as constituted at the date of the census, but the subsequent changes in the county area do not seriously affect the value of the figures for the purposes of comparison with the later years. 18820 I 60 Annual Report of the London County Council, 1912. The following table, showing the number of dwelling rooms found overcrowded, according to the standard prescribed by the bylaws relating to houses let in lodgings, in each metropolitan borough, is compiled from information supplied by the medical officers of health, in their annual reports:— Metropolitan borough. No. of dwellingrooms overcrowded. No. remedied. No. of prosecutions. City of London 5 5 Battersea 72 72 — Bermondsey 68 68 — Bethnal Green 242 218 — Camberwell 115 115 3 Chelsea 13 13 — Deptford 40 40 — Finsbury 141 141 — Fulham 46 46 — Greenwich 29 29 — Hackney 71 71 — Hammersmith — — — Hampstead 4 4 — Holborn 39 39 — Islington 122 122 — Kensington 113 113 — Lambeth 8 8 — Lewisham 17 17 — Paddington 299 265a — Poplar 143 138 2 St. Marylebone 85 85 — St. Pancras 170 170 — Shoreditch 186 186 — Southwark 417 417 — Stepney 549 548 5 Stoke Newington 10 10 — Wandsworth 76 76 — Westminster, City of 137 137 — Woolwich 91 91 — Totals 3,308 3,244 10 Registration and inspection of houses let in lodgings. 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, the number of inspections, notices issued and proceedings taken during the year 1912. Metropolitan borough. Number of places. No. of Inspections, 1912. No. of Notices, 1912. No. of Prosecutions, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. City of London 247 — — 227 — 285 — Battersea 123 — — 123 321 98 — Bermondsey 228 — 228 912 159 — Bethnal Green 536 4 12 528 1,033 590 — Camberwell 254 — — 254 528 374 — Chelsea 569 — — Continued on next page. (a) No action taken in 34 cases, the deficiency of air space being very slight. 67 Report of the County Medical Officer—General. Number of places. No. of Inspections, 1912. No. of Notices, 1912. No. of Prosecutions, 1912. Metropolitan borough. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. Deptford 273 — — 273 273 9 — Finsbury 1,209 __ — 1,209 10,240 1,182 — Fulham 114 Greenwich 215 23 — 228 416 128 — Hackney 470 — — 470 404 199 — Hammersmith 2,412 205 166 2,451 — 759 — Hampstead 425 — — 425 201 92 5 Holborn 633 7 34 606 998 234 1 Islington (a) (a) 9,037 1,205 12 Kensington 2,091 3 — 2,094 8,704 1,236 10 Lambeth 372 — — 372 744 — — Lewisham 11 — 8 3 3 1 — Paddington 1,348 1,348 7,161 2,022 1 Poplar 1,124 13 — 1,137 2,535 526 2 St. Marylebone 1,052 278 329 1,001 7,774 1,881 — St. Pancras 2,353 11 6 2,358 10,244 1,176 — Shoreditch 266 6 — 272 379 95 — Southwark 1,236 — 7 1,229 10,849 2,616 — Stepney 2,911 — — 2,911 5,319 2,611 12 Stoke Newington 217 — — 207 — — — Wandsworth 292 — — 292 769 538 — Westminster 1,392 — 47 1,345 5,555 1,105 4 Woolwich 429 8 5 432 516 241 — Totals including Islington 23,824 558 614 23,595 84,915 19,362 7 Houses let in lodgings —by-laws 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. So far as can be gathered from the annual reports, new by-laws have been adopted in Battersea, Bethnal Green, Hackney, Islington, Kensington, Paddington, Poplar, St. Marylebone, Shoreditch, and Westminster. In the case of Hampstead new by-laws have been informally submitted to the Local Government Board, and in Lambeth the question is still under consideration. In the report relating to St. Pancras it is stated that inasmuch as inspection under the Housing, Town Planning Act is to supersede inspection under Section 94 of the Public Health (London) Act, there is no intention to recast the by-laws. Dr. Whitehouse points out that the by-laws at present in operation in Deptford are quite inadequate, only 10 per cent. of sublet houses being registered. Dr. Davies discusses the anomalous position of Woolwich in this respect. At present three different sets of by-laws are in existence, one each in Woolwich, Eltham and Plumstead. The by-laws in Eltham assign a rent limit which nullifies all action, and no houses have ever been registered in this parish. In the by-laws relating to the other two parishes all the sections dealing with structural defects are in abeyance owing to difficulty in fixing the responsibility as between "landlord" and "tenant." New by-laws have been under consideration for several years, in fact ever since the formation of the borough, and on two occasions a draft code has been submitted to the Local Government Board. The Board, however, required certain alterations to which the borough council could not agree, and the question of making new by-laws has been deferred. (a) No register is now kept, under the Borough of Islington's new by-laws, but during the year there were 1,572 houses on the lists for inspection. 18820 I 2 68 Annual Report of the London County Council, 1912. Death Rales 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 1912. The population thus dealt with comprised 28,121 persons, and the death-rate at "all ages," after correction for age and sex distribution, was 8.4 per 1,000 living, compared with 15 0 for London:— Cause of death. Death-rate per 1,000 living, 1912. Council's dwellings. London. All Causes—All Ages 8.4 15.0 „ „ age 0—5 202 45.2 ,, ,, ,, 5—20 1.6 2.6 „ ,, „ 20 and upwards 8.4 15.5 Diarrhœa 05 1.4 Principal epidemic diseases (excluding Diarrhœa) 1.0 1.0 Phthisis 08 1.3 Tubercular diseases other than Phthisis 02 0.4 Bronchitis 0.9 1.2 Pneumonia 06 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. 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. No. of cases of infectious disease. £ s. d. 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 28,379 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 1912 351 27,110 25,354 1,872 5 5 7 5 0 9 Proceedings before the magistrate were instituted in five cases, resulting in five convictions, the penalties inflicted amounting to £5 5s. with £2 costs. The number of cases of notifiable infectious disease—other than phthisis—reported in common lodging houses was as follows: Erysipelas, 4; diphtheria, 3; scarlet fever, 2; total, 9. 69 Report of the County Medical Officer—General. The following table shows the total number of common lodging houses, and the authorised accommodation for the different classes of lodgers in the several districts other than the City of London on 31st December, 1912 Metropolitan boroughs. Number of Houses. Authorised Accommodation. Men. Women. Couples. Total. Battersea 3 99 66 — 165 Bermondsey 5 1,297 — — 1,297 Bethnal Green 13 673 — — 673 Camberwell 5 549 — — 549 Chelsea 6 236 — — 236 Deptford 8 1,155 80 — 1,235 Finsbury 7 484 — — 484 Fulham 2 43 51 — 94 Greenwich 3 121 — — 121 Hackney 7 498 — — 498 Hammersmith 9 466 — 4 474 Hampstead — — — — — Holborn 25 1,489 162 — 1,651 Islington 41 1,164 187 18 1,387 Kensington 22 401 267 — 668 Lambeth 7 693 — — 693 Lewisham 1 30 — — 30 Paddington 7 195 37 — 232 Poplar 9 1,143 — — 1,143 St. Marylebone 14 1,094 109 — 1,203 St. Pancras 7 610 36 — 646 Shoreditch 12 764 — — 764 Southwark 41 3,071 449 — 3,520 Stepney 53 5,238 667 180 6,265 Stoke Newington 1 37 — — 37 Wandsworth 8 175 5 16 212 Westminster, City of 13 2,255 62 — 2,317 Woolwich 22 465 51 — 516 London—excluding the City of London 351 24,445 2,229 218 27,110 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 774; 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 (1911) and licensed common lodging-houses (1911 and 1912). Cause of death. Age 25 to 35. Age 35 to 45. Age 45 to 55. Age 55 to 65. Age G5 and upwards. London 1911. C.L.H 1911. C.L.H. 1912 London' 1911. C.L.H. 1911. CL.H. 1912. London, 1911. C.L.H. 1911* C.L.H. 1912 London* 1911. C.L.H. 1911. C.L.H 1912. London, 1911. C.L H. 1911. 1912. Phthisis 393 451 625 330 500 416 194 286 284 105 256 256 28 64 83 Other tubercular diseases 22 32 62 12 — 11 7 6 6 6 12 11 2 5 18 Alcoholism (including cirrhosis of the liver) 6 32 31 24 — 22 35 26 33 26 12 21 8 13 — Urinary diseases 44 96 63 46 11 34 68 80 68 86 68 70 79 60 78 Violence, suicide 106 64 94 83 11 22 69 20 33 44 18 32 27 30 24 Cancer 23 — — 46 35 33 122 68 89 160 86 149 111 84 83 Circulatory diseases 159 197 31 215 90 179 243 96 123 179 132 80 278 112 138 Nervous diseases — — 57 34 28 40 30 65 40 34 Bronchitis 18 32 31 27 35 67 53 102 123 91 152 112 150 166 178 Pneumonia 86 64 63 98 139 125 84 169 160 70 132 134 48 66 28 Other causes 143 32 — 119 122 57 125 119 41 133 102 70 269 360 336 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 70 Annual Report of the London County Council, 1912. Phthisis in common lodging houses. Enquiry has been made with regard to 252 persona notified under the Orders and giving addresses at common lodging houses licensed by the Council, viz., 239 male3 and 13 females. The age distribution of these cases was as follows:— 15— 20— 25— 35— 45— 55— 65— 2 3 40 61 91 42 13 The place of birth in 33 per cent. of the above cases was stated to be outside London, and in 54 instances a previous history of consumption in the patient's family was obtained. Information was also obtained in respect of 246 of the patients as to whether their illness began before or after they had resorted to this mode of living. Of the total (246) the onset of illness was stated in 79 cases to date from a time prior to that when resort was made to common lodging houses, while in 29 cases it was practically coincident with entry. As regards cases developing after commencement of this mode of life, in 37 cases the illness was first manifested before the expiration of three years; in 17 cases in from three to five years, in 31 cases in from five to ten years, in 41 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. In July, 1901, the London County Council made by-laws under Section 214 of the Merchant Shipping Act, 1894, for the inspection, sanitary condition and well ordering of seamen's lodging houses. In 1909, after experience of their application, the by-laws were amended, a new series was issued and came into force on 1st January, 1910. By an Order in Council dated 19th February, 1910, powers were conferred on the County Council for the licensing of seamen's lodging houses. The first licensing meeting was held in May of that year and since that date all such premises are annually licensed. At the end of the year 1912, the number of seamen s lodging houses under supervision was 41. situated in the following metropolitan boroughs:— Metropolitan borough. Houses. Lodgers. Poplar 11 336 Stepney 30 730 Total 41 1,066 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. No. of cases of £ s. d. 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 1908 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 1,465 204 7 6 52 13 0 — 1912 41 1,066 1,079 210 18 13 81 12 0 — Proceedings before the magistrate were instituted in 18 cases, resulting in 13 convictions ; of the five remaining, three were dismissed, one withdrawn and the other adjourned sine die, the defendant being reported to have gone down with the "Titanic." In only three of the 18 cases were the proceed?ngs in respect of licensed houses, the offence being in these instances, overcrowding; in all other cases the summonses were for keeping unlicensed premises. No cases of infectious disease were reported among inmates of seamen's lodging houses during the year. 71 Report of the County Medical Officer—General. Cleansing of Persons Act, 1897. Cleansing of Persons Act, 1897, etc. The Cleansing of Persons Act, 1897, 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. For several years the metropolitan borough councils, with some lew exceptions, took very little action under the provisions of this Act, and so recently as 1906 there was little progress to record. It was recognised, however, in dealing with verminous persons and more particularly in the case of children, that the cleansing of the individual could be of little service unless accompanied by the cleansing of the home and the purification of articles of furniture and clothing. The London County Council, therefore, in its General Powers Bill of 1904 inserted clauses empowering local authorities to cleanse, purify, or destroy articles which the medical officer of health certifies are filthy, dangerous, or unwholesome. In addition, power was obtained to compel owners to strip and cleanse any house or part of a house certified by the medical officer of health to be infested with vermin. These clauses became law and have been increasingly used, so that during the year 1912 more than 100,000 articles of clothing and bedding are recorded as having been freed from vermin, and if the exact figures were obtainable it would probably be found that twice this number of articles was dealt with. During the last three years, moreover, an average number exceeding 10,000 rooms a year received the attention of the borough councils on account of their verminous condition. General Powers Act, 1904. sects. 19,20, 21, 24 A further impetus was given to this work by the passing of the London County Council (General Powers) Act of 1907. This Act contained clauses empowering the Council as Education Authority to make arrangements for the cleansing of school children, and as supervising authority for the cleansing of the inmates of common lodging houses. In both cases power was obtained to detain and convey to suitable premises for the purpose of cleansing any person failing to comply with a twenty-four hours' notice. Section 38 of the Act expressly provided that the Council might enter into agreements with local authorities possessing suitable stations for the cleansing of school children and inmates of common lodging houses, and incidentally this section has been the means of securing a considerable extension throughout London of the facilities for cleansing which were first made possible by the Cleansing of Persons Act. 1897. General Powers Act, 1907, sects. 36-40. Almost immediately following the General Powers Act of 1907, the Children Act, 1908, was passed. This Act also gave power to cleanse when necessary elementary school children, and, as a Government Act, gave somewhat greater facility of action than the Council's Act. I11 London, therefore, Section 122 of the Children Act has been mainly used, but it has been supplemented by the powers obtained in 1907. Children Act, 1908. Sect. 122. From this brief statement it will be seen that considerable attention has of recent years been directed to this most important branch of personal hygiene. The development of the Council's scheme for securing the cleanliness of school children is fully discussed in Part II. (Education) of this report, and it will only be necessary here to summarise the results of the action taken by the several borough councils. With very few exceptions, all the London boroughs have now made provision for personal cleansing, and most of the annual reports of medical officers of health contain information as to the action taken. The number of cleansings at the several stations as shown in the following table has been obtained from this source:— Metropolitan borough. Adults. Children. Metropolitan borough. Adults. Children. City of London — — Islington 25 — Battersea 1,351 841 Kensington 19a — Bermondsey 47 1,920 Poplar 378 1,834 Bethnal Green 25 2 St. Marylebone 8,202 1,878 Camberwell — 2,160b St. Pancras 1,292 3,464 Deptford — 773 Southwark 93 1,351 Finsbury 2a — Stepney 2,292 13 Greenwich — 28 Stoke Newington — 551 Hackney 34 1,338 Wandsworth 1 9 Hampstead 20 157 Westminster, City of 48 464 Holborn 23a — Woolwich 92 338 Number of cleansings during the year 1912. Some of the reports contain comments on the arrangements made. Thus in Battersea Dr. Lennane points out that the use of the station has long outgrown its capacity, and gives a statement showing that while during 1907, the first complete year after its opening, only 621 persons were treated, in 1912 the numbers had swelled to 2,192. He suggests the early provision of a new station as a matter (а) Dealt with by the Board of Guardians at the expense of the Borough Council. The casual ward in Holborn Was discontinued on 31st March, 1912, and that in Kensington in July of the same year. (b) Adults and children. 72 Annual Report of the London County Council, 1912. for the sympathetic consideration of the borough council. In Camberwell some improvements at the cleansing station were found necessary during the year, but these were put in hand and are now completed. The cleansing station in Deptford was opened in July, 1912, and the medical officer reports that it is self-supporting. In Finsbury arrangements were made some years ago with the Holborn Board of Guardians and a capitation fee of 6s. was paid. Owing to the transfer of the casual wards to the Metropolitan Asylums Board, this arrangement ceased in March, 1912, and no other provision has since been made. The closing of this ward, moreover, affected the borough of Holborn, from which verminous persons were also sent, but the borough council has now made provision for cleansing at the mortuary, the alterations being completed in May of this year. The borough of Kensington also had an agreement with the guardians, which was nullified by the closure of the casual ward in Maryplace. Unfortunately, here the borough council had decided against the provision of a cleansing station in November, 1911; a rescinding resolution was passed in July, 1912, by 29 votes to 20, but it was not during 1912 supported by the two-thirds majority necessary to make it effective. Dr. Dudfield, in Paddington, suggests that the provision of a station in the borough would be of great benefit, as under present conditions little can be done in the direction of promoting personal cleanliness. St. Marylebone was the first borough to take effective action under the Cleansing of Persons Act, and still maintains its position as regards the numbers of persons cleansed. The shelter has been opened fifteen years and during that time has cleansed 109,611 adults, and since 1905, when they were first received, 25,560 children. Fulham, Hammersmith, Lambeth, Lewisham and Shoreditch have not yet provided stations. At some of the shelters scabies, or itch, is treated. This is specially mentioned in the reports relating to Hackney and Southwark. The borough of Stepney undertook disinfection after scabies by co-operation with the London Hospital and treated the clothing and bedding of 250 patients from July to December. In nearly all the London boroughs, whether cleansing is undertaken or not, considerable effort is made to deal with verminous homes notified as the result of action by the school authority, and many of the reports refer to the large amount of work involved in this duty. This additional visiting, however, has not been unproductive of good, and many other defects have been found as the result of the special inquiries made by the sanitary inspector or health visitor. In addition, many thousands of articles have been purified and thousands of rooms cleansed, and this work alone cannot be regarded as unprofitable, affecting as it does the welfare of the whole community. Cleansing of verminous rooms or premises. The details obtainable from the annual reports concerning the cleansing of rooms are shown in the following table:— Metropolitan borough. Number of rooms or premises cleansed. Metropolitan borough. Number of rooms or premises cleansed. City of London Lambeth 1,109 rooms. Battersea Not stated. Lewisham 39 rooms. Bermondsey Not stated. Paddington 217 premises. Bethnal Green 409 rooms. Poplar 264 rooms. Camberwell 172 premises. St. Marylebone 341 rooms. Chelsea .. 354 rooms. St. Pancras 306 rooms. Deptford 109 rooms. Shoreditch 910 rooms. Finsbury 38 premises. Southwark *3,354 rooms. Fulham 220 rooms. Stepney 1,369 rooms. Greenwich 70 premises. Stoke Newington 147 rooms. Hackney 408 premises. Wandsworth 574 rooms. Hammersmith Not stated. Westminster 232 premises. Hampstead 87 rooms. Woolwich 214 rooms. Holborn 75 premises. Total 10,212 rooms. Islington 292 premises. Kensington 406 rooms. 1,504 premises. Cleansing of adults. 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, free of charge, any persons sent for that purpose to the cleansing station by the County Council from 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. Agreements to this effect have been made with the borough councils of Bermondsey, Camberwell, Hackney, Poplar, St. Marylebone, St. Pancras, and Woolwich. From the information supplied by the Council's inspectors it appears that during the year 1912, 1,926 men and 14 women were sent to have their clothing cleansed by reason of their beds having been found verminous. Of these numbers 1,642 men and 8 women were known to have been cleansed, 277 men and 6 women went away and could not be traced. Only 7 men were expelled by keepers for refusing to go to the cleansing station, attempts at persuasion having failed. * 1,707 of these cleansed by owners. 73 Report of the County Medical Officer—General. Vermin Inquiry. On pages 62 and 63 of the annual report of the medical officer of health for the year 1911, the question of the seasonal prevalence of three particular kinds of vermin (fleas, lice, and bugs), is discussed at some length, and a diagram was included illustrating this point. It was noted that the high autumnal level in the flea and bug curves suggested comparison with the curves of diseases which have an autumn prevalence. The mode of spread of certain infectious diseases is by no means completely understood, and the possibility of biting insects acting as carriers of infection cannot be ignored. It is, however, impossible to base any definite hypothesis on the scanty information at present available, and the most that can be done is to continue the collecting of evidence to form material for future investigations in this branch of work. In the meantime the efforts of public health authorities working with the object of diminishing the prevalence of vermin are being persisted in, and it is possible that this work may have even more far-reaching effect than is now generally appreciated. Water supply to tenement houses. Sanitary authorities have made considerable use of the powers provided by section 78 of the London County Council (General Powers) Act, 1907, for requiring the provision of a water supply to the upper floors of tenement houses. 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 during 1912:— Metropolitan borough. No. of premises caused to be supplied. No. of legal proceedings. Battersea 96 — Bethnal Green 4 — Deptford 2 — Finsbury 72 — Fulham 43 — Greenwich — — Hackney — — Hampstead 152 — Holborn 21(a) — Islington 258 1 Lambeth 2 2 Paddington 57 — Poplar 8 — St. Marylebone 321 1 Shoreditch 83 — Southwark 100 6 Stepney 19 — Westminster, City of 21 2 Woolwich 6 — Total for 19 boroughs 1,265 12 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:— 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 three pence; 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 before. (a) Number of notices served. In the majority of cases the work was completed during the year. 18820 K 74 Annual Report of the London County Council, 1912. Applications for certificates, Revenue Act, 1903. The number of applications following table:— received and certificates granted during 1912 is shown in the Metropolitan borough. No. of houses for which applications for certificates were received during 1912. No. of tenements comprised therein. No. of tenements for which applications for certificates were Granted. Refused. Deferred or withdrawn. Battersea 3 18 9 4 5 Bermondsey — — — — — Bethnal Green 3 — — 3 — Camberwell 55 272 233 2 37 Chelsea 7 37 23 14 — Deptford 53 83 83 — — Finsbury — — — — Fulham — 484 344 94 66 Greenwich 1 3 — — 3 Hackney 13 21 21 — — Hammersmith 62 151 26 3 122 Hampstead 14 57 3 — 54 Holborn 47 231 1 230 — Islington 8 27 12 15 — Kensington 58 169 153 — 17 Lambeth 85 235 119 100 16 Lewisham 65 133 117 16 — Paddington 17 64 14 23 27 Poplar — None — — St. Marylebone 17 152 152 — — St. Pancras 13 300 185 4 71 Shoreditch — — None — South wark 338 354 354 — — Stepney 19 121 110 11 — Stoke Newington — — — — Wandsworth 49 109 80 29 — Westminster, City of 7 23 11 12 — 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. Workshops It will be seen from the following table, comparing the work done in 1912 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. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Number of workshops on register 36,632 37,891 37,673 37,782 37,742 43,035 44,592 Number of inspections, excluding inspections of outworkers' premises 79,526 81,171 84,058 84,174 89,040 89,995 84,854 Total number of defects found 19,407 22,071 22,012 21,522 21,888 21,013 20,946 Want of cleanliness 7,206 8,319 7,130 7,256 7,248 6,725 6,734 Want of ventilation. 736 652 639 727 607 681 594 Overcrowding 461 295 237 278 250 253 263 Sanitary conveniences Insufficient 296 256 278 377 262 293 281 Unsuitable or defective 3,717 4,229 5,255 5,377 5,402 5,516 5,289 Not separate for sexes 251 388 376 292 312 277 324 75 Report of the County Medical Officer—General. As an instance of the beneficial effect of inspection under the Act, Dr. Thomas, medical officer of health of Finsbury, mentions the case of a workshop where table sauce made principally of pressed dates, old and of poor quality, was being mixed in a galvanised iron bath, afterwards being ladled into bottles by means of a jug. The surroundings were dirty, and hair oil, lime, cream, perfumery, and boot polish were being made in the same room. After inspection the business was discontinued. In Shoreditch a bake-house was being used as a sleeping place; 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 increasing use of deep basements and sub-basements as workplaces and restaurants and to the special difficulties met with in securing the proper ventilation, warming, and lighting of premises of this character. 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. 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. 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, 1912. No. of notices, 1912. No. of prosecutions, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. City of London 243 215 – – – Battersea 174 25 18 181 491 9 — Bermondsey 139 — 19 120 117 11 — Bethnal Green 104 5 7 102 236 33 — Camberwell 219 17 73 163 460 6 — Chelsea 30 — 2 28 19 1 — Deptford 129 24 21 132 215 7 — Finsbury 97 — — 106 126 18 — Fulham — — — — — — — Greenwich 118 13 6 125 132 20 — Hackney 175 — — 190 186 31 — Hammersmith 170 7 1 176 86 6 — Hampstead 32 2 4 80 171 14 — Holborn 35 8 8 35 125 — — Islington 229 13 18 224 98 21 — Kensington 173 67 69 171 184 14 — Lambeth — — – — .— — — Lewisham — — — — — — Paddington 108 12 10 110 114 — — Poplar 116 — — 124 233 3 — St. Marylebone 96 15 7 104 120 20 — St. Pancras 491 — — 491 302 — Shoreditch 95 7 9 93 154 24 — Southwark — — — 142 267 96 — Stepney 185 25 9 201 325 37 — Stoke Newington 38 — — — — — — Wandsworth 304 31 13 322 542 41 — Westminster, City of 174 — — — 30 — Woolwich 89 11 11 89 142 5 — Ice-cream premises. 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 one in London under these powers, various conditions having been dealt with in their administration. 18820 K 2 76 Annual Report of the London County Council, 1912. The annual reports of medical officers of health supply information as to the number of premises inspected and the number of inspections as shown in the following table:— Metropolitan borough. Premises used for the preparation and sale of food.(a) Number of inspections. Metropolitan borough. Premises used for the preparation and sale of food. (a) Number of inspections. City of London 883 1,598 Kensington 681 1,229 Battersea 258 — Lambeth 248 29 Bermondsey 996 8,837 (b) Lewisham 49 57 Bethnal Green 224 1,083 Paddington 366 — Camberwell 182 419 Poplar 307 872 Chelsea 64 82 St. Marylebone 246 617 Deptford 116 145 St. Pancras 617 992 Finsbury 237 278 Shoreditch 257 — Fulham 85 — Southwark 909 1,732 Greenwich 122 248 Stepney 450 977 Hackney 117 111 Stoke Newington 28 438 Hammersmith 180 — Wandsworth 594 673 Hampstead 479 1,124 Westminster, City of — 92 Holborn 379 2,147 Woolwich — — Islington 730 342 Total for 27 boroughs 9,804 — Inspection of food. A very considerable amount of work is done throughout London in connection with the protection of the food supply. As regards meat, the City of London Corporation, which has the control of the Central Markets, has the greatest amount of responsibility; indeed, it is estimated that three-fourths of the meat imported into the United Kingdom passes under the observation of the officers of the Corporation either in the Central Meat Markets or in the City Cold Stores. For instance, during the year 1912, the total amount of meat imported into the United Kingdom was 667,492 tons, and of this amount a very high proportion (430,283 tons) was received at the Central Markets alone, exclusive of the Cold Stores. The markets also received 1,511 tons of fish. The total amount of meat destroyed as diseased or unsound amounted to rather more than 1,114 tons, and of this 12.4 per cent, was tuberculous. This is a much smaller percentage than in any year of the preceding five years. At or near Billingsgate Market fish amounting to 223,926 tons was received and of this nearly 0.6 per cent. (1,336 tons) was condemned by the inspectors of the Fishmongers Company. With regard to miscellaneous food the officers of the City Corporation found it necessary to destroy 219 tons, out of the whole amount received at the wharves within the City boundary. Dr. Collingridge in his report includes some notes on the large decrease in recent years in the number of live animals imported for slaughter, and it is mentioned that for three months prior to the writing of the report no animals had been slaughtered at Deptford, whereas" a few years ago the number of animals killed in a day often exceeded 1,000 cattle and 2,000 sheep. Reference is made to the improvement in the condition of Australian meat, which was found so unsatisfactory in 1910 and 1911. A consignment of pigs' carcases from Shanghai was, however, subjected to severe criticism during the year. All the carcases were stamped " Killed, Municipal Slaughterhouse Shanghai, February, 1912," and bore evidence that some attempt at examination hud been made before shipment. It was found necessary to condemn 9 per cent. of the consignment on account of tuberculosis and a further 9 per cent. for hæmorrhagic adenitis. Certain suggestions for the carrying out of a proper examination were made to the agent for the consignors which, if adopted, would admit of the inspection of the carcases in England without "thawing out" which is prejudicial to the meat. As an interesting experiment it is also recorded that post-mortem examinations are now being made of emaciated fowls condemned at the City Markets. So far as the enquiry had proceeded at the time the report was written it was found that among fowls of poor quality 50 per cent. were tuberculous and, it is added, " in a degree which requires to be seen in order to realise its importance." Concerning bovine tuberculosis some figures are given showing that of 1,890 cows slaughtered 498 or 26.3 per cent. were affected with tuberculosis; of 12,184 oxen, 527 or 4.3 per cent. were so affected. The total number of oxen, bulls, cows, heifers, and calves slaughtered at Aldgate, was 26,998, of which 1,141 or 4.2 per cent. were tuberculous. (а) Other than bakehouses, milkshops, slaughterhouses, and ice-cream premises. In some cases the figures relate to restaurant-kitchens only. (b) Including visits for the purpose of sampling under the Food and Drugs Act. 77 Report of the County Medical Officer—General. All the London sanitary authorities in addition to the City Corporation take active steps as regards detecting unsound food, and most of the reports contain references to seizures or surrenders, some of very large quantities. For instance, in Bermondsey, 271 tons of food, including eggs, to the amount of 81 tons, were destroyed, and 3,153 tons disposed of for purposes other than the food of man. In all 70,000 tons of food was examined. In Finsbury, 74 tons of meat and 82 tons of decomposed food stuffs were destroyed. Southwark has the following record—2,412 tons of food examined at wharves, 153 tons unsound; of 316 tons examined in the borough, 35 tons were surrendered by the owners, and half a ton was seized; of a total of 16,185 samples taken, 2,083 were unsound. In Stepney, food stuffs from the wharves amounting to 243 tons were destroyed, and from shops 3 tons of unsound meat and 11 tons of miscellaneous food were surrendered. Dr. Harris, the medical officer of health of Islington, mentions the curious fact that the representative of an American canned meat firm with an English factory in Islington asked for a certificate to enable him to export his firm's products to the United States, where, it is mentioned, there is a growing shortage of meat. The reports relating to the following districts show that proceedings before the magistrates in connection with unsound food were instituted in the number of instances stated. Sanitary district. Proceedings. Instances. Result. City of London 1 1 conviction. Bermondsey 11 11 convictions (1 with a penalty of six weeks' imprisonment). Bethnal Green 7 5 convictions, 2 summonses withdrawn. Deptford 3 3 convictions. Fulham 2 1 conviction, 1 case dismissed. Kensington 3 2 convictions, 1 summons withdrawn. Paddington 2 2 cases dismissed. Poplar 1 Acquitted, but refused costs. St. Marylebone 2 2 convictions. Shoreditch 3 2 convictions. Southwark 5 2 convictions, 3 cases dismissed, in 2 of them with costs aaainst defendant. Stepney 3 3 convictions (in 1 case with 4 months' hard labour). Westminster 4 3 convictions, 1 case defendant bound over. Unsound food—legal proceedings. In summary of the above table it may be mentioned that there were in all 47 prosecutions. In 36 instances convictions Were obtained, 2 cases were dismissed with costs against the defendants, in one case defendant though acquitted was refused costs, one defendant was bound over in his own recognisances, 3 cases were withdrawn and 4 cases were dismissed with costs against the borough councils. A Fulham butcher was convicted and fined in respect of a tuberculous bullock's pluck found on his premises. A summons was issued against the wholesale dealer at Smithfield who supplied the pluck, but the action failed, the defendant proving that when he sold the meat he did not know, nor had he any reason to believe, that the pluck was tuberculous. Dr. Sandilands mentions the prosecution of a Billingsgate vendor who was convicted for supplying dabs in a state of putrefaction. The retailer escaped by stating that he had intended to surrender the fish. The Billingsgate vendor was convicted on a second summons in respect of another consignment of dabs on the same day. In this case the fish had been surrendered by the retailer. Dr. Sandilands states the second conviction would probably have been quashed on appeal as the surrender of the goods nullified the suggestion that the dabs were intended for the food of man, and he cites the case of Rex v. Ascanio Puck and Co., K.B.D., 18th October, 1912. In Stepney, proceedings were instituted against a dealer for selling unsound corned beef for human food. The defendant traded as a company and all the invoices to him or to the company were marked " to be used for poultry food." In spite of this fact cases of the meat had been sold to various tradesmen under guarantees. In respect of the specific action 60 of 66 tins were in a putrid condition and were condemned. The case was decided at the Central Criminal Court, when the defendant was sentenced to four months' imprisonment with hard labour. Dr. Allan quotes the case of a pork butcher in Westminster upon whose premises a pig had been seized and who sued the Central Market salesman from whom he had bought the carcase. The defence was that there was no expressed or implied warranty and that the carcase was not tuberculous. The jury found against the defendants on all points and awarded damages. During the year the Stepney Borough Council circularised all the metropolitan borough councils with reference to the seizure and condemnation of tuberculous meat. The purchase in the case cited had been completed outside the County of London, and the Stepney Borough Council had been advised that section 47 (3) of the Public Health (London) Act, 1891, could not be applied. The borough council had, therefore made a representation to the Local Government Board asking for an amendment of the law. 78 Annual Report of the London County Council, 1912. Shelters. The following figures, which are taken from the annual reports, show the extent to which the existing shelters were used during the year 1912, 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 — Lambeth — Bermondsey 44 Lewisham — Bethnal Green — Paddington (a) Camberwell — Poplar — Chelsea 33 St. Marylebone 15 Deptford — St. Pancras 22 Finsbury 18 Shoreditch 4 Fulham — Southwark 551 Greenwich 2 Stepney 28 Hackney 13 Stoke Newington — Hammersmith (a) Wandsworth — Hampstead — Westminster, City of — Holborn 14a Woolwich — Islington 7 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 191 — Kensington 238 _ Battersea. 264 7 Lambeth 357 2 Bermondsey 194 2 Lewisham 133 4 Bethnal Groen 337 5 Paddington 287 3 Camberwell 330 — Poplar 482 — Chelsea 114 — St. Marylebone 292 2 Deptford 97 1 St. Pancras 418 10 Finsbury 254 2 Shoreditch 373 1 Fulham 138 5 Southwark 791 2 Greenwich 141 2 Stepney 565 3 Hackney 442 — Stoke Newington 47 — Hammersmith 211 — Wandsworth 186 — Hampstead 107 — Westminster, City of 324 6 Holborn 92 — Woolwich 143 4 Islington 634 4 % National Insurance Act, 1911. The Public Health Committee in a report to the Council on the 11th February, 1913, in regard to the treatment of tuberculosis, after setting out the provisions of sections 8 (1), 16 (1), 17, 64 (1), 64 (4) of the Insurance Act, 1911, and the principal recommendations of the departmental committee on tuberculosis, reported as follows:— "The Local Government Board in a circular letter, dated 14th May, 1912, called attention to the report of the departmental committee, and stated that they agreed generally with the findings of the committee, including the financial recommendations in regard to the distribution of the capital grant. The Board suggested that the Council of each county and county borough should forthwith take the matter into serious consideration, and by conference and consultation with the other councils, determine what action they should take. As a first step in formulating a scheme, the Board suggested that the medical officer of health should be asked to submit a report setting out the existing means for the tuberculosis within the county or county borough, whether in the hands of local authorities or otherwise, and his estimate of the needs of the area generally. "The circular letter above referred to was not addressed to the Council but was sent to other county councils, the councils of boroughs (including the metropolitan boroughs) and urban and rural (a) No shelter maintained by borough council. In the case of Holborn 14 persons were accommodated in the Finsbury Borough Council's shelter. 79 Report of the County Medical Officer—General. district councils. It was followed by a further circular letter, dated 6th July, 1912, addressed to county councils and county borough councils, dealing with provisional arrangements for the treatment of insured persons recommended for sanatorium benefit, and urging that complete schemes relating to the whole population, and not only to insured persons, should be prepared in conference with the insurance committees and sanitary authorities, the unit area for such schemes to be generally the county or county borough. " At the beginning of August, 1912, it was intimated that, as a result of the consideration of representations made on behalf of the County Council's Association in connection with the proposal that schemes for the treatment of tuberculosis should extend to the whole community, the Government would contribute annually a sum, representing approximately half the total estimated cost of treating the non-insured persons as well as the dependants of insured persons. This sum would be distributed to local authorities which undertook schemes, to be approved by the respective local government boards, for the general treatment of tuberculosis in the areas under their jurisdiction. "On 27th July, 1912, a circular letter was sent by the Board to county councils, sanitary authorities and insurance committees in England and Wales relative to the domiciliary treatment of insured tuberculous persons." Further correspondence took place between the Council and the Board, and ultimately on the 11th December, 1912, the Board addressed to the Council a letter suggesting that the Council should prepare a scheme for dealing with the disease in London. Homeless persons. It has been the practice for some years past for the Council during the months of January or February to undertake an enumeration of homeless persons in London. The seventh of these enumerations was made on the night of the 9th February, 1912, and a report on the results obtained in the several years with comparative tables is included here in Chapter XXXIIa. In order to prevent duplication in counting, the method adopted was for certain groups of officers to work from the centre outwards and other groups to work from the boundary of the selected area inwards. Inasmuch as counting was begun at 1 o'clock a.m. in both directions there was little likelihood of the same persons being observed more than once on the same evening. The officers principally engaged in the work have had many years' experience of the homeless and common lodging-house classes of the population, and there is every reason to assume that the persons counted in the street were absolutely homeless. Consideration of the appended report will show that the numbers reached a maximum in 1910, the year of maximum charitable effort, and that the figures obtained in February, 1912, were some 1,500 less than in the earlier year. It cannot, however, be said that this reduction in numbers was entirely due to the alteration of method adopted by charitable organisations, and, indeed, later figures show that other more obscure factors must have had no small influence on the decline in numbers. Evidence of this will be found in the two most recent reports on this subject giving the results of enumerations made on the nights of 14th February and 24th October, 1913. Sanitary officers. During the year under review the eleventh return of sanitary officers in London was published and is included in Chapter XXXIIa of this report. The return gives details as to the officers employed in the several boroughs with their duties and salaries. Reference to this return will show that while there is an increase in the total number of officers as compared with previous years there is still considerable variation among the several districts in the amount of work allotted per inspector on the basis of population, and in some of the annual reports of medical officers of health comment is made on the inadequacy of the staff. For instance, the average population to each inspector throughout London, excluding the City of London as not comparable, is, on the revised Census figures of 1911, roughly 14,570 persons. Sixteen boroughs have a smaller average population than this, whilst the remaining twelve boroughs exceed the mean average population to each sanitary inspector by the numbers stated. The figures are given to the nearest hundred. Islington, 300; Stepney, 1,000; Greenwich, 1,400; Lewisham, 1,500; Chelsea, 2,100; Stoke Newington, 2,300; Poplar, 3,500; Shoreditch, 4,000; Fulham, 4,600; Lambeth, 5,300; Camberwell, 5,500; Wandsworth, 9,400. This statement, of course, though serving as a rough guide to the amount of work to be performed, deals only with one criterion, and that a comparatively unimportant one in the combination of circumstances which must be taken into consideration in forming an estimate of the adequacy of the staffs engaged in the administrative work arising out of the Public Health and cognate Acts in London. It is, in fact, impossible to arrive at any true judgment without detailed knowledge of the widely varying conditions obtaining in each borough, and the absurdity of adopting a uniform standard for such boroughs as Finsbury, Hampstead, Shoreditch, and Wandsworth would be obvious to the most casual observer. For this reason no general standard of efficiency can be adopted, and regard must be paid to the reports on the subject presented by the medical officers of health of the district concerned. Attention has been directed in the following instances to the inadequacy of the staff— Dr. Lennane, in a special report written early in 1912, discussed the effect of the large increase of duties imposed by recent legislation, and pointed out that in Battersea the determination of the Council not to fill the place of the woman workshop inspector, who had resigned at the beginning of 1911, had not reacted to the benefit of the borough, the necessary readjustment of duties among the 80 Annual Report of the London County Council, 1912. remaining officers making it impossible for the work of inspection to be carried out efficiently. He pointed out, moreover, that owing to improved and cheapened means of transit the character of the population was changing, and that in the near future increased supervision would be necessary. The result of Dr. Lennane's report was that another woman inspector was appointed, and she entered upon her duties in the latter half of 1912. Dr. Harris, the medical officer of health of Islington, refers in his report to the amount of work devolving on the inspectors, and states that at times it is with the greatest difficulty that they are able to perform it. He adds that some of the work is not such as should be performed by men, and he again advocates, as he has done for several years past, the appointment of women health visitors. With regard to Southwark, the Local Government Board in March, 1912, expressed disapproval of the arrangements made by the borough council for the discharge of the duties of woman sanitary inspector and health visitor in the borough, and instructed one of its medical inspectors to confer with representatives of the borough council on the matter. Ultimately, the borough council decided that the woman sanitary inspector should supervise the inspection of about 600 houses let in lodgings, the remainder being allotted to the ward inspectors, and that a health visitor should be appointed in place of a woman sanitary inspector who had resigned. This arrangement was approved by the Local Government Board. In the report relating to St. Pancras it is mentioned that the claims upon the woman inspector's time have been so great that very little inspection of workplaces where women are employed could be done. Upon reference to the Factory and Workshop table at the end of this report it will be seen that there were no inspections of outworkers during the year. The medical officer of health of Shoreditch, Dr. L. T. F. Bryett, also had occasion during the year to report adversely upon the adequacy of the staff of the borough. As already mentioned the average population to each sanitary inspector in Shoreditch was much above the average for London as a whole, and the local conditions in Shoreditch do not permit of any deviation from the average in this direction. Dr. Bryett discussed the matter fully in his report, which forms an appendix to his annual report for 1912. After consideration, the borough council decided to increase the staff of the public health department by the addition of two sanitary inspectors, one health visitor, and one clerk. These officers have since been appointed. The average population to each sanitary inspector in Shoreditch therefore is now 13,922 as against 14,570 for London. Inspection of theatres, music-halls, etc. Since June, 1910, officers of the public health department have carried out the duty of reporting on the ventilation and sanitary condition of theatres, music-halls, cinematograph premises and other places of public entertainment licensed by the Council or the Lord Chamberlain. The rapid development of cinematograph theatres initiated in London in 1909, and continued almost without remission until the present time, has imposed a considerable amount of work on the officers concerned. With this special form of entertainment the absence of sunlight and the continuous nature of the performance make the provision of adequate means of ventilation an urgent need, and but small natural facilities exist for its satisfaction. It has, therefore, been necessary in most cases to devise a scheme of ventilation by mechanical means. This has generally been effected by the installation of proper air inlets and of exhaust fans in suitable positions. It is required that the fans should be capable of securing a minimum air change of from 700 to 800 cubic feet for each person every hour. At the present time most of the theatres and music-halls in London are mechanically ventilated, using indifferently the exhaust or plenum systems or a combination of both. A standard has been adopted for the provision of sanitary conveniences at places of entertainment and this standard is being applied as opportunity arises. Inspections are constantly being made to secure that the arrangements approved by the Council are maintained. During the year under review this work necessitated nearly 700 reports to the Theatres and Music-Hails Committee. Rag Flock Act, 1911. In the last annual report reference was made to the passing of this Act which 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 made by the Local Government Board. The Board, in pursuance of its powers, on 8th June, 1912, made regulations which came into operation on the same day as the Act, namely, 1st July, 1912. The regulations provide that the amount of soluble chlorine in the form of chlorides, removed by washing with distilled water at a temperature not exceeding 25 deg. C. from not less than 40 grammes of a well-mixed sample of the flock, must not exceed 30 parts of chlorine in 100,000 parts of the flock. 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 and to a penalty of £50 for any subsequent offence. Although the Act came into operation so late in the year local authorities have already availed themselves of its provisions. For instance, in Finsbury six samples were taken and four were found to be grossly polluted, whereupon all the makers and users of flock throughout the borough were circularised and the Act brought to their notice. In Kensington, 57 premises occupied by probable users of flock have been registered. In Poplar, seven samples were taken. In Shoreditch, 32 samples were taken, and proceedings were instituted in 10 cases. Convictions were obtained in seven instances, but the remaining summonses were dismissed, in two cases with costs 81 Report of the County Medical Officer—General. against the borough council. Thirteen samples were examined in Stepney, of which four exceeded the limit of pollution. In Wandsworth, 14 samples were taken, and prosecutions were instituted in five cases. Some of these cases present special points of interest: (1) A sample of black shoddy flock was purchased from a shop where bedding was sold. The vendor having no loose flock in stock supplied the inspector with some from a new pillow. The flock was found to contain 340 parts of chlorine in 100,000. The defendant pleaded that had he sold the pillow no proceedings could follow, as the sale would be of a pillow and not of flock. The magistrate in convicting said that it was immaterial whether the flock was in a case or loose, and if it failed to comply with the standard the defendant was liable for having it in his possession. (2 and 3) The defence in both these cases was ignorance of the fact that the Act applied to the remaking of old bedding. The magistrate held that it was unlawful to make or remake bedding if the flock was unsatisfactory. (4) A woman had bought an old bed for 2s. and was using the filling for upholstering a couch. A sample of the flock was found on analysis to contain 326 parts of chlorine in 100,000. The magistrate severely condemned the practice of using old bedding in this way, and convicted the defendant. (5) In the last case a sample of flock containing 329 parts of chlorine per 100,000 was taken from a workshop. The defence was that it was not intended for use for bedding or upholstery, but the magistrate convicted. Water Supply. In his annual report for 1912, Dr Houston again refers to the importance of efficient storage of raw river water and commends the policy of the Metropolitan Water Board, which has been not only to provide adequate storage, but to secure the circulation of all the river water through all the storage reservoirs for the purpose of equalisation. This policy is referred to not only as being economically sound, but as tending to secure epidemiological safety. In support of this argument, Dr.. Houston comments once more on experiments made on the vitality of the typhoid bacillus in samples of raw Thames, Lee, and New River waters, and points out that in practically all the 18 experiments made, 99.9 per cent. of the typhoid bacilli could not be recovered after one week. He urges, therefore, that although as a counsel of perfection, storage of water for one or two months may be desirable, the advantages of a few days' storage are so material that there is no justification for the use of raw unstored river water. In this connection Dr. Houston states that "the safety, apparently conferred by filtration, even when the filter beds are in good working order, is probably merely relative, and depends mainly on the comparatively innocuous character of the water antecedent to filtration." Reference is made in the report to the large number of complaints received during the year, restricted, however, almost entirely to the districts supplied from the Staines reservoirs. It is stated that the complaints were justifiable and that on a number of occasions, but chiefly on Mondays, the water had a most unpleasant "geranium" taste and smell due to the excessive development of Tabellaria. The trouble was augmented by restorage of the water at Barnes and Barn Elms; sudden marked increases in the rate of filtration on Mondays as compared with Sundays; and on one, if not more occasions, by the dragging of filter beds on Sundays. The water, though unpleasant, was always innocuous. On March 15th, 1913, the Chingford reservoir, now known as King George's reservoir, having a capacity of about 3,000 million gallons was opened by His Majesty the King. Dr. Houston points out that there is already a chain of reservoirs having a combined capacity of 2,400 million gallons, which draw their water from the River Lee, and adds that it is a little difficult to see how all these reserviors are to be utilised for storage purposes unless on the assumption that it is proposed to use flood water. For this and other reasons he is experimenting upon supplementary processes of water purification which will convert the worst river water into water of passable purity, and by the use of which on special occasions the yield of the Thames and the Lee may be drawn upon to an extent not hitherto contemplated. Dr. Houston forms the conclusion that the safety of London's water supply is being secured to a progressively increasing extent. He urges, however, that every effort should be made to guard against accident, not only sudden accidental gross infection, but more constant, highly diluted pollution, which the most perfect and costly system of water examination might fail altogether to detect. Intercepting traps to house drains. In 1908 a departmental committee was appointed by the Local Government Board to inquire into the use of intercepting traps in house drains, and the report of the Committee was issued towards the end of 1912. The inquiry was instituted as the result of an application by the Willesden Urban District Council asking the Board to sanction new drainage bylaws from which the requirement to provide an intercepting trap had been omitted. The Board refused sanction to the bylaws as drafted, but appointed a special committee to inquire into the whole matter. 18820 82 Annual Report of the London County Council, 1912. The conclusions of the Committee are briefly as follows:— (1) That the systematic ventilation of sewers is of secondary importance and that free ventilation is unnecessary and impracticable. It is pointed out that in all cases before men enter the sewers special precautions should be taken, and that it is dangerous to rely for safety on ventilation. (2) That sewer gas is offensive to the sense of smell, but is not injurious upon bacteriological or epidemiological grounds, and the instance is given "that human beings deliberately exposed to sewer air do not appear to be affected in health." (3) That in some circumstances the intercepting trap might with advantage be omitted from the drain. (4) That where a permanently sound drain is required, iron pipes should be used. (5) That the fresh air inlet to house drains is of small importance and may frequently with advantage be omitted. These conclusions are discussed in some of the annual reports from varying reports of view, but the Departmental Committee has anticipated difference of opinion in its final conclusion that as circumstances vary in different localities, the question whether the intercepting trap is or is not required, is one which must be considered and determined by local authorities and their advisers in the light of local conditions. 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, 1913, will be found in Volume I., page 50. Midwives Act. 1902. Registration. The number of midwives giving addresses in London whose names appear on the Roll of Midwives for 1912 is 4,985. This number includes midwives who may 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, 555 notified their intention to practise during the whole year or for shorter periods. The qualification of the London midwives is as follows:— Qualification of Midwife. Number not giving notice of intention to practise. Number giving notice of intention to practise. Total. (а) Holding certificates from the Central Midwives 2,644 262 2,906 Board (b) Holding a certificate, obtained as the result of an 1,615 217 1,832 examination prior to the passing of the Midwives Act (c) Enrolled by virtue of having been in bona fide prac171 76 247 tice as midwives a year previous to the passing of the Act 4,430 555 4,985 83 Report of the County Medical Officer—General. 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 14 per cent. The 555 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 9 per cent. of those on the roll are in actual practice in London. The remaining 91 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; 86 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 an infant's 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 1,570 visits to midwives or institutions employing midwives. In 1,121 cases the report was satisfactory, in 75 unsatisfactory, and in 374 the midwife was not seen. Most of the unsatisfactory reports related to cases in which some slight breach of the rules had occurred, and the midwife's attention was called to the matter by the inspector, who was subsequently able to report favourably. In cases of a more serious nature, or where the midwife had a bad record 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 six cases on the following grounds:— Omitting to advise the seeking of medical assistance for the mother 2 Delay in reporting the facts to medical practitioner summoned to case 1 Failure to take temperature and pulse 1 Employment of uncertified parson as substitute 1 Lack of care with respect to the cleanliness of mother and child 1 Charges of malpractice, negligence or misconduct against eight midwives were investigated during the year, and in the three undermentioned instances prima facie cases were established against the midwives concerned. Charge. Result. Infringements of rules of Central Midwives Board Cautioned by Board Malpractice, negligence and misconduct Name removed from Roll Failure to advise the seeking of medical assistance Name removed from Roll. Inspection. 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. The fee a midwife receives for attending a confinement and the subsequent visiting for 10 days, varies in different localities from 5s. per case upwards, but usually a fee of 7s. 6d. to 10s. is expected. The charities employing midwives pay 5s. or 6s. a case, and provide the midwife with registers, forms, antiseptics, etc. It is apparent from the number of cases taken by midwives and the small fees paid that very few can rely solely on their practice as a means of livelihood. Many of them are married women who do not trouble to obtain a large practice; a few keep lying-in homes ; others, especially those with 18820 l 2 Fees charged by midwives. 84 Annual Report of the London County Council, 1912. 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 1s. per week, which includes board and lodging in addition to the practical instruction given by the midwife. Maternity charities. 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:— 7 midwives reported over 500 cases in the year. 5 „ „ between 400 and 500 cases in the year. 10 „ „ „ 300 and 400 „ „ 12 „ „ „ 250 and 300 „ „ 23 „ „ „ 200 and 250 „ „ 26 „ „ „ 150 and 200 „ „ 43 „ „ „ 100 and 150 „ „ 71 „ „ „ 50 and 100 „ „ 69 „ „ „ 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. By Section 1 (2) of the Act it has been illegal since March, 1910, for any woman, unless she be certified under the Act, habitually and for gain to attend women in childbirth except under the direction of a registered medical practitioner. Since the date on which this sub-section of the Act became operative enquiries have been made into all cases in which it has come to the knowledge of the Council that a delivery had been conducted by an uncertified woman, and in 20 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 seventeen cases amounting to £24 16s., with £13 2s. 6d. 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 had only conducted one case and consequently could not be described as practising habitually; these women were informed of the provisions of the Act, and in some cases cautioned by letter. Medical help. 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 requires 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 3,603 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; 1911, 3,477. 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 335 midwives. Midwives in infirmaries and hospitals acting under the direction of a qualified medical practitioner are not required to comply with this rule. 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 between 80 and 100 times during the year 3 midwives „ „ „ 60 and 80 „ „ 9 „ „ „ „ 40 and 60 32 „ „ „ „ 20 and 40 68 „ „ „ „ 10 and 20 222 „ „ „ „ less than 10 times during the year. Pregnancy. The reasons assigned by the midwife for giving the advice were as follows:— Pregnancy— Purulent discharge 4 Abortion or miscarriage 48 Fit 1 Varicose veins 16 Ante partum haemorrhage 107 General unhealthy conditions 27 203 85 Report of the County Medical Officer—General. Labour— Presentations— Unable to make out 13 Difficult breech 37 Elbow 3 Shoulder 11 Face 30 Funis 31 Transverse 47 Difficult twins 22 Persistent occipito posterior 27 Hand 12 Abnormal (details not given) 9 Placenta prævia 24 Prolonged labour (uterine inertia, contracted pelvis, etc.) 624 Laceration of perineum 345 Prolapse of uterus 8 Hæmorrhage during labour 16 Retained or adherent placenta 220 Exhaustion or collapse 37 Hysteria or fits 3 Rapid pulse 1 Other conditions 89 1,606 Lying-in— Rise of temperature 272 Post partum hæmorrhage 124 Pain or swelling in leg 23 Abdominal pain or swelling 19 Pain or swelling of breast 22 Quick pulse 5 Eclampsia, convulsions 17 Condition of vagina 10 Puerperal mania 4 Offensive lochia 6 Sub-involution of uterus 1 Excessive sickness or headache 10 Skin eruptions 5 Other illness 11 529 Child— Injury at birth 10 Malformation or deformity 110 Skin eruption or rash 38 Jaundice 15 Convulsions 36 Partial asphyxia 13 Bronchitis, etc. 3 Cyanosis 12 Inflammation of eyes 383 Feebleness and prematurity 460 Hæmorrhage 7 Stillborn 58 Death of infant 41 Diarrhœa 4 Inflammation of navel 4 Abnormal sickness 3 Other conditions in child 76 1,263 Infectious diseases in patient's house 2 3,603 Assuming that 30,000 births are attended annually by midwives, the above figures show that medical assistance was required in 12 per cent. of the cases; in 7.8 per cent. on behalf of the mother and in 4.2 per cent. on account of the child. 86 Annual Report of the London County Council, 1912. Still births. During the year, 258 midwives reported having stillbirths in their practice, the number of stillborn children being 670. This represents 2.4 per cent. of the births. 1 midwife reported 14 stillbirths 14 1 „ „ 12 „ 12 2 midwives each reported 11 stillbirths 22 2 „ „ 10 „ 20 4 „ „ 9 „ 36 9 „ „ 7 „ 63 8 „ „ 6 „ 48 17 ,, ,, 5 „ 85 20 „ „ 4 „ 80 26 „ „ 3 „ 78 44 „ „ 2 88 124 „ „ 1 stillbirth 124 258 670 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 332 still-born infants were males, 335 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 349 159 73 88 28 1 Not macerated 311 214 38 37 21 1 No statement 10 3 — 4 1 2 Total 670 376 111 129 50 4 The presentations were as follows:— Vertex 410 Hand, arm and shoulder 12 Complicated vertex 31 Funis 5 Breech 105 Placenta prævia 1 Complicated breech 8 Born before arrival and presentation not known 56 Footling 33 Transverse 3 Face or brow 6 Total 670 Some additional information was obtained as to still-born infants not macerated, of eight or more months' gestation, as follows:— Concerning the child— Cord round neck 2 One of triplets 1 Encephalic head 1 One of twins 17 Born in membranes 1 Hydrocephalus 3 Malformed child 4 Concerning the mother— White asphyxia 1 Difficult labour 5 Blue asphyxia 1 Death of mother or child. 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 27 cases midwives notified the deaths of infants, and in three cases notices of deaths of mothers were received. 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. Ninety-three inquests were thus reported upon, including cases attended by uncertified women as well as by certified midwives. In the following table particulars are given with respect to these cases:— Confinement conducted by Total number of inquests. Deaths of mothers. Deaths of infants. Midwives 91 7 84 Uncertified women 2 0 2 93 7 86 87 Report of the County Medical Officer—General. The medical evidence given at the inquests as to the cause of death was as follows:- Mothers. Infants. Rupture of uterus 1 Atelectasis 8 Peritonitis 1 Suffocation at birth 9 Heart disease 2 Suffocation in bed 19 Cerebral hæmorrhage 1 Prematurity and debility 13 Collapse from long labour 1 Convulsions 11 Eclampsia 1 Bronchitis and pneumonia 4 Want of skilled attention at birth 4 Cerebral hæmorrhage 4 Tetanus 1 Syncope 1 Marasmus 1 Congestion of stomach 1 Congenital heart disease or malformation 4 Stillbirth 6 7 86 During the year 1912, 380 cases of puerperal fever were notified in the County and the Registrar General records 159 deaths from puerperal septic disease during the year. Three deaths recorded by the Registrar General refer to cases which were notified in 1911. The term puerperal septic disease used by the Registrar General includes puerperal septicaemia, pyaemia and saprsemia, 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 380 notified cases, 124 proved fatal, a case mortality of 32.7 per cent. Of the remaining deaths recorded, one occurred in a London institution, the patient having been confined outside London and probably notified as puerperal fever in the district where the confinement took place. The other deaths related to cases which were not notified. Early information of notified 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 the person by whom the patient was delivered. The following table gives the results of these inquiries which relate to the 380 notified cases and 35 deaths of cases not notified in London:— Puerperal fever. Delivery conducted by Cases. Deaths. (а) Medical practitioners (including cases attended by medical students 243 97 and also cases in which a medical practitioner was in charge of the case, but the birth took place before his arrival) (б) Certified midwives (including cases in which birth took place before 106 29 the arrival of the midwife) (c) Medical practitioner and certified midwife, i.e., cases in which a 10 4 midwife was unable to deliver and called in a medical practitioner (d) Hospitals and poor law institutions 28 12 (e) Cases of miscarriage or abortion where no attendant was engaged 28 17 415 159 The cause of death as stated in the death certificates in the 159 fatal cases occurring in London is shown in the following table:— Cause of death. Notified cases. Unnotified cases. Total. Puerperal septicaemia, toxæmia, and septic absorption 90 19 109 (20) Puerperal peritonitis 9 3 12 (2) Pyaemia 6 — 6(2) Sapræmia 1 2 3 Puerperal fever (not defined) 12 1 13 (3) Metritis, perimetritis, parametritis and endometritis 5 4 9(3) Pelvic cellulitis 1 4 5(1) Salpingitis — 1 1 Septic pneumonia — 1 1 124 35 159 88 Annual Report of the London County Council, 1912. The number of fatal cases of puerperal fever which followed abortion or miscarriage was 31. 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 415 cases was as follows:— Total. 15-20 20-25 25-35 35-45 Over 45 Recovery cases 256 9 69 115 62 1 Fatal cases 159 4 27 84 43 1 In case where a midwife was concerned the Council's inspector visited her, learnt particulars of the case, 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. 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; 272 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 166 cases it was found that the temperature had fallen, or that no further symptoms of puerperal fever occurred. 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 of temperature (if noted) occurred, (b) medical aid was obtained, and (c) the death took place if the case were fatal. Day of confinement. 2nd day. 3rd day. 4th day. 5th day. 6th day. 7th day. 8th day. 9th day. 10th day. After 10th day. Total. 1 Rise of temperature— Recovery cases 4 4 13 14 10 8 3 1 2 5 11 75 Fatal cases — 5 7 6 7 1 — — — 1 2 29 . Medical aid obtained— Recovery cases 7 4 14 15 8 11 3 — — 5 10 77 Fatal cases 1 5 5 9 3 — — — 1 — 4 29 Bay of death in fatal cases — — — 1 1 1 2 2 3 1 18 29 The parity of women who contracted puerperal fever was ascertained from the midwife to be:— Total Primipara. 2 para. 3 para. 4 para. 5 para. 6 para. 7 para. 8 para. 9 para. 10 para. Over 10 para. Recovery 77 19 15 7 8 5 8 7 5 2 — l Fatal 29 4 8 2 2 6 2 1 — 3 — l The following conditions were noted among the cases of puerperal fever attended by midwives:— Recovery. Fatal. Laceration of perineum 5 4 Retained or adherent placenta 4 1 Ante partum haemorrhage 1 — Post partum hæmorrhage 3 1 Prolonged labour 1 — Macerated infant 1 — Domestic trouble after confinement — 2 Phthisis 1 3 89 Report of the County Medical Officer—General. In three cases of puerperal fever, birth took place before the arrival of the midwife. Seventeen midwives each had two cases during the year: in five instances the interval between the cases was three months or more. 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 condition 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 46 cases. During the year 383 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, 2 other cases came to light in which medical help was not called by the midwife. The Council's inspectors investigated all the cases and endeavoured to watch the progress of the patients and learn the final result. 298 cases were reported to be completely cured. In 4 cases there was impairment of vision, 20 died while still suffering from the disease, and in 63 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, 23 cases; second day, 43; third day, 41; fourth day, 42; fifth day, 40; sixth day, 33; seventh day, 42; eighth day, 31; ninth day, 36; tenth day, 26; later than tenth day, 24; not ascertained, 4 cases. A history of vaginal discharge in the mother was obtained in 114 instances, i.e., in 29 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 137 instances; perchloride of mercury (1 in 4,000 or weaker) in 146; silver nitrate (a 1 or 2 per cent. solution) in 58; protargol in 12, and biniodide of mercury in 3 instances; in the remaining cases sterile water was used. An interval between the birth and the use of an antiseptic occurred in 82 instances owing to the fact that the infant was born before the arrival of the midwife. The following facts relating to the 5 cases in which impairment of vision supervened were learnt: (1) History of vaginal discharge in the mother during pregnancy. Boric lotion used for eyes at birth. Onset of symptoms and medical assistance on sixth day. Result: Infant reported blind in one eye. (2) No history of vaginal discharge in mother. Perchloride of mercury (1 in 8,000) used for eyes at birth. Onset of symptoms and medical assistance on sixth day. Result: Infant reported to be blind in one eye. (3) No history of vaginal discharge in mother. Perchloride of mercury (1 in 8,000) followed by a 2 per cent. solution of nitrate of silver within an hour. Onset of symptoms on fourth day. Medical aid obtained from private practitioner, specialist and at hospital as in-patient. Result: Blindness of both eyes. (4) History of vaginal discharge in mother. Boric lotion used for eyes a few minutes after birth (child born before the arrival of the midwife). Onset of symptoms on ninth day and medical aid obtained the next day. Out-patient at hospital. Result: Loss of sight in one eye. (5) History of vaginal discharge in mother. Perchloride of mercury (1 in 8,000) used at birth. Onset of symptoms and medical aid obtained on seventh day. Result: Loss of sight in one eye. These results summarised are as follows:— Blind in both eyes 2 cases. Blind in one eye, other uninjured 3 cases. 18820 M Ophthalmia Neonatorum 90 Annual Report of the London County Council, 1912. In 1 of the 6 cases where impairment of vision resulted, the onset of symptoms occurred on or before the fifth day of life. In three instances there was a history of vaginal discharge in the mother. The 385 cases of inflammation of the eyes occurred in the practices of 155 midwives. 1 midwife had 20 cases during the year 20 1 „ 12 „ „ 12 11 2 midwives each had 9 cases during the year 18 3 ,, ,,8 ,, ,, 24 4 „ „ 7„ „..... 28 6 ,, ,, 6 ,, ,, 36 2 ,, „ 5 ,, ,, 10 9 ,, „ 4 ,, ,, 36 15 ,, „ 3 „ ,, 45 34 ,, „ 2 „ ,, 68 77 „ „ 1 case „ „ 77 155 385 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. In March, 1911, the Council made an order extending the provisions of settion 55 of the Public Health (London) Act, 1891, to opthalmia neonatorum. Of the 1,373 cases notified from that time until the end of this year. 405 were in the practice of midwives. Classes for midwives. 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. Pemphigus Neonatorum. During the month of September, 1911, there occurred in the practice of a certified midwife a series of cases of skin disease characterised by superficial blebs and subsequent excoriation. Inquiry was made into the outbreak by Dr. Wanklyn, assistant medical officer, and Dr. Macrory, woman inspector under the Midwives Act, who reported jointly upon the matter. As stated in their report, which was issued by the Council, it would have been desirable to have ascertained whether similar cases were occurring at the same time and in the same neighbourhood, among infants not attended by this midwife, with a view to making the point clear as to whether or not cases were exclusively confined to her practice. The facts only came to light some days after their occurrence, and this lapse of time rendered it impossible for completely satisfactory control investigations to be made. Such inquiry as was possible was carried out. The evidence taken as a whole is certainly suggestive, but it cannot be held conclusively to demonstrate that the association of the midwife with the cases was the factor determining their occurrence. 91 Report of the County Medical Officer—General. CHAPTER XXXIIa. SPECIAL REPORTS SUBMITTED BY THE MEDICAL OFFICER OF HEALTH DURING THE YEAR 1912. I. Report by the Medical Officer Submitting the Result of a Census of Homeless Persons Taken on the Night of the 9th February, 1912. In accordance with the instruction of the Public Health Committee the seventh census of homeless persons in London was undertaken on the night of the 9th February, 1912. 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. 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 566 170 23 2,388 †11,629 18th February, 1910 732 220 17 2,747 †l,778 17th February, 1911 768 256 2 1,785 *†694 †65 9th February, 1912 758 213 12 1,203 †220 - ‡A smaller area than in later years. For purposes of comparison the total may be estimated at about 2,000 persons. †Men or women accommodated for a few hours in shelters but unprovided with beds. *160 of these men were in a shelter consuming soup and bread, but would be turned out immediately on the conclusion of their meal. 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 the particular night. The figures marked with a dagger relate to persons who, most probably, would have been in the streets had it not been for charitable effort. The 220 men coming within this category on the night of the 9th February, 1912, included 44 men at Work in the King's Tents belonging to the Church Army; 76 men and 58 men in two shelters used in conjunction with the Tents; and 42 men who were sitting up in the Salvation Army Shelter in Middlesex-street, City. It will be observed that the number marked with a dagger for 1912 is very much smaller than the numbers obtained in the years 1909, 1910 and 1911, and the decrease practically accounts for the reduction in the total number of homeless persons. The shelter accommodating 65 women in 1911 was closed in 1912. The people found actually in the streets included 758 men, 213 women, and 12 young persons about 16 years of age or less. For comparison with the figures obtained on previous occasions, therefore, the total number of homeless persons is 1,203. This is less by 582 than the total for 1911, and is the lowest recorded number. As mentioned in previous reports on this subject, the figures shown in the table do not include all persons who might be regarded as homeless. Several of the licensed common lodging houses in the county afford free accommodation, and there are some night refuges for the destitute not licensed by the Council. In the earlier years, in which enumeration was made, accurate figures for these institutions were not available, and for the sake of comparison it has been again necessary to omit them. It may be stated, however, that there were in licensed common lodging houses where no charge is made, 360 men, 41 women, and 15 children who occupied free beds, and 938 men who received a night's lodging in return for labour. In the shelters not licensed by the Council, there were 286 men, 225 Women, and 14 children. In addition, 166 tickets were given to persons entitling them to free beds in a common lodging-house on the night of the census. These tickets were given chiefly by the Church Army, the City Temple Mission, and the Willow-street Mission. The information given in this and the preceding paragraph is summarised in Table V. 18820 M 2 92 Annual Report of the London County Council, 1912. The following table compares the numbers of persons included as "homeless," found to be taking shelter on staircases and under arches on the particular nights on which enumeration was made in the several years. Details are also given as to the weather conditions obtaining on each of six occasions:— Weather conditions and number of persons found on staircases and under arches. Year. Weather conditions. Males. Females. Total. 1904 Cold at first followed by rain 100 68 168 1907 Fine and not very cold - - 50 1909 Heavy rain followed by strong, cold wind 49 39 88 1910 Fine and not very cold 10 20 30 1911 Fine and not very cold 12 53 65 1912 Rain early, afterwards fine and not cold 25 23 48 In previous reports it has been pointed out that in any comparison of figures relating to homeless persons some attention must be paid to the extent of occupation of common lodging-houses and casual wards, as there is a continual interchange among the inmates of these two classes of institutions and the homeless class. I therefore submit tables showing the use made of common lodging-house and casual ward accommodation on certain specified dates. For the figures relating to the casual wards I am indebted to Sir James Davy, K.C.B., of the Local Government Board. Licensed Common Lodging Houses. Date. Authorised accommodation. Number of persons occupying beds. Men. Women. Couples. Total. Men. Women. Couples. Total. 29th January, 1904 25,718 2,281 447 28,893 21,058 1,517 390 87 Children 23,442 17th February, 1905 25,671 2,450 422 28,965 21,055 1,578 357 34 Children 23,381 8th February, 1907 25,599 2,436½ 245 28,525 20,438 1,598 207 22,450 15th January, 1909 25,976 2,365 245 28,831 20,059 1,483 161 21,864 18th February, 1910 25,902 2,344 245 28,736 19,346 1,456 177 21,156 17th February, 1911 25,376 2,376 245 28,242 19,470 1,356 189 21,204 9th February, 1912 25,352 2,455 245 28,297 19,710 1,373 196 24 Children 21,499 Casual Wards. Date. Accommodation. Beds. How used. Persons. Men. Women. Women and children. Total. Men. Women. Children. Total. 29th January, 1904 1,243 410 114 1,767 1,034 175 9 1,218 17th February, 1905 1,263 420 120 1,803 926 210 3 1,139 8th February, 1907 — — — 1,882 — — — 1,137 15th January, 1909 1,241 444 122 1,807 1,001 184 3 1,188 18th February, 1910 1,219 454 119 1,792 928 173 6 1,107 17th February, 1911 1,220 452 123 1,795 962 129 — 1,091 9th February, 1912 1,233 456 125 1,814 900 132 1 1,033 The next table shows the common lodging-house and casual ward accommodation, the extent of its use, and the number of homeless persons in each year. Date. Accommodation (beds). Persons. C.L.H. Cas. wards. Total. C.L.H. (Inmates.) Cas. wards. (Inmates.) Homeless. Total.* 29th January, 1904 28,893 1,767 30,660 23,442 1,218 1,797 26,457 17th February, 1905 28,965 1,803 30,768 23,381 1,139 2,181 26,701 8th February, 1907 28,525 1,882 30,407 22,450 1,137 2,404 25,991 15th January, 1909 28,831 1,807 30,638 21,864 1,188 2,388 25,440 18th February, 1910 28,736 1,792 30,528 21,156 1,107 2,747 25,010 17th February, 1911 28,242 1,795 30,037 21,204 1,091 1,785 24,080 9th February, 1912 28,297 1,814 30,111 21,499 1,033 1,203 23,735 *These figures do not include the persons in the unlicensed homes and institutions referred to in Table No. IV. who might also be regarded as belonging to the common lodging house class. 93 Report of the County Medical Officer—General. In the last report on homeless persons attention was directed to the reduction in the numbers of the three classes of persons referred to in this last table. This reduction in numbers has been maintained in the present year, and, as will be observed, it is entirely due to the smaller number of homeless persons; whereas in the years antecedent to 1911, the diminution was due mainly to a falling off in the number of persons finding shelter in common lodging-houses and casual wards. In 1905 and later years the area covered in enumerating homeless persons was practically the same, and it is interesting to note that in comparing the totals for 1905 and 1912 in the above table there is a reduction of nearly 3,000 persons. If the figures for men only are compared for the two years, 1911 and 1912, it will be seen that in the latter year there was an increase in the number in common lodging-houses of 247 (240 single men and 7 men among the couples). In casual wards there was, however, a reduction of 62 men, which gives a nett increase for common lodging-houses and casual wards together of 185 men, and this in spite of the fact that the number of tickets for free beds in common lodging-houses distributed this year was 80 less than in 1911. In the number classified as homeless there is, on the other hand, a decrease of 484 men. The total diminution was therefore 299 men. It might be added that, on the same basis of calculation, there were 1878 men less in 1911 than in 1910. With regard to women the 1912 figures show in common lodging-houses 17 more single women, and 7 women among the couples, an increase on the 1911 figures of 24 women. In the casual wards there were 3 more women. The number of homeless women was less by 108, the nett result, therefore, being 81 women less than last year. Last year's figures showed a reduction of 31 women on the figures for 1910. Disregarding children there were 299 men and 81 women, or 380 adults less in 1912 than in 1911. Concerning children it is difficult to obtain precise information, inasmuch as the bylaws provide for two children being counted as one adult, and it is beyond question that in the figures supplied to the Council in past years children have been included in this way. Hence, no true comparison can be made from year to year as regards children. It should be mentioned, however, that few children are received in the ordinary common lodging-houses, and, of course, in such circumstances they are in the care of a parent, but Dr. Barnardo's Homes in Whitechapel and Kensington, licensed as common lodging-houses, both have beds for doubles, i.e., for mother and child, as is the case also in the casual wards. Even including the two homes just mentioned, it is probable that the total number of children received in London common lodging-houses would not exceed 50 a night, a small number when it is remembered that the London common lodging-house population nightly exceeds 20,000 persons. Special mention has been made in previous reports of the use made of free shelters by women. The conditions have not materially changed during the past year. Although the number of homeless women was less by 108 than in 1911, there is no corresponding increase in the use made of common lodging-houses, casual wards, and free shelters. Comparatively little use is made of the sleeping accommodation provided at Dr. Barnardo's Homes, and the Salvation Army Shelter in Hanbury-street shows a further decline in numbers. On the other hand, Providence-row Refuge, where only destitute women are received, continues to be filled every night, and the Field-lane Refuge has very few vacant beds. A feature of the enumerations of 1909 and 1910 was the system instituted by the Salvation Army of allowing homeless men to sit and rest for some hours in certain of their shelters after receiving a free meal of soup and bread. In 1910, as many as 1,428 men were provided for in this way by the Salvation Army alone, and 350 men took advantage of similar facilities offered by other charitable associations. During the winter of 1910-11 this system was considerably modified so far as the Salvation Army was concerned, and during the past winter there has been further restriction, only one shelter being used for this purpose, and in this there were only 42 men sitting up on the night of the 9th February last. The Church Army last year somewhat extended its scheme in connection with the King's Tents, but this year on the night of the census a much smaller number of men was being dealt with. The total number of men working or resting in shelters was 220 as against 1,778 in 1910, the difference in numbers almost exactly corresponding with the difference in the numbers of homeless persons for two years. Cheap and free food.—There is little alteration from year to year in the amount of cheap and free food distributed. The Euston-road Soup Kitchen, which is open from November to April, in 1910-11 supplied upwards of 214,000 meals, and on 9th February, 1912, supplied more than 1,300 meals, comparatively few of which were paid for by the applicants. On the same day the Willow-street Mission gave 935 free meals to men, and 20 to women. From a barrow on the Embankment provided by Mr. Eustace Miles, some 600 persons are supplied each day in three batches, bread and cocoa being distributed at 7 a.m., soup and bread at noon and at 6 p.m. At Medland Hall free food is provided nightly, and between 6 p.m. and 4 a.m. on the 9th-10th February more than 400 men in addition to the 340 inmates of the shelter were supplied with 8 ounces of bread and margarine. The Field-lane Refuge feeds about 100 families each day, and every Sunday about 400 men are supplied with bread and cocoa. The Ham-yard Hospice supplies individuals and families with cheap or free food all the year round; during the month of January 7, 367 meals were provided in this way, mainly to families. There is said to be some reduction in the number of individuals applying for food, but an increase in the number of families. Daily Graphic coupons are available at Salvation Army and other institutions throughout London, and some thousands are given away every week. At an institution in Settles-street, Stepney, men are able to wash, shave, and wash their clothes, and about 70 or 80 men use the house daily. They are also supplied with a meal once a week. Another institution in Stepney on the 9th February provided 196 men with tea and a scone, and during the week ended the 10th February, 468 men were supplied at this institution in this way. 94 Annual Report of the London County Council, 1912. I append the following tables summarising the information obtained on the night of the 9th February, 1912 :— Table I. shows the number of homeless persons found in streets and on staircases, and the distribution in sanitary areas. Table II. shows the authorised accommodation in common lodging-houses, the number of beds occupied, and the number of beds vacant in the City of London and in each metropolitan borough. Table III. shows the free accommodation in shelters provided by philanthropic bodies, and licensed by the Council, but does not include the beds in ordinary common lodging houses occupied by persons, on the night of the census, whose accommodation was paid for by charitable organisations. Table IV. shows the accommodation in shelters not licensed as common lodging houses. Table V• summarises the information contained in the second and third paragraphs of the report, and shows the total number of persons who might be regarded as homeless on the ground of being unable to pay for a bed, but does not include persons permanently provided for in public institutions. (Signed) W. H. Hamer, Medical Officer of Health. 9th February, 1912. TABLE I. dumber of Homeless Persons found in the streets and on staircases distributed according to Sanitary Areas. Sanitary area. Men. Women. Young persons. Bermondsey 20 - Bethnal Green 15 — - Camberwell 6 — - City of London 140 8 - Deptford 1 — - Finsbury 13 1 2 boys Fulham t3 3 — Hammersmith 22 9 — Holborn 24 2 l youth Islington 71 53 3 youths 1 girl Kensington 26 9 Lambeth 17 2 3 youths Paddington 3 1 — St. Pancras 24 19 — Shoreditch 15 2 — Southwark 38 19 2 boys Stepney 122 28 — Wandsworth 7 — — Westminster 187 57 — Totals 754 213 7 youths 4 boys 1 girl Report of the County Medical Officer—General. 95 TABLE II. Common Lodging Houses. Sanitary District, No. of Houses. Accommodation. Census on 9th-10th February, 1912. No. of vacant beds on 9th-10th February, 1912. Men. Women. Couples. Men. Women. Couples. Men. Women. Couples. Battersea 9 157 144 23 109 38 4 48 106 19 Bermondsey 5 1,297 — — 1,179 — — 118 Bethnal Green 13 674 — — 500 — — 174 Camber well 5 549 — — 424 — — 125 Chelsea 5 212 — — 140 — — 72 - City of London* 1 453 — — 441 — — 12 Deptford 8 1,155 80 — 692 13 — 463 67 - Finsbury 8 535 — — 426 — — 109 —. - Fulham 2 43 51 — 40 43 — 3 8 Greenwich 3 121 — — 94 — — 27 Hackney 7 495 — — 356 — — 139 — - Hammersmith 9 466 — 4 337 — 2 129 — 2 Hampstead — — — — — — — — — — Holborn 25 1,512 162 — 1,305 92 — 207 70 — Islington 42 1,171 275 18 820 154 8 351 121 10 Kensington 22 398 272 — 294 124 ll Chldn. 104 148 — Lambeth 7 693 — — 590 — — 103 Lewisham 1 30 — — 18 — — 12 — Paddington 7 195 40 — 133 20 — 52 20 — Poplar 9 1,143 — — 623 — — 520 — - St. Marylebone 14 1,189 109 — 960 91 — 229 18 — St. Pancras 7 610 36 — 510 23 — 100 13 Shoreditch 12 764 — — 626 — — 138 — — Southwark 42 3,173 449 — 2,401 253 — 772 196 Stepney 53 5,367 694 180 4,213 437 171 13 Chldn 1,154 257 9 Stoke Newington 1 37 — — 37 -- - - - - Wandsworth 10 185 - 20 159 3 11 26 2½ 9 Westminster, City of 13 2,248 62 — 1,863 44 - 385 18 Woolwich 23 480 76 — 410 38 — 70 38 — Totals 363 25,352 2,455J 245 19,710 1,373 196 24 Chldn. 5,642 1,0824 49 *For tho figures relating to the City of London, I am indebted to Dr. W. H. Collingridge, medical officer of health of the city. Note.—In addition to the figures given above, there were in Rowton Houses on the same night, 4,837 men and 247 vacant beds, or 208 fewer vacant beds than in 1911. TABLE III. Number of permanently Free Beds in premises licensed as Common Lodging Houses on the night of 9th February, 1912. In other licensed Common Lodging Houses from 150 to 200 beds occupied on that night Were paid for by charitable institutions, chiefly by the Church Army, the City Temple Mission, and the Willow-street Mission. Premises. Free beds. For labour. Men. Women. Children. Men. Bermondsey. Salvation Army, Spa-road - 543 Bethnal Green. Church Army Labour Home, Warner-place — — - 58 Finsbury. Church Army Labour Home, Banner-street — — - 124 Kensington. Barnardo's Home, St. John's-place — 9 11 — Stepney. Medland Hall 28, Betts-street Barnardo's Home, Commercial-street Salvation Army, Quaker-street 340 4 28 4 213 Westminster. Ham-yard Hospice, Great Windmill-street 20 — — — 360 41 15 938 Unoccupied on night of census 3 77 — 40 96 Annual Report of the London County Council, 1912. TABLE IV. Number of persons in Shelters, etc., not licensed as Common Lodging Houses. Sanitary district. Free beds. For labour. Men. Women. Children. Men. Bermondsey. (1) — 21 — — Holborn. (1) 34 22 — — (2) — 13 — — St. Marylebone. (1) — 6 — — Southwarlc. (1) — — — 155 Stepney. (1) 19 — — — (2) 130 112 14 — 183 174 14 155 There were on the same night in the Labour Homos and Homesfor Women of the Church Army 103 men and 225 women. TABLE V. A Table summarising the information contained in the second and third paragraphs of this report, and showing the total number of persons who might be 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 42 - - 42 Number of men in the King's Tents 44 - - 44 Number in shelters in connection with the King's Tents 134 — - 134 Persons found homeless in the streets 758 213 12 983 In licensed common lodging houses where no charge is made 1,298 41 15 1,354 In unlicensed houses where no charge is made 286 399 14 699 Beds in licensed common lodging houses paid for by charitable institutions 141 25 - 166 Persons in casual wards 900 132 1 1,033 Total number of persons found homeless, or resting in shelters, or occupying free beds in common lodging houses, shelters and casual wards 3,603 810 42 4,455 Report of the County Medical Officer—General. 97 II. Report by Medical Officer on the Sanitary Staffs of the Corporation of the City of London and of the Metropolitan Borough Councils. I present herewith a return of the sanitary officers in London showing the information available at the present time. Previous returns have been published in the several years from 1893 to 1910, and the numbers of sanitary officers obtained on each occasion are compared in the following table:— Year. Inspectors. Whole time health visitors. Year. Inspectors. Whole time health visitors. Men. Women. Men. Women. 1893 188 — — 1904 285 28 1894 219 — — 1906 281 38 1895 227 1 — 1908 279 40 — 1898 250 6 — 1910 286 41 12 1901 264 11 — 1912 290 41 16 1903 281 20 — It will be seen that the number of men inspectors is greater by four than in 1910, and whilst the number of women inspectors has remained stationary, the number of whole time health visitors has increased by four. The difference in the number of men inspectors is due to new appointments made in Deptford, Hampstead, Southwark, and the City of London. In no district has there been any reduction in the number of men inspectors since the date of the last return. With regard to women, an additional inspector has been appointed at Greenwich, but Battersea has reduced its staff by one. Four additional health visitors have been appointed, one each in Bermondsey, Hackney, Poplar and Westminster. I may add that the Deptford Borough Council has under consideration the appointment of a woman inspector and an additional health visitor. There are now only five sanitary districts in London without one or more women inspectors, and in one of these districts there are two whole time health visitors, whilst the remaining four districts have one health visitor each. In recent reports figures have been given comparing statistics of overcrowding taken from the report on the 1901 census. The complete census returns for 1911 are not yet available, and the figures relating to overcrowding have therefore been omitted from the present report on sanitary officers. The following table, however, gives particulars of the population, and number of separate occupiers in each London sanitary district, quoted from the Preliminary Report on the Twelfth Census of the population of England and Wales taken on the 3rd April, 1911. The average population for each sanitary inspector in London boroughs is also given; although, it should be pointed out that, it is not possible, without knowledge of the character of the population in each borough, to draw any conclusion as to the sufficiency of the sanitary staffs. District. Enumerated population 1911 (preliminary census). Families or separate occupiers, 1911. No. of Sanitary Officers. Population to each Sanitary Inspector. Houses let in lodgings on the register. Inspectors. Whole time health visitors. 1910. 1912. M. W. M. W. W. Battersea 167,793 39,645 11 †2 11 †l 1 13,983 123 Bermondsey 125,960 28,050 11 - 11 — 2 11,451 224 Bethnal Green 128,282 27,811 9 †1 9 †1 — 12,828 536 Camberwell 261,357 58,725 12 1 12 1 — 20,104 254 Chelsea 66,404 15,952 3 1 3 1 — 16,601 583 Deptford 109,498 25,050 7 — 8 — 1 13,687 273 Finsbury 87,976 21,278 8 †1 8 †1 2 9,775 1,233 Fulham 153,325 36,481 7 1 7 1 - 19,166 114 Greenwich 95,977 21,503 5 — 5 1 — 15,996 215 Hackney 222,587 50,654 15 2 15 2 1 13,093 463 Hammersmith 121,603 28,474 9 — 9 — 1 13,511 2,432 Hampstead 85,510 18,674 6 *2 7 *2 — 9,501 364 Holborn 49,336 11,097 3 1 3 1 — 12,334 641 Islington 327,423 80,025 20 2 20 2 — 14,883 No register Kensington 172,402 38,433 11 2 11 2 2 13,262 2,091 Lambeth 298,126 70,891 13 2 13 2 1 19,875 372 Lewisham 160,843 37,047 8 2 8 2 — 16,084 15 Paddington 142,576 33,962 9 2 9 2 — 12,961 1,326 Poplar 162,449 35,179 8 1 8 1 2 18,050 1,124 St. Marylebone 118,221 28,554 11 †3 11 §3 — 8,444 485 St. Pancras 218,453 53,092 15 2 15 2 — 12,850 2,282 Shoreditch 111,463 24,807 6 — 6 — 1 18,577 263 Southwark 191,951 44,580 12 3 13 3 — 11,997 1,265 Stepney 280,024 57,082 18 — 18 — 1 15,557 2,881 Stoke Newington 50,683 12,165 2 †1 2 †1 — 16,894 263 Wandsworth 311,402 70,236 11 *2 11 *2 — 23,954 275 Westminster 160,277 36,137 10 2 10 2 1 13,356 1,436 Woolwich 121,403 26,549 8 †2 8 †2 — 12,140 395 City of London 19,657 4,013 18 3 19 3 — 893 286 4,522,961 1,036,146 286 41 290 41 16 13,665 — † One inspector appointed also as health visitor under the L.C.C. (General Powers), Act, 1908. section 6. * Two inspectors appointed also as health visitors. § Three inspectors appointed also as health visitors. 18820 98 Annual Report of the London County Council, 1912. DETAILS AS TO THE SANITARY STAFF IN THE SEVERAL SANITARY DISTRICT! OF LONDON, APRIL, 1912. Battersea.—Population, 1911—'167,793. A medical officer of health (whole time appointment), £600 per annum. Eleven men inspectors ; one woman inspeotor, who is appointed also as health visitor; one health visitor. 1 chief inspector £325 per annum. 1 food inspector £200 „ 1 inspector £190 „ 7 inspectors £18Q „ 1 insDector £150 ,, 1 woman inspector 195 per annum, (receives also as health visitor £30 per annum) 1 health visitor £120„ The district inspectors receive, in addition,10£ per annum tor new drainage worK. Assistants.—(a) 9 disinfecting assistants; (6) 5 drain-testing assistants; (c) 1 mortuary keeper and 1 temporary assistant. Clerical staff.—Six clerks are engaged upon duties arising out of the work of the department. Duties of inspectors.—The chief inspector supervises the work of the sanitary inspectors, inspects in all cases of importance and where statutory proceedings are about to be taken, and is specially concerned with combined drainage Eight have each an assigned district, in which they are concerned with duties under the Public Health and other Acts. They supervise drainage of new buildings, for which they receive an additional £10 yearly. The food inspector takes samples under the Food and Drugs Acts, and inspects slaughterhouses, butchers' shops, sausage factories, ham and beef shops, etc. One inspects factories, workshops and workplaces. The woman inspector is concerned with duties under Public Health Act, investigates deaths of infants under one year, visits children fed from the Council's milk depot, and gives instructions to mothers in the feeding and care of infants. The health visitor is concerned with duties under the Notification of Births Act and the Public Health (Tuberculosis) Regulations. Bermondsey.—Population, 1911—125,960. A medical officer of health (whole time appointment), £600 per annum. Eleven men inspectors; two health visitors. 1 food inspector £135 per annum, (also receives £135 per annum as assistant under unsound food regulations) 1 food inspector £175 „ (also receives £25 per annum as assistant under unsound food regulations) 1 food inspector £200 per annum. 3 inspectors £180 „ 2 inspectors £165 „ 3 inspectors £150 „ 1 health visitor £110 „ 1 health visitor £105 „ Assistants.—(a) 6 disinfecting assistants ; (b) 1 mortuary keeper ; (c) 1 shelter caretaker (female). Clerical staff.—Four clerks and one office youth are engaged in the work of the department. Duties of inspectors.—Eight inspectors have each an assigned district, in which they carry out all the duties arising under the Publio Health Act and Factory and Workshop Acts. The inspectors also supervise drainage work reconstruction. One special inspector devotes his whole time to the inspection of food landed at wharves and riverside premises, acting under the Publio Health Act, the Unsound Food, and Foreign Meat Regulations. The two food inspectors act under the Sale of Food and Drugs Acts, each having an assigned district extending over half the borough. One of these inspectors acts as deputy inspector to the special wharves inspector, and also devotes a small part of his time to the examination of food under the Unsound Food Regulations. The health visitors have duties under the Notification of Births Aot, visit houses after notification of pulmonary tuberculosis, and inquire into deaths of infants. Bethnal Green.—Population, 1911—128,282, A medical officer of health (part time appointment), £400 per annum. Nine men inspectors; one woman inspector. 1 chief inspector £325 per annum, (also receives £75 per annum for other duties) 8 inspectors £200 „ 1 woman inspector £114 per annum. (also receives £6 per annum as health visitor) Assistants.—(a) One general assistant; (b) one leading disinfector ; and three disinfectors ; (c) one mortuary keeper. Clerical staff.—There are six clerks. Duties of inspectors.—The chief inspector, in conjunction with the medical officer of health, is responsible for the operations of the entire sanitary staff. Six have each an allotted district, in which they are concerned with duties arising under the Public Health Act, including the inspection of registered tenement houses. One is concerned with work under the Food and Drugs Acts, the inspection of meat, etc. One makes special visits and inquiries over the whole of the borough. The woman inspector investigates cases of diarrhoea, and other diseases of young children, reports on the sanitary condition of the premises, and visits houses where births have occurred. Camberwell.—Population, 1911—261,357. A medical officer of health (whole time appointment), £800 per annum. Tu-pK-r mpn insneetors ; r»ne woman insnector. 1 food inspector £250 per annum. 7 inspectors £200 „ 1 inspector £190 „ 1 woman inspector £150 „ 1 inspector £167 per annum. 1 inspector £137 „ 1 inspector £127 „ Assistants.—(a) 1 superintendent and 7 disinfecting assistants; (b) 1 mortuary keeper. Clerical staff.—There are five clerks in addition to the chief clerk, who was formerly a sanitary inspector. Duties of inspectors.—The inspector who carries out work under the Food and Drugs Acts is emergency inspector under all Acts of Parliament relating to public health, and is also concerned with smoke nuisances. Eleven have each an allotted district in which they carry out duties arising under the Public Health and Factory and Workshop Acts and on occasions under the Food and Drugs Acts. The woman inspector is chiefly concerned with laundries, factories and workshops employing female labour. Report of the County Medical Officer—General. 99 Chelsea.—Population, 1911—66,404. A medical officer of health (part time appointment), £525 per annum. Three men inspectors; one woman inspector. 1 chief inspector £265 per annum. 1 inspector £180 „ 1 inspector £130 per annum. 1 woman inspector £120 „ Assistants.—(a) Mortuary keeper, who assists disinfectors when required ; (0) 22 disinfecting and drain-testing assistants. Clerical staff.—No clerical assistance is provided. Duties of inspectors.—The chief inspector carries out duties connected with infectious disease and complaints,and obtains samples under the Food and Drugs Acts. Two have an allotted district, in which each is concerned with house-to-house inpsection, and inspection under the Factory and Workshop Acts. They also arrange for the disinfection of clothing and bedding by the disinfecting assistants. The woman inspector is concerned with inspection of workshops and outworkers' homes where female labour is employed. She also makes special investigations, visits mothers of newly-born infants, and inquires into notified cases of tuberculosis. Deptford.—Population, 1911—109,498. A medical officer of health (whole time appointment) £500, rising to £600 per annum. Eight men inspectors ; one health visitor. 6 inspectors £200 per annum. 1 inspector £140 „ Assistants.—(a) 3 disinfecting assistants. Clerical staff.—There is one clerk. 1 inspeotor £125 per annum. 1 health visitor £110 „ Duties of inspectors.—Seven have each an assigned district in which they perform the general duties of a sanitary inspector. One is charged with the duties under the Dairies and Milkshops Order, Factory and Workshop Act, Canal Boats Acts, and with the administration of the regulations as to slaughterhouses, knackers' yards, offensive businesses, throughout the borough. All inspectors are qualified to act under the Food and Drugs Acts. One health visitor. Finsbury.—Population, 1911—87,976. A medical officer of health (whole time appointment), £600 per annum. Eieht men inspectors : one woman inspector: two health visitors. 1 chief inspector £250 per annum. 1 meat inspector £300 „ 5 inspectors £180 „ 1 inspector £140 „ 1 woman inspector £140 per annum. (also receives £10 per annum for health visiting). 2 health visitors £110 „ Assistants.—(a) 1 disinlectors ; (0) 22 keepers of the mortuaries and coroners courts. One of these assists in disinfecting rooms. The other works the steam disinfector, and his wife attends to those who are temporarily housed in the Council's shelter ; (c) 1 van driver, who upon occasions assists with disinfection. Clerical staff.—One chief clerk and two junior clerks. Duties of inspecter.—The chief inspector supervises generally. Five have each an allotted district in which they carry out duties imposed by the Metropolis Management, Public Health and Food and Drugs Acts, and supervise sanitary and drainage works in old buildings. They also supervise houses let in lodgings and are concerned with smoke nuisances. They take it in turns to inspect the market streets and hawkers' barrows on Saturday evening and Sunday morning throughout the year. One of these inspectors has charge of the canal boat inspection on the Regent's canal, which traverses his district. One is specially concerned with factory and workshop inspection. One is a special meat and market inspector and exercises close supervision over the wholesale dealers in Cow Cross-street, Charterhouse-street and St. John-street, just outside Smithfield. The woman sanitary inspector is specially deputed to visit and inspect homeworkers' premises, workshops where females are employed, kitchen restaurants, houses where oases of measles occur, and to revisit cases of phthisis. She also arranges for the subsequent disinfection. The two health visitors visit houses where births have recently occurred,and advise mothers as to clothing and feeding their children. They make enquiries into the deaths of infants, and hold infant weighing days at three centres in the borough every week. Fulham.—Population, 1911—153,325. A medical officer of health (whole time appointment), £750 per annum. Seven men inspectors : one woman inspector. 1 food inpsector £200 per annum. 3 inspectors £180 „ 1 inspector £145 „ 1 inspector £140 „ 1 inspector £105 per annum. (also reoeives £40 for new drainage work). 1 woman inspector £120 „ Assistants.—(a) 4 disinfectors ana 1 driver ; (b) 1 mortuary keeper. Clerical staff.—Two clerks are employed. Duties of inspectors.—Five have each an assigned district, in which they perform all duties arising under the Public Health Act and Factory and Workshop Act. One is employed on duties arising under the Food and Drugs Act and in the inspection of places where food is sold or stored. The inspector employed in the supervision of drains of new houses does other special work. The woman inspector is chiefly engaged in the inspection of workshops, etc., where women are employed, but also visits after notification of births and inquires into cases of phthisis among women. Greenwich.—Population, 1911—95,977. A medical offioer of health (whole time appointment), £700 per annum. Five men inspectors ; one woman inspector. 1 inspector £225 per annum. 3 inspectors £200 „ Assistants.—(a) 3 disinfecting assistants. 18820 1 inspector £150 per annum. 1 woman inspector £110 N 2 100 Annual Report of the London County Council, 1912. Clerical staff.—There are three clerks. Duties of inspectors.—One is concerned with infectious disease. Four have each an allotted district in which they are concerned with duties under the Public Health and Factory and Workshop Acts. The woman inspector in engaged chiefly in the inspection of houses let in lodgings, and places where women are employed. Hackney.—Population, 1911—222,587. A medical officer of health (whole time appointment), £700 per annum. Fifteen men insDectors : two women inspectors : one health visitor. 11 inspectors £200 per annum. 1 inspector £174 „ (also receives £26 per annum for duties under Canal Boats Act). 1 inspector £190 „ 1 inspector £180 per annum. 1 inspector £170 „ 1 woman inspector £200 „ 1 woman inspector £150 „ 1 health visitor £110 „ Assistants.—(a) I dust inspector ana 1 assistant; (b) a assistants tor disinfecting ; (c) I mortuary keeper, l caretaker and wife, for disinfecting station and temporary shelter; (d) 1 drain-testing assistant, 1 smoke nuisance assistant. Clerical staff.—There are four clerks and one messenger. Duties of inspectors.—Twelve have each an assigned district, in which they carry out duties arising under the Public Health, Factory and Workshop and Food Adulteration Acts. One of these inspectors performs duties under the Canal Boats Act (for which he gets £26 a year, no part of which is repayable by the London County Council). One is concerned with dairies, cowsheds, milkshope, slaughterhouses and knackers' yards and is also food inspeotor. Two are engaged upon house-to-house inspection. The inspectors supervise re-construction and alterations of drains, but not in new premises. One woman inspector visits workshops, laundries, etc., where female labour is employed. One woman inspector visits the houses of outworkers. One health visitor. Hammersmith.—Population, 1911—121,603. A medical officer of health (part time appointment), £550 per annum. Nine men inspectors ; one health visitor. 8 inspectors £180 per annum. 1 inspector ' £127J „ 1 health visitor £100 per annum. Assistants.—(a) 2 assistants lor disinfection ; (6) I mortuary keeper; (c) 1 drainage inspector. Clerical staff.—There are three clerks. Duties of inspectors.—Four inspectors have each an assigned district in which they carry out all duties under the Public Health (London) Act. One inspects under the Housing and Town Planning Act, and makes a systematic house-to-house inspection throughout the borough. One inspects houses let in lodgings. One inspects slaughterhouses, ice cream merchants, houses let in lodgings, and deals with smoke nuisances. One carries out duties under the Food and Drugs Acts and inspects dairies. One visits factories and workshops. One health visitor. Hampstead.—Population, 1911—85,510. A medical officer of health (whole time appointment), £700 per annum. Seven men inspectors : two women inspectors, who are also appointed as health visitors. 1 senior inspector £300 per annum. 2 inspectors £200 „ 1 inspector £185 „ 1 inspector £165 „ 1 inspector £160 „ 1 inspector £150 per annum. 1 woman inspector £150 „ (also receives £10 per annum for health visiting) 1 woman inspector £70 „ (also receives £30 per annum for health visiting) Assistants.—(a) 3 disinfecting assistants ; (b) 3 drain-testing assistants, one of whom acts as mortuary keeper. Clerical staff.—There are three clerks and one clerk draughtsman. Duties of inspectors.—The senior inspector supervises generally and makes special inspections and investigations. Four have each an allotted district, in which they are concerned with duties arising under the Public Health Act. One carries out the inspection of slaughterhouses, dairies, factories, workshops and workplaces. He also takes all samples under the Food and Drugs Act. One makes inspections under the Housing and Town Planning Act, and visits houses let in lodgings. Two women inspectors visit premises where females are employed and tenement houses. They also inquire into cases of infectious disease. Both work as health visitors, give special attention to the prevention of infant mortality, and visit notified cases of phthisis. Holborn.—Population, 1911—49,336. A medical officer of health (whole time appointment), £800 per annum. Three men inspectors ; one woman inspector. 1 inspector £175 per annum. 2 inspectors £195 „ (including an allowance of £25 1 woman inspector £150 per annum. per annum for residing in district). Assistants.—(a) 2 disinfecting assistants ; (6) 1 mortuary keeper. Clerical staff.—There are three clerks. Duties of inspectors.—Three have each an allotted district, in which they are concerned with duties arising under the Public Health, Factory and Workshop, and Food and Drugs Acts. The woman inspector is engaged under the direction of the medical officer on special inspections of such premises as factories, workshops, and restaurants where females are employed, outworkers' homes, and visits in connection with the prevention of consumption, the non-notifiable infectious diseases, and infant mortality! She also carries out duties under the Sale of Food and Drugs Acts. Report of the County Medical Officer—General. 101 Islington.—Population, 1911—327,423. A medical officer of health (whole time appointment), £800 per annum. Twenty men inspectors ; two women inspectors. 1 chief inspector £300 per annum. 1 meat inspector £250 „ 16 inspectors £184 „ 1 inspector £160 „ 1 inspector £154 per annum. 1 woman inspector £150 „ 1 woman inspector £110 „ Assistants.—Two permanent and two temporary ctisinlectors. Clerical staff.—There are eight clerks. Duties of inspectors.-—The chief inspector supervises work of staff and visits premises when it is necessary to serve a statutory notice. Fourteen have each an allotted district in which they are concerned with duties arising under the Public Health Act (except as regards houses let in lodgings and workshops), and also inspect milkshops and dairies and visit icecream factories One inspects workshops, workplaces and bakehouses. Two inspect houses let in lodgings. One carries out duties under the Food and Drugs Acts. One inspects meat, food, cowsheds and offensive trade premises. Two women inspectors visit workshops and out-workers' homes where females are employed, and restaurant kitchens. Kensington.—Population, 1911—172,402. A medical officer of health (whole time appointment), £650 per annum. Eleven men inspectors : two women inspectors : two health visitors. 1 chief inspector £300 per annum. 10 inspectors £200 „ 2 women inspectors £150 per annum. 2 health visitors £120 „ Assistants.—(a) an inquiry officer for cases of infectious diseases, who is also overseer of the disinfection of houses and infected articles, and 3 disinfectors, including one man who acts as engineer; (6) a mortuary keeper ; (c) a sanitary labourer to assist in testing drains. Clerical staff.—There are five clerks. Duties of inspectors.—The chief inspector exercises supervision. Ten have each an allotted district, in which they are concerned with all duties arising under the Public Health (London) Act, the Factory and Workshops Acts, and the Housing of the Working Classes Acts. They also obtain samples under the Food and Drugs Acts. Two act at one time for three months and then are exempt from this duty for 12 months. No inspector collects samples for analysis in his own district. The two women inspectors are engaged mainly in the inspection of workshops, workplaces, laundries, etc., where females are employed, but also make inquiries into cases of pulmonary consumption, measles and whooping cough. The two health visitors act in connection with the Notification of Births Act for the prevention of infant mortality. Lambeth.—Population, 1911—298,126. A medical officer of health (whole time appointment), £900 per annum. Thirteen men inspectors; two women inspectors; one health visitor. 1 food inspector £205 4s. per annum. 11 inspectors £184 lis. „ 1 inspector £153 18s. „ 1 woman inspector £153 18s. per annum. 1 woman inspector £133 5s. „ 1 health visitor £107 12s. „ Assistants.—(a) 1 superintending and 10 disinfecting assistants; (6) 2 mortuary keepers and a deputy ; (c) 1 woman, temporary caretaker of shelter; (d) 1 manageress of milk depot. Clerical staff.—Four men clerks and one boy clerk. Duties of inspectors.—Twelve have each an allotted district, in which they are concerned with all duties arising under the Public Health, Factory and Workshops Acts, and the Housing and Town Planning Act. The district inspectors supervise the execution of drainage works in both new and old houses. One inspector deals with smoke nuisances, and carries out duties under the Food and Drugs Acts, assisted by a deputy. The two women inspectors carry out duties under the Factory and Workshop Act, inspect underground conveniences, and perform duties of a general character (inquiries into tuberculosis, etc.). The health visitor carries out duties under the Notification of Births Act for the prevention of infant mortality, visits babies fed on milk from the municipal depot, and inquires into tuberculosis, ophthalmia, etc. Lewisham.—Population, 1911—160,843. A medical officer of health (whole time appointment), £700 per annum. Eight men inspectors : two women inspectors. 6 inspectors £200 per annum. 1 inspector £170 „ 1 inspector £150 „ 1 woman inspector £120 per annum. 1 woman inspector £115 „ Assistants.—-(a) 7 disinfecting assistants ; (b) 2 drain-testing assistants. Clerical staff.—There are three clerks. Duties of inspectors.—Six have each an assigned district in which they carry out general sanitary duties. One is engaged on duties arising under the Factory and Workshop Act, smoke nuisances and special inspections. One is engaged in house-to-house inspection. Two women inspectors visit laundries, work places, etc., where females are employed, and make special investiga,s into cases of infectious disease, infant mortality, etc. Paddington.—Population, 1911—142,576. A medical officer of health (whole time appointment), £800 per annum. Nine men inspectors ; two women inspectors. 2 inspectors £250 per annum. 1 food inspector £240 „ 2 inspectors £200 per annum. 2 women inspectors £160 „ Assistants.—(a) 1 mortuary keeper ; (6) 3 navvies employed for opening defective drains,etc. ; (c) 1 disinfecting assistant. 102 Annual Report of the London County Council, 1912. Clerical staff.—There are five clerks. Dalies of inspectors.—Five each supervise a district, performing all duties under the Public Health (London) Act; they take charge of drainage works in existing buildings, and attend to notified cases of infectious disease, but one also carries out duties under the Canal Boats Act, for which a separate salary is assigned. (N.B.—Drainage works in new buildings are under the direction of the surveyor). One has supervision of workshops and work-places and is concerned with the enforcement of the Factory and Workshop Acts. Two attend to houses let in lodgings and the enforcement of by-laws under section 94 of the Public Health (London) Act, 1891. One has to watch food supplies, and inspect slaughterhouses, cowsheds, dairies, refreshment houses, etc. Icecream inspection is also carried out by him, and he is inspector under the Sale of Food and Drugs Acts. The two women inspectors visit all workplaces where women are employed and make enquiries into infectious diseases not scheduled for notification. They also do health visiting. Poplar.—Population, 1911—162,449. A medical officer of health (whole time appointment), £700 per annum. Eight men inspectors ; one woman inspector ; two health visitors. 4 inspectors £195 per annum. 3 inspectors £194 „ (also receive £1 per annum each under unsound food regulations) 1 inspector £190 per annum. 1 woman inspector £185 „ 1 health visitor £160 „ 1 health visitor £100 „ Assistants.—(a) 1 chief and 4 disinfecting assistants ; (b) 5 labourers who assist inspectors ; (c) 1 female attendant at the Yeo-street shelter and cleansing station, and a non-resident attendant. Clerical staff.—There are five clerks, one of them a certified sanitary inspector, London. Duties of inspectors.—Seven have each an assigned district in which they carry out duties under the Public Health Metropolis Management, Factory and Workshop, Food and Drugs, Canal Boats, Housing and Town Planning Acts, and the Public Health (Tuberculosis) Regulations. Three of these inspectors act also as assistant officers under the Unsound Food Regulations. One visits houses let in lodgings. The woman inspector visits all places where female labour is employed and sanitary offices of schools for girls. She also makes enquiries under London County Council General Powers Act as to verminous clothing. The health visitor is also the Organising Secretary of the Poplar Health Visiting Association, comprising some 60 voluntary workers. St. Marylebone.—Population, 1911—118,221. A medical officer of health (whole time appointment), £750 per annum. Eleven men inspectors (inoluding one temporary inspector); three women inspectors, who also do health visiting. 1 inspector £183£ per annum 1 inspector £130 „ 2 inspectors £180 „ 2 inspectors £124 „ 1 inspector £163J „ 3 inspectors £160 „ 1 temporary inspector £110V „ 1 woman inspector £157 „ 1 woman inspector £127 » 1 woman inspector £65 „ (also receives £6½ per annum for new drainage work). (also receives £60 per annum as superintendent of the mortuary and the sanitary conveniences). (also receive £56 per annum for new drainage work). (also receives £6½ per annum for new drainage work). (also receives £13 per annum for health visiting). (also receives £13 per annum for health visiting). (also receives £65 per annum for health visiting). Assistants.—(a) uisintecung assistants ; (D) 1 mortuary keeper; (c) I woman caretaker of shelter ; (d) I Dath attendant; (e) 1 woman attendant (part time); (/) 1 messenger. Clerical staff.—One chief and two assistant clerks. Two office boys. Duties of inspectors.—Five inspectors have each an allotted district in which they carry out all the duties arising under the Public Health and cognate Acts. Two inspectors supervise all drainage work, whether reconstructive or new work, but in addition do some work of a general character. One food inspector takes samples under the Sale of Food and Drugs Acts. One makes house-to-house inspections and visits houses let in lodgings. One supervises the sanitary conveniences, the public mortuary, the work of disinfection, etc. The temporary inspector acts as dust inspector. Three women inspectors carry out duties under the Factory and Workshop Acts, the Cleansing of Persons Act, the Notification of Births Act, inspect schools and inquire into infant mortality and cases of phthisis. All of them do health visiting. St. Pancras.—Population, 1911—218,453. A medical officer of health (whole time appointment), £900 per annum. Fifteen men inspectors; two women inspectors. 3 inspectors £225 per annum. 10 inspectors £200 „ 1 inspector £190 „ 1 inspector £140 „ 1 woman inspector £150 per annum. 1 woman inspector £110 „ (also receives £35 per annum for health visiting). Assistants.—(a) 1 foreman and 3 disinfecting assistants ; (b) I caretaker of the mortuary and coroners court, and 1 contact shelter attendant and attendant at the cleansing station and children's baths. Clerical staff.—One chief and seven assistant clerks. Duties of inspectors.—Thirteen inspectors have each an assigned district in which they deal with infectious diseases, complaints, drainage and nuisances generally. One of these inspectors also carries out duties under the Food and Drugs Aot3 and the by-laws regulating slaughterhouses and dairies and the periodical inspection of food in his own district. Two inspectors carry out entirely the duties under the Food and Drugs Acts and the by-laws regulating slaughterhouses and dairies. They also periodically inspect food places. One of these inspectors carries out duties under the Canal Boats Act'. Two women inspectors divide between them the inspection of factories, workshops and workplaces where women are employed. They visit houses where births have occurred, homes of verminous children, and notified cases of phthisis. Report of the County Medical Officer—General. 103 Shoreditch.—Population, 1911—111,463. A medical officer of health (whole time appointment), £500 per annum. Six men inspectors ; one health visitor. 3 inspectors £185} per annum. 1 inspector £170} „ 1 inspector £150 „ 1 inspector £145} „ 1 health visitor £105 „ (including £20 per annum for market duty, and £5} for Saturday and Sunday duty). (including £25 per annum for market, and Saturday and Sunday duty). (including £20 per annum for market duty, and £5} for Saturday and Sunday duty). Assistants.—(a) 1 general assistant; (b) 1 disinfector and 2 assistants; (c) 1 mortuary keeper; (d) woman caretaker of shelter. Clerical staff.—There are three clerks, and the general assistant helps in the clerical work. Duties of inspectors.—Each of the six inspectors has an allotted district in which he performs the various duties arising under the Public Health and Factory and Workshop Acts, including the abatement of smoke nuisances, the supervision of drainage work, both in new and existing houses, and the testing of drains. Each inspector is required to take four samples per fortnight under the Food and Drugs Acts, and from time to time to be on duty in the street markets on Saturday evenings and on Sundays with a view to taking samples and watching the quality of the food stuff exposed for sale. The inspectors are not restricted to their own districts for taking samples under the Food and Drugs Acts. One of the inspectors is on duty for the purposes of food inspection and for taking samples under the Food and Drugs Acts on each evening of the week between 6 and 10 p.m. Two inspectors are on duty on Saturday evenings and on Sunday mornings. The health visitor acts under the Notification of Births Act, investigates cases of ophthalmia neonatorum and phthisis in women and school children. Southwark.—Population, 1911—191,951. A medical officer of health (whole time appointment), £750 per annum. Thirteen men inspectors ; three women inspectors. 1 assistant to M.O.H £240 per annum. 1 food and drugs inspector £230 „ 1 inspector £200 „ 6 inspectors £180 „ 1 inspector £160 „ 2 inspectors £150 „ 1 inspector £170 per annum. (also receives £30 per annum under unsound food regulations) 1 chief woman inspector £180 „ 1 woman inspector £160 „ 1 woman inspector £110 „ Assistants.—(a) 2 engineers; (6) 10 disinfecting assistants ; (c) 2 mortuary keepers, and a superintendent and his wife at the reception house. The superintendent is concerned with infectious disease ; (d) 1 assistant drain tester ; (e) 1 woman attendant for cleansing verminous children. Clerical staff.—There are six clerks. Duties of inspectors.—The inspector who acts as assistant to the medical officer of health helps in supervising and coordinating the work of the inspectors. One acts as a Food and Drugs inspector. Ten inspectors have each an assigned district in which they are concerned with duties under the Public Health Act, and the inspection of factories and workshops. One inspector examines food at the wharves and at other places in the borough where it is stored. The chief woman inspector visits workshops and does special work. The two women inspectors visit houses let in lodgings, and premises where births have ocourred. Stepney.—Population, 1911—280,024. A medical officer of health (whole time appointment), £750 per annum. Also holds position of chief public analyst. Eighteen men inspectors ; one health visitor. 6 inspectors £250 per annum. 1 inspector £238½ „ (also receives £11½ for work under unsound food regulations) 1 inspector £240 „ 3 inspectors £230 „ 1 inspector £210 per annum. 3 inspectors £200 „ 1 inspector £190 „ 2 inspectors £170 „ 1 health visitor £120 „ Assistants.—Fourteen disinfecting and general assistants. Clerical staff.—There are eight clerks. Duties of inspectors.—Fifteen have each an allotted district, and are concerned with duties arising under the Public Health, Factory and Workshop and Food and Drugs Acts. These inspectors supervise the construction of drainage work in old as well as new houses as far as the front wall of the house. One inspector has also duties under the Canal Boats Act. Two are concerned with houses let in lodgings. One inspects food stuffs landed on wharves. One health visitor. Stoke Newington.—Population, 1911—50,683. A medical officer of health (part time appointment), £450 per annum. Two men inspectors : one woman inspector, also appointed as health visitor. 1 inspector £230 per annum. 1 inspector £200 „ 1 woman inspector £ 35 per annum, (also receives £90 per annum as health visitor). Assistants.—Une disinfecting assistant. Clerical staff.—There is one clerk. Duties of inspectors.—Each of the two inspectors has an assigned distriot in which he carries out general sanitary duties. The woman inspector also acts as health visitor. In the former capacity she inspects workshops and workrooms where women are employed, homes of outworkers, and houses let in lodgings. As health visitor she does work under the Notification, of Births Act, assisted by six voluntary workers. 104 Annual Report of the London County Council, 1912. Wandsworth.—Population, 1911—311,402. A medical officer of health (whole time appointment), £1,100 per annum (including £100 per annum for travelling expenses). Eleven men inspectors ; two women inspectors, also appointed as health visitors. 9 inspectors £200 per annum. (3 of these inspectors also receive £1 per annum each under the Canal Boats Acts). 1 inspector £174 4s. per annum. 1 inspector £187 4s. per annum, 2 women inspectors £125 (also receive £25 per annum for health visiting). Assistants.—(a) 10 disinfecting assistants; (b) 3 mortuary keepers. Clerical staff.—There are five clerks. Duties of inspectors.—Ten have each an assigned district in which they carry out duties under the Public Health Act, including all by-laws and repair of drains and sanitary fittings. They also take samples under the Food. and Drugs Acts if required. Three have additional duties under the Canal Boats Acts for which a separate allowance is made. One carries out duties under the Food and Drugs Acts over the whole borough, inspects meat, and performs special duties under the Public Health Act as required. Two women inspectors are chiefly occupied in visiting laundries and workshops which employ female labour. They also visit houses after a notification of a birth, and make inquiries into cases of consumption and deaths from diarrhoea. Note.—The drainage work in both old and new houses is performed by five inspectors under the oontrol of the surveyor. Westminster.—Population, 1911—160,277. A medical officer of health (whole time appointment), £1,075 per annum. Ten men inspectors ; two women inspectors ; one health visitor. 9 inspectors £220 per annum. 1 inspeotor £170 „ 2 women inspectors £160 per annum 1 health visitor (with uniform) £100 „ The 8 district inspectors also receive to per annum each tor tne supervision ot new drainage worn. Assistants.—(a) 9 disinfectors"; (6) 2 drain testing assistants; (c) 1 mortuary keeper; (d) 1 woman in charge of shelter and one cleaner. Clerical staff.—There are five clerks. Duties of inspectors.—Eight district inspectors. These inspectors supervise the construction of drainage work in all houses as far as the interceptor. Two perform duties under the Food and Drugs Act3, abatement of smoke nuisances, inspection of street markets, slaughterhouses, offensive trades, cowhouses, and inspection of food generally. The two women inspectors are engaged in the inspection of workshops, workplaces, etc., where female labour is employed, and also they inspect houses let in lodgings. The health visitor is assisted by a staff of voluntary workers, and carries out duties under the Notification of Births Act. Woolwich.—Population, 1911—121,403. A medical officer of health (whole time appointment), £600 per annum. Eight men inspectors ; two women inspectors, one of them is appointed also as a health visitor. 1 chief inspector £280 per annum. 6 inspectors £170 „ 1 inspector £140 „ 1 woman inspeotor £140 „ 1 woman inspector £90 per annum (also receives £50 per annum as health visitor). Assistants.—(a) 3 disinfectors ; (b) three drainage workmen ; (c) 1 mortuary keeper. Clerical staff.—There are three clerks. Duties of inspectors.—The chief inspector supervises generally. Seven inspectors have each an assigned district in which they perform duties arising under the Public Health Act. They have also some additional duties; two are inspectors under the Food and Drugs Acts, and one inspects dairies cowsheds, and milk shops. Three, who are qualified meat inspectors, in rotation inspect the market, slaughterhouse and principal butchers' shops. One inspects workshops where women are not employed. One woman inspector visits houses let in lodgings, workshops where women are employed and verminous houses. One woman inspector visits houses where births have occurred, and acts as health visitor. Both the women ,ors visit houses from which cases of phthisis, measles, zymotic enteritis, etc., have been notified. City of London.—Population, 1911—19,657. A medical officer of health (whole time appointment), £1,250 per annum. Nineteen men inspectors ; three women inspectors. 3 senior inspectors £300 per annum. 3 inspectors £250 „ 2 inspectors £190 „ 1 veterinary inspector £475 „ 1 senior meat inspector £350 „ 3 meat inspectors £250 „ 1 meat inspector £225 „ 1 meat inspector £200 per annum. 1 meat inspector £180 „ 1 meat inspector £170 „ 2 meat inspectors £160 „ 1 woman inspector £180 „ 1 woman inspector £130 „ 1 woman inspector £120 „ Assistants.—(a) 3 assistant inspectors of meat (on probation); (6) 1 matron at the shelter; (c) 1 mortuary keeper; (d) 1 disinfecting assistant; (e) 1 mortuary labourer. Clerical staff.—There are seven clerks. Duties of inspectors.—One is concerned with notified infectious diseases. One is specially engaged in carrying out the provisions of the Sale of Food and Drugs Acts Three are concerned with duties arising under the Public Health Act. Three are concerned with duties arising under the Factory and Workshops Acts. Eleven inspectors are engaged in meat inspection. Three women inspectors visit workplaces where females are employed, and one of these in addition to the ordinary duties of a sanitary inspector visits houses in connection with births and with infant mortality. 105 Report of the County Medical Officer—General. III. The London Life Table, 1901-1910. Method of construction. It has long been recognised that crude death-rates afford an inadequate and fallacious basis for the purpose of comparing the health conditions of different communities or of the same community at different periods of time. The use of a life table for comparative purposes of this nature is more free from objection inasmuch as by this means errors due to differences in the age and sex constitution of the populations compared are eliminated, and to this extent the reliability of comparative result is increased. The large amount of arithmetical labour involved in the preparation of an extended life table militates against the general use of this method of comparison. Notwithstanding this, however, an increasing number of extended decennial life tables for large urban communities have been constructed in recent years. The first extended life table for London was published as an appendix to the Report of the County Medical Officer of Health and was based on the mortality experience of the decade 1891-1900. In the introduction to that table the Medical Officer stated: "This table is, it may be hoped, the first of a series which will enable comparison to be made between the viability of the London population in successive decennia, and thus show whether there is indication of progress or of regress, and whether the movement in either direction corresponds with the changes observed in other parts of the country." The present table is the second of the series and its value is enhanced by the fact that the results can be compared with those obtained by the construction of the first life table. The method of construction followed is generally the same as that used for the life-table of 1891-1900, described in detail in the annual report of the Medical Officer of Health of London for the year 1901, Appendix I., in which will be found the first London life-table. A different method of calculating the mean intercensal population was required for the present life-table, as it was apparent that the population of the county was increasing at the time of the 1901 census and subsequently began to decline, so that there was a net decrease of 14,582 persons during the ten years intervening between the census of 1901 and that of 1911. The assumption that the population had increased in geometrical progression, which was reasonably made in the previous decennium, could not in the circumstances be made here; and it was therefore decided to calculate the intercensal population in the period 1901-1910 from the censuses of 1891, 1896, 1901 and 1911 by integrating between suitable limits the difference equation of a population curve deduced from these four census populations. Reference may be made on this point to London Statistics, Vol. XXII., p. 32, where the results of various methods of arriving at the intercensal population are presented in diagrammatic form. With regard to the calculation of the age-group populations by sexes, only three censuses could be used, as ages were not enumerated in 1896. The aggregate of the age-group populations thus determined somewhat exceeded the total mean population derived from the four censuses, and it was therefore necessary to reduce each age-group population proportionately. Circumstances affecting the estimate of the mean intercensal population. The estimate of the mean intercensal population from census returns for this decennium is affected apart from the actual method of calculation, by several circumstances for which it is difficult to make any satisfactory adjustment. The Boer war undoubtedly caused a reduction, largely temporary, in the enumerated population in 1901, and must also, to some extent, have affected the age and sex constitution, more especially between the ages of 15 and 45 years. tution, more especially between the ages of 15 and 45 years. The introduction of the Old Age Pensions Act, 1908, which came into force on 1st January, 1909, seems to have had an influence upon the ages returned in 1911, the number of persons from 65 to 75 years of age then enumerated having apparently increased at the expense of the number returned as between 55 and 65, as will be seen from the appended table (a) :— MALES. FEMALES. 1901 Census Population 1911 Census Population. Increase (+) or decrease (-) Corresponding increase (+) or decrease(-) in previous decennium. 1901 Census Population. 1911 Census Population Increase (+) or decrease (-) Corresponding increase (+) or decrease (—) in previous decennium. 0— 247,913 234,563 —13,350 — 2,258 247,695 232,851 —14,844 — 5,545 5— 220,287 215,927 — 4,360 — 6,494 222,393 217,715 — 4,678 — 6,705 10— 207,770 199,011 — 8,759 + 685 211,816 202,966 — 8,850 + 733 15— 208,921 193,256 —15,665 + 10,726 232,912 212,388 —20,524 + 12,417 20— 217,350 191,019 —26,331 +22,452 260,566 237,825 —22,741 +25,133 25— 371,418 363,607 — 7,811 + 36,532 437,763 432,392 — 5,371 +52,322 35— 280,698 293,943 + 13,245 + 33,616 310,368 333,138 + 22,770 + 35,869 45— 195,233 214,011 + 18,778 + 21,453 218,294 240,895 + 22,601 + 22,027 55— 118,716 131,654 + 12,938 + 19,578 140,974 153,574 + 12,600 + 17,625 65— 55,003 68,244 + 13,241 + 4,400 77,772 92,596 + 14,824 + 5,148 75 + 18,776 21,106 + 2,330 + 3,137 33,903 39,004 + 5,101 + 5,055 (a) Slight alterations in the county boundary between 1891 and 1911 affecting the populations shown only to a negligible extent have been ignored, but the addition of South Hornsey to the county area in 1901 has been allowed for by the inclusion of the census population of that area throughout. 18820 o 106 Annual Report of the London County Council, 1912. The organised efforts of some of the supporters of the women's suffrage movement to escape enumeration in 1911 may have been to some extent successful, but it is believed that the accuracy of the Census was not greatly affected. It is evident from the above figures, however, that changes in the age-constitution of the London population greater than can be accounted for by any of the causes referred to have taken place in recent years, and these changes are undoubtedly due mainly to the marked outward movement of the population, over the county boundary, and, so far as the earlier ages are concerned, to the diminution in the birth-rate since the eighties. The subject of this outward movement is dealt with in the report of the Medical Officer of Health of London for 1910, p. 8, where an estimate of the total loss to the Countv during the decennium resulting therefrom is shown. Data upon which the life-table is based. It will be seen on reference to the first life-table that fully corrected (a) deaths for London were not available before 1897, and consequently the deaths belonging to London for the period 1891-1900 could only be arrived at by an estimate based upon the ascertained effect of correction during the last four years of that decennium. The present life-table is, however, calculated upon fully corrected deaths, which are available for the whole period 1901-1910. With the corrections thus made, the data are as complete as at present possible; circumstances, however, for which no adjustment can satisfactorily be made, afEect the correctness of the figures, and these deserve to be mentioned. Thus, patients coming to London for treatment in hospitals or homes may, previous to admission, take temporary residence within the County, and in case of subsequent death they will in many cases have been regarded as London residents: similarly, London residents who became inmates of hospitals, homes, etc., in other parts of the County and died away from London, may not necessarily have been allocated to the London population. These circumstances, however, tell in opposite directions, and it may reasonably be assumed that the net result of correction for them, were it possible, would not seriously affect the accuracy of the life-table. The deaths having been corrected for institutional deaths in the manner described above, it became necessary to make a corresponding correction in the population by addition to, or deduction from, the census population, of the total inmates of the various institutions. Obviously, this correction can only be partial, as it is not possible to say what number of patients in London hospitals are not London residents. The total effect of the corrections thus made is shown in the following table :— Age group. Net addition to estimated intercensal population (10 years). Addition to ( + ) or deduction from ( -) deaths registered in London. Difference per cent. in group mortalityrates resulting from correction. Males. 0— 2,758 —2,356 —1.9 5— 2,877 — 314 —4.2 10— 2,654 — 268 —6.6 15— 4,336 — 346 —5.6 20— 6,600 — 367 —4.5 25— 19,480 — 602 —3.4 35— 23,692 — 140 —1.2 45— 23,308 — 489 —2.3 55— 20,112 — 317 —2.3 65— 12,960 + 419 —1.1 75 + 3,722 + 348 —0.7 All ages 122,499 —4,432 —1.8 Females. 0— 2,738 —1,527 —1.5 5— 2,833 — 267 —3.3 10— 2,005 — 190 —4.2 15— 3,367 — 230 —4.4 10— 5,898 — 229 —3.5 25— 18,869 — 283 —2.1 35— 26,535 — 78 —1.1 45— 28,954 + 122 —0.9 55— 25,351 + 444 —0.5 65— 16,741 + 1,123 +0.5 75 + 6,380 + 999 +0.3 All ages 139,671 — 116 —0.6 (a) The correction referred to consists in the allocation to London of deaths of London residents occurring in the chief London institutions situated without the County (namely, the asylums of the County and City of London, and the hospitals and asylums of the Metropolitan Asylums Board, together with certain workhouse establishments, The Middlesex County Asylum is situated within the County of London, and deaths among its inmates have, therefore, been deducted), and the exclusion of deaths of persons in the principal London institutions who, prior to their admission, were not resident within the County. 107 Report of the County Medical Officer—General. The population at risk for the purposes of the life-table is arrived at by adding to the total intercensal population estimated for the last four census, by the method explained above, the institutional population shown in the preceding table, and is as follows:— Age group. Population at risk, ten years 1901-1910. Males. Females. 0— 2,425,196 2,414,417 5— 2,180,995 2,200,569 10— 2,044,492 2,083,945 15— 2,039,004 2,260,089 20— 2,093,491 2,540,778 25— 3,729,634 4,414,470 35— 2,907,554 3,245,935 45— 2,064,938 2,316,391 55— 1,272,955 1,497,595 65— 617,891 855,943 75— 183,121 321,731 85 + 19,893 47,493 All ages 21,579,164 24,199,356 The deaths in the population during the ten years, fully corrected for institutions, were specially abstracted for the Council by arrangement with the Registrar-General:— Age group. Total deaths in population at risk, 1901-1910. Males. Females 0— 129,876 110,246 5— 7,550 7,654 10— 4,056 4,252 15— 5,865 5,408 20— 7,947 7,016 25— 21,240 18,430 35— 31,649 26,133 45— 39,552 31,859 55— 43,855 38,127 65— 41,802 45,841 75— 25,322 37,846 85 + 5,680 12,104 All ages 364,394 344,916 The construction of the life-table from these data then proceeded upon the same lines as were followed in the calculation of the life-table for 1891-1900. Other recently proposed methods of life-table construction Reference deserves to be made here to methods of life-table construction from census returns which have been advocated since the first life-table was issued, especially to that proposed by Mr. George King (see Inst. Actuaries Jnl., vol. xlii., part III., p. 225), who applies Dr. Sprague's method of osculatory interpolation with advancing differences, and to that of Dr. Buchanan (ibid., p. 359), who illustrates the application of Dr. Sprague's method, and of Dr. Karup's process of continuous summation, to central difference formula}. The work is somewhat shortened by both these methods, even when, as is here the case, the populations and deaths in years of life are also required. On the other hand it is clear from both the papers referred to that the method of construction used affects the results to some extent; and it has appeared to be desirable to retain comparativity between this and the former life-table so far as possible by adhering to the method already used. The interpolated populations and deaths in each year of life, and the mortality-rates, are shown in the following table :— 108 Annual Report of the London County Council, 1912. MALES. Total number of lives at risk, deaths and mortality-rates for each year of life, 1901-1910. Age. Population. Deaths. Rate of mortality per unit. Age. Population. Deaths. Rate of mortality per unit. In original groups. Distributed. In original groups. Distributed In original groups. Distributed. In original groups. Distributed 0 2,425,196 517,688 129,876 88,191 .17036 55 1,272,955 161,100 43,855 4,251 .02639 1 491,190 23,859 .04857 56 153,294 4,286 .02796 2 477,712 9,017 .01888 57 145,626 4,320 .02966 3 471,494 5,316 .01127 58 138,066 4,349 .03150 4 467,112 3,493 .00748 59 130,584 4,381 .03355 5 2,180,995 455,817 7,550 2,518 .00552 60 123,179 4,412 .03582 6 444,890 1,820 .00409 61 115,872 4,441 .03832 7 434,905 1,330 .00306 62 108,691 4,463 04106 8 426,246 1,030 .00242 63 101,679 4,476 .04403 9 419,137 852 .00203 64 94,864 4,476 .04718 10 2,044,492 413,675 4,056 765 .00185 617,891 11 409,845 748 .00183 65 88,260 4,465 .05059 12 407,547 779 .00191 66 81,847 4,440 .05425 13 406,613 844 .00208 67 75,619 4,404 .05824 14 406,812 920 .00226 68 69,586 4,353 .06255 69 63,752 4,287 .06725 15 4,132,495 407,886 13,812 1,007 .00247 41,802 16 409,549 1,101 .00269 70 58,124 4,205 .07235 17 411,501 1,190 .00289 71 52,713 4,105 .07788 18 413,451 1,275 .00309 72 47,527 3,989 .08393 19 415,126 1,357 .00327 73 42,580 3,854 .09051 74 37,883 3,700 .09767 20 416,255 1,436 .00345 21 416,631 1,508 .00362 22 416,068 1,577 .00379 75 183,121 33,448 25,322 3,527 .10546 23 414,422 1,644 .00397 76 29,288 3,339 .11399 24 411,606 1,717 .00417 77 25,415 3,131 .12321 78 21,839 2,911 .13329 25 3,729,634 407,494 1,780 .00437 79 18,568 2,679 .14428 26 401,681 1,840 .00458 27 394,277 1,892 .00480 80 15,607 2,437 .15615 28 385,725 1,950 .00505 81 12,956 2,191 .16910 29 376,782 2,019 .00536 82 10,614 1,943 .18311 21,240 83 8,571 1,700 .19829 30 368,052 2,111 .00574 84 6,815 1,464 .21474 31 359,944 2,221 .00617 32 352,524 2,347 .00666 33 345,340 2,476 .00717 85 19,563 5,331 5,498 1,239 .23255 34 337,815 2,604 .00771 86 4,097 1,032 .25178 87 3,090 842 .27249 35 2,907,554 329,433 31,649 2,716 .00825 88 2,285 674 .29483 36 320,605 2,825 .00881 89 1,654 527 .31878 37 311,704 2,934 .00941 38 302,915 3,035 .01002 90 1,170 403 .34464 39 294,371 3,132 .01064 91 808 301 .37223 92 544 219 .40180 40 286,060 3,224 .01127 93 357 155 .43337 41 277,905 3,316 .01193 94 227 106 .46705 42 269,787 3,403 .01262 43 261,571 3,480 .01330 44 253,203 3,584 .01415 95 330 140 182 71 .50291 96 84 45 .54084 45 2,064,938 244,661 39,552 3,655 .01494 97 49 28 .58115 46 236,086 3,733 .01581 98 27 17 .62363 47 227,517 3,806 .01673 99 15 10 .66844 48 218,971 3,875 .01770 49 210,466 3,940 .01872 100 15 21 .75894 50 202,019 4,002 .01981 51 193,643 4,059 .02096 52 185,352 4,110 .02218 53 177,156 4,163 .02350 54 169,067 4,209 .02489 Note. —The interpolated populations and deaths are shown to the nearest whole number, but the mortality- rates are calculated on more exact figures. 109 Report of the County Medical Officer—General. FEMALES. Total number of lives at risk, deaths and mortality-rates for each year of age, 1901-1910. Age. Population. Deaths. Rate of mortality per unit. Age. Population. Deaths. Rate of mortality per unit. In original groups. Distributed. In original groups. Distributed In original groups. Distributed. In original groups. Distributed 0 2,414,417 512,041 110,246 70,279 .13725 55 1,497,595 183,249 38,127 3,508 .01914 1 488,242 22,456 .04599 56 175,159 3,561 .02033 2 476,322 8,766 .01840 57 167,280 3,611 .02159 3 470,927 5,197 .01104 58 159,652 3,667 .02297 4 466,885 3,548 .00760 59 152,308 3,735 .02452 5 2,200,569 460,658 7,654 2,529 .00549 60 145,243 3,814 .02626 6 450,710 1,827 .00405 61 138,435 3,905 .02821 7 439,555 1,346 .00306 62 131,838 4,007 .03039 8 429,074 1,065 .00248 63 125,390 4,109 .03277 9 420,572 887 .00211 64 119,041 4,210 .03537 10 2,083,945 414,909 4,252 823 .00198 11 412,536 801 .00194 65 855,943 112,759 45,841 4,303 .03817 12 413,571 829 .00200 66 106,557 4,392 .04122 13 417,871 871 .00209 67 100,427 4,477 .04458 14 425,058 928 .00218 68 94,359 4,554 .04826 4,800,867 69 88,345 4,619 .05228 15 434,585 991 .00228 16 445,770 1,043 .00234 70 82,381 4,672 .05671 17 457,860 1,104 .00241 71 76,470 4,708 .06157 18 470,061 1,157 .00246 72 70,622 4,722 .06687 19 481,582 1,209 .00251 73 64,850 4,715 .07270 12,424 74 59,173 4,679 .07906 20 491,687 1,264 .00257 21 499,727 1,313 .00263 22 505,169 1,382 .00273 75 53,617 4,612 .08603 23 507,614 1,440 .00284 76 48,212 4,514 .09363 24 506,812 1,521 .00300 77 42,987 4,382 .10194 78 37,981 4,215 .11096 25 502,417 1,582 .00315 79 33,226 4,015 .12084 26 493,277 1,623 .00329 321,731 37,846 27 479,649 1,663 .00347 80 28,754 3,782 .13154 28 462,909 1,693 .00366 81 24,599 3,523 .14321 29 445,422 1,734 .00389 82 20,785 3,239 .15584 4,414,470 18,430 83 17,328 2,938 .16955 30 429,183 1,801 .00420 84 14,242 2,626 .18435 31 415,542 1,900 .00457 32 404,788 2,018 .00499 33 395,487 2,151 .00544 85 11,528 2,310 .20037 34 385,796 2,265 .00587 86 9,182 1,998 .21766 87 7,188 1,698 .23630 35 373,959 2,350 .00628 88 5,525 1,417 .25639 36 361,191 2,423 .00671 89 4,165 1,158 .27796 37 348,638 2,493 .00715 46,270 11,498 38 336,877 2,552 .00758 90 3,076 926 .30109 39 326,312 2,602 .00797 91 2,224 725 .32593 3,245,935 26,133 92 1,571 554 .35244 40 316,853 2,645 .00835 93 1,083 413 .38084 41 308,191 2,690 .00873 94 728 299 .41104 42 299,894 2,739 .00913 43 291,447 2,789 .00957 44 282,573 2,850 .01009 95 477 211 .44321 96 304 145 .47738 45 273,226 2,912 .01066 97 188 97 .51360 46 263,789 2,972 .01127 98 1,223 112 606 62 .55190 47 254,373 3,038 .01194 99 65 39 .59231 48 245,009 3,097 .01264 49 235,728 3,160 .01340 2,316,391 31,859 100 77 52 .68175 50 226,560 3,219 .01421 51 217,531 3,280 .01508 52 208,668 3,335 .01598 53 199,990 3,394 .01697 54 191,517 3,452 .01802 Note. —The interpolated populations and deaths are shown to the nearest whole number, but the mortality- rates are calculated on more exact figures. 110 Annual Report of the London County Council, 1912. A comparison of these figures with those of the first life table shows the same features in the general trend of the interpolated populations to be common to both decennia. There is in both marked evidence of the attraction which London offers to young adults of both sexes, resulting in an influx of population apparently even more than sufficient to compensate for losses by deaths. Reference may here be made to the diagram facing this page, which shows the interpolated populations and deaths together with the original grouped figures from which they have been calculated. The increase in the population between 14 and 25 years of age appears to be relatively more pronounced in the later decennium and this is probably largely accounted for by the outward movement of families of young married persons, for it is seen from the census of 1891 that the proportion at that time of the population between the ages of 15 and 25 years who were married was 15.1 per cent., while in 1911 the proportion had fallen to 10.7 per cent. It is probable that the method of graduation used tends to exaggerate the increase of the population shown after the fourteenth year: upon this point it is of interest to refer to the census figures for 1911 given in vol. VII, page lix, where the enumerated population of London in single years of life for each sex is given. The figures show considerable variations from one year to another and the actual age at which the population for 1911 attained a maximum after the fourteenth year is scarcely to be satisfactorily determined from them. Mr. King's graduated figures given on the same page show a maximum about the 25th year, but the increase up to that year is much less marked in the census figures for 1911 than in the figures shown above for the decennium 1901-1910. This difference is partly accounted for by the addition made to the London population in respect of inmates of institutions (see p. 106). Mortalityrates at age periods in successive decennia. For the purposes of comparison the mortality-rates of London by sexes at ages for the last six decennial periods are here shown. Age-group. Death-rates per 1,000 living at difierent age-periods in successive decennia since 1851. Decrease or increase in death-rates at age-periods in successive decennia. 1851-60. 1861-70. 1871-80. 1881-90. 1891-00. 1901-10. 1851-60 to 1861-70. 1861-70 to 1871-80. 1881-80 to 1881-90. 1881-90 to 1891-00. 1891-00 to 1900-10. Males. 0— 83.11 86.91 77.86 73.09 71.97 53.55 + 3.80 —9.05 —4.77 —1.12 —18.42 5— 9.70 9.37 7.42 5.93 4.97 3.46 —0.33 —1.95 —1.49 —0.96 — 1.51 10— 4.52 4.24 3.57 2.92 2.46 1.98 —0.28 —0.67 —0.65 —0.46 — 0.48 15— 6.25 5.82 5.05 4.05 3.47 2.88 —0.43 —0.77 —1.00 -0.58 — 0.59 20— 8.31 8.23 6.95 5.44 4.59 3.80 —0.08 —1.28 —1.51 —0.85 — 0.79 25— 10.50 10.86 10.13 8.65 7.36 5.69 +0.36 —0.73 —1.48 —1.29 — 1.67 35— 16.29 17.14 16.64 14.96 14.22 10.89 +0.85 —0.50 -1.68 —0.74 — 3.33 45— 24.68 25.68 25.37 23.87 23.14 19.15 + 1.00 —0.31 -1.50 -0.73 — 3.99 55— 42.43 43.85 43.20 41.33 40.68 34.45 + 1.42 —0.65 -1.87 -0.65 — 6.23 65— 85.22 82.83 80.08 77.97 77.78 67.65 -2.39 -1.75 —2.11 —0.19 —10.13 75 + 186.48 184.51 176.81 169.36 166.45 152.71 -1.97 -7.70 -7.45 -2.91 -13.74 All ages 25.70 26.55 24.38 22.10 20.88 16.89 + 0.85 —2.17 —2.28 —1.22 — 3.99 Females. 0— 72.95 76.32 67.66 63.26 61.99 45.66 + 3.37 —8.66 —4.40 —1.27 —16.33 5— 9.21 8.85 6.73 5.82 5.17 3.48 —0.36 —2.12 -0.91 —0.65 — 1.69 10— 4.15 4.07 3.45 2.89 2.48 2.04 —0.08 —0.62 -0.56 —0.41 — 0.44 15— 5.43 5.10 4.36 3.58 2.94 2.39 —0.33 —0.74 -0.78 —0.64 — 0.55 20— 6.48 6.22 5.46 4.40 3.46 2.76 —0.26 —0.76 —1.06 -0.94 — 0.70 25— 8.75 8.80 8.04 6.82 5.65 4.17 + 0.05 —0.76 —1.22 —1.17 — 1.48 35— 12.81 12.84 12.32 11.42 10.68 8.05 +0.03 —0.52 —0.90 —0.74 — 2.63 45— 18.06 18.52 18.08 17.23 17.12 13.75 +0.46 —0.44 —0.85 —0.11 — 3.37 55— 33.27 33.45 32.95 30.77 31.01 25.46 +0.18 —0.50 —2.18 + 0.24 — 5.55 65— 69.59 67.23 66.63 63.38 63.44 53.56 -2.36 —0.60 -3.25 + 0.06 — 9.88 75 + 167.46 164.71 159.50 150.26 150.73 135.28 —2.75 —5.21 —9.24 +0.47 -15.45 All ages 21.82 22.34 20.60 18.83 17.88 14.25 +0.52 —1.74 —1.77 —0.95 — 3.63 It will be observed that the decrease in the mortality during the last twenty years has been much greater at all ages and for both sexes than in any two consecutive decennia back to 1851-60, the first decennium for which satisfactorily complete data are available; but generally speaking the ageperiods in which the decrease is most marked are those at which mortality-rates are highest, namely, in infancy and after maturity. It might be supposed that the decrease in mortality in infancy was greatest in the first year of life, but this is found not to be the case. If the mortality rates in years of life for the first ten years, as shown by the first life-table calculations, be compared with the similar figures for the present life-table, it will be seen that the greatest improvement proportionately in the 1ll Report of the County Medical Officer—General. mortality-rate is shown at the age of from four to five years: the percentage reduction is as follows : Year of age. Males. Females. Mortality-rate. Decrease. Decrease % Mortality rate. Decrease. Decrease. % 1891-1900. 1901-1910. 1891-1900. 1901-1910. 0 — .21070 .17036 .04034 19.1 .17190 .13725 .03465 20.2 1 — .06791 .04857 .01934 28.5 .06286 .04599 .01687 26.8 2 — .02801 .01888 .00913 32.6 .02740 .01840 .00900 32.8 3 — .01810 .01127 .00683 37.7 .01803 .01104 .00699 38.8 4 — .01238 .00748 .00490 39.6 .01262 .00760 .00502 39.8 5 — .00863 .00552 .00311 36.0 .00877 .00549 .00328 37.4 6 — .00602 .00409 .00193 32.1 .00619 .00405 .00214 34.6 7 — .00426 .00306 .00120 28.2 .00445 .00306 .00139 31.2 8 — .00315 .00242 .00073 23.2 .00338 .00248 .00090 26.6 9 — .00253 .00203 .00050 19.8 .00272 .00211 .00061 22.4 The difference in the mortality-rates in the two successive decennia shown in London in the first ten years of life appears to be generally similar to the difference at corresponding ages observed when healthy districts are contrasted with others less healthy over the same period of time. In Part I of the supplement to the 65th Annual Report of the Registrar-General, life-tables are given for the whole of England and Wales (p. xlvi) and also for a group of selected healthy districts of the country during the same decennium (p. lii). The districts selected, 260 in number, had an aggregate population of about million persons, and were those in which the general death-rate in 1891-1900 did not exceed fourteen per thousand living (p.xx). fourteen per thousand living (p.xx). The life-table mortality-rates for these populations in the first ten years of life compare as follows :— Excess of mortality-rates in the whole of England and Wales over the rates in selected healthy districts, 1891-1910. Year of age. Males. Females Excess Percentage. Excess. Percentage. 0— .06083 31.5 .05281 34.3 1— .02614 47.8 .02433 47.9 2— .01005 47.7 .01000 49.1 3— .00588 44.3 .00634 47.2 4— .00396 40.6 .00393 41.0 5— .00260 36.4 .00260 36.7 6— .00154 29.5 .00158 30.2 7— .00085 22.1 .00088 22.4 8— .00043 14.7 .00045 14.8 9— .00022 9.2 .00022 8.7 A comparison of the group mortality-rates in the fife-table population and the corresponding rates calculated upon the actual data shows relatively small differences except at the extreme ages of life, when necessarily the divergence of the two series of rates must be appreciable if the life-table population and deaths accurately represent the actual experience. MALES. Age-group. Observed rate of mortality. Rate of mortality from life-table. Difference per cent. (a). 0— 53.55 54.16 + 1.13 5— 3.46 3.43 — 0.90 10— 1.98 1.98 + 0.00 15— 2.88 2.88 + 0.10 20— 3.80 3.80 + 0.05 25— 5.69 5.74 + 0.84 35— 10.89 10.98 + 0.88 45— 19.15 19.35 + 1.01 55— 34.45 34.88 + 1.25 65— 67.65 68.56 + 1.34 75 + 152.71 157.37 + 3.05 (a) Calculated upon rates carried to three or more places of decimals. 112 Annual Report of the London County Council, 1912. FEMALES. Age-group. Observed rate of mortality. Rate of mortality from life-table. Difference per cent. 0- 45.66 46.17 + 1.12 5— 3.48 3.45 — 0.95 10— 2.04 2.04 — 0.05 15— 2.39 2.40 + 0.33 20— 2.76 2.75 — 0.25 25— 4.17 4.24 + 1.58 35— 8.05 8.13 + 0.96 45— 13.75 13.92 + 1.24 55— 25.46 25.77 + 1.24 65— 53.56 54.11 + 1.04 75 + 135.28 139.38 + 3.03 The mx curves shown in the diagram facing this page could not conveniently be reproduced upon a scale large enough to enable the incidence of death upon males and females to be contrasted throughout life; the vitality-rates, or persons living per death, are therefore shown in the diagram facing page 9, and the two diagrams in conjunction will enable ready comparison to be made between the mortality of the two sexes. It will be noted that the female vitality-rate exceeds that of the males throughout, except from about the 8th to the 13th year of age. The relative depression in the female vitality about this ageperiod is found to arise from the fact that at this age, only, the deaths from phthisis among females exceed those among males. If the deaths from all tubercular diseases are deducted, and the vitalityrates are then compared, it is found that the female rate exceeds the male rate over the whole period of life, and also that the considerable augmentation in the relative vitality of females observable after the 20th to about the 45th years largely disappears. The deaths from specified causes are only available in groups of ages, and consequently no very precise analysis of the causes leading to variations in mortality can be made, even by means of the lifetable: small irregularities in the relative contour of the vitality-curves of the two sexes still remain when the tubercular deaths are deducted throughout. The effect of variations in the death-rate from phthisis among males in successive decennia upon the contour of the mortality-rate curves appears to be well illustrated by diagram C (see p. 5). The age constitution of the life-table population (see page 115, Px values), differs considerably from that of the census population : and consequently the death-rates per thousand living in the life-table population will differ from those based upon the census estimates, for obviously a population in which the number of persons at higher ages is relatively in excess (as is the case in the life-table population) will with an equal mortality-rate at each age of life have a higher death-rate for all ages taken together. together. From the life-table we may, however, calculate the percentage of lives entering the life-table experience who would die from certain specified causes and thus obtain rates which admit of accurate comparison :— Cause of death. Deaths in the life-table population per 100 births. Males. es. Measles 1.77 1.69 Rheumatic fever 0.33 0.38 Cancer 6.68 8.86 Phthisis 10.37 5.89 Other tubercular diseases 2.38 2.10 Pneumonia 9.21 7.78 Other respiratory diseases 11.28 13.32 All other causes 57.98 59.98 These figures do not, however, measure the relative loss in lifetime, sustained by the community from the diseases named; for deaths at early ages involve the loss of a greater number of years of possible future lifetime than deaths in later fife. of possible future lifetime than deaths in later life. The expectation of life, or mean future life-time at certain periods of age is given in the life-table, however, and this affords us a measure by which to ascertain approximately the relative years of life lost by various diseases. Cause of death. Approximate comparative loss in years of life by deaths. Males. Females. Years. Years. Measles 483,277 475,647 Rheumatic fever 52,250 60,769 Cancer 433,075 633,23 Phthisis 1,253,348 830,130 Other tubercular disease 549,927 513,333 Pneumonia 1,326,473 1,148,120 Other respiratory disease 953,559 989,495 113 Report of the County Medical Officer—General. Hence it will be seen that among males the loss in years of life caused by the mortality from measles is greater than that due to cancer, although the death-rate from cancer has been shown to be more than three times greater than that from measles; similarly the mortality from pneumonia causes greater loss than the somewhat more numerous deaths from phthisis. The loss from phthisis, which appears from the death-rate for both sexes taken together to be nearly four times as great as the loss from all other tubercular diseases, is, in terms of years of lifetime lost only about twice as great. The marked decrease in the mortality rates from all causes observed during the present decennium when comparison is made with the similar rates for 1891-1900 (see page 110 above) occasions a correspondingly large increase in the expectation of life. spondingly large increase in the expectation of life. The figures for the two tables are shown below and there are appended to them for the purpose of further comparison the approximate increase in expectation in 1891-1900 over the period 1881-1890. Age. Males. Females. Corresponding increase 1881-80 to 1891-1900. 1891-1900. 1901-1910 Increase. 1891-1900. 1901-1910. Increase. Males. Females. 0 40.98 46.74 5.76 45.33 51.41 6.08 1.13 1.15 5 51.60 54.82 3.22 55.12 58.63 3.51 1.25 1.16 10 47.84 50.73 2.89 51.49 54.61 3.12 1.05 1.01 15 43.40 46.21 2.81 47.10 50.14 3.04 0.96 0.92 20 39.13 41.84 2.71 42.77 45.72 2.95 0.87 0.80 25 34.96 37.59 2.63 38.46 41.32 2.86 0.72 0.61 35 27.25 29.50 2.25 30.42 32.87 2.45 0.36 0. 25 45 20.65 22.31 1.66 23.29 25.21 1.92 0.21 0.07 55 14.76 15.98 1.22 16.72 18.19 1.47 0.12 0.05 65 9.76 10.56 0.80 11.01 12.03 1.02 0.05 0.07 75 5.91 6.35 0.44 6.57 7.17 0.60 0.07 0.02 The expectation shown here for London may be compared with the similar figures for Salford, which are given for both decennia on page 118. It will be observed that the marked increase shown in London is also equally evident in the Salford figures. The values of the London expectations for both sexes at all ages of life are shown in diagram facing this page. In the first life-table for London Dr. Tatham's method of estimating the life-capital, or aggregate future years of life, of the intercensal population was described, and the result of its application to the data for the period 1891-1900 given. data for the period 1891-1900 given. For the purpose of the similar calculations for the present lifetable the expectation of life of quinquennial or decennial age-groups of the population are required and these are found to be as follows :— Age-groups. Males. Females. Years. Years. 0— 54.43 58.24 5— 52.88 56.72 10— 48.47 52.38 15— 44.02 47.93 20— 39.72 43.52 25— 33.52 37.06 35— 25.90 29.04 45— 19.18 21.72 55— 13.34 15.16 65— 8.60 9.70 75— 5.15 5.74 85 + 2.93 3.22 The application of these values to the intercensal population of each age-group gives the years of future life-time, the total of these figures being the required life-capital of the whole population:— Age-groups. Males. Females. Population. Life-capital. Population. Life-capital. 0— 242,520 13,200,342 241,442 14,061,565 5— 218,100 11,533,102 220,057 12,481,627 10— 204,449 9,909,653 208,395 10,915,704 15— 203,900 8,975,696 226,009 10,832,607 20— 209,349 8,315,346 254,078 11,057,466 25— 372,963 12,501,733 441,447 16,360,026 35— 290,755 7,530,565 324,593 9,426,195 45— 206,494 3,960,551 231,639 5,031,201 55— 127,296 1,698,122 149,760 2,270,354 65— 61,789 531,386 85,594 830,265 75— 18,312 94,307 32,173 184,674 85 + 1,989 5,829 4,749 15,293 All ages 2,157,916 78,256,632 2,419,936 93,466,977 18820 p 114 Annual Report of the London County Council, 1912. Hence the average years of future life-time of the total population, and the rate at which it is annually expended, are obtained:— Mean population 1901-1910. Total life capital of the population. Average life capital of the population. Proportion per cent. of life capital expended in a year. Corresponding figures in 1691-1900. Average life-capital. Percentage expended annually. Persons 4,577,852 171,723,609 37.51 2.666 35.76 2.797 Males 2,157,916 78,256,632 36.26 2.757 34.59 2.891 Females 2,419,936 93,466,977 38.62 2.589 36.80 2.717 It is thus found that the value of the future life-time of the population in 1901-1910 shows a small increase upon that of the population in the preceding decennium. A question of some importance then arises for determination: has the increase in the expectation of life been sufficient to compensate for the marked diminution of the birth-rate in the period covered by the two life-tables ? In the first life-table it was shown that for every 100 years of life lost by deaths, 132 years of life were added by births. life were added by births. As will be seen, however, from the following figures, the relative addition by births has been increased to 134 years. Sex. Births in 1901-1910. Mean future lifetime. Years of life added by births in 1901-10. Years of life expended by the population 1901-1910. Years added for 100 years expended. 1901-1910. 1891-1900. Males 635,197 46.74 29,689,108 21,579,164 138 135 Females 613,003 51.41 31,514,484 24,199,356 130 129 Persons 1,248,200 - 61,203,592 45,778,520 134 132 The increase may seem small, but it is to be borne in mind in considering this result, that there is evidence that London, during the past 20 years, has been losing its younger married population (see above, page 110) and if correction for that fact could be made there seems reason to suppose that the relative addition by births would have shown greater increase. Reverting to the contrast which has been made of the mortality-rates (i.) in successive decennia in London, (ii.) in selected healthy districts and the whole of England and Wales in the same decennium it is of interest here to compare similarly the birth-rates of the life-table populations: it is found that for every 100 females aged 15-45 the births in England and Wales numbered 97.0 as compared with the corresponding rate of 86.5 in the selected healthy districts in 1891-1900; while, in London, the first life-table population gives a corresponding birth-rate of 100.9 and the present life-table 91.4 per 100: thus it appears that improvement in the healthiness of a community is accompanied with a corresponding decrease in the birth-rate, equally whether the rates compared are contemporaneous or for successive periods. These figures do not, of course, take into account the differences there may be in the proportion of the females 15-45 years who are married: they merely show the actual comparative reproduction-rates of the life-table populations. Appended to the life-table, for the purpose of comparison, will be found tabular statements of lx, px and Ex values obtained from other life-tables, but with the exception of the figures for Salford, they relate to the decennium 1891-1900. Other tables for the period 1901-1910 are in preparation, however, and further analysis of the relation which the London experience bears to that of other large towns, must be delayed until these tables are published. be delayed until these tables are published. The expectation of life in various towns or countries for the period 1891-1900, may be compared with London for the same period, and taking the London expectation as the standard at each age, the excess (+) or defect (—) in expectation elsewhere is, for males, as follows:— Age. Salford. Berlin (a) Norwich. Brighton. England and Wales. Scotland. Germany (a) 0 -7.68 —3.03 + 2.89 + 3.94 + 3.15 + 3.73 —0.42 5 —3.58 +0.35 + 3.64 +2.34 + 1.90 + 0.76 + 1.67 10 —3.45 + 0.56 +3.34 + 1.96 + 1.79 +0.76 + 1.82 15 —3.40 + 0.57 + 3.37 + 1.89 + 1.81 +0.94 + 1.91 20 —3.20 +0.70 + 3.46 + 1.96 + 1.89 + 1.30 +2.10 25 -2.86 + 0.80 + 3.73 +2.16 + 2.05 + 1.79 +2.42 35 -2.81 +0.77 +3.41 +2.20 + 1.99 + 2.05 +2.34 45 —2.73 +0.61 + 2.68 + 1.89 + 1.55 + 1.59 + 1.72 55 —2.31 +0.46 + 1.82 + 1.68 + 1.03 + 1.09 + 1.05 65 -1.46 +0.33 +0.78 + 1.25 +0.58 +0.81 +0.36 75 —0.72 +0.15 +0.09 +0.58 +0.14 + 0.47 —0.11 Although the expectation at ages above 5 years in Berlin exceeds that of London, the high infantile mortality brings the expectation of life at birth below the London figure by more than three years. The px, lx and mx curves for 1901-1910 in London are shown on the diagram facing page 112: corresponding curves for 1891-1900 are not here reproduced, as in the small scale necessitated to show the whole life-period the differences between the two curves would only be apparent at the two extremes of life. (a) Statistik des Deutschen Reichs, Band 200 (Deutsche Sterbetafeln fiir das Jahrzehnt 1891 bis 1900.) 115 Report of the County Medical Officer—General. MALES. Life-Table for London based on the mortality in the decennium 1901-1910. Age. Dying in each year of age. Surviving at the beginning of each age. Population or years of life lived in each year of age. Population or years of life lived in and above each year of age. Expectation of life at each age. Age. Dying in each year of age. Surviving at the beginning of each age. Population or years of life lived in each year of age. Population or years of life lived in and above each year of age. Expectation of life at each age. X. dx. Ix. Px. Ox. Ex. X. dx. Ix. Px. Qx. Ex. 0 77,368 508,891 459,506 23,787,316 46.74 55 6,749 259,152 255,777 4,140,786 15.98 1 20,464 431,523 421,291 23,327,810 54.06 56 6,960 252,403 248,923 3,885,009 15.39 2 7,686 411,059 407,216 22,906,519 55.73 57 7,175 245,443 241,855 3,636,086 14.81 3 4,522 403,373 401,112 22,499,303 55.78 58 7,389 238,268 234,574 3,394,231 14.25 4 2,972 398,851 397,365 22,098,191 55.40 59 7,618 230,879 227,070 3,159,657 13.69 5 2,181 395,879 394,789 21,700,826 54.82 6 1,607 393,698 392,895 21,306,037 54.12 60 7,857 223,261 219,333 2,932,587 13.14 7 1,197 392,091 391,492 20,913,142 53.34 61 8,099 215,404 211,354 2,713,254 12.60 8 944 390,894 390,422 20,521,650 52.50 62 8,340 207,305 203,135 2,501,900 12.07 9 792 389,950 389,554 20,131,228 51.63 63 8,571 198,965 194,679 2,298,765 11.55 64 8,777 190,394 186,006 2,104,086 11.05 10 719 389,158 388,799 19,741,674 50.73 11 708 388,439 388,085 19,352,875 49.82 12 740 387,731 387,361 18,964,790 48.91 65 8,961 181,617 177,136 1,918,080 10.56 13 803 386,991 386,589 18,577,429 48.00 66 9,119 172,656 168,097 1,740,944 10.08 14 872 386,188 385,752 18,190,840 47.10 67 9,254 163,537 158,910 1,572,847 9.62 68 9,358 154,283 149,604 1,413,937 9.16 15 951 385,316 384,841 17,805,088 46.21 69 9,428 144,925 140,211 1,264,333 8.72 16 1,032 384,365 383,849 17,420,247 45.32 17 1,106 383,333 382,780 17,036,398 44.44 18 1,177 382,227 381,639 16,653,618 43.57 70 9,461 135,497 130,767 1,124,122 8.30 19 1,244 381,050 380,428 16,271,979 42.70 71 9,448 126,036 121,312 993,355 7.88 72 9,391 116,588 111,892 872,043 7.48 20 1,308 379,806 379,152 15,891,551 41.84 73 9,283 107,197 102,556 760,151 7.09 21 1,368 378,498 377,814 15,512,399 40.98 74 9,118 97,914 93,355 657,595 6.72 22 1,426 377,130 376,417 15,134,585 40.13 23 1,488 375,704 374,960 14,758,168 39.28 24 1,557 374,216 373,438 14,383,208 38.44 75 8,895 88,796 84,348 564,240 6.35 76 8,617 79,901 75,592 479,892 6.01 25 1,624 372,659 371,847 14,009,770 37.59 77 8,273 71,284 67,147 404,300 5.67 26 1,695 371,035 370,187 13,637,923 36.76 78 7,875 63,011 59,074 337,153 5.35 27 1,769 369,340 368,456 13,267,736 35.92 79 7,419 55,136 51,427 278,079 5.04 28 1,853 367,571 366,644 12,899,280 35.09 29 1,955 365,718 364,740 12,532,637 34.27 80 6,912 47,717 44,261 226,652 4.75 30 2,081 363,763 362,722 12,167,896 33.45 81 6,362 40,805 37,624 182,391 4.47 31 2,225 361,682 360,570 11,805,174 32.64 82 5,778 34,443 31,554 144,767 4.20 32 2,385 359,457 358,265 11,444,604 31.84 83 5,171 28,665 26,079 113,213 3.95 33 2,550 357,072 355,797 11,086,339 31.05 84 4,556 23,494 21,216 87,134 3.71 34 2,723 354,522 353,160 10,730,542 30.27 35 2,889 351,799 350,354 10,377,382 29.50 85 3,946 18,938 16,965 65,918 3.48 36 3,060 348,910 347,380 10,027,028 28.74 86 3,352 14,992 13,316 48,953 3.27 37 3,240 345,850 344,230 9,679,648 27.99 87 2,792 11,640 10,244 35,637 3.06 38 3,415 342,610 340,902 9,335,418 27.25 88 2,273 8,848 7,712 25,393 2.87 39 3,590 339,195 337,400 8,994,516 26.52 89 1,808 6,575 5,671 17,681 2.69 40 3,762 335,605 333,724 8,657,116 25.80 90 1,401 4,767 4,066 12,011 2.52 41 3,936 331,843 329,875 8,323,392 25.08 91 1,057 3,366 2,838 7,944 2.36 42 4,110 327,907 325,852 7,993,517 24.38 92 772 2,309 1,923 5,107 2.21 43 4,280 323,797 321,657 7,667,665 23.68 93 548 1,537 1,263 3,184 2.07 44 4,491 319,517 317,272 7,346,008 22.99 94 374 989 802 1,921 1.94 45 4,672 315,026 312,690 7,028,736 22.31 95 247 615 491 1,119 1.82 46 4,868 310,354 307,920 6,716,046 21.64 96 157 368 289 628 1.71 47 5,068 305,486 302,952 6,408,126 20.98 97 95 211 164 338 1.60 48 5,269 300,418 297,784 6,105,174 20.32 98 55 116 88 174 1.50 49 5,474 295,149 292,412 5,807,390 19.68 99 31 61 46 86 1.41 50 5,683 289,675 286,833 5,514,978 19.04 100 16 30 22 40 1.33 51 5,891 283,992 281,047 5,228,145 18.41 101 8 14 10 18 1.25 52 6,099 278,101 275,051 4,947,098 17.79 102 3 6 5 8 1.17 53 6,318 272,002 268,843 4,672,047 17.18 103 2 3 2 3 1.10 54 6,532 265,684 262,418 4,403,204 16.57 104 1 1 1 1 1.03 Note. —The figures are here shown to the nearest whole number only, but rates based upon them are calculated from more exact values. 18820 P 2 116 Annual Report of the London County Council, 1912. FEMALES. Life-Table for London based on the mortality in the decennium 1901-1910. Age. Dying in each year of age. Surviving at the beginning of each age. Population or years of life lived in each year of age. Population or years of life lived in and above each year of age. Expectation of life at each age. Age. Dying in each year of age. Surviving at the beginning of each age. Population or years of life lived in each year of age. Population or years of life lived in and above each year of age. Expectation of lift at each age. X. dx. Ix. Px. Qx. Ex. X. dx. Ix. Px. Qx. Ex. 0 61,645 491,109 452,854 25,247,985 51.41 55 5,456 287,744 285,016 5,234,919 18.19 1 19,309 429,464 419,809 24,795,131 57.74 56 5,681 282,288 279,448 4,949,903 17.53 2 7,479 410,155 406,415 24,375,322 59.43 57 5,907 276,607 273,654 4,670,455 16.88 3 4,420 402,676 400,466 23,968,907 59.52 58 6,147 270,700 267,626 4,396,801 16.24 4 3,015 398,256 396,749 23,568,441 59.18 59 6,409 264,553 261,348 4,129,175 15.61 5 2,164 395,241 394,159 23,171,692 58.63 60 6,691 258,144 254,799 3,867,827 14.98 6 1,590 393,077 392,282 22,777,533 57.95 61 6,995 251,453 247,955 3,613,028 14.37 7 1,197 391,487 390,888 22,385,251 57.18 62 7,319 244,458 240,798 3,365,073 13.77 8 968 390,290 389,806 21,994,363 56.35 63 7,646 237,139 233,316 3,124,275 13.17 9 820 389,322 388,912 21,604,557 55.49 64 7,975 229,493 225,506 2,890,959 12.60 10 769 388,502 388,118 21,215,645 54.61 65 8,296 221,518 217,370 2,665,453 12.03 11 752 387,733 387,357 20,827,527 53.72 66 8,611 213,222 208,917 2,448,083 11.48 12 775 386,981 386,594 20,440,170 52.82 67 8,922 204,611 200,150 2,239,166 10.94 13 804 386,206 385,804 20,053,576 51.92 68 9,222 195,689 191,077 2,039,016 10.42 14 841 385,402 384,981 19,667,772 51.03 69 9,501 186,467 181,716 1,847,939 9.91 15 876 384,561 384,123 19,282,791 50.14 70 9,760 176,966 172,086 1,666,223 9.42 16 897 383,685 383,236 18,898,668 49.26 71 9,986 167,206 162,213 1,494,137 8.94 17 922 382,788 382,327 18,515,432 48.37 72 10,174 157,220 152,133 1,331,924 8.47 18 939 381,866 381,397 18,133,105 47.49 73 10,315 147,046 141,889 1,179,791 8.02 19 955 380,927 380,450 17,751,708 46.60 74 10,399 136,731 131,532 1,037,902 7.59 20 975 379,972 379,484 17,371,258 45.72 75 10,420 126,332 121,122 906,370 7.17 21 995 378,997 378,499 16,991,774 44.83 76 10,367 115,912 110,728 785,248 6.77 22 1,033 378,002 377,486 16,613,275 43.95 77 10,237 105,545 100,426 674,520 6.39 23 1,067 376,969 376,436 16,235,789 43.07 78 10,020 95,308 90,298 574,094 6.02 24 1,127 375,902 375,338 15,859,353 42.19 79 9,719 85,288 80,428 483,796 5.67 25 1,178 374,775 374,186 15,484,015 41.32 80 9,327 75,569 70,905 403,368 5.34 26 1,227 373,597 372,983 15,109,829 40.44 81 8,853 66,242 61,815 332,463 5.02 27 1,290 372,370 371,725 14,736,846 39.58 82 8,297 57,389 53,241 270,648 4.72 28 1,354 371,080 370,403 14,365,121 38.71 83 7,673 49,092 45,255 217,407 4.43 29 1,436 369,726 369,008 13,994,718 37.85 84 6,991 41,419 37,923 172,152 4.16 30 1,543 368,290 367,519 13,625,710 37.00 85 6,271 34,428 31,292 134,229 3.90 31 1,673 366,747 365,912 13,258,191 36.15 86 5,527 28,157 25,394 102,936 3.66 32 1,815 365,074 364,166 12,892,279 35.31 87 4,782 22,630 20,239 77,542 3.43 33 1,971 363,259 362,273 12,528,113 34.49 88 4,056 17,848 15,820 57,303 3.21 34 2,114 361,288 360,231 12,165,840 33.67 89 3,366 13,792 12,109 41,484 3.01 35 2,250 359,174 358,049 11,805,609 32.87 90 2,728 10,426 9,062 29,375 2.82 36 2,386 356,924 355,731 11,447,560 32.07 91 2,158 7,698 6,619 20,313 2.64 37 2,527 354,538 353,275 11,091,829 31.29 92 1,660 5,540 4,710 13,694 2.47 38 2,657 352,011 350,683 10,738,554 30.51 93 1,241 3,880 3,259 8,984 2.32 39 2,774 349,354 347,967 10,387,871 29.73 94 900 2,639 2,189 5,725 2.17 40 2,881 346,580 345,139 10,039,904 28.97 95 631 1,739 1,424 3,536 2.03 41 2,988 343,699 342,205 9,694,765 28.21 96 427 1,108 894 2,112 1.91 42 3,097 340,711 339,163 9,352,560 27.45 97 278 681 542 1,218 1.79 43 3,215 337,614 336,007 9,013,397 26.70 98 174 403 316 676 1.68 44 3,356 334,399 332,721 8,677,390 25.95 99 105 229 176 360 1.58 45 3,510 331,043 329,288 8,344,669 25.21 100 60 124 94 184 1.48 46 3,669 327,533 325,698 8,015,381 24.47 101 32 64 48 90 1.39 47 3,845 323,864 321,941 7,689,683 23.74 102 17 32 23 42 1.31 48 4,021 320,019 318,009 7,367,742 23.02 103 8 15 11 18 1.23 49 4,207 315,998 313,895 7,049,733 22.31 104 4 7 5 8 1.16 50 4,399 311,791 309,591 6,735,838 21.60 105 2 3 2 3 1.09 51 4,600 307,392 305,092 6,426,247 20.91 106 1 1 1 1 1.03 52 4,801 302,792 300,392 6,121,155 20.22 53 5,014 297,991 295,484 5,820,763 19.53 54 5,233 292,977 290,360 5,525,279 18.86 Note. —The figures are here shown to the nearest whole number only, but rates based upon them are calculated from more exact values. 117 Report of the County Medical Officer—General. MALES AND FEMALES. Life-Table for London based on the mortality in the decennium 1901-1910. Age. Probability of living one year from each age. PX. Of 1,000,000 males born, the number surviving at the beginning of each age. Of 1,000,000 females born, the number surviving at the beginning of each age. Of 1,000,000 of both sexes (508,891 males and 491,109 females) born. Age. Probability of living one year from each age. Px. Of 1,000,000 males born, the number surviving at the beginning of each age. Of 1,000,000 females born, the number surviving at the beginning of each age. Of 1,000,000 of both sexes (508,891 males and 491,109 females) born. The number surviving at the beginning of each age. Population or years of life lived in and above each year. The number surviving at the beginning of each age. Population or years of life lived in and above each year. Males. Females. Males. Females. X. Ix. Ix. Ix. Qx. X. Ix. Ix. Ix. Qx. 0 .84797 .87448 1,000,000 1,000,000 1,000,000 49,035,301 55 .97396 .98104 509,248 585,906 546,895 9,375,705 1 .95258 .95504 847,968 874,477 860,987 48,122,941 56 .97243 .97987 495,985 574,798 534,691 8,834,912 2 .98130 .98176 807,755 835,161 821,214 47,281,841 57 .97077 .97864 482,309 563,230 522,050 8,306,541 3 .98879 .98902 792,651 819,931 806,049 46,468,210 58 .96899 .97729 468,211 551,201 508,968 7,791,032 4 .99255 .99243 783,764 810,932 797,107 45,666,632 59 .96700 .97577 453,691 538,685 495,432 7,288,832 5 .99449 .99452 777,925 804,793 791,120 44,872,518 60 .96481 .97408 438,721 525,635 481,405 6,800,414 6 .99592 .99595 773,640 800,386 786,775 44,083,570 61 .96240 .97218 423,282 512,011 466,857 6,326,282 7 .99695 .99694 770,482 797,148 783,578 43,298,393 62 .95977 .97006 407,366 497,767 451,762 5,866,973 8 .99759 .99752 768,129 794,711 781,184 42,516,013 63 .95692 .96776 390,977 482,864 436,104 5,423,040 9 .99797 .99789 766,275 792,741 779,272 41,735,785 64 .95390 .96525 374,135 467,296 419,887 4,995,045 10 .99815 .99802 764,719 791,072 777,661 40,957,319 65 .95066 .96255 356,888 451,057 403,135 4,583,533 11 .99818 .99806 763,306 789,505 776,172 40,180,402 66 .94718 .95961 339,279 434,165 385,878 4,189,027 12 .99809 .99800 761,913 787,974 774,712 39,404,960 67 .94341 .95639 321,360 416,631 368,148 3,812,013 13 .99793 .99792 760,459 786,396 773,197 38,631,005 68 .93935 .95287 303,174 398,462 349,972 3,452,953 14 .99774 .99782 758,881 784,758 771,590 37,858,612 69 .93494 .94905 284,786 379,685 331,392 3,112,272 15 .99753 .99772 757,168 783,046 769,877 37,087,879 70 .93018 .94485 266,259 360,339 312,462 2,790,345 16 .99732 .99766 755,300 781,262 768,050 36,318,915 71 .92503 .94027 247,669 340,467 293,243 2,487,492 17 .99711 .99759 753,272 779,437 766,122 35,551,830 72 .91945 .93529 229,102 320,132 273,808 2,203,967 18 .99692 .99754 751,098 777,559 764,093 34,786,723 73 .91341 .92985 210,648 299,417 254,243 1,939,942 19 .99674 .99749 748,784 775,647 761,977 34,023,687 74 .90688 .92394 192,407 278,413 234,646 1,695,497 20 .99655 .99743 746,342 773,702 759,779 33,262,809 75 .89982 .91752 174,490 257,238 215,128 1,470,610 21 .99639 .99737 743,770 771,716 757,495 32,504,173 76 .89216 .91056 157,009 236,021 195,813 1,265,140 22 .99622 .99727 741,083 769,690 755,132 31,747,860 77 .88394 .90301 140,077 214,911 176,829 1,078,820 23 .99604 .99717 738,280 767,588 752,673 30,993,957 78 .87503 .89487 123,819 194,066 158,318 911,247 24 .99584 .99700 735,357 765,414 750,118 30,242,561 79 .86543 .88604 108,346 173,664 140,424 761,875 25 .99564 .99686 732,297 763,121 747,434 29,493,785 80 .85516 .87657 93,766 153,874 123,285 630,020 26 .99543 .99672 729,105 760,721 744,632 28,747,752 81 .84408 .86636 80,185 134,882 107,047 514,854 27 .99521 .99654 725,773 758,222 741,709 28,004,582 82 .83225 .85543 67,682 116,856 91,832 415,415 28 .99496 .99635 722,298 755,597 738,651 27,264,401 83 .81960 .84370 56,328 99,962 77,757 330,620 29 .99465 .99612 718,657 752,839 735,444 26,527,355 84 .80608 .83121 46,166 84,337 64,913 259,286 30 .99428 .99581 714,815 749,915 732,053 25,793,606 85 .79167 .81787 37,214 70,102 53,365 200,147 31 .99385 .99544 710,726 746,774 728,429 25,063,365 86 .77637 .80370 29,461 57,334 43,150 151,889 32 .99336 .99503 706,354 743,367 724,531 24,336,883 87 .76018 .78866 22,873 46,080 34,270 113,179 33 .99286 .99458 701,667 739,670 720,331 23,614,452 88 .74305 .77275 17,387 36,341 26,696 82,696 34 .99232 .99415 696,655 735,658 715,810 22,896,382 89 .72505 .75595 12,920 28,083 20,366 59,165 35 .99179 .99374 691,306 731,353 710,973 22,182,991 90 .70602 .73831 9,367 21,229 15,193 41,385 36 .99123 .99331 685,629 726,772 705,835 21,474,588 91 .68618 .71974 6,613 15,674 11,063 28,257 37 .99063 .99287 679,615 721,913 700,388 20,771,477 92 .66542 .70036 4,538 11,281 7,850 18,801 38 .99003 .99245 673,248 716,768 694,621 20,073,972 93 .64381 .68008 3,020 7,901 5,417 12,168 39 .98942 .99206 666,537 711,358 688,549 19,382,387 94 .62137 .65903 1,944 5,373 3,628 7,646 40 .98879 .99169 659,483 705,709 682,185 18,697,020 95 .59814 .63719 1,208 3,541 2,354 4,654 41 .98814 .99131 652,091 699,842 675,542 18,018,157 96 .57428 .61461 723 2,256 1,476 2,740 42 .98746 .99091 644,357 693,759 668,619 17,346,077 97 .54970 .59135 415 1,387 892 1,556 43 .98678 .99048 636,279 687,452 661,411 16,681,062 98 .52460 .56746 228 820 519 850 44 .98594 .98996 627,870 680,906 653,916 16,023,398 99 .49901 .54302 120 465 289 446 45 .98517 .98940 619,045 674,073 646,070 15,373,405 100 .47307 .51814 60 253 154 224 46 .98431 .98880 609,864 666,926 637,888 14,731,427 101 .44687 .49283 28 131 79 107 47 .98341 .98813 600,298 659,454 629,350 14,097,809 102 .42054 .46729 13 65 38 49 48 .98246 .98744 590,339 651,625 620,437 13,472,916 103 .39417 .44154 5 30 17 21 49 .98145 .98669 579,984 643,438 611,147 12,857,123 104 .36791 .41573 2 13 8 9 50 .98038 .98589 569,227 634,871 601,466 12,250,816 105 .34191 .38996 1 6 3 3 51 .97926 .98504 558,060 625,913 591,383 11,654,392 106 - .36436 - 2 1 1 52 .97807 .98414 546,485 616,548 580,893 11,068,253 107 - - - 1 - - 53 .97677 .98317 534,499 606,772 569,993 10,492,810 54 .97541 .98214 522,084 596,561 558,661 9,928,483 Note. —The figures are here shown to the nearest whole number only throughout, but rates based upon them are calculated from more exact values. 118 Annual Report of the London County Council, 1912. Mean future life-time at exact ages, in years, of the life-table populations (Ex values). MALES Age. 1901-1910. 1891-1900. 1901-1910. 1891-1900. London. London. Salford. Salford. Brighton. Berlin. Norwich. England and Wales. Scotland. 0 46.74 40.98 40.27 33.30 44.92 37.95 43.87 44.13 44.71 5 54.82 51.60 50.81 48.02 53.94 51.95 55.24 53.50 52.36 10 50.73 47.84 47.05 44.39 49.80 48.40 51.18 49.63 48.60 15 46.21 43.40 42.61 40.00 45.29 43.97 46.77 45.21 44.34 20 41.84 39.13 38.37 35.93 41.09 39.83 42.59 41.02 40.43 25 37.59 34.96 34.28 32.10 37.12 35.76 38.69 37.01 36.75 35 29.50 27.25 26.41 24.44 29.45 28.02 30.66 29.24 29.30 45 22.31 20.65 19.43 17.92 22.54 21.26 23.33 22.20 22.24 55 15.98 14.76 13.38 12.45 16.44 15.22 16.58 15.79 15.85 65 10.56 9.76 8.47 8.30 11.01 10.09 10.54 10.34 10.57 75 6.35 5.91 4.71 5.19 6.49 6.06 6.00 6.15 6.38 FEMALES. Age. 1901-1910. 1891-1900. 1901-1910 1891-1900. London. London. Salford. Salford. Brighton. Berlin. Norwich. England and Wales. Scotland. 0 51.41 45.33 44.66 36.81 50.19 43.81 48.41 47.77 47.47 5 58.63 55.12 53.83 50.31 58.52 57.03 58.05 55.79 54.02 10 54.61 51.49 50.19 46.79 54.53 53.70 54.01 51.97 50.39 15 50.14 47.10 45.80 42.51 50.21 49.33 49.63 47.61 46.26 20 45.72 42.77 41.49 38.29 45.82 45.11 45.34 43.44 42.41 25 41.32 38.46 37.29 34.18 41.42 41.08 41.26 39.37 38.63 35 32.87 30.42 29.14 26.47 33.06 33.34 33.22 31.52 31.37 45 25.21 23.29 21.69 19.75 25.42 25.77 25.58 24.20 24.27 55 18.19 16.72 15.07 13.73 18.41 18.47 18.25 17.24 17.42 65 12.03 11.01 9.68 8.98 11.98 11.97 11.75 11.27 11.60 75 7.17 6.57 5.52 5.69 6.91 6.91 6.76 6.70 7.05 Probability of living one year from exact age of life (Px values). MALES. Age. 1901-1910. 1891-1900. 1901-1910. 1891-1900. London. London. Salford. Salford. Brighton. Berlin. Norwich. England and Wales. Scotland. 0 .84797 .81588 .82595 .73981 .83194 .74524 .79226 .82814 .85657 5 .99449 .99141 .99391 .99121 .99536 .99158 .99454 .99288 .99343 10 .99815 .99775 .99692 .99682 .99785 .99722 .99773 .99786 .99683 15 .99753 .99689 .99678 .99642 .99705 .99704 .99699 .99695 .99614 20 .99655 .99588 .99539 .99341 .99523 .99546 .99513 .99543 .99374 25 .99564 .99477 .99439 .99250 .99412 .99447 .99436 .99432 .99275 35 .99179 .98880 .99020 .99011 .99068 .99022 .99352 .99103 .99066 45 .98517 .98177 .98153 .97540 .98403 .98219 .98642 .98519 .98539 55 .97396 .96892 .96599 .96068 .97390 .97025 .97917 .97432 .97207 65 .95066 .94348 .93697 .92395 .95328 .94674 .95292 .95031 .95084 75 .89982 .88619 .85275 .82767 .90939 .89062 .90625 .89460 .89431 FEMALES. Age. 1901-1910. 1891-1900. 1901-1910 1891-1900. London. London. Salford. Salford. Brighton. Berlin. Norwich. England and Wales. Scotland. 0 .87448 .84569 .85649 .78320 .85894 .78590 .83516 .85934 .88211 5 .99452 .99127 .99349 .99211 .99519 .99136 .99485 .99294 .99322 10 .99802 .99757 .99720 .99650 .99734 .99722 .99759 .99769 .99638 15 .99772 .99721 .99701 .99641 .99732 .99708 .99750 .99694 .99535 20 .99743 .99682 .99632 .99551 .99741 .99584 .99613 .99586 .99434 25 .99686 .99597 .99538 .99438 .99676 .99486 .99532 .99498 .99345 35 .99374 .99142 .99241 .98913 .99376 .99299 .99354 .99218 .99059 45 .98940 .98657 .98632 .98130 .98918 .99098 .98988 .98830 .98814 55 .98104 .97673 .97252 .96660 .98193 .98305 .98426 .97977 .97899 65 .96255 .95562 .94617 .93601 .96503 .96405 .96143 .95813 .95676 75 .91752 .90371 .89929 .84509 .91907 .91293 .92298 .90689 .91475 119 Report of the County Medical Officer-General. Numbers surviving in the life-table population at exact age, per 100,000 born (lx values). MALES. Age. 1901-1910. 1891-1900. 1901-1910. 1891-1900. London. London. Salford. Salford. Brighton. Berlin. Norwich. England and Wales. Scotland. 0 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 5 77,792 71,898 71,565 62,092 75,790 66,173 75,028 77,550 72,393 10 76,472 70,152 69,785 60,296 74,550 64,311 73,430 75,676 71,141 15 75,717 69,295 68,912 59,421 73,785 63,516 72,537 74,482 70,295 20 74,634 68,072 67,633 57,979 72,430 62,219 71,171 72,581 69,001 25 73,230 66,555 65,947 56,013 70,551 60,700 69,389 70,128 67,168 35 69,131 61,742 61,435 51,553 65,732 56,487 64,817 64,895 63,443 45 61,904 53,471 53,697 43,491 58,260 49,438 57,701 57,822 57,360 55 50,925 42,224 41,991 32,117 47,535 39,642 47,585 47,637 48,652 65 35,689 27,764 25,971 17,895 33,836 26,669 33,234 33,033 35,883 75 17,449 12,199 9,243 6,064 17,655 12,268 15,861 16,091 18,059 FEMALES. Age. 1901-1910. 1891-1900. 1901-1910. 1801-1900. London. London. Salford. Salford. Brighton. Berlin. Norwich. England and Wales. Scotland. 0 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100.000 5 80,479 74,937 75,403 65,867 78,656 70,220 80,058 76,386 78,214 10 79,107 73,050 73,461 63,909 77,272 68,152 77,995 75,100 76,527 15 78,305 72,151 72,532 62,880 76,272 67,315 76,600 74,208 75,550 20 77,370 71,089 71,399 61,681 75,306 66,210 74,639 73,108 74,177 25 76,312 69,876 69,969 60,179 74,273 64,737 72,426 71,556 72,539 35 73,135 65,944 66,125 55,726 71,045 60,906 66,918 67,877 68,215 45 67,407 59,196 59,727 48,241 65,449 56,055 60,276 62,578 61,918 55 58,591 49,722 49,413 37,840 56,984 49,520 51,647 55,327 53,310 65 45,106 36,173 33,644 23,473 44,767 39,017 38,342 43,378 39,830 75 25,724 18,592 14,924 8,786 25,837 22,441 20,900 24,702 21,069 120 Annual Report of the London County Council, 1912. CHAPTER XXXIII. REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER (Dr. W. H. Hamer) FOR THE YEAR 1912. Part II.—Education. Introductory Note. On 25th July, 1911, the Council resolved that the whole of the school medical work, including the organisation and administration of medical inspection and treatment of children, should be placed under the direction of the Medical Officer of Health of the County of London. The resolution of the Council thus combined the duties of medical officer of health with those of school medical officer, and took effect from 1st January, 1912. As the result of this decision the public health department has during the year been re-organised, and many changes in administration have been effected. Special attention has been directed to the co-ordination of medical inspection and treatment, "following-up," the control of infectious disease, and the increase of facilities for the cleansing of school children found to be verminous. Inspection and treatment. The need for co-ordination of medical inspection and treatment had been especially felt owing to changes brought about by the passing of the Education (Administrative Provisions) Act, 1907. Section 13 (i.) b of this Act imposed upon local education authorities as from 1st January, 1908, the duty of providing for the medical inspection of children on admission to a public elementary school, and on such other occasions as the Board of Education may direct. This duty was compulsory, but the section foreshadowed further developments by giving power to make arrangements for attending to the health and physical condition of the children. A beginning as regards inspection had been made in 1889 when the late London School Board appointed a part-time medical officer, generally to advise the Board on medical matters, and to examine candidates for permanent appointments. Owing to increase of Work arising out of the Elementary Education (Blind and Deaf Children) Act, 1893, the Board in 1898 appointed two doctors to give half their time to this duty. In 1902, Dr. James Kerr was appointed as medical officer to the Board. Later eight oculists were engaged to devote 200 school sessions each to testing children's eyes, and a ringworm nurse was transferred to the department. On 1st May, 1904, the London County Council assumed control of the work hitherto carried out by the London School Board. The school medical staff then consisted of one medical officer, one assistant medical officer (whole-time), one half-time and two quarter-time. There were also six oculists and six ringworm nurses. In 1905, a scheme was prepared for dealing with the general condition of the scholars, the control of infectious disease, the promotion of cleanliness, school hygiene, and the sanitary condition of school buildings. To carry out this work a permanent half-time assistant, and twenty quarter-time temporary assistants were appointed in place of the six oculists. For dealing with ringworm and personal cleanliness a superintendent and twenty-six nurses were added to the staff. The general routine was for the medical inspector to visit the school and see the classes at work, take note of all hygienic matters, and examine the children presented by the teachers as defective. During the year ended 31st March, 1907, as many as 20,110 children had been examined at the routine inspections, and, of these, 6,271 were found to require urgent treatment. These figures are interesting for the sake of comparison, and as illustrative of the growth of the work in more recent years. For instance, in the year ended 31st July, 1912, nearly 260,000 children were examined, and treatment was actually provided by the Council for nearly 28,000. Medical treatment. The detailed inspection required by the Education (Administrative Provisions) Act, 1907, and carried out in accordance with the Code and Memoranda issued by the Board of Education was begun in March, 1909. This work necessitated a considerable augmentation of the medical staff, and at the end of that year 56 men and 12 Women giving time equivalent to the whole time of 19 medical officers were employed by the Council. About this time, too, the inadequacy of the existing arrangements for treatment was brought into prominence. With the inauguration of a scheme of medical inspection it soon became evident that there was need for further facilities for treatment of some of the ailments discovered. As the result of inspection the numbers of children attenoing the hospitals were so seriously increased that many of the larger hospitals were compelled to limit the attendance for school children to certain numbers of children to be seen on any appointed day. Thus, the London Hospital set apart one day a week, and limited the number of children to 15. The Great Northern Hospital made provision for the attendance of ten children a week. Complaints were also received from the Victoria Hospital for Children, and the Royal London Ophthalmic Hospital as to the very great difficulty in dealing with the numbers of children received. It was evident, therefore, that the time had arrived for more efficient co-ordination of inspection and treatment, and that the facilities for treatment should be materially increased. The story of the growth of the Council's treatment scheme is outlined in the following report, and it will be sufficient here to mention that beginning in January, 1910, by agreement with six hospitals, the Council had at the end of 1912 made arrangements with 11 hospitals and 17 treatment centres for the treatment of 54,208 children suffering from diseases of the eye, ear. nose and throat, from ringworm and from minor ailments. Dental treatment. The Council's dental scheme may be said to date from January, 1910, when advantage was taken of the offer of Dr. R. A. Kirby to provide dental treatment free of charge at St. George's Dispensary, Blackfriars-road, for a period of one year. In order that the utmost benefit should be derived from 121 Report of the County Medical Officer—Education. this offer a scheme was devised by the assistant medical officer who advises on dental matters, and it is from this scheme that the subsequent dental treatment organisation has been developed. Besides voluntary lantern lectures to children and parents the neighbourhood was thoroughly worked up with the result that to-day St. George's Dispensary is one of the most popular of the dental treatment centres. In order to obtain the necessary attendance of children at the other centres it was found necessary to appoint "dental inspectors," as the purely medical inspection did not cover the age group of children amongst whom cases suitable for conservative treatment are more especially to be found. The appointment of dental inspectors has been of great benefit, as, in addition to their work of inspection, the last half-hour of their time is devoted to advising the parents who have been assembled for the purpose. By this means their co-operation and interest is obtained in regard to the teeth of the children, and thus the endeavour is made to minimise the incidence of dental disease and bring about the ideal of combining preventive with curative dental treatment. At the end of 1912 arrangements had been made for the treatment of 18,850 dental cases per annum. The total number of dentists devote each Week 49½ sessions of 2½ hours to treatment, and each fortnight 13½ sessions to inspection in the schools combined with the work of advising the parents on the subject of the care of their children's teeth. Government grant. During the financial year, 1912-13, the State has recognised the claims of local authorities for grants towards the expenses of the medical treatment of school children and services ancillary thereto, and a sum of £60,000 was placed on the Government education estimates for this purpose. Regulations on the subject were issued by the Board of Education in April, 1912, and specified the conditions Under which grants would be made (1) in respect of the medical treatment of children attending elementary schools and work ancillary to medical treatment, and (2) in respect of the medical treatment and care of children suffering from tuberculosis or from ailments for which open-air treatment is specially suitable. No grant was allowed in respect of routine medical inspection, but the Board stated that, in determining the amount of grant for treatment and work associated with treatment they would have regard to the character and completeness of the arrangements and the degrees of efficiency with which the routine inspection was carried out. The Board gave no indication as to the scale on which payment of grant would be made, but the amount actually paid for the work carried out in London under part (1) for the year ended 31st July, 1912, was £12,958 8s. 10d. This represents about 58 per cent. of the expenditure on the work of medical treatment. Developments during year. The resolution of the Council of 25th July, 1911, which had for its object the combination under one head of the Council's public health administration, the school medical service, and the arrangements' for the medical treatment of elementary school children, has necessitated a reorganisation of the Public Health Department. Reference to the following report will show that much has been accomplished but much remains to be done, and the changes here briefly detailed merely indicate the progress made in the year under review. In March, 1912, an experiment was made in the East End of London with a view to the replacement of the part-time school doctors, hitherto employed, by whole-time officers under the control of a divisional medical officer. In consequence of the experience gained the principle was applied from 26th August to the whole county, and four divisions were defined. In addition to the whole-time officer in charge of each division there are in the north-eastern division ten, in the north-western seven, in the south-western seven, and in the south-eastern six school doctors. Four quarter-time officers are also employed, and their services are distributed over the four divisions. At the end of the year the school medical staff consisted of 65 officers, including the school medical officer, who is also medical officer of health, a deputy medical officer, a medical research officer, six full-time medical officers, twelve part-time assistant medical officers, thirty-three full-time medical assistants, four part-time medical assistants, and seven part-time inspecting dentists. Two of the full-time assistant medical officers are engaged at the head office in the supervision of the work of medical inspection, the investigation of epidemics and other medical problems in connection with elementary schools, and three carry out special duties in regard to special schools, higher education, home nursing, first aid, etc. The twelve parttime medical officers devote their time to special schools, secondary schools, ophthalmic, aural, orthopaedic, tuberculosis, and dental work. Twelve of the medical officers and school doctors are women. Concurrently with the reorganisation of the medical staff, the duties of the nursing staff have also been rearranged and extended. At the end of the year the staff consisted of one superintendent of nurses, six assistant superintendents, and 122 nurses. Four of the assistant superintendents of nurses are provided with accommodation at the offices of the divisional medical officers, and each supervises the work of the nurses in her own district. Ninety nurses assist in medical inspection in the schools, 22 supervise the work of cleansing verminous children and ten nurses are attached to the treatment centres. " Following up." In dealing with the question of staff, some reference should be made to the Council's Care Committee system, and generally to the question of "following up," to which much attention has been given by the Council during the past year. Care committees were originally formed in 1907 in connection with the feeding of necessitous children. As reconstituted in 1909, their duties were extended to include arrangements with regard to medical treatment, home visiting and after-care. The members of care committees are voluntary workers appointed according to specified rules by the Children's Care (Central) Sub-Committee of the Council, and a committee is appointed for each school except in the case of very small schools, which are grouped. In order to standardise the work, and insure co-ordination, 27 local organisations have been formed, the representation including members of school care committees, teachcrs' 18820 Q 122 Annual Report of the London County Council, 1912. consultative committees, and the Children's Care (Central) Sub-Committee of the Education Committee of the Council. The local associations are grouped in 12 educational administrative areas, and the school correspondents act as clerks and accounting officers. In connection with the organisation and maintenance of care committees, the Council employs a staff of paid organisers, who act as intermediaries between the Council and these committees, and whose duties include attendance at all the meetings of the local associations, and at meetings of school care committees when specially desired. During the year 1912, one half of the time of one of the principal organisers of children's care work, and the whole of the time of one of the district organisers, was placed at the disposal of the Public Health Department, and, as a temporary measure, the entire organising staff continued to perform its existing duties in connection with medical treatment, the directions with regard to this work being given by the school medical officer. The decision of the Council to allow a care committee representative to be present in the inspection room when the children are inspected has placed care committees in a better position to give suitable advice to parents and to facilitate the obtaining of treatment for the children. The "following up" arrangements have also been improved by the adoption of a special card which is now kept at the school for each child found to require medical treatment. Upon this card the school doctors enter particulars of the defects found at the inspection, the care committees record the various stages in respect of treatment and the school doctors note results of their reinspection. Each case is thus kept before the school care committee until finally discharged by the school doctor. The variations made in the arrangements for "following up" and the extension of the facilities for treatment have thrown a considerable amount of extra Work unon the school care committees. Co-operation with after care associations. The reports of the school doctors upon older children prove to be of great assistance to those engaged in the after care of the children and arrangements have been made whereby the material facts in the medical record are placed upon the "school leaving" form which is sent to the Secretary of the Juvenile Advisory Committee working in connection with the local Labour Exchange. In addition a large number of special examinations of leavers are carried out at the request of care committees and these requests are sometimes made at the instance of the secretaries of the Juvenile Advisory Committees. In accordance with an instruction of the Children's Care (Central) Sub-Committee, a memorandum has been drawn up and issued for the guidance of children's care (school) committees, showing the disabilities from a medical point of view, attaching to certain employments. The need has been greatly felt for pamphlets dealing with health and personal hygiene drawn up in simple language for distribution to parents. The " Health Hints " formerly issued have been revised, and sections dealing with the care of the teeth, discharging ears and ringworm added. Infectious diseases. The question of the control of infectious disease has been facilitated by the establishment of the four local offices. A greater measure of co-operation with local authorities has been secured, and in addition to this more elasticity has been given to the arrangements for medical inspection and reinspection with a view to ascertaining the results of treatment. In fact, without some such system, it would be impossible for the school medical officer properly to control the work being done in the more remote portions of the county, or to secure uniformity of method, a matter of considerable importance in drawing conclusions from the results obtained by such a large number of investigators. The present arrangement has, moreover, enabled a larger number of bacteriological examinations to be made. Formerly, all the necessary preliminary work in connection with suspected cases of disease was done at the central offices. Although the general control of infectious disease is still exercised centrally, preliminary investigations are made locally, and culture tubes are forwarded to the Council's bacteriologist, who is thus able to devote more attention to his legitimate duty. Cleansing and personal hygiene. It is not possible here to enumerate all the activities of the department, of which details will be found in their appropriate places in the following report, but the extension of the cleansing scheme is worthy of mention. Previously to 1902, nurses supplied by voluntary associations had visited some few schools in connection with the personal hygiene of the scholars, but in that year a paid ringworm nurse was appointed by the late education authority, the London School Board. In 1903, three additional ringworm nurses were appointed, and in the summer of 1904 the London County Council increased the number to 12. At the same time, the duties of the nurses were extended to include attention to personal cleanliness as well as ringworm. During successive years increases were made from time to time, until at the end of 1912 there were 22 nurses engaged on work arising out of the cleaising scheme. In the early days considerable difficulty was experienced in obtaining facilities for cleansing, inasmuch as only four borough councils had made suitable provision for children under the Cleansing of Persons Act, 1897, but after the passing of the Council's General Powers Act, 1907, and the Children Act, 1908, both of which gave special powers in connection with the cleansing of children, the Council took active steps to secure adequate provision for cleansing. Thus, at the end of 1911, agreements for this purpose had been made with nine borough councils, and the Council had itself established cleansing stations at four schools. During that year, of 251,592 examinations made, in 14,893 the child was in a verminous condition; 3,682 children were cleansed at the Council's stations, and 1,517 at stations belonging to local sanitary authorities; whilst 4,976 children were cleansed by the parents. At the end of 1912, in addition to the Council's four stations, agreements had been made with sixteen borough councils, and with the committee of St. Cecilia's House. During the year, of 630,369 examinations made, in 23,573 the child was verminous, 10,179 children were cleansed by the Council and the borough councils, and 10,348 by the parents. These results are very satisfactory, and though the effect of the awakening of parental responsibility upon the general health of the children cannot be precisely estimated, there is direct evidence that the children are cleaner and better clad. 123 Report of the County Medical Officer—Education. Modifications have been introduced into the Council's schemes for securing the cleanliness of children attending elementary schools. In the scheme which deals exclusively with children with unclean heads provision has been made for specially communicating with parents in cases where the condition is one of only slight degree of uncleanliness. The scheme for dealing with children suffering with verminous bodies or clothing has been modified so as to give increased facilities for voluntary baths so as to reduce the number of statutory notices served and to secure closer co-operation with the local sanitary authorities for the purpose of dealing with clothing, etc., in the homes. Examination of Candidates. The number of candidates for permanent appointments in the school service and candidates for scholarship awards who were medically examined increased from 5,970 to 5,984. Special reports were made in regard to 941 employees who were unable to carry out their duties owing to personal illness, an increase of 178 or 23.32 per cent. In addition, 107 claims for exceptional treatment in respect of illnesses alleged to have been contracted during the course of school duties were investigated. The pupils in the Council's institutions for higher education and the London County Council scholars in attendance at aided secondary schools have also been inspected and reference is made to the physique, posture and personal hygiene of the pupils. Open air schools. The open-air schools at Birley House and Shooters Hill were both kept open throughout the year; the latter has been enlarged and the former is being transferred to a more suitable site. The Kensal House school for tuberculous children has been continued, but the type of children admitted has undergone some change. Graduated exercise has been given in the form of gardening instruction, games and physical exercises, while steps have been taken for the establishment for the boys of classes in carpentry. The playground classes have largely increased in numbers and some of them were held in the public parks. A detailed statement with regard to these classes will be found on pages 45-55 from which the impression is to be gained that much benefit has been derived by the children. This is obviously the opinion held by H. T., a pupil who has contributed an account of the good resulting from her attendance in the open air class at Eglinton-road school (see page 50). Special schools. The children examined with a view to admission to special schools were 8432, of these 3,957 were certified as suitable for admission thereto and the remainder were either returned to the elementary schools or found to be unsuitable for any of the Council's institutions. The results of the periodical re-examination of the children in the schools for the mentally and physically defective, are shown in the report and a considerable amount of time has been spent on questions relating to family history, heart cases in physically defective schools, classes for myopes and the partially deaf. The duties and salaries of the medical officers of residential institutions have been standardised, the dietary of the residential industrial schools and places of detention has been placed on a uniform basis, and notes have been made in regard to the nutrition, average height and weight, effect of residence on weight and the illnesses and defects of children admitted to the Pentonville-road Place of Detention. Mcdical Inspection. General summary. The work of inspection of children in elementary schools imposed upon the Council by the Education (Administrative Provisions) Act, 1907, was carried out in London during the early part of 1912 by 64 quarter-time, 8 half-time and 6 full-time school doctors, and later in the year by 30 full-time and 4 quarter-time doctors, working in districts under the direction of four divisional medical officers. The doctors are assisted in their work by a staff of 90 nurses, who prepare the children for examination and assist in the weighing, measuring and vision testing. When a child is found to be in need of treatment an advice card is issued and the parent, if present, is informed. If the parent is not present the advice card is delivered at the home of the child by the school nurse. A representative of the School Care Committee is invited to be present at the inspection and makes arrangements for the child to obtain the treatment prescribed. Arrangements are made for the inspection of some children in all the elementary schools in London during each term, the date of the inspection is published in the Council's gazette, and the parents of scholars who are to be inspected are invited to attend- The regulations of the Board of Education require the examination of children entering school life ("entrants") and of children reaching the school-leaving age, which is taken as 11-12 years (" leavers "). In addition to these groups the Council's scheme provides for an examination of children at the age 8-9 and for special and urgent cases not falling within one of these age groups. The record of the medical examination of each child is entered on a card drawn up on the lines of the form prescribed by the Board of Education, and from the information thus classified the tables in the appendix (X. and XII.) are prepared. At the time of the examination the children are weighed and measured and special note is taken of the clothing, cleanliness of head and body, the standard of nutrition, and the condition of the teeth. Details on these points will be found for the children in schools in each of the London boroughs. The classification is made as to whether the conditions found were "good," "fair," or "bad." The interest taken by the parents in the examination of their children is evinced by the numbers who were present at the examination (Appendix IX.) represented as follows :— Children examined Parents present. Percentage. Boys 76,670 44,349 57.8 Girls 77,085 50,836 65.9 Infants 97,625 74,369 76.1 18820 Q 2 132 Annual Report of the London County Council, 1912. There is another point to be noted regarding nutrition. A child 2 cm. and 2 kilograms below normal is probably better nourished than a child 2 c.m. above normal and 2 kilograms below; and comparison with the weight of a normal child of that height shows the following differences :— Boys 8. A —2.7 kilograms Girls 8. A —2.0 kilograms B -2.9 „ B -1-6 „ C -2.4 „ C -2.2 „ Boys 12. A —2.4 kilograms Girls 12. A —1.9 kilograms B -1.9 „ B -1-9 „ C —1.3 „ C -1-8 „ It is found that nutrition in every case is practically identical, and whilst the C schools show a marked deficiency in growth the comparative nutrition is about the same as the other schools. Dr. Pinchin suggests that if it is accepted that the ill-fed, underclothed children of the very poor are not so well nourished as their more fortunate fellows, then the nearer the figures approximate in the schools of the various classes the more good is being done for the children in the poorer schools. 124 Annual Report of the London County Council, 1912. It is noteworthy that at routine examinations in Bethnal-green and Shoreditch the parents of 71 and 67 per cent. of the children were present at the school. In Holborn the percentage was lowest at 49 per cent. Reference to the tables in the appendix (XII.) shows that 35.5 per cent. of the children examined in detail were regarded by the school doctor as requiring treatment, whilst amongst special and urgent cases the percentage was 64.2. The percentage of cases referred for treatment varies from 55.6 in Woolwich, 47.4 in Southwark and 45.6 in Shoreditch, to 21.3 in Stoke Newington, 24.3 in Lewisham and 26.2 in Kensington. The time devoted by the doctors, nurses and teachers to the examination of children is as follows:— No. examined during school hours. Time of doctor in hours. Time per child. Time of nurse in hours. Time per child. Time of teacher in hours. Time per child. 251,380 25,314 6 minutes 34,922 8.3 minutes 23,350 5 6 minutes The heights and weights of children of the two special age groups, 8-9 and 11-12 years, are recorded, but as the figures for 1912 are not yet available, those for 1911 are here shown. In making comparisons it must be noted that the age group 8-9 relates to children born in 1903 and reaching the age of eight during the year 1911. A child born in January, 1903, would be approaching nine years of age at the end of 1911, and a child born in December, 1903, would be little more than seven in the early part of 1911. For purposes of comparison it has been assumed that the children aged 8-9 are born in the middle of the year 1903, and reach the age of eight in the middle of 1911. The time of examination must also be considered and it must be pointed out that the "leavers" were mostly examined in the early part of the year, and the 8-9 group were examined at periods ranging evenly over the whole year. Further reference to the question of heights and weights will be found on page 11. Vision.—The sight of children of ages 8-9 and of " leavers " is tested by means of the Snellen types at six metres distant. During the first two terms the school doctor reported whether the vision was seriously defective or not, but during the third term the actual result of the test was furnished ; it will be noted that during this term some 38,000 children or about 60 per cent. failed to read the type at six metres. In a large proportion of these cases the vision was only slightly below normal and the children were not considered to require glasses. 7,805 cases, were noted for treatment for eyes during this term, and these included cases of disease and squint as well as cases of defective vision. (See Appendix XII.) The number of cases of squint apart from defective vision, viz., 1,457, is shown for the third term (Appendix X. and XII.). This figure represents 1.6 per cent. of the children examined. During the year 1912 children to the number of 251,380 were medically inspected as follows :— Entrants. Leavers. Age 8—9. Special Senior. Special Infants. Boys 47,880 40,035 33,648 2,987 1,769 Girls 46,438 39,574 33,189 4,322 1,538 Mental condition. Mental Condition.—During the third term the mental condition of children age 8-9 and "leavers" was classed under four headings as to varying degrees of intelligence; l=bright; 2=fair; 3=dull; 4=backward; included in group 4 are 43 children reported to be mentally defective. The totals for London are as follows :— Age 8-9. Leavers. Boys. Girls. Boys. Girls. 1 6,264 6,864 2,201 2,093 2 15,316 14,867 4,251 4,248 3 2,794 2,658 591 508 4 427 351 70 57 24,801 24,740 7,113 6,906 Tonsils and Adenoids. Enlarged tonsils and adenoids.—Of the 240,764 children examined in detail (see Appendix XII.) 23,166, or nearly 10 per cent. were found with enlarged tonsils and 15,257, or 6 per cent., were found with adenoids. Of these, 21,826 were referred for treatment. The cases for treatment for adenoids or tonsils formed 9.1 per cent. of the children examined. The proportion amongst entrants was just under 10 per cent., and this declined to 8:7 per cent. among children in the age group 8-9, and further declined to 8.3 percent. among the children in the age group 11-12. This decline is probably due to the fact that some of the children in the later age groups have already been treated either as special cases or in the earlier age group. The complaint seems to be 12") Report of the County Medical Officer—Education. fairly evenly distributed amongst boys and girls, and no special incidence appears to be associated with any locality or with any particular class of children. The proportion of cases referred for treatment varies from 4.6 per cent. in Bethnal-green to 18 per cent. in Woolwich, but it should be noted that while Bethnal-green shows only 4.6 per cent. the adjoining and similar borough of Shoreditch shows 16 per cent. Finsbury has 6.6 and St. Pancras 5.4 per cent. The difference is no doubt mainly due to the varying standards adopted by the school doctors. Other detects ot the nose or throat were tound in 5,720 or 2.4 per cent. of the children examined in detail. Of these 1,324, or 0.55 per cent, of those examined, were noted as requiring treatment. Glands. Enlarged glands.—During the year 12,969 children (Appendix XTI.) or 5.4 per cent. of the children examined were found with diseased or swollen glands. Of this number, in only 1,695, equal to an incidence of 0.7 per cent, was the condition regarded as severe enough to require treatment. The proportion of cases noted as requiring treatment in Shoreditch was 3 per cent.; in Deptford, Kensington and Bermondsey, from 1.9 to 2.4 per cent., while in Bethnal-green and Finsbury 0.14 and 0.5 per cent. only were noted. During the third term of the year defects of the sub-maxillary and cervical glands (which form the bulk of the cases) were classed separately from those of other glands, and during this term only 197 cases of glands other than the cervical or sub-maxillary were noted as enlarged, and 30 were referred for treatment out of 90.000 children examined. Ears and hearing. Ear disease.—Defects in hearing are classed separately from diseases of the ear or discharging ears, but with regard to the figures for treatment which include both classes, a child that has defective hearing due to disease or discharge is not counted for both the defect and the obvious cause of that defect. The figures for children examined in detail are :— Boys Disease of ears. Defective hearing. Cases for treatment. 1,508 (2.05 per cent.) 1,525 (2.05 per cent.) 1,666 (2.26 per cent.) Girls 1,685 (2.32 per cent.) 1,566 (2.15 per cent.) 1,761 (2.42 per cent.) Infants 2,327 (2.47 per cent.) 1,082 (1.15 per cent.) 2,202 (2.34 per cent.) The percentage of children with defective hearing in Shoreditch was 4.9 and in Bethnal-green 1.5. This corresponds with the percentage of cases of adenoids. The close connection between adenoid growths and defective hearing may be demonstrated by taking the random case of the Hoxton electoral area, where during the third term, 69 children were reported to be deaf. Of these 69, 44 were reported to have adenoids and eight had enlarged tonsils. Thus, only 17 cases of deafness occurred in this area in which the defect was not associated with adenoids or enlarged tonsils. Speech. Speech.-—Stammering and other defects of speech such as lisping are noted. Very few of these cases are referred for medical treatment owing to the absence of the necessary facilities. During the year 771 (or 0.3 per cent.) cases of stammering were noted at routine inspection. 561 were boys and 210 girls. As in former years the disproportion between the sexes was marked. A similar disproportion, though to a slighter degree, was noted among the children having other defects in speech. The boys show 991 cases and the girls 668. The cases requiring treatment were :— stammering—bovs. 98: girls. 31; other defects of sneech—bovs. 40; girls, 31. Heart Disease and Amæmia. Diseases of the heart, valvular lesions and other defects were noted in 5,454 cases (2.3 per cent.), 1,134 being referred for treatment. 5,228 (2.2 per cent.) children were found to be anæmic, and of these 2,096 were considered to require treatment. Among the infants there Were more anaemic boys than girls, but in the other age groups the number of girls was greater, indeed among the children of the age groups 8-9 and 11-12 referred for treatment for this cause, the number of girls to be treated was 797 and the number of boys only 484. Lungs. Diseases or defects of the lungs (exclusive of phthisis) were noted in 7,828 (3.25 per cent.) children, 2,957 (1.23 per cent. of the number examined) of whom were referred for treatment. In Shoreditch the percentage was 9.7 cases found and 5.5 referred for treatment, and in Bermondsey 5.9 per cent.of cases found, and 3.0 per cent. referred for treatment, while in Lewisham, the percentages were 0.6 and 0.1 respectively. Nervous Diseases. Nervous defects were noted in 2,247 children (0.9 per cent. of those examined) and 637 of these were reported to reauire treatment. The cases were fairlv evenlv distributed between the sexes. Tubercular diseases. Tubercular diseases.— 740 (.31 per cent.) cases of phthisis were noted at routine examinations, and 439 of them were referred for treatment. The cases for treatment were: boys, 203; girls, 236. In addition to these cases 188 (1.77 per cent.) children among the special or urgent cases were found to present symptoms of phthisis and 111 of these were referred for treatment. (Appendix XII.) Tubercular diseases, other than phthisis, were noted in 585 children in the three age groups, and in 108 children among those specially examined. Of these 693 cases 222 were referred for treatment. Comparing the various districts the highest phthisis case-rates occur in Shoreditch (0.61), Finsbury (0.60), Fulham (0.53), and Holborn (0.52). The lowest in Stoke Newington (0), Lewisham (0.04) Hammersmith (0.16), St. Pancras (0.16), and Wandsworth (0.18). Rickets. Other tubercular diseases were reported most frequently in Stepney (0.62), Holborn (0.48) and Finsbury (0.48 per cent.); the lowest rates were in Lewisham (0.06), Greenwich (0.07), and Stoke Newington (.07). (Appendix X.) Rickets.—4,074 (1.69 per cent.) children were noted as having rickets. Of these 2,634 were boys and 1,440 girls. The proportion was found to be highest among the "entrants" and lowest among "leavers." The percentage was as low as 0.3 in Lewisham and Greenwich and as high as 4.5 in Hackney and 5 in Hampstead. 126 Annual Report of the London County Council, 1912. Deformities. Deformities.—3,840 (1.59 per cent.) children were noted as having deformities and 1,082 (0.45 per cent.) were regarded as requiring treatment. Amongst the infants the boys with deformities formed 1.35 per cent. of those examined and the girls 0.74 per cent. In the age group 8-9 the proportions were bovs 1.87 per cent., girls 1.97 per cent., and at age 11-12 boys 1.61 per cent. and girls 2.32 per cent. The chief deformities noted were bow legs, talipes, and deformities of the chest among younger children and curvature of the spine among the older children. It is clear, therefore, that many cases of deformity amongst younger children are in effect due to rickets and the numbers referred to previously under this heading are to this extent less than they should be. Infectious Diseases. Infectious diseases.—Very few cases of infectious diseases are found at the routine examinations. Such cases are usually detected at home or by teachers in the school. In 118 cases or 0.05 of those examined some symptom of one or other of the infectious diseases was found, but only 46 of these cases were regarded as requiring medical attention, exclusion from school and home treatment being sufficient for the remainder. Among the special or urgent cases referred for examination 17 cases of infectious disease were noted. Full details of cases of infectious disease amongst elementary school children will be found in another part of this report. (See page 145). Malnutrition Malnutrition.—1,068 (0.44 per cent.) children were noted as badly nourished, and of these 1,012 were referred for treatment. In addition to these, 71 children not coming within the special age groups were found, and 68 of them referred for treatment for malnutrition. These cases, when necessitous, are usually given milk and cod liver oil in school. The proportion of cases was higher among bovs than girls, the ratio being 56 to 44. Bethnal-green had 19 per 1,000, Woolwich 18, Bermondsey and Poplar each 8 per 1,000, Hampstead 7 per 1,000, Stepney and Southwark each 6 per 1,000. Kensington had less than one per 1,000, Chelsea, Westminster, Finsbury, St. Pancras and the City of London had iust over one per 1,000 (Appendix X.). During the third term of 1912 the children were grouped as regards nutrition into four divisions— (1) good, (2) normal, (3) below normal, and (4) bad, and during this term 497 cases were classed as definitely "bad." In Woolwich only one such case was reported and this tends to show that the standard adopted throughout the year in Woolwich must have been much higher, inasmuch as 18 cases in every 1,000 were returned as cases of malnutrition, indeed, many cases which during the third term were classed in division 3 (i.e., sub-normal) were regarded as cases of malnutrition and referred for treatment for this cause. The same may be said of Hampstead, where no cases were entered in class 4 during the third term, and yet on the year's figures this borough shows a rate of 7 per 1,000. Of the 497 cases of definite malnutrition, Bethnal-green had 160, Stepney 93, Bermondsey 60, Poplar 41, Islington 30, Southwark 22 and Lambeth 20, while no cases were reported in Kensington, Westminster, Hampstead, St. Pancras, Holborn or Finsbury. In the two boroughs last named, and in some other boroughs also, it must be assumed that the absence of recorded cases of malnutrition is attributable to the inclusion of such cases under the heading "3" instead of their being referred to the heading "4." All cases marked "Nutrition 4" are made the subject of special investigation, stress being laid on the condition of the home, the food the child receives, adequacy of sleep, etc. Dr. Thomas has analysed the reports relating to 200 children suffering from malnutrition. He found that the following conditions were noted as being either the main or contributory causes of the deficient nutrition :— Conditions of ill-health (apart from tuberculosis) 64 Tuberculosis 40 Necessitous conditions at home 93 Insufficient sleep 44 Overcrowding 32 Mother at work all day 17 Neglect at home 10 Congenital debility 12 Prematurity or other adverse conditions at the time of birth 8 Pre-natal influences 5 Infantile illness, chiefly rickets 10 in no less than 82 instances out of the 200 the conditions of the home were said to be 'good, and some reports contain notes such as "comfortable home," or "maid kept," Dr. Thomas formed the conclusion from the history of these cases that a number of the children had only survived the adverse conditions at birth or subsequent illness by reason of the special care bestowed on them by their parents, and that had they been born in necessitous circumstances or been neglected they would in all probabilitv have died. An attempt was made to assign the main cause of the malnutrition of these 200 cases with the following result:— Cases. Per cent. Under feeding due to necessitous conditions 74 37 Recent illness—tuberculosis 40, other illnesses 41 81 40.5 Congenital debility, prematurity and pre-natal conditions, and infantile illnesses 24 12 Neglect 8 4 No definite cause apparent 13 6.5 200 127 Report of the County Medical Officer—Education. Feeding was provided at school for 95 of these cases, 81, being necessitous and 14 being cases in which the children's parents themselves desired to pay for milk meals. Of the 74 cases in which underfeeding was adjudged the chief cause, 46 were placed on the feeding list for the first time as a result of the medical examination, 16 were already being fed, and 12 were, for various reasons, not fed at school. Among the cases of the 16 children who were already being fed the following additional measures were taken in consequence of the medical report. Milk or cod liver oil was given in addition to dinners in eight cases, convalescent treatment obtained for two, and hospital treatment for two. In the 12 cases not placed upon the feeding list the following measures were taken—for 4 children hospital treatment was obtained, for two, a county holiday was arranged, in two cases the home conditions had improved and parents were able themselves to provide extra nourishment, one child was out of school but was fed on return, in one case the question of providing milk meals is now being considered by the care committee, one case was referred to the organisers for further report, and for one child milk and cod liver oil were obtained from outside sources. In the case of the 42 children whose malnutrition was due to illness other than tuberculosis, amongst which convalescence from infectious disease and suppurating ears were noticed, the following measures were taken—Provision of free milk meals at school 2, of milk meals paid for by parents 8, of extra nourishment from other sources 11. Medical treatment at a hospital or health centre was arranged for in 16 instances, a country holiday in 3, while 2 were nominated for admission to special schools. One child of the 42, whose malnutrition was due to illness, died not long after the condition was diagnosed. In the 40 cases in which tuberculosis was suspected, or actually diagnosed the following measures were taken—In 25 cases cod liver oil, malt and milk were provided at school; 19 of these cases were necessitous, and the parents contributed in the case of the other six. Twenty cases obtained sanatorium, dispensary or other medical treatment, one was nominated for a physicallv defective school, and one case in which neglect was suspected at home was reported to the special officer for visitation. In all these cases the sleeping accommodation in the home was investigated and advice as to management in this and in other directions was given. All these cases are still being kept under careful observation. Of the 24 cases in which prenatal or congenital conditions had been the chief cause of the malnutrition extra nourishment was provided in four cases, medical treatment arranged for in four, while in the others, mainly coming from good homes, it was considered that no special action was necessary as the parents were fully aware of the delicacy of the children and had taken all possible care of them. Among the eight cases in which neglect appeared to be the chief factor one was removed to a remand home, one to one of the scattered homes of the poor law authority, two were reported to the National Society for Prevention of Cruelty to Children, and in one case where the parents were addicted to alcohol, meals were given at school and steps taken for the recovery of the cost. The remaining three were reported to the "special" officer, an improvement being reported after visiting in two of these cases. Seventy of the 200 cases have been re-inspected by the school doctors, and of these 36 are reported as being improved. The improvement in some cases has been such that the children can no longer be classed as ill-nourished. The improved condition was observed in 15 after milk meals and cod liver oil had been provided at school, in 13 after attention had been given at home to the suggestions of the school doctor and care committee, in seven after medical treatment, and in one after a country holiday had been provided. Two of the cases re-inspected are reported to have lost ground, one being a phthisis case under treatment, and one being a case where home conditions are unsatisfactory. Skin defects. Diseases of the skin.—Under this heading are classified cases of such skin diseases as impetigo, eczema; parasitic diseases as scabies and, for the third term, figures relating to the presence of nits in the hair are included. Ringworm cases are for the most part excluded from school by the nurses, who examine children of all ages for this complaint, and it is comparatively rare for a case to be discovered for the first time by the doctor at routine examination. Figures relating to ringworm will be found in another part of the report (p. 156). The "skin defects" found by the doctor numbered 8,109, and 1,896 of these were noted as requiring treatment. Of these 8,109 defects. 5,152 or 64 per cent. were among girls, but the girls had only 44 per cent. of the cases referred for treatment. This difference between the percentages is accounted for by the fact that nits were found to a greater extent among girls, while the ordinary skin diseases which would provide the cases for treatment were more prevalent among boys. Other defects. Other defects.—The examination of children in the three age groups disclosed 6,327 defects other than those named in the tables. 3,017 of these cases were referred for treatment. 605 other defects were found among the special or urgent cases and 339 of these were noted for treatment. The cases include debility (when not associated with malnutrition), diseases of the digestive system, urinary diseases, hernia, abscesses, etc. In comparing the figures for various districts it should be borne in mind that the elementary school population is somewhat different from the school age population in relation to social conditions. In the County of London 72.2 per cent. of the children of school age (3-14) (census 1911) are on the roll of the elementary schools. In Shoreditch the percentage is 79.2, Bethnal-green 78.3, Poplar 77.0, while in Hampstead it is 49.7, Lewisham 59.3, Kensington 66.1. In Kensington the elementary school population resides chiefly in North Kensington, while Hampstead elementary school children reside mostly in the Kilburn and West Hampstead divisions of the borough. The social conditions of these districts approximate more to the general London average than is the case when the whole of each of these boroughs is considered. In Lewisham, on the other hand, the schools are more evenly distributed throughout the borough, and the elementary school population is more similar to the school age population. 128 Annual Report of the London County Council, 1912. Special and urge nt cases Certain children not in the age groups coming automatically for examination selected for special medical examination because of some more or less obvious defcct or symptom of disease detected by the head teacher, the school nurse, school doctor or representative of the school care committee, and occasionally at the request of the parent. These cases, being selected, cannot be taken as a basis for forming any judgment of the general health of school children, and the relative proportions of such cases in the various districts must depend to a certain extent on the energy or powers of observation of the head teacher or care committee representative. During the year 10,616 special cases were examined, and of these 6,816 (64.2 per cent.) were referred for treatment. (Appendix XII.) Among the special and urgent cases the children with skin diseases formed 5.3 per cent., children with defective teeth requiring treatment 9.9 per cent., cases of adenoids or enlarged tonsils requiring treatment 14.6 per cent., children needing treatment for diseases of the eyes or defective vision 21.9 per cent., diseases of the ears or hearing 9.4 per cent., heart affections 5.2 per cent., anæmia 3.7 per cent., phthisis 1.8 per cent., while 2.4 per cent. of the children had deformities, and 0.67 per cent. were found with malnutrition. Many special cases were examined at various schools or centres on Saturday mornings. These cases were referred by the school care committee, the head teacher, the divisional superintendent or the school doctor himself. A large number of these cases were children who for one cause or another had not recently been attending school. Other cases elder children leaving school, were examined as to fitness for some particular occupation, while a number of children, contacts of cases of phthisis, were specially examined to ascertain whether they presented symptoms of this disease. Children who have been in contact with cases of infectious disease are also examined to ascertain whether any signs of infection are present. 450 children were examined at these inspections during the third term and 164 cases were referred for treatment. The following defects were found:— Skin defects, 3; defective teeth requiring treatment, 28; enlarged tonsils, 27; adenoids, 22; defects of throat and glands, 14; eye diseases, 23; squint, 10; defective vision requiring treatment 54 ; disease or discharge from ears, 12; defective hearing, 4; heart affections, 18; anaemia, 21; lung complaints. 49: phthisis. 29: deformities. 13: rickets. 1: malnutrition. 3: other defects. 13. Comparison of age groups. Comparison of age groups.—The results of the complete examination of all children at three age groups should give comparative figures of considerable value as bearing upon the effect of school life in ameliorating or aggravating various defects. (See Appendix XII.) The percentage of children referred for treatment for enlarged tonsils and adenoids tends to diminish during school life. The highest percentages, 10.73 boys and 9.20 girls, are found amongst the infant group, falling to 8.76 boys and 8.61 girls amongst the middle age group and to 7.92 boys and 8.68 girls amongst the oldest group. Discharging ears are highest amongst the entrant infants (boys 2.47, girls 2.46) and lowest amongst the oldest children (boys 1.98, girls 2.03). Defective hearing, on the other hand, shows an increase during school life from 1.06 per cent. boys and 1.23 per cent. girls amongst infants, to 1.90 per cent. boys and 2.10 girls in the middle age group and 2.21 per cent. boys and 2.19 per cent. girls in the oldest group. Some allowance in the case of infants must, no doubt, be made on account of the difficulty of discovering subjective defects among them, but on the whole these figures appear to indicate that the attention which defects of nose, throat and ears now receive has resulted in a progressive amelioration during school life of primary conditions, but that the secondary results as shown in defective hearing accumulate and that many children suffering from the primary defects are still not detected or brought under treatment early enough to avoid the danger of permanent damage. Heart disease tends to increase during school life, being found in 1.85 per cent. boys and 1.73 per cent. girls amongst infants and in 2.24 per cent. boys and 3.01 per cent. girls amongst the older children. This is again probably to be explained by the cumulative results of attacks of rheumatism, scarlet fever and chorea. It must be remembered also that a large number of the more pronounced cases of heart disease at the older ages are either excluded from school or drafted into physically defective schools. Diseases of the lungs (other than phthisis) on the other hand are found in considerably larger proportions among the younger children, being recorded in 4.58 per cent. boys and 4.45 per cent. girls amongst infants, 3.75 per cent. boys and 3.40 girls in the middle age group, and 1.55 per cent. boys and 1.42 per cent. girls in the oldest group. This preponderance in the younger children of lung trouble is due to the prevalence of bronchitis associated with rickets. Rickets—The number of children reported as suffering from the effects of rickets is naturally highest amongst the entrants, 2.77 per cent. boys, 1.44 per cent. girls; with increasing age the effects of this disease become less easily recognisable and only 1.19 per cent boys and 0.80 per cent. girls are reported amongst the oldest group. It has been pointed out that many of the deformities found amongst entrants are really the effects of rickets although they have not been classed under that heading and the number of infants suffering from the effects of rickets would probably be still higher than these figures show. Deformities.—In spite of the fact above mentioned that the number of deformities among infant children is swollen by the inclusion of certain cases which should be properly classed as rickets, the percentages of deformities show a tendency to increase during school life. Amongst entrants 1.35 per cent. boys and .74 per cent. girls are reported; in the middle age group 1.87 per cent. boys and 1.97 per cent. girls, and in the oldest age group 1.61 per cent. bovs and 2.32 per cent. girls. It is to be remembered that many children at the older age group suffering from grave deformity are out of school or drafted into schools for the physically defective. 129 Report of the County Medical Officer—Education. The shifting of sex incidence is probably due to the inclusion of rickets, which is more prevalent amongst boys at the younger ages, and to the increase at the older ages of minor degrees of spinal curvature, which is more prevalent among older girls. Squints.—The vision of infants cannot be tested in school, but during the third term of 1912 squints were recorded separately for each age group, and for the first time we are enabled to state the number of infants entering school who have already developed this condition. Out of 13,144 entrant boys the number with squints was 251 or 1.91 per cent., and out of 13,269 entrant girls examined the number with squints was 272, or 2.05 per cent. It is of importance to note this fact, inasmuch as the proportion of squints found in the 8 to 9 group of children is less, amounting to 1.6 per cent. boys and 1.5 per cent. girls. It would, therefore, appear that in spite of school work, involving the close use of the eyes, there is a tendency towards restoration during school life of the co-ordination of the eyes in children in whom it has been disturbed before admission to school. Vision.—The number of children failing to reach the acuity of vision regarded as normal is only available for the third term of 1912, and during this term practically only the middle age group was being examined. The percentage of children during the whole year who were referred for treatment on account of the condition of the eyes was 10.62 boys and 11.30 girls in the middle age group, and 14.57 boys and 16.10 girls in the older group. These figures include cases of external eye disease, but it may be taken that the incidence of the latter is fairly constant in each sex and age group, and that the excess of numbers referred for treatment at the older age group is on account of the larger amount of visual defect. The greater incidence upon girls is also noteworthy in connection with the theory that some amount of visual defect is caused by excessively fine work in school, which of course is more marked amongst older girls who do fine sewing. When considering the numbers of children referred for visual defect, however, it should be made clear that the standard of defect requiring treatment has been higher in the older age group than in the middle age group, and (apart from the sex incidence) these numbers cannot be taken to throw any light on the vexed question of how far visual defect is caused by modern school conditions. Tuberculosis.—There is very little variation from the average of 0.31 per cent. for all children inspected to be noted in the percentages of cases of pulmonary tuberculosis found at each age during routine inspection. The lowest percentage during the past year was 0.23 recorded in entrant boys, the corresponding percentage in entrant girls being 0.30. In the middle-age group the percentage was 0.32 in boys and 0.36 in girls, and in the oldest age group 0.36 and 0.31 for boys and girls respectively. Other forms of tuberculosis were found more frequently in the middle-age group than in the younger or older children. The percentages in the middle age group were 0.30 and 0.37 in boys and girls respectively, as compared with 0.24 and 0.20 in the entrant group, and 0.23 and 0.15 in the oldest age group. Many of the older children suffering from tuberculosis of the bones and joints are, of course, drafted into schools for the physically defective, and therefore do not appear in the statistics of routine examinations. Defects of the nervous system are found most frequently in the middle age group, amounting to 1.29 per cent. in boys examined and 1.24 per cent. in girls, the corresponding figures in entrants being 0.75 and 0.80 per cent. and in the oldest group 0.75 per cent. and 0.93 per cent. in boys and girls respectively. Similarly a greater incidence of speech defects is discovered amongst children of the middle-age group, although the age variation is here over-shadowed by the sex variation—boys, as previously pointed out, being considerably more prone than girls to suffer from defects of articulation. The percentages of cases of stammering in boys are 0.26 in entrants, 0.62 in the middle age group, and 0.57 in the oldest age group. The corresponding percentages in girls are 0.15, 0.21, and 0.18 for the entrant, middle and oldest age groups respectively. Malnutrition and anæmia have been separately recorded, and it is noteworthy that both these conditions, which are intimately associated with each other, aae found to be most prevalent in the middle age group of children. group of children. It is not at present clear why this should be so Anæmia Malnutrition Infants. Boys 2.13 .34 Girls 1.93 .34 Children aged 8-9. Boys 2.67 .97 Girls 2.94 .67 Children aged 11-12. Boys 1.37 .27 Girls 2.24 .23 Clothing, nutrition, cleanliness and teeth.—In accordance with the schedule of the Board of Education the condition of all children with regard to clothing, nutrition, cleanliness and teeth is classified into good, average and bad. The percentages of the figures resulting from this classification have been set out for the different boroughs of London. In making a comparative estimate of this kind the school doctor or school nurse is naturally influenced by the condition of the children as a whole whom he is at the time engaged in examining and the estimate of good, average or bad can only have reference to his recent experience. While such estimates, therefore, have some value in directing the attention of the care committees and head teachers to the cases in each school most in need of special consideration, and some value in comparing the conditions of a particular school with others in the same school doctor's area, it is clear that no special significance can be attached to them for the purpose of comparing district with district. In the aggregate, however, such estimates are of some value in comparing the conditions according to age and sex. 18820 R 130 Annual Report of the London County Council, 1912. Clothing. Nutrition. Condition of Cleanliness. Condition of Teeth. Good. Av. Poor. Good Av. Poor. Good. Av. Poor. Good. Av. Poor. Entrants B. 48.5 45.5 6.0 40.9 51.3 7.8 60.5 34.1 5.4 61.9 27.8 10.3 G. 50.6 44.6 4.8 43.1 50.3 6.6 60.9 33.5 5.6 62.6 27.3 10.1 Aged 8—9 B. 46.5 46.3 7.2 26.6 58.4 15.0 62.9 31.7 5.4 45.6 37.4 17.0 G. 49.7 45.2 5.1 30.6 56.5 12.9 63.7 31.0 5.3 46.5 37.0 16.5 Aged 11-12 B. 44.8 47.1 8.1 35.6 56.0 8.4 57.5 36.3 6.2 47.3 39.8 12.9 G. 48.8 45.9 5.3 39.2 53.2 7.6 58.7 35.2 6.1 50.6 37.6 11.8 It will be observed that in cleanliness and condition of clothing there is very little difference to be noted either in age or sex, and this would be expected, inasmuch as these conditions have little relationship to school influence or to bodily development. With regard to nutrition, it is to be noted that a much greater proportion of children in the middle age group are reported as poor and a much lower proportion as good than amongst the infants and oldest children. This corresponds with the findings in anaemia and malnutrition (which is really a lower class in nutrition than poor) and, as stated above, there is not at present any explanation of this remarkable fact. With regard to condition of teeth it is also to be noted that the middle age group show the most unsatisfactory results. This, of course, admits of the easy explanation that they are at the age in which the milk teeth are being shed and that in too many cases this is attended by caries of the deciduous teeth with consequent sepsis of the mouth, which in a certain number of cases spontaneously improves after shedding of the teeth, this improvement, of course, being largely dependent upon whether the caries has spread to the permanent teeth or not. Heights and weights. Heights and weights.—The standards of height and weight in use in London are based upon a set of curves prepared from the measurements made in London schools of 18,000 children distributed over various ages and published in the Report of the Medical Officer (Education) for the year 1906. The figures now available for 1911 are based upon the largest set of simultaneous measurements of children of particular age groups that have ever been recorded in this or any other country. It is, therefore, of extreme interest to compare them with the previous standards which are based upon much smaller numbers. In doing so it is necessary to determine with some accuracy the average age of the children measured. The older age group were children who reached the age of 12 during the calendar vear, but as the inspection of this group was completed in the early part of the year the average age would be ll¾ at the time they were measured. The younger age group consisted of children arriving at their eighth birthday during the year, and as their examination was pretty evenly distributed over the year their average age would be 8 at the time of measurement. Compared with the standard the present measurements are extremely close, in no instance is the difference between the two sets of averages more than a fraction of a centimetre, while the weights are so close that they may be called identical. This shows that the 1906 measurements are sufficiently representative of the whole of the school population and may be relied upon as standards over the ages 7 to 14. Certain figures have been collected by Drs. Tuxford and Glegg from measurements of children examined under the Education (Administrative Provisions) Act throughout the country ; by charting these upon a curve the measurements of children at the ages corresponding to the children measured in London have been deduced and are shown below. The 1911 measurements in London show amongst children aged 7 to 9 that the boys are taller and heavier than the girls, the average being—Height, 118.62cm. boys and 118.14cm. girls; weight, 22.20 kilos boys, 21.64 kilos girls. In Holborn, City of London, Hackney, Poplar and Paddington the average height of the girls measured exceeds that of the boys, but in none of the boroughs does the average weight of the girls exceed that of the boys. In the 11-12 group the girls are found to be taller and heavier. The average for London in this group is—Height, boys, 136.14 cm. ; girls, 137.32 cm. Weight, boys, 30.57 kilos; girls, 30.77 kilos. In every district in London the girls at this age were found to be taller than the boys, but in Lewisham, Deptford, Bethnal Green, Shoreditch, Holborn, Finsbury, St. Pancras, Stoke Newington and Chelsea the boys were on the average slightly heavier. 131 Report of the County Medical Officer—Education. Relative physique and incidence of disease in school children with reference to environment and social status. Dr. Scott Pinchin has paid special attention to the differences found amongst children inspected at schools under his care, classified into different types according to the social conditions of the homes from which the children come. He points out that since his enquiry was commenced a report on somewhat similar lines has been made by Dr. Neave on conditions found in Manchester—in which it was shown that whilst the children in the better class schools approximated to the anthropometric standard, in the poor class schools they were considerably below the standard. For the purposes of the present enquiry a series of schools extending over a large area in the South-West of London was taken ; the pupil population being about 22,000. The schools vary from some counted as being amongst the best class elementary schools in London to some of the worst; at the same time it is possible that worse results might be obtained from the schools in crowded districts in inner London. The parents of the best class are of the clerk and small shopkeeper type, mostly living in separate houses; those of the worst are labourers and casuals of all sorts, living in small houses, (in many cases several families in the same house) in a very poverty-stricken neighbourhood around the River Wandle. About 5,000 children have been examined and their defets relative to age, sex and environment tabulated. The schools have been divided into good, medium and bad, represented below by A, B, and C respectively. The numbers taken in the calculation of the height and weight averages do not comprise the whole of the children examined owing to the fact that children suffering from any marked disease have not been included in any of the groups. These figures are compared with the anthropometric standard allowing a regular increase in height and weight for each month. Differences such as Dr. Neave found in Manchester in the 13-year-old age group obtain, but to a much smaller extent; and this would appear to be far more satisfactory; for if the child is taken into hygienic airy surroundings and fed if necessary, there should not be such a vast difference between the three classes. The maximum difference in weight in boys and girls of 12 is approximately 2 kilograms in each case, as against 5.3 boys and 3.5 girls in the Manchester series. The maximum difference in height is 4.2 c.m. in boys and 2.0 c.m. in girls, as against 11.7 and 7.8 cm. in Manchester schools. In the C schools the height and weight in each group are both considerably inferior; but comparing A and B schools with one another there is not such a big class difference, as every A school has a considerable number of B class children and vice versa, but a difference is still to be traced, except that in the case of bovs asre 12 and girls ace 8 there is a slightly better result in the B schools. It is to be remarked that in the 8-year-group in A schools the height is well above normal and is reduced to slightly below normal in the 12-year-old group. No. Average Age. Average Ht. in cms. Average Wt. in kilograms. Variation from Standard Height. Variation from Standard Weight. BOYS 8—9 YEARS. Class A 135 8 3/12 123.4 23.7 +2.3 —1.8 „B 193 8 2/12 122.3 23.0 + 1.7 —2.4 „C 170 8 2/12 120.0 22.7 -0.6 —2.7 GIRLS 8—9 YEARS. Class A 149 8 1/12 121.1 22.5 + 2.6 —1.2 „B 131 8 4/12 121.7 23.1 + 1.7 —0.9 „c 111 8 3/12 121.4 22.3 —2.1 —1.7 BOYS 11—12 YEARS. Class A 134 11 5/12 137.0 30.9 —0.4 —2.6 „B 228 11 3/12 137.0 31.4 +0.4 —1.8 „C 156 11 8/12 133.8 30.3 —4.6 —3.8 GIRLS 11—12 YEARS. Class A 115 11 4/12 136.8 30.2 —0.2 —1.9 „B 159 11 8/12 137.6 30.8 —1.2 —2.6 „C 132 11 7/12 135.1 29.4 —3.1 —3.7 The falling off in growth as compared with the anthropometric standard shows as follows during the vears 8—11. Boys. A 2.7 c.m. Girls. A 2.8 c.m. B 1.3 c.m. B 2.9 c.m. C 4.0 cm. C 5.2 cm. These figures show that the B schools are the more normal in this respect. Both the A and C schools show a great falling off in growth between 8 and 11 years, and in the C schools this is half as much again as in the A schools. It is thus seen that among the better schools the rate of growth is much increased during the first three years of school life with a larger decrease during the next three years. 18820 r 2 Annual Report of the London County Council, 1912. There is another point to be noted regarding nutrition. A child 2 cm. and 2 kilograms below normal is probably better nourished than a child 2 c.m. above normal and 2 kilograms below; and comparison with the weight of a normal child of that height shows the following differences:— Boys 8. A —2.7 kilograms. Girls 8. A —2.0 kilograms. B -2.9„ B -1.6„ C -2.4„ C -2.2„ Boys 12. A —2.4 kilograms. Girls 12. A —1.9 kilograms. B —1.9„ B —1.9,, C —1.3„ C —1.8,, It is found that nutrition in every case is practically identical, and whilst the C schools show a marked deficiency in growth the comparative nutrition is about the same as the other schools. Dr. Pinchin suggests that if it is accepted that the ill-fed, underclothed children of the very poor are not so well nourished as their more fortunate fellows, then the nearer the figures approximate in the schools of the various classes the more good is being done for the children in the poorer schools. 132 The defects of 4,353 of the children examined have been tabulated : — No. Examined. Defects excluding teeth. Teeth. Tonsils and Adenoids. Eyes. Heart Disease. Otitis. Enuresis. Curvature. % % % % % % % % Total No 4,353 33.2 32.1 16.0 7.3 1.5 0.9 0.7 1.2 A 1,066 31.0 39.0 16.0 7.0 1.3 0.5 0.2 1.5 B 1,653 34.4 32.8 15.8 8.8 1.3 1.1 0.5 1.1 C 1,634 33.4 27.1 16.4 6.4 2.0 1.1 1.1 1.1 Children who required the attention of a dentist have all been included. Children under 5 years were not included if they only had one or two slightly carious teeth, nor were children who had loose carious teeth likely shortly to fall naturally. Class. Infants. Boys 8. Girls 8. Boys 12. Girls 12. Totals in all departments. A. 39.0% 48.3% 41.2% 31.0% 27.1% 39.0 per cent. B. 32.8% 44.0% 47.0% 34.0% 27.4% 32.8,, C. 24.4% 35.4% 30.6% 16.0% 28.5% 27.1,, The above figures show, as has been pointed out in previous reports, that the teeth of the children are better in the poorer class schools and in actual inspection this would be far more noticeable, if account had been taken in the figures of the number of carious teeth per child ; the C schools would show even better results if this had been done. This difference has been accounted for by the coarser food eaten by the poorer class children, and possibly by a smaller supply of sweets. Dr. Pinchin is also of opinion that the cheaper sweets, i.e., those of the boiled sugar variety, are less detrimental than the better kinds such as chocolates and caramels, which have far more tendency to cling round the teeth and form a nidus for fermentation. In the matter of the teeth the school doctor is much handicapped by the attitude of the dentists who attend this class of patient; and who in most cases, when the children are taken at the school doctor's request, refuse to remove the carious first teeth even after the six-year-old molars are through. In most cases this is quite in accord with the parents' view, and this fact renders satisfactory treatment very difficult. There is, however, Dr. Pinchin reports, great satisfaction in reinspecting the mouths that have been treated at the Wandsworth Treatment Centre, which does first-rate work amongst the children whose parents can be persuaded to take them. The following figures relating to nasal obstruction are mostly made up of tonsils and adenoids but include a few cases of hypertrophied turbinates and deflected septa. Totals. A 15.0 per cent. B 22.1„ C 17.7„ Class. Infants. Boys 8. Girls 8. Boys 12. Girls 12. A. 23.4% 15.0% 13.1% 10.1% 6.3% B. 22.1% 17.0% 17.5% 10.0% 10.4% C. 17.7% 20.9% 15.2% 12.5% 11.9% 133 Report of the County Medical Officer—Education. These figures show very little difference in the various schools. The boys show a decided preponderance over the girls; and the numbers appear to be decidedly less in the infants in the C schools; taken as a whole the results of operation have been very satisfactory, more care is taken nowadays in directing the parent as to after care, and in most cases improvement is noticed by the teachers in the children's aptitude for school work. Out of 13,500 children in the boys' and girls' divisions in various schools the numbers wearing glasses were as follows :— Schools. Boys. Girls. A. 7.3% 6.8% B. 4.8% 6.9% C. 4.6% 6.3% The numbers appear fairly uniform; the girls preponderate in all cases except the A schools. It was thought at first that this might be due to the parents in the A schools being more willing to go to the expense of glasses for the boys whilst the parents of the B and C schools only made an effort on behalf of the girls; but it was found that in the children examined in the A schools the boys with defective vision were also in the majority. Of the children examined the following percentages were found to have defective vision - Schools. Boys 8. Girls 8. Boys 12. Girls 12. A. 9.5% 7.5% 10.1% 7.7% B. 8.0% 9.7% 10.1% 19.0% C. 6.9% 5.2% 9.0% 11.9% It appears from this table that the vision of boys in the A schools is materially worse than that of the girls; Dr. Pinchin is unable to give any explanation as to why this should be so. The vision, however, of the girls as a whole is worse than the boys, and in some schools is extremely bad. Taking the unexamined children as being about equal to those examined and adding those that are already wearing glasses, we get a total of 10-15 per cent. of children with defective sight. Dr. Pinchin points out that unfortunately it is still possible in the higher classes of the infants' department in some schools to see the children striving with their needle with the objective work held from 4 to 5 inches from their eyes; the evils arising from this practice have been repeatedly pointed out. It is difficult to see what advantage is gained by teaching needlework to children of this age; it requires fine co-ordinated movements, which are trying both to the nervous system and the vision, and the children are trained in the bad habit of fixing their eyes close to the work in hand, and carry this habit with them to the boys' and girls' departments. In this connection Dr. Pinchin describes a visit to the lowest Standard of a boys' school during a writing lesson, where he found nearly all the children with their eyes much too close to their work although attention had been repeatedly directed to this fault. The total number of children suffering from definite valvular disease is 1.5 per cent. Schools. Infants. Boys 8. Girls 8. Boys 12. Girls 12. A 0.3% 1.3% 1.2% 2.0% 2.3% B 0.7% 0.3% 0.8% 1.7% 2.8% C 1.0% 2.8% 2.2% 3.5% 1.1% As would be expected many more cases are found in the poorer class schools. Rheumatism as such is not complained of in a great number of cases, but a history of fairly severe "growing pains" and abdominal pain probably due to rheumatism is very frequent, more especially in the low-lying districts and poorer schools. Although medical opinion at present encourages all sorts of games for children it is a question whether a strenuous game such as football, especially match games, should be allowed in poorly nourished children who may be suffering from rheumatic carditis. In an examination of 25 boys recently, 2 were found to be suffering from markedly dilated hearts. Dr. Pinchin says: "I was informed after the inspection that I had excluded from football the two best boys in the team and the only two of the team who happened to be in the 25 examined; they had played in a match a few days before and were both of them ' seedy ' afterwards." 134 Annual Report of the London County Council, 1912. Otitis. This condition was not found at routine inspection as often as would be expected. The total number returned was equivalent to 0.9 per cent. There appears to be little difference in the classes of schools except in the infants' departments. Schools. Infants. Boys 8. Girls 8. Boys 12. Girls 12. A 0.5% - 1.2% - 1.3% B 1.1% 0.6% - 0.5% 1.0% C 1.7% 0.6% 1.5% 1.1% Enuresis was only found in 0.7 per cent. of cases. Special enquiry was not made in every case as to its presence so that possibly the percentage is really higher. The C schools are worse than the A. This may be due to a greater reticence of the parents of the children, but more probably is due to less careful training in the C class. Schools. Infants. Boys 8. Girls 8. Boys 12. Girls 12. A 0.2% - - - - B 0.5% 0.3% — 0.25% 1.0% C 1.1% 2.1% 0.7% - 1.1% Spinal curvature was present in 1.2 per cent. of the children examined. In some schools it was much more marked than in others and in one school 9 cases were found in a series of 53 children examined. There does not appear to be any special incidence in the classes of Schools. Schools. Infants, Boys 8. Girls 8. Boys 12. Girls 12. A 1.5% - 1.9% 1.0% 4.1% B 1.1% 0.3% 2.7% 1.0% 1.4% C 1 0.7% - 4.7% Dr. Pinchin suggests that the treatment of these cases cannot be very satisfactorily attempted, as only the worst cases can be sent to the physical exercise department of a large hospital. Good results in the less pronounced cases, however, have been obtained, as will be seen in the section of this report dealing with physical exercises, by means of experimental classes carried out by teachers in the schools and the extension of these classes is being carefully watched. Dr. Pinchin also points out, as has been noticed by most other observers in the schools, how poor an idea most of the children have of expanding their chests; when told to breathe deeply they fix their chests and make strenuous efforts with the accessory muscles of respiration; it is Surprising that this should be the case in view of the fact that the children have breathing exercises in the schools. The further examination of children with doubtful signs in the chest. X-ray examination in early tuberculosis. Dr. A. G. L. Reade has carried out a series of examinations of the chests of delicate children by X-rays, especially in relation to early tuberculosis. He points out that there is a class of child whom the school medical inspector is frequently asked to examine, who is generally delicate and ana?mic, whose nutrition may be classified as "3" or "4," and who, the parents say, suffers from headache, loss of appetite and general ill-health. In addition there may be some cough, which is usually worse at night; very often the children are languid, the parents stating that the children are always tired. There may be frequent fainting attacks, while night sweats occur in a certain number of cases. On examining these children by the ordinary physical methods of examination, if may be found that they are the subjects of early pulmonary tuberculosis, but in the vast majority of cases no physical signs are observed. A number of these children have been examined by X-rays, some in conjunction with Dr. Caley, at Queen Mary's Hospital for Children, whither they have been sent either for a period of convalescence or as early cases of pulmonary tuberculosis, the remainder selected from routine examination in school or from a special examination of delicate children, recommended for open air schools in the X-ray department of the Mildmay Mission Hospital, Bethnal Green. In some of these children the examination showed evidence of definite tubercular disease of the lungs as shown by— (a) Poor movement of the chest or diaphragm on one or both sides, according to whether disease is present on one or both sides. (b) Lack of illumination on deep inspiration in some parts of the lungs. (c) Definite mottling due to disease. 135 Report of the County Medical Officer—Education. In the vast majority of cases, however, the examination showed shadows cast by enlargement of glands at the roots of the lungs, or in the mediastinum. These glands may be primarily tubercular, or the enlargement may be due to lesions in the lungs so small that they escape detection during life. In the latter class of case definite shadows were found localised to the roots of the lungs, some of these were globular in shape, others extended along the larger bronchi from the enlarged glands, some were extremely dense and therefore probably calcareous. These shadows are found so frequently in this class of child that it might be argued that they are physiological and not pathological. A number of healthy children who have been sent to the hospital for hernia or accident, in some of whom the Von Pirquet reaction had been tried and was found to be negative, do not show the shadows described, but merely the normal linear shadows due to the larger bronchi. The following are notes on 29 cases investigated in children aged 5-14 years. The Von Pirquet reaction could not be tested owing to these children being seen at ordinary school inspections. All the children were thin and of poor nutrition and in ill-health. One child had a tubercular knee. One had an old tubercular hip. Cough was a symptom in most of the cases and was marked in 11 cases. It was worse at night, and if of long standing, was more marked in the winter. In one case the signs were occasionally present. In one case they were definite. The glands of the neck had been removed in 30 cases. The glands of the neck were palpable in 2 „ Night sweats in 2 „ Family history of tuberculosis in 12 „ X-ray results. Shadows at root of both lungs : Right and left equally 14 cases. Right more than left 3 ,, Left more than right 6 „ At root of right lung only 3 ,, At root of left lung only 3 „ It seems certain that the X-ray appearances above described are produced by disease, in the region of the bronchial glands. It is reasonable to suppose that the shadows are due to tubercular lesions, for two reasons. First, shadows were constantly present in the children, who gave a positive reaction to Von Pirquet's test. In these children the general symptoms mentioned earlier were present, and some of them had signs in the lungs. Secondly, no shadows were found in children who reacted negatively to the same test, and in whom there were no symptoms or physical signs of tuberculosis. It is extremely difficult to diagnose the exact condition present in any given case ; indeed, the shadows may be caused by any one or more of the following conditions :— (1) Enlargement of the bronchial glands—with or without calcification. (2) Fibrous thickening around the glands. (3) Healed tuberculous foci in that part of the lung near the glands. (4) Active tuberculosis in the same situation as (3). The differences in the shadows are doubtless due to the varying conditions, which may be present. One cannot at present, say positively from the appearance on the screen what stage of the disease is indicated. Dr. A. C. Jordan, writing in the "British Medical Journal," 31st August, 1912, p. 484, maintains that in the vast majority of cases pulmonary tuberculosis commences at the roots of the lungs, and spreads to the apices along the bronchi. He supports his conclusion by comparing results of examination of the lungs after death with the X-ray shadows produced. This view has given rise to a good deal of discussion and there does not seem enough evidence to support it. On the other hand, however, the enlarged glands may be secondary to lesions in the lungs. Whichever view is adopted, it is evident that the recognition of these X-ray appearances as pathological and not physiological is of the utmost importance : if the shadows are found, when there are no physical signs in the lungs, the case is in an early stage, when treatment may reasonably be expected to be more beneficial than if left till the disease is further advanced and has caused such pulmonary involvement as to be recognised by physical signs in the chest. The diagnosis of early pulmonary tuberculosis in children is always difficult: physical signs are frequently absent; sputum is difficult to obtain. The X-rays are of assistance, but it is difficult to say whether the lung or only the glands are affected, and whether the presence of a shadow indicates tuberculosis of one or both. These children, if left in their homes with poor food and worse accommodation will almost certainly develop pulmonary tuberculosis. The ideal treatment for these children is a prolonged stay—at least a year—at a residential open air school, where they could sleep out. In addition to ordinary school work, the elder ones should do a certain amount of supervised physical work, and play games such as cricket and football, the temperature being always taken after exercise, 136 Annual Report of the London County Council, 1912. and the work and games regulated by the rise of temperature observed in individual cases Absolute rest after meals and after exercise should be insisted upon. Where residential treatment is impossible, the next best thing is the open air school. Children treated on these lines for a long time—at least a year—develop sufficient resistance to prevent the spread of disease : if treatment is only continued for a few months the cases almost always relapse. Following up and supervision are extremely important, and when the children pass from school suitable open air work should be found for them, and they should continue to be examined periodically. Medical inspection in training colleges, secondary and trade schools. L.C.C. Training Colleges Secondary and Trade Schools. Since 1908 medical inspection has been carried out in all the Council's training colleges, secondary schools, trade and technical schools. Each student is examined once a year, and each institution visited once in six weeks, so that the doctor can be consulted concerning pupils presenting any symptoms likely to affect their health or work. Every student has a medical record card showing at a glance the condition, so that the students are continually under observation and are not permitted to continue at the institution if through illness or other causes they become unfit. Appendix Ia shows the defects noted. The principals, head masters and head mistresses thoroughly recognise the advantages to be gained not only to the scholar but indirectly to the school, for the efficiency of teaching must largely depend on the receptivity of the pupil and this again on conditions of good health. More and more do those in authority tend to consult the doctor on health questions, and they devote a considerable amount of time and energy to interviewing and writing to parents with the result that steps are taken to remedy the majority of defects found. This co-operation of principals, parents and students with doctors brings about a harmonious working of the scheme with most gratifying results. Non- maintained institutions. During the past year 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 has not been adopted have been periodically examined. In many cases the scholars were examined at the institutions at which they were in attendance, but in others the examinations were conducted at the head office in order to meet the wishes of the governors who preferred such an arrangement on the ground either of lack of accommodation, or the undesirableness of differentiating at the schools between the holders of the Council's scholarships and other pupils. As in the case of the Council's institutions a medical record card was filled in for each scholar, go that the scholars were continuously under observation and were thus not permitted to continue at the institution if through illness or other causes they became unfit. The head masters and mistresses exercised vigilance and showed keenness in obtaining prompt treatment of any ailments noted at the medical examinations, and the parents responded to their efforts. In some cases the scholars were accompanied to the head office by assistant masters and mistresses, who made notes and otherwise assisted the doctors. Appendix IB shows the defects noted. Thjroidism. During the year special attention has been paid to the history of pupils who have exhibited any signs suggestive of thyroidism. In a total of 1,160 girls Dr. Woodcock found nine cases or 0.7 per cent. of general enlargement of the thyroid gland. Only one of these showed all the cardinal signs of Graves' Disease. In four the thyroid had decreased in size during the time they were under medical observation, one of the remaining eight had slight tremor. Dr. Tchaykovsky noted nineteen cases of enlarged thyroid gland in 900 cases analysed, or two per cent. All these cases were kept under strict supervision. Physique. A marked difference is observed in physique and nutrition in different neighbourhoods and Under different conditions. For example, the pupils at Hackney Downs and Marylebone Grammar schools are physically superior to those of the George Green school, which is largely recruited from a crowded east end neighbourhood. The former to have the advantage of spacious grounds and a swimming bath, while the latter are handicapped by the lack of playground and facilities for outdoor games. Some provision in this respect is badly needed. The parents at the George Green school have been somewhat slower in obtaining treatment, hence the higher proportion of unremedied defects, particularly of the teeth, among the girls. Improvement in health has gone pari passu with the improvement in the mid-day meal. At the training colleges the hot mid-day meal is much appreciated and is within the reach of all the students. In the Bermondsey Secondary school the experiment has been made of insisting on all children having a hot dinner either at home or at school instead of the unappetising cold repast of sandwiches and bread and butter formerly adopted by many. Arrangements are made to assist with payment for dinners where this is the real difficulty. The greatest improvement in physique was found among the younger children. This change might with advantage be adopted in all schools. It might be found desirable to use some of the scholarship grant for this important meal. There is no doubt that so long as the feeding is adequate the technical work in the trade schools proves beneficial to nutrition and good Physique. Posture. The carriage of the students bears testimony to the energy of the drill mistresses, which, however, needs to be supplemented by vigilance of the class mistresses, since faulty attitudes of sitting in desks or standing with the weight on one foot are very productive of minor spinal defects. The long mirror which has been supplied to many schools is a helpful means of demonstrating to the individual pupil the effect of bad positions and the ease with which they can be avoided or corrected by a little personal care. The drill mistress consults with the doctor at the medical inspections and suitable exercises are given in school for those with minor postural deformities. At Graystoke Place Training College, the morning health exercises continue to show the beneficial effect of daily gymnastics. 137 Report of the County Medical Officer—Education. Personal hygiene. A considerable advance is recorded. When medical inspection was first started, at least a quarter of the doctor's time was spent on matters dealing with personal hygiene; the most elementary laws of health, such as cleansing the teeth, a daily wash, not sleeping in the garments worn during the day, were all neglected, but there is now much less need for the doctor to give advice on these matters, though where there is obvious infringement no pains are spared to bring about a healthy mode of living. Informal health talks given once a term to the pupils collectively would prove economical as well as educational and would ensure the more essential details reaching each child. Three lectures a year on personal health are given by the examining doctors to the students at the training colleges. The standard of cleanliness in the trade schools for boys is as yet far below that of the secondary schools. Dr. Tchaykovsky emphasises the importance of organising talks to girls attending the various trade schools. These girls receive two years of special education between the time of leaving the elementary school and beginning to work for their living and the great improvement in physique obtained during the past two years when every attempt was made to get medical defects remedied is sufficient assurance that a little time spent on special instruction in personal hygiene would not be wasted. It might also prove useful to have an occasional lecture to mothers, many of whom are anxious to know how to do the best for their children. Dr. Riviere calls attention to an increase in the frequency of errors of refraction among students in the training colleges. Since 1909 the number wearing glasses has increased from 15 per cent, to 31 per cent, in the London Day Training college and from 11 per cent. to 21 per cent. in the Islington Day Training college. In the former college the students are engaged in a combined university and teaching course. The larger percentages wearing spectacles may in part be explained by the constant medical supervision, which reveals defects which were liable to be overlooked in the past. Dr. Murrell found 2.25 per cent, suffering from nervous strain and the increased number of slight cases of neurasthenia suggests that the work is carried on at higher pressure than in the past. There is marked improvement both in dental hygiene and in the number of carious teeth. Much is now being done by the students to prevent as well as to remedy decay. Dr. Tchaykovsky points out that the larger number of those suffering from decayed teeth in secondary schools are fee paying pupils for instance at one school out of fourteen pupils with two or more dental defects twelve were fee-paying. It is almost possible to diagnose a Council scholar by examination of the mouth, for medical inspection with treatment as a sequel is showing itself in a raised standard of dental hygiene. Dr. Riviere also notes great improvement in the care of the teeth in the training colleges, but observes that neglect in the past is revealed more by the deficiency of teeth for mastication and the need for artificial dentures than by the presence of existing dental disease. Medical treatment. The begin- ning of the Council's medical treatment scheme. The scheme for the medical treatment of school children in London began tentatively in January 1910, when arrangements were made with six hospitals for dealing with adenoids, enlarged tonsils, eye defects and ringworm. During the year, the facilities made available were extended by the addition of nine hospitals and three medical treatment centres, and provided for the treatment of some 26,000 children a year, suffering from affections of the eye, ear, nose and throat, and from ringworm. With the exception that the Council's cases were treated on specified days by specially appointed surgeons whose salaries were paid by the Council, on distinction was at first made at the hospitals between children sent by the Council and the ordinary out-patients. Early hospital arrangements The first appointments were made from the central office on the application of head teachers and school care committees after it had been ascertained that the parents were unable to make their own provision for the treatment of the children. The view was then taken that, when the children passed within the hospital organisation, all further responsibility was transferred from the Council to the authorities of the hospital, and there Were at that time no arrangements for following up the cases. In claiming the capitation payment agreed upon for the treatment, the hospitals informed the Council whether or not the patients continued in attendance at the hospitals until discharged. This information was, however, received too late to be of any service in following up cases which had ceased attendance before being discharged. Later the authorities both of hospitals and centres undertook to inform the Council daily of cases which failed to keep appointments. These cases were referred to the school care committees with a view to securing that the children resumed attendance at the hospital or centre. It was found, however, that there was still room for improvement, both in respect of the number of children keeping first appointments and of the number of children who continued attendance at the hospital until discharged, and it was thought desirable that arrangements should be made for the attendance of an officer of the Council at the hospitals on the days when the children were dealt with. Modification of hospital arrangements In February, 1911, arrangements were made, at the request of the authorities of the London Hospital, for an assistant organiser of school care committee work to attend the London Hospital to regulate the attendance of the children and to supply immediate information to the school care committees in regard to the treatment of the cases. At first her duties were limited to informing the school care committees when children failed to keep appointments, and to making arrangements for bringing into the Council's scheme children who attended the hospital without official appointments. Soon after the work was extended so as to secure, wherever possible, voluntary nursing assistance in the homes and treatment in convalescent homes where advised by the doctors at the hospital. Arrangements were made to inform the school care committees of each step in the treatment, and they were specially asked to sec that spectacles, if prescribed, were obtained and worn by the children. 18820 8 138 Annual Report of the London County Council, 1912. In the autumn of 1911, all the hospitals included in the scheme agreed to allow the attendance of a Council's officer for this work, and the work connected with making the appointments and of regulating the attendance at the hospital was transferred from the central office to local offices. At the Norwood and Wandsworth centres provision was made for the Council's nurses employed at the centres in assisting the surgeons to jrive additional time in order to perform these extra duties. Procodure at hospitals and centres. The procedure within the hospitals and treatment centres is necessarily not uniform. The authorities of all hospitals or centres reserve the right to refuse cases if they consider that the parents are able to pay for private treatment. At some hospitals the children are dealt with entirely apart from the ordinary out-patients, and the authorities regard the fact that the children have been sent by the school care committees as evidence of their suitability, while at others they are received for registration and the parents are questioned as to means by the almoner or inquiry officer in the general reception room. In all cases, except the Metropolitan Ear, Nose and Throat Hospital, the children are treated by surgeons specially appointed to deal with children referred to the hospital by the Council. Some of the hospitals have provided separate departments for the treatment of children; others reserve special times for school children, while in other cases the surgeons appointed for the Council's Work see the patients in a reserved part of the ordinary out-patients' room. These special arrangements are of very great advantage, as not only is the risk of a child contracting an infectious disease while in attendance at the hospital reduced to a minimum, but the period of waiting at the hospital is considerably lessened. In all cases involving operation the children are kept anart, from the ordinary out-patients. The hospital. The inclusion of the hospital as part of a permanent treatment scheme has met with some criticism. The wording of Section 13 (1) b of the Education (Administrative Provisions) Act, 1907, however, shows that it was intended by Parliament that all available voluntary agencies for treatment should receive due consideration and, in London especially, the hospital was of necessity a very important factor in the construction of a complete scheme. This is the view taken by the Board of Education, which has generally advised that before the direct treatment of ailments is undertaken by the education authority out of rate, advantage should be taken of existing institutions. The Board's chief medical officer, in his annual report for 1909, wrote as follows :— "That the State has called upon the local authorities to organise machinery for detecting the ailments of school children many of whom are poor and necessitous, does not therefore make the claim of these children upon these institutions (i.e.,the hospitals), any the less in principle though it rapidly becomes wholly different in degree. Indeed, it is the difference in degree, the added bulk and burden of work thus thrown upon the hospitals, which has in practice brought the honorary medical staff to the verge of breakdown." As the result of later inquiry and inspection by the Board's officers, the conclusion was drawn that the hospitals fill, and must continue to fill, an important place in any comprehensive scheme for the medical and surgical treatment of school children. The treatment centre. The Council has supplemented the hospital scheme by entering into agreements with committees of local medical practitioners for the treatment of certain defects at "Medical Treatment Centres." The first centre of this kind was opened in July, 1910, at Hampstead, on the premises of the Kilburn Provident Medical Institute, but was discontinued in July, 1911. A centre at Norwood was opened in September, 1910, and was followed by another at Wandsworth in January, 1911. In August, 1911, the Council submitted for the approval of the Board of Education a scheme providing for arrangements with ten hospitals, and for the establishment of eleven medical treatment centres in addition to those at Norwood and Wandsworth. The Board, however, withheld consent in respect of ten of the medical treatment centres on the ground that they were not satisfied that the existing conditions were such as to justify the particular form of development on such an extensive scale as proposed by the Council. New proposals were made by the Council on the 19th March, 1912, and submitted to the Board. In reply, on the 14th May, 1912, the Board again expressed the opinion that the establishment of a large number of treatment centres were undesirable, and stated that the constitution of these centres would need modification in several important respects, before they could form an integral part of the London system of co-ordinated medical inspection and treatment. In the same letter the Board suggested that a discussion of the whole question should take place between certain of the Board s officers and representatives of the Council. Five members of the Children's Care (Central) Sub-Committee were selected to represent the Council and met the officers of the Board on the 23rd May. Following this conference a letter was received from the Board to the following effect:— "The Board contemplate that (he Council's scheme will continue composite in character, and might properly continue to include : — (1) Hospitals with which the Council will have agreements on the basis of that now in operation at the London Hospital, where the special arrangements practically constitute a children's treatment centre within the hospital; (2) Voluntary institutions of various kinds other than hospitals with which the Council will have agreements; (3) Medical treatment centres conducted on the lines of those now opened at Norwood and Wandsworth, but with certain modifications." With regard to the medical treatment centres, the Board held that the arrangements then existing were not satisfactory for the following reasons :— " 1. That the centres were not sufficiently under the direct supervision of the Council and its School Medical Officer. 139 Report of the County Medical Officer—Education. 2. That the centres were not sufficiently in touch with the Council's system of medical inspection. 3. That the centres were not available for the further examination of school children referred by the inspecting medical officer or for the examination of special cases referred by the school nurse, school attendance officer, head teacher, or care committee. 4. That the centres were not available for the treatment of minor ailments." Following this letter the Chairman and Vice-Chairman of the Children's Care (Central) Sub-Committee interviewed representatives of committees of medical practitioners for the districts of Hackney, Islington, St. Pancras and Poplar, with regard to the practicability of giving effect to the suggestions of the Board of Education, with the result that the conditions of agreement were modified in certain respects. The Education Committee in reporting these facts to the Council on the 23rd July, 1912, expressed itself as being generally in agreement with the views of the Board. At the same time suggestions were made for the establishment of medical treatment centres on the lines indicated by the Board, and for the treatment of minor ailments, including discharging ears, external eye diseases, e.g., blepharitis and conjunctivitis, skin diseases such as impetigo and sores, and such other conditions as require the daily services of a nurse. The Council adopted the Committee's report with which were submitted the general terms of agreement with committees of local medical practitioners as modified after consideration of the suggestions of the Board of Education. These amended terms of agreement afterwards received the approval of the Board, and are set out in the appendix to this report. Nursing treatment. On the same date (23rd July, 1912) the Council adopted an important development of its medical treatment scheme by agreeing to arrangements being made with local nursing associations for the employment of the equivalent of a full time nurse in connection with six of the school treatment centres. It was provided that the scope of the work should include the nursing treatment of children suffering from minor ailments as already defined, and home visits after operations for adenoids, tonsils, etc. The conditions of agreement contain clauses to secure the supervision of the work by the Council's school medical officer, and the appointment of a doctor by the Committee of the Association, such doctor to be selected by the Council from nominations made by the Association. The doctor appointed is to attend at the centre on one half day a week to see the children and supervise the work of the nurse. Points to be considered in a Treatment Scheme. In his report for 1910 the chief medical officer of the Board of Education has formulated some rules for guidance in scrutinising the details and working of a medical treatment scheme. Briefly it is stated that such a scheme must be considered in relation to the following points: (1) the degree to which it meets the requirements of the area; (2) the means taken to secure that the child is actually presented at the hospital, and that once under treatment, attendance is continuous; (3) the arrangements made to ensure that the treatment given by the doctor is followed up, and supplemented in whatever direction is necessary; (4) the degree to which the arrangements of the school medical service in general, and of the primary medical inspection of the child in particular, are linked Up with those for treatment, and similarly the degree to which such arrangements are again associated with the subsequent re-eXamination of the child in school. Action tken in London during 1912. During the year under review, attention has been directed to all these points. For instance, with regard to the degree to which the scheme of medical treatment meets the needs of the county as a whole, much headway has been made towards providing centres in the districts remote from the hospitals, and though there are still some topographical difficulties to be overcome, it is hoped in the near future that every area will be provided with a convenient treatment centre. This aim has, of course, only been brought within the bounds of possibility through the acceptance by the Board of Education of the system of arrangements with committees of medical practitioners for the establishment of the "Medical Treatment Centres" to which reference has already been made. More recently, the agreements with nursing associations have been the means of making much needed provision as regards the treatment of discharging ears, and other minor ailments requiring the services of a nurse. Concerning the second point, the scheme of re-examination now provides for a complete record to be kept of every child recommended for treatment, and every effort is made to secure the attendance of the child for treatment until treatment is completed, and to prevent leakage. The third point of the Board is that the arrangements should ensure that treatment is followed up and supplemented where necessary, Here again, the "following up" System just referred to is of value, moreover, the agreements with nursing associations provide that the nurse shall attend the centre and shall also visit the homes of the children, thus combining treatment at the centre under the supervision of the doctor with the advantage, in certain cases of home treatment. I11 consideration of the annual payments made by the Council the nursing associations have further agreed to allow the nurse to visit the homes of children operated on for tonsils and adenoids. This part of the scheme has not yet been fully developed, but a beginning has been made. The fourth suggestion of the Board is the necessity for the co-ordination of inspection and treatment. The inspecting doctor examines the child both before and after treatment, he is directed to place his knowledge of the child at the service of the centre doctors, and he confers with them at the treatment centres. Mention has already been made of the modification of the agreements with medical practitioners to secure (1) more direct supervision of the centre by the school medical officer; (2) the use of the centres in connection with the scheme of medical inspection; (3) that the centres are available for inspection; (4) that they are available for the treatment of minor ailments. It will thus be seen that effort is being steadily directed towards securing co-ordination of inspection and treatment, and that considerable progress has been made in developing a harmonious and unified scheme. 18820 s 2 140 Annual Report of the London County Council, 1912. As regards the actual arrangements for treatment, a considerable extension has been provided for in the current year, but as these arrangements do not properly come within the period of this report, it will be sufficient here to note that they provide for the treatment of nearly 84,000 children, at an estimated cost of £23,275. Twelve hospitals and 22 centres are included in the scheme. At the end of 1912 provision was made for the treatment at 11 hospitals and 17 centres of 73,058 children at an estimated cost of about £20,000. Details of the ailments treated at the several hospitals and centres will be found in Appendix VIII. of this report. ment for the year ended 31st July, 1912. The following statement shows the results of treatment for the year ended 31st July, 1912. Agreement Number of cases provided for under agreement Number of cases tr.ated. All ailments. Eye cases. Ear, nose'and throat cases. (1) (2) (3) (4) (5) Spectacles. (8) (9) At'ended until lischarged. Ceased a'tendance before discharged No treatment requbed or treatment not possible. Still attending. Cases in which no nfor at on is available (6) (7) Operation performed. After care— (a) Nursing treatment obtained. (b) Convalescent home. (c) Other arrang merits. (a) (b) (c) Prescribed Obtained. Eye 16,620 16,670 12,125 1.901 743 1.554 347 10,188 8,401 ... ... ... ... Ear,nose and throat 10,330 9,814 6,649 1,055 317 1,759 34 ... ... 5,674 1,729 16 419 Ringworm 1,030 1,112 535 136 6 426 9 ... ... ... ... ... ... Minor ailments 40 51 7 ... 3 41 ... ... ... ... • •• ... ... ... ... ... 28,020 27,647 19,316 3,092 1.069 3.780 390 10,188 8,401 5,614 1,729 16 419 It will be seen that during the year provision existed for the treatment of 28,020 children, and that the number of children who attended the hospitals and centres was 27,647. Dealing with the ailments separately, provision was made for the treatment of 16,620 eye cases, and the number attending was 16,670; of ear, nose and throat cases, the numbers were respectively 10,330 and 9,814; of ringworm cases, 1,030 and 1,112; and of minor ailments, 40 and 51. The percentages of cases failing to complete treatment were 13.5 in eye cases, 13.6 in ear, nose and throat cases, and 20.3 in ringworm cases. Of the 10,188 children who have been prescribed spectacles 8,401 (or 82.4 per cent.) have obtained them. This percentage is very satisfactory, more especially when it is pointed out that only cases where definite information has been available have been included as having obtained glasses. Some notes on the visual defects of children referred for treatment based on the observations of Mr. Bishop Harman will be found on pages 82-86. Of the 9,814 children treated in the ear, nose and throat departments, 5,674 children were operated upon, and in 1,729 cases nursing assistance was provided by voluntary nursing associations. The treatment obtained at the hospitals and centres was supplemented in other ways in 435 cases. Dental treatment, In connection with the facilities for dental treatment Mr.C.E.Wallis reports as follows :— As will be seen from the table given later much development in the provision of dental treatment for elementary school children in London has taken place since the date of the last report. Whereas at the end of July, 1912, there were but six dental treatment centres, there are now (July, 1913) thirteen centres in actual working order and negotiations are in progress for the establishment of several more in such populous districts as Woolwich, Battersea, Westminster, Notting-dale and elsewhere. The general scheme of development of these centres has been found to work well and the information gained at the earlier centres has enabled the later ones to be opened and equipped on a uniform and satisfactory basis. The experience of the London centres shows clearly that the plan of a gradual development of dental treatment facilities in London is in every respect a wise one. Good school dentists are by no means easily found, and it would be incurring a great risk to open simultaneously a large number of centres with little or no prospect of staffing them in a really satisfactory manner. The number of applicants for these appointments in London is not large and the number of suitable candidates is at the present time comparatively small. If these appointments remain popular the supply will in all probability grow in proportion to the demand. The general policy in London has been to establish a complete scheme in which preventive and curative treatment may be developed side by side. It is essential that every opportunity should be taken of instructing and interesting parents and teachers as well as their children in the care of the teeth and in all the London developments this point has constantly been borne in mind as will be shown later. School dental inspection.—When the location of a new dental centre has been decided upon, schools within a radius of half a mile or so are shown upon a sketch map of the district and from the schools contained in this area the centre is supplied with cases. The number of contributory schools varies from 12 to 24. According to the needs of each centre the inspecting dentist attached thereto makes a weekly or fortnightly inspection as required and So secures an adequate supply of cases to be treated. The dental inspections usually begin at about 9.45 a.m. and at 11.30 a.m. the parents who have been previously invited to be present are addressed by the inspecting dentist on the care of the teeth. A member of the care committee is invited to be present at the inspection and one of the organisers is also present, who, there and then, after obtaining the written consent of the parents, gives out dental appointment vouchers. This plan has been found to work admirably, and since its initiation very little difficulty has been experienced in obtaining an adequate attendance of children for treatment. In such districts as Poplar and Deptford, where the population is largely of a migratory character, difficulty from time to time arises, but even in these districts improvement continues to take place. The inspections are confined to children aged 6, 7 and 8 years of age, as it is considered that 141 Report of the County Medical Officer—Education. this is the most suitable age for conservative treatment. It is intended that continuous observation shall be maintained during school life over those children already inspected or treated at the centres, and consequently the schools in the areas supplying each centre will be revisited and the children further treated as may be required. Dental treatment.—The general principle adopted is that each child's mouth shall be made absolutely healthy and free from sepsis. This involves the stopping of all teeth, whether temporary or permanent, that can be saved, and the extraction of such unhealthy teeth or roots as are beyond the scope of ordinary conservative treatment. No countenance is given to the mere extraction or stopping of an odd tooth here and there. If the mouth is not rendered healthy and free from sepsis the gain to the health of the child may be little or nothing. Anœsthetics.—Nitrous oxide or ethyl chloride are given in cases where a large number of extractions or specially difficult teeth have to be removed. The general experience tends to show that an anaesthetic day in each week is required at all the centres in order to avoid a cumulative list of "waiting cases," many of whom are suffering from enlarged or perhaps tuberculous glands which cannot heal so long as the mouths remain septic. General remarks on the dental centres.—The plan of adapting existing homes or institutions for dental treatment purposes has answered admirably, the essentials sought for being a well-lighted room suitable for a surgery, with a recovery room immediately adjacent, and a third room, some distance off and therefore out of hearing, to be used as a waiting-room. No centre can be worked satisfactorily which is limited to two rooms alone. In addition, the surgery is always located in such a way as to enable the children who have been treated to leave the centre without being seen by those awaiting treatment. This is a point of great importance, as nothing demoralises a room full of waiting children more than the crying face of a child who has perhaps had some teeth extracted. Equipment of the centres.—The sum of £50 allowed by the Council for this purpose is sufficient so long as strict economy is exercised, and at the present time the requirements have been so standardized that little or 110 difficulty arises on the score of expense. All the centres are well and economically equipped. The accompanying table gives under the necessary headings details of attendances and nature of work carried out. Return of Dental Treatment for Year Ended 31st December 1912. Centre. No. of sessions a week. No. of children attended. No. of attendances. No. of teeth or roots extracted. No. of stoppings. No. of other operations, e.g., scalinc, immediate regulation. application of AgNO3, etc. No. of general anæsthetics. Nitrous Oxide. Ethyl Chloride. Other general anaesthetics. Tcmpy. Pcrmt. Deptford 7 2,752 3,809 4,454 927 4,771 458 732 - Fulham, from 4.6.12 4 695 970 3,156 357 1,208 462 137 — 9 Norwood 4 1,257 2,961 4,217 657 2,266 323 325 32 - Poplar Hospital 4 1,267 1,658 3,556 473 2,646 724 209 22 255 St. George's Dispensary 5 1,864 2,279 5,195 941 3,527 304 134 87 32 St. Marylebone Dispensary, from 10.9.12 3 335 627 1,164 189 638 49 4 140 - Wandsworth 6 1,629 2,360 5,931 840 1,201 53 415 - — Re-inspection. The school doctors in addition to their work of examination of school children re-inspect all cases referred for treatment at the inspection. By this means the doctor is able to ascertain whether treatment has been obtained and the extent to which it has been successful or otherwise. If treatment is still required steps are taken to follow up the case and to induce the parents to obtain the necessary medical attention. In cases where the parents refuse to act and there is strong evidence that the child's health is seriously affected as the result of neglect, the National Society for Prevention of Cruelty to Children is informed of the circumstances in order that legal proceedings may be taken under Section 12 of the Children Act. As a rule the cases referred for treatment in one term are re-inspected during the following term and those found to be still in need of treatment are submitted to a second re-inspection in the term succeeding that in which they were first re-inspected. During the year under review 41,015 children were thus re-inspected, and with regard to 23,344 of these children full particulars of the results of re-inspections are shown in the AppendixThese 23,344 children were all re-inspected in the third term of the year, and from that time onwards the results of re-inspections are being kept in classified form. The tables in the Appendix summarise the defects under five headings showing separately the ailments for which provision has been made, under the Council's scheme for treatment, at the various hospitals and centres. Refraction.—This group includes defects in vision, strabismus, nystagmus, etc. Minor ailments.—These include minor complaints provided for by the Council's scheme, e.g., slight conjunctivitis, discharging ears, minor diseases of the skin, etc. Ear, nose and throat.—The complaints comprise cases of enlarged tonsils, adenoids, and diseases of the ear which are not suitable for treatment as minor ailments. Teeth.—This class includes cases of defective teeth found by the school doctor, but not those found by the dentist. 142 Annual Report of the London County Council, 1912. Other ailments, i.e., complaints not included in any of the preceding groups. The 28,031 defects were noted among 23,344 children referred for treatment, and the following numbers appear in each class:—Refraction cases, 6,304 (22.5 per cent.); minor ailments, 2,229 (8.0 per cent.); ear, nose and throat cases, 7,651 (27.3 per cent.); dental cases, 7,749 (27.6 per cent.); other ailments, 4,098 (14.6 per cent.) On re-inspection it was found that of these defects 12,080, or 43.1 per cent., had received treatment, and that in 3,368 cases. the treatment was no longer considered to be necessary, thus leaving 12,583 defects, or 44.9 per cent. untreated. This number will no doubt be materially reduced when the cases are re-inspected the second time. Taking the defects by classes, it was found that the percentage of refraction cases treated was 54.4; minor ailments, 57.1; ear, nose and throat, 40.4; teeth, 30.5; and other ailments, 46.9. Of the 12,080 defects which had received treatment, 7,228 (or 59.8 per cent.) were reported as completed and satisfactory, and 2,795 (or 23.1 per cent.) as still under treatment, the remaining 2,057 (17.0 per cent.) having discontinued treatment or from other cause remaining uncured. An examination of these figures shows that the percentage of completed cases is highest (viz., 63.7) in the case of children treated under the Council's scheme; the percentage in the case of children treated by private doctors being 55.4, and in the case of children treated at hospitals, etc., outside the Council's scheme, 58.2. The relatively high percentage in the cases under the Council's scheme is doubtless attributable to the fact that an officer of the Public Health Department is always present while treatment is given at the centres and hospitals covered by the scheme, and the cases are Systematically followed up. The Table in Appendix XIV. refers only to ailments for which the Council has made provision, viz., refraction, minor ailments, and ear, nose and throat defects, and shows the results of re-inspections classified in relation to the 29 borough areas. The percentages of cases treated show considerable variations in the different parts of London. In some boroughs this is due to the small numbers of cases under review, but as a general rule it is probable that the main determining factor is the existence of adequate facilities for obtaining treatment. As an illustration of this point two examples may be taken. First, that of the borough of Stepney where it is found that the percentage of cases treated is 59.3. This district is served by the London Hospital, where the Council has made considerable provision for the treatment and following up of school children and the percentage is relatively high. Against this may be set the contiguous borough of Poplar, where the percentage treated is only 42.9. In the latter district there was a clearly felt need for treatment facilities which will now be met by the establishment of the Poplar Treatment Centre. The second comparison is between the district comprising the boroughs of Greenwich, Lewisham and Deptford where the percentage is 66.4 and the borough of Islington, where the percentage is only 50.2. The former district was served by the Miller General Hospital and the Deptford Health Centre. In the latter, where facilities appeared to be inadequate, the Council has now made arrangements for the establishment of a treatment centre. The Education (Provision of Meals) Act. The menus of meals supplied to necessitous children were originally drawn up in consultation between the Superintendent of Domestic Economy and the Medical Officer (Education). During the past year the renewal of the contract with the Alexandra Trust afforded an opportunity for the revision of the dietaries. I have satisfied myself in every case that, provided the ingredients are of average quality and supplied in the amounts and proportions stipulated, the Council obtains good value for the money expended. Where the proposed menus appeared inadequate or unsuitable I have advised as to their improvement; in some cases my recommendations have been carried out, but in others it has been pointed out to me that to comply would necessitate exceeding the agreed limits of expenditure, but in every case modifications resulting in improvement have been made. Dinners.—The dinner menus which are given in the appendix to this report supply about twofifths of the theoretical amount of nourishment required daily by children of twelve years of age. Breakfasts.—The breakfast menus included in the dietaries give approximately ¼ of the proteids; 7/20 of the fats and ⅜ of the carbohydrates required by a child during the 24 hours. There is a tendency to give foods of a soft nature to the young children through a mistaken belief that they are incapable of masticating ordinary food ; this is a practice greatly to be deprecated, as there is good reason to believe that the absence of fibrous material in the diet of young children plays a considerable part in the production of the excessive amount of dental caries which is prevalent. During the autumn term of 1911 the whole of the feeding centres were visited by the school doctors. During the present year the centres in respect of which defects were previously noted were re-visited. In many instances improvement had taken place, but in the case of 60 centres attention was drawn to defects of varying degrees of importance. Exercises for children in elementary schools suffering from physical defects. Physical Exercises. Special classes in physical exercises for children suffering from physical defects were conducted daily for a period of six months in the girls', or junior mixed departments, of eight elementary schools. The types of children selected as likely to benefit from daily exercises carried out under conditions permitting of a definite degree of individual supervision were those suffering from various minor deformities brought about by the general weakness and lack of tone of the muscles, the effects of which were 143 Report of the County Medical Officer—Education. to some extent accentuated by the enforced confinement and special postures incident to school life. Such children have Usually a poor physique and imperfect breathing powers. They appear flabby, with rough skins, presenting with unusual frequency various forms of rashes indicative of local congestion and unhealthy tissue changes. They consequently appear ill-nourished to a degree quite unwarranted by the quantity and even quality of the food they have actually received. This is mainly the result of an imperfect local or general circulation of the body fluids, the products of tissue change not being swept away and replaced by fresh lymph laden with nourishment. The mucous surfaces are affected in a similar manner to the skin, so that the children suffer from a condition of " stuffiness " with chronic nasal, pharyngeal and bronchial catarrhs and indigestion primarily the expression of an ill-balanced circulation, and only secondarily the result of microbic infection. Adequate resistance to the attacks of micro-organisms is only possible when the exchange of body fluids is maintained at an efficient level. This circulatory exchange depends only partially on the action of the heart, being to a large degree established by the pumping action of the respiratory movements of the chest and by the movements of the limbs. In cases of pronounced illness an imperfect circulation is often aided by the employment of massage in which the body fluids are driven from various organs by the stroking and squeezing movements of an operator, while during the intervals of relaxation between each stroke fresh supplies of blood and lymph nourish and enter to refresh the tissues. The physiological effects of muscular exercise are of a similar nature. The effect of each muscular contraction is to squeeze out the contained body fluids while the movements of the limbs as a whole tend to propel onwards both blood and lymph. The effect on the circulation of the body fluids is the greater the more fully the muscle contracts, consequently when movements are carried out regularly to their fullest extent, as in Swedish gymnastics, better results are obtained than from ordinary uncontrolled exercises. Owing to this action certain groups of massive movements taken in the course of physical exercises are sometimes termed nutritive movements. The degree of exercise taken by the normal child keeps his circulation in a condition adequate to his needs; for such the ordinary drill class conducted under good conditions suffices to prevent the under-development of any group of muscles, and avoids the onset of any deformity as a result of the confined attitudes of school hours. In the weaker children, the adequate circulatory balance has not been established, so that on the one hand their general health suffers, while on the other, when any muscle group becomes relatively weaker, the movements in which this is concerned are not fully carried out, so that the muscles suffer still further in nutrition and the unchecked action of opposing muscles may lead to the appearance of some deformity. In the ordinary large classes it is difficult for the teacher to ensure that every child shall carry out full movements, particularly as their exact nature is often masked by the unsuitable nature of the costume worn. Also the movements suited to the average member of a normal class may be in some points too severe for the weaker children, who substitute automatically other and less complete movements, thus losing all benefit, or even producing harm. When the retarded children are taken in small groups, and particularly when they can be exercised while suitably clad, as for example, in a jersey, faults can be noted, full execution ensured, the circulatory balance restored by progressive exercises affecting each part according to its needs, while the weakened muscles can be built up by special corrective exercises, in which each muscle group acts in a more or less isolated manner. All the necessary exercises occur in the ordinary syllabus, the only need is to draw up tables of movements for individual classes of children. Early signs of improvement are noted in the carriage and buoyancy of gait, while the skin can be observed to lose any roughness or eruption and resume the normal texture of health. When a child goes to school at all, he is sure from time to time to exert himself violently, even if this is physiologically undesirable, and it is better that his strength should be trained gradually and his heart and muscles accustomed to increased exertions. Educational gymnastics can fulfil this task effectively. Breathing exercises, Special attention is often drawn to breathing exercises; breathing is an automatic movement best ensured by general exercise. The only real breathing exercise is breathing itself, though the combination of breathing with movements of the limbs or trunk in the same rhythm at appropriate places in a table of exercises produces several useful effects. Deep breathing exerts an aspirating effect on the lymph stream and also serves in some measure to provide automatic massage for the heart muscles. At the commencement of a lesson, when none are out of breath and children are of approximately the same age, the breathing may be performed to command, and taken by all to a uniform rhythm, but after vigorous exercise, each must breathe in his own time, when the movement will serve to quiet the circulation, and only later, when both functions are nearly normal, can it rightly be taken to an artificial rhythm. Such exercises, after preliminary quieting movements, usually conclude a gymnastic lesson. Breathing exercises in general physical education play a different role from those used to teach breath control for speech or song ; they best take their places in a full table, but may be employed with other simple movements in brief periods between lessons. Some doubt their value when taken by themselves, and regard progressive general exercise as the best and only corrective mechanism for the respiratory apparatus. Nature of Defects. In the course of an experiment now to be reported upon, certain children selected by the teachers and organisers in each of eight schools were submitted to one of the assistant medical officers (Dr. Shrubsall) on his visit, when a final selection for each class was made. The children in the class were examined prior to the commencement and at the expiration of their subjection to the special course of exercises. The number, 125, on which this report is based is a few short of the total, owing to absentees on the occasion of the second visit, and the inclusion, during the progress of the experiment, of a few other children under special circumstances. The chief defects noted were spinal curvature, 144 Annual Report of the London County Council, 1912. 80 cases; round shoulders, 33 cases; defective breathing, 51 cases, though in none could the breathing have been described as good. The following table shows the results noted on re-examination at the end of the course. Defect. Much improved. Improved. Little change. Worse. Total. Lateral curvature of spine 4 10 7 1 22 Ant.post. curvature of spine 15 33 10 — 58 Round shoulders 21 12 — — 33 Weak breathing 30 19 2 - 51 The case of lateral curvature which deteriorated had ceased to receive exercises in the special class, and was in July receiving special remedial exercises at a hospital, but it seemed not improbable that eventually other measures would be required. Effect of Instruction The effect of the instruction was most marked on the general posture and carriage of the children, and particularly on the power of executing complete stretching movements of the trunk and limbs. Many exercises quite unsuited for performance at the commencement were easily undertaken at the end of the course, while many children who had been unable to benefit from the ordinary class exercises had caught up to the normal standard and even surpassed it. The numbers and changes recorded in posture, carriage, and stretching movements were as follows: Condition. General posture and carriage. Power of executing full stretches. Much improved 41 43 Improved 67 65 Little change 16 17 Worse 1 — The children recorded as showing little change were, for the most part, those who had carried themselves best originally and had the least leeway to make up. Very definite advances were recorded in the chest expansion of the children in the special class; they gained on an average 16 mm. (⅔ inch) in the six months, whereas the average change during that period for children of a corresponding class varied from 2 to 4 mm. (1/12 to 1/6 inch). Although this gain is not so much one of growth as of the utilisation of powers of movement previously in a dormant condition, the actual growth somewhat exceeded that of the normal children, the average increase in the circumference of the fully expanded chest being 15 mm. instead of 12 mm. The improvement in the condition of the skin previously referred to was commented upon by several teachers. Since this was the case in those who had not received school meals or milk, as well as in those in receipt of this additional aid to health, the change may be credited in part, at least, to the exercises. At the end of the period the children were brighter, in a better state of health, and able to undergo much more exertion without getting out of breath. They consequently were in a better condition to Undertake their ordinary class work. During the progress of the experiment the medical staff of a hospital adjacent to one of the schools requested that certain of their patients should be allowed to join the special class for daily exercise. The exercises employed were all taken from the syllabus issued by the Board of Education, though the selection, and to some extent the interpretation varied from school to school, and in consequence perhaps, the extent of the maximum improvement manifested was not always the same. It is interesting to note that the greatest improvement in the breathing capacity occurred in those instances in which the attention had been most evenly spread over all varieties of exercise and in which the teachers had had the most experience prior to the commencement of the special classes. This lends support to the view that the best method of improving the general breathing powers is to take complete courses of movements at each lesson rather than to concentrate attention on special movements to the exclusion of others of a more general character. The teachers took the greatest interest in these classes and stated that they had derived much benefit from being shown the exact movements performed by each child while it was stripped for the purpose of the preliminary and final medical examinations. Their admission to these examinations and demonstrations does something to put them in the position of those drill mistresses at secondary schools who attend the medical examinations to receive special advice on the defects of individual pupils. It would be useful for the teachers to receive a little instruction in the principles involved in the exercises demonstrated by or on a few children, some able and some unable to carry out the movements correctly. The most suitable age period would be 8 to 10, as in these children the onset of faults might be prevented and the more weakly brought to a stage at which they could profit by the ordinary class instruction rather than to attempt the far more difficult task of remedying the perhaps long standing defects in the older children. The results of the experiment are such as to warrant its extension, and arrangements have been made for the classes to be held during the present year in connection with 27 schools—an increase of 19. 145 Report of the County Medical Officer—Education. Similar classes in Sweden, During the period in which this experiment has been in progress classes of a similar character have been established in Sweden for children selected by the school doctors as retarded or slightly defective in their physical development. In the Stockholm Folk schools the children throughout the exercises, which last for some 30 to 35 minutes, are clad only in knickers and gymnasium shoes so that every movement of their trunk and limbs may be noted by the instructresses. The children thoroughly enjoy the classes and although attendance is voluntary, it is stated that no objection has ever been raised by parents, but that on the contrary there are more applicants than can be provided for at present. The first three months' experience showed a great improvement and resulted in a large number of the children being able to return to, and profit by, the ordinary class work. No limit of attendance had, however, been proposed, as part of the experimental stage was being devoted to ascertaining the limits of defect susceptible of full benefit from class methods as opposed to individual instruction and treatment. The experience in the Council's schools is of a similar nature, though in London the teachers of the special classes have not had the advantage of a full training in remedial gymnastics. Infectious Diseases. Amendment of Regulations. During 1912 the rules and regulations for the guidance of teachers in dealing with infectious diseases occurring among school children or in their homes have been revised and regulations have also been framed to apply to secondary schools, technical institutes, etc. Copies of the full text of all these rules and regulations may be obtained from the offices of the Public Health Department. The principal modifications effected are as follows:— Diphtheria and Scarlet Fever.—Children suffering from either of these diseases and under treatment in their homes were allowed under the former rules to return to school when the medical attendant issued a certificate of freedom from infection, whereas the contacts were not allowed to resume attendance until two weeks after the premises had been disinfected. Under the revised instructions both patients and contacts are similarly dealt with and are required to remain away from school until the expiration of two weeks from the date of disinfection of the premises. Children excluded, on suspicion of their being possible mild or unrecognised cases of scarlet fever or diphtheria, are now required to absent themselves from school attendance for a provisional period of four weeks. They are allowed to return, however, if appropriate medical certificates are furnished in the meantime, otherwise arrangements are made upon the termination of the provisional exclusion period for the suspected children to be examined by the school doctor with a view to determining whether or not they are fit to attend school without danger of conveying infection. In the case of diphtheria the examination is conducted upon bacteriological lines. The former rules did not specify any provisional period of exclusion and the children were not allowed to resume attendance until they were certified as free from infection ; in cases of suspected diphtheria a certificate based upon bacteriological examination was demanded. By the operation of these rules during outbreaks of scarlet fever or diphtheria children were frequently out of school for an unnecessarily long period where there was difficulty in procuring a certificate in the prescribed form. Measles.—The former rules provided that children attending senior departments who had been in contact with cases of measles at home and had not previously suffered from the disease should be excluded from school until the Monday following the expiration of a period of 14 days from the occurrence of the first case in the house. The new rules require the exclusion of such children until the Monday following the expiration of a period of 14 days from the commencement of illness of the last case in the house. The practice of permitting children in senior departments to attend school, in the event of the occurrence of measles in their homes, if they have previously suffered from the disease, has been continued. German Measles.—A differentiation has been made between ordinary measles (morbilli) and German measles (rubella), whereas formerly they were dealt with similarly for purposes of exclusion. Whooping Cough and Chicken pox.—The exclusion period for "contacts" has been altered to three weeks instead of two weeks as formerly, and for unprotected children attending senior departments the period has been calculated from the onset of illness of the last case in the house, instead of the first case. Sore Throat.—All cases of sore throat of any description are, under the revised rules, required to be excluded trom school. Ringworm.—Children suffering from ringworm on parts of the body other than the scalp were allowed to attend school under the earlier regulations if they were under proper medical treatment. This rule has now been withdrawn. Cooperation with Army medical authorities. The Board of Education issued a circular (774) in July, 1911, to local education authorities intimating the desirability of co-operating with the Army medical service in protecting military communities from the possibilities of infection conveyed through the agency of soldiers' children attending public elementary schools. Negotiations with the Army medical authorities have now been completed and a scheme established with the object of securing the interchange of information respecting the occurrence of infectious disease. 18820 x1 146 Annual Report of the London County Council, 1912. Comparative incidence.— Scarlet fever, diphtheria and measles. The subjoined table shows the incidence of scarlet fever, diphtheria and measles upon persons of all ages as compared with children attending the Council's schools, during the past seven years:— Disease. Total numbers notified. Weekly mean. Year. All ages. L.C.C. school children. All ages. L.C.C. school children. Scarlet fever 1906 20,333 8,371 391 161 1907 25,923 12,307 498 237 1908 21,648 10,291 416 198 1909 17,389 7,716 335 148 1910 10,513 4,700 202 90 1911 10,484 4,640 202 89 1912 11,319 5,060 218 97 Diphtheria 1906 7,934 2,549 153 49 1907 8,597 3,170 167 61 1908 7,671 2,809 148 54 1909 6,617 2,212 127 43 1910 5,391 1,861 104 36 1911 7,268 2,572 140 49 1912 7,009 2,571 135 49 Measles 1906 18,899 365 1907 26,179 503 1908 Nonnotifiable 19,385 Nonnotifiable 373 1909 20,145 387 1910 25,677 494 1911 31,905 614 1912 19,809 381 Scarlet fever. The accompanying Diagrams A and B compare the weekly notifications of cases of scarlet fever and diphtheria occurring amongst school children and all other persons during the year 1912. The year 1912 has not been characterised by any marked increase in the prevalence of scarlet fever, although numerically the incidence is slightly higher than during the preceding year. Since 1907 when the disease assumed epidemic form, it appears to have been diminishing both in prevalence and intensity, although this reduction has been most accentuated during the past three years (vide Table above). Diagram A shows the characteristic autumnal rise, the disease having been comparatively quiescent during the spring and summer of the year. 458 schools were under observation for scarlet fever during the year, and 40 of them were visited by school doctors from time to time for special investigation. It is interesting to note that two schools, rincess Road and Stanhope School, where diphtheria was prevalent were also under special supervision owing to outbreaks of scarlet fever. In every case where a school came under special observation, reliance was placed upon the detection and exclusion of individual children who exhibited scarlatinal symptoms, however slight, in controlling the spread of infection. Diphtheria. The number of cases of diphtheria reported as Occurring among school children during the year was 2,571, as compared with 2,572 during the preceding 12 months. Altogether 273 elementary schools have been under observation as having shown evidence of possible school infection, and of these 75 schools were specially visited for the purpose of investigating the sources of infection and carrying out culture tests in regard to all children presenting any suspicious symptoms. In the course of these investigations large numbers of children have been examined, and during the year 2,349 cultures were tested in the laboratory for diphtheria bacilli, of which 250 yielded the true Klebs-Lœffler bacillus, whilst a further 174 were found to be sufficiently suspicious to warrant exclusion from school. The majority of the children proved to be carrying germs of diphtheria in the nose or throat do not suffer the more serious manifestations usually associated with an attack of diphtheria. Many appear quite well. These "carriers" are excluded from school and reported to the local sanitary authority, with a view of being followed up. They are not allowed to return to school until it is established by further bacteriological tests that they are no longer carrying diphtheria germs. In addition to these special precautions, the teachers have been instructed to exclude all children suffering from sore throat until certified free from infection upon bacteriological grounds, whenever there exists any suspicion of the spread of infection. Investigations similar to those above referred to were also necessary at a secondary school where one case of diphtheria and a number of " sore throats " were reported in February. Four children were swabbed and one of them was found to be harbouring diphtheria bacilli. This "carrier" was at once excluded. No fresh cases occurred until June, when one more isolated case was reported, but upon enquiry it was found unnecessary to take any further action and no developments arose. The discovery of "carrier" cases of disease has brought about a situation of much difficulty in public health administration. In those instances where no apparent symptoms are discernible, it is not possible to certify the cases as suffering from diphtheria, and thus they are excluded from the scope of the Public Health (London) Act, 1891. It cannot be definitely asserted that persons harbouring diphtheria bacilli, without any outward manifestations of the disease, are in every case infectious, but it is generally held that administrative action should be taken to ensure that healthy persons may THE CITY OF LONDON LITHOGRAPHIC C9.HARP ALLEY LONDON, E.C THE CITY OF LONDON LITHOGRAPHIC C9. HARP ALLEY LONDON, E.C 147 Report of the County Medical Officer—Education. be protected from the possibilities of infection. So far as children are concerned a rigid policy of exclusion from school is consistently adopted in such cases, but the problem of satisfactorily dealing with cases outside the jurisdiction of the education authority by some comprehensive and co-ordinated system has yet to be solved. Special investigations, extending over several months, were carried out in the case of six schools where diphtheria was particularly prevalent during 1911-12. The investigations involved many visits and much bacteriological work. The outbreaks are fully described in the following pages, in order to illustrate the marked tenacity with which the disease persists in certain schools and districts, and to give prominence to its various characteristics. (I) Princess-road School.—During the autumn and winter of 1910-11 this school was entirely free from diphtheria. The first notified case was from room 6 of the infants' department on April 19. By the end of the summer holidays (July 31, 1911)—that is, in eleven weeks—seventeen cases had been notified in the whole school, with six deaths. Apparently no diphtheria occurred amongst the scholars of this school during the summer holidays, but there is no doubt that a good deal of infection prevailed in the immediate neighbourhood, for between August 28 and November 22 (twelve weeks) twenty-five further cases were notified in the ward in which this school is situated, and of these twelve children attended this school. Six of these children attended room 3 of the infants' department, and two ended fatally. By January 8,1912,38 cases had been notified from this school, and of this number 33 occurred in the infants' department. In addition to the ordinary medical supervision, the department was thoroughly cleansed, and the use of the hall as a classroom was discontinued. Special weekly cleansing was also carried out, and the drainage system of the school was completely overhauled. Cases of diphtheria still continued to occur in spite of all vigilance and care until July 10, 1912. The school was closed for the summer during August, 1912, and has remained free since. The cases notified were distributed as follows:— Cases. Deaths. Infants 48 8 Boys 8 0 Girls 4 0 Total 60 8 Every care Was taken to discover mild, unrecognised, or carrier cases. This school was visited on 24 occasions, and the children in attendance examined. As had been the practice in such circumstances for some years, a cultivation on serum was made in every case from both throat and nose. Every child found to be carrying Klebs-Loeffler bacilli or germs suspicious of diphtheria was excluded until a satisfactory certificate based on bacteriological examination had been produced. Several cases of clinical diphtheria were discovered attending school and were also excluded. On two occasions children recently discharged from hospital were subsequently found to be chronic carriers. These were again excluded and kept out of school until the school doctor obtained satisfactory bacteriological results. One child, E. L., remained infectious until lost sight of by the end of the summer term. The cause of the epidemic prevalence of diphtheria in the neighbourhood of this school during the autumn and winter of 1910—11 can only be surmised, but it is possible that the prevalence during the spring and summer of 1911 was due to carriers of the kind referred to. When swabbing was undertaken on a large scale a number of children who had returned to school either from hospital or with a certificate based on bacteriological grounds were found to be carrying germs of diphtheria. The preventive measures adopted did not produce immediate relief, perhaps for the reason that the infection was too widespread and affected persons beyond the control of the school authorities. (II) Stanhope-street School.—This school is situated in one of the poorer and more congested neighbourhoods of London. The first case occurred early in January in an infant in room 3, and then spread rapidly throughout the department. The school was frequently visited, and the children in all the departments subjected to a frequent and careful scrutiny. Several cases of clinical diphtheria were found to be in attendance, and immediately excluded. It is the practice in all Council schools where diphtheria is prevalent for the teachers to keep a careful watch over the children, to exclude immediately all cases of sore throat or suspicious illness, to notify them to the school medical officer and the Medical Officer of Health, and not to readmit them until a satisfactory certificate has been produced. In this school in view of the special circumstances all suspicious cases were examined by the school doctor himself. It may be mentioned that diphtheria was at this time also present in other schools in the immediate neighbourhood. This general prevalence, apart from school influence, may therefore be partly responsible for the continuation of the cases in this school. In all, 29 visits were made to the school; 253 children were bacteriologically tested, and 399 swabs taken, on 56 occasions Klebs-Loeffler bacilli were discovered, and on 42 occasions suspicious bacilli. When germs suspicious of diphtheria were found, the infected children were excluded until a further examination had been made. The suggestion was made that both healthy and chronic carriers were responsible for this outbreak. On four occasions secondary cases occurred in the homes of children immediately after the discharge of the first case from hospital. Three of these primary cases were bacteriologically tested, but gave negative results ; but the fourth gave, and continued to give, Klebs-Loeffler bacilli (chiefly from the nose) for about six weeks after the occurrence of the secondary case. (III) The Fox School.—The characteristics of the outbreak of diphtheria at this school were its suddenness and severity whilst it lasted. At the time no diphtheria had been notified from the neighbourhood. On December 4, 1911, three cases were notified, and by the evening of December 5 seven 148 Annual Report of the London County Council, 1912. cases were known to have occurred in this school. All of them came from two class-rooms in the mixed department, the majority from room 5. Arrangements had been made for the school to be visited on the morning of December 5. At this visit all the children in the affected classes were examined, and suspicious throats were swabbed for bacteriological examination; those absent at the visit were excluded, pending inquiry at their homes by the Medical Officer of Health. The dates of last attendance of the notified cases were as follows:— One case November 28 Five cases „ 29 One case „ 30 Four cases December 1 Two cases „ 5 Two cases „ 8 Five cases „ 21 Subsequent inquiries pointed to a certain child who, though ill on November 27, continued to attend school until the afternoon of November 29. During these two days he had been attending lessons in two rooms (Nos. 5 and 7), and he may have been responsible for most of the cases in these two rooms. Fifteen children from a neighbouring orphanage attended school until December 1; on this date one of them failed with diphtheria, and the remainder were kept at home; of these, three others failed with diphtheria during the next few days. Teachers were instructed to segregate the classes and to keep a strict watch for suspicious illness, and the two affected classes were closed from December 5 to December 11. The school was kept under observation and six visits made to detect bacteriological carriers. The infants' school subsequently also became affected. In the two departments 70 children were tested bacteriologically, and of the 89 tests made 13 showed the presence of the Klebs-Loeffler bacillus. Two carriers Were subsequently discovered. One is of special interest as he was apparently examined at a period when not showing evidence of bacilli and he was allowed to return to school. The following summary gives the important facts of the case: C. C., aged 12. Throat unhealthy on December 5; culture showed Klebs-Loeffler bacillus. December 13: Certificate produced—freedom from infection based on bacteriological grounds—teacher re-admitted him. December 19: Medical officer visited school and attention was drawn to this boy. He had no discharge from the nose, but only crusts; boy picked his nose and there was a tendency to bleeding. Bacteriological examination now gave KlebsLoeffler bacillus in both throat and nose ; he was again excluded. On testing Klebs-Loeffler bacillus from this growth it gave the glucose broth reaction and it was slightly virulent. Klebs-Loeffler bacillus was isolated on five subsequent occasions. Those bacilli isolated on January 25 were re-tested; the result was a positive sugar broth reaction, but no virulence. He was allowed to remain at school but kept under close observation until April. During this time the nasal crusts had disappeared, and though the tonsils were enlarged there was no inflammation. Klebs-Loeffler bacilli were found until March, but by April they had apparently disappeared. (IV) Lavender-hill School.—This outbreak was at first limited to one class-room, attended by boys who had recently been transferred from the infants' school. The corresponding girls and the infants remained free. The outbreak was possibly attributable to a boy who was re-admitted by a misunderstanding on the part of the teacher, and later again on a bacteriological certificate. He was found to be a carrier. There were in all five notified cases with one death and 16 bacteriological cases in a class of 60 boys (26 per cent). The class was visited on nine occasions. At the fifth visit every boy in the class was swabbed, and amongst the apparently healthy children five Klebs-Loeffler bacillus carriers (8 per cent.) were detected. The history of the unrecognised case is as follows: C. B., aged 9, was absent from January 20 to February 19 with "chill and bad cold." On February 19 he was re-admitted on producing a certificate which read, "No signs of diphtheria, bacteriological examination unnecessary." February 23: Reexcluded on advice of a school doctor. February 26: Re-admitted on certificate, which stated "No Klebs-Loeffler bacilli present." As further cases continued to occur in this class-room, C. B. was retested on March 20 and found to be harbouring Klebs-Loeffler bacilli. He was excluded and remained out of school until May 24. The history of some carrier cases suggests that the infection not only may be of long standing, but may also be intermittent in character. The following is a case in point. As cases of diphtheria continued to occur in Kilburn-lane school, teachers were advised to exclude all cases of sore throat or suspicious illness. A boy, T. R., aged 13, was excluded on January 19 with "swollen tonsils." February 13: Medical Officer of Health took a culture; result, Hoffmann's bacilli. February 24: Medical Officer of Health took a culture ; result, Klebs-Loeffler bacilli; parents advised to get the boy's throat treated. March 8: Klebs-Loeffler bacilli still present. March 27: Hoffmann's bacilli only found; no treatment obtained; parents again advised. April 10: Klebs-Loeffler bacilli found, and child notified as bacteriological case. April 12: Removed to hospital. April 25; Discharged from hospital with certificate "not diphtheria." May 20: Medical Officer of Health finds Klebs-Loeffler bacilli; tonsils still enlarged; no treatment yet obtained; Medical Officer of Health desires exclusion of other children from home. June 7: Parents not only refuse treatment, but apply for re-admission of children to school asserting that the boy had no diphtheria when discharged from hospital. June 10 : Father writes complaining of the exclusion from school of his children and demanding immediate readmission. Refuses treatment. June 17: T. R. "swabbed" by school doctor: KlebsLoeffler bacilli found ; parents advised to seek treatment, June 26; Boy again " swabbed " ; Kleba- 149 Report of the County Medical Officer—Education. Loeffler bacilli in both throat and nose. July 5: Another letter from father asking for readmission of a brother. July 8: Arrangements made at a hospital for enucleation of tonsils. This was carried out August 26: After holidays all members of family "swabbed"; no suspicious germs found. August 27: Children re-admitted to school. (V) Wix's-lane School.—Three children attending room 6 of the infants' department were notified on June 13, 15 and 21 respectively. The child (No. 2 on the subjoined diagram) notified on June 21 was subsequently found to have had rhinorrhœa for a month, whilst still attending school. She last attended on June 18, and on June 21 was notified as suffering from nasal diphtheria. On June 6 a niece (age 15) of the class teacher, living at the same address, had also been notified as suffering from diphtheria. This girl had only just recovered from rheumatism and had not been out of the house. In spite of this case the teacher continued at her duties until June 17. On this date she was asked to absent herself from school until a bacteriological examination had been made. She stated that she had had no contact with her niece, and as the latter was immediately removed to hospital and the premises disinfected, she did not stay away from school. On June 18 she was. bacteriologically tested. The throat and nostrils appeared quite healthy, but she had Klebs-Loeffler bacilli in both throat and nose. She was re-examined from time to time afteT this date, but in spite of local treatment remained infectious until August 23 (68 days). She resumed her duties after three successive negative results had been obtained. It is quite impossible in this case to say definitely whether the class teacher or case No. 2 may have been the primary case and responsible for this local outbreak. The subjoined diagram shows the places in which the affected teacher and children sat in class, together with the dates of last attendance at school. Infants' Dept. Seating accommodation in Classroom 4. The affected children or possible carriers are indicated thus (within the square):— Diphtheria cases, by diagonal lines X. Bacteriological cases B. Sore throat or other suspicious cases S. Note,—Each oblong represents a dual desk, and each square a child's seat. The places occupied by the affected children and dates of last attendance at school are specified in each case. (VI) Brixton-hill Residential Industrial School.—The case of a girl R.C., now aged 13, who was admitted to Brixton-hill School on 1st January, 1910, in a weakly condition, is deserving of special consideration, inasmuch as the child's throat has been found to yield diphtheria bacilli for such a prolonged period as to make the case quite a unique one. On 27th December, 1910, R.C. was found to be suffering with a sore finger and on 28th December Dr. Benham lanced a whitlow on the second finger of the right hand. On 29th December R.C. developed 150 Annual Report of the London County Council, 1912. a rash, and this was diagnosed as scarlet fever. She was removed to the Grove Fever Hospital, Tooting. The medical superintendent states that the mother gave provisional permission for the removal of the finger should this prove to be necessary. It transpired, however, that amputation was not required. R. C. was subsequently transferred to Gore Farm Convalescent Hospital, and discharged as cured on 27th March, 1911. On her return to Brixton-hill school, she was placed in isolation, but used the same water closet as the rest of the children. She was very pale; looked ill; the finger showed no suppuration, but a piece of dead bone half-an-inch long protruded from the end of the finger. On 1st April she was released from quarantine and admitted to Dormitory IV with 27 other girls. On 8th April suppuration was observed and she was removed to isolation, where the sequestrum was removed and the finger dressed. On 12th April she was notified as still being infectious and sent back to the Grove Fever Hospital. Meantime on 5th April the first case of a series of scarlet fever cases occurred in Dormitory IV in the person of A. B., and in all 21 cases of notified scarlet fever and 15 cases of suspicious illness occurred in this school. R. C. herself was, as aforesaid, again notified and sent to hospital, making a total of 36 cases removed to hospital amongst 60 girls. None of the staff contracted the disease. The dates of removal, and dormitories which the children occupied, are given in the table below:— 7th April—A. B. —Dormitory IV. 10th „ — M. P. — „ IV. 12th „ — D. G. — „ IV. 12th „ — R. C. — „ IV. 13th „ — D. B. — „ I. 13th „ — M. W. — „ III. 13th „ — M. S. — „ III. 15th „ — I. B. — „ III. 15th „ — L. B. — „ III. 15th „ — K. S. — „ IV. 16th „ — L. R. — „ III. 16th „ — E. M. — „ IV. 16th „ — E. G. — „ III. 16th „ — B. S. — „ IV. 21st „ —F. D. — „ III. 21st „ — E. S. — „ IV. 21st „ — M. F. — „ IV. 25th „ — T. B. — „ III. 25th „ — E. D. — „ IV. 27th „ — A. C. — „ III. 27th „ — M. H. — „ III. 28th „ —A. A. — „ III. Of the suspicious cases treated in isolation, a large proportion subsequently peeled and very probably were cases of mild scarlet fever. Of these 11 were in Dormitory IV., and four were in Dormitory III. Twenty-one of the 27 girls in Dormitory IV. and 15 of those in Dormitory III. were either notified as cases of scarlet fever or came under suspicion. R. C. was discharged from the Grove Hospital on 11th May, 1911, and kept in quarantine at the school. She was still in a poor state of health and on 29th May returned to Dormitory IV., where there were 27 other girls. From the date of her readmission to Dormitory IV. (29th May) until 27th July, 1911, there were no cases of sickness in the school, but on the latter date a girl, D. T., in Dormitory IV was unwell and on 28th July exudate was discovered on the tonsils. She was immediately isolated on suspicion of diphtheria. The child was bacteriologically examined, with the result that diphtheria germs were found, and she was removed to the S.W. Hospital (Stockwell) on July 30th. Dormitory IV. was put into quarantine and all precautions taken to prevent spread of infection. The whole of the inmates of the school, including the staff, were examined bacteriologically on 31st July, onwards, and those found to be carrying diphtheria germs or organisms of a suspicious character were classified; isolated in separate dormitories and re-examined from time to time. There was at this time no adequate accommodation for isolation, and all the dormitories being fully occupied, the staff found considerable difficulty in arranging for the segregation of the groups in quarantine and of cases in isolation. At this time keen vigilance was exercised to detect cases of sore throat and slight indisposition; these, when detected, were isolated and bacteriologically tested from time to time. Between 31st July and 9th August, nine children were isolated on suspicion, but only one (F.D.) was found to be definitely harbouring diphtheria germs, and as she was suffering from sore throat and albuminuria, she was removed to hospital Subsequently R. C. and another girl, E.M., continued to give positive results, although they showed no clinical symptoms of diphtheria. In view of their continuing to be carriers, however, they were notified as cases of bacteriological diphtheria and removed to hospital. The net result was that the school was under observation from 28th July to 28th August, 1911, during which period two children were attacked by diphtheria, whilst two others were notified as cases of bateriological diphtheria, and all four children were removed to hospital. Analysis of the results of examination of cultures showed that 25 children were harbouring diphtheria germs at some time during the investigations, but were treated at school and soon cleared up, four children were found carrying Hoffmann's bacilli, and 29 continued to give negative results throughout. Of the two persistent carriers, R. C. was always pale and weakly, but 151 Report of the County Medical Officer—Education. E. M. was a very robust and healthy girl. The cause of the outbreak was never definitely determined, but the subsequent history led to suspicion being cast upon R. C. It was suggested that she became infected with the germs of diphtheria during the period of her convalescence in the fever hospital, most probably from some other carrier child, and that she brought these germs back with her to the school. The infective condition must on this hypothesis have been dormant in her case for some time. Her throat began to yield diphtheria bacilli some time in August, however, and she may have been responsible for infecting other children in the school. As already stated, only two of these developed diphtheria, whilst 28 others passively carried diphtheria bacilli in their throats without showing any symptoms of illness or indisposition. These germs soon disappeared when the throats of the children had been treated with gargles, etc., and the original source of infection had been removed. F. D. returned from Grove Hospital on 7th September, 1911, and D. T. on 13th October. They were isolated at school for the usual period, bacteriologically examined, and finally allowed to mix with the rest of the girls. R. C. and E. M. returned from the Grove Hospital on 2nd November. They were placed in isolation together and bacteriologically tested. As R. C. was found to be a carrier of the infection of diphtheria she was sent back to hospital on 11th November. She remained at the S.W. Hospital from 11th November to 4th April, 1912. Upon her return to school on the latter date she was swabbed, with the result that diphtheria germs were again detected in the culture. A specimen was sent to the Lister Institute for a virulence test, with the result that both the throat and nose swabs showed typical Klebs-Loeffler bacilli and were slightly virulent. She was not returned to hospital, but bacteriological tests were made weekly. E. M. subsequently also yielded positive results and was sent back to hospital on 16th November, where she remained until 22nd December. Upon her return to school she remained in quarantine for 14 days, and as two series of three successive swabs proved negative, she was allowed to return to Dormitory IV. She subsequently remained in good health. On 3rd June, 1912, M. W. from Dormitory IV. was found suffering from diphtheria and sent to hospital, where the diagnosis was confirmed. On the same date R. C. was sent to the N.E. Hospital as a carrier and possible source of infection. Between 4th April and 3rd June, 1912, cultures from the nose and throat of R. C. proved positive, but after admission to hospital no suspicious germs were found between 4th to 27th June. On 28th June a positive result was obtained. She continued harbouring true diphtheria germs until December, 1912, and then for three weeks negative results were obtained. In January, 1913, Klebs-Loeffler bacilli were again discovered, and since that time she has been continuously discharging them from the throat and nose. During her detention in the N.E. Hospital the virulence of the germs has been tested regularly, and during the major portion of the period she was discharging Klebs-Loeffler bacilli, they were found to be non-virulent, but on several occasions, especially during November, they proved to be virulent. After the occurrence of diphtheria in the school in June, 1912, every child was bacteriologically tested, with the result that one girl, E. M., the companion case to R. C., during the previous outbreak, was found with the typical bacillus, six others were carrying suspicious germs, and the remainder were free. E. M. was removed to the N.E. Hospital, whilst the six suspects were isolated, bacteriologically tested from time to time, and eventually returned to school routine. E. M. remained in the N.E. Hospital from 12th June, 1912, to 19th October, 1912, and Klebs-Loeffler bacilli were isolated from the throat only. The virulence was tested on several occasions and the result in each case was reported as follows:— Reaction — Neisser + Gram + Sugar broth + Animals 0 E. M. was detained in hospital until these non-virulent bacilli had disappeared, and was proved to be free from diphtheria germs on three successive occasions. She was placed in quarantine at the school from 19th to 30th October, 1912, and, as successive examinations gave negative results, she was re-admitted to Dormitory IV. and has remained in good health since. The suspicion that E. M. acted as a chronic carrier of infection to others cannot be Seriously entertained. In the case of R. C., however, the facts are difficult of interpretation. The suspicion that she might have been at fault was first entertained on the occurrence of the group of scarlet fever cases, the first of which was removed on 7th April, 1911. R. C. was subsequently found to be a carrier of diphtheria bacilli, and on the occurrence in July, 1911, of cases of diphtheria, the question arose as to whether she might have been the source of infection. She continued from time to time to give positive results as regards diphtheria bacilli, but no further cases of diphtheria occurred until June, 1912. For some time preceding the occurrence of this last case R. C. had been quarantined at the school. The facts have been set out in detail inasmuch as much interest attaches to the questions, first, whether R. C. suffered from scarlet fever, and, second, whether she was responsible for the spread of that disease, of dipthheria or of certain septic conditions which prevailed in the school. The case of this girl is, moreover, as already stated, unique in respect of the lapse of time during which she was shown to be a carrier of diphtheria bacilli. It is noteworthy that during the outbreak of scarlet fever in the school from December, 1910, to 7th April, 1911, a number of cases of septic infective abscesses and sores were observed amongst the inmates, which lasted from 15th January, 1910, until May or June of 1911. Many of the children admitted to these industrial schools have previously been neglected and are often in a poor state of health. It is possible that their condition of sepsis is associated with their previous life, and is really not of notably infectious character ; it is, however, remarkable to find so many cases occurring within a definite period amongst such a small community. Although the circumstances were suspicious, no relation could be traced between the septic cases and scarlet fever. 152 Annual Report of the London County Council, 1912. The following is a resume of the facts with regard to the school:— January 15th, 1910—A child suffering from whitlow. „ 15th, 1910—Another child sent to hospital with abscess in axilla. „ 24th, 1910—A child found to have a septic finger. February 13th, 1910—The second child returned from hospital; had a recurrence; was operated upon and treated at the school. April 8th, 1910—Cases of discharging ears. „ 8th, 1910—Child with suppurating ringworm of scalp—recovered by June 16th. November 4th, 1910—Further cases of discharging ears. November—December, 1910—A series of cases with septic fingers. December 27th, 1910—R. C. has sore finger, developed a whitlow on December 28th, when it was lanced. December 29th—A rash resembling that of Scarlet fever appeared on R. C., who was notified and removed to S.W. Fever Hospital—she returned to school infirmary on March 27th and to school routine on April 1st. February 9th—April 25th, 1911.—Seven cases of severe septic fingers and 15 other minor cases were reported and treated at the school. April 8th, 1911—Sequestrum removed from R. C.'s finger. „ 12th—R. C., although presenting no evidence of scarlet fever, sent as a measure of precaution to Grove Fever Hospital for isolation purposes. „ 5th to 28th—21 cases of scarlet fever and 15 cases of suspicious illness occurred at the school. May 11th—R.C. returns to school and is kept in quarantine until May 29th. July 27th—A child sickened with diphtheria. „ 31st to August 9th—Bacteriological examination of all inmates of school. R.C., E.M., and one other child found to give positive results. All four children removed to hospital. November 2nd—R.C. and E. M. returned to school. „ 11th—R.C. found still to harbour diphtheria bacilli and sent back to hospital. April 4th, 1912—R.C. returned to school, found still to harbour diphtheria bacilli. June 3rd, 1912—M.W. developed diphtheria, R. C. returned to hospital. „ 11th, 1912.—E.M. sent to hospital as a carrier of diphtheria bacilli. October 19th, 1912—E.M. discharged from hospital. R.C. still remains there. The subjoined Table represents an analysis of the bacteriological work done in connection with the investigations in the above-mentioned outbreaks. Schools. Departments. Class or Classes. Number of visits, Period of Investigation. Number of children bacteriologically examined. Bacteriological analysis. Remarks. Number of swabs. KlebsLoefliar bacilli. Suspicious organisms. Hoffmann's bacilli. Negative. Princessroad Boys, Girls, and Infants, All 24 July 17th, 1911, to June 3rd, 1912 233 334 36 32 39 227 Throat and nose examined in every case Stanhopestreet Boys, Girls, Infants Mixed All 29 Jan. 24th, 1912, to July 17th, 1912 253 399 56 42 43 258 Visits to Boys, 12 Girls, 16; Infants, 22 Mixed, 1 "Fox" Mixed and Infants All 6 Dec. 5th, 1911, to April 25th, 1912 70 89 13 5 1 70 - Lavenderhill Boys No. 8 9 Feb. 1st, 1912, to June 21st, 1912 82 146 20 5 126 - - Wix's-lane Infants No. 4 2 June 21st, 1912, to June 28th, 1912 16 21 - 2 7 12 - M. K. - - 8 June 6th, 1912, to Aug. 26th, 1912 - 8 5 - - 3 M. K.'s niece notified with diphtheria June 6th, 1912(out of school case); M.K. excluded, June 17th, 1912. Brixton-hill Industrial (1) first outbreak Girls All 21 July 31st, 1912, to Aug. 28th, 1912 60 ( + 8 adults) 276 60 5 23 188 The results obtained from the children were: Klebs-Loeffler bacilli, 31 children; Hoffmann bacilli, 4; negative, 29. (2) second outbreak Girls All - June 5th, 1912 60 85 3 5 18 59 Analysis in regard to children gave this result: Klebs-Loeffler bacilli, 4. 153 Report of the County Medical Officer—Education. The distribution of cases of diphtheria in the schools concerned is given below in Table A. Table B shows the age distribution of cases. Table A Class School Age Boys' Department. Girls' Department. Infants' Department. Remarks. 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 — 13-14 12-13 11-12 10-11 9-10 8-9 7-8 — 13-14 12-13 11-12 10-11 9-10 8-9 7-8 7-8 — 6-7 6-7 5-6 5-6 4-5 3-4 Princess-road — — 1 — 1 1 2 3 — 1 — — — — 3 — 7 — 8 3 10 10 5 5 First case, Infants, room 5, May 8th, 1911; last case, room 8, July 10th, 1912 Stanhope-street — — 2 1 — 1 — 1 — 1 2 — — 4 2 — — 9 4 7 6 4 4 1 First case, Infants, room 6, June 19th, 1911; last case, room 6, July 1st, 1912 Mixed Department " Fox " — — — — — — — — — — 1 2 4 1 10 1 4 — — — — 1 1 2 First case, Mixed, room 5; November 29th, 1911; last case, room 7, May 3rd. 1912 Lavender-hill — — — — 1 1 — 7 — — — — 1 — — — 1 1 — — 1 1 — 1 First case, Boys, room 8, January 19th, 1912; last case, room 8, May 3rd, 1912 Wix's-lane — — — — — — — — — — — — — — — — — 1 — 5 1 1 — — First case, Infants, room 4, January 12th, 1912; last case, room 4, June 18th, 1912; M.K. discovered +; excluded June 17th, 1912 Brixton-hill Industrial — — — — — — — — 4 cases in 1911 and one case in 1912. — — — — — — — — 18820 154 Annual Report of the London County Council, 1912. Table B Age distribution Years. 13-14 12-13 11-12 10-11 9-10 8-9 7-8 6-7 5-6 4-5 3-4 Total population 4,708 794 348 460 390 465 816 498 488 255 194 Total diphtheria cases 159 8 3 7 8 17 35 27 35 10 9 Percentage incidence % 3.3 % 1 % 0.8 % 1.5 % 2 % 3.6 % 4.2 % 5.4 % 7.2 % 3.9 % 4.5 Persistence of scarlet fever and diphtheria, in certain schools The cases of the six schools above referred to, illustrate unusual diphtheria prevalence. Study has been made of the extent to which both scarlet fever and diphtheria sometimes persist in schools. The accompanying Diagram C shows the distribution of cases of both diseases week by week for three consecutive years, in 30 selected schools. Examination was made of the scarlet fever record of all the large Schools (over 1,000 on the roll) and the 30 schools with the highest and the 30 with the lowest incidence of scarlet fever in 1912 were selected. From each group of 30 Schools, 15 were chosen as being those which during the period 1910-12 showed the highest and lowest incidence of the two diseases taken together. The cases for each of the 30 schools were then plotted out in weekly periods. In the diagram each horizontal line represents a school, the scarlet fever cases are shown above, and the diphtheria cases below this line. Study of the diagram shows clearly the tendency in some instances for both scarlet fever and diphtheria to persist when once a school has been definitely involved. This fact is one familiar to those who have studied records of disease distribution in schools. Dr. Niven, Medical Officer of Health of Manchester, referred to it nearly 20 years ago (see particularly his Annual Reports, 1897-1901). He speaks of "the tenacity of the disease scarlet fever) 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." The evidence afforded by the diagram now under consideration goes to show that this process of repeated attack continues not only for months but for years. This subject of occasional persistence of infection in classrooms was referred to in the Annual Report of the Medical Officer of Health of the County of London of last year, p. 63, to which reference may be made in this connection. Another point to be observed is the close association of the two diseases scarlet fever and diphtheria. Thus, in the schools in which there is heavy incidence of scarlet fever the incidence of diphtheria is often well marked also. For instance, school No. 1 had by far the greater number of scarlet fever cases in the three years under observation and it also suffered to a notable extent from diphtheria, more especially when scarlet fever was at its period of maximum prevalence in the latter end of 1911 and the beginning of 1912. Similarly in school No. 2, where diphtheria was especially prevalent, the period of maximum incidence was preceded by a crop of scarlet fever cases which continued also to occur throughout the period of maximum diphtheria prevalence. It is important to note that the persistence of the two diseases in the affected schools was maintained in Spite of the careful exercise of precautionary measures, and these included, in the case of diphtheria, the carrying out of bacteriological examinations and the rigid exclusion of all children found to present evidence of acting as carriers of diphtheria bacilli. The facts certainly seem to indicate that the subject of the association of scarlet fever and diphtheria is deserving of further study. Measles- It will be noted in the Table on p. 27 that there has been during the year a very considerable diminution in the prevalence of measles, 19,809 cases having been reported as compared with 31,905 the preceding year, whilst 761 schools have been under special observation. This reduced incidence has followed in natural sequence upon the extensive epidemic of 1910-11 which largely reduced the proportion of susceptible children. The mortality of all persons due to measles presents a corresponding reduction, there having been 1,799 deaths from measles during the year as compared with 2,570 in 1911. The usual seasonal influences were experienced in the spring and autumn, the spring outbreak having reached its culminating point in the early part of June, whereas the autumnal prevalence was felt chiefly during November. When measles has been introduced into an infants' department of a school immediate steps are taken to prevent the unprotected children from attending school during the fall of the second crop, and special attention is focussed upon the children under five years of age among whom the mortality is chiefly felt. During the year large numbers of unprotected children were excluded for protective purposes and particulars of these exclusions are to be found in the table on p. 38. In addition to direct action taken at the school as regards exclusion of unprotected children, head teachers are consistently advised, apart from the general rules laid down in the prescribed regulations, to take the utmost precautions in promptly excluding suspects, exercising a strict surveillance over the children, preventing as far as possible all mixing and massing of the classes, and generally assisting in minimising the risk of dissemination of infection. In addition, the parents of susceptible children in affected classrooms are warned of the occurrence of measles at the school by means of a card upon which appropriate advice is given. Measles. 1840-1912 The charts in diagram D show respectively the average weekly deaths from measles in London for the 34 years before and the 39 years after the year 1874. Diagram C. Diagram D. Diagram E. 155 Report of the County Medical Officer—Education. The waves of measles recur at intervals of 2 years or 18 months and it is seen from study of both charts that at two periods of the year there is a special tendency for the time of maximum prevalence of measles to occur; one period of maximum death-rate being noted in May and one in December, with corresponding minima about September and March. When, however, the two charts are compared one with another it is seen that in the earlier series of years the range of variation in the weekly average is much smaller than in the later series. In the latter the maxima and minima become much more pronounced and the characteristic deviations of the curve from the mean thus becomes much more accentuated. It may be taken that the Elementary Education Act began to exert its influence about the year 1874. The accentuation of the curve of measles mortality during the later series of years may in all probability be attributed to the increasing aggregation of the population, combined with the effects produced by compulsory school attendance. Under modern conditions the natural tendency of measles to exhaust the susceptible cases finds freer expression, with the result that outbreaks climb more readily to their maxima, and correspondingly intervals are left in which the disease is less active than formerly. It will be seen that the two times of minimal death-rates occur three or four weeks after the two main school holiday periods. The minimal depressions in the lower chart correspond, roughly speaking, in point of time with those in the upper chart, but the point to be observed is that they are sensibly deepened in the lower chart. Diagram E shows the incidence of measles month by month during the seven years 1906-1912. The uppermost curve gives the deaths, the middle curve the cases notified from the elementary schools and the bottom curve the cases as calculated from the deaths; for the last named Dr. Butler's experience in Willesden, as to average interval between notification and death, has been used as a basis. Measles in London, 1903-1912. The curves show a considerable degree of correspondence. The most noteworthy difference is that to be seen in the greater irregularity of the curve of notified cases. Especially is this observed in a drop in the curve which occurs year by year between Easter and Whitsun, with a subsequent rise in the month of June. This regularly recurring phenomena has no counterpart in the other two curves and requires explanation. Teachers are required to notify the school medical officer immediately upon becoming aware of the occurrence of a case of infectious illness in a scholar; they are debarred, however, from sending to the homes in these cases, and are dependent for their information upon visitation by the attendance officers ; this brings about delay in notification and in some cases it may be a fortnight after the date of last attendance before the results of visitation in a specific case are known to them. But during the period about the Easter holiday this source of information practically ceases inasmuch as the attendance staff are engaged in "scheduling" in their respective districts and visitation of the homes of absentees remains in abeyance during this time. This results in a cessation of notification of cases, and produces a depression of the curve during scheduling time with a corresponding rise in the curve owing to the belated notification of cases when normal visitation of absentees is again resumed after W hitsun. Inasmuch as early knowledge of cases is the starting point from which all preventive action must take place, the cessation of notification during the scheduling period is a serious blot upon the system upon which reliance is placed for the control of measles. During the latter part of the past year an arrangement was effected whereby each attendance officer notifies the school medical officer directly a case of measles is encountered by him during visitation. In the Southwark area an experiment has, moreover, been initiated with the co-operation of teachers and attendance officers, whereby infant absentees receive preferential visitation, with the result that notification of measles is speeded up and in many instances as much as ten days is gained. This procedure has been continued throughout the period usually devoted to scheduling. It is very desirable that there should in future be an extension of this procedure. Whooping cough was prevalent during the spring and summer months. This disease is one which is difficult to control in schools, inasmuch as the patient is frequently capable of spreading infection during unrecognised stages of the disease, and for this reason it is specifically provided in the regulations in regard to infectious diseases framed for the guidance of teachers that, during the prevalence of the disease, children suffering from bad coughs, whether or not the characteristic "whoop" is heard, should be temporarily excluded from school as a precautionary measure. In addition, however, in view of the high mortality for which the disease is responsible among children of tender years it has been thought necessary in some instances to exclude from attendance during school outbreaks all children under the age of five. The efficacy of this procedure depends in urban communities upon social conditions; in congested areas the opportunities for infection encountered in streets, tenement dwellings, etc., are very considerable. This factor was usually borne in mind and such exclusions were upon occasions only carried out after consultation with the local medical officer of health. Whooping cough. Whooping cough was made a notifiable disease in Greenwich and Lambeth by order of the borough councils. Chickenpox ranks among the infectious diseases associated with school life next to smallpox in its infectivity. The disease is probably infectious a day or two before the appearance of the typical rash. If a child attends school during the infectious stage, whether that be before the appearance of the rash, with the disease fully established, or whether as a missed case, secondary cases are sure to crop up in large numbers about 14 days afterwards. A good instance in point occurred at the Royal Victoria Patriotic Asylum in July, 1912, where out of 264 children at this home 104 contracted chickenpox (40 per cent.) probably as the result of a missed but undetermined case on or about 28th June. Chickenpox An analysis of 73 of the cases was made as follows:-On the 13th day after exposure, 2 cases; on the 14th day after exposure, 62 cases; on the 17th day after exposure, 5 cases; on the 18th day after exposure, 3 cases; on the 19th day after exposure, 1 case; total 73 cases, 18820 U 2 156 Annual Report of the London County Council, 1912. The ages of children at this school vary between 7 and 16 years and the inference is that a good many of them, therefore, must have suffered from chickenpox before. The previous history of these children in regard to infectious illness could not be ascertained and the incidence in susceptibles can, therefore, not be determined. The same experience is met with in elementary schools, and more especially in infants' departments. When chickenpox is introduced into the school a crop of cases follows some 13 to 19 days after the exposure to infection. Fortunately, apart from interfering with and disorganising school attendance,this disease is harmless and school closure or exclusion of susceptible children is usually not recommended. Ophthalmia Ophthalmia has been very prevalent in London during 1912 and cases have been reported from many districts. The districts where the infection has been most prevalent are Hackney, Hoxton, Haggerston and Shoreditch, where schools have been in many cases seriously affected. For example, from London Fields 234 cases have been reported during the year, most of them during the first quarter of the year. In the annual report of the medical officer for 1911 attention was drawn to an outbreak of ophthalmia in Drury-lane Industrial School, and it is of interest to note that many of the cases occurred in boys drawn from the Hoxton district. The outbreak has quite subsided and the school has remained free throughout 1912. The disease is very contagious and protracted. Its spread may be ascribed to various causes— the chief of which are— (1) Early, mild or chronic cases in an infectious state are not excluded from school. This was confirmed in every case where a school doctor was asked to make a special visit to a school affected with ophthalmia. (2) Children excluded from school do not receive treatment, wander about the street, come in contact with healthy children in the street and playground. (3) Infection may further be carried through the agency of towels and handkerchiefs. Dr. Forbes has also drawn attention to the danger of spread through the agency of swimming baths. Ringworm and Favus. The following table furnishes a comparison of the statistical returns of ringworm which are compiled periodically, showing the numbers of new cases, cured cases and those outstanding at the end of each school term. It should be noted that at the end of 1911 there were 2,458 children known to be suffering from ringworm. Terms. New Cases reported. Cured Cases. Suffering Cases at end of Term. No. Treatment by which cures effected. No. Treatment being obtained. Spring Term 1,617 1,421 X-rays 35% Ointments, etc., from hospitals, etc. 37% Ointments, etc., from private doctors 23% Chemists and " home " remedies 5% 2,480 X-rays 21 % Ointments, etc., from hospitals, etc. 39% Ointments, etc., from private doctors 27% Chemists and "home " remedies 9% None 4% Summer Term 2,001 1,635 X-rays 36% Ointments, etc., from hospitals, etc. 33% Ointments, etc. from private doctors 24% Chemists and "home" remedies 7% 2,717 X-rays 22% Ointments, ctc., from hospitals, etc. 43% Ointments, etc. from private doctors 24% Chemists and "home" remedies 9% None 2% Michaelmas Term 1,693 2,075 X-rays 39% Ointments, etc. from hospitals, etc. 34% Ointments, etc., from private doctors 20% Chemists and "home" remedies 7% 2,204 X-rays 22% Ointments, etc., from hospitals, etc. 40% Ointments, etc., from private doctors 24% Chemists and "home" remedies 9% No treatment 5% The cases in which children were lost sight of owing to removals, or by other means passed out of the Council's jurisdiction are not recorded in the above table. During the year large numbers of hair specimens have been forwarded by school doctors and school nurses for microscopical examination and these have been tested in the laboratory. The subjoined table sets out the result of these examinations, and for purposes of comparison the work done in preceding years is also shown. 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 1908 (Mar. to Dec.) 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 4757 — 1912 2,820 1,991 41721 67 157 Report of the County Medical Officer—Education. During the year 27 fresh cases of favus were discovered. The subjoined table may be of interest in demonstrating the nationality of the parents, the periods of residence in England and the possible duration of the disease. Case. Age. Nationality. Period of residence in England. Possible duration of disease. Father. Mother. I.S. 8 Russian English Since birth Absent 1 year with ringworm before favus diagnosed R.G. 10 Polish Polish Since birth Since 2 years old. L.D. 10 English English Since birth Always suffered from skin disease. W.F. 11 Russian Russian 8 years Suffered from skin disease 2 years. A.H. 8 Russian Pole Russian Pole 6½ years Suffered from skin disease 3 months. H.F. 11 Russian Russian Since birth Suffered from skin disease for 3 or 4 years. E.P. 11 English Dutch Since birth 7 weeks. Y.K. 12 Russian Russian Since birth Suffered from scalp disease about 5 months. H.B. 6Russian Russian Since birth Suffered from scalp disease about 9 months. A.D Russian Russian 9 months Scalp disease on arrival in England. F.B. 6 English English Since birth Suffered from scalp disease some months. B.C. 13 Russian Russian Since birth Suffered from scalp disease some years. J.T. 6 English English Since birth 5 weeks. L.C. 9 Russian English Since birth 2 months. J.V. 9 Belgian English Since birth Suffered from scalp disease 1 year. H.S. 9 Russian Russian Since birth R. S. suffered from scalp disease some years. No R. S. 12 information re H.S. J. A. 7 Russian Russian Since birth Suffered from scalp disease 2 years. C.G. 11 English English Since birth Suffered from disease for 9 months. W.S. 6 English English Since birth 6 weeks. J.S. 10 Russian Russian Since birth Suffered from scalp disease for 3 years. A.S. 10 Russian Russian 4 years About 2 weeks. L.A. 10 Austrian Austrian Since birth 11 weeks. B.C. 13 Russian Russian Since birth Suffered from scalp trouble for 6 years. R.W. 8 Russian Pole Russian Pole Since birth Short time. R.L. — — — — Admitted to Pentonville Place of Detention. No further information. Favus being a disease of foreign importation, the cases with but one or two exceptions have occurred among the alien population in the East End, and it will be noted that in only five instances were both parents returned as being of English nationality. The following table shows the number of special exclusions and school closures, apart from individual exclusions, consequent upon the occurrence of infectious illness. It is noteworthy that measles and whooping cough are the only diseases involved, as in the cases of scarlet fever and diphtheria the method adopted is to exclude individual suspects as the result of a systematic and careful surveillance of affected classes. An organised attempt has been made during outbreaks of scarlet fever and diphtheria, by means of a periodical examination of the children in attendance at school, to detect any children who are either exhibiting symptoms indicative of the presence of disease in a mid and previously unrecognised form or cases showing existence of the sequelae of the disease, and in the case of diphtheria of any children whose throats or noses show the presence of diphtheria bacilli. All such children are excluded until, by re-examination, they have been found free from any symptoms of the disease. Special exclusions and closures owing to infectious disease. Number of occasions on which exclusions or closures were carried out. Measles. Whooping cough. Co-existence of measles and whooping cough. Departments closed — — — Classrooms closed 1 1 — Exclusion of all children under 5 years of age 13 98 15 Exclusion of all unprotected children under 5 years of age 195 1 — Exclusion of unprotected children from whole of infants' depart17 — — ment Exclusion of unprotected children from individual classes 2,171 — — Exclusion of all children under 5 years from individual classes — 19 — Exclusion of unprotected children under 7 years of age 1 — — (deaf school) Exclusion by local medical officers of health acting under Article 57 of the Board of Education Code. Departments closed 1 — — Classrooms closed 1 1 — Exclusion of all children under 5 years of age 3 2 — 158 Annual Report of the London County Council, 1912. Infectious Disease in Places of Detention. Places of detention were transferred to the Council in 1910, they serve the purpose of temporary shelters for those London children who, for various reasons, come under the notice of the police. The average time during which children may be detained in a home is 14 days. During this period it is the Council's duty to house and provide for them; they must be sorted into groups according to age, sex, and whether healthy or sick, must be cleansed, medically treated, fed and educated, until they can attend the Children's Court. They are generally dealt with in two ways:— (i.) The magistrate sends them to an industrial school; if too young, they are boarded out with foster parents. (The education department of the Council is responsible for providing and maintaining these institutions and keeping them under inspection.) (ii.) The magistrate allows the child to return to its home and parents. While the Council has control of these homes, the decision as to who shall, or shall not, be sent to them rests with the police. Legally no case can be refused admission if brought with a warrant. Inasmuch as infectious cases must be admitted there is a very grave risk of spreading infection amongst children detained in these homes, and by them to industrial schools, often out of London, or to homes where they have to be boarded out. Under the present conditions the first risk cannot be entirely avoided, but may be minimised; but the second risk may be entirely overco me. The efficiency of a home of detention from this point of view depends upon the following conditions: 1st. The home must be provided with a sufficient trained staff. 2nd. It must be so arranged that the following principles can be readily carried out:— (a) Every new admission should be quarantined until the child has been cleansed, inspected and passed by the doctor subsequently at his visit. (b) Accommodation for inmates should be so adapted as to allow for grouping of children into small sections. (c) Provision of isolation accommodation should be available for all suspicious cases as they arise in the home. (d) Arrangements should be made with outside authorities for the reception of all cases of infectious and contagious diseases occurring in the home, and with hospitals for the reception of all other medical and surgical cases which require treatment and may be detained in the home for any period over the 14 days. It is essential for the working of such a home that no child should be detained there longer than is absolutely necessary. The three homes taken over by the Council in 1910 were quite unsuitable for carrying out the work in accordance with the principles outlined above. The accommodation was insufficient, necessitating overcrowding and excluding any possibility of classification; moreover, there was no medical supervision and no attempt at isolation and quarantine. The Council has, since taking the homes over, introduced many improvements, one of the first of which was the remodelling of Pentonville Home. This scheme involved the building of separate dormitories, and the provision of separate lavatory and washing accommodation and playgrounds so that the separation of the sexes was possible. The sleeping accommodation in the old building was discontinued and arrangements were made for— (1) Admission and quarantine of new cases. (2) Isolation and quarantine of old cases. (3) Schoolroom and dining accommodation. (4) Providing a doctor's room. The next step was to transfer all young children to a separate home. For this purpose Camberwell-green Home was set apart and all the children under seven were transferred there. Camberwell-green, unfortunately, is also an unsuitable place, but arrangements are being made to provide a suitable home at Ponton-road to take the place of Camberwell-green. This home will be ready for occupation early in 1913. The risk of introducing infectious and contagious diseases into the home from without is exhibited in the subjoined table showing that the following infectious diseases were from time to time introduced into Pentonville—whooping cough, chickenpox, rubella, ophthalmia and ringworm—some of these diseases it will be seen from the table were transferred with the younger children to Camberwell-green Home. Here the accommodation and the nursing arrangements were unsatisfactory, so that whooping cough, ringworm and ophthalmia cases continued to recur amongst the inmates. Altogether 15 cases of whooping cough, 2 of ringworm and 15 of ophthalmic occurred from the date of transference of the young children in July to the end of the year, and the home was placed in quarantine from 10th October to 13th December. It is hoped that when Ponton-road is open efficient nursing arrangements and opportunity for segregation and quarantine will prevent such occurrences. An outbreak of an infectious fever results in the closing of the whole or a part of the institution until it is certain that no other case will develop. If the home is closed the committed children have all to be distributed among the other homes; as the supply of cases is fairly constant the other homes are congested and there is greater liability of spread of infection. In 1912 Pentonville and 159 Report of the County Medical Officer—Education. Camberwell-green were closed wholly or in part for 152 days; of that period only 41 days (or 26 per cent.) was due to actual illness amongst the children over seven years of age. The younger the children the more susceptible they are to disease. The cases of chickenpox, German measles and whooping cough which occurred at Pentonville were all due to children who had contracted the diseases shortly before admission to the home and were therefore incubating the disease at the time. As they were quite well on admission and there was no history given of contact they were admitted to the general community in the home. One outbreak of chickenpox was attributed to a mother bringing a child to court covered with the rash of chickenpox and thereby infecting two sisters whom she was allowed to see and handle ; subsequently other children in the home also contracted the disease. On February 2nd a boy aged 13 was admitted ; up to February 10th there was no sign of any illness. On February 15th he developed chickenpox. He contracted the disease through spending the afternoon with a friend suffering with chickenpox, about three days before he was charged. No other case occurred. On February 9th a little girl of 5 was admitted. She rarely spoke or played with the other children; on the 25th the doctor saw her in the evening and found her with a temperature of 104, and signs of broncho-pneumonia. A fading rash was discovered on examining her in daylight. The other children were watched, and isolated as soon as they showed signs of being unwell three other children developed German measles. In April a small boy was found to have spots which proved later to be chickenpox. The two boys who slept on either side of him subsequently developed the complaint. There are objections to placing all young children in one home—for instance, the distances that have to be covered going to and from the courts. To take a concrete case, a girl of five is taken from a house situated in the north of London, on Thursday night, she is charged at the police station and sent off to Ponton-road—a distance of six miles in a straight line—arriving perhaps after midnight. The next morning a policeman and matron journey to Ponton-road, which they reach about 12 ; from there, they have to convey the child to the Children's Court at Old-street—a distance of four miles in a straight line—after the remand the child is taken back to Ponton-road, which may be reached about six o'clock ; the total distance which the child was conveyed in this instance amounted to some 15 miles in 24 hours. The incidence of infectious and contagious diseases occurring at the places of detention is given below. The distribution of cases at Pentonville and Camberwell Places of Detention is presented in tabular form as illustrating the effect, upon the incidence of disease, of the transference of the children under seven years of age from the former to the latter institution in the early part of July. The thick black line represents the date by which the children were transferred. Residential, Industrial, and Special Schools. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Whooping Cough Pentonville 2 Camberwell 2* 1* 5 7 German Measles Pentonville 3* Camberwell Mumps Pentonville 2 Camberwell Chickenpox Pentonville 1* 2* 4 1 Camberwell Ringworm Pentonville 2 2 5 3 1 Camberwell 1 3 1 Favus Pentonville 1 Camberwell Ophthalmia Pentonville 5 Camberwell 1 9 3 3 Scabies Pentonville 2 1 3 3 4 1 Camberwell At Harrow-road Place of Detention 8 cases of scabies and 1 case of chickenpox occurred among the inmates. *Denotes that the institution or the affected section thereof was placed in quarantine. 160 Annual Report of the London County Council, 1912. Thanks to the care taken when transferring children from homes to industrial schools the latter are remarkably free from infectious and contagious diseases. In many of the larger schools cases seldom if ever occur; in others occasional outbreaks have to be recorded. Brixton-hill. See under Diphtheria. Gordon House. Some trouble was found in dealing with a small outbreak of ringworm of the scalp. The cases, as discovered, were isolated in a separate block. They yielded with difficulty to treatment, and moreover acted as centres for spread to others in the school. The Council made arrangements therefore for the removal of those suffering, and the medical officer was thus better able to control the disease. Children with scalp ringworm are now admitted to the Metropolitan Asylums Board Hospital to be treated by X-rays. The period of detention is much curtailed and the cure is sure. Home for Little Boys—Clapham-park. The children at this school attend the infants' department of Lyham-road school and therefore run the risk of contracting infection from day scholars. During the past year they were affected by measles and chickenpox, which necessitated the exclusion of all children from this home from attending school. Home for Little Boys—Stormont House. This home was opened during the year for the reception of industrial school children under seven years, and accommodates 30. The children attend Sigdon-road school. During 1912, 12 cases of ophthalmia and 13 cases of measles occurred in the home, necessitating the exclusion of all the children belonging to this institution from attending the day school. Infectious Disease in Residential Industrial and Special Schools. The subjoined statement shows the number of cases of infectious and contagious diseases reported during the year from the Council's residential schools. Acre-lane (M.D.) Ringworm, 2 cases. Anerley (Deaf) Ringworm, 1 case. Conjunctivitis, 2 cases. Gordon House Industrial Ringworm, 4 „ Highbury Industrial Chickenpox, 2 „ Home for Little Boys, Clapham-park Measles, 7 „ Whooping cough, 2 „ Chickenpox, 5 „ Diphtheria, 1 case. Ringworm, 2 cases. Homerton (Deaf) Measles, 3 „ May ford Industrial Chickenpox, 1 case. Oak Lodge (Deaf) Scarlet fever, 1 „ Stormont House Industrial Home for Little Boys Measles, 13 cases. Conjunctivitis, 12 „ The facilities afforded by the Metropolitan Asylums Board for the accommodation of those suffering from measles, whooping cough, ophthalmia and ringworm have been freely utilised. The necessary precautions have been taken to prevent the spread of disease, not only within the various institutions, but also from one institution to another, by prohibiting migration during the appropriate quarantine period. Open air schools. Children admitted to Open-air Schools. The two open-air schools maintained by the Council have been fully described in previous reports. Formerly the schools were open only from April to October. Both have now been continued throughout the winter months. No difficulties have been experienced, and the results upon the health of the children have been uniformly good. The demonstration that it is possible in our climate to carry on the schools continuously is very valuable, and perhaps the most serious difficulty with regard to organisation has thus been solved. Of the children nominated for admission during the past year 573 were examined and the following classification made :— A1 (very suitable) 343. A2 (suitable) 91. B1 (suitable only if a shortage of entrants) 56. B2 (not recommended) 25. C (unsuitable) 58. Applications for places in open-air schools are becoming increasingly numerous; unfortunately it has been impossible to provide places for children north of the Thames, but the Council has sanctioned the provision of a third school to be established in North London and it is anticipated that accommodation in this area will soon be forthcoming. In view of the difficulty experienced in obtaining sites for the purpose, it might be desirable to consider the utilisation of a vessel moored in the river after the plan followed in New York. This would be a solution of the problem of providing full open-air treatment in a day school for those children needing it in the crowded districts near the river in the East End of London. Birley House School. Birley House.—The general organisation of Birley House has continued unaltered, and in January, 1912, there were in attendance 84 children who had been admitted at various times since the preceding April. Their physical condition was carefully reviewed during March, and 29 were selected for stay during 161 Report of the County Medical Officer—Education. the new school year; these were joined by 64 others admitted after the medical examination of nominees of teachers, care committees and school doctors. It is to be regretted that in some instances less suitable children were enrolled, parental indifference preventing the attendance of first selections. The 93 children above referred to were chosen by the examining medical officers on account of the following conditions— Malnutrition and generally poor physique 30 Family history of or signs suggesting phthisis 22 Phthisis 19 Anaemia 9 Chest conditions (non-tubercular) 4 Enlargement of glands 5 Other conditions4 Apart from the condition which was the guiding factor in determining their admission, the majority were found at subsequent examinations to require dental treatment, and many needed surgical attention for the common defects of eyes, ears, nose and throat; this was arranged for and obtained in most cases during the year. The children for the most part came from poor homes, as can be gathered from the fact that their average weekly contribution for meals was only 6d. out of the estimated cost of 2s. 6d.; extra clothing consequently had to be provided for them during the colder months, and a blanket coat was devised and answered well; similarly some 40 pairs of clogs were lent for use during school time. It was intended that the normal length of stay should be the full school year, but in some few instances children were returned to their ordinary elementary schools earlier, and in a few others were invalided as unfit for any school attendance. In this latter group was a case of phthisis ; this girl had been doing well until she met with a street accident; she was found to have lost ground considerably on her return six weeks later, failed to recover in the next few days' observation, and died a fortnight after she had been discharged from the school. The improvement in the physical condition, general appearance and carriage was evident to all who had opportunities of watching the children, and can be partly demonstrated by the following tables showing gain in weight. Improvement in physical condition. Table showing the average weight at different ages on admission to the school, expressed in kilograms and compared with the corresponding averages of all London elementary school children. The superiority of the latter is seen in each age group except one where the total was swollen by the inclusion of two unusually big boys— Gain in weight. Boys. Girls. Age last birthday. (1) No. of children. (2) Average weight on admission. (3) Average weight of all L.C.C. School boys. (4) Age last birthday. (5) No. of children. (6) Average weight on admission. (7) Average weight of all L.C.C. school girls. (8) 7 4 22.57 — 7 1 20.07 — 8 4 22.32 23.47 8 4 19.10 22.92 9 7 23.78 25.46 9 9 23.10 25.00 10 7 26.77 27.59 10 7 26.35 27.16 11 11 28.62 29.25 11 7 27.80 29.87 12 11 34.26 32.46 12 8 28.81 33.32 13 3 33.13 36.40 13 2 35.30 37.71 Table showing the average gain in weight (in kilograms) in each age group during the 40 weeks commencing 1st April, compared with the corresponding averages of all London elementary school children. The comparison becomes still more favourable when it is remembered that the increase has occurred in children who, while in their old environment, had been making less than the standard gain— Boys. Girls. Age last birthday. (1) No. of children. (2) Average gain in 40 weeks. (3) Average gain in standard boys. (4) Age last birthday. (5) No. of children. (6) Average gain in 40 weeks. (7) Average gain in standard girls. (8) 7 4 2.7 — 7 1 1.5 — 8 4 1.7 1.56 8 4 3.9 1.67 9 7 2.2 1.78 9 9 2.9 1.89 10 7 2.7 1.78 10 7 3.4 2.42 11 11 2.7 2.33 11 7 3.5 2.89 12 11 3.8 2.89 12 8 4.2 3.33 13 3 4.3 2.67 13 2 4.9 3.67 18820 x 162 Annual Report of the London County Council, 1912. Table showing the average weekly gain in weight (in kilograms) at various ages, compared with the corresponding average weekly gain of all London elementary school children— Boys. Girls. Age last birthday. No. of children. Average weekly gain Average weekly gain in standard boys. Age last birthday. No. of children. Average weekly gain. Average weekly gain in standard girls. (1) (2) (3) (4) (5) (6) (7) (8) 7 4 .07 - 7 1 .04 - 8 4 .04 .04 8 4 .10 .04 9 7 .05 .04 9 9 .07 .05 10 7 .07 .04 10 7 .08 .06 10 11 .07 .06 11 7 .09 .07 12 11 .10 .07 12 8 .10 .08 13 13 .11 .07 13 2 .13 .09 Table showing the weekly increase in weight expressed as percentage of body weight on admission, compared with the corresponding percentage increases in all London elementary school children— Boys. Girls. Age last birthday. Birley House, 1912. Open-air schools, 1907-8. London elementary schools, 1906. Age last birthday. Birley House, 1912. Open-air schools, 1907-8. London elementary schools, 1906. (1) (2) (3) (4) (5) (6) (7) (8) 7 •29 - - 7 •18 •60 •15 8 •19 •42 •14 8 •50 •48 •16 9 •23 •36 •16 9 •32 •51 •16 10 •25 •46 •16 10 •32 •52 •17 11 •24 •37 •15 11 •32 •49 •19 12 •31 •38 •18 12 •36 •55 •23 13 •34 •31 •17 13 •33 •54 •22 The smaller increase as compared with that obtained in 1907-8 is due to the considerably longer time the school is now open, a rapid initial increase being followed by a period of steady normal improvement. Some measure of improved conditions of bodily health is afforded by the estimations of the haemoglobin content of the blood; the summary of these (made with Tallquist's scale) is set out in the table below, 100 being taken as normal. Hæmoglobin averages. Table showing the haemoglobin averages at Birley House at certain intervals, 1912. Boys. Girls. At opening of school 86.6 85.3 At end of 24 weeks 89.1 88.7 At end of 44 weeks 91.8 90.7 Table showing estimated changes in haemoglobin content in 44 weeks. Boys. Girls. Number showing decrease of 5 percent 1 _ Number stationary 9 5 Increase of 5 per cent. 15 16 Increase of 10 per cent. 8 8 Increase of 15 per cent. 2 2 Increase of 20 per cent, or over 1 1 The demonstration of the results obtained in the special defects which had led to the children's admission being recommended is made somewhat difficult because of the varying conceptions which different observers have of the term "tuberculosis." Using the word in the wide sense in which it is sometimes employed, probably one-half of the scholars could be considered titberculous, but four alone 163 Report of the County Medical Officer—Education. presented physical signs which warranted their notification as definite cases of phthisis. All did well with the exception of some five or six in whom no definite signs of disease could be detected, but who remained the same to all appearance at the end of the year. Broadly, it may be said that this year's work agrees with previous experience and furnishes further evidence of the benefits of open-air school life in strengthening the debilitated condition of children. | I Shooters Hill.—The school was re-opened on 12th April, 1912, with about 83 children mostly drawn from East Greenwich, Westcombe Park. Charlton. Woolwich and Abbey-wood Shooters Hill School. During the period between the commencement of the school (12th April) and the end of that month the weather was cold, but fine generally. May was warm, dull and changeable, and on one day in each week it was necessary for the rest time to be passed in the bungalow. The greater part of June was fine and rest in the bungalow was compulsory on one day only, but during July and the first ten days of August, hot and cold and dull weather alternated and rest was taken in the bungalow on one day each week. For several days afterwards the weather was dull, but rest was taken outside ; the last seven days of the month were all wet and the bungalow had again to be used several times for rest. September was fine and rest was taken outside during the whole month. " Slats," that is, pieces of wood in lattice form nailed together and placed on the ground for the seats to rest Upon so as to prevent them sinking into the mud, were Used occasionally during the summer months, but from September they were a necessity. Although the year was wet, the occasions on which it was necessary to take rest in the bungalow were few. The attendance for June was 96'5 per cent., and for the whole quarter 92 4 per cent. All the children belonged to the delicate class, i.e., to the class including some 10 or 15 per cent, of the ordinary school population who, as a result of ill-health, are backward and dull. The following is a list of the morbid conditions noted in the children admitted. Although acute and active cases of phthisis were refused, a certain proportioif, as will be seen, showed early signs of tuberculosis. Some children had two or more defects— Defect or Disease. Boys. Girls. Total. Anæmia and debility 14 23 37 Tonsils 4 6 10 Adenoids 4 3 7 Rickets 5 2 7 Nasal disease 1 — 1 Emaciation and malnutrition 3 2 5 Tubercular disease of glands 4 6 10 Eczema 1 — 1 Tubercular disease of lungs 3 4 7 Heart disease 2 1 3 Otorrhcea — 1 1 Nephritis — 1 1 Defective vision 3 1 4 Blepharitis 6 1 7 Bronchitis and other chest complaints 4 — 4 Scoliosis 1 6 7 Poor expansion of chest 9 7 16 Strabismus — 1 1 Defective teeth—1 carious tooth 7 1 8 2 „ teeth 12 12 24 3 „ 4 4 8 4 „ „ 4 1 5 5 „ „ 1 1 2 6 „„ - 2 2 Total 92 86 178 Some 3¼ hours were devoted each day to actual study, one hour to manual work and two hours in the afternoon for sleep. At 9 o'clock a breakfast of bread and milk or porridge was provided. At 12.40 dinner, and at about 5, or earlier when the days grew shorter, a meal, consisting of cocoa made with milk, bread and butter, with either cake or jam, or occasionally a banana. There were two bungalows, in each of which two classes were held, but when the weather permitted all the classes were held in the open. The school syllabus consisted of recitation, reading, composition, arithmetic, geography, history, nature study, music (including breathing exercises), handwork, drawing, needlework, organised games and physical exercises ; the school doctor reported very favourably upon the various methods by which these subjects were taught in such a way as to combine physical exercise with instruction. The school doctor has made the following suggestions for improvements. " If, say, 60 by 20 ft. in front of each bungalow were levelled and drained it would be possible for the classes to be held more frequently in the open air. On many occasions it was impossible for this to be done because of the mud that existed, and two classes were then held in each bungalow. It would seem preferable to have a 18820 X 2 164 Annual Report of the London County Council, 1912. separate bungalow for each class. The bungalows are well provided with windows, but it would be better if all the walls were removable so that if the rain came from one quarter the wall in the other end could be taken down. Deck chairs are provided for the rest time. I think rest in a more correct position would be obtained by the use of hammocks on low poles and they should, of course, be slung inside the bungalow in wet weather." A certain number of children had poor expansion of the chest, for which they were given breathing exercises. A smaller number (7) suffered from slight scoliosis, for which some attended the clinic of the Invalid Children's Aid Society. It would be an advantage if the treatment of slight scoliosis by exercises were carried out by the nurse under the supervision of the school doctor, The heights, weights and haemoglobin measurements show satisfactory improvement in the physical condition of the children in each age group, and demonstrate the fact that the beneficial results of attending an open-air school are obtained in the colder as well as in the summer period of the year. The children who in April were anaemic, listless and miserable looking, exhibited great improvement in their physical condition in the later months of the year by their shouts, their eagerness and their healthv looks. The following table compares the weights of children admitted to Shooter's Hill with certain children weighed as standards in London schools in 1906. Shooter's Hill, 1912. Weights. Kilograms gained in 40 weeks. Average weekly gain in kilograms. Sex. Age groups. Number in age group. Shooter's Hill. Standard children. Shooter's Hill. Standard children. Shooter's Hill. Standard children. Boys 7 2 24.40 - 2.05 - .05 8 7 24.11 23.47 2.53 1.56 .06 .04 9 7 26.81 25.46 2.39 1.78 .06 .04 10 12 26.33 27.59 2.39 1.78 .06 .04 11 9 27.52 29.25 2.42 2.33 .06 .06 12 10 30.25 32.46 3.27 2.89 .08 .07 13 5 33.92 36.40 3.08 2.67 .08 .07 Girls 7 4 23.57 - 2.20 - .05 - 8 10 21.84 22.92 2.25 1.67 .06 .04 9 9 23.25 25.00 2.61 1.89 .07 .05 10 9 26.93 27.16 2.66 2.42 .07 .06 11 4 27.30 29.87 3.10 2.89 .08 .07 12 8 33.36 33.32 5.21 3.33 .13 .08 13 2 41.80 37.71 4.95 3.67 .12 .09 Playground classes. Playground classes have now been held for four years in connection with the elementary schools maintained by the Council. In view of the attention now being paid to methods of open-air instruction it has been thought desirable to deal somewhat fully in this report with the results of the playground classes during the past year. In the following pages, therefore, will be found a synopsis of the medical report on each playground class. The various types of classes are as follows:— Type A.—A class held at a centre and composed of specially delicate children drawn from neighbouring schools, the same class working in the open-air all the summer. Type B.—A class in which the children are specially selected from various standards in one school, the same children being in the class for the whole period. Type C.—A class in which the pupils are drawn from a particular school only, but are all in one class, the same class working in the open-air during the whole of the summer. Type D.—A class in which the pupils are drawn from a particular school only, and various classes are taken out in turn into the open. A considerable extension of the number of the classes took place during the summer of 1912, 85 classes in all being carried on, viz., Type A, 4 ; Type B, 1; Type C, 43 ; Type D, 37 ; an increase of 20 classes. In consequence of this increase, it was found impossible to give Uniform medical supervision, but arrangements were made for the classes of the " A " type to be under constant medical supervision, for classes of the " C " type which were in existence in 1911 to be again inspected periodically, and for new classes of " C " type to be visited by the school doctors when at the schools for the purpose of conducting statutory medical inspections. In the last-named cases, the head teachers were asked to arrange for the weighing and measuring of the children by the teachers at intervals of one month. It was considered unnecessary to pay special attention to classes of Type D. In many cases, awnings and wind-screens were supplied as protection against sun, wind and rain. Old desks were obtained from the stores, and, where necessary, tarpaulins for their protection when not in Use. In a few cases, owing to the danger of upsetting them by the wind, blackboards were fixed to the wall. Woollen rugs were supplied where desired to protect children against cold, and in view of the fact that a certain risk of harbouring vermin was experienced, an endeavour Was made, without success, to discover some substitute; special attention was, therefore, necessary to secure the cleanliness of the children in certain of the classes. The reports sent in by the school doctors leave no doubt as to the importance of the question of tuition in the open-air. Careful observations have demonstrated- Report of the County Medical Officer—Education. 165 that great benefit is derived by children spending their time in the open air compared with those who have lessons indoors; particularly does this apply to children who are normal or slightly sub-normal in physical development. The specific defects most amenable to cure in the open-air classes appear to be anaemic and catarrhal conditions of moderate severity. The good results of the classes are shown by physical measurements, by the increased spontaneity and mental alertness of the children, by improvement in carriage and muscular tone, and, as is pointed out by several school doctors, by the general freedom from colds and coughs compared with the children in the indoor classes. The factors producing these results are the constant breathing of pure air as opposed to the quickly fouled air of the ordinary classroom, the stimulation of the skin tending to increase muscular tone, and the facility with which school work can be periodically interrupted by simple physical exercises. Type "A" Classes. Type A Classes.—From the medical records which were kept it is manifest that there is a certain proportion of debilitated children for whose needs the playground class is insufficient. This proportion forms a third of those selected on medical grounds. These children made no perceptible improvement in physical condition, and, on that account, the average results of the classes are disappointing when compared with the open-air schools or with classes of type "C." For these children the full open-air school regime is required. A fully developed system of open-air tuition will require three distinct types of institution, viz., (i.) The playground class; (ii.) The open-air day school; and (iii.) The residential sanatorium school in the country. A large number of the children suffered from ailments to which the parents in many cases could not be induced to pay attention, and, in some instances, wretched home conditions, with lack of proper sleeping arrangements, nullified what was done at school, particularly in the cases of the Daniel Street and Turin Street classes. Daniel-street (Bethnal Green, S.W.)—This class consisted of 31 boys. The low standard of personal cleanliness was especially remarked, and the strenuous efforts of the teachers failed to bring about much improvement in this respect. At the outset all the children were ill-nourished and in poor health, with the exception of three, and feeding at school was necessary in most instances. Eleven boys improved greatly in colour, alertness, muscular tone and general nutrition, but quite a third of the class made little or no improvement, the explanation given being the existence of bad home conditions and lack of attention to remediable defects which included septic mouths, otorrhœa, adenoids, etc. : two of the boys were tuberculous. The increases in height and weight under these circumstances were not remarkable, the average increase of height being 1.8 cm. and in weight, 1.0 kilogram. It was noted, however, that children suffering from anaemia were uniformly benefited, and two boys were cured of their nervous symptoms (twitching and stuttering). The "Laurrence" (Bethnal Green, (S.W.).—This class was composed of 31 boys. At the outset, 15 were considerably below and 15 others were below the average in nutrition; nearly all suffered from minor ailments. The average increase in height was 0 9 cm., and in weight 1.3 kilograms. The majority of the boys improved in physical condition and became brighter and more energetic; hilt about ft third were not strikingly improved. Rochelle-street (Bethnal Green, S.W.).—This class was composed of 33 boys. Here, again, the majority of children suffered from minor ailments requiring active treatment, for only a portion of which treatment was secured. Seventeen boys improved distinctly in general condition, and those suffering from anaemia showed definite improvement. The increases in physical measurements noted are shown in the following tables, the figures in brackets being percentage increases on the original measurements:— Number of children. (1) Increases in Height. (2) Weight. (3) Chest measurement. (4) 4 Age 9, 3.4 cm. (2.8%) 1.3 kilos. (5%) .75 inch 8 „ 10, 2.4 „ (2.1%) 2.0 „ (6.5%) .58 „ 7 „ 11, 2.8 „ (2.0%) 1.4 „ (5%) .20 „ 12 „ 12, 3.0 „ (2.27%) 228 „ (7.6%) .50 „ The effect of warm weather upon the weights observed is shown by the following table representing the percentage of boys whose weights rose, fell, or remained stationary for each month. It was stated that the boys wore the same amount of clothing on each occasion when they were weighed:— Month. (1) Rise. (2) Fall. (3) Stationry (4)a per cent. per cent. per cent. April-May 82 14 4 June ... 30 66 4 July 63 33 4 September 78.5 18 3.5 October 92 — 8 Turin-street (Bethnal Green, S.W.).—This class consisted of 32 boys. The scholars came from poor homes in the larger proportion of which the sleeping accommodation was unsatisfactory; 13 were given meals at school. Many suffered from minor ailments; in the case of anaemia and enlarged glands, 166 Annual Report of the London County Council, 1912 0 great improvement Was noted, but in other conditions which required active treatment, such as otorrhcea, no improvement was obtained. On the whole, colour, carriage and muscular tone improved noticeably, and the boys became more alert and energetic. The average increase in chest measurement was 3.44 centimetres, and in chest movement, 1.4 centimetres. The average increase in height was 2.67 centimetres (due largely to improved carriage), and average gain in weight, 1.74 kilograms. The school doctor kept very careful records of individual increases in weight in this class, and the benefit derived by removing the children entirely from their surroundings is suggested by his analysis of the figures comparing the whole class with those who went away for a summer holiday and with those who were being fed at school. Increase in weight in kilograms. 22nd July. 3rd September. 15th October. Whole class (27) —.31 + 1.29 + 1.74 Boys who had a country holiday (7) —.38 + 1.44 + 1.92 Boys having meals at school (13) + .05 + 11.9 + 1.62 Breathing exercises formed an important part of the curriculum, and the satisfactory results in producing chest expansion are shown in the following table:— Average 24.4.12. Average 25.10.12. Average increase. Full inspiration 67 cm. 70.4 cm. 3.44 cm. Range of movement 5 6.4 „ 1.40 „ Type "B" Class. Type "B" Class.—The only class of this type was that at the "Forster" (Islington, E.) school. It consisted of defective girls of all ages, and especially of those supposed to be "consumptive. The principle of a definite rest time which was actually spent in sleep was adopted with good results. The children are said to have been benefited by the outdoor treatment, but no figures are available. Type "C" Classes. Type "C" Classes.—The attention paid to these classes by the medical staff varied considerably inasmuch as definite sessions could not in all cases be allotted to the supervision owing to the impossibility of sparing time from statutory duties. Reports received from school doctors upon thirty-two of the classes were almost all uniformly satisfactory. In certain cases the improvement of the children was compared with a control class working under indoor conditions. This was done at the " John Ruskin," Berkshireroad, Gainsborough-road and Fulham Palace-road schools. In the three former, the measurements showed a considerable advantage on the side of the outdoor class. The measurements, however, do not wholly express the benefit accruing to the children which is shown in various ways, such as greater alertness, alleviation of minor conditions of ill-health and improved carriage. An important point to notice is that the reports show that lessening of nasal catarrh and improvement in the habit of mouth breathing were brought about by the open-air conditions. At Fulham Palace-road the results as shown by comparison of physical measurements were disappointing, but this class was recruited from children who appeared the most weakly scholars in the school, and, therefore, the comparison with a class of healthier children is misleading. In this connection, it is to be pointed out that, although the committee decided that no special selection should be made in classes of type " C," the medical reports make it clear that in several schools the children were often, in fact, selected on the ground of physical defect or mental dulness. " Ben Jonson " [Stepney).—In this class the whole of Standard IIa. in the girls' department was selected for the experiment, and the children were taken without any selection, either on the score of age or mental powers. The average age of the class was ten years, and of twenty-eight children who remained in constant attendance, and who were weighed and measured at least four times during the period of observation, the average growth was 2.3 cm., and weight increase was 0.9 kilograms. In five the weight alone increased, four remained stationary, and the remaining 19 showed both increase iu weight and height. The good effects of the class were not so noticeable as at either St. Paul's-road or Essex-street schools, where specially picked children were taken for the class. This is also to be explained by the fact that the class at the " Ben Jonson " school was held in a corner of the playground ill-adapted to the purpose, being sunless, draughty and exposed, and no wind screen was forthcoming until late in the term (June). Furthermore, the children themselves suffered severely owing to the continued dock strike. Berkshire-road (Hackney, S.).—The number of boys noted in the class was 57 ; the ages ranged between nine and fourteen, but the great majority were about ten or eleven. This was an ordinary class (Class V.), but they were the " slow " half of a set of about 100, thus their physical condition would be expected to be below normal, and thirteen of the boys had obvious defects. The period of observation as regards weighing and measuring extended over twenty-nine weeks, April to October. The gains of weight and height were taken as average percentages of initial measurements, and a comparison was made with a control indoor class. The figures were:— Weight.—Percentage gain in Playground class = 4.92 „ „ control class = 4.0 „ „ another control class = 4.1 Height.— „ „ playground class = 2.08 „ control class = 1.78 Report of the County Medical Officer—Education. 167 The figure for chest expansion was taken as ratio of expansion to circumference of emptychest. In April the average expansion was 8.53 per cent. of the chest; in September it was 10.38 per cent. There were three case of defective vision and squint, and one of severe adenoids ; for these treatment was advised. The improvable defects were:— Two " adenoids," i.e., large tonsils and mouth breathing; both improved. Two enlarged glands, marked ; both much diminished. Two blepharitis ; both quite well. One heart (hæmic murmr); murmur disappeared. One impetigo, cured by treatment; no fresh, cases. Three debility; all markedly improved. One chronic conjunctivitis; not improved, Five " nerve signs," e.g., tremors of hands. Four much improved, one a little better. One severe (old) rickets. General health and chest expansion much improved. One definite pulmonary tuberculosis. Quiescent. This boy seems to have gained practically no weight, and seems to have had a fresh " attack," with cough, loss of weight, etc., in May. Latterly hot milk was advised, and he now begins to show marked improvement. One of the cases classed as " debility " showed signs of early tuberculosis. Nasal respiration was a point to which the school doctor specially directed the attention of the master in charge of the class. Breathing exercises were especially well carried out and great care was taken to discourage mouth breathing. With a view to keeping the nose free from mucus, a special effort was made to secure the use of handkerchiefs, and the school doctor sent three or four dozen cheap handkerchiefs for distribution among those boys who had regularly brought " substitutes." The idea was well carried out and the boys who had these handkerchiefs given to them took care of them and washed them. At the first inspection, only 20 per cent. of the boys had handkerchiefs; at the later inspection, about three months after any handkerchief had been given, 90 per cent, of the boys had them. Corresponding to these measures, there was a considerable improvement in spite of the very unfavourable weather conditions. The changes noted were (1) shrinkage of tonsils; (2) almost complete disappearance of mouth breathing and on the other hand, improved nasal respiration, even in those cases where symptoms suggested definite adenoids ; (3) several cases with defective hearing appear to have improved somewhat, as measured by watch distance. There were scarcely any cases of " colds " contracted in the class, although up to the last medical visit in October the boys had only spent one day indoors, and this was on the occasion of a thick fog. Besides the results noted above, there were very marked changes in other respects which cannot be expressed statistically. There was a marked improvement in the colour of the boys ; in their postures while sitting, standing, doing exercises and marching ; in their expressions, which were both more alert and more cheerful; and more especially in their cleanliness and neatness. It was evident that the boys themselves were interested. Bolingbroke-road (Battertea) — A boys' class held in a somewhat unsuitably drained part of the playground. Satisfactory increases in height and weight are noted and most of the children suffered from catarrhal troubles which were cured by the open-air treatment; it was noted that they remained free from colds except on the occasions when they were obliged to spend long periods under shelter. Bow-creek (Poplar).—This class was made up of twenty girls and eighteen boys of Standards V., VI. and VII., not selected on medical grounds. The playground is pleasantly situated on the river bank, and is open. The children showed great improvement in colour, carriage and muscular tone. The increases in physical measurements are shown in the following tables, the first showing nutrition expressed as grammes per centimetre, and the second the average weights in kilograms. Beginning of session. Beginning of holidays End of holidays. End of session. Girls (16) 234.5 230.7 (—3.8) 232.8 (—1.7) 242.4 ( + 7.9) Boys (16) 229.7 228.1 (—1.6) 229.0 (—0.7) 232.9 ( + 3.2) 15th April, beginning of session. 23rd July, beginning of holidays 30th August, end of holidays. 22nd October, end of session. Girls (16) Boys (16) 32.53 31.18 32.47 (—0.06) 31.28 (+0.1) 32.97 ( + 0.44) 31.56 (+0.38) 34.68 (+2.15) 32.31 ( + 1.13) Country holidays (5 girls, 6 boys) 32.41 32.50 ( + 0.09) 33 04 ( + 0.53) 34.27 ( + 1.86) Meals at school (4 girls, 3 boys) 31.85 31.71 (—0.14) 32.75 ( + 0.50) 33.42 ( + 1.57) Canal-road (Haggerston).—Forty-two boys whose ages ranged from 8 to 13½ years. The class was held in a corner of a large open playground to the south of the school buildings. Although, in reality one of the ordinary classes drafted into the playground, the general condition of the children was identical with that of children found in type "A" classes ; several showed old tuberculous lesions. 168 Annual Report of the London County Council, 1912. The general appearance indicated distinct improvement at the end of the summer, evidenced by better colour and state of nutrition and by a gain in weight averaging 1.6 kilograms. The physical measurements are given in the following tables, the second showing the monthly variations in weight. Number. Average increase in weight. Average increase in height. kilograms. centimetres. Under 9 years 4 1.2 3.8 „ 10 „ 17 1.8 3.2 „ 11 1 1.0 2.6 12 „ 6 2.0 2.9 ,, 13 ,, 3 2.2 2.1 „ 14 „ 1 — — Average gain ... 1.6 2.9 Month. Rise. Fall. Stationary. per cent. per cent. per cent. April 92 0 8 May 61 10 29 June 43 48 7 July 60 31 9 August 83 10 7 September 85 8.5 6.5 October 70 21 9 The largest percentage of loss of weight occurred in June and July, at a time which would appear to correspond with the hot weather during those months, as was also observed to have been the case in the playground class at Rochelle-street school (see p. 46). Cayley-street (Limehouse).—This class consisted of the ordinary Standard III. girls, comprising 40 children, who were drawn from a very poor district in Limehouse. The district was greatly affected by the dock strike, and more than half the children were on the feeding list. The class was held in the playground shelter facing south, and was rather too near the street. Rugs and tarpaulins were provided. Some difficulties were experienced in securing attention for various ailments, but a decided all-round improvement in health was noted, and the children became brighter and more alert. All increased in height and weight. Denmark-hill (Dulwich).—A mixed class made up of backward and delicate children of Standard I. level. The children made satisfactory improvement in weight and became more lively and responsive. The "Earlsfield" (Wandsworth).—A mixed class of infants consisting of boys of ages from 3 to 44/12 (average 38/12) and girls of ages from 39/12 to 45/12 (average 4 years). The number of the class suffering from colds is reported to have been very small, whereas the infants in indoor classes showed a large percentage of absence from school for catarrhal conditions. The average gains in height and weight for the period of four months for nineteen boys and thirteen girls were as follows:— Height Boys 1.7 centimetres Normal 1.7 centimetres Girls 2.8 „ „ 2.5 „ Weight Boys 1.3 kilograms „ .45 kilograms Girls .8 „ „ .45 „ Eglinton-road (Woolwich).—An ordinary class of girls (Standard VI.). None of the children were specially selected. The work of the class was of the following nature:—About half the time was spent in the playground, Under cover when wet, and the other half was occupied in visiting places of geographical and historical interest, such as Shooters-hill, Eltham-common, the Geological Quarry at Charlton, Blackheath, Greenwich-park with its old Roman remains, the Old Dover-road, the old Museum and the Painted Hall (Greenwich), Morden College, King John's Palace (Eltham), Sevendrogg Castle, etc. These excursions entailed country walks in which special stress was laid on observation of physical features of the ground and in studying pond life and the habits of birds, bees and butterflies, as well as in acquiring a practical knowledge of mensuration and elementary surveying. In addition, manual training formed part of the curriculum, the footstools (referred to later on) being made by the children, as were also inkstands, blotters, sundials, etc. Until August, the class was held, in an uncovered portion of the playground except when it rained, when the class was held in the covered-in part. An awning was supplied on 24th August and fixed in the centre of the playground. Trestle tables were used, but the chairs of Austrian bentwood were made for adults, and there was no support for the children's backs at the base of the scapulae. In many instances the chairs were too high and did not lend themselves to the maintenance of the ideal position, but improvised footstools somewhat remedied this defect. Summary of improvement from May to November, 1912, in height, haemoglobin content and weight:— Average height in May, 140 centimetres, in November, 147 centimetres. ,, haemoglobin ,, 72 82 „ weight 34 kilograms „ 37 kilograms Report of the County Medical Officer—Education. 169 Essay of pupil, H— T—, on the benefits derived from the open-air class.—" Since I have been in the open-air class I have had a better appetie (sic.) I have felt much better in health. My weight has increased 3.4 kilograms. My height has increased 4.5 cent. At first it seemed very cold downstairs but soon got used to it. I have gained 12 per cent, in my blood. I have not such a bad temper, and I do not think I am rough or selfish. My mother said I shall eat her out of house and home. I was very sorry when we had to come upstairs but it is a little bit too cold down there now. I enjoyed the lovely walks we had. And I have more brains to do my work with. The room is so stuffy. When it rained we went Under the shed built for us but it was put up rather late." Essex-street (Mile End).—The class consisted of Standard V. and a number of delicate children with bronchitic and chronic lung conditions. The average age was 107/12 years, and the average increases in weight and height were 2 kilograms and 2.1 centimetres respectively. A slight fall in increases in weight was observed during the dock strike of June and July. The respiratory efficiency as measured by chest expansion (difference of full expiration and inspiration) was marked in 23 of the class. Each child was tested on three separate occasions, and, as a result of detailed and systematic breathing exercises carried out by teachers, an increase in respiratory expansion varying from 2.3 centimetres to 0.5 centimetres was noted. Fulham Palace-road (Fulham).—A girls' class of 80 children, but of 24 only was the continuity of attendances sufficiently Unbroken to render the records of any value. The children were specially selected by the teachers on account of ill-health. The school doctor made a comparison of the growth with the ordinary children in the next indoor class, with the following result:— Playground class. Control children indoors Average growth in height in centimetres. During class time 1.18 1.91 „ holidays .48 .29 Total 1.60 220 Growth in weight in kilograms. During class time .27 .50 „ holidays .61 .74 Total .88 1.24 These figures are very disappointing, and suggest that not much benefit was obtained by the children. Such a deduction, however, would probably be erroneous, as it must be borne in mind that, although this class was supposed to be of " C " type, in point of fact it more closely approximated to the " B " type. The poorest children in the school were, therefore, being compared with children above the average. It is further to be noted that distinct mental improvement was observed in the children in the open-air class. Gainsborough-road (Hackney, S.).—The number of boys noted in the class was 30, the ages ranging between ten and thirteen, with an average about twelve. The boys were selected from various classes in the school, and thus every boy had some defect, and, beyond these defects, there was a very great prevalence of mental dulness and personal neglect, etc. The period of observation as regards weighing and measuring extended over 26 weeks. For an expression of the gain in weight and height, a rough calculation was made showing the average percentage gains contrasted with a control class. The figures were:— Weight — Gain in playground class 5.8 per cent. „ control class 4.1 „ Height „ playground class 1.72 „ „ control class 1.64 „ Special attention was paid to breathing exercises, and the effect is seen in improved chest expansion measured in centimetres:— Average expansion in April 5.44 cm. „ „ October 6.34 „ The Haemoglobin Index was taken for some 16 debilitated boys who volunteered. Comparing the figures obtained in April and October, it was found that 13 showed increase varying from 5 to 30 per cent.; two remained stationary, and one showed a decrease of 5 per cent. The special defects noted were :— 4 adenoids. Two showed improvement in symptoms. 4 enlarged tonsils. Three improved. 4 enlarged glands. Three improved. 3 enlarged hearts. Two improved. 2 blepharitis. Both cured by treatment, no cases now. 1 anaemia (marked). Not improved. 18820 Y 170 Annual Report of the London County Council, 1912. 1 arrested phthisis. No active signs now. 3 suspected phthisis. All improved considerably. 2 spinal curvatures. Both improved. 4 cases of impaired hearing. Two improved. 1 otitis. Practically well. 1 follicular conjunctivitis (specially marked). Improved. 8 " nerve signs." Five improved, two not improved, one had chorea lately. C defective vision (including results of old severe inflammation). Noted for treatment as specially serious. To obtain some rough idea of mental progress, the master in charge consented to adopt the following test, based on Burgerstein's method:— In April, each boy was given 20 simple sums in addition, to work in a given time, 62 minutes. In October, the same number of sums of equal difficulty were set for the same time. Taking the work of 22 boys, the average of correct answers in April was 7 6, in October 9 8. Besides the special defects the general condition of the boys was much below normal. Many of them were stunted physically and still more so mentallly, some showed so-called " stigmata of degeneration." The appearance of the boys as regards clothing, cleanliness, condition, etc., was markedly bad at first, but later there was some improvement in this respect. Any improvement in these boys is more noteworthy in view of the fact that their home conditions, etc., made any influence for good very difficult. Garratt-Lane (Wandsworth).—The class was composed of fifteen boys whose ages varied from 11 to 134/12, the average being 129/12 years. The number of children suffering from colds is reported to have been exceptionally small, and the average gains in height and weight were as follows:— Height 2.5 centimetres, normal 2.1 centimetres. Weight 1.4 kilograms „ 1.1 kilograms. Holy Trinity, Vaushall Bridge-road (Westminster).—In this case, the class was made up of infants picked out from the ordinary classes for malnutrition, or some other defect. The personnel of the class changed frequently, and only twelve children attended throughout the period. In these children the increase in height and weight is said to have been greater than in the case of average children taught indoors. "John Ruskin" (Newington, IF.).—Both boys and girls were physically below the average, and material improvement in the general condition was noted. Comparison with an indoor class showed a greater increase in physical measurements in the case of the playground children, but the figures have not been provided. New End (Hampstead).—A mixed class composed of 26 boys and 17 girls. The class was held in the semi-covered roof playground attached to the senior department, and was completely sheltered on the north side. The pupils ranged from eight to twelve years of age, and had been selected by the teachers on account of inferior physique. In all the children there was an improvement in the conditions of general nutrition. The heights and weights of the boys were taken on 29th April, and on 29th October. Of 24 boys thus measured, the lowest recorded height on the first occasion was 113 centimetres, and the highest 136 centimetres. On the second occasion the lowest was 117 centimetres and the highest 140 centimetres (the same boys). The greatest increase in height was five centimetres (two cases); the smallest 3/4 centimetre (one boy, who, however, increased three kilograms in weight). The average for the 24 boys in April was 123.5 centimetres, and in October 128 centimetres, an average increase of 4.5 centimetres. Of the same group of boys the lowest recorded weight in April was 21 kilograms (four boys), and the highest 35 (one boy). In October the lowest recorded weight was 23 kilograms (three boys), and the highest 36 (the same boy as in April). The average weight in April was 24.5 and in October 27 kilograms, an average increase of three kilograms. The records of the heights and weights of girls have not been kept so well, and only seventeen are available for purposes of comparison. In general the improvement of the girls is not so marked as that of the boys. In April the lowest recorded height among the girls was 115 centimetres (three cases), and the highest 136 centimetres (one girl). In October the lowest height was 118 (two of the girls whose height was 115 centimetres in April), and the highest 141 centimetres (the tallest girl in April). The average height in April was 123.5, and in October, 126.5, an average increase of three centimetres. The weight records show the same diversity. In April the highest weight recorded among the girls was 30 kilograms, and the lowest 19 (one case of each) ; in October the highest recorded weight was 32 kilograms (three cases), and the lowest 21 kilograms (also three cases). The average weight during April was 24.5 kilograms, and during October 26 kilograms, an average increase of 1.5 kilograms only as compared with the three kilograms among the boys. In one or two cases among the girls the increase of weight was very slight, being less than a quarter of a kilogram. In one the weight remained stationary, though the height increased; this girl suffered from repeated attacks of bronchial catarrh, and was much neglected and ill-nourished. On the whole the records show that there has been, with few exceptions, a conspicuous increase in the heights and weights of the children. In view of the fact that the average of nutrition is high among these children, some credit must be given to the class environment in producing these favourable results. Measurements of the chest can only give an approximate idea of the chest capacity ; in order Report of the County Medical Officer—Education. 171 to find out if there has been an absolute increase in the lung capacity, spirometric measurements must be made, but as it was impossible to take these, the measurements of the chest during ordinary breathing and during forced inspiration were recorded. The measurement was in all cases taken at the level of the nipple. In almost every case an increase in the total girth was observed, though such increase did not always correspond with a proportionate increase in the measurement during forced inspiration. In April the highest recorded chest measurement among 21 boys was 215 inches, during ordinary, and 26.5 during forced inspiration ; the greatest chest expansion recorded was 2f inches. The lowest chest measurement was 20 inches, and the lowest expansion | inch. The average for the 21 boys was 22.1 for ordinary and 24 inches for forced inspiration. In October the greatest chest measurement was 23 inches during ordinary and 28 inches during forced inspiration ; the lowest 22 inches for ordinary and 23 for forced inspiration. The average for ordinary inspiration in October was 24 inches, and for forced inspiration 25.7, an average increase of 1.7 inches. The corresponding figures for the girls (17) were as follows :—The lowest recorded chest measurement in April was 20 inches, the lowest expansion measurement was 201/8 inches, the largest girth was 21 and the largest expansion measured 26. The average was 21.2 for ordinary and 23.5 for forced inspiration. In October the largest girth measurement was 25, and the largest expansion 27, the lowest 21 and 21.8 respectively. The average for October was 23 for ordinary and 24 for forced inspiration, an increase of only 0 5. In several cases the chest expansion had not altered, though the girth of the chest had increased. To a large extent this increase in the chest measurement is undoubtedly due to the breathing and other exercises carried out in the class. Defective nasal breathing has been much improved and the children who were at the first inspection noted as " mouth-breathers " showed an ability to breathe steadily and without effort with one nostril closed. In the few cases where the chest measurement showed little or no increase, the weight also remained nearly stationary. These cases need further watching, although the school doctor could not find that they presented any special and definite signs calling for urgent treatment. In one case carious teeth and underfeeding were probably responsible for the lack of improvement; this case is now receiving attention. Olga-street (Bethnal Green, N.E.).—This class consisted chiefly of backward girls taken from one standard, but there were also some delicate, sub-normal, and overgrown children of about the same mental capacity. The class was held under the shelter of a wall in fine weather, but in a shed in Wet weather. The children appeared to have improved mentally to a certain extent, and seemed brighter and more attentive. The majority improved in their physical condition, gaining weight and increasing in height, four remained stationary in height, while three lost weight. At the last inspection twelve children appeared to be normal, eight had made marked improvement, and four noted originally as suffering from cough had recovered therefrom. Of the four whose weight was stationary, one had lost cough, one coughed less, one was less anaemic. One child who was suffering from chlorosis and who was very sub-normal in height, improved markedly in colour and grew one centimetre in the last two months. Peckham Rye (Peekham).—This class was made up of children who should be in Standard I. (average age 7½), and who were sickly and delicate. The lessons were given under a large shady tree in the playground if fine,or if wet. under the playground shelters of which there were two, so that, in the event of too bright sunshine or high wind, some mitigation was obtainable. During the summer the class was never forced to shelter in the school itself. Unfortunately no weights and heights are available, but the children on the whole were brighter and better, and there was a notable absence of catarrhs in spite of defective boots and occasional wet feet. There were 30 on the roll, and the average attendance was 28. Eleven children had very defective boots (that would not keep out water), and half the children were given milk in the middle of the morning. Priory Grove (Kennington).—Thirty-eight boys, nearly all in the 7.8 age group, who were not " picked " in any way. The average increase in weight was 1.2 kilograms, and in height 3 4 centimetres. Great improvement was noticed in cases of anaemia, and the school doctor pointed out especially the improvement in nasal catarrh with lessening of the habit of mouth-breathing. Queensmill-road (Fulham).—The class was held in a very open playground with a convenient roofed shelter. No special selection was made, one of the school classes being taken as a whole. The class was a complete success. The following gives the increases in height and weight between 17.4.12 and 25.10.12:— Year of birth. Number of children. Average increase in Height. Weight. centimetres. kilograms. 1901 3 30 2.20 1900 4 19 1.25 1899 14 2.93 2.44 1898 2 3.25 2.15 18820 Y 2 172 Annual Report of the London County Council, 1912. The "Redriff" (Rotherhithe).—There were present 24 children (11 girls and 13 boys), of whom 16 improved in general physical condition, three greatly improved, in two there was no change and one became worse. Nine were mouth-breathers, eight of whom showed definite improvement, and one case diagnosed as pulmonary tuberculosis gained in weight 2 5 kilograms. In this last case no physical signs were found on examination, and there is no history of recent symptoms. Generally speaking, those children mentioned as "pale" in earlier reports showed less anaemia and were more alert at the end of the period. The "Wandle" (Wandsworth).—Two mixed classes of children. The number suffering from colds is reported to have been very small. A "rotatory" class also occupied the playground at intervals, and physical measurements for this class were made for comparison. Class A consisted of boys whose ages varied from 71/12—84/12 (average 77/12), arid girls whose ages varied from 72/12—711/12 (average 76/12). Class B consisted of boys whose ages varied from 71/12—77/12 (average 74/12), and girls whose ages varied from 72/12—75/12 (average 74/12). The rotatory class consisted of boys whose ages varied from 73/12 to 81/12 (average 78/12),and girls whose ages varied from 69/12 to 711/12 (average 76/12). The average gains in height and weight for a period of five months were as follows, the figures in brackets indicating the number of children concerned:— Height. 1 Centimetres. Centimetres. Class A Boys (15) 2.2 Normal 1.1 Girls (13) 2.2. „ 2.6 Class B Boys (10) 2.3 „ 1.1 Girls (14) 2.5 „ 2.6 Rotatory Clas3 Boys (13) 2.6 „ 1.1 Girls (10) 2.3 99 2.6 Weight. Kilograms. kilograms. Class A Boys (15) .6 Normal 1.0 Girls (13) .3 „ .85 Class B Boys (10) .5 „ 1.0 Girls (14) .8 „ .85 Rotatory Class Boys (13) .4 „ 1.0 Girls (10) .4 „ .85 St. Pauls-road Mile End).—A very satisfactory class of 48 girls in .Standard V. was held in a sunny sheltered corner of the playground and was excellently supervised. The children showed a marked improvement in general health, and also in powers of mental observation, and this in spite of being taken from a very poor section of the population and being in many cases ill-nourished and ill-clad. Delicate children Were added to this class from other standards, and these showed good physical improvement. The average increases in weight and height were 2-1 kilograms and two centimetres respectively. The general results of this class were better than those of the " Ben Jonson" school (see p. 47) showing that the selection of a suitable site is of great importance. St. Paul's (C.E.) Burdelt-roa,d (Mile End).—This class was composed of 55 girls in Standard III., four were born in the year 1900, six in 1901, 15 in 1902, 15 in 1903 and 15 in 1904. Between April and October four of the children gained four kilograms in weight, the average gain for the class being about two kilograms. From April to June there was very slight increase in weight, not one child gaining more than 0.5 kilograms, whilst more than half the class lost slightly. From June to September there was a marked increase in weight in almost all of the children, but from September to October the increase was slight. All increased in height (average about two centimetres). The class was held in a warm bright part of the playground covered over with tarpaulin for roof, and a raised wooden floor was provided. The children were very comfortable, were well protected from rain, had a good supply of rugs, and all showed a marked improvement. Sandford-row (Walworth).—The open-air class, consisting of girls between ages of seven and ten, all picked delicate children from various classes, was conducted in the covered-in portion of the roof-playground from April to October (middle), and was only discontinued for a few days during the summer when there was a heavy rainfall. A quarter of a pint of milk was given daily to each child after May. The school nurse weighed and measured each child every month and recorded the results on charts. Twenty-two children only out of the 30 attended during the whole time, the remaining eight only attended for short periods, and their records are of no value for report. The average gain in weight was 1.7 kilograms (eleven below average and nine above). The average increase in height was 2.3 centimetres 14 below and eight above average). The attendance of the children showed a satisfactory improvement. A few of the children had colds during the rainy periods in the summer, but not of sufficient severity to interfere with their attendance at school. One of the children notified as having early phthisis lost her cough and generally improved, though the physical signs in her chest have not entirely disappeared. The general physical condition showed a decided improvement in all but two cases, where the children still remained anaemic and generally debilitated. Mental fatigue and listlessness were much less, particularly in the afternoon, the children remaining bright, active and attentive up to the end of the afternoon, in marked contrast Report of the County Medical Officer—Education. 173 to their appearance when taught in a closed classroom. In eight of the children there was not so much improvement in intellectual capacity, and in one child this varied at different times. At first greater fatigue was exhibited, but subsequently there was improvement in this respect and fewer headaches were noted. West-square (Southward).—No special selection of children was made for the experiment, but the whole of one class was chosen, consisting of 18 boys and 13 girls between the ages of six and seven years. The average gain of the boys in weight from April to September was 1.05 kilograms (nine of the 18 were below the average and nine above), the average increase in height being 2.7 centimetres (ten below average and eight above). The average gain of the girls in weight was .93 kilograms (eight of 13 below normal and five above), the average increase in height being three centimetres (eight of 13 below and five above). The attendance of the children was particularly satisfactory, being quite above the average. No child was absent with a "cold," coughs were less frequent, and one child with chronic bronchitis lost his cough, his chest on examination presenting no symptoms. The decrease in general and mental fatigue was marked; instead of becoming drowsy and inattentive, particularly in the afternoon, the children remained quite bright, with undiminished mental activity to the end of the day. Appetites were much improved. Information on this point was volunteered to the teacher by the parents. The teacher of the class remarked that her health had been excellent during the period ; her apprtite was goad, her work was done with less mental fatigue and she slept more soundly at night. White I ion-street (Finsbury, C.).—This class comprised 36 children selected from the girls' department primarily on account of varying degrees of mental backwardness. It was held on a roof playground in the open-air from April to October, and during the colder months in an adjoining classroom open on three sides, thus permitting of adequate light and ventilation. It is difficult to contrast the development of children who have been especially selected for mental and physical backwardness with a number of normal children working under the ordinary conditions. A comparison of the increase in weight and other measurements of the children in the open-air class with that of a similar number of children of the same age in the ordinary classes, taken over a corresponding period of time, shows that as regards development, these physically and mentally backward children placed under these altered conditions, may compare very favourably with the normal children in the rest of the school. The following figures shew the average increase in weight and height of children aged 12 years in playground class and ordinary class, in a period of 1½ years:— Playground class—Weight 4.7 kilograms Ordinary class—Weight 5.2 kilograms Height 7.0 centimetres Height 6 6 centimetres In the case of the children aged 13, the lack of development is more marked : thus taken over a period of nine months the average increase per child :— Playground class—Weight 2 5 kilograms Ordinary class—Weight 3.2 kilograms Height 41 centimetres 5'5 centimetres While these figures indicating the physical progress are satisfactory, equally satisfactory conditions are found to exist in regard to the mental and moral progress of the playground.class. Thus while as a rule the mentally backward child who is kept in the ordinary class is irregular in attendance, lacking in personal cleanliness, deficient in self-respect, and, usually, unless given special tuition, quite incapable of assimilating scholastic knowledge, it is found that, placed apart under the novel conditions of the open-air class, with its modified curriculum, drill, etc., these children become, almost immediately, happier, brighter, cleaner, more confident, and infinitely more regular in their attendance, while the fresh zest and interest which is given to their existence is generally productive of a marked increase in their mental powers. Wood-street (Woolwich).—This class, called Class V., is a special class of backward boys selected from those in Standards I. to IV. considered to be weak, either physically or mentally. It ranks as Standard IV B., and was started in April, 1911, it began as an open-air class at the beginning of May, and ended on 13th September. The boys, however, continue to form a class by themselves indoors, at first in the central hall and now in a classroom, the windows in this room being kept open. The average number on roll has been 35 ; 26 boys were present for the whole time that the class was held in the playground. The Weather conditions during the past summer have been obviously very different from those obtaining in 1911, and not nearly so favourable or so pleasant for open-air sedentary occupation. Overcoats have been worn by the boys, and in the past summer, rugs have been provided ; they were available but not required in 1911. The 26 boys of the class for the present year who were in attendance the whole time showed an average increase in weight of 0 959 kilograms and an average increase in height of 0-808 centimetres between 1st June and 13th September. The following notes relate to particular pupils. E.N., aged 13. Sufficiently nourished, has a good home, nervous and excitable, subject to fainting, also headaches. Weight at beginning of June, 32.2 kilograms. July, 34.4 August, 34.7 „ „ September, 35.7 ,, „ „ October, 35.6 „ This was the greatest increase of weight observed, viz., 3.4 kilograms. 174 Annual Report of the London County Council, 1912. II. I., aged 11. A mouth-breather, tonsils somewhat enlarged, probable adenoids. Weight, June, 35 kilograms. September, 33 „ October, 369 „ November, 37.4 General improvement in physique. S. B., aged 11.2. A delicate boy who has suffered from fistula in arm. He is now well. The open air appears to have been the chief factor in the cure. W. M., aged 12. A small pale boy much improved. Weight increased from 23.4 to 24.5 kilograms (in November). F. S., aged 10.6. Weight increased from 25.2 kilograms in June to 26.3 kilograms at end of August. He is said to have been tubercular, and has been taking cod liver oil since last winter. During all the time the class was going on he was free from colds, though habitually subject to them before and since. From the appearance of the boys and their records of growth, there appears to be no doubt that this playground class has been beneficial to the health of the children concerned. Open-air class in Finsbury Park.—(Islington, N.).—Held in the band stand in Finsbury Park, and composed of 31 girls from the Poole's Park (G.) school, between the ages of eight and nine years. They were all chosen as being particularly delicate, a fact to be remembered in estimating the health of the class as compared with that of a class of normal girls. On the whole the results are satisfactory, as the children showed a general improvement in health and in mental capacity, though in some cases, owing to adverse circumstances, the improvement was less marked. Though all the children were more or less delicate, in 19 or 64 0 per cent., definite defects and actual illness prevented their regular attendance. These 19 children showed 22 defects as follows :— Adenoids—four cases. Blepharitis and conjunctivitis—five cases. Skin disease (impetigo and scabies)—three cases. Heart disease (slight mitral bruit)—one case. Anaemia—one case. Rickets—one case. Chorea—two cases. Wasting—one case. Appendicitis—one case. Slight sore throat—two cases. " Consumptive throat "—one case. With the exception of two children (cases of appendicitis and chorea) who left the clas3 shortly after its start, all showed marked improvement. It is worthy of remark that in one case of conjunctivitis, the child was one of a family who were all affected, and that she recovered long before the other members of the family who were not in the open-air. The children for the most part came from wretched homes, where they are neglected, underfed, and kept dirty, and the hours spent amid these surroundings have probably done much to counteract the good effects of the open-air during school hours. In spite of these facts, the increase in height and weight during the period was satisfactory, and compares very favourably with that of the control class composed of normal girls. This is well shown bv the following figures, which were worked out bv the head mistress:— Table showing increase in height and weight of girls attending open-air class compared with those in control class. I. Open-air class— (a) Those present on first and last days of class (24) Average increase .. Height 3.0 centimetres. Weight 1.5 kilograms. Greatest „ .. „ 4.5 „ 2.7 „ Least „ .. „ 1.5 0.1 (b) Average increase in the 13 regular children— Height 2.9 centimetres Weight 1.8 kilograms II. Control class— Average increase .. Height 2.6 centimetres Weight 1.1 kilograms. Greatest „ .. „ 5.0 „ 2.8 „ Least „ .. „ 2.0 „ 0.4 A study of the charts showing the heights and weights of the children shows in almost every case a steady rise, though in many of them, as might be expected, the holiday period is marked by a fall in weight. This fact is significant, pointing as it does to the deleterious effect of home life as compared with that at school. Open-air class in Southwark Park.—This class was composed of children picked out by the head teachers of Farncombe-street (Rotherhithe) and Southwark Park (Rotherhithe) schools. Owing to the fact that these children had to be selected from a small number (to secure similarity in their educational status) it was found impossible to pick out many cases which were greatly in need of open-air treatment. Most cases were selected because they were considered to be pale or ill-nourished, or were mouthbreathers or had a bad family history. Report of the County Medical Officer—Education. 175 An improvement was noticed in their appearance; they were less pale and more alert. They also required more keeping in order. No ill effects were observed. The improvement in weight among the Farncombe-street boys was as follows:— From 1.5 to 2.0 kilograms gained in three months 4 „ 1.0 to 1.4 ,, ,, „ 6 „ 0.5 to 0.9 „ „ „ 14 „ 0.0 to 0.4 „ „ „ 3 Boys who lost weight 2 Increase of weight among the girls at Southwark Park school. From 2.0 to 2.5 kilograms gained in three months 5 „ 1.5 to 1.9 „ „ „ 5 „ 1.0 to 14 „ „ „ 9 „ 0.5 to 0.9 „ „ „ 2 No change in three months 2 Kensal House Tuberculosis School.—This school has been under the regular supervision of Dr. Williamson, the medical officer of the Paddington and Kensington Dispensary, who is attached to the Council's service for this purpose. The type of children admitted has undergone a gradual transition. Many whose home conditions are so bad that they regularly came to school, especially on Monday mornings, with high temperatures, have been eliminated, a certain number having been sent to the Metropolitan Asylums Board's home at Rustington. These have been replaced by others whose home conditions and state of health allowed of more benefit being derived from the facilities afforded by the school. The authorities of the Dispensary have provided free dinners and other assistance in cases of extreme poverty and every effort has been made to ensure that children leaving the school shall proceed to suitable occupations. The proportion of cases without raised temperatures has increased ; this has permitted a resumption of graduated exercise in the form of gardening instruction, games and physical exercises, while steps have been taken for the establishment for the boys of classes in carpentry. The cordial co-operation of the teachers with the medical officers in connection with rest and exercise shows its effect in the improved general appearance and carriage of the children. Kensal House Tuberculosis School 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 5,984 ; these may be classified as (a) candidates for entrance to the permanent service, (b) cases specially referred, and (c) candidates for award of scholarships. This division includes all who work on the staff of the various educational institutions, i.e., teachers and instructors, matrons, nurses, and needlewomen, schoolkeepers and caretakers in all classes of educational establishments under the Council. The numbers medically examined do not coincide with the number of appointments, as candidates from the Council's training colleges, having been under regular medical inspection, are not further examined on entering the permanent service within the year after leaving college. Appendix II. gives particulars of the various candidates examined and the conditions noted as present. Of the 258 referred candidates 11 (2 males and 9 females) were referred a second time owing to the condition not having been remedied. defects:— Permanent service candidates The following table shows the nature of these defects:— Sex. Teeth. Vision. Anæmia. Chest. (1) (2) (3) (4) (5) Men 1 — — 1 Women — 8 1 — In addition to the first examinations 941 referred cases were dealt with. These referred cases relate to leave granted to employees absent owing to personal illness ; to cases in which questions have arisen in regard to students in institutions for higher education whose health is considered such as to render exceptional attention advisable ; to teachers returning to duty after extended leave of absence (a) owing to personal illness, (b) for educational purposes, (c) to married women under No. 115 of the regulations in regard to the education service, and to teachers about to be superannuated. The number of references under review compared with those for the preceding year shows an increase of 178 or 23.32 per cent. In addition 107 cases were medically investigated in which claims were received from teachers and others in the permanent service for exceptional treatment as regards sick pay and reimbursement of medical and other expenses in respect of illnesses alleged to be due to conditions under which they were required to carry out their duties. Cases specially referred 176 Annual Report of the Lonclon County Council, 1912. Scholarship and candidates for teaching profession 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. 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 in special cases 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 IIIa. shows the number of candidates for county scholarships examined and the conditions found. Of the 769 junior county scholars who were referred back for various defects, excluding those 15 whose scholarships were finally withdrawn, 87 (32 boys and 55 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— Sex. Want of cleanliness. (1) Vision. (2) Teeth. (3) Throat. (4) Ears. (5) Ringworm. (6) Nose. (7) Boys — 23 1 0 1 1 1 Girls 25 24 5 3 1 1 — Some of the scholars were referred again for more than one defect. Of the 120 supplementary junior county scholars who were referred back for various defects, 1 boy was referred again owing to a defect of vision not having been remedied, and 4 girls were also referred for defects of vision, and 4 girls for personal hvsiene. The following table shows the nature of the defects of 15 junior county scholars who were rejected— Sex. Want of cleanliness. Vision. Teeth. Throat. Heart. Tuberculosis. General health. (1) (2) (3) (4) (5) (6) (7) Boys — 2 1 1 — — — Girls 7 — — — 2 1 — Three supplementary junior county scholars were rejected ; 1 boy on account of hearing and 2 girls owing to unsatisfactory personal hygiene. Of the candidates passed as fit 39 junior county scholars, 6 supplementary junior county scholars, 4 intermediate county scholars and 1 senior county scholar 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. Report of the County Medical Officer—Education. 177 Appendix IIIb shows the number of candidates examined in connection with each award, and the conditions found. Of the 198 students referred, 23 (4 boys, 19 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) Speech. (7) M. F. M. F. M. F. M. F. M. F. M. F. Beaufoy Institute 1 ... ... ... 1 ... ... ... ... ... ... ... Book production 1 ... ... ... ... ... ... ... ... ... 1 ... Building and Allied Trades 2 ... ... ... 2 ... ... ... ... ... ... ... Cookery ... 2 ... 2 ... ... ... ... ... ... ... ... Dressmaking ... 5 ... 5 ... ... ... ... Laundry work ... 3 ... 3 ... 1 ... ... ... 1 ... ... Millinery ... 2 ... ... ... ... 2 ... ... ... Ready-made clothing (designing and making of) ... 6 ... 3 1 ... 1 ... 1 ... ... Waistcoat making ... 1 ... ... ... 1 ... ... ... ... ... ... Some of the scholars were referred again for more than one defect. 28 candidates (12 boys, 16 girls) were rejected for reasons set out below. One of the candidates was rejected for two defects— Scholarship. (1) Reason of rejection. Number rejected. (2) Want of cleanliness. (3) Teeth. (4) Vision. (5) Chest. (6) Sundry. (7) m. f. m. f. m. f. m. f. m. f. m. f. Apprenticeships (dressmaking) ... 1 ... ... ... ... ... ... 1 1 ear disease ... Artificers, boy 11 ... ... ... 1 ... 7 ... 1 ... 3 2 under standard measurement Beaufoy Institute 1 ... ... ... ... 1 ... ... ... ... ... Corset making ... 2 ... 2 ... ... ... ... ... ... ... Dressmaking ... 5 ... ... ... ... ... 3 ... ... ... 2 (heart) Photography ... 2 ... ... ... ... ... 2 ... ... ... ... Ready made clothing (designing and making of) ... 1 ... 1 ... ... ... ... ... ... ... ... 1 heart Tailoring (ladies) ... 3 ... ... ... ... 1 ... ... 2 1 general health Upholstery ... 1 ... ... ... ... ... ... ... ... ... 1 (scoliosis) Waistcoat making ... 1 ... ... ... ... ... ... ... ... ... 1 (physique) The Council has made provision for a number of awards of a special character which cannot well be classed as trade scholarships. Appendix IIIc shows the number of candidates examined and the conditions found. Of the 295 special scholarship candidates who were referred, 61 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) Domestic economy, junior 61 26 30 2 5 Some of the candidates were referred again for more than one defect 18820 z 178 Annual Report of the London County Council, 1912. Twelve (1 boy, 11 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) m. f. m f. m. f. m. f. m. f. Cripple 1 ... ... ... 1 ... ... ... ... ... Domestic economy ... 11 ... 8 ... 1 ... 3 ... 1 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 of handicraft 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 IV. Of the 454 candidates who were referred, 17 were referred more than once for reasons indicated below— Awards. (1) Number referred a second time. (2) Referred for Want of cleanliness. (3) Teeth. (4) Vision. (5) M. f. M. f. M. F. M. f Bursars ... 8 ... ... ... 1 ... 7 Student teachers ... 3 ... ... ... 1 ... 3 Training college students ... 6 ... 1 ... 1 ... 4 One of the candidates was referred again for two defects. 29 candidates (12 males, 17 females) were rejected for the reasons given in the subjoined table- Awards. (1) Number rejected. (2) Cause of rejection. Teeth. (3) Hearing. (4) Vision. (5) Heart. (6) Sundry. (7) m. f. m. f. m. f. m. f. m. f. m. F. Bursars 1 3 ... ... 1 ... ... ... ... 3 ... ... 1 goitre 1 hernia Student teachers 5 4 ... ... ... ... 1 1 1 ... 3 1 speech 31 phthisis 1 lungs 1 goitre 1 lungs 1 lungs Training college students 6 10 ... 1 ... 1 1 2 1 3 42 speech 4/ 2 chest 1 gen. health 1 gen. health One of the candidates was rejected for two defects. Elementary Schools. Verminous heads. Personal hygiene schemes. The Council, as the education authority, has powers Under the London County Council (General Powers) Act, 1907, and the Children Act, 1908, to convey to suitable premises and there cleanse children who are found in school in a verminous condition. In order to take advantage of these powers, the Council arranged for the establishment of 24 cleansing stations. In certain parts of the county, pending the completion of the scheme, the method adopted by the late School Board for dealing with those children whose heads alone are verminous has continued in operation with one slight modification. Report of the County Medical Officer—Education. 179 The procedure of this scheme, which is applied in certain schools in which the conditions necessitate stringent action, and in which the more complete scheme, to be later described, is not in operation, is as follows:— The school nurse examines all the children at the 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 taken home by the child. At the end of the first week all cases not treated are separated from the other children and a red card with full details is filled Up by the nurse for each child still 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 superintendent of school nurses visits the school and examines the children proposed for exclusion. After exclusion the the divisional superintendent takes out a summons ; but any child properly cleansed before the hearing of the case, is re-admitted to school, examined by the nurse and the summons is not pressed, the circumstances being explained to the magistrate. It was found, however, that there were a number of children whose hair required attention, but who could not be classed with dirty children. There existed no method whereby the attention of the parents could be drawn to the condition except by verbal messages. Difficulty arises with regard to such messages, and to overcome this an additional (yellow) card was prepared in July, 1912, drawing attention to the condition and this card has since been used. The following table shows the results of examinations in those schools where the cleansing scheme as applied to heads has been put into operation during the year:— Department (1) Number Examined (2) Number Clean (3) Number slightly dirty heads (4) Number verminous (5) Number Yellow Cards served (6) Number White Cards served (7) Number Bed Cards served (8) Number Proposed for Exclusion (9) Number Excluded for Prosecution (10) Boys 637 596 - 41 - 41 25 18 11 Girls 41,025 29,330 3,854 7,841 1,413 7,841 4,721 3,804 2,877 Infants 13,781 11,607 780 1,394 229 1,394 791 596 400 Mixed 7,875 6,862 358 655 120 655 428 322 227 Special 933 635 81 217 15 217 157 143 79 64,251 49,030 5,073 10,148 1,777 10,148 6,122 4,883 3,594 The parents of 133 children were prosecuted, and fines varying from 2s. 6d. to 10s. imposed. The percentages in the specially selected schools in which this scheme has been applied, of children verminous amongst children examined was 15 8 in 1912, as compared with 142 in 1911. The head cleansing scheme still gives very good results in districts where the cleansing stations have not been established, and the standard of cleanliness in the schools has been progressively raised both in poorer schools and those attended by better class children. The standard set in the case of scholarship candidates in respect of cleanliness of the head has had an educative effect on the elementary and secondary schools. Only a very small proportion of scholarship children are now rejected on this account. Although it was held by the King's Bench Division of the High Courts of Justice "that sending a child to school in a verminous condition which, if a parent took a proper course, could be remedied, was not causing a child to attend school within the meaning of the by-laws, and also that there was no obligation on a teacher to admit a verminous child,"some of the magistrates are reluctant to convict, and in order to meet their wishes it has been decided that obstinate cases which do not improve under the scheme for dealing with verminous heads, should be dealt with under the powers conferred upon the Council under section 122 of the Children Act. In the districts, therefore, in which the schools are within a mile radius of a cleansing station, and where magistrates decline to convict, the procedure of the above scheme is followed up to the point of exclusion, but if is found that the condition is not improved the child concerned is re-admitted to the school and the procedure of the persons and clothing scheme is applied (see below). The scheme originally adopted in order to give effect to the provisions of section 122 of the Children Act, 1908, provided that attention should be drawn to the condition by a card issued by tha school nurse in respect of each child found in a foul or filthy condition, and that this card, placed in a sealed envelope, should be taken home by the child. Simultaneously the name of the child was forwarded to the nurse in charge of the cleansing station to which the school contributed, and after the lapse of 48 hours the latter nurse re-examined the child. If the unsatisfactory condition persisted the divisional superintendent was requested to serve the statutory notice necessary under the Act, and an opportunity was offered to the parents to send the child voluntarily to the cleansing station. In the event of the parents neglecting to take action, the child was conveyed from the school to the cleansing station by the nurse. In these cases if the offence were repeated a second statutory notice was served and police court proceedings were instituted. In the case of children who were cleansed voluntarily after the first statutory notice, but who at a subsequent date relapsed it was necessary once more to commence, ab initio, by the service of a first statutory notice. It was soon found that a large number of parents took advantage of the facilities for voluntary baths and then allowed the unsatisfactory conditions to recur, and it became necessary repeatedly to 18320 z 2 Elementary Schools. Verminous persons and clothing. 180 Annual Report of the London County Council, 1912. serve the first statutory notice upon them. Much of the time of the attendance officers was thus spent in serving these first notices. In order, therefore, both to effect a saving of their time and to produce a more lasting effect the scheme Was revised in June, 1912. Since then facilities have been offered for voluntary baths before the serving of the statutory notice. The mode of procedure is now as follows:— CLEANSING SCHEME (PERSONS AND CLOTHING). Slight cases. Severe cases. Advice given. Remedied by parents. Unremedied. A Card given offering voluntary Local Medical Officer baths at cleansing station. of Health informed. Opportunity accepted. Opportunity neglected. B Three voluntary baths given. C Child separated from others in school. Child cleansed. In case of Divisional Superintendent directed Local Medical Officer relapse begin again at A. to serve Statutory Notice. of Health informed. Parents now come volunta- Child cleansed by parent. No steps taken by rily to station. In case of relapse begin parent. again at C. D Three voluntary baths given. E Child examined within 24 hours by In case of relapse commence nurse and conveyed to station for | Local Medical Officer again from C. compulsory bath. Child cleansed of Health informed. in one operation. J F If the child again becomes verminous police court proceedings are taken. Pending the hearing, the child, if not cleansed, is excluded from school. After a conviction the child is taken again to the centre for a compulsory bath. The school nurse visits the schools and examines all the children. Those whose persons or clothing are not infested with vermin or are not in a foul or filthy condition, but show traces of vermin or are in an unclean condition take home in a closed envelope a card drawing attention to the unsatisfactory condition and containing advice as to remedial treatment. The children are kept Under observation and if an improvement does not occur a similar card drawing attention to the Council's powers under the Children Act is forwarded by the school nurse to the nurse in charge of the station, who inserts on the card in a space provided for the purpose, particulars as to when the child may attend for a voluntary bath. The card is then returned to the head teacher who places it in a closed envelope to be taken home by the child. This card is also issued to children actually found verminous at the first examination. At the same time, with a view to simultaneous action being taken under the L.C.C. (General Powers) Act, 1904, Part IV., in regard to conditions obtaining within the homes, the local medical officer of health is informed of the child's condition and of the opportunity given for a bath. Children who keep the initial appointment are given opportunities for three voluntary baths in all at intervals of from three to ten days. Should the conditions recur, a further notice is issued. Those children who do not take advantage of the opportunities afforded are separated from the clean children in school and the divisional superintendent is requested to serve on the parent or guardian a statutory notice requiring them to cleanse the child within 24 hours and again offering a voluntary cleansing should there be no convenience for bathing at home. In the event of a child attending voluntarily at this stage and subsequently becoming verminous, the statutory notice is served again, and if necessary repeated before the scheme can proceed. Notification of the request for the service of the statutory notice is forwarded to the local medical officer of health in order that he may deal with clothing, etc., at the home if necessary. The divisional superintendent notifies the nurse when the notice has been served and she re-examines the child and, if necessary, conveys it to the station for compulsory cleansing. The divisional superintendent is kept informed with regard to all compulsory baths. In the case of children compulsorily cleansed who are subsequently found verminous, a form similar to the statutory notice, but stating that police court proceedings are being instituted and offering a further voluntary bath, is served upon the parent or guardian. A summons is immediately procured and the local medical officer of health informed of the fact. Pending the hearing by the magistrate, those children who fail to attend for the voluntary bath are examined and if necessary excluded, but any child who presents itself at school as clean is re-admitted. The nurse is immediately notified of the readmission, makes an examination and decides whether the child should continue in attendance. After the hearing of the case in court the child is conveyed to the station and cleansed. Report of the County Medical Officer—Education. 181 In December, 1910, the Council decided to enter into agreements for one year with 14 borough councils for the cleansing of verminous children at their stations, and to establish seven additional stations in the vicinity of certain schools, making, with the two Council stations already established, a total of 23 stations. The agreements with the borough councils were subject to the following conditions :—1. The place of treatment of children to be entirely distinct from any establishment used for the isolation of suspected infectious disease contacts. (2) The exclusive use of the baths for the cleansing of children to be allowed on certain days. (3) The cleansing station to be in a convenient position and the children to be elfficiently supervised, with female attendants for the treatment of the girls. (4) A payment at the rate of 2s. per child to be made to the borough councils in respect of the cleansing of children infested with vermin, the payment to cover a period to the end of the calendar month subsequent to that in which the first cleansing takes place, and within the period specified to be irrespective of the number of baths required before a child can be regarded as cleansed. (5) The scheme to be subject to the Metropolitan Borough Council's undertaking where necessary to deal with the homes of the children cleansed. These conditions were subsequently varied, (4) being amended so that the period covered by the payment of 2s. is to the end of the calendar month from the date of the first cleansing, and (5) was rescinded. It was also decided that the agreements might be entered into for three or five years, and that when considered desirable arrangements might be made whereby both adults and children could be cleansed at the same cleansing station, on condition that separate entrances were provided to those sections of the station which were used by adults and by children respectively. In districts where the borough councils had not adopted the Cleansing of Persons Act, or could not see their way to enter into an agreement with the Council, stations were to be established and maintained by the County Council. Each station was to serve an area approximately of a mile radius, but the scheme did not cover the whole of London, as provision was not made for the outlying portions of Bermondsey, Camberwell, Greenwich, Hackney, Hammersmith, Lambeth, Lewisham, Poplar, St. Pancras, Wandsworth and Woolwich. Further, the Corporation of the City, who agreed to cleanse the children free of charge, will only undertake to cleanse children residing within the City ; the Borough Council of St. Pancras will only deal with children resident or attending school within the borough; and the Borough Council of Stoke Newington at first dealt only with children attending schools within the borough, but have since included three schools which are outside the boundary. London as a whole will therefore, under the scheme, be provided with stations for the cleansing of verminous children, but there will be certain schools which are over a mile from the nearest station,and experience has shown that in these cases there are difficulties in conveying the children compulsorily to the station. In such schools, however, efforts are made to persuade the parents to send the children voluntarily to the nearest station, and if advantage is not taken of the facilities offered, and the conditions are not otherwise remedied, the children are excluded from school and proceedings instituted against the parents or guardians, under the attendance by-laws. At the beginning of the year 1912 cleansing was carried out at 12 stations, viz. : four L.C.C. stations, Bath Street (Finsbury), Finch Street (Whitechapel), Fountain Road (Wandsworth) and Sedlescombe road (Fulham), and eight borough council stations—Bermondsey, Camberwell, Hackney, City of London, St. Marylebone, Stoke Newington, Southwark and Woolwich. Agreements had been concluded with the borough councils of Battersea, Hampstead and Poplar and the City of Westminster, but the cleansing work had not begun. Agreements have since been concluded with the borough councils of Deptford, Greenwich, Islington, St. Pancras and with the Committee of St. Cecilia's House. The last-named, which is an extra station, was not included in the Council's original proposal to establish 23 stations. Agreements have thus now been entered into for the use of 16 borough stations in which work is proceeding, in addition to the four L.C.C. stations above-mentioned and St. Cecilia's House. The areas served by the stations are shown on the accompanying map, those belonging to the Council being shaded. (Diagram F.) At all these stations the Council has appointed a nurse to superintend the attendances of the children ; she conveys them under the powers given by the Children Act, and in the case of the borough stations, certifies the cleansing on the vouchers in respect of which the Council makes the capitation payment. At Finch-street and Southwark extra nurses have been appointed to cope with the press of work, and there is now a staff of 23 nurses exclusively employed at cleansing stations as compared with ten nurses employed in 1911. Negotiations are proceeding with two other borough councils and efforts are being made to find suitable sites for the establishment of council stations in the districts of Lambeth and Bethnal Green. In the event of these efforts being successful there will be 25 stations, but the outlying districts referred to above, and certain schools within a mile of St. Pancras station, will even then not be provided with stations. The total number of children examined by the nurses under the scheme was 630,359, and 23.573 children were found to be verminous : of these. 10.179 were cleansed bv the parents. The following table shows the number of cleansings (not children cleansed) at each station:— Council Stations — Bath-street 3,455 Finch-street 2,927 Fountain-road 1,719 Sedlescombe-road 2,264 —10,365 182 Annual Report of the London County Council, 1912. Other Stations— Battersea 776 Bermondsey 1,883 Camberwell 2,061 Deptford 792 Greenwich 69 Hackney 1,352 Hampstead 171 City of London 43 Poplar 1,835 St. Cecilia's House 519 St. Marylebone 1,752 St. Pancras 1,689 Southwark 1,883 Stoke Newington 552 Westminster 794 Woolwich 377 — 16,548 26,913 Very few scholars reside in the City and the small numbers cleansed at Hampstead are accounted for by the fact that on receiving the Council's first notifications, the local sanitary authority took such prompt and stringent action that the parents recognised their responsibilities and improved the condition of the children, an improvement which has since been maintained. During the year, 670 parents were fined amounts varying from 1s. to 10s. with 2s. costs in respect of each child. The following table compares the work done in the year under review with that for the year 1911. Number examined. (1) Number clean. (2) Number verminous. (3) Number returned clean. (4) Number of statutory notices served. (5) Number cleansed at stations. (6) Boys— 1911 84,581 79,196 5,385 1,909 3,476 2,006 1912 188,926 181,378 7,548 3,511 4,037 3,285 Increase 104,345 102,182 2,163 1,602 561 1,279 Girls— 1911 83,239 78,187 5,052 1,550 3,502 1,856 1912 202,720 194,738 7,982 3,245 4,737 3,995 Increasa 119,481 116,551 2,930 1,695 1,235 2,139 Infants— 1911 68,453 65,398 3,055 1,102 1,953 810 1912 171,101 166,005 5,096 2,157 2,939 1,675 Increase 102,648 100,607 2,041 1,055 986 865 Mixed— 1911 12,080 11,256 824 262 562 272 1912 57,169 55,191 1,978 788 1,190 877 Increase 45,089 43,935 1,154 526 628 605 Special— 1911 3,239 2,662 577 153 424 265 1912 10,443 9,474 969 478 491 516 Increase 7,204 6,812 392 325 67 251 Totals—- 1911 251,592 236,699 14,893 4,976 9,917 5,209 1912 630,359 606,786 23,573 10,179 13,394 10,348 Increase 378,767 370,087 8,680 5,203 3,477 5,139 Children's Country Holiday Fund. The practice of keeping the borough medical officers of health informed concerning the various stages reached in each case was introduced with a view to further co-operation between the authority responsible for cleanliness in the home and that responsible for cleanliness in school; it being useless to cleanse a child if the clothing, bedding, etc., in the home are allowed to remain in a filthy condition. The form of notification has a counterfoil attached, upon which the borough medical officer of health can make a note of the action taken in each case. The school nurses again assisted the executive committee of this fund by examining with a view to detecting any infectious disease (e.q., ringworm), or any form of uncleanlmess, among the children whom it was proposed to send to the country as soon as the summer vacation began, and the scheme was modified so as to include an extra inspection. Diagram G. Report of the County Medical Officer—Education. 183 The scheme consisted of (1) a preliminary examination ; (2) an inspection beginning immediately after the Whitsun holidays and ending within four weeks; and (3) a final examination during the last two weeks of the term. The object of the preliminary examination was to ascertain in good time the children who Would require special care and to warn the parents that if Unsatisfactory conditions were not remedied the children would not be sent on the holiday. The first inspection, at which a Children's Country Holiday Fund visitor was present, was made at the ordinary rota visits, but for the purposes of the final inspection the nurses were authorised to devote ten working days, beginning on July 8th, always provided that the arrangements for assisting the school doctors at medical inspection were not disturbed. To facilitate the examination of the children at the final inspection the schools were grouped and the children attended at a convenient central school, the details of these arrangements being left to the nurses and the visitors or honorary secretaries of the local committees. The scheme as amended appears to have worked very smoothly and given general satisfaction, and this was probably due to the freedom in the matter of arrangements allowed to the nurses, who in many cases took much trouble in order to ensure that the children should not be prevented from obtaining their holiday. The Executive Committee of the Fund have expressed to the Council their thanks for the way in which the nurses carried out the work. The personal hygiene scheme in girls' secondary schools and kindred institutions has continued in operation during the past year. The scheme was applied also to one boys'school. In past years the inspection was 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, but this arrangement was not considered satisfactory, as, with the exception of one school, which was excused from the operation of the scheme, the head mistresses desired that the schools should be visited and the pupils examined within a week from the date of the beginning of the term. The first three examinations are now made by the school nurses, and pupils who have not remedied unsatisfactory conditions at the third examination are seen by an assistant superintendent of nurses Upon whose report official action is taken. There is an interval of four weeks between the first and last examinations. In obstinate cases scholarships are withdrawn from scholarship holders, and fee paying pupils are permanently excluded from attendance at the institutions. Few cases are Unsatisfactory at the second examination and a still smaller number at the third, but during the year nine pupils (girls) were proposed for permanent exclusion from the institutions and one for withdrawal of scholarship owing to Unremedied defects in personal hygiene. Secondary schools and kindred institutions. Verminous heads. The following table shows the conditions found during the past year:— Examination, 1912. (1) Number of pupils. Number of verminous heads found. Percentage of verminous heads among the pupils examined. Boys. (2) Girls. (3) Boys. (4) Girls. (5) Boys. (6) Girls. (7) Spring 76 3,841 — 181 — 4.71 Summer 52 3,741 — 207 — 5.53 Autumn 78 3,942 1 248 1.28 6.29 Seasonal Prevalence of Fleas. From the beginning of 1909 onwards, the attempt has been made to obtain a detailed record of the seasonal prevalence of fleas in London. The question was first referred to in a report on " Flies and Vermin," which appeared as an appendix to the Annual Report of the Medical Officer of Health for 1909. The subject was further discussed on p. 62 of the Annual Report for 1911. The inquiry, had, until last year, been limited to observation of flea prevalence as affecting persons of the common lodging-house class, and was carried out by the Council's inspectors of common lodging-houses, who made notes of the condition of the bedding found in the ordinary course of their routine inspections. At the latter end of the past year, however, it was found possible to secure the additional information on the subject made available by the examination of elementary school children. The accompanying Diagram G shows the seasonal prevalence of fleas for four years, based on the result of the examination of beds in common lodging-houses, and for the last four months of 1912 the percentage of flea-marked children has also been plotted out. With regard to the last-mentioned curve, it should be explained that the uppermost series of circles shows the total percentage of children observed to be flea-marked irrespective of degree; the lower series of circles shows the percentage of children flea-marked to a slight degree, whilst the difference between them represents the percentage badly marked. It is interesting to note that the curve shown by the uppermost series of circles corresponds very closely with that obtained by the examinations made in common lodging-houses, and tends to confirm the results obtained in previous years in the class of the population living in such houses. 184 Annual Report of the London County Council, 1912. Special schools. Defective children. During the year three new schools, one for the mentally defective and two for myopes, have been opened ; none have been closed. The number of special schools with a total average roll of about 11,500, is:— Schools for the mentally defective (M.D.) 92 „ „ physically defective (P.D.) 35 „ „ deaf (D.) 10 „ „ partially deaf (hard of hearing) 1 „ „ blind (B.) 8 myopic (My.) 3 The medical examinations of children with a view to admission to special schools have been carried out as in previous years; 8,432 children have been seen and deemed suitable for the following educational treatment. M.D. M.D. and P.D. P.D. Blind. Blind and Deaf. Blind and M.D. Myopes. Deaf. Deaf and M.D. Partially deaf. Industrial schools Elemen tary school. Imbecile. Invalids Total. 2,025 4 1,444 106 — 1 196 Ill 4 34 32 2,628 138 2,017 8,740* * Some of the hard of hearing and myopes in this table are also included under "Elementary School" or "Invalids," and others were seen on more than one occasion during the year. The special schools were visited at least once a quarter and every child present was seen at least once during the year. Whenever possible three days' notice of the intended visit of the medical officer was given to the head teacher, who in the cases of the mentally defective and physically defective schools was requested to present for examination all children included in the following categories:— (a) Those who had been admitted to the school during the preceding three months. (b) Those who had not been seen for nine months. (c) Those who were applying for exemption or Were approaching the age of 14 years. (d) Those whom it was considered desirable to place before the doctor. (e) Those who had attained the age of 10 years 9 months since the last visit. The total number of medical examinations made during the year was 14,652. The following table shows the recommendations made as regards re-classification in the case of scholars attending the schools for the mentally and physically defective. Elementary school. Blind. Deaf. Physically Defective to Mentally Defective. Mentally Defective to Physically Defective. Excluded as Imbecile. Invalids. Exemption recommended. Not suitable for Suitable for Elder boys. Elder girls. Elder boys. Elder girls. 426 6 17 55 17 93 99 187 69 30 361 109 Schools for mentally defective, The children in these schools present grades of defect with no hard and fast lines of separation, varying from those who, after a period of special instruction under the more favourable conditions in the way of smaller classes and simpler methods of teaching, are able to return to the lower standards of the ordinary elementary school, to those who, after a prolonged trial, are found incapable of benefiting from any instruction that can be given in the classes of a day school. Generally speaking, however, two main classes can be distinguished; those whose general intelligence in out-of-school matters is relatively little behind that of the weaker members of the ordinary school class, but whose faculties, so far as the academic requirements of reading, writing, or calculation are concerned, remain in a dormant or larval condition ; and those who are many years behind their normal fellows in all intellectual manifestations. The former under the stimulating influence of the special trade schools for elder children often develop fresh aptitudes and are able, on leaving, to take up profitable employment. The latter class make very slow progress both in the junior and senior schools, contribute largely to the flotsam and jetsam of the population, and in their later school years are often a source of trouble to their parents, neighbours, attendance officers and the police. With a view to the differentiation of these classes special attention has been paid to the psychological as well as the medical examination of the children. Experiments have been made and reported on by the medical officers concerned in this work in the course of which all types of graded diagnosis have been tested. It is necessary from time to time to make some variation in the methods employed since the children become, to some extent, familiar with the tests utilised, and occasionally the experiments made by those teachers, who have attended courses in and paid special attention to psychological methods, reveal themselves during the routine examination by unexpectedly rapid responses of the children. Dr. Argles has adopted objective methods following the lines of Dr. Weygandt. He employs pictures, toys, form boards and simple utensils which attract the attention of the children and banish the shyness and restraint which 185 Report of the County Medical Officer—Education. often accompany medical examinations. The answers as to the uses and defects of the various implements reveal much of the powers of observation and reasoning of the children submitted to him. He also employs the following card:— Each child is given a card and is shown a large copy which is exhibited on the blackboard. The children are told to make everything in the first space like the central dotted circle. The doctor points to one plain circle and says "To make this like the one in the middle you must put a dot in it," and then points to a dot and says, "To make this like the middle one you must put a circle around it." This is illustrated in the copy on the board. The third square is treated in a similar manner. The objects, letters and figures in the second square have to be copied and in the fourth square all the figure 4's have to be crossed out. Five minutes are allowed to do this after which the children write their name and age on the back of the card. This method can be applied to a whole class at one time and is useful as affording a basis for subsequent individual examination. These tests are necessarily supplemented by a series of questions on simple problems and tests of academic"progress in reading and writing. The Binet tests have, perhaps, received the greatest amount of attention. Three sets of these have been employed—the 1908 series, the 1911 series, and the modified series devised by Dr. Goddard, of Vineland, New Jersey. The 1908 series was referred to in some detail in the report of the medical officer (Education) for 1911. The series contains a test of reading and report on the subject matter read which was found adapted to the normal child of 8 years, but which proved a serious stumbling block to the defective children of all subsequent school ages. This somewhat impaired the value of the tests as a means of differentiating the children into groups, though it proves of the greatest value in testing their fitness for return to the ordinary school. In the later series tests involving a knowledge of reading have been omitted, and the series have been somewhat re-arranged. On the whole, the series arranged by Goddard has proved of most value for the earlier years, though it is exceptional for any child in the special schools to show evidence of a greater intellectual development than the child of average intelligence aged 11 years. The chief 'stumbling blocks are counting backwards from 20 to 1, and the making up of one or two sentences to contain three given words. In the latter test for the ages 10 and 11 the influence of school practice is most apparent. Dr. Gowdey has made a careful study of a group of children employmg the Binet-Goddard tests, with the following results:— Actual age. Number examined. No response. Intellectual age. 4 5 6 7 8 9 10 7 3 - 1 1 - 1 - - - 8 6 - 5 - - 1 - — — 9 6 - — - 1 3 2 — — 10 10 - — — 1 7 2 — — 11 11 - 1 1 — 3 4 2 — 12 12 1 1 1 1 5 3 — — 13 - - — — — - — — — 14 3 - - - — - 2 — 1 15 1 — — — — 1 — - — 52 1 8 3 3 21 13 2 1 18820 A A 186 Annual Report of the London County Council, 1912. The uniform experience of the medical officers that the children fail with the tests for age above 10 affords satisfactory evidence of real deficiency, but it is to be hoped that as the data accumulate it will be possible to find a corresponding series dealing with manual occupations in which many appear to be far less behind the normal standard. The academic subjects reading and writing are those in which the defects of children render them least able to continue in the ordinary schools, or, at any rate, are those which lead to their being nominated by the head teachers as prospective candidates for a special school education. An attempt has been made by Drs. Gowdey and Shrubsall to ascertain if there was any relationship between the labour involved in writing a short narrative and the accuracy of the report. In several schools a short passage was read through twice to the children who were told to listen carefully as they were afterwards to be asked to write it down from memory, if possible in the same words, but, if not, to write down the sense of the passage in their own words. The passage having been read through twice the children wrote down their version. They were then told to read it through carefully, and add anything they could remember that they had left out. The papers were marked so as to record the number of facts mentioned, the number of Words used in the narrative, the number of spelling errors, and the proportion of errors in spelling to words used. The correlations between these were then calculated. The passage contained 60 words and was adjudged to present 33 separate facts. The figures from 37 children in one school will serve to show the nature of the results. Feature investigated. Average value. Standard deviation. Age 11.50 1.45 Number of facts recorded in narrative 8.03 6.90 Number of words used in narrative 25.51 16.32 Percentage of errors in spelling 50.43 4.92 Correlations— Age to number of words used Value of r.+ .20 ±.10 Age to number of facts recorded „ +.03 ±.11 Age to percentage of spelling errors „ —.24 ±.10 Facts recorded to number of words used „ +.80 ± .04 Facts recorded to percentage of spelling errors „ — .48 +.08 Percentage of spelling errors to number of words used „— .62 ±.06 Facts recorded to percentage of spelling errors for a constant number of words +.02 From this it appears that while the facility of writing as estimated by the number of words used increased with age, the accuracy of the spelling bore a less definite relation, and the accuracy of the record appeared to be independent of age. There was no apparent relation between the accuracy of the written narrative and the correctness of the spelling. The nature of the spelling errors proved of considerable interest. There were a few examples of almost complete word blindness, the written matter in these being entirely unintelligible, both to the teacher and the pupil when he was shown his production after a short interval and asked to read it. The bulk of the errors were either the omission or displacement of letters, a type of motor mistake with which all who commence to use a typewriter will be familiar; an auditory misconception; or a substitution of somewhat similar letters, indicating an incomplete acquaintance with the written alphabet. A few examples will serve to indicate these types Word. Spelling in narrative. Night sonhdt, nodi, namd, neaeff, snight, nigk, nitt, nitsej niet, nitheg, neught, nitht. Fire fime, ford, fith, fia, frie, fiar, fir, far, fiver, fior, fiah, firir,' fari, fore, fror. Burnt birn, benr, brin, bernt, bunt, barnt, bant, but, bent, bert, brurnt. Many maven, menny, mene, mened, menne, meeny. Children cadnn, cail, chirldnen, chrthirn, chibden, chand, chidans, chlind. Were ware, whr, wa, wer, wen, weri. Girl girll, girel, grl, gll, giall, gile, gols, cal, cail, gori. Could camd, colud, good, cood, hood, cowd, cad, cul, cod. Find fiend, finde, fine, fide, furd, formd, fored, fonad, ford, fild, fuord. Engine engin, enjens, ingin, ing, engenl, ingan, heagne. Most of the smaller words, which had been learnt as single ideographs, were correctly spelt. The productions of the children in the special schools serve to show the difficulties which surround the use of phonetic methods, and it is not improbable that the majority of pupils only progress so far as they can learn and remember word wholes. The record cards used in the schools for the mentally defective contain references to the family history and the previous history of the child. Entries are made partly by the medical officers at the Report of the County Medical Officer—Education. 187 admission examinations, but mainly by the head teachers after the child has been admitted to the school. Every credit is due to the teachers for their attention and efforts in obtaining full and accurate data in the following schedule. What is the condition of parents, mental and physical ? Are they temperate ? Family history. Has any near relative, dead or living, suffered from insanity, fits, gout, spitting of blood, consumption, scrofula, or any other hereditary disease ? When was the mental deficiency of the child first observed ? To what cause is this mental deficiency attributed ? Is the child subject to epileptic or other fits ? From what illness has the child suffered ? Has the child received any special treatment ? If so, where ? When did the child commence to walk ? When did the child commence to talk ? Dr. Shrubsall has analysed some 3,000 records and has obtained the following results; the figures must be regarded as minimal since in many records some one or other of the points was not recorded:— Causes assigned by the relative for the deficiency of children (from 2,000 records). Premature birth 59 Prenatal troubles 187 Cruelty to mother before the birth of the child 22 Injury at birth 43 Twin birth 6 Triplet birth 1 Size of family 4 Early closure of head 1 Deafness 4 Defective vision 3 Malnutrition 25 Delicacy 77 Ill-treatment 3 Neglect 21 Over-petting 2 Being kept indoors 1 Fright 39 Obstinacy 3 Consanguinity of parents 2 Heredity 31 Illness— Indefinite illness 32 Diphtheria 13 Scarlet fever 37 Whooping cough 5 Measles 9 Chorea 1 Rickets 5 "Fits" 32 Brain disease 23 "Water on the brain" 4 Sunstroke 4 "Large brain" 1 Worms 1 "Medical treatment" 1 Age at which the deficiency was noted. During infancy Number— 762 .. Percentage—60.81 By 4 years „ 88 „ 7.02 „ 5 ,, ,, 32 ,, 2.55 „ 6 „ „ 10 „ .80 „ 7 ,, 3 ,, .24 „ 8 ,, „ 2 ,, .16 At school „ 356 „ 28.41 1,253 18820 AA2 188 Annual Report of the London County Council, 1912. In over two-thirds of the cases the relatives had noted a deficiency apart from the child's attendance and lack of progress at school. In 1,326 cases the age at which the child commenced to walk and to talk had been recorded; in many of the others the parent had been unable to supply the information. The percentage distribution of the age of commencement of these activities is as follows:— Age. Percentage who walked. Percentage who talked. 1 year 24.3 23.8 11½ „ 273 20.0 2 „ 23.4 26.3 3 „ 158 14.6 4 „ 6.7 8.6 5 „ 2.2 5.8 6 „ .3 .9 The previous history and the initial medical examination revealed the following defects and stigmata in 1,500 children adjudged to be mentally defective:— History of "fits" probably epileptic in nature 91 History of infantile convulsions 259 Enlarged tonsils and adenoids 138 Deafness 89 Word deafness 1 Otorrhœa 27 Markedly defective articulation 177 Defective vision 95 Corneal opacities 17 Squint 95 Nystagmus 19 Cataract 9 Coloboma 3 Exophthalmos 1 Microphthalmos 6 Infantile paralysis 15 Club foot 11 Spastic paraplegia 7 Hemiplegia 15 Spinal caries 4 Hip disease 9 Other tuberculous joints 3 Coxa vara 1 Spinal curvature 19 Rickets 112 Chorea 15 Congenital heart disease 19 Hutchinson's teeth 17 Cranial asymmetry 35 Bossed forehead 85 Prominent and bulbous forehead 25 High narrow forehead 24 Narrow forehead 21 Low forehead 37 Depressed bridge of nose 19 High arched palate 181 Narrow palate 146 Cleft palate 9 Webbed fingers 1 Epicanthic fold 67 Nervous poise 111 Drooping thumbs 13 Twitching 105 Tremors 36 Over-action of face muscles 78 Vacant expression 112 Lack of control of reflexes 19 Dribbling 11 General retardation 85 189 Report of the County Medical Officer—Education. Suicidal tendency 1 Religious mania 1 Albinism 1 Microcephaly 19 Hydrocephaly 32 Cretinism 13 Mongolism 29 Size of head.—The size of head was formerly regarded as an important aid to diagnosis. The following table shews the maximum horizontal circumference of the head in 500 boys in schools for the mentally defective grouped according to age last birthday:— Size of head in inches. Age 6 7 8 9 10 11 12 13 14 15 18 - 4 - 6 - 2 1 - - - 18½ 2 5 3 6 3 — 2 — — — 19 1 15 10 10 6 3 1 — — — 19½ 4 33 28 9 8 9 7 1 1 — 20 — 29 23 17 8 10 9 5 — — 20½ 1 24 18 8 10 13 3 1 3 — 21 2 17 15 19 11 8 11 1 — - 21½ — 5 8 5 7 — 4 — — 3 22 - 2 3 — 3 1 4 — — 1 22½ - — — — 1 2 — — — — 23 - - - 1 2 - - - - - The maximum circumference of the head is thus clearly restricted. Adequate figures for comparison of these dimensions with those of children from the ordinary elementary schools of London are not available, but the comparison with American and Continental records is shown below:— Age. Average maximum circumference in millimetres. London (mentally defective). New York (Hrdlicka). Washington (Macdonald). Posen (Landsburger). Zurich (Hoesch Ernst). 6 495 — — — — 7 506 — 518 — — 8 508 516 520 513 520 9 506 519 522 517 520 10 515 520 525 518 522 11 510 525 526 519 525 12 517 525 529 525 531 13 508 530 532 523 527 14 508 533 . 536 — 531 15 549 — — — — Family history.—The family histories contained in most cases considerable information as to the health and physical conditions. From 2,000 records of—so far as is known—separate families the following data were obtained of the affections of relatives:— Consumption— In parent 239 „ brothers or sisters 171 „ collaterals 273 „ grandparents 81 Heart disease 65 Repeated miscarriages of mother 81 Intemperance— In father 241 „ mother 122 „ both parents 68 Cancer 123 Insanity— In father 24 „ mother 49 „ brothers and sisters 19 „ collaterals 189 „ grandparents 108 190 Annual Report of the London County Council, 1912. Fits, other than in infancy— In father 34 „ mother 49 „ brothers and sisters 134 „ collaterals 85 „ grandparents 83 Member of family not specified 25 Mental deficiency— In father 96 „ mother 127 „ brothers and sisters 259 „ collaterals 33 „ grandparents 6 All the family described as "dull" 89 One brother or sister defective 137 Two brothers or sisters ,, 87 Three „ „ „ 21 Four „ „ „ 6 Five „ „ „ 6 Six „ „ 1 Eight „ „ „ 1 Members in family defective.—In the case of 700 families it was possible to note the total number of children in the family and the number who were defective; from the results obtained it appeared that on an average 143 were mentally defective in a family of the average size of 6-05 children. | Number of children defective. Number of children in the family (size of fraternity). Total. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 37 45 59 49 78 84 45 47 12 23 14 8 9 4 3 — 1 1 — 2 521 2 3 15 13 14 11 12 12 3 4 1 1 2 2 — 2 — — 1 — 96 3 4668 11 10 22111132 — — — — 58 4 211232211 — — — — — — — — 15 5 1 1 — — 1 — — 1 — — — — — — 4 6 121— 1 — — — — — — — — 5 7 1— — — — — — — — — 1 Totals 37 48 78 70 99 104 71 74 21 32 19 12 12 8 6 4 1 1 1 2 700 The number of members of each of these 700 families recorded as being defective, epileptic or insane was thus distributed:— No. affected. No. of families. 1 367 2 148 3 79 4 49 5 32 6 10 7 6 8 5 9 2 10 1 11 1 Order of child in the fraternity.—Some forms of mental deficiency are believed to affect the later members of large families. In order to ascertain if this applied generally to the children in special schools, the number of children in the family and the order of birth of the defective child were taken from the records of 1,000 families. To obtain a normal series for comparison the same data were extracted from the records of 1,000 junior county and trade scholars, who would represent the best of the elementary school population. Comparison can also be made with data from the village colony for epileptics at Spillman, New Jersey. Type. Number observed. Order of l.irth. Standard deviation. Size of fraternity. Standard deviation. Defectives (1,000) 4.35 3.24 6.32 3.27 Epileptics (391) 3.61 2.48 6.32 3.24 Normals (1,000) 2.87 2.16 4.79 2.55 191 Report of the County Medical Officer—Education. The correlation co-efficient between the size of the fraternity and the order of birth is for the defectives, r = .81 ± .06, and for the normals, r = .65 ± .008. The detailed distribution of the size ot the fraternity including detective children is shown in the following table:— Order of birth. Size of fraternity. Total. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 38 22 45 39 35 18 7 6 3 3 1 1 1 - - - - - - - 219 2 32 24 19 32 19 7 5 1 2 1 - - - - - - - - - 142 3 38 17 27 25 11 7 2 2 2 1 - - - - - - - - 132 4 35 22 27 22 5 1 1 1 - - - - - - - - - 114 5 20 17 26 16 6 6 1 — 1 — — 1 — — — - 94 6 30 16 20 7 1 1 1 1 1 - - - - - - 78 7 24 11 7 5 1 2 1 1 1 - - - - - 53 8 29 9 7 2 2 1 1 1 - - - - - 52 9 12 16 10 2 2 1 - - - - - - 43 10 13 7 1 2 1 1 - - - - - 25 11 9 2 2 - - - - - - - 13 12 4 2 — 1 - - - - - 7 13 5 3 1 1 1 — — - 11 14 2 2 1 - 1 1 - 7 15 2 1 - 1 — - 4 16 2 - — 1 - 3 17 - — - 1 1 18 - - - - 19 1 - 1 20 1 1 38 54 107 110 136 136 113 99 48 56 36 16 18 10 9 6 1 2 3 2 1,000 Defective children. The next table shews the detailed distribution as regards scholarship children. Order of birth. Size of fraternity. Total 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 1 64 80 73 49 30 23 18 5 4 4 - - - - - - - - 350 2 49 51 44 20 23 7 11 2 - - - - - - - - - 207 3 40 40 35 13 12 12 2 2 1 1 - - - - - - 158 4 28 21 13 10 8 1 1 1 1 — — — - — - 84 5 28 22 9 11 7 1 — — 2 — — — — — 80 6 13 19 6 3 3 — 2 1 - - - - - 47 7 19 5 4 1 — — 1 — — — — — 30 8 8 3 1 1 2 - - - - - - 15 9 7 4 2 1 1 - - - - - 15 !i0 5 1 2 — — — — 1 - 9 11 2 1 - - - - - - 3 12 - - - - - - - - 13 - - - - - - - 14 2 — — — — 2 64 129 164 161 134 107 94 66 33 22 8 10 5 2 — — 1 — 1,000 Scholarship children. These tables are at their extremes open to the possible fallacies: (1) that the smaller families may not be complete, actually over 80 per cent, of those with only one or two members were complete, owing to the death or age of the parents; (2) that in the smaller families there would be a greater chance of the older members having attained the age at which the examination, whether for scholarships or mental deficiency, coilld be conducted, and that other members may subsequently qualify; this, however, appears contradicted in the defective children, but may be asserted for the groups of efficient families in which there are only two or three members; (3) that in the larger families the younger members would be more likely to be of the required ages, and that earlier members may also have been specially efficient or deficient; this criticism cannot be negatived from the data available for families with more than ten members. Relative fertility of efficient and deficient stocks.—Great importance attaches to the relative fertility of efficient and deficient stocks. It is often asserted that the fertility rate of the deficient is so great that in a short time they will outnumber the sound stocks. Others think that a selective death rate operating more strongly against the defective stock will quite counterbalance this fertility. Some data bearing on the question can be obtained from the medical records of the special and secondary schools. The numbers of children born and the number who had died at the date of the record have been taken 192 Annual Report of the London County Council, 1912. out for 1,000 families, in which there is at least one child who was mentally defective, and for 3,000 families in which at least one member had gained a scholarship or bursary. As the latter group were on an average some five years older than the former the data were corrected to the younger age by noting the dates of death of any members of the family, and subtracting those who had died after the date on which the individual round whom the record centred had reached the age of 9. From the data thus collected the following results appear:— Number in fraternity. Standard deviation. Number dead Standard deviation. Correlation between number born and number dead. "Defective" families (1,000) 6.46 3.35 1.91 2.15 r = .7 +.01 Normal "scholarship" families (3,000) 4.59 2.48 0.48 0.89 r = 5 ± .009 This gives an average net family of 4.55 for the defectives and 4.11 for the normals, showing that although the selective death rate has reduced the disparity, it has not, up to the period represented by a record centring round a child of the age of 9, reversed the balance in favour of the inferior stock. Defective stock. The detailed distribution of deaths and size of fraternity among defective stocks is shown in the following table:— Number of children dead. Size of fraternity. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 0 44 45 68 54 47 36 29 19 10 1 1 1 1 - - - - - - - 356 1 22 22 24 18 21 28 11 11 5 2 1 1 1 1 - - - - - 168 2 12 19 20 23 24 26 17 6 3 5 3 - 1 1 - - - - 160 3 9 12 16 17 16 16 14 8 6 3 - - - - - - - 117 4 6 11 9 10 14 7 6 6 3 1 - - - - - - 73 5 2 4 10 9 10 12 5 3 1 1 - - - - - 57 6 2 3 9 4 5 5 3 1 2 - 1 — 1 - 36 7 2 2 2 1 1 1 2 1 1 — — — — 13 8 1 1 - 1 2 2 1 - - 1 - - 9 9 3 - - 1 - 1 - - - - - 5 10 - - - - - - - - - - - 11 - - - - 1 — 1 — — 2 12 - - - - - - - 1 1 13 - — 1 — 1 — — 2 n — 1 — — — — 1 44 67 102 106 103 109 113 97 89 53 38 31 21 8 8 5 1 3 1 1 1,000 Scholarship stock. The next table gives the same information regarding normal or scholarship stock. Number of children dead Size of fraternity. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 0 210 411 435 358 246 174 132 68 40 16 9 2 3 1 - - - 2,105 1 25 81 110 88 87 66 44 28 13 3 3 1 — — — — 549 2 5 23 43 49 39 25 15 13 7 3 3 - — — — 225 3 1 7 14 11 12 12 14 5 5 - - - - - 81 4 1 2 3 4 2 3 6 5 — 1 — — — 27 5 — — 1 1 1 1 — 1 — 1 1 — 7 6 — - - - - 1 - - - - 1 2 7 — 1 — — — 1 1 — — — 3 8 - - - - - 1 - - - 1 210 436 521 492 385 326 251 154 99 60 31 19 9 4 1 1 1 3,000 Schools for the physically defective Physically defective children have been under the special care of Mr. Elmslie, and he has received assistance from the other medical officers who, when visiting the schools for the purpose of admission examinations, were asked by the head teachers to see special cases. Mr. Elmslie has kept a duplicate set of records of his observations, from which he contributes the following analysis of the defects of 193 Report of the County Medical Officer—Education. 3,350 children who are attending or who have recently attended these schools for the physically defective. 1. Tuberculous diseases- Spine 380 Hip 447 Knee 266 Ankle and tarsus 35 Elbow 12 Various 38 1,118 2. Infantile paralysis 539 3. Spastic paralysis— Hemiplegia 88 Paraplegia 50 Diplegia 25 163 4. Other forms of paralysis— Pseudohypertrophic and other progressive paralysis 15 Various paralyses 7 22 5. Congenital deformities— Dislocation of the hip 63 Talipes equinovarus 81 Various 27 171 6. Various deformities— Rickets 95 Septic osteitis 55 Amputations 70 Scoliosis 50 Kyphosis 6 Coxa vara 11 Malunited fractures 5 Scarring from burns 3 Spina bifida 5 Achondroplasia 6 Infantilism 2 Cretin 2 Fragilitas ossium 7 Congenital syphilis 1 Various 29 Ectopion vesicæ 1 351 7. Heart disease 614 8. Other chronic diseases— Chorea 104 Alleged phthisis 52 Bronchiectasis 22 Old empyema 4 Chronic bronchitis and asthma 12 Haemophilia 6 Anæmia 15 Nephritis 11 Epilepsy 10 Lupus 3 Hysteria 3 Various 17 Delicate, convalescent, etc. 81 340 9. Other defects— Eyes 12 Ears 6 Mental 1 Albino 1 Fractured skull 5 Tracheotomy 7 32 3,350 18820 B B 104 Annual Report o] the London County Council, 1912. Compared with the figures given in the annual report of the Medical Officer (Education) for 1909, this shows a relative diminution in the number of cases of tuberculous disease and an increase in those of infantile paralysis and heart disease. Special attention has been paid to the physical condition and educational progress of the latter class of children, who may be grouped into categories according to the nature of the lesion. Heart Disease. The first class includes the important group of children who have no organic valvular lesion, but whose heart muscle has been weakened temporarily as a result of some acute illness, usually of an infectious nature, such as scarlet fever or diphtheria. After severe attacks of such illnesses, convalescence is protracted and sudden violent exertion may be attended with serious danger to health or even to life, and it is necessary that the re-establishment of school routine should be slow. Many physicians are disinclined to allow school attendance or only permit attendance for an hour or two a day, or perhaps for half-time only. These children are able to attend an invalid school. Many months may elapse before it is possible for them to attend an ordinary school, where they are exposed to the exertion of games and stair-climbing, and the value of the invalid schools is generally now recognised by the medical staff of hospitals, who, from time to time, suggest that certain children, though unfit for the ordinary school, might be admitted to a school for the physically defective. In many cases these children, who constitute a small minority of the total heart cases in the special schools, are able to return to the ordinary schools after a time ; but the return thereto depends on the age at which they are admitted to the special schools. The second class consists of children suffering from definite organic, usually valvular, lesions of the heart. This group must be sub-divided into two groups, those with congenital lesions and those in whom the lesion has been acquired as a sequel to some serious illness, such as chorea, rheumatic or scarlet fever. In some case3 it is impossible to state with certainty the category in which a given child should be placed. The ultimate prognosis in congenital cases is unfavourable, but a considerable proportion of the children survive for many years after the school period, and the education they receive not only adds to their happiness, but often enables them to contribute in some measure to their own support by means of various light home occupations. Cases of acquired heart disease were found to constitute 86 per cent, of those of an organic nature, the chief cause being a preceding attack of rheumatism or chorea. In connection with these cases, two factors are of paramount importance—the prevention of fresh attacks of rheumatism and chorea which would be accompanied by further damage to the heart, and the physical education of the damaged heart muscle to enable it to overcome the mechanical difficulties associated with injured heart valves. The risk of recurrence of rheumatism and chorea can be appraised only in general terms. The more remote the original attack the less likely a recurrence, and the younger the child at the date of the first attack the more likely is it to be subject to recurrences. Exposure to damp predisposes to rheumatism, while long hours of ordinary school subjects have been found to encourage chorea. Hence it is that the travelling to school in an ambulance and the spending of half the day in manual occupations have a preventive function. A case in which the rheumatic condition has once returned is much more unfavourable than one in which there has been a single attack only, so that care is desirable for a long period after the original attack, in order to avoid such an untoward event. The prospects of health tor a rheumatic subject with a damaged heart turn largely upon the choice of occupation, for exposure and strain may lead to the early ending of a life which in sheltered and sedentary surroundings might wall have attained the average expectancy. Cases are on record in which advice as to occupation on leaving school has been neglected, and the subject has died within a short period; while others, instead of being able to earn a partial living, have been converted into confirmed invalids. An investigation into the prospects of children in the schools showed that nearly half had a reasonable chance of looking forward to a normal existence if they were able to take ordinary care. A study of the causes of prolonged absence of children from school shows that heart disease is responsible for about 10 per cent., and the increase in the numbers attending is largely due to the more general realisation of the advantages of the invalid schools, so that children now attend who at one time were kept away under medical certificate, which could not have been contested successfully in court. The children suffering from heart disease deemed suitable for the physically defective schools are those in whom compensation has been but recently established or in whom there is a risk of recurrent attacks of illness leading to further damage. Fully compensated cases with no recent rheumatic history who are able to continue their ordinary occupations are not deemed suitable for admission. Mr. Elmslie has the following record of children who have been in the schools for the physically defective at some period during the years 1908-1912 inclusive. Chorea 157 Admitted for observation; no heart lesion subsequently detected 63 Non-valvular heart lesions with a rheumatic history 95 ,, ,, ,, without ,, ,, ,, 53 Adherent pericardium 6 Congenital heart disease 118 Valvular lesions 743 Comprising Mitral stenosis 26 Mitral incompetence 536 Double mitral 108 Aortic and mitral 41 Aortic 32 1,235 195 Report of the County Medical Officer—Education. Dr. Shrubsall has made a somewhat further analysis of Mr. Eimslie's records to ascertain the subsequent history ot these cases, with the results shown in the following table:— Result at date on last note. Admitted for observation as possible heart disease. No evidence found to date. No evident heart lesion. Heart lesions suspected but not demonstrably valvular in nature. Definite heart disease. History of chorea. No recurrence after admission to physically defective school. Recurrent attacks of chorea while attending physically defective school. History of rheumatism. History of rheumatism and chorea History of recurrent chorea. No history of rheumatism— nature of lesion not certain. Adherent pericardium — no valvular lesion evident. Congenital heart disease. Mitral stenosis. Double mitral. Mitral incompetence Mitral and aortic. Aortic Total. Still in physically defective school 15 26 21 13 8 27 24 4 58 8 36 232 16 19 507 Elementary school 23 37 4 11 2 5 9 — 7 4 — 32 1 1 136 Mentally defective school 2 3 — — — 1 1 — 2 — — 4 — - 13 Private, secondary or other schools 1 - — — — — 1 — 1 — 1 8 — - 12 At work 11 20 13 7 — 8 9 1 6 5 17 91 8 5 201 Left at 16—unfit for much work - - 5 - — - - — 7 - 17 27 3 2 61 Invalided — — 7 2 — 1 - — 13 2 14 40 1 1 81 Died — — 3 — — — 2 — 16 1 15 49 5 2 93 Lost sight of—ailing at last note — — 1 — — 2 4 1 5 — 3 12 2 1 30 Lost sight of—fair condition at last note 11 6 5 1 — 2 3 — — 5 2 21 3 1 60 Left London — 4 2 3 — 2 — — 3 1 3 20 2 — 40 Total 63 96 61 37 10 48 53 6 118 26 108 536 41 32 1,234 It is probable that the majority of those who were lost sight of subsequent to being invalided have died. There has thu3 been a fatality rate of between 8 and 15 per cent, in five years, but, on the other hand, 30 per cent. have been able to return to the ordinary schools or to proceed to productive employment. The antecedent history of the 743 cases of acquired valvular disease of the heart is of interest, and shows the frequency with which this disease has been preceded by rheumatism or chorea. The following tables give this information for boys and girls respectively. Antecedent history. Nature of valvular lesion. Boys. Mitral stenosis. Double mitral. Mitral incompetence Mitral and aortic. Aortic. Total. Rheumatism 4 19 97 19 14 153 Rheumatism and chorea - 2 10 2 2 16 Rheumatism and scarlet fever - 1 4 1 1 7 Chorea - 4 17 - 1 22 Scarlet fever - 1 5 - - 6 Diphtheria - - 2 - - 2 Measles 1 - - - - 1 Pneumonia - 2 1 - - 3 No history of illness at onset and no history of rheumatism or chorea 2 13 56 6 3 80 Total 7 42 192 28 21 290 Antecedent history. Girls. Nature of valvular lesion. Mitral stenosis. Double mitral. Mitral incompetence Mitral and aortic. Aortic. Total. Rheumatism 6 29 159 9 5 208 Rheumatism and chorea - 6 29 - 35 Rheumatism and scarlet fever 1 2 9 1 - 13 Chorea 7 8 43 1 — 59 Scarlet fever — 1 7 — 3 11 Diphtheria - 1 — — — 1 Measles - - - - — — Pneumonia - 1 2 - - 3 No history of illness at onset and no history of rheumatism 5 18 95 2 3 123 Total 19 66 344 13 11 453 18820 BB 2 196 Annual Report of the Loudon County Council, 1912. The greater frequency of cases of heart disease among girls is associated with the increased incidence of rheumatism in their sex, but the proportion of cases of heart disease which had presented previous rheumatic manifestations is substantially the same in boys (68.3 per cent.) and girls (69.5 per cent.) Schools for the doaf. Schools for the Deaf and Partially Deaf. The investigation of the causes of educational deafness is one of very great importance and the results obtainable therefrom will, if acted upon, materially reduce the number of children who suffer from acquired deafness to such a degree as to require highly specialised teaching. The prevention of acquired deafness is a question of a very far-reaching nature, and requires the disinterested co-operation of many bodies, educational, medical, municipal and social. Mr. Macleod Yearsley visits the deaf schools in rotation, giving the head teachers at least three days' notice of his visit, and seeing such scholars as they may wish him to inspect. All new scholars are seen at the first visit after their admission when the condition ot their ears and hearing and of the upper air passages is ascertained, so far as this is possible with uneducated deaf children. In many cases it is not possible to make complete tests of their hearing until such children have received a considerable amount ot special education, but as far as may be it is ascertained whether they are stone deaf or have hearing for noises, vowels, or words and sentences, as these points are of importance for determining on education by the oral system. Head teachers welcome the visits of the otologist and have generally some matter to discuss or some case upon Which they want advice. Eegular visits are also made to the residential schools, where the scheme of work is much the same as at the day schools. All the new arrivals are seen at the first visit after their admission and are examined de novo, so that those whose previous examinations as to the amount of hearing have been necessarily incomplete are freshly and more thoroughly investigated, and those whose examinations have already been exhaustive are all re-examined and the notes confirmed. By this means, it has been possible, since 1908, to collect records of some 1,100 cases, approximately 600 boys and 500 girls. During the first month of the year, it is the custom to visit each school, residential or day, and to see every scholar, so that no child misses being seen at least once during the twelve months. The children in the schools for the deaf are also regularly supervised by the Council's ophthalmologist to avoid, so far as possible, any risk of impairment of vision which has assumed a greater importance from the failure of auditory activity. Similarly, from time to time, the otologist reports on cases in the schools for the blind. Children nominated for admission to schools for the deaf are examined at the offices of the Public Health Department, their auditory status and physical condition determined, and a conclusion arrived at as to educational treatment. The results of these examinations for the year are as follows:— Fit for elementary schools (including, however, some cases with suppurating ears) 114 Fit for elementary schools, but to sit in front row 74 Fit for classes for the partially deaf 34 Fit for education in a deaf centre 111 Fit for education in a mentally defective school 9 Imbecile 2 Physically defective 8 Invalided 13 Exempted 4 Total 369 Schools for the partially deaf. The class for the partially deaf at Ackmar-road began on 12th September, 1910, with six children and has, at the present time, sixteen on the roll. In all, twenty-six children have been taught, and of these six were returned to elementary schools, one was transferred to a mentally defective school, one was invalided for treatment and later transferred to a deaf centre, one left for domestic service, one was taken to a home, sixteen are still in the class. The children are under the special supervision of Mr. Macleod Yearsley, the Council's otologist, who reports that the deafness of the children now attending the class Was due in nine cases to suppuration and in seven to catarrhal conditions of the middle ear. In no case was the hearing distance for the ordinary voice (conversational tone) more than 4 ft., and in every case the deafness was such that the child was severely handicapped for the work of a hearing school, even when placed in the front benches. It is, however, equally the case that none of these children were sufficiently deaf for special education in a deaf centre and had they been placed in deaf schools they would have been brought into contact with deaf scholars whose habits of thought are entirely different from their own and whose language attainments are more limited. Some of the partially deaf children have appeared to improve in hearing since their admission. This may be attributable to the functional rest of the ears, due to their having been subjected to less strain by reason of the acquisition of an additional means of communication (lip-reading) and the increased knowledge of language that this new means of communication has given them. The general result of the education received in the class has been marked, from a dull apathy due to the hopelessness of understanding the teaching in an ordinary hearing class, to a brightness and happy alertness. In order to ensure this the hours of attendance and the arrangements for meals and prayers are such as to separate the partially deaf from the other scholars in the deaf school. Lip-reading appears to be readily acquired by most children. Those with most hearing seem Report of the County Medical Officer—Education. 197 to learn it most rapidly, so that children who are only very slightly hard-of-hearing require a shorter term of instruction than those who have less hearing, and when trained to watch the lips of the speaker they should gather what is said by the mutual assistance of hearing and lip-reading. Children who are very hard-of-hearing would probably require longer teaching and practice to enable them to become thoroughly proficient lip-readers. The conclusion arrived at, after carefully watching this class and consulting on several occasions with the teacher, is that, in a class of about 16 children of ages varying from 7 to 14 years and representing all standards, it is not practicable to teach all together, as the language and ideas of the older scholars are much in advance of those of the younger ones. With the aim in view of their return to hearing classes, a certain amount of teaching, with practice in lip-reading, of such subjects as geography and history seems advisable, besides adding interest to the school work. A considerable amount of time must necessarily be spent in keeping the little ones usefully employed and in training them to work by themselves whilst the older ones are receiving lessons. The younger ones also require instruction in reading and writing. In a small class some of the children can with advantage be set to practise lip-reading with one another, whilst the teacher pays special attention to the more backward or to those with speech defects. There are, scattered throughout the Council's elementary schools, a number of children who are unfit by reason of their defective hearing for education therein, and equally unfit by the limited extent of their defect for instruction in a deaf school, yet who should receive a modified form of special teaching, such as is provided in a class for the partially deaf. Out of 1,194 cases seen during the last three years, 113 were judged to be fit for classes for the partially deaf, or 9.4 per cent. The greater proportion of such children noted in the course of 1910 was due to the presentation of a number of cases from one district to be examined specially with a view to the establishment of a class for the partially deaf in the neighbourhood of Old Kent-road. The area served by the present class at Ackmar-road comprises Battersea, Chelsea, Fulham, Hammersmith, Kensington and parts of Wandsworth and Westminster. It is possible, therefore, that the establishment of five more such centres would be sufficient to enable the partially deaf children in the county to be dealt with in an efficient and practical manner. The greatest necessity for such centres exists in the areas about the north and north-west, east, south-east and south-west. The question of the organisation of classes or centres for the partially deaf requires careful consideration. In the first place, it is essential that the partially deaf child should be guarded from mixing with deaf mutes, and removed from proximity to deaf centres. Even the precautions taken at Ackmarroad are powerless to keep such a child from contact with the deaf mute outside the school, whereas he should be encouraged to mix with normal hearing children. For this reason, centres for the partially deaf should for preference be arranged in a large elementary school. The scholars could then mix with their hearing fellows in the playground. By this means, also, they could attend ordinary hearing and manual work classes, whilst passing a part of their time in the special centre. Each centre should contain two classes, one for younger children, from say 7 to 10, and one for older children, from 11 to 14. These would require to be in charge of an experienced teacher of the deaf, and could be taken by one teacher, the younger children attending in the morning and the older in the afternoon. Those not being taught in the special centre would be taking part in the work of an ordinary hearing class. Failing the establishment of these classes, the only alternative is to place the partially deaf children in deaf schools, where alone they can receive the instruction required, but they are costing the Council the full expense of deaf children and are occupying places which can be filled by children more suited to deaf schools. Mr. Yearsley draws attention to the needs of children suffering from stammering and similar speech defects. There are, at present, no arrangements for dealing with these cases, although a few isolated instances of stammering, idioglossia and cleft palate have been seen and recommended for a course of instruction in articulation at a deaf school. This involves certain disadvantages. In the first place, they have to make the journey from their own school to a deaf centre, which takes up time and is an expense, and, secondly, the teacher who is giving them instruction has to neglect his or her own class in the deaf school in order to give the undivided attention necessary to the lesson in articulation. Moreover, the educational treatment of stammering, etc., is of a special nature, and it is not every teacher of the deaf who has the requisite expert knowledge. It is not possible to overcome the defective speech known as stammering in a class. It is true that certain fundamental laws of breathing and the co-ordination of the various mechanisms concerned in the production of speech may be taught in a class the numbers in which are strictly limited, but, once this spade-work is accomplished, each stammerer has to be considered as an individual and, therefore, each must have individual attention from a skilled expert. The best course to be pursued with regard to these defects of speech would be to arrange for certain centres to which children suffering from stammering and allied conditions could come for lessons once a week, where they could be taught by a visiting teacher, each for from half to one hour. It is, however, of paramount importance that this teacher should be an expert. Instruction, save from an evnert is worse than useless. There have been no changes to record in the ordinary special schools of this character, the important feature of the year has been the increased provision of accommodation for those suffering from high myopia and other defects of vision which have rendered the children incapable of benefiting adequately by the instruction available either in the ordinary elementary schools or in the special schools for the blind. These schools have been under the special supervision of the Council's ophthalmologist, Mr. Bishop Harman, who contributes the following notes of the progress and present state of this experiment in the instruction of those who while not blind suffer from severe visual defects. Schools for the blind and partially blind bo soon as any attempt was made to ascertain the cause of bad vision amongst school children, cases of high myopia were discovered and immediate difficulty arose in providing for their satisfactory Myope schools. 198 Annual Report of the London County Council, 1912. education. Such children had no place within the ordinary scheme; their sight was too bad or too susceptible of further damage to permit ol education in any elementary school; and they were not blind or partially blind, and were unsuitable for a blind school. Some few of the least defective were admitted to an elementary school to take what they could of its curriculum; some of the most defective were admitted to blind schools, often with difficulty owing to a not unnatural opposition from the parents; but most were invalid and received no education at all. Attention was drawn to the state of affairs in the reports of the medical officer (education). In 1908 the first experimental class for myopes was established. There are now three centres; the original experimental class in the Boundary-lane Blind Centre, one at Harvist-road, Islington, and another at Fountain-road, Tooting. These three centres accommodate 100 children, many of whom have to travel considerable distances. There is still, however, a waiting list of children for whom no suitable accommodation can be found, many of these are in attendance at the ordinary elementary schools under conditions that will be noted subsequently. The immediate want is a centre in the east and one in the west of London. But it is quite certain that these and the three already in working will not meet the requirements of the future, for the establishment of these myope centres has become known to the hospital surgeons of London, so that now children attending hospital clinics who are found to have grave defects of vision are recommended for admission to these schools, instead of being turned adrift with a certificate of unfitness for school attendance, as was formerly the custom. Further, the formation and systematic working of the treatment centres has resulted in the discovery of a number of children with defective vision for whom nothing was done in former years beyond the possible provision of spectacles. The increase in the attention given to these cases is shown in the numbers recommended for admission to a myope school from amongst the children seen at the head office. There were:— 1909 13 , 1910 22 1911 46 1912 92 These figures do not include children recommended for admission to these special classes on account of defective vision due to other causes than myopia. The possible necessary increase in the number of these schools or classes in the near future makes it desirable that some scheme or general plan should be arrived at which would be applicable to the whole of London and which would be capable of easy expansion or contraction as the number of children requiring this form of education varied. In any such scheme it is highly desirable that the arrangements shall be such as will permit the closest association of these special classes with the existing elementary schools, rather than their organisation as separate units; in no case should they be associated with the blind schools. The necessity for the close .association of the myope classes with the ordinary schools is advocated for two reasonsto reduce to the minimum the reluctance of parents to the transference of their children to the special classes; and to reduce the handicap which attaches to children who have required special forms of education on account of physical disability, a handicap which becomes manifest when they leave school and apply for work. These two reasons are really identical. The working of the Employers' Liability Acts has increased the difficulty of securing employment for those who suffer physical disability. Short sight will be counted such a disability if education arrangements are made so as to segregate these children. An idea scheme would be the selection of an ordinary elementary school centrally situated for every residential area. To that school should be transferred all the short-sighted children living in that district. They should be entered as regular scholars of that school. One or two classrooms could be set apart for their accommodation. In these rooms such part of their work as must be different from that of the regular pupils of the school should be taken. The rest of their work should be taken with their normal class mates. The teachers who would have charge of the special part of this curriculum Would be trained for the work, and the rooms allotted would be appropriately equipped. Lighting is a point of particular importance in the case of myopes, for not only does their defective vision necessitate perfect illumination, but the very nature of the defect from which they suffer reduces their sensibility to objects viewed under feeble illumination. Method of selection of cases.—On one afternoon of each week the Council's ophthalmologist examines a number of children who have been reported by the Council's school doctors, or by hospital or other authorities, as probably suitable for special educational treatment on account of grave defect of vision. These cases are examined, note made of the state of their eyes and of such vision as may be present, and some decision arrived at as to what education is possible for each of these children. Some are returned to the elementary school as capable of receiving the regular education, and others are graded for various degrees of exemption or special treatment up to that of admission to the blind school:— (a) Elementary school, for easy treatment as regards eye work. (b) Elementary school, oral teaching only. (c) Myope class, Elementary school., oral teaching pro tem. (d) Myope class. (e) Blind school. (/) Resident blind school; either the Council's for elder children, or one of the country homes for younger children. (g) Invalided temporarily, or in some cases permanently. Many cases are referred for medical treatment before any determination is made as regards education. Each case is considered on its merits, and many conditions besides eyesight, influence the Report of the County Medical Officer—Education. 99 decision arrived at, e.g., the age of the child; whether one or both eyes is affected; the nature and degree of the affection; the probability of amelioration or aggravation of the affection during school age; the possible effect of school attendance and work; the possible educational advantage of a change of regime, may be, of school and of home; lastly, in the case of the blind or partly blind, the most suitable school for the particular child, in the knowledge of his or her age and capability. Up to the end of 1912, 313 had been entered on the roll of "myopes," some of these are now in myope schools, some have left London, others again have passed the school age, but there is still a considerable list of children for whom there are as yet no places. They are for the most part attending ordinary elementary schools, to which they are admitted under special conditions for oral instruction onlv, but are likely to be seriously harmed if these directions are not followed. Children admitted to elementary schools under such limitations are obviously in an anomalous position, and their presence is a source of some difficulty to the teachers in that they disturb the normal routine. Despite these difficulties there is on the whole some advantage to the child, who is better off in school than loafing at home or in the streets; and it would be quite easy to demonstrate that the children themselves prefer to be in school. To make clearer the nature of the condition of the eyes of these children, and the limitation of the educational treatment that is to be received, both these points are explained to the parent in attendance at the office, who is given at the same time a card printed as follows:— Notice Regarding the Care of the Eyes.—To the Parents or Guardians of Your child suffers from a defcct of vision that prevents him or her from joining in the ordinary work of the school. If it is impossible for you to obtain admission for the child to a special class for shortsighted children he (or she) may attend an elementary school with a view to gaining the educational advantages of school discipline and such general knowledge as can be given in the oral lessons of the classes. Reading and writing of any kind will not be allowed except blackboard work. You are particularly asked to watch your child at home, to teach games and outdoor play, and to stop all reading and writing. (In the case of a girl, sewing should be completely stopped, but knitting may be learned provided the child does it by feeling the stitches and not by looking at them.) The child should be out of doors as much as possible. It is equally necessary that the teachers to whose care these children are committed should be clear as to the necessary limitation of their work, and to this end a circular letter, which reads as follows is sent to the head teacher of the school to which any such child is admitted :— 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 or 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 bo 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 homo 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 freearm 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 childien 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. The head teacher should, in the course of each year, draw the attention of the school doctor to these children, and give the doctor information as to their educational progress or any difficulties which may have arisen in connection with the eases. Even presuming the greatest understanding and watchfulness of the parents at home, and the greatest readiness of the teacher at school to make the necessary allowances for these abnormal units in their classes, this arrangement for the admission of myopes of high degree to elementary schools for oral teaching only is a makeshift. The work of the myope class.—The scheme of work laid down for these classes was as follows: (1) Oral teaching with normal children, for such subjects as can be taught orally; (2) Literary work, such as is necessary for the knowledge of the ordinary means of communication, to be learned without books, pens, or paper, but by the Use of blackboards and chalk, the writing to be done free-arm fashion; (3) A very full use of every sort of handicraft that would develop attention, method, and skill, with the minimum use of the eyes. After four years' experience with the experimental class, and the extended observation of the work of the two larger schools, it has been found quite possible to carry on the teaching of children in this manner ; and the experience has shown that the scheme is a success not only in that the condition of the eyes of the children under observation has remained as satisfactory as could be anticipated, but also from the attraction it presents to both teachers and scholars. Both enjoy it, notwithstanding that for the teachers the method calls for a degree of alertness and constancy of effort that is greater 200 Annual Report of the London County Council, 1912. than that necessitated in ordinary teaching. The essential difference in the basis of the teaching required under this scheme from that practised Under ordinary conditions was early demonstrated. The teachers found themselves cut oft from the use of books, the regular stand-by of modern teaching, whether of normal children, or the deaf, or even the blind. They had to teach with no adventitious aid other than the most primitive of materials, chalk and a board. The readiness, intelligence, and suggestiveness of their efforts in face of the difficulties has made the success of the experiment. The classroom.—The necessity of a room for a myope class is sufficient natural illumination. The windows must be of such size in relation to the floor space that there is on an ordinary winter's day at least 15 foot-candle illumination on the wall opposite the window at the height of 4 feet from the floor. The window should be on the left hand side of the children's desks. Windows on the right hand side in addition to those on the left are permissible if the sills are at least 6 feet above the floor level, indeed such windows, or top lights, are an advantage in these rooms on account of the considerable amount of handicraft to be done in them. Windows on several sides of the room are objectionable unless they are placed high up in the walls, for they limit the wall space available for blackboards. Artificial lighting for these rooms is a negligible consideration. All work, other than drill, oral lessons, or games, should be suspended immediately artificial light is required. No special equipment other than table and blackboard provision is required. The ordinary school desk is unsuitable, and a special desk for these classes was designed by Mr. Harman in 1908. The first half-dozen of these desks were made by the boys in the workshops at the Anerley Deaf School. The desk has proved to be satisfactory, and is now the ordinary equipment of these classrooms. The desk provides a good sized blackboard for each child, suitably sloped and at a convenient height for sitting ; and also a large flat table for handwork. It is convertible from one use to the other by merely lifting the board. Each room has fitted all round the walls a band of blackboard. The boards are fixed to the walls at a convenient level; so that they are available for both teachers and scholars without adjustment, which is not provided. The use of a hall, or room clear of furniture, is essential for the satisfactory working of these classes. Prolonged sitting or close work of any kind, even when it is so simple that it entails little use of the eyes, is bad for these children. For this reason none of the furniture of the rooms occupied by them is fixed, the myope desks and the chairs on which they sit are easily moved to the walls and the greater part of the floor space cleared. Further, a bare floor space permits of a variety of useful and attractive methods of teaching which cannot be undertaken in an ordinary classroom. With the oral lessons, to be taken in company with the normal children of the school with which the myope class is associated, there is no difficulty; it is merely a matter of a convenient time table, and of the recognition by the teachers of the elementary school that front places are required by the short-sighted children. In the higher standards the want of some permanent record of the work of the children was felt, the essentially temporary character of blackboard work did not seem altogether satisfactory, mistakes were so easily corrected that carelessness was engendered. In these standards exercise books of a distinctly novel pattern are being tried. They are made up of large black paper sheets, and the writing is done with white crayon which gives a record of fair durability, but it can be washed off if desired. The exercise books are clipped on to the desk blackboards and the writing is, done free-arm fashion, so that none of the dangers of ordinary Writing, such as stooping over the Work are involved. The eldest of the pupils are allowed to make a permanent record of their work by printing. Two sets of printing type ar? provided for the use of each class. The sets are rubber-faced block letter types one of 1 in. height, the other of 2 in. height. These are mounted on wooden blocks fitted with lateral pegs and holes so thai they can be joined together to form words. The words are prepared and printed upon large sheets of white paper, and the record is permanent and goes to form a class library of scrolls which are useful for subsequent teaching. This device has done away with the necessity of invoking the aid of the professional printer to provide some form of literary matter which could be hung up in the sight of all the children and read with comfort by even the children in the back row. The printing itself is an admirable training in care and exactness, and is greatly liked by the children, in fact it becomes one of the prize tasks of the class. The ordinary thin white lines seen in the blackboard work of lecture theatre or schoolroom are quite out of place in a myope class where the chalk lines must be broad and strong. To secure this the chalk supplied to these schools should be square edged, and of at least double the measure of the stock size. Drill and games enter largely into the time table, and attempts are being made to associate some of these games with instructional work. The most difficult section of the work to arrange is the manual training. Whatever the work done, it must be such that fixed attention of the eyes is not demanded. For that reason all sewing work is prohibited ; it has been tried with a few of the elder children but was quickly stopped. Knitting, on the other hand, fulfils the necessary conditions, a child that has any aptitude for the work readily learns to do it automatically and with little use of the eyes; these children are allowed to practise it. The junior children, both boys and girls, are taught modelling, paper folding, stick laying, felt weaving in colours, and knitting. The seniors, and some juniors, might be taught modelling maps or rough woodwork where measuring can be done with brass rulers with raised and fretted divisions such as are used in the blind schools ; advanced basket work, according to the advanced scheme on the workshop principles (but not including Raffia work, which is too fine); bent ironwork, particularly for boys; netting of hammocks, tennis nets; and for the girls cookery and laundry of a simple sort, just so much as is sufficient to give help in housewifery. The extent to which the short-sighted children can be permitted to join in games with the normal children depends upon the state of their eyes. Many of these highly myopic eyes are very frail and 201 Report cf the County Medical Officer—Education. unnaturally susceptible to injury. To give the teachers guidance in this matter lists are kept of the average and the special cases, according to the directions of the ophthalmologist; those on the special list are limited in their games and drill to the mildest and least risky performances, and during school hours they do not play with the normal children. The following tables show graphically the character of the cases now on the list of the myopes, only those cases are included of whose condition there are full notes, most have been examined on two or three occasions. In dealing with the myope cases proper it has been necessary to arrive at some simple means of tabulating the degree of myopia found in any given case so as to make all the cases fairly comparable. To arrive at this, the measures of the myopia of the two meridians of each eye have been added together, this figure divided by four gives the average myopia for the eyes of that particular child. The method allows the cases to be compared, but it does not bring out the particular seriousness of those cases where the astigmatism is high and the vision proportionately defective. For example:- Meridians in Meridians in Average myopia, right eye. left eye. Cases (a) —2 and —6 —2.5 and —7.5 —4.5 (b) —7 —7 —7 (c) —8 and —9 —9 and —16 —10.5 Cases entered on the roll of myopes up to the end of 1912:— Cause of defective vision. Boys. Girls. Total. Superficial keratitis 16 34 50 Interstitial keratitis 7 17 24 Disseminated choroiditis 2 6 8 Cerebral defect 3 1 4 Albinism 2 1 3 Purulent conjunctivitis after exanthemata 1 3 4 Ophthalmia neonatorum 3 6 9 Extreme hypermetropia 2 — 2 Cataract 4 2 6 Coloboma uvese 2 1 3 Muscle defect — 1 1 Aniridia 1 —1 Buphthalmia 1— 1 Dislocated lenses 1 — 1 Myopia 93 103 196 Totals 138 175 313 In some, myopia was associated with other causes of defective vision, e.g.:— Superficial keratitis 10 Interstitial keratitis 7 Purulent conjunctivitis 2 Albinism 1 Congenital defects 4 One of these cases of purulent conjunctivitis is of particular interest in that it illustrates the danger to the community of allowing infants suffering from ophthalmia neonatorum to be "at large." A girl in the myope class with badly damaged eyes caught the disease from a neighbour's baby which she took care of, her own baby sister took it from her and this baby's eyes Were also seriously injured. The baby from whom the contagion was taken died. The effect of hereditary influence in the production of high myopia was suggested in eight cases in which definite evidence that one of the parents and other children of the same parents were myopic was obtained. In the accompanying Diagram H, Chart I. gives a graphic representation of the distribution of the cases of myopia (excluding defective vision resulting from any cause other than myopia) in 198 children, as regards sex, age, and degree of myopia. It is noteworthy that in the earlier years the recorded cases are of fairly high degree, from nine to fourteen dioptres ; the cases of five and six dioptres in the fourth and fifth years are cases of astigmatism in which the method of averaging the myopia in the four divi-ions ot the two eyes reduces the apparent seriousness of the cases. The lower degrees of myopit. are not reported until the age of seven and over when the children enter the standards. Chart II. gives the age distribution of the cases, and confirms the foregoing observation; cases ot myopia begin to be discovered and are reported in the seventh and eighth years and onwards. Chart III. gives the frequency of occurrence ot the different degress of myopia, the bulk of the cases range from six to twelve dioptres. Few cases of lower degree than 6 D are reported for special consideration, and happily there are not many extreme cases. Those that figure in the chart with fifteen and more dioptres are in the myope classes under strict supervision ; any sign of further deterioration of the eye3 would necessitate their transference to the schools for the blind and partially blind. The nature of the defects of vision for which children are referred to one of the treatment centres for treatment is a matter of importance. In the first place it is desirable to know how far the vision tests made by the school doctors correspond with the tests made by the doctors at the centres. Do these doctors find by their special tests that all or most of those children sent for treatment are defective and requiring treatment ? Secondly, it is desirable to examine the records of the centres, the only Visual defects of children referred for medical treatment. 18820 CC 202 Annual Report of the London County Council, 1912. data from which any indication can be obtained as to the effect of school life and conditions upon the vision of the child. A private investigation of this nature was made and published in 1908 by Mr. Bishop Harman, and some of the findings were incorporated in the Report of the medical officer (Education), 1908, p. 57. The cases collected were those attending the out-patient departments of two hospitals, and numbered 1,100 children ; all these children were patients attending the hospitals on their own or their parents' initiative, and not transferred under a scheme worked by the Council. In this point there is a difference between these cases and those which form the basis of the new enquiry. The present enquiry has been made by Mr. Harman from the records of the treatment centre established at the Belgrave Hospital for Children in the Clapham-road, S.W. This centre has been working since 24th January, 1910. From that date until December, 1912, the cases entered therefor eye treatment numbered 1,907, and of these 1,721 have been discharged as completed and are available for classification. The case papers have been examined and classified according to sex, age, and the condition of the eyes. The work of the centre has varied to some extent during the three years of its existence. During the first two years or 23 months, there were two sessions weekly, with an average attendance of 7 new and 8 old cases. During the last year there was one session only each week with an average attendance of 11*3 new and 26 old cases each session. During the last period an officer of the Council has been in regular attendance at the hospital to arrange a regular supply of children and to secure their return for the completion of treatment. The value of this arrangement has been thoroughly proved. Since the character of the school population varies considerably according to location and social status, it will be well to state that the children seen at the Belgrave hospital are, with rare exceptions, British and natives of London. Socially they are the children of a fair average class of workers —artisans, transport workers, and motor drivers being predominant. Some of the children of the extremely poor are included, but they are so few as not to affect the character of the returns. The neighbourhood is open and healthy. The following table sets out the complete returns of 1,670 of the 1,721 cases examined. The balance of 51 cases is omitted from the returns since the children made no effective attendance for complete treatment. These 51 cases form a wastage of 3"01 per cent. Ages. 4 5 6 7 8 9 10 11 12 13 14 Boys. Girls. Totals B.G. B. G. B.G. B. G. B. G. B. G. B. G. B. CTK G. B. G.IB. G. Superficial diseases 5 8 8 19 18 6 7 14 7 1 93 7 5 6 11 11 6 9 16 20 8 1 100 193 Injuries 2 2 1 5 2 1 3 8 Congenital syphilis 11 2 1 7 1 1 2 2 9 Congenital defects 2 2 3 2 15 2 1 2 2 3 1 1 1 13 28 Ophthalmia neona- 1 12 torum 1 1 2 4 Retinitis pigmentosa 1 1 111 3 4 Habit spasm 1111 4 Squint* 6 9 13 19 6 16 3 4 8 2 1 (87) 5 24 18 13 13 10 5 10 11 2 1 (112) (199) Emmetropia 3 5 3 7 3 1 22 2 2 6 3 1 22 44 Hypermetropia 4 10 14 23 34 22 9 17 19 9 1 162 3 11 14 16 22 22 21 48 17 11 2 187 349 Hypermetropic astig- 2 2 5 21 56 34 30 26 45 17 3 240 matism 2 9 12 27 53 23 34 53 55 31 6 305 545 Mixed astigmatism 1 12 3 9 14 14 2 55 3 9 3 2 6 22 10 55 110 Myopia 9 12 7 24 16 16 5 89 3 3 7 5 18 17 19 6 78 167 Myopic astigmatism 3 1 7 4 5 22 23 6 4 75 1 1 3 4 9 17 32 20 10 5 102 177 Odd eyes 12 113 1 2 11 1 4 2 4 2 4 17 28 Sex totals—Boys 12 22 33 70 148 88 70 112 132 72 20 771 Girls 12 28 35 64 117 74 94 188 157 98 22 889 1,670 Age totals 24 50 68 134 265 162 164 289 300 170 42 * Not to be added in the totals as they are also entered under their refraction errors. 203 Revert of the County Medical Officer—Education. Of those examined 771 were boys and 889 girls, forming of the whole number 46-9 per cent, and 53.1 per cent, respectively. The greater incidence of eye defects amongst the girls extends to nearly all varieties of conditions found. The preponderance of girls is not uniform in all the age groups, but is well marked between the ages of 10 and 13, the eleventh year presenting the maximum difference. Age incidence is unequal, consequent upon the arrangements for medical inspection at the schools. At the earlier ages, 4, 5 and 6 years, only such children are sent for examination as have obvious defects of the eyes, for example, squints and surface diseases. Among the higher ages there are two peaks of high attendance, the eighth year, and the eleventh and twelfth years, which correspond to the two medical inspections of the children at school after they have left the infant department. Of the 1,670 cases analysed no less than 1,420 were found to be in difficulties on account of" errors of refraction " without other defect. The balance of 250, or 19-17 per cent, were found to be suffering from a large variety of diseased or abnormal conditions as the following table indicates :— Variety of eye conditions. Boys. Girls. Surface diseases. Blepharitis 44 38 Conjunctivitis 23 27 Trachoma 1 — Xerosis — 1 Corneal ulcers 24 33 Herpes ophthalmicus 1 1 93 100 193 Injuries 5 3 8 Congenital defects. Dermoids 2 3 „ of lids and muscles 2 2 „ of iris 1 1 „ of macula (and congenital nystagmus 3 — Albinism 1 2 Lens opacities and cataract 6 4 Dislocated lenses — 1 15 13 28 Effects of Ophthalmia Neonatorum (not bad enough for blind school) 2 2 4 General disease, interstitial keratitis, iritis, disseminated choroiditis— Congenital syphilis 6 2 Optic atrophy 1 — 7 2 9 Retinitis pigmentosa (of these one only had a bad pedigree) 1 3 4 Habit spasm, blinding, etc. 4 — 4 250—19-17% 199 cases of squint were seen, or 14 per cent. of the refraction cases, forming no inconsiderable Squints proportion. In the first few age periods they comprise the whole of these cases, a fact well brought out by a comparison of the percentages as shown in the following table:— Age 4 5 6 7 8 9 10 11 12 13 14 % 100 100 63.2 32 7.6 17.7 5.5 5.2 7.5 2.7 5.4 The varieties of squint were as follows:— Convergent 166 „ alternating 16 „ associated with scarred cornæ 6 „ fundus disease. 1 „ congenital defect 1 „ hydrocephalus 1 191 Divergent 8 199=14 per cent. 18820 cc 2 204 Annual Report of the London Ccunty Council, 1912. During the year 1912 thirty-two cases of squint, in which the condition, either by reason of age or variety of squint, was irremediable by other methods, were operated upon for the readjustment of the eye muscles with satisfactory results. The extreme importance of securing early treatment for squint cannot be too strongly insisted upon; if the case be neglected the squinting eye may become blind from disuse; treated early the deformity may be reduced, and the sight of the eye recovered. Errors of refraction (including those found in the squint cases) numbered 1,420. Errors of refraction Reference should be made to the manner of ascertaining and recording the refraction of the children under examination. In about 75 per cent, of the cases the refraction was determined after an ointment of atropine sulphate of 1 per cent, had been used at home for one week. In the remaining 25 per cent. the mydriatic used was a solution in castor oil of the pure alkaloids of homatropin and cocaine 2 per cent. of each, and the oil was instilled into the conjunctival sac of the eyes at the hospital, when the child had to wait with the eyes closed for one hour to ensure the full effects of the mydriatic. Both methods have their advantages and disadvantages. The use of the quickly acting mydriatic has the advantage of saving one attendance at hospital and the possible risk of non-attendance for complete treatment. It has the disadvantage that the actual waiting at the hospital for both child and parent is long; a yet more serious disadvantage is that the oil causes some smarting on instillation so that a timid, or, more usually a spoiled child, will scream and disturb all the other children in attendance. The balance of convenience is found to rest with the use of the ointment; the parents are told how to use it, and it is rarely found that they fail to carry out the directions. They appear to prefer themselves to apply the ointment at home. The refraction is determined by retinoscopy with a plane mirror, the results obtained at the distance of 1 metre are corrected for infinity, xD being the retinoscopy x-1D = the real refraction of the eye. With this result there should be obtained the best visual acuity whilst the eye is Under the influence of the mydriatic; the actual glass to be ordered depends upon the nature of the refractive error. The character of the conditions found is best seen when presented in tabular form. The following table shows the varieties of refraction. Varieties of refraction. Variety. Number. Per cent. Emmetropic 44 309 Hypermetropic. 349 24.51 Compound hypermetropic astigatism 458 32.25 Hypermetropic astigmatism 87 6.12 Mixed astigmatism 110 7.74 Myopia 167 11.7 do. with astigmatism 177 12.4 Odd eyes 28 1.9 1,420 ... Of the eight classes the first includes a few cases referred for some failure to attain the visual standard in which no defect of the eyes could be found at the centre. In a few there was a history of temporary indisposition or mild conjunctivitis; in some the failure arose from misunderstanding; a few were children with mental defect; and a very few were children who apparently were interested in the possibilities of a visit to hospital. Of the other classes only the last ("odd eyes") needs explanation. The term does not connote "anisometropia," of which there were very many cases, it includes only those cases where .one eye was found to be hypermetropic and the other myopic in some degree, either with or without astigmatism. These eight groups may be considered as forming sections of two main groups: hypermetropia and myopia. Ranged thus, the percentage of defects approximates very nearly to that published in 1908:— Date. Hypermetropia. Myopia. per cent. per cent. 1912 66 34 1908 71 29 Age incidence of the defects The figures are fairly comparable; no stress should be laid on the small differences, for the situation of the centres, and the method of transmission of the cases to them were not the same. Owing to the inequality of the age distribution of the cases comparison is somewhat difficult. Diagram J shows the age incidence of the several groups of errors by numbers and by per- 205 Report of the County Medical Officer—Education. centages. Whichever way the figures be exhibited there is evidence of a distinct increase in the incidence of myopia with each year of age. This result agrees almost exactly with that obtained in 1908, and with observations published by other observers both at home and abroad. In conjunction with this higher incidence of myopia in the elder children the greater incidence both of myopia and all forms of errors of refraction amongst the elder girls should be considered. Boys. Girls Cases. Cases. All errors 644 766 Myopia 230 252 Ophthalmic surgeons are not in complete agreement regarding the primary cause or causes of myopia, but there can be no doubt that these constantly recurring figures showing many cases of defective vision associated often with comparatively small errors of refraction amongst the girls, and of the increased incidence of myopia in the elder children, do point to some correlation between the visual defect and the work done; they suggest that the failure in the nutrition and stability of the eye is connected with undue stress or unnatural conditions. Incidence of serious cases of error of refraction. An error ol refraction 01 5 dioptres or upwards, whatever the nature 01 that error, is beyond all question a distinct handicap. With such a degree of error it is common to find that vision cannot be brought up to the normal standard even with the most accurately arranged correcting glasses. The disability is more pronounced when the error is partly or wholly astigmatism. The next table shows the number and character of these cases. They form 16.2 per cent, of the whole number of refraction cases, actually 231 cases, in 1,420. Error of 5 dioptres and over. Boys. Girls. Totals. Hypermetropia 35 33 68 Do. with astigmatism 37 44 91 Mixed astigmatism 1 1 2 Myopia 8 7 15 Do. with astigmatism 17 37 54 Odd eyes — 1 1 Totals 108 123 231 The total number of eye cases throughout London referred for treatment by the Council from January, 1910, to December, 1912, was 41,946. The number seen at the Belgrave hospital centre was 1,907, or 4.5 per cent. of the total. As an interesting comparison the total figures have been dealt with in the same manner as the Belgrave figures. In this way it is possible to form some idea of the number of special difficulty children who will have to be dealt with in the schools, and who will probably require some form of modified educational curriculum such as that contained in any general scheme for dealing with children suffering from myopia of more than ordinary degree. Estimate of total number of myopes. Total cases 41,946 Deduct unfinished cases not included in analysis 10 per cent 4,194'6 Deduct ineffective cases 3 per cent l,132-5 37,751.4 Diseases of the superficies of the eyes 19.17 per cent. 7,019 Cases of defective vision from errors of refraction 29,599 Special difficulty children with errors over 5D = 16.2 per cent. 4,795 Of these those with hypermetropia, or hypermetropic astigmatism could in most cases be dealt with in the elementary schools with "easy treatment as regards eye work," the balance are myopes requiring special educational treatment to the number of 1,509 Add proportion of children with damaged eyes from ulcers, etc., in existing myope classes = 30 per cent., say 500 Number of children requiring the education of a myope class on a three years' basis 2,000 The demonstration in Germany of a considerable percentage of low-grade short-sightedness among the population proportionate to the amount of education which they had received, made nearly half a century ago, was the beginning of the modern movement of school hygiene. Siies of type sehool books, etc. The researches of Cohn, of his pupils Ensmann in Russia (as regards print), and Schubert in Bavaria (as regards script), and also of Javal in France, have given the data for fixing the requirements of sizes of print necessary for ocular hygiene. In 1908 the Russian Education Department issued complete regulations requiring for elementary schools a minimum height of small letters of 1 75mm., 206 Annual Report of the London County Council, 1912. with an interlinear distance of 3 mm., and for students over 14, having regard to use of technical books, logarithm tables and dictionaries a minimum height of small letter of 15 mm. These standards may be compared with what is actually observed in practice. Newspapers, which form the bulk of popular reading have smaller print. Measurements show that the height of small letters in most newspapers ranges from 1.30 mm. to 1.40 mm. The standard for book print advocated by Cohn and generally accepted on the Continent is a minimum height ot l.5 mm. for small letters. In regard to ocular hygiene in educational work, the size of book print is, however, only a part of the general question of eye work for children and young people. Exclusion of sewing as part of the necessary work of the infant department has gradually been brought about in recent years. During the last ten years there has been great improvement in the general reduction of the amount and kind of fine and near eye work required in schools. The publication during 1912 of the report of a committee of the British Association served to direct renewed attention to the print of school books. The report gives a careful statement of what the print of school books should be. It gives examples of minimal sizes recommended for children in five age groups. Such a report, although based on well established researches in the past, is bound to be somewhat dogmatic, and in the absence of detailed reasons the five sub-divisions would seem to entail unnecessary administrative difficulties on education authorities and on printers, publishers and those commercially interested in book production. For practical purposes the size of reading types need only be considered for three groups of children:— A.—Children learning to read (infants) who require very large print with distinct letters. B.—Children who have not mastered the mechanical difficulties of reading (aged 7 to 10 years). C.—Scholars who read with facility (over 10 years of age). For school purposes the British Association Committee report may be followed with the omission of the recommendations for the sizes of type for children over 12. The committee appears to have paid regard to the average attainments of children at various age without going into the psychology and pathology of vision. The statement is repeated that the acuteness of vision when school life begins is below the standard proper to the fully developed eye ; the correctness of this is open to grave doubt as the proportion of children below 6 years of age who fail to reach normal acuity (V 6/6) proves to be comparatively small if suitable precautions are used in testing. On the other hand in suggesting a smaller type for children over 12, the committee does not appear to have taken into consideration the large proportion whose astigmatism then begins to make itself manifest. Considerable allowance for astigmatism of low degree and other visual defects should be made, so that a theoretical determination of print sizes based on normal vision would probably give unhygienic results for a large proportion of scholars. The sizes of type and the relations and spacing of words and lines are best determined by trial; for example, the letters at the beginning and end of words are more legible when tested this way than in any other position in a word. It is usual in England and America to measure these relations by " printers' points," of which seventy-two go to an inch. Various types are usually expressed in terms of these points, the height of the solid bar or body of the type being stated as, say, 24, 20 or 10 point. The actual size of the letter form or face does not necessarily correspond with the height. Although usually a certain height goes with the type body, yet printers speak of a large face or a small faced type so that an 11 point body might be made with a small face of letter corresponding to that usual in 10 point body or even less. The actual form of the letter is of importance, but provided the due ratio of black and white appears in the letters, with the exception of exclusion of bizarre forms, the form or style of type does not need to be specified in any regulations which might be issued. It would be unwise, for instance, to stipulate that school books should have old style letters, although this kind of type has the advantage of improving with use, and is to be regarded as one of the best. Experience shows that a minimal size of type can be prescribed for each age group of children. The most suitable minimal sizes to fix for infants books are those of 24 point types, for children under 10,14 point, and for other children 11 point type. The sizes of letters being prescribed the clear distance between the words should be equal to the width of a standard letter " n " and the distance of white surface between the lines should not be less than double the height of small letters. In the Russian regulations with small letters of 175mm. for elementary schools and 15 for older scholars it is stipulated that the distance between the lines must be not less than 3 mm. clear. The specification of the actual height of the letters, and of the spacing between the lines would be the simplest and most scientific way to state a minimum, leaving it to the printers to decide upon their own mechanical adjustments to comply with the requirement. Italics being less legible than other letters should be avoided as far as possible, and for characters in mathematical works the rules set out above should be followed. For higher grade schools and institutions where dictionaries, reference books, tables of logarithms, or other bulky books are used, the convenience of portability and small type is very great, and although such print is not recommended for general use exceptions should be allowed under these special conditions. Re-port of the County Medical Officer—Education. 207 The length of line should never exceed four inches. The Continental rules lay down 100 millimetres as the maximum. The surface of the paper should also receive consideration. Whilst the paper should be as smooth as possible, glaze should be avoided. The ink used should be as black as the price of printers' ink, which varies greatly with quality, will allow. The extra cost is well repaid by increased legibility. Book illustration is rather a matter for the psychologist, but clear outline is generally to be preferred to process half-tone Work, and simple illustration to complicated pictures. Flat colour wash is preferable to detailed tints. The minutiae of maps should not be too detailed, and the printing of names on a lined surface of the same colour should be especially avoided. The learner forms a word memory which is composed of letters in a certain spatial relation, and it will facilitate legibility in reading script if the same relative proportions, and so to some degree, the same relative word forms are preserved in writing. For the small letters the written characters therefore should approximate in shape to the circle or the square, and the approach, or distance between two letters should, as in print, not exceed one-fifth of the width of the letter. This would eliminate the handwriting exercises seen occasionally where a neat, but nearly illegible, script consists of very narrowed letters separated by spaces of about five or six times their width crossed by oblique joining hair lines. Attention, moreover, should be given to some of the existing copy books which undoubtedly cause some eye strain by reason of the superfluous guiding lines contained in them. The multiplication of lines in exercise books is also quite unnecessary, simple direction lines being all that are required. Industrial schools. Residential institutions During the year there were 7 residential industrial schools and 6 (2 blind, 3 deaf and 1 mentally defective) residential special schools with an accommodation of 965. An additional residential industrial school for 57 girls has since been opened and the total accommodation now is 1,022. The inmates of each institution are under the supervision of a local practitioner. Mayford Industrial School In connection with the periodical medical inspection of the children at the Mayford Industrial School, it was noted that a certain number of the younger children continued for considerable periods in a sub-normal condition of health and nutrition, and that their progress in these respects though definite was very slow. The children were ot poor stock and often a long period was required for them to recover from the influence of previous privations. Such general features as the temperature of the dormitories in winter, the nature of the beds and washing arrangements, however well suited for hardy elder boys, may press a little heavily on the younger who are less able to fend for themselves. The latter are backward mentally as well as physically and cannot be expected to make the same progress in their lessons, or even to work continuously for so long a period, as those more happily circumstanced and of better initial stock. The usual note with regard to the physical condition is that the child is undersized and delicate, with perhaps a poor circulation but no definite organic mischief of any kind. Every care and attention that the numbers permit is given by the matron and her staff to these younger children, but it is possible that if such sub-normal children were boarded-out at a home where they would obtain the benefits of family life and a greater share of individual attention, their progress both physical and mental would be much greater. A certain number of the more delicate and retarded children have now been boarded out and the reports received on their progress have been satisfactory. There is some evidence that the accumulation of younger children in any industrial school gives rise to difficulties in administration, especially as regards the carrying out of necessary fatigue duties and manual labour. The younger boys cannot do as much work as the elder ones, and where the former predominate further assistance is needed to avoid the danger of overstrain. The attention of the superintendents has been called to the necessity of graduating the work according to the strength of the children, but it is obvious that the presence of numbers of young, weakly or small children must impair the value of some occupations such as farming work. The beds Were of stretched canvas and as this had somewhat shrunk, more especially in the transverse direction; they were practically hammocks and some of the children were found to sleep in an uncomfortable position and to feel cold in severe weather from the absence of a mattress. The bedsteads have been changed and mattresses provided and each boy supplied with a flannel nightgown for use in the winter months. Since this change occurred the cases of nocturnal enuresis which formerly had proved troublesome have been very materially reduced in number. The lavatory accommodation has been remodelled with the result that the children remain partially stripped for a shorter period than heretofore Dietary— Residential Industrial Schools and Places of Detention Prior to the transfer of the medical supervision of the residential institutions to the public health department there was no uniform dietary, and in view of suggestions made from time to time by some of the managing committees it was considered desirable to frame one that would answer the needs of all the industrial schools and places of detention. In this connection the results of the special enquiry in regard to the cases of appendicitis at the Mayford Industrial School were taken into consideration and it was thought advisable to modify the existing dietaries, especially in the direction of reducing bulk while not interfering with the total nutritive value. An attempt was also made to avoid the unappetising effects of monotony. No one dietary would meet the needs of children of all ages up to sixteen, so two scales have been formulated, one for institutions containing children up to the age of 8, 208 Annual Report of the London County Council, 1912. and the other for children between the ages of 8 and 16. The revised dietary is set out in Appendix V. These diets on the average are estimated to yield approximately the following food stuff values:— Diet. Daily quantity in grams. Proteid. Fats. Carbohydrates. Under 8 ... 55-60 45-50 270 Over 8 ... 75-80 50-55 350 In the places of detention it is possible that accommodation might have to be provided for infants and very young children whose needs could not be met by the dietary prescribed for the younger children. To overcome this difficulty the superintendents of these institutions have been instructed that for children under the age of nine months the diet should consist entirely of modified milk, prepared subject to the concurrence of the visiting medical officer, in accordance with the table set out in notes on infant care used in the evening school classes. Between the ages of 9 and 12 months milk should be given and also a little bread and milk, or milk pudding, and a little thin bread and butter. Towards the end of this period a lightly boiled egg should be introduced. For children from 12 to 18 months of age milk should still be the chief article of diet, but milk pudding, a lightly boiled egg, porridge and milk, and a little bread crumb or mashed potato and gravy may be included ; five meals a day should be given. After 18 months a little finely chopped mince or plain boiled fish and potato may be given in the middle of the day, and at breakfast and teatime a little cocoa may be added to the milk. The amounts of meat and fish should be increased gradually and the food should become of firmer consistence so that the children may use their teeth for mastication. After the age of 3 years the dietary for children under 8 years should be applied. Places of detention The Children Act, 1908, which established the children s courts made it compulsory upon the Council to arrange for all children taken into custody within the metropolitan area to be accommodated in remand homes, a duty which had previously been invested in the Metropolitan Asylums Board. The homes in the possession of that authority Were transferred to the Council in April, 1911, when the term " place of detention " was substituted for " remand home." Originally children were admitted to the homes only from the sitting of the magistrates' court and frequently after arrest the children had to be kept at police stations till their appearance before the courts, but now the place of detention must be prepared to admit the children at any hour of the day or night. During the year under review there were four places of detention in London—Camberwell-green (Camberwell), Harrow-road (Paddington), Pentonville-road (Islington), and Ponton-road (Battersea) ; the last-named was open for a short time only and was used for the accommodation of children who would ordinarily have been sent to Camberwellgreen, which was closed in so far as admissions and withdrawals were concerned owing to an outbreak of infectious disease. In the course of the year 2,932 children were admitted to the institutions as follows : Camberwell-green, 323 ; Harrow-road, 1,230; Pentonville-road, 1,302 ; Ponton-road, 77. Camberwell-green is now closed and a new place of detention was opened at Ponton-road in February, 1913, when the accommodation of the institutions was re-classified as under Harrow-road 45 boys, 12 to 16 years of age. Pentonville-road 51 boys, 7 to 12 years of age ; 33 girls, 7 to 12 years of age. Ponton-road 40 infants Under 7 years of age ; 30 girls 12 to 16 years of age. To each institution is allocated a medical officer who briefly is required : (1) to attend the institution at least once every week and at such other times as may be necessary, and to enter the visits and the names of the patients attended by him in a book kept for the purpose ; (2) to examine the children on admission ; (3) to attend any cases of illness occurring amongst the children and to make a note on the cards kept for the purpose of all serious cases of illness, their course, duration and treatment prescribed ; (4) to furnish reports to the school medical officer on the health of the inmates ; (5) to furnish any other reports or certificates that may be required to the school medical officer; (6) to give immediate notice to the coroner of the district of cases of sudden or violent death or cases where he does not feel justified in giving a death certificate of any inmates and to report the circumstances of the case to the school medical officer; (7) to furnish certificates in respect of fitness for admission to industrial schools for children who have previously resided in places of detention in those cases where the cost of such certificates is payable by the Council. The salaries of the medical officers are according to the following scale:—£30 per annum in respect of places of detention, where the total number of the accommodation and staff is 30 or under. For each unit of accommodation and staff beyond 30 an extra payment of 8s. a head per annum. An additional payment at the rate of £40 in respect of every 1,000 children passing through the institution. These sums to include the provision of certificates in the cases of children committed to industrial schools where the cost of such certificates is payable by the Council. During the year, as already incidentally mentioned, the question of accommodation for isolation has been dealt with. It is not merely a question of providing one or two large sick rooms, since, save in the event of an outbreak of infectious character, it is seldom that any considerable number of the 209 Report of the County Medical Officer—Education. inmates are found on admission to be suffering from the same complaint. It may happen that live or six children are admitted, each with a different illness, necessitating that they shall be kept apart, not only from the general body, but also from each other. In addition to the rooms for infectious cases, provision has to be made for nursing cases of acute illness, at any rate in the initial stages prior to removal to a hospital. Equally important with the provision of sick rooms has been the appointment of a nurse to each place of detention. The decision of the Council to have every child medically examined as soon after admission as possible, for the purpose of intercepting cases of infectio us disease, has revealed the number of children who enter the places of detention suffering from defects which had previously been unrecognised, or with suppurating wounds upon their bodies. At Pentonville, in four months, 98 children were found to need minor surgical attention and the nurse carried out 1,130 dressings. The following notes have been prepared by Dr. Hawkes from the notes made on the admission of 493 children to the Pentonville-road Place of Detention. Boys. State of nutrition. Very good 20 Good 97 Average 165 Bad 56 Very bad 14 Girls. State of nutrition. Very good 8 Good 51 Average 59 Bad 16 Very bad 7 An examination of the above table shows that by no means all the children admitted into the Homes are destitute or suffering from malnutrition. It is rare to examine a boy or girl who is really suffering from starvation ; many are soft and flabby, but they have had enough, more than enough, to sustain life. In many of the cases marked " bad " and " very bad " the condition was due to illhealth and in not a few some of the stigmata of tuberculosis were found. The following table shows the average height and weight of boys and girls. Boy3 (352). Girls (141). Age. (1) Height in centimetres. (2) Weight in kilograms. (3) Height in centimetres. (4) Weight in kilograms. (5) 3 89 13 — — 4 94 14.8 — 5 99.6 18.2 93.2 15 6 104.9 17.8 107.6 18 7 10.5 20.9 106.6 18.6 8 11.8 22.4 111.6 20.6 9 120.8 26.4 120.3 23.8 10 127.4 27.2 124.5 24.2 11 124.2 29.4 130.9 30 12 126.7 30.5 138.1 31.6 13 136.3 33.4 140.3 34.9 14 150.1 41.7 152.3 40.6 15 156.6 46.3 154.9 48.6 Such data as were available for comparing the height and weight show that up to the age of 14 the children in the places of detention were little below the average for the elementary schools of London, but that the older children charged with offences against the law were usually well developed, especially the girls. A series of observations was made upon the effect of residence, the children being weighed on admission and discharge. The following table shows the results obtained:— Sex. Total number. Weight. Stationary. Gained. Lost. Boys 62 5 37 20 Girls 44 2 38 4 The boys who lost weight were of the age periods from 9-12, and the change may in part be due to the absence of exercise, and it might be wise in the case of the boys to give longer periods of daily drill and organised games in the open-air. The confinement would naturally be less felt by the girls, who do not roam so much about the streets. 1882a SB 210 Annual Report of the London County Council, 1912. The following is the first summary of the physical condition of the inmates of the places of detention. Eyes— Epilepsy (Convulsions) 4 Vision defective 29 Verminous 133 Squint 9 Ringworm 15 Blepharitis 21 Scabies 15 Ophthalmia 8 Impetigo 26 Ears— Deaf 3 Sores, boils, &c. 105 Eczema and psoriasis 15 Discharge 13 Favus 1 Nose—Adenoids 26 Deformities 15 Throat Tonsils enlarged 26 Infantile paralysis 1 Cleft palate 1 Tonsillitis 3 Enlarged spleen 1 Enlarged glands 76 Enlarged liver 1 Heart— Valvular 14 Hernia 6 Varicocele 6 Functional 13 Gonorrhoea 2 Lungs Tubercle 13 Rickets 15 Suicide attempted 3 Catarrh 17 Accidents 5 Tuberculosis other than pulmonary 40 Chickenpox 8 Anaemia 16 German measles 4 Pallor (see below) 15 Whooping Cough 6 Rheumatism 14 Mumps 1 Dull and Backward.. 19 Erysipelas 1 Syphilis (hereditary) 1 Vaccinated, boys 63% Pneumonia 2 Vaccinated, girls 65% Pleurisy 2 It is clear that dirt and overcrowding are responsible for much of the illness discovered. Dr. Hawkes notes a peculiar pallor, which is not a true anaemia, in a certain number of children and he thinks that he has found the condition associated with cases in which the account given indicates that four, five or more children have been sleeping in one bed. He mentions that this condition is not persistent, but that a dose of aperient mixture and increased cubic space at night, soon brings the skin back to its normal condition. Miscellaneous. Co-operation between the School Attendance and Public Health Departments During the Michaelmas term, 1912, attention was drawn to the number of children remaining out of school on account of illness for a longer period than three months. It was anticipated that the attention being paid to case3 of latent and actual tuberculosis and the establishment of tuberculosis dispensaries would tend to increase the number of such children. It was therefore considered desirable to adopt some procedure whereby close'r co-operation between the attendance department and the School Medical Officer should be brought about and arrangements were made for the medical certificates of all such children to be submitted to the School Medical Officer and for a renort, to be made at the end of six months. end of six months. Two thousand and ninety-five certificates have been submitted to the School Medical Officer and the following table gives particulars of 618 cases in which action was taken. Division. Children recommended for examination. By the Divisional medical officers at the local offices. With a view to admission to special schools. With a view to admission to open air schools. Total. Camberwell 48 1 49 Chelsea 67 — — 67 City and Stepney 11 3 — 14 Greenwich 62 16 12 90 Hackney 28 6 — 34 Islington 40 4 — 44 Lambeth 25 1 — 26 Paddington 39 1 — 40 Poplar 21 5 — 26 St. Pancras 32 — — 32 Southwark 84 9 4 97 Wandsworth 93 6 — 99 550 52 16 618 2ii Report of the County Medical Officer—Education. With regard to 1,563 of the certificates, the stated causes of illness have been analysed by Dr. C. J. Thomas, with the following results:— Rheumatic conditions— Acute rheumatism.. 57 Heart disease 134 Chorea 154 - 345 23 per cent. Nervous conditions— Paralysis 24 Epilepsy 33 Brain disease 12 Other nervous conditions 26 95 6 Tuberculous conditions— Lungs 162 Glands 14 Other conditions 49 225 15 ,, Disease of chest (excluding phthisis) 164 10 ,, Anaemias and debility 202 13 ,, Ringworm 147 9 Infectious disease 65 4 ,, Diseases of skin 66 4 ,, Diseases of ear, nose and throat 41 2 ,, Diseases of eyes 79 5 Diseases of kidneys 14 1 ,, Rickets, &c. 12 1 Surgical conditions 48 3 ,, Diseases of digestion 20 1 ,, Illegible and unsatisfactory certificates 40 3 ,, 1,563 100 ,, It is remarkable that the rheumatic group of diseases, 23 per cent. of the total, forms the highest proportion among the causes which produce long absences from school. This is a fact of the utmost importance and was not known until the present mode of procedure was adopted. That rheumatism in childhood is of more consequence than is generally assigned to it has been frequently pointed out during recent years, but hitherto little has been done from the public health point of view towards the study of its aetiology and distribution amongst the population. A beginning has been made this year towards the study of the distribution of rheumatism in the London area and the information obtained from the certificates of absence will be of assistance in completing the knowledge of the distribution of rheumatic diseases amongst school children. This is of very great importance inasmuch as these diseases are not only very fatal but are very painful, causing great suffering in their early stages and producing in their later stages much crippling and incapacity for continued exertion. Most of the cases of phthisis are out of school on certificates from tuberculosis dispensaries but in spite of the attention that has been paid during the past six months to tuberculosis in school children, and of the increase in the number of children excluded from school from this cause, the total number (15 per cent.) is considerably lower than that due to rheumatic illness. Ringworm accounts for 9 per cent. of the absences. Much is being done towards speedy and efficient treatment of this complaint and the information obtained from the certificates has given an opportunity for bringing into the scheme several children who were not on any school books and who therefore had escaped the following up machinery. The advantages of interchange of information between the medical and attendance departments in cases ot children who are out of school on account ot ill-health are so great and the completion of the knowledge of the distribution of illness among school children so important that the continuance of the practice of submitting to the medical officer medical certificates upon which children are out of school should be continued. Instruction in Swimming Extension of School hours During the year attention was drawn to the possibility of injury to school children arising out of the extension of the ordinary school lessons in additional subjects, particularly swimming. Owing to the demand for accommodation for swimming instruction, and the special arrangements of the authorities in control of the swimming baths, it had been found necessarv in various districts to hold some swimming classes out of school hours. The extent to which this was done is shown in the following table :— Number of classes attending before 9 a.m. Number of classes attending during mid-day interval. Number of classes attending after 4.30 p.m. Boys. Girls. Boys. Gins. Boys. Girls. ½hr. ¾ hr. 1 hr. ½ hr. ¾ hr. 1 hr. ½hr. ¾ hr. 1 hr. ½ hr. ¾ hr. 1 hr. ½ hr. ¾ hr. 1 hr. ½ hr. ¾ hr. 1 hr 23 4 — 8 — — 31 5 — 13 2 4 12 4 — 24 1 2 18820 DD 2 212 Annual Report of the London County Council, 1912. Recent reports and the finding of Parliamentary Committees on employment out of school have made it exceedingly difficult to recommend extension of school hours for any purpose. If it be admitted that extension is possible and advantageous, there would appear to be no reason on the one hand for keeping school hours within the limits at present laid down, or, on the other hand, for debarring children from engaging in light Wage earning employments out of school. The maximum educational time which can be used economically without danger of over-pressure at school ages is represented by the ordinary school hours. These have been fixed both by common experience and by fatigue experiments. Any encroachment upon school time should, therefore, be critically watched. It has been represented, however, that swimming cannot be compared with either school lessons or wage-earning employment, and should be looked upon as a species of recreation. This contention does not bear examination. The swimming classes as observed fall into two categories. Firstly, there are learning classes. In these the children have with great pains to learn new muscular co-ordinations ; it has been demonstrated frequently that learning new physical exercises causes quite as much nervous fatigue as other mental occupations; added to the fatigue of nerve is the fatigue of muscle which is particularly great after swimming. Secondly, there are classes in which the children already swim well. In these, great stress is laid upon speed, and children are urged to compete with their fellows in speed and distance trials. Great enthusiasm is shown by both masters and children, and strenuous competitions are arranged with neighbouring schools. The length of the races is frequently above the average strength of the children ; only the very strong are able to finish, and even these show signs of distress. Children sometimes engage in these races when quite unfit physically to do so. Under these circumstances, it is not possible to maintain that the fatigue caused by swimming is a negligible quantity. The objections to swimming classes before the day's school work begins are considerable. To engage in strenuous exercises immediately after breakfast is harmful. The succeeding school work must suffer and the morning session is extended beyond the three hours, which has been shown to be the maximum length of time that elementary school children can safely be kept at a stretch without danger of over pressure. Hardly less objectionable is swimming during the mid-day rest. It is to be noticed in the above table that four classes of girls had a swimming lesson of the duration of one hour during the dinner interval. This does not appear to be defensible. It is important that all children should learn to swim, and a choice between extension of school hours for this purpose, and deprivation of opportunity to learn is a choice of two evils. Much difficulty was, therefore, felt in advising the Committee. Not without hesitation, it was recommended that a swimming lesson not exceeding half an hour might be permitted in the midday interval in the case of classes of children who are able to swim 100 yards and who present no sign of being weakly. It was also advised that swimming lessons should not be permitted before morning school; and, that where absolutely necessary to extend school hours for the purpose, the after school class of not more than an hour's duration is probably the least objectionable. The Committee decided inter alia— (a) That instruction in swimming before 9 a.m. to pupils attending the Council's elementary schools be discontinued. (b) That the period devoted to instruction in swimming during the midday interval shall in no case exceed half an hour. (c) That, as far as possible, only classes of well-nourished children be permitted to take instruction in swimming after 4.30 p.m. School journeys. The development of the practice of arranging for educational journeys involving the withdrawal of pupils from their homes for periods extending from seven to 21 days, during which time they are in the charge of teachers, is likely to add appreciably to the work of the medical department. The responsibility thrown upon the teachers who accompany the parties is so great that anxiety to obtain a medical opinion upon the health of each scholar before the commencement of the journey naturally arises. It is important, for instance, that no child suffering from a contagious disease or in the early stages of an infectious illness should be included in the party. Then, too, unless the physical capacity of all the party is Uniform there is considerable danger of Weaklings, who may be suffering from unrecognised heart trouble or other serious affections, being injured by attempting tasks of too great magnitude. In previous reports the serious possibilities of the production of heart strain by too sudden an alteration from a moTe or less sedentary existence to one of intense activity has been pointed out. The advice of the school doctor upon regime during the holiday, both in general, and in the case of particular members of the party, is eagerly sought and taken. The physical benefits or otherwise of such excursions require careful consideration and it has been the practice wherever possible to arrange for an examination by the school doctor after return in those cases in which a medical inspection was carried out before the journey commenced. During the holiday season of 1912 eleven applications were received for the services of a medical assistant in connection with the examination of scholars who were proceeding upon school journeys. Owing to insufficient notice or pressure of work it was not possible in every case to render the assistance asked for. In the case of four schools, however, an examination of the scholars was carried out both before and after the journey. Special attention in each case was paid to the condition of the heart muscle and circulatory system. The examinations enabled the school doctors to advise the organisers of the expeditions in regard to particular scholars where health demanded special care or treatment, and the results were uniformly good. 213 Report of the County Medical Officer—Education. St. Mary Magdalene's (B.) School, Paddington, N.—School excursion to Dymchurch, 22nd June to 8th July. Of 34 boys taking part 33 were examined before and after the journey. All increased in weight except one, the average increase being l.08 kilos. Twenty-two improved in colour as shown by haemoglobin tests, 13 showed improvement in the condition of the circulatory system. The result so far as health is concerned was extremely satisfactory. Holy Trinity (B.) School, Rotherhithe.—School excursion to Hove,4th September to 18th September. Fourteen boys, aged 13-14 years, were medically examined on 2nd September and 20th September. All on their return showed decided improvement in their physical condition and with two exceptions increased in weight, the average increase being .97 kilos. Four boys before the excursion showed evidence of poor circulation ; of these three were normal after the holiday. Alverton-street (G.) School, Deptford.—School journey to North Chapel 15th to 29th June. The girls making this journey numbered 27. The school doctor reported that all gained decided benefit from the trip especially certain children in whose case anaemia and cardiac debility were recorded before the holiday. Hanover-street (B.) School, Islington, S.—School journey to Malvern 24th May to 7th June. Twenty-seven boys were examined. Before the holiday the school doctor classified the pupils as— boys in good health 12, fair health 9, poor health 6. After the holiday he returned them as—in good health 23, fair health 2, poor health 1 (one boy not re-examined). All those who had been marked for re-examination on the score of having deficient cardiac tone were found to have improved. Condition of school buildings. During the previous two years (1910 and 1911) the school doctors had been instructed to make a careful and detailed survey of the condition of the buildings in the case of every school under their charge. The results of these inspections have been recorded in previous annual reports. The department therefore possesses a recent record in duplicate of the condition of all school buildings maintained bv the education authoritv. In the vast majority of the schools the reports for the year 1911 show no great variation from the condition found in the preceding year and during 1912, the directions given to the school doctors were to the effect that they should call attention to any defects that come under their notice during their visits to the schools for the purpose of medical inspection or reinspection of scholars, and only in certain special cases have complete reports been called for. Thirty-three schools have been dealt with in this Wav. T he following table gives a summary ot the defects reported upon in these 33 schoools:— Previously reported upon. Condition in 1912. New defects reported in 1912. Improved. Not improved. Sanitation 8 4 4 1 Lighting 18 7 11 2 Ventilation 9 2 7 — General condition of building 4 3 1 1 Heating 9 3 6 2 Overcrowding 1 1 — — Desking 9 6 3 — Water supply — — — 1 Cloakroom 1 1 — I Cleanliness 1 1 — — Noise — — — 1 Total 60 28 32 9 On the 23rd July, 1912, the Council agreed, in connection with the adoption of the scheme for the reduction of the accommodation of classrooms to a maximum of 40 in senior departments and 48 in infants' departments, (a) to carry out a minimum programme of structural work within three years from 31st March, 1912, (b) to complete the modernising of certain schools within 5 years from 31st March, 1912, (c) to commence the structural work in connection with the modernising of certain schools within five years from 31st March, 1912, and (d) to reduce the accommodation of 1,000 classrooms to the new maximum within five years from 31st March, 1912 A considerable number of school buildings have been dealt with in the course of the year in accordance with this scheme, and an opportunity has thus been afforded of securing the inclusion of improvements already reported upon as necessary from the hygienic standpoint. An important modification in procedure has been effected during the year whereby the school medical officer is invited to send a representative to the preliminary conference of officers upon plans of all new buildings and remodellings in lieu of, as heretofore, seeing and passing the plans as finally decided Upon by the other officers. This modification of procedure has been of great value in procuring the adoption of fundamental principles in regard to lighting, ventilation, etc., at the earliest possible moment; in addition, the arrangement of many smaller details bearing upon hygienic matters has been secured, whereas on the old method considerable hesitation would have been felt in disturbing on this account plans already in a mature state before reaching the school medical officer. 214 Annual Report of the London County Council, 1912. During the year ending the 31st March, 1913, the number of classrooms provided within the 40 and 48 maxima were:— Council schools. Non-provided schools— rooms with 40 or 48 maxima. In new schools, enlargements and adaptations (8 schools) 57 (1 school) 5 By modernising (3 schools) 50 3— By minor structural alterations (47 schools) 260 (13 schools) 9 By writing down the accommodation of existing large classrooms (10 schools) 94 — Total 461 44 Total, Council and non-provided schools 505 Two new schools were completed during the year 1912-13, enlargements were carried out in 5, adaptations in 2, and modernising in 3. During the same period action has been taken to minimise the nuisance occasioned by noise from street traffic, railways, etc., in four schools regarded as noisy, viz., Holmes-road (St. Pancras, N,W.), The "Hermitage" (St. George-in-the-East), the Highway (St. George-in-the-East), and Waldronroad, Wandsworth, and it is proposed to take action immediately in six further schools for this reason. Inasmuch as complete and recent records of the sanitary and hygienic conditions of all school buildings in the Council's area at present exist it is proposed in future to obtain each year detailed routine reports from the school doctors upon only a portion of the school buildings in their charge in such a way that every school will be reported upon once in five years. The fact that a progressive programme of adaptations, modernising and minor alterations is in progress in connection with the new standards of accommodation ensures that the hygienic conditions of the school buildings will come under review by the medical department at times when the necessary alterations can be most usefullv insisted upon. Playgrounds. The establishment of open air schools has demonstrated the possibility of teaching out ot doors and a natural result has been the rapid development of the system of playground classes in London. Fresh air and physical exercise are now regarded as essential conditions. Physical drill is included in the curriculum of every elementary school. Organised games demanding free space are becoming more and more general. As a result of this tendency the playground in connection with the school building has assumed increasing importance. In connection with the evidence to be given by the Council's representatives before the Departmental Committee of the Board of Education on Playgrounds, the school medical officer was instructed to report upon playgrounds from the point of view of health and hygiene. It was pointed out that the development of the child depends largely on the exercise of its powers of movement. For efficient nourishment abundant physical exercise is needed, especially during the first dozen years of life. The exercise of very young children should be intermittent, but occasionally the child should extend his physical strength to the utmost, unless this is done there is incomplete development of the child's reserve powers, the respiratory capacity remains low, the circulation is feeble and there is a tendency to lymphatic congestion resulting in poor resisting powers to the attacks of disease with liability to catarrhs and tuberculosis. Such children are debilitated and ill nourished, suffer from enlarged tonsils and adenoids, and from excessive prevalence of external eye diseases and suppurative ear trouble. At all intervals during school time the children must have offered to them abundance of freedom for romping, running, jumping and other active and intermittent exercise if they are to be in proper health, and no other provision than sufficient room immediately around the school building can ever replace this want hygienically. In great towns the provision of playgrounds for children is becoming a serious need. All available free spaces such as unoccupied grounds and churchyards should be used as playgrounds, and during daylight all school playgrounds should be made available under proper supervision. The covered shelters in school playgrounds have hitherto not received the consideration they deserve. Many of those erected in London are dark. ill-ventilated and unsuitable for any purpose. In fact they are very often avoided as though they were plague spots and in effect merely reduce the playground accommodation. More airy, higher and lighter sheds forming suitable protection for open air classes need to be provided in place of many of the present structures. The drinking arrangements in playgrounds should not be by cups, but by water jets ; one going constantly, others to be turned on when necessary. From the hygienic point of view, opinion should be thoroughly opposed to any relaxation of rules about playground space. In the case of some schools a much greater requirement of space than at present is necessary. The original design of the schools for the physically defective did not take into consideration that over 80 per cent. of the scholars are able to take exercise under supervision and that in some districts many of the children are tuberculous and of the type especially needing fresh air treatment. Stagnation of air takes place when many buildings are crowded together. Ventilation is insufficient at times in nearly all schools and all the air possible is wanted that can be obtained by free space around the school. The shadows of surrounding buildings should not fall upon any part of the window surface of a school; particularly is this necessary in infant departments, and yet there are class rooms on the ground floor in a large number of schools in London where no direct sunlight can 215 Report of the County Medical Officer—Education. enter or any glimpse of the sky be seen. Such rooms are, of course, unhealthy. Noisy surroundings have a prejudicial effect upon the work of the school, and in particular upon the health of the teachers. There are schools whose walls abut on main roads. The windows cannot be opened, as the noise totally prevents the continuance of school work. The result is considerable suffering to both teachers and scholars, especially on account of the deplorable conditions of ventilation which closed windows entail. Dust from roads is worse than mere playground dust, especially in summer, for the younger children. A properly situated school building, therefore, should have the protection from shadow, foul and stagnant air, noise and dust which an adequate playground can alone give. These are points which have not received sufficient attention at the hands of authorities in the past, and are not affected by the provision of neighbouring parks or playing fields or bv the use of roof playgrounds. School gardens. Some 170 school gardens exist in London in connection with schools maintained by the Council. No doubt the advantages of school gardens outweigh the disadvantages of the consequent reduction of space open to free play ; but it should be pointed out that more than the actual space taken up by the garden is involved, as there is a considerable neutral zone adjoining the garden in which anything like free play is impossible without danger to the usefulness of the garden itself. It would, therefore, be advantageous if all school gardens adjoining playgrounds were protected by railings. Health of teachers. The absences of teachers on account of illness during the three years 1910-11-12 have been under consideration. It appears that the numbers of women teachers referred to the school medical officer for report for certain complaints were as follows— Nervous complaints. Throat affections. Other illnesses. 1910 45 5 25 1911 61 14 35 1912 111 9 26 Similarly the numbers ot men teachers referred were— Nervous complaints. Throat affections. Other illnesses. 1910 10 — 5 1911 12 4 5 1912 14 3 3 The above returns are admittedly incomplete, and it is doubtful how much reliance can be placed upon them statistically. So far as they go they indicate (a) an absolute increase in the average number of days per teacher absent on account of illness; (b) an increase in 1912 in the absences ascribed to nervous complaints ; (c) an increase in both 1911 and 1912 in the number of women teachers referred to the medical officer on account of absences ascribed to nervous complaints. It is probable that there has been an alteration of procedure in the office whereby a larger proportion of the cases absent on fortnightly certificates from private practitioners has been referred for advice. This would tend to an increase in the number of days absences on account of illness, inasmuch as it is the practice in cases of nervous breakdown to insist upon a sufficient period of rest from school duties to ensure a thorough restoration to health before resumption. A careful analysis of the cases of nervous breakdown during 1912, shows that they were distributed throughout all the branches of the Council's teaching service, and that there are more cases proportionally amongst secondary mistresses than amongst elementary school teachers, while there appears to be an undue preponderance in domestic economy and special school teachers. The following table shows the distribution of nervous breakdown in women teachers in various branches. Service. Total number of teachers in service. Number referred for nervous breakdown. Percentage. Provided 9,153 80 .87 Non-provided 3,114 23 .71 Domestic economy 418 10 2.4 Secondary schools 310 9 2.9 Special schools 550 11 2.0 Unattached staff 341 10 2.9 It further appears that an undue incidence of cases of nervous breakdown occurred in women teachers at the age period 55-65; more than 3 per cent, of the elementary teachers in this decads in Council schools have suffered from breakdown during 1912, while less than 1 per cent, of the cases have occurred in teachers of any other age decade during the year. There was also a greater relative incidence upon spinsters than upon married women. The total number of the cases in question is insufficient to base any definite conclusion upon. If, however, any increase in the number of cases of nervous breakdown has taken place, it is confined to women teachers and the explanation might be sought in a natural tendency to nervous breakdown in women teachers at certain periods. 216 Annual Report of the London County Council, 1912. CHAPTER XXXIV. Public Health. Powers and duties of the Counoil. 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) the removal or carriage of offensive or noxious matter or liquid ; (c) the removal and disposal of refuse, etc.; and (d) the construction, etc., of 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 supplied 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 towards the salary of a health visitor appointed by a metropolitan borough council any sum not exceeding one-half of such 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. 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. The supervision and licensing of common lodging-houses devolves upon the Council under the Common Lodging Houses Acts, 1851 and 1853, and the London County Council (General Powers) Acts, 1902 and 1907. In addition, the Council licenses seamen's lodginghouses and enforces the by-laws with regard thereto made by it under section 214 of the Merchant Shipping Act, 1894. 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 Diaries, Cowsheds and Milkshops Orders of 1885, 1886 and 1899, the Council has power to secure the 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 therefrom. 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, authorise the Council to represent to the Local Government Board when a sanitary authority has made default in carrying out its duties in regard to the purifying and cleansing of articles and premises and to the accommodation for the storage of food. The majority of the Council's powers and duties referred to above do not extend to the City of London, and, in the matter of the examination of milk under part IV. of the London County Council (General Powers) Act, 1907, the Council has powers in the City concurrent with those of the City Corporation. Treatment of tuberculosis. One of tne most important subjects relating to public health which engaged the attention of the Council during the year was that of tuberculosis. Provision had been made in the National Insurance Act, 1911, for the treatment of insured persons and their dependents suffering from tuberculosis and in April, 1912, the Departmental Committee on Tuberculosis issued an interim report in view of the coming into force of this Act. They recommended that for the prevention, detection and treatment of the disease, existing public health administration should be supplemented by the establishment and equipment of two units linked up to the general public health and medical work carried on by the medical officers of health, (1) the tuberculosis dispensary, and (2) sanatoria, hospitals, etc. The principal recommendations of the departmental committee were to the following effect— " That with a view to encouraging the early provision and equipment of tuberculosis dispensaries, capital grants should be made up to four-fifths of the amount required, provided that this sum should generally not exceed £1 per 750 population, or an average of £240 per dispensary." 217 Public Health. " That for the provision of the additional sanatorium beds for adults required at the outset, capital grants should be made up to three-fifths of the cost per bed, provided that the total sum does not exceed an average of £90 per bed." " That grants should be made for beds other than sanatorium beds." " That schemes dealing with the whole population should be drawn up by the councils of counties and county boroughs, or by combinations of these bodies, at the earliest possible date, on the lines recommended in the report, with due regard to the incidence of the disease and the special conditions and circumstances of the area." " That the early establishment in working order of an adequate number of tuberculosis dispensaries is essential." " That so far as possible grants in aid of tuberculosis dispensaries should only be given when such institutions will eventually form constituent parts of complete schemes." " That, in framing complete schemes, regard should be had to all the existing available authorities, organisations and institutions with a view to avoiding waste by overlapping, and to obtaining their co-operation and inclusion within the schemes proposed." " That special regard should be given to securing the co-operation of medical practitioners in the working of the schemes, particularly in the relation to the early detection of the disease and its domiciliary and dispensary treatment." " That special attention should be paid to securing suitably qualified and experienced medical practitioners for the senior appointments in connection with institutions established, as the ultimate result obtained by the treatment recommended must depend to a great extent upon their medical and administrative qualifications." " That in erecting or adapting institutions, local authorities and other bodies should avoid pretentious and extravagant buildings, and should aim rather at providing institutions of a simple and inexpensive character." " That, as regards London, it should be considered whether some of the sanatoria and hospitals required should not be provided by the Metropolitan Asylums Board, and whether dispensaries should not be provided by the metropolitan borough councils." The Local Government Board in a circular letter, dated 14th May, 1912, called attention to the report of the departmental committee, and stated that it agreed generally with the findings of the committee, including the financial recommendations in regard to the distribution of the capital grant. The Board suggested that the council of each county and county borough should forthwith take the matter into serious consideration, and, by conference and consultation with the other councils, determine what action they should take. The circular letter above referred to was not addressed to the Council, but was sent to other county councils, the councils of boroughs (including the metropolitan boroughs) and urban and rural district councils. It was followed by a further circular letter, dated 6th July, 1912, dealing with provisional arrangements for the treatment of insured persons recommended for sanatorium benefit, and urging that complete schemes relating to the whole population, and not only to insured persons, should be prepared in conference with the insurance committees and sanitary authorities, the unit area for such schemes to be generally the county or county borough. At the beginning of August, 1912, it was intimated that the Government would contribute annually a sum, representing approximately half the total estimated cost of treating non-insured persons as well as the dependents of insured persons. This sum would be distributed to local authorities which undertook schemes, to be approved by the respective local government boards, for the general treatment of tuberculosis in the areas under their jurisdiction. On 27th July, 1912, a circular letter was sent by the Board to county councils, sanitary authorities and insurance committees in England and Wales relative to the domiciliary treatment of insured tuberculous persons. In the meantime no communication had been addressed by the Local Government Board to the Council, and no indication had been given as to what authority was to be responsible for dealing with the disease in London. On 19th October, 1912, a letter was received from the Local Government Board stating that the proposal of the departmental committee that the Metropolitan Asylums Board should provide institutions for the treatment of tuberculosis could not be carried out owing to the fact that, under the National Insurance Act, they were prohibited, as a poor law authority, from entering into arrangements with the Insurance Committee with regard to the treatment of insured persons. The Local Government Board, therefore, suggested that the Council should act in the matter. Further correspondence followed and on 11th December, 1912, a letter was received, in which the Board suggested that the Council should prepare a complete scheme for dealing with the disease in London. The Board also referred to the fact that it had invited metropolitan borough councils to provide or arrange for the provision of dispensaries, and stated that, in its opinion, the Council should provide or arrange for the provision of residential institutions, and should be the central organising body for the provision of institutional treatment, whether indoor or outdoor. These letters were under careful consideration at the close of the year. Although time did not permit of any decision being arrived at as to the permanent arrangements to be made for the treatment of tuberculosis, the Council recognised the urgency of making available for insured persons certain accommodation belonging to the Metropolitan Asylums Board which was understood to be vacant, but which the Insurance Committee for London were unable to obtain owing E E 18820 218 Annual Report of the London County Council, 1912 to the reason specified above. The Council therefore decided to enter into a temporary arrangement for the provision of accommodation for about 500 persons at a time in institutions belonging to the Board. Notification of tuberculosis. On 19th December, 1912, the Local Government Board issued the Public Health (Tuberculosis) Regulations, 1912. These regulations, which will be in operation on and after 1st February, 1913, consolidate and in some respects amend the previous regulations of 1908 and 1911 (two) which related to the notification of cases of pulmonary tuberculosis. The most important change effected by the new regulations is that cases of tuberculosis of all kinds must be notified to the local medical officer of health by the medical practitioner who detects the case. The Local Government Board in its circular letter forwarding copies of the new regulations stated that more than half of the deaths from non-pulmonary tuberculosis were of children under five years of age and that it was probable that a much higher percentage of persons suffering from non-pulmonary tuberculosis were children of this age. The Board, therefore, expressed the hope that the notification of these cases would facilitate the investigation of sources of infection and assist in securing improvement in the conditions under which the children lived. The duty of taking preventive measures devolves in London upon the local medical officers of health. Each of these officers is also required to send weekly to the county medical officer of health a statement of every notification received by him under the regulations. Cerebrospinal fever On 26th February, 1907, the Council made an Order, under section 56 of the Public Health (London) Act, 1891, rendering compulsory, for a period of six months, the notification of all cases of cerebro-spinal fever (epidemic cerebro-spinal meningitis) within the administrative county of London. This Order came into force on 12th March, 1907, and the period of its operation was extended from time to time. On 20th February, 1912, the Council decided to add the disease to the list of diseases permanently notifiable in 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 1912, 105 cases were notified, making a total of 652 cases since notification became compulsory in 1907. Acute poliomyelitis. On 25th July, 1911, the Council made an Order rendering compulsory, up to and including 12th March, 1912, the notification of all cases of acute polio-myehtis or acute polio-encephalitis within the administrative county of London. During recent years this disease has engaged attention in Europe, especially in Norway and Germany, as well as in the great cities of the United States of America. It occurs principally among children, and, not only does it prove fatal in about 11 or 12 per cent. of the cases, but it frequently causes infantile paralysis among those who survive. The Council decided on 27th February, 1912, that the disease should be made permanently notifiable, and in arriving at this decision the Council was, to a great extent, influenced by the fact that the disease may possibly he mistaken for cerebro-spinal fever referred to ahove. Census of homeless persons. J. In 1904,1905, 1907, 1909, 1910 and 1911 censuses were taken, by the medical officer, of homeless persons in the County of London 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 9th February, 1912, and the medical officer submitted a report showing the number of persons found homeless on that night in the street, on staircases or under arches, the number and sex of persons who might reasonably be regarded as homeless on the ground of not being able to pay for a bed, the arrangements made for the shelter of persons of this description, and other information bearing on the question. The total number of homeless persons found was 1,203 as compared with 1,785 at the census in 1911. It is worthy of note that on the night of the census there was vacant accommodation for 6,798 persons in common lodging-houses and for 781 persons in casual wards. Following the practice adopted in previous years, the report was printed and placed on sale.* Milk. 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, 1912, 10,638 samples of milk forwarded from places outside the county had been examined, with the result that 1,071, or 10.1 per cent., proved tuberculous. During the year, 2,991 samples were taken, of which 241 were found to be tuberculous. The Council's veterinary inspector has visited, for inspection purposes, since the Act came into operation, 2,101 farms and inspected 55,947 cows, of which number 637, or 1.1 per cent., were found to be affected with tuberculosis of the udder. During the year 479 farms were visited and 11,640 cows were examined, of which 63 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, 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 22 animals have been seized and slaughtered under the Act, and compensation amounting to about £240 has been paid, the post-mortem examination showing in each case that the udder of the animal was tuberculous. During the year the Council again considered what steps should be taken to secure a pure and wholesome supply of milk for London. In this connection the Council was to a great extent guided by * Report by the Medical Officer, submitting the result of a census of homeless persons taken on the night of 9th February, 1912. (No. 1489.) Price 2d. 219 Public Health. the conclusions arrived at by the Royal Commission appointed in inquire into the relations of human and animal tuberculosis. Reference to the final report of the Commission is made in the last annual report of the Council.* Having regard to the fact that the Council had been repeatedly unsuccessful in its attempts to obtain further powers to deal with the milk supply of London and that urgent necessity for action was manifest, the Council decided to appoint a deputation to wait upon the President of the Local Government Board to urge— (i) The promotion of general legislation to provide— (i.) For the extension of provisions such as those contained in part IV. of the London County Council (General Powers) Act, 1907, with respect to cows suffering from tuberculous disease of the udder, and to the milk from such cows, to any cow suffering from any form of tuberculosis with emaciation, or giving tuberculous milk, and to the milk from any such cow. (ii.) Further powers throughout the country for the supervision of places where cows are kept and where milk is received, stored and exposed for sale. (iii.) Such further powers throughout the country as are necessary for the taking of the samples in any place from the time the milk leaves the cow until such time as it reaches the consumer. (iv.) Adequate penalties to deter from wilful breaches of the law. (v.) For the more complete supervision throughout the country of the import trade. (2.) Failing general legislation, the promotion of special legislation to provide— (i.) Power for the Council to extend the provisions contained in part IV. of the London County Council (General Powers) Act, 1907, with respect to cows suffering from tuberculous disease of the udder, and to the milk from such cows, to any cow suffering from any form of tuberculosis with emaciation, or giving tuberculous milk, and to the milk from any such cow. (ii.) Any necessary additional powers to take samples anywhere within the county of milk and of milk products in transit and in wholesale or retail establishments; and in the event of such milk being found to be adulterated or to contain any matter unwholesome or unfit for human consumption, to proceed for penalties. (iii.) Powers for the Council to make orders prohibiting the supply of milk into the county from the dairies or depots without the county from which such impure milk was obtained. (iv.) Such additional powers (if any) as are necessary to enable sanitary authorities to take samples, other than on railway premises, and to proceed for penalties as in (ii.). (v.) Additional powers to enable the Council, at its discretion, to pay the expenses of any dairyman appearing before it to show cause why an order should not be made requiring him not to supply milk from specified animals. (vi.) For the application within the county of section 53 of the Public Health Acts (Amendment) Act, 1907. The President of the Local Government Board received the deputation on 22nd November, 1912, and stated that he was in general agreement with the Council in the matter. He added that he proposed to introduce immediately and hoped to carry through in that session of Parliament, a Bill to deal with the subiect. Uommon lodging houses. Seamen's lodging houses. Applications were received for licences to keep and use, as common lodging-houses, 296 premises in the County of London, and in each case a licence was granted. During the year 5 licensed keepers were fined £6 5s. with £2 costs for having infringed the Council's by-laws. During the year licences to keep seamen's lodging-houses were granted in respect of 41 premises. Legal proceedings were instituted in 18 instances for keeping unlicensed seamen's lodginghouses. In 13 cases a conviction followed and fines amounting to £65 6s. with £16 9s. costs, were imposed. Nuisances. During the year a number of complaints were made to the Council under the Public Health (London) Act, 1891, as to insanitary conditions or failures in sanitary administration. 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. Offensive businesses. In pursuance of the authority conferred upon the Council by section 19 of the Public Health (London) Act, 1891, in 2 cases certain premises were removed from the register, as the right to carry on (1) tripe boiling, and (2) soap boiling and tallow melting thereat had lapsed. The number of slaughterhouses, cowhouses and knackers' yards licensed during the year was 234 slaughterhouses, 180 cowhouses, and 4 knackers' yards. There were two appeals against the decision of the Committee not to grant renewal of licences in respect of slaughterhouses. In one case the Committee's decision was confirmed and in the other the appeal was allowed. Draft by-laws relating to the businesses of a fried fish vendor, 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. All the above services are administered under the direction of the Public Health Committee. * Annual Report of the London County Council, 1911. Vol. III. (p. 173). 18820 EE 2 220 Annual Report of the London County Council, 1912. Appeal Committee. Under section 212 of the Metropolis Management Act, 1855, the Council is required to appoint an Appeal Committee to hear and decide appeals under that Act. This section of the 1855 Act is also applied by statute to appeals made under the Metropolis Management Act, 1862, and under sections 37, 41 and 43 of the Public Health (London) Act, 1891. An appeal to the Council is also provided for by section 6 of the Metropolis Management Act Amendment Act, 1890, and the Council has referred such appeals also to the Appeal Committee. During the year 1912 the Appeal Committee heard five appeals against orders made by metropolitan borough councils. In two cases the appeal was allowed in respect of part of the Order appealed against and dismissed as regards the remainder. In two cases the parties agreed as to an Order being made by the Appeal Committee varying the Order of the local authority. In the remaining case the appeal was dismissed. Midwives. By section 8 of the Midwives Act, 1902, every council ot a county or county borough in England and Wales is constituted a local supervising authority over midwives within the area under its jurisdiction. The duties of a local supervising authority are:—(1) to exercise general supervision over all midwives practising within the county or county borough ; (2) to investigate charges of malpractice, negligence or misconduct on the part of any practising midwife ; (3) to suspend from practice any midwife if such suspension appears necessary in order to prevent the spread of infection ; (4) to report at once to the Central Midwives Board the name of any midwife convicted of an offence ; (5) during the month of January in each year to send to the Central Midwives Board a list of all midwives who, during the preceding year, had notified their intention to practise within the county; (6) to keep a current copy of the roll of midwives accessible at all times for public inspection; (7) to report at once to the Central Midwives Board the death of any midwife or any change in the name or address of any midwife ; and (8) to give due notice 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 any case of puerperal fever occurring in the practice of a midwife, and to attend if possible any inquest held upon the body of a woman or infant upon whom a midwife had been in attendance. During the year 1912 there were 116 cases of puerperal fever in the practice of midwives, and 91 inquests were held in which midwives were concerned, 7 being on the bodies of women, and 84 on the bodies of children. Charges of malpractice, negligence or misconduct on the part of eight midwives were investigated during the year, with the result that the Central Midwives Board was informed that in three instances prima facie cases (malpractice, negligence and misconduct, 1 case ; negligence and misconduct, 2 cases) had been established, the charges in the remaining cases not being sustained. The Board did not announce its decision with regard to the charges during the period covered by this report. During 1912 the Central Midwives Board announced its decisions with regard to three certified midwives against whom charges had been brought during the preceding year, the name of one of the midwives being removed from the roll, one woman being censured, no action being taken in the remaining case. During the year ended 31st December, 1912, 528 midwives notified to the Council their intention of practising within the County during the year ; and, in addition to these, 9 notices were received from persons who had acted as midwives on specific occasions, and 18 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 on that date sub-section 2 of section 1 of the Act came into operation. This sub-section prohibits a woman who is not certified under the Act from habitually and for gain attending women in childbirth, legally qualified medical practitioners and persons rendering assistance in cases of emergency being exempted from the operation of the section. It became necessary during the year 1912 to institute legal proceedings against 8 women for infringing the law in this respect. Convictions resulted in 7 instances, fines amounting to a total of £6 16s., with £7 5s. 6d. costs, being inflicted. In the remaining case the summons was dismissed. The accounts of the Central Midwives Board showed an adverse balance for the year 1911, and the Council was called upon in May, 1912, to pay a sum of £88 6s. 8d. as its proportion of this deficit. There are certain services closely allied to that of public health which it is convenient to review in this chapter. They are (a) infant life protection, and (b) diseases of animals. The powers of the Council in these matters are exercised bv the Public Control Committee. Infant life protection. The Council administers (except in the City of London) Part 1. of the Children Act, 1908. A staff of 2 male and 8 women 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 221 Public Health. 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, before Part I. of the Act of 1908 came into force, the number of homes under inspection by the Council's officers was 268, containing 668 infants, and on 31st December, 1912, these numbers had risen to 2,876 and 3,728 respectively. In addition, at the end of the year there were 15 homes with one nurse infant each, which were under inspection by philanthropic societies acting as infant protection visitors under powers delegated by the Council under the Act. There were also at the end of the year 22 homes, containing 58 children, exempted from official inspection. The Act of 1908 did not deal with children adopted for lump sums of money and, as this system has been found to be grossly abused in many cases, the Council decided on 30th April, 1912, to make representations to the Secretary of State as to the desirability of the Act being amended so as to provide that no infant shall be adopted by a nurse-mother for payment of a lump sum of money without the written approval of the local authority. Diseases of animals. The Diseases of Animals Act, 1894 to 1911, make provision tor 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 Council's outdoor staff for the administration of the Acts consists of four veterinary inspectors, and certain other inspectors, who devote their whole time to the work. The prevalence of contagious disease in animals in London during the year 1912 is shown by the following statement indicating the number of animals attacked:—Glanders, including farcy, 172 cases ; typhoid in swine, 12 outbreaks ; anthrax, 14 cases ; and parasitic mange, 1,978 cases. Details were given in the last annual report* of the steps which led to the conference between the Council and the local authorities of districts adjacent to London on the general question of the amendment of the Glanders or Farcy Order of 1907. As a result of this conference the Board of Agriculture and Fisheries, in August, 1911, issued the Glanders or Farcy (Metropolitan Police District) Order, 1911. The new Order empowers local authorities in the metropolitan police area to destroy infected articles under certain conditions and to make a second application of the mallein test to suspected or in-contact animals at any time not later than six weeks after the first application of the test. Compensation amounting to £1,889 was paid by the Council in respect of glandered horses slaughtered during the year. Five infringements of the Glanders or Farcy Order of 1907 were detected, and in one case legal proceedings were taken, a penalty of £1 being imposed. The number of infringements of the Parasitic Mange Order of 1911 detected was 134, and in 28 cases legal proceedings were taken, penalties amounting in all to £120 5s. 6d. being imposed. Foreign animals. The Board of Agriculture during the year issued an Order, known as the Foreign Animals (Amendment) Order, 1912, which requires that any provision of the Foreign Animals Order of 1910, having relation to an animal brought from a port in a scheduled country, shall apply in like manner to an animal brought from a port in a country which is not scheduled, if the animal since it was taken on board at that port has entered a port in a scheduled country. The Order further makes it unlawful to land in Great Britain, without licence, cattle, sheep, goats or swine taken from the United Kingdom, the Channel Islands or the Isle of Man into a port in a scheduled country. The Order of 1910 does not apply, except where otherwise expressly stated, in relation to animals brought from the Channel Islands or the Isle of Man and certain portions of an Order of 1911 are revoked so far as it concerns animals, the landing of which at a foreign animals quarantine station has been approved under the Foreign Animals (Quarantine) Order of 1896. Importation of dogs. The Board of Agriculture also during the year issued an Order applying the Importation of Dogs Order, 1901, and the Importation of Canine Animals Order, 1909, to dogs or canine animals taken from the United Kingdom, the Channel Islands or the Isle of Man into a port in any country out of the United Kingdom, except the Channel Islands or Isle of Man as if the animal were an imported animal, unless it is shown that the animal has not been landed in that country and that while on board it has not been allowed to come into contact with any dog, etc., from that country, and unless a licence has been obtained previously to its landing in Great Britain. Destructive insects and pests. The Board ot Agriculture during the year issued under the Destructive Insects and Pests Acts, 1877 to 1907, an Order entitled the American Gooseberry Mildew (Fruit) Order of 1912, the object of which is to prevent the spread of the disease known as American gooseberry mildew which affects gooseberry and currant bushes and has become prevalent in this country. The Order prohibits the sale or exposure for sale of gooseberries affected with the disease, and directs that foreign gooseberries shall not be landed in this country except in packages to which labels are attached marked " Imported gooseberries," and stating the name of the consigner and the country and district in which the fruit was produced. The Order also provides that a package which has contained diseased gooseberries must be * Annual Report of the Council, 1911, Vol. III., pp. 176-7. 222 Annual Report of the London County Council, 1912. Destructive pests. thoroughly cleansed before being used for the packing of gooseberries or any other description of fruit. The Order requires that a fruit seller who detects the presence of American gooseberry mildew on any fruit in his possession must notify the fact to the Board of Agriculture and Fisheries or to an inspector of the local authority. Offenders against the Order are liable to a fine not exceeding £10. The eradication of the disease is a matter of some importance from a commercial point of view, as on account of its prevalence in this country several continental countries have prohibited the importation of English gooseberries. The necessary arrangements have been made for the administration of the Order. During the portion of the year for which the new Order was in force a considerable quantity of diseased fruit was discovered and in one case, where a grower had been previously cautioned, legal proceedings were instituted, a penalty of £1 and £7 7s. costs being imposed. 223 Main Drainage. CHAPTER XXXV. Main Drainage. Powers and duties of the Council. 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. Metropolitan main drainage area. In addition to the county, several adjoining districts drain into the system and the area resident population thereof (1911) are approximately as 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 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. Treatment and disposal of sewage. 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, with the quantity of refuse intercepted at the gratings at the outfall works at Barking and Crossness respectively during the year 1912:— Barking, gallons. Crossness, gallons. Total, gallons. Sewage treated 60,996,525,761 50,779,946,100 111,776,471,861 Sewage daily average 166,657,174 138,743,022 305,400,196 tons. tons. tons. Lime used 11,659 1 10,410.6 22,069.7 Proto-sulphate of iron used 2,536.894 2,358.25 4,895 .144 Sludge sent to sea 1,719,000 880,000 2,599,000 Sludge, weekly average 33,058 16,923 49,981 Refuse intercepted at gratings 3,528 1,709.25 5,237.25 From the above figures it will be seen that at Barking Outfall one ton of sludge was extracted from an average of 35,484 gallons of sewage treated ; or slightly less than in the previous year. At Crossness Outfall the average quantity of sewage treated to produce one ton of sludge was 57,704 gallons, which is approximately the same as in the preceding year. The total quantity of sewage treated is shown as about 2 per cent. less than in the preceding year, but this is accounted for by the alteration in the methods of gauging at Barking Outfall, the present method being more reliable than that formerly in vogue. The quantity of sludge sent to sea was more than in 1911. At the Barking outfall there is a one-acre coke bed which has been maintained in action for over nineteen years for the bacterial treatment of some 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. At the southern outfall a sand pit has been constructed to collect the sand and gravel brought down by the southern outfall sewer No 1. 224 Annual Report of the London County Council, 1912. 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 stafE of officers and crew numbering 24. Each vessel carries a load of about 1,000 tons. During the year under review the vessels made 2,599 trips to and from the deposit area in the Black Deep ; the distance travelled being about 259,900 miles. The vessels are insured for £108,000. The arrangements for making lime water to be mixed with the crude sewage at the northern outfall have not been satisfactory and proper value has not been obtained from the quantity of lime used. The present liming station is situated about half a mile from the precipitation channels and any large expenditure on it would not be justified. Plans are therefore being prepared for a new liming station more conveniently situated. Main drainage extension scheme. On 5th December, 1899, the Council approved in principle a scheme of main drainage extension works necessitated by the increasing strain imposed upon the existing system owing to the growth of the population. This scheme was estimated to cost roughly £3,772,550. All the works comprised in the scheme have been completed, with the exception of the enlargement of the Abbey Mills pumping station and the southern low level sewer No. 2 (Battersea to Deptford) which are, however, approaching completion. There are certain works which, while not specifically provided for in the scheme, are so closely connected therewith as practically to form part of it, and although their cost was not included when the rough estimate of £3,772,550 was prepared, it is anticipated that their inclusion in the scheme will not cause this estimate to be exceeded. They are (i.) the enlargement of the Crossness pumping station, roughly estimated to cost £120,000; (ii.) the extension of the southern high-level sewer No. 2 from Catford to Nunhead, estimated to cost £93,500 ; and (iii.) the enlargement of North Woolwich pumping station, estimated to cost £51,000. 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 being 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, estimated to cost £30,000, will be installed. During the year the undermentioned tenders for the supply and erection of machinery, etc., in connection with the enlargement of this pumping station have been accepted : Fullerton, Hodgart and Barclay, Ltd., four triple expansion engines, with condensing plants circulating pumps, etc., £9,842 19s. , Boving and Co., Ltd., four centrifugal pumps, £5,180 ; Galloways, Limited, boilers and superheaters, £3,220 ; J. Blakeborough and Sons, penstocks, pipes and valves, £2,745 ; and Bumstead and Chandler, Ltd., mechanical stokers, coal conveyors, etc., £260. 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 and 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 Bro., at the contract price of £88,398 14s. 9d. The quantity of sewage pumped at North Woolwich pumping station has increased from 1,200 million gallons to 1,800 million gallons during a period of ten years owing to the increase in the number of buildings, including many large factories, in the area drained. The enlargement of this station is essential and the necessary preliminary work, including the preparation of plans, etc., has been authorised. Storm relief There is no separate system of sewers in London for dealing with the surface water apart from the sewage, but large storm-water sewers have been constructed to relieve the main and intercepting sewers in times of heavy rainfall, and at various points on both banks of the Thames there are storm overflows which can be utilised at certain states of the tide. Pumping stations have also been erected for the sole purpose of pumping storm water into the river and, in addition, arrangements are made for discharging storm water by means of auxiliary engines at the Western and North Woolwich sewage pumping stations. The flood relief scheme of 1904, to which reference has been made in previous reports, is nearing completion. Certain other works will be undertaken, but it is not anticipated that the estimate of the cost (£795,000) of the scheme will be exceeded. One of the most important of these is 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. When the Falcon Brook pumping station was erected, only one-half the pumping power for which the station was designed was installed. In order to obtain the best advantage for the expenditure incurred and to meet the growing needs of the surrounding district, the Council on 7th May, 1912, decided to complete the equipment of the station, at an estimated cost of £9,500. The tenders of the Campbell Gas Engine Company, Limited, for the supply, delivery and erection of three gas engines for £5,680 and of John Cochrane for the supply, delivery and erection of three centrifugal pumps for £1,800 was subsequently accepted. An action was commenced in 1907 by Price's Patent Candle Company, Limited, to restrain the Council from pumping storm water from Falcon Brook pumping station into Battersea Creek, which adjoins the company's premises. The verdict of the High Court was given in the company's favour and 225 Main Drainage. the Council appealed to the Court of Appeal and to the House of Lords. Subsequently, by arrangement, the outlet pipe from the station was extended under the company's premises into the bed of the River Thames, thus removing the cause of complaint. The company's claim, amounting to £1,073 6s. 7d. for damage sustained in connection with the construction of the new outlet under their property, was settled during the past year for £886 13s. 3d., the Council, in addition, granting the company a licence to build over the sewer under certain conditions for safeguarding the sewer. In addition to the works included in the enlargement and flood relief schemes 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, it has been found necessary owing to the very large development of building operations in the borough since the schemes were prepared to undertake further works as follows:— (i.) A relief sewer from the junction of Balham High-road and Tooting Bec-road to the river Graveney ; (ii.) the improvement of certain portions of the waterway of the river Graveney ; and (iii.) a sewer (the Wandle-valley sewer) with branches, from the Wandle sewer extension near Mitcham-road to the Wandle sewer at Summerstown to relieve the low lying areas in the valley of the rivers Wandle and Graveney. A contract amounting to £34,319 has been let for (i.) and (ii.). The preliminary work of making drawings, etc., in connection with the Wandle-valley sewer, which is estimated to cost £100,000, is in hand. Illegal discharges into sewers. 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 other matters or liquid in a sewer, may cause a nuisance, or involve danger or risk of injury to the health of persons entering the sewers, or be injurious to the structure or materials of the sewers or works of the Council. Copies of an order made by the Council on 20th December, 1898, under section 10 of the Act, prohibiting the discharge of dangerous substances into sewers, were served during the year upon a number of persons licensed under the Petroleum Acts, and carrying on businesses such as might produce residues which would be dangerous if discharged into sewers. Building over sewers. By sections 204 and 68 ot tne Metropolis Management Acts of 1855 and 1862 respectively, the erection in, on, over, or under any sewer of a building, wall, bridge, fence, etc., without the previous consent of the Council is prohibited. During the year 28 licences to build over sewers were granted. Repairs, etc. The principal works of repair, etc., undertaken during the year, and the expenditure sanctioned therefor in each case were as follows:— Barking Outfall.—Repairs to pier and dolphin, £1,050 ; repairs to liming station, £520; erection of store building, £350 ; repairs to river wall, £250. Crossness Outfall.—New centrifugal sludge loading engines, £4,850 ; new condensers to beam engines, £500 ; repairs to water settling pond, £300. North Woolwich Pumping Station.—Overhaul of engines and pumps, £500. Northern Outfall Sewer.—Repairing bridge over Waterworks river, £500. Main Sewers.—Reconstruction of Ranelagh sewer at Chelsea, £8,100 ; culverting Stamfordbrook sewer in Old Oak-common-lane, £3,000. Repairs to Sewers.—Counters-creek river outlet, £1,500 ; Ravensbourne and Sydenham £1,500 ; Ranelagh (in Paddington), £1,000 ; Limekiln Dock, £1,000; Fleet (Argyle branch), £500 ; Nightingale-lane, £500 ; King's Scholar's-pond, £250. Overhaul and repair of Sludge Vessels.—£6,785. Section 69 of the Metropolis Management Act, 1855, provides that no new local sewer shall be Local sewer made without the previous approval of the Council and during the year sanction was given for the construction of local sewers as shown in the subjoined table. Size. North of Thames. South of Thames. Total length. feet. feet. feet. 3 ft. 9 in. by 2 ft. 6 in 225 — 225 2 ft. 6 in 350 — 350 2 ft. 3 in 510 — 510 2 ft — 530(a) 530 1 ft. 6 in 290 290 580 1 ft. 3 in 2,695(6) 1,435(e) 4,130 1 ft 7,210(c) 9,745(f) 16,955 9 in 4,260(d) 8,865(g) 13,125 6 in 215(h) 1,045 1,260 Totals 15,755 21,910 37,665 (a) Reconstruction 530 feet. (b) Including reconstruction 2,255 feet. (c) „ „ 2,900 „ (d) „ „ 2,315 „ FF 18820 (e) Including reconstruction 575 feet. (f) „ „ 5,125 „ (g) „1,640 „ (h) „ ,, 85 ,, 226 Annual Report of the London County Council. CHAPTER XXX VI. HOUSING OF THE WORKING CLASSES. Powers and duties of the Council. 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, a right of appeal to the Local Government Board being reserved to the owner of the property. The Council has power to take action in default of a borough council, both as regards obstructive buildings and closing and demolition orders. Part III. of the Act of 1890, as extended by the Acts of 1900 and 1909, empowers the Council to acquire land, either within or without the County, and to provide thereon accommodation for persons of the working 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. Action taken under Parts I. and II. of the Act of 1890. 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. Tabardstreet, etc. scheme. The Council is at present carrying out another large scheme under Part 1. of the Act of 1890, known as the Tabard-street, Grotto-place and Crosby-row (Southwark and Bermondsey) Scheme, 1910, which provides for the clearance of three distinct areas comprising altogether about 17 acres. The Order of the Local Government Board confirming the scheme was issued on 13th March, 1912. The scheme involves the displacement of 4,552 persons of the working classes, and the confirming order requires the provision on the Tabard-street area of dwelling accommodation for not less than 2,580 persons, including not less than twenty-five cottages to be erected on the detached portion of the area between Law-street and Little Hunter-street. The Board approves of the Council itself undertaking the erection of the necessary dwellings. Such accommodation for the storage of barrows has to be provided by the Council on the Tabard-street area as may, in the opinion of the Board, be required for the use of street traders displaced by the execution of the scheme. St. Stephen's Vicarage has, in accordance with the Council's request, been excluded from the scheme. Two plots of vacant land abutting on Long-lane and Sterry-street respectively, and the premises known as No. 23, Chapelplace, have been removed from the category of insanitary property and included in the scheme as neighbouring lands required for making the scheme efficient. The Order provides for the clearance of the three areas being carried out in five sections, the new dwellings on one section having to be completed before any displacement is permitted from a further section. By this means it will be possible, except in the case of the first section of the Tabard-street area, to provide new accommodation for the inhabitants before they need remove from their old homes. It is provided that a portion of the Tabard-street area, not less than five acres in extent, shall be laid out and maintained as an open space, and the Order applies the provisions of the Open Spaces Act, 1906, to such land as if the land had been provided by the Council under the provisions of that Act. The effect of this will be that the cost of acquiring the land will be a charge against the scheme and that the cost of laying out and maintaining the open space will be charged to the general county account out of which expenditure on parks is met. The gross cost of the scheme, exclusive of the cost of erecting the new dwellings, and laying out the open space, is estimated at £467,000. The value of the surplus lands and rehousing sites is estimated at £77,100, making a net estimate of £389,900, exclusive of the cost (£4,800) of laying out the open space. 227 Housing of the Working Classes. Negotiations are proceeding for the acquisition of the various interests in the properties, and it is anticipated that the buildings on the first section will be demolished early in 1913. Plans have been prepared for the section of the first block of new dwellings and have been submitted to the Local Government Board for approval. Closing and demolition orders. Very important powers nave been conferred upon the metropolitan borough councils by 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. Local authorities may by these means secure the closing and demolition of insanitary houses at no cost to the ratepayers beyond the expenses of administration ; and it is hoped that vigorous action by the metropolitan borough councils under these sections will tend to obviate in many cases the necessity for expensive clearance schemes by the Council under Part I. of the Act of 1890. The figures given in the following table, which are taken from a memorandum dated 9th November, 1912, issued by the Local Government Board, indicate the action taken during the year ended 31st March, 1912, so far as the information could be obtained, and for comparison the corresponding figures are also given for the year ended 31st March, 1911, 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:— Year. 1911-12. 1910-11. 1909-10. 1908-9. Number of houses in respect of which representations were made to the metropolitan borough councils 556 1,395 82 21 Number of houses made fit for human habitation or closed or demolished voluntarily without the issue of a closing order 93 83 19 8 Number of houses in respect of which closing orders were made 280 243 35 5 Number of houses in respect of which closing orders were determined 102 4 Information not available Number of houses (in respect of which closing orders were made) demolished by owners without orders for demolition 64 25 Information not available ,, Number of houses in respect of which orders for demolition were made 51 2 ¯ ¯ Capital expenditure on clearance. The amount expended on capital account by the late Metropolitan Board of Works and the Council up to 31st March, 1913, in respect of the clearance of insanitary areas (exclusive of the cost of erecting new buildings), amounted to £3,424,865 3s. 2d., 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 £2,518,125 2s. Id. Rehousing in connection with improvements, etc. In carrying out public improvements other than schemes under the Housing Acts, involving a statutory obligation to rehouse, the Council has displaced 12,244 persons of the working classes, and has provided accommodation in new dwellings for 12,902 persons in lieu of that destroyed. The displacement of persons of the working classes by the Council does not always involve a statutory obligation to provide rehousing accommodation, and, in numerous cases where such obligation has existed, the Local Government Board has, in the exercise of its powers under the Act of 1903, dispensed with the necessity for a special housing scheme. On 23rd and 30th July, 1912, the Council considered as to the course to be pursued with regard to the impending displacement of 2,285 persons of the working classes 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 1912. 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 wab decided to ask the Local Government Board to release the Council from the rehousing obligation. 18820 FF2 228 Annual Report of the London County Council, 1912. Rehousing. During the year the Local Government Board released the Council from rehousing obligations as regards 2,534 person of the working classes displaced from properties over which compulsory powers of acquisition had been obtained mostly for purposes of the education service. In one case, however, in which it was proposed to displace 526 persons of the working classes from a site in Nicholasstreet, Hoxton, which was required for the erection of a new public elementary school, the Board came to the conclusion that the circumstances were such that it would not be justified in dispensing with the housing obligation. The Council also decided during the year that special rehousing schemes were not necessary in respect of the displacement of 367 persons from certain other properties acquired for similar purposes, there being no statutory obligation to rehouse these people. Common lodginghouses. 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. Action taken under Part III. of the Act of 1890. Under Part III. ot the Housing of the Working Classes Act, 1890, 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 about 341 acres, for the erection of cottages. Up to 31st December, 1912, 2,648 cottages, with accommodation for 19,182 persons, had been completed on these estates, making a total accommodation for 23,250 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. White Hartlane estate. The White Hart-lane Estate, lottenham (226 acres) was purchased in 1901 for £90,225. It 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 Council was obliged by the vendor to take both sections, but as the northern portion was not required for housing purposes the Local Government Board consented in 1911 to its being sold, and efforts are now being made to dispose of it. The estate is situated in a district where the working-class population already largely predominates ; and the Council after some years felt that it would be impolitic to cover such a large area with cheap-rented dwellings, and that it would be to the advantage of the district generally if a substantial proportion of better-class property could be erected on the land. The provisions of the Housing Acts, however, do not permit of the erection of dwellings for any other than the working classes on land which the Council holds under Part III. of the Act of 1890, and special parliamentary authority was therefore obtained in the session of 1912, to enable the Council to develop any part of the southern section then unbuilt upon on the lines of a garden suburb, and not Solely for the accommodation of the working classes. The Council is authorised to make a scheme for laying out and developing the land and to sell or lease all or any of it for the purpose, but the Council is not permitted itself to undertake the erection of any other than working-class houses. Any such scheme, which is subject to the approval of the Local Government Board, may confer exemption from or may relax or vary local by-laws relating to buildings or the laying out of streets. During the year an offer was received from the Tottenham and Wood Green Burial Board to purchase for £3,000 the freehold of about 4¼ acres of the estate adjoining the Tottenham Cemetery. Owing to its irregular shape the piece of land in question would be costly to develop for building and the Council considered it would be well advised to dispose of it. It was therefore decided to accept the offer, subject to the Local Government Board's consent for which application has been made. The sale proceeds will be devoted to the development of the remainder of the estate. The development 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 48¾ acres to be developed. Cottages have been erected or are being erected on about 33 acres, and 3⅓ acres have been laid out as an estate garden. About 28 acres have been laid out as allotments for the benefit of the tenants of the cottages. On sections A and B (10½ acres) 304 cottages, containing accommodation for 2,454 persons, have been erected. Administrative buildings are about to be erected on the estate, and five shops are being built along the frontage to Lordship-lane, between Waltheof-avenue and Kevelioc-road. If the demand is sufficient, further shops will be erected later. Lord Swaythling's gift. In 1903 the late Lord Swaythling (then Sir Samuel Montagu, Bt.), gave to the Council £10,000 to be applied towards the development of about 25 acres of the White Hart-lane estate. After taking into account the interest which had accrued, the gift amounted to £12,041 8s. Id. on 31st March, 1913, when the gift account was closed, the balance of the fund having been transferred to the dwellings account during the year. 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 3⅓ acres have, by arrangement with the donor, been laid out as an estate garden, the cost being defrayed out of the gift. On 31st December, 1912, 509 cottages, capable of accommodating 3,961 persons, had been completed on this section, and 62 others were in course of erection. Totterdown Fields estate. The development of the Totterdown-fields estate, Tooting (38 ¾ 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 comprising 1,261 separate tenements affording accommodation for 8,733 persons. Four shops have also been provided. Particulars of the cottages and the rents charged are given in Appendix XXI. 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 £29,333, and the actual surplus for 1912-13 as shown in the accounts is £1,520. 229 Housing of the Working Classes. Totterdown Fields estate. The Council, regarding the financial prospects of the estate as satisfactory, thought that some further capital expenditure might usefully be incurred in improving the amenities of the cottages and the estate generally, and on 26th November, 1912, expenditure not exceeding £2,500 was sanctioned for this purpose. There is an increasing demand for the accommodation provided and the loss by empties at the present time is less than 3 per cent. of the rent receivable. Norbury estate. Further progress has been made with the development of the Norbury estate, Croydon (28½ acres). Roads and sewers have been constructed and cottages have been erected on about 16½ acres of the estate, and the work of finishing the roads is being carried out by the Croydon Corporation. Up to 31st December, 1912, accommodation for 3,472 persons had been provided in 472 cottages. Four shops have also been provided. The development of the remainder of the estate will shortly be proceeded with. Old Oak estate. The Old Oak estate, Hammersmith (about 46½ acres), is now in course of development. Contracts have been let for the erection of 305 cottages and cottage flats and 5 shops on the western section of the estate, comprising about 14½ acres. Roads and sewers have been constructed on this portion of the estate, and 102 cottages and cottage flats with accommodation for 562 persons have been completed. Administrative buildings with an estate office, workshop and store and dwelling accommodation for the superintendent are in course of erection. Ducane-road has been widened to 50 feet in front of Wormwood-scrubs prison and extended along the southern boundary of the estate to Old Oak Common-lane. Plans for the laying out of roads on the eastern section of the estate (32 acres) have been provisionally approved and plans and estimates for the cottages are in course of preparation. A temporary school has been erected on the estate and the question of allocating a site for the provision of permanent school accommodation is under consideration. An acre and a quarter of land abutting on the housing estate and Wormwood-scrubs was acquired for the purpose of constructing an outlet from the eastern section of the estate in the north-west corner. The portion of this land not required for the proposed new road has been added to the open space. The new road will be continued to Old Oak Common-lane over a small piece of land which formerly belonged to the Great Western Railway Company, but which has now been surrendered by the Company in exchange for some 60 square yards of land forming part of the housing estate. Leasing of cottages to tenants. In the London County Council (General Powers) Act, 1912, parliamentary authority was obtained to enable the Council to grant leases for 99 years of single houses erected on estates developed under the Housing of the Working Classes Acts. It is proposed to grant leases to occupiers on payment of a deposit of £5, the lessee being required (i.) to pay throughout the lease the equivalent of a ground rent and (ii.) to make equal weekly payments for the first 15, 20 or 25 years sufficient to repay the amount spent on the land and buildings (less the deposit and the capitalised value of the ground rent) interest, legal, etc., costs, establishment charges, etc. The prospective iessee will have to satisfy the Council that he has a bona-fide intention of residing in the house, but he will be allowed, with the Council's consent, to let the house or to transfer the lease to a suitable assignee. The Council will also under certain circumstances agree to accept a surrender of the lease and make a payment to the lessee in consideration of such surrender. The charges to the lessee will be fixed as low as is possible without involving a charge upon the rates. It is proposed, as an experiment, to allocate for leasing some of the cottages to be erected on the eastern section of the Old Oak estate, and, if the experiment is successful the scheme will be extended to other cottage estates. Dwellings provided by the Council. Dwellings capable of accommodating 1,518 persons were completed during the year 1912 at an approximate cost for buildings and plans of £46,648. The erection of new cottages designed to accommodate 1,210 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 £55,680. 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 these requirements ; but this is mainly due to the fact that the Council was obliged to build on sites which were so unsuitable as to be unsaleable for the purpose. Management of dwellings. The Council's dwellings, on 31st December, 1912, contained accommodation for 55,326 persons. With a view to effecting a desirable improvement in the lighting of the yards, staircases and balconies of the Council's dwellings, inverted incandescent gas burners were during the year substituted for flat flame burners at a cost of £500. It is anticipated that the alteration will effect a substantial economy. A small demand having arisen on the part of gas stokers, lightermen and others working at night-time for sleeping accommodation at Carrington House, Deptford, during the day, arrangements have been made for these men to be accommodated in the cubicles on the top floor of the lodging house. Bath accommodation has been provided for the use of the tenants at Preston's-road estate, Poplar, a three-roomed tenement on the ground floor having been converted into five bathrooms at a cost of about £230. A charge of 1½d. is made for the use of a bath if the tenant chooses to provide the soap and towel, and 2d. a bath if a towel is provided by the Council. 230 Annual Report of the London County Council, 1912. New working class accommodation. 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 year 1902 to 1911 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 1911 shows that the number of rooms in new dwellings provided during the year in the County of London was 5,204, the number of rooms in dwellings demolished 4,969, and that the net addition to the number of rooms was therefore 235. The figures in respect of the adjoining districts were 15,680, 807, and 14,873 respectively. The average rents for each room at which the new dwellings were let or to be let were, during 1911, 3s. 0½d. in the central districts of London, 2s. 7¼d. in the outer districts of London and 2s. 3½d. in the extra-London districts. History of housing question. A revised account of the Council's housing work up to 31st December, 1912, has recently been published, † * New working-class accommodation. †Housing of the Working Classes in London, 1855-1912. 231 Housing Accounts and Statistics. CHAPTER XXXVII. ACCOUNTS AND STATISTICS. Working Class Dwellings Accounts, 1912-13—Memorandum by the Comptroller (Mr. H. E. Ha ward). These accounts are prepared, subject to audit, in advance of the Annual Accounts of the Council for the year ending 31st March, 1913. They comprise all the dwellings and lodging houses erected or owned by the Council. These dwellings are provided either (a) under the Housing of the Working Classes Act, 1890 (Parts I., II. and III.), or (b) under Improvement Acts. The results of the year 1912-13, after interest and sinking fund charges have been met are shown by the Revenue Accounts to be as follows— Dwellings— £ s. d. Housing of the Working Classes Act, 1890 Surplus 7,562 16 2 Improvement Acta Surplus 3,093 18 9 Surplus on dwellings 10,656 14 11 Estates in Course op Development Deficiency £4,322 14 - Less—In respect of the utilisation of the Acquisition of Lands Fund 963 6 - 3,359 8 _ Net surplus on all dwellings and estates 7,297 6 11 Summary of results of year. For the year 1911-12 there was a net surplus on all dwellings and estates of £3,383 8s. 7d., made up of a surplus on dwellings of £8,332 15s., and a deficiency on estates in course of development of £4,949 6s. 5d. It will be seen that the suiplus in 1912-13 is due, to the extent of £963 6s., to the application of the credit arising from the use of the Acquisition of Lands Fund. Housing of the Working Classes Act, 1890. The Council's operations under the Housing Act comprise (a) dwellings erected under Parts I. and II. of the Act to provide rehousing accommodation for persons displaced by schemes for the clearance of insanitary areas, and (b) dwellings erected under Part III. of the Act to provide accommodation for persons of the working classes, apart from any displacements. Dwellings erected under Parts I. and II. represent, therefore, compulsory provision for rehousing under statutory obligations, whereas dwellings under Part III. represent housing accommodation voluntarily provided by the Council. In certain instances of compulsory rehousing it has been necessary to erect dwellings on sites, on the working of which, owing to their character or situation, an unfavourable financial result was anticipated from the first. These cases are separately shown in the accounts. The account under Part III. is sub-divided to show the results of the dwellings apart from the debt charges on estates in course of development, which are referred to in a subsequent paragraph. The results of the year's working under the Housing of the Working Classes Act, 1890, are as Results of follows:— year. £ s. d. Part I. Surplus 5,496 11 5 ,, II Surplus 421 - 9 „ III.—Dwellings Surplus 1,645 4 - Surplus on dwellings 7,562 16 2 Part III.—Estates in course of development Deficiency 3,359 8 - Net Surplus for Housing Act 4,203 8 2 The surplus on dwellings under Part III. is after allowing for a deficiency of £1,536 5s. Id. 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 £164,663 Is. Deducting therefrom allowances for empties, caretakers' quarters and amounts irrecoverable, the net rental amounted to £154,281 12s. 4d., exclusive of £538 4s. 2d. for interest on cash balances. The amount of rent irrecoverable was £141 18s. Id., or only 0.08 per cent, of the gross rental. The total loss of income due to " empties " was £9,113 18s. Id., or 5.54 per cent, of the gross rental, as against 8-73 per cent, in 1911-12. Of this loss £5,223 occurred on four estates, viz. : Carrington House (£3,307, or 43.02 per cent, of gross rental), Preston's-road Estate (£1,130, or 28.35 per cent.), Hughes Fields Cottages (£499, or 24.32 per cent.), and Hughes Fields Dwellings (£287, or 22.46 per cent.}. Income. 232 Expenditure. Annual Report of the London County Council, 1912. The total expenditure on dwellings was £147,257. 1911-12. Per cent. of gross rental 1912-13. Per cent. gross rental. £ Working Expenses— £ 9,543 6.00 Supervision and collection of rent 10,457 6.35 25,984 16.34 Rates and taxes (less tax on interest on debt recovered) 27,621 16.77 8,044 5.06 Lighting, heating, water and insurance 8,234 5.00 322 0.20 Stores and incidentals 234 0.14 14,711 9.25 Repairs and renewals (transfers to fund) 16,944 10.29 58,604 36.85 63,490 38.55 I Debt Charges— Interest (gross) Land £12,221 Buildings 57,930 67,189 42.25 70,151 42.60 Sinking Fund— Land 2,350 Buildings 11,266 13,114 8.25 13,616 8.27 138,907 87.35 Total Expenditure 147,257 89.42 15,108 9.50 Net deductions from gross rental (empties, etc.) 10,381 6.30 5,022 3.15 Surplus on dwellings (excluding interest on cash balances) . 7,025 4.28 159,037 100.00 Gross rental 164,663 100.00 Appendix XVII. (e) (pages 1 and li) showing the percentages on gross rental of the several item of income and expenditure for each estate. Repairs and renewals fund, The repairs and renewals fund has been established with the view of equalising the charges against revenue under this head between one year and another, as the expenditure in future years will naturally be larger than at present, when many of the buildings are new. The sums charged to revenue account and carried to this fund are based on the estimated cost of all repairs and renewals during the loan period, after deducting interest earned on the accumulations of the fund. The credits to this fund during the year exceeded the expenditure thereout by £1,723 8s. The amount standing to the credit of the fund on 31st March, 1913, was £43,692 14s. 9d., of which £38,899 5s. lOd. was invested. Estates in course of development The interest and sinking fund charges, less receipts in aid, in respect of the capital outlay on lands acquired under Part III. of the Housing of the Working Classes Act, 1890, and still in course of development, are included in a separate account. The charge on the rates in respect of the deficiency under this head for the year 1912-13 was £3,359 8s., after deducting £963 6s. in respect of debt charges on the capital expenditure met out of the special fund for the acquisition of lands under Part III., referred to in a following paragraph. The aggregate amount raised in the rates to 31st March, 1913, is £78,255 2s. 2d. This amount includes the annual instalments of sinking fund to redeem debt. Sir Samuel Montagu (Lord Swaythling) gift fund. The gift of £10,000 received from Sir Samuel Montagu on 5th August, 1903, for improving the Whites Hart-lane estate, amounted, with the interest thereon, on 31st March, 1913, to £12,041 8s. Id. A sum of £9,788 3s. 8d. had, up to 31st March, 1912, been applied to the purposes of the gift, and the balance of the fund was transferred to the credit of the dwellings capital account in the year 1912-13, the gift account being closed as on 31st March, 1913. Special fund for the acquisition of lands under Part III. of the Housing of tho Working Classes Act, 1890. 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, whioh 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, 1913, to £55,041 Is. lid. 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 £44,445 12s. 9d. has been applied to meet expenditure on this estate. The balance available on 31st March, 1913, for future expenditure on this estate is thus £10,595 9s. 2d., of which £10,125 is invested. The debt charges on the expenditure met out of the moneys of the Fund (amounting in 1912-13, the first year of charge, to £963 6s.) have, in accordance with the Council's decision, been taken in reduction of the amount raised in the rate in respect of the development of estates under Part III. Capital expenditure and debt on dwellings and estates. The total expenditure on capital account on the dwellings and estates up to 31st March, 1913, amounted to £2,217,380 17s. The Summary of Financial Results shows the apportionment of this figure as between land and buildings. The capital expenditure during the vear 1912-13 amounted to £25,750 4s. l1d.. 233 Housing of the Working Classes. With regard to dwellings erected to rehouse persons displaced by clearance schemes under Parts I. and II. of the Act, the Council's practice is to charge the capital account of the dwellings with the value of the site as earmarked for housing purposes, the account of the clearance scheme being credited with this value. The latter account, which is charged with the cost of clearance and laying out (less sales), is thus placed in the same position as it would have been if the Council had disposed of the land for the erection of dwellings. In the case of dwellings erected under Part III. of the Act the total cost of the land and of its development for building is chargeable against the dwellings. Appendix XIX. shows the estimated commercial value and housing value in: respect of all sites utilised for the erection of working class dwellings under Parts I. and II. of the Act, whether the dwellings have been erected by Dwellings Companies or by the Council. As regards sites sold to Dwellings Companies, the aggregate commercial value at the time of disposal is estimated at £472,100, and the aggregate housing value as represented by cash received from Dwellings Companies is £198,915, the difference of £273,185 being charged against the clearance schemes. The aggregate commercial value on the same basis of sites acquired or appropriated by the Council'is estimated (at £465,804, and the housing value charged to dwellings accounts at £163,361, the difference of £302,443 being charged against the clearance schemes. As regards the debt on dwellings and estates, the decision of the Council on the 7th May, 1912 (Minutes, page 1071), as approved by His Majesty's Treasury, to vary the method of stating its stock debt, in respect of the separate services, from the cash basis to the stock (par value) basis, has been given effect to as on 31st March, 1913. In place of the liability represented by the net cash raised by the stock, the par value of the stock outstanding appears as a liability in the balance-sheet (page 16), with an item on the assets side for expenses of issue. Appendix XVIII. shows the capital expenditure on the clearance of insanitary areas under Parts I..and II. of the Housing of the Working Classes Act, 1890, as distinct from the expenditure on dwellings. The net capital expenditure to 31st March, 1913, under both parts of the Act for clearance schemes, amounted to £2,518,125 2s. Id. The capital expenditure during the year 1912-13 amounted to £2,187 4s. 8d., being mostly in respect of the new Tabard-street, etc., scheme. Capital expenditure on clearance schemes. Dwellings under Improvement Ads. These dwellings were erected in pursuance of statutory obligations to provide rehousing accommodation for persons displaced by improvements, etc., under various Acts of Parliament. Certain dwellings were erected on sites on which, owing to their character or situation, an unfavourable financial result was from the first anticipated ; these are shown under a separate head. The result of the year's working of Dwellings under Improvement Acts is a net surplus of £3,093 18s. 9d., as compared with £2,859 18s. 9d. in 1911-12. Results of year. The gross rental for the year from dwellings was £55,835 14s. 2d. (page xlviii). Deducting therefrom allowances for empties, caretakers' quarters, and amounts irrecoverable, the net rental amounted to £52,878 lis. 10d., exclusive of £181 6s. 5d. for interest on cash balances. The amount of rent irrecoverable was £41 18s. 2d., or only 0-08 per cent, of the gross rental. The total loss of income due to " empties " was £2,356 6s. lid. or 4-22 per cent, of the gross rental, as against 4-89 per cent, in 1911-12. The greater part of this loss occurred on three estates, viz.: Durham Buildings (£394 or 29-23 per cent, of gross rental), Hughes Fields Dwellings (£144, or 22-46 per cent.) and Swan-lane Dwellings (£843, oi 20.46 per cent.), which account for £1,381. On two other dwellings the loss from empties was more than 10 per cent, of the gross rental. Income. The total expenditure on dwellings was £49,966 (pages xlviii and xlix). 1911-12. Per cent. of gross rental 1912-13. Per cent. of gross rental. £ Working Expenses— £ 4,371 7.77 Supervision and Collection of rent 4,523 8.10 8,643 15.36 Rates and taxes (less tax on interest on debt recovered) 8,258 14.79 2,544 4.52 Lighting, heating, water and insurance 2,532 4.53 86 0.15 Stores and incidentals 86 0.15 5,253 9.34 Repairs and renewals (transfers to fund) 5,293 9.49 20,897 37.14 20,692 37.06 Debt Charges— Interest (gross)— Land £3,515 Buildings 20,997 24,525 43.60 24,512 43.90 Sinking Fund— Land 657 Buildings 4,105 4,762 8.53 4,765 8.47 50,187 89.21 Total Expenditure 49,966 89.49 3,393 6.03 Net deductions from gross rental (empties, etc.) 2,957 5.30 2,677 4.76 Surplus on dwellings (excluding interest on cash balances) 2,913 5.21 56,257 100.00 Gross rental 55,836 100.00 Expenditure 18820 GG 234 Annual Report of the London County Council, 1912. Repairs and renewals fund. The amount standing to the credit of this fund on 31st March, 1913, was £19,316 10s. 9d., of which £19,103 4s. 2d. was invested. The expenditure during the year exceeded the credits to this fund by £564 5s. l0d. Capital expenditure and debt on dwellings. The total expenditure on capital account up to the 31st March, 1913, in respect of Dwellings under Improvement Acts amounted to £743,351 4s. The Summary of Financial Results shows the apportionment of this figure as between land and buildings. The capital expenditure during the year 1912-13 amounted to £45 3s. l0d. 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 XIX. 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 commercial value at the time of disposal is estimated at £255,435, and the aggregate housing value as mainly represented by cash received from Dwellings Companies is £131,007 the difference of £124,428 being charged against the accounts of the improvements. The aggregate commercial value on the same basis of sites acquired or appropriated by the Council is estimated at £416,277, and the housing value charged to dwellings accounts at £108,213 the difference of £308,064 being charged against the accounts of the improvements. As regards the debt in respect of Dwellings under Improvement Acts, the variation in the method of stating the Council's stock debt has been already referred to in the previous section of this memorandum. Financial Results of all Dwellings and Estatz» to 31s< March, 1913. 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, 1913, apart from contributions from or to rates, are as follows— Dwpllinan—. Housing of the Working Classes Act. 1890— £ s. d. Part I surplus 39 ,557 4 7 Part II surplus 3,388 10 _ Part III deficiency 26,112 14 7 surplus 16,833 - - Estates in course of development deficiency 78,255 2 2 Total under Housing Act deficiency 61,422 2 2 Dwellings— Improvement Acts surplus 11,747 6 4 Net aggregate deficiency 49,674 15 10 Contributions from Tramways Account 1,151 7 3 Net contributions from Rates 48,523 8 7 Details on page liv £49,674 15 10 (The net aggregate deficiency at 31s< March, 1912, was £56,972 2s. 9d.) These results are arrived at after (a) charging interest on capital outlay, (b) making full provision 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, 1913, amounted to £221.833 14s. Id. (including £13,684 16s. 3d. proceeds of sales). 235 Housing of the Working Classes—Accounts. Housing Statistics.—Memorandum, by the Housing Manager (Mr. S. G. Burgess). The new buildings completed and opened between 1st April, 1912, and 31st March, 1913, comprise 239 cottages, providing accommodation for 1,503 persons. Five sheds werealso providedand 1 tenement was converted for use as bathrooms. Up to 31st March, 1913, a total of 6,420 tenements in block dwellings, and 3,090 cottages, or a total of 9,510 lettings, containing 27,051 rooms ; and 1,856 cubicles in lodging houses, affording accommodation altogether for 55,571 persons, had been provided and opened by the Council. The gross rent receivable for the year 1911-12 was £215,294 0s. 0d., and for the year 1912-13, £218,925 17s. 10d., being an increase of £3,631, 17s. l0d. Accommodation. 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 £9,937 4s. 4d., which, after adding interest on cash balances (£719 10s. 7d.) gives a total net surplus of £10,656 14s. lid., or 4 83 per cent, of £220,498 15s. 2d., the gross rent receivable for the year. The interest and sinking fund charges amount to 51 '26 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 £24,018 lis. 0d., and the total sum now set aside in this fund in respect of dwellings in occupation amounts to £216,294 lis. l0d. The expenditure for the management of the estates, including repairs, rates and taxes, water, lighting, etc., amounts to 38"18 per cent, of the gross rental. During the year the sum of £22,237 has been transferred to the repairs and renewals account, the unspent accumulations on which, with the interest earned during the year (£1,874 Is. Id.), now amount to £63,009 5s. 6d. The total addition to the fund was 10 90 of the gross rental. Financial results. The loss of rent by empties (including the amounts lost at the opening of the new buildings— 239 lettings) is equivalent to 5-20 per cent, of the gross rental. During the year 2,482 tenants left the dwellings. This is equivalent to 26'09 per cent, of the total number of tenements, as compared with 32 63 per cent, in 1911-12. Of the 2,482 tenants who removed, 257 tenants, or 10-35 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 2,225 tenants, or 89'65 per cent., gave notice to the Council and left to suit their own convenience. A total of 6,564 applications for accommodation on the Council's estates (excluding lodging houses) were dealt with, and 760 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 6,564 applications received, 2,975 or 45-32 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 vacation, but the amount of £183 16s. 3d. or -08 per cent. (l'7d. per £100) of the gross rental has been included .n the accounts as irrecoverable. l Empties, transfers, rents irrecoverable, etc. 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, 1913, is 1,756. Rehousing. The usual annual enumeration of tenants of the Council's dwellings was taken in March, 1913 and showed that the rooms (excluding lodging houses), available for letting, were actually occupied by 34,023 persons, or an average of 1-26 persons per room. The birth rate for the year amounted to 25-40 per 1,000, and the death rate (exclusive of the three men's lodging houses) to 10-05 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 32 or -34 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. Census of tenants. A sum of £22,951 18s. lid. (10 40 per cent, of the gross rental) has been spent in repairs to the buildings during the year. These repairs include external painting at 42 blocks of tenements and 362 cottages, whitening the soffits and cleaning or painting walls of 267 staircases, comb graining and varnishing the woodwork of 1,414 tenements and 283 cottages, repainting 56 tenements, and cleansing repairs at 7,035 tenements. The whole of these repairs have been executed by direct labour employed in the housing department. Repairs. During the year 24 small fires occurred in the dwellings. The damage was in every case slight, Fires, and the total cost of reinstatement, amounting to £31 1s. 6d., was covered by the Council's insurance fund. APPENDIXES. ii iii APPEN DIX |. iii TABLE SHOWING PROCEEDINGS OF LONDON SANITARY AUTHORITIES UNDER THE FACTORY AND WORKSHOP ACT, 1901. Premises, Particulars, Class, &c. City of London Battersea. Bermondsey. Bethnal Green. Camberwell. Chelsea. Deptford. Finsbury. Fulham. Greenwich. Hackney. Hair mersmith. Hampstead. Holborn. Islington. Kensington. Lambeth. Lewisham. Paddington. Poplar. St. Marylebonc. St. Pancras. Shoreditch. Southwark. Stepney. Stoke Newington. Wandsworth. City of Westminster. Woolwich. 1. Inspections. Factories (including factory laundries) 3,638 556 197 167 398 3 166 1,170 140 34 59 751 92 141 484 151 10 94 110 72 91 66 384 115 129 42 826 67 67 Workshops (including workshop laundries) 4,232 1,638 86 3,573 2,635 890 390 2,325 520 208 2,100 1,532 675 689 2,558 2,339 157 1,630 2,926 1,164 3,330 398 2,924 1,012 4,797 190 3,227 2,784 241 Workplaces (other than outworkers' premises) 1,179 1,575 221 1,004 815 7 200 235 170 121 1 908 1,693 2,530 1,147 185 — 174 40 1,230 659 121 674 3,906 81 16 1,997 2,491 91 Total (Inspections) 9,049 3,769 504 4,744 3,848 893 756 3,730 830 363 2,160 3,191 2,460 3,360 4,189 2,675 167 1,898 3,076 2,466 4,080 585 3,982 5,133 5,007 248 6,050 5,342 399 2. Defects Found. Nuisances under the Public Health Acts. Want of cleanliness 674 77 44 650 54 17 140 248 58 74 262 73 79 59 492 81 97 71 58 504 218 62 198 709 622 26 154 880 63 Want of ventilation 22 3 3 31 3 1 1 27 2 — 51 — 2 1 33 35 3 2 2 3 15 3 — 76 112 1 7 146 9 Overcrowding 9 8 — 5 3 7 2 6 — — 15 — 2 5 14 9 7 4 23 — 6 — 3 26 38 3 2 63 3 Want of drainage of floors — 3 8 8 4 — 4 1 9 — — 35 — — 2 — — 1 1 — 8 3 1 — 16 3 Other nuisances 1,586 113 163 638 60 27 104 479 6 24 129 165 43 124 247 81 143 17 — 172 79 5 76 648 330 37 183 1,230 19 Sanitary accommodation Insufficient 16 11 11 14 1 1 8 15 3 1 2 3 2 4 44 10 1 1 — 1 4 3 18 16 18 4 5 64 Unsuitable 2,887 26 11 315 65 3 49 210 19 16 100 42 3 63 554 74 135 43 30 61 5 123 17 187 33 100 98 20 Not separate for sexes 56 1 1 8 4 2 — 46 2 — 5 1 — 9 14 3 1 — 2 — 9 5 8 6 20 1 2 114 4 Offences under the Factory & Workshop Act. Illegal occupation of underground bakehouse (s. 101) — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — Breach of special sanitary requiremcnts for bakehouses (ss. 97-100) — 37 6 — — 5 — — 8 — — 96 — — — 45 — 57 — — 14 13 — — 21 — 9 4 — Other offences (excluding offences relating to outwork) — — — — — — — 17 — — 2 — — — — — — — Total (defects found) 5,250 279 247 1,669 194 63 304 1,122 97 116 568 389 132 265 1,433 338 387 197 132 680 407 99 426 1,506 1,352 106 462 2,615 1ll 3. Homework. — Outworkers' Lists (s. 107). 60 108 128 296 128 64 78 120 138 122 38 92 138 318 47 124 656 60 Received twice" in the year from employers 1,382 76 72 170 152 56 72 286 26 26 380 Outworkers, Contractor 3,656 41 13 2,8031 60 228 11 437 6 304 34 3,071 76 92 215 88 137 9 — 30 67 462 68 73 1,107 4,263 346 j 82 9,050 9eo "corresponding there to, W kmen 11,661 320 669} 1,850 416 530 4,595 60 90 226 561 2,308 892 564 186 544 2,455 1,340 136 1,652 349 Received once in the year from employers Number of Lists 99 7 18 11 24 1 5 39 3 3 59 14 8 18 55 7 9 21 9 13 13 13 7 16 — 8 39 7 Outworkers.1 Contractors 178 1 1 1251 7 — — 48 — 6 — 8 6 3 24 1 15 — 16 291 48 179 { 3 171 corresponding thereto. Workmen 688 22 105 130 1 9 406 6 313 24 5 17 92 15 37 41 29 77 — 47 76/ — 22 24 Number of addresses of outworkers received from other Councils 709 825 — 3,103 — 135 — — — 268 3,478 — — — 2,746 360 1,008 — 386 2,'08 — — 2,385 1,133 — 747 511 443 115 Number of addresses of outworkers forwarded to other Councils 15,737 181 — 1,561 — 648 — — — 151 2,472 1,228 798 341 350 1l,336 82 589 87 285 4,663 148 Prosecutions Failing to keep lists or permit inspection thereof — — — — — — — — — — — — — — — — — — — — — — — — — — — — Failing to send lists — — — — — — — — — — 1 Outworkers' Premises. Number of inspections of outworkers premises — 760 1.384 6,031 1,325 122 331 508 — 278 1,658 588 — 193 637 121 167 364 298 1,294 — — 2,645 1,033 4,886 773 461 979 629 Outwork in unwhole- some premises(s. 108) Instances — 33 132 490 37 21 31 — 396 17 — — 26 3 — — — — — — 95 — 531 — 18 400 — Notices served 33 132 490 11 21 1 — 31 — 348 17 26 3 — — — 26 — — 95 — 531 — 28 813 18 Prosecutions — — — — — — — — — — — — Outwork in infected premises (ss. 109, 110) Instances 5 — 19 6 — — — — — — 24 8 8 — 7 — — — — 2 149 — 16 23 — Orders made (s. 110) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Prosecutions (ss. 109, 110) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Workshops. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Workshops on the Register at the end of 1912. — — — — — — — — — — — — — — — — — — — — — — — — — — — — Bakehouses (a) 21 79 74 89 162 33 69 60 71 57 105 62 34 32 241 91 214 91 53 84 75 167 75 107 179 24 127 85 42 Laundries 3,6571 29 401 2,0681 49 20 7 19 35 23 93 305 6 13 100 167 193 82 101 26 4,434 74 26 59 21 206 147 42 16 Other workshops 452 653 1,585 673 176 1,931 294 201 873 727 415 1,171 2,037 1,586 1,204 413 1,290 848 1,718b 1.117 2,871 3,320 1,429 2,772 175 Total (number of workshops on the Register) 3,678 560 767 2,157 1,796 726 252 2,010 4C0 281 1,071 1,094 455 1,216 2,378 1,844 1,611 586 1,444 958 4,509 1,959 1,218 3,037 3,520 230 1,703 2,899 233 5. Other Matters. Matters notified to H.M. Inspector of Factories. Failure to affix abstract of the Factory and Workshop Act (s. 133) 106 28 — 21 16 5 9 72 — 6 51 — 10 4 197 41 — 35 52 12 46 — 2 37 15 25 124 4 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acta but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 45 1 8 71 10 6 — 17 7 1 48 15 — 18 9 10 8 3 — 17 40 8 32 30 290 4 9 91 2 Reports (of action taken) sent to 45 8 72 3 6 17 7 1 41 15 — 18 7 10 8 3 — 17 35 8 15 1 244 4 9 91 2 H.M. Inspector Other 31 — — — 1 — — 48 — — — 36 — — — — — — — 4 6 — 9 46 — — 3 — Underground Bakehouse3 (s. 101). Certificates granted during 1912 — — — — — — — — — — — — — — 1 — — 1 In use at the end of 1912 21 30 32 26 65 28 25 34 49 12 50 30 21 21 195 75 72 20 54 25 65 132 41 40 59 19 47 68 15 (a) Including bakehousw not in use during the year. (6) Including workplaces. IV. Annual Report of the London County Council, 1912. APPENDIX II. TABLE SHOWING THE PERCENTAGE OF TENEMENTS IN EACH METROPOLITAN BOROUGH OCCUPIED AS TENEMENTS OF ONE, TWO, THREE OR FOUR ROOMS, AND THE PERCENTAGE OF THE POPULATION OCCUPYING OVERCROWDED TENEMENTS. Borough. Tenements of Percentage of total tenements in borough. Overcrowded tenements. (Tenements occupied by more than 2 persons per room.) Percentage of total population living in overcrowded tenements. 1901. 1911. Inc. ( + ) Dec. ( —) 1901. 1911. Inc. (+) Dec. (—) Paddington 1 room 2 rooms 3 „ 4 „ 150 19.8 19.5 10.6 15.6 20.1 21.9 12.7 + 0.6 +0.3 + 2.4 + 21 2.57 6.53 3.26 1.21 2.55 6.65 4.02 1.15 —0.02 +0.12 +0.76 —0.06 1-4 rooms 64.9 70.3 + 5.4 13.57 14.37 +0.80 Kensington 1 room 2 rooms 3 „ 4 „ 14.9 20.3 12.4 7.5 151 20.0 14.6 9.5 + 0.2 —0.3 + 2.2 + 2.0 2.91 7.43 3.39 1.11 2.88 7.53 3.53 1.25 —0.03 +0.10 +0.14 +0.14 1-4 rooms 55.1 59.2 + 4.1 14.84 15.19 +0.35 Hammersmith 1 room 2 rooms 3 „ 4 „ 10.5 17.0 191 13.6 11.6 17.0 21.8 16.5 + 1.1 — + 2.7 + 2.9 1.78 4.60 3.38 2.00 1.74 4.61 4.38 1.97 —0.04 +0.01 +1.00 —0.03 1-4 rooms 60.2 66.9 + 6.7 11.76 12.70 +0.94 Fulham 1 room 2 rooms 3 „ 4 „ 7.7 13.6 25.9 20.4 7.3 12.9 32.1 20.6 —0.4 —0.7 + 6.2 +0.2 1.26 2.97 4.16 2.46 1.37 3.53 5.87 2.86 +0.11 +0.56 +1.71 +0.40 1-4 rooms 67.6 72.9 + 5.3 10.85 13.63 +2.78 Chelsea 1 room 2 rooms 3 „ 4 „ 21.8 21.4 16.8 9.2 19.7 21.4 17.7 10.4 —21 +0.9 + 1.2 3.21 5.96 4.07 1.19 2.47 5.29 3.97 1.17 —0.74 —0.67 —0.10 —0.02 1-4 rooms 69.2 69.2 — 14.43 12.90 —1.53 Westminster, City of 1 room 2 rooms 3 „ 4 „ 18.3 23.4 15.2 7.8 17.8 25.3 19.4 10.1 —0.5 +1.9 +4.2 + 2.3 3.16 5.88 3.08 0.91 1.96 4.48 2.75 0.92 —1.20 —1.40 —0.33 +0.01 1-4 rooms 64.7 72.6 +7.9 13.03 10.11 —2.92 St. Marylebone 1 room 2 rooms 3 „ 4 „ 26.3 26.1 13.2 7.0 23.9 26.0 15.4 90 —2.4 —0.1 + 2.2 + 2.0 5.65 10.40 3.81 1.26 4.07 8.69 3.66 1.33 —1.58 —1.71 —0.15 +0.07 1-4 rooms 72.6 74.3 + 1.7 21.12 17.75 —3.37 Hampstead 1 room 2 rooms 3 „ 4 „ 6.4 13.7 13.7 8.4 6.9 13.1 16.0 9.8 + 0.5 —0.6 + 2.3 + 1.4 0.75 3.01 1.89 0.72 0.69 2.60 2.37 0.60 —0.06 —0.41 +0.48 —0.12 1-4 rooms 42.2 45.8 +3.6 6.37 6.26 —0.11 St. Pancras 1 room 2 rooms 3 „ 4 „ 23.5 29.5 16.5 9.4 21.9 29.8 19.9 11.2 —1.6 +0.3 + 3.4 + 1.8 5.57 12.21 4.39 1.81 4.72 11.38 5.07 1.85 —0.85 —0.83 +0.68 +0.04 1-4 rooms 78.9 82.8 +3.9 23.98 23.02 —0.96 Islington 1 room 2 rooms 3 „ 4 „ 16.4 23.9 18.2 120 17.8 24.3 21.7 13.7 + 1.4 +0.4 + 3.5 + 1.7 3.51 7.78 3.86 1.85 3.53 7.97 4.93 2.08 +0.02 —0.19 + 1.07 +0.23 1-4 rooms 70.5 77.5 +7.0 17.00 18.51 + 1.51 V Appendix II.—Tenements. Borough. Tenements of Percentage of total tenements in borough. Overcrowded tenements. (Tenements occupied by more than 2 persons per room.) Percentage of tolal population living in overcrowded tenements. 1901. 1911. Inc. ( + ) Dec. (—) 1901. 1911. Inc. ( + ) Dec. (—) Stoke Newington 1 room 2 rooms 3 „ 4 „ 7.6 13.5 15.9 12.1 8.6 14.3 20.0 15.4 +1.0 +0.8 +4.1 + 3.3 0.90 2.64 1.42 0.56 0.91 3.29 2.61 1.25 +0.01 +0.65 +1.19 + 0.69 1-4 rooms 49.1 58.3 + 9.2 5.52 8.06 + 2.54 Hackney 1 room 2 rooms 3 „ 4 „ 9.9 14.8 19.2 15.7 9.5 14.7 23.9 19.2 —0.4 —0.1 + 4.7 + 3.5 1.70 3.32 3.13 2.03 1.38 2.93 4.29 2.59 —0.32 —0.39 +1.16 + 0.56 1-4 rooms 59.6 67.3 + 7.7 10.18 11.19 +1.01 Holborn 1 room 2 rooms 3 „ 4 „ 27.0 27.8 16.1 7.2 22.6 32.6 20.6 9.4 —4.4 +4.8 +4.5 +2.2 8.28 11.36 4.38 1.03 4.83 913 4.27 110 —3.45 —2.23 —0.11 +0.07 1-4 rooms 78.1 85.2 +7.1 25.05 19.33 —5.72 Finsbury 1 room 2 rooms 3 „ 4 „ 26.4 32.7 17.6 8.4 27.9 33.9 19.1 8.8 +1.5 +1.2 +1.5 +0.4 8.02 16.72 8.23 2.25 7.52 18.35 9.40 2.63 —1.50 +1.63 +1.17 +0.38 1-4 rooms 85.1 89.7 + 4.6 35.22 37.90 +2.68 London, City of 1 room 2 rooms 3 „ 4 „ 14.5 210 16.6 9.8 13.0 26.0 23.2 16.3 —1.5 + 5.0 + 6.6 + 6.5 2.09 5.77 2.40 0.59 1.47 4.14 1.88 0.58 —0.62 —1.63 —0.52 —0.01 1-4 rooms 61.9 78.5 + 16.6 10.85 8.07 —2.78 Shoreditch 1 room 2 rooms 3 „ 4 „ 24.8 27.8 18.9 13.4 24.9 28.6 20.0 14.5 +0.1 + 0.8 + 1.1 + 1.1 7.03 12.17 7.40 3.35 6.99 13.85 8.75 4.46 —0.04 +1.68 +1.35 +1.11 1-4 rooms 84.9 88.0 + 3.1 29.95 34.05 +4.10 Bethnal Green 1 room 2 rooms 3 „ 4 „ 19.1 25.8 23.9 15.4 17.5 26.9 26.1 16.4 —1.6 + 11 + 2.2 + 1.0 5.86 10.95 8.56 4.25 4.53 1110 10.21 4.88 —1.33 +0.15 +1.65 +0.63 1-4 rooms 84.2 86.9 + 2.7 29.62 30.72 + 1.10 Stepney 1 room 2 rooms 3 „ 4 „ 21.7 25.7 19.5 13.6 18.3 27.3 21.9 15.3 —3.4 + 1.6 + 2.4 + 1.7 7.67 13.18 8.43 3.93 4.85 13.13 9.44 4.31 —2.82 —0.05 +1.01 +0.38 1-4 rooms 80.5 82.8 + 2.3 33.21 31.73 —1.48 Poplar 1 room 2 rooms 3 „ 4 „ 11.0 18.0 23.1 21.1 11.0 18.4 28.8 21.4 — + 0.4 + 5.7 + 0.3 2.50 4.88 5.40 3.63 2.03 4.86 7.24 4.37 —0.47 —0.02 + 1.84 +0.74 1-4 rooms 73.2 79.6 + 6.4 16.41 18.50 +2.09 Southwark 1 room 2 rooms 3 „ 4 „ 20.7 261 21.4 14.7 19.8 26.6 24.7 14.7 —0.9 +0.5 + 3.3 — 4.57 9.23 5.86 2.69 3.93 9.44 7.08 2.94 —0.64 +0.21 +1.22 +0.25 1-4 rooms 82.9 85.8 + 2.9 22.35 23.39 + 1.04 18820 H H VI Annual Report of the London County Council, 1912. Borough. Tenements of Percentage of total tenements in borough. Overcrowded tenements. (Tenements occupied by more than 2 persons per room.) Percentage of total population living in overcrowded tenements. 1901. 1911. Inc. ( + ) Dec. (—) 1901. 1911. Inc. ( + ) Dec. (—) Berinondsey 1 room 2 rooms 3 „ 4 „ 14.6 24.0 19.7 17.5 14.8 24.0 22.4 18.8 +0.2 — + 2.7 + 1.3 3.22 7.45 5.84 3.15 3.28 7.43 6.49 4.02 +0.06 —0.02 +0.65 + 0.87 1-4 rooms 75.8 80.0 + 4.2 19.66 21.22 + 1.56 Lambeth 1 room 2 rooms 3 „ 4 „ 14.2 17.4 17.1 14.1 12.7 16.8 20.7 17.9 —1.5 —0.6 + 3.6 + 3.8 2.61 4.83 3.14 1.64 2.03 4.29 3.64 2.30 —0.58 —0.54 +0.50 + 0.66 1-4 rooms 62.8 68.1 + 5.3 12.22 12.26 +0.04 Battersea 1 room 2 rooms 3 „ 4 „ 8.8 15.1 20.4 17.6 8.3 14.3 25.4 22.3 —0.5 —0.8 + 5.0 + 4.7 1.60 3.95 3.32 2.02 1.29 3.60 4.46 2.88 —0.31 —0.35 +1.14 + 0.86 1-4 rooms 61.9 70.3 + 8.4 10.89 12.23 +1.34 Wandsworth 1 room 2 rooms 3 „ 4 „ 4.1 7.2 15.0 16.0 4.1 6.5 18.9 19.8 —0.7 + 3.9 + 3.8 0.41 0.88 1.74 1.43 0.41 0.90 2.52 1.61 +0.02 +0.78 +0.18 1-4 rooms 42.3 49.3 + 7.0 4.46 5.44 + 0.98 Camberwell 1 room 2 rooms 3 „ 4 „ 8.6 13.6 17.4 16.4 9.0 13.7 23.2 19.0 +0.4 +0.1 + 5.8 + 2.6 1.37 3.18 3.29 1.81 1.47 3.47 4.73 2.62 +0.10 +0.29 +1.44 +0.81 1-4 rooms 56.0 64.9 + 8.9 9.65 12.29 +2.64 Deptford 1 room 2 rooms 3 „ 4 „ 8.0 13.5 15.9 19.3 7.5 13.4 23.5 20.2 —0.5 —0.1 + 7.6 +0.9 1.84 2.71 2.25 2.26 1.46 3.09 3.98 2.57 —0.38 +0.38 +1.73 +0.31 1-4 rooms 56.7 64.6 + 7.9 9.06 11.10 +2.04 Greenwich 1 room 2 rooms 3 „ 4 „ 7.0 13.0 15.2 20.1 6.4 12.1 21.4 21.7 —0.6 —0.9 + 6.2 + 1.6 0.92 2.16 2.67 2.55 0.80 2.25 4.86 2.59 —0.12 +0.09 +2.19 +0.04 1-4 rooms 55.3 61.6 + 6.3 8.30 10.50 +2.20 Lewisham 1 room 2 rooms 3 „ 4 „ 3.5 6.2 9.0 12.2 3.5 6.1 13.5 15.4 —0.1 + 4.5 + 3.2 0.34 0.75 0.79 0.79 0.28 0.75 1.39 0.94 —0.06 — + 0.60 + 0.15 1-4 rooms 30.9 38.5 + 7.6 2.67 3.36 +0.69 Woolwich 1 room 2 rooms 3 „ 4 „ 7 0 13.7 16.7 19.6 4.7 9.8 16.4 23.2 —2.3 —3.9 —0.3 + 3.6 0.96 1.84 1.83 1.97 0.51 0.98 1.82 1.70 —0.45 —0.86 —0.01 —0.27 1-4 rooms 57.0 54.1 —2.9 6.60 5.01 —1.59 VII Appendix III. APPENDIX III. DEFECTS NOTED ON MEDICAL EXAMINATION. Institutions. Defects. Returns analysed. Two or more defective teeth Vision. Throat and Nose. Ears. Heart. Lungs. Anœmia. Back. Various. Defective Signs of Eye Strain. Hearing. Discharge. Bound. Curvature. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) A.—L.C.C. Training Colleges, Secondary and Trade Schools. Training Colleges. Males 200 6 9 3 3 4 1 1 — — 1 11 — Females 568 31 89 19 10 3 3 3 — 43 72 20 45 Secondary Schools. Males 556 48 32 4 28 5 3 6 2 1 2 25 2 Females 1,559 176 117 36 45 15 6 34 8 96 190 63 53 Trade Schools. Males 521 70 46 8 25 7 8 12 2 3 6 9 11 Females 387 59 35 30 25 7 1 5 — 43 106 29 19 B.—Secondary and Trade Schools, aided but not maintained by the Council. Secondary Schools. Males 1,117 135 204 15 73 13 5 66 7 23 9 27 52 Females 974 111 178 27 29 8 3 63 1 53 36 72 42 Trade Schools Males 135 30 11 2 17 7 2 11 2 6 — 5 5 Females 265 17 39 — 6 1 1 13 1 14 18 28 18 18820 n h 2 VIII Annual Report of the London County Council, 1912. APPENDIX IV. NUMBER OF CANDIDATES EXAMINED FOR THE PERMANENT SERVICE AND THE CONDITIONS FOUND. Status. No. Examined No. of Examinations. No. Fit. Vaccination. Referred back. Rejected. Withdrawn prior to re-ex amiuation or Dot yet reported. Unvaccinated. No marks. Want of cleanliness. Throat. Teeth. Vision. Heart. Vaccination. Sundry. For one defect. For two or more defects. Total. l 2 3 A 5 6 7 8 9 10 l1 12 13 14 15 16 17 18 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. M. f. Head and assistant teachers and instructors 307 810 390 964 313* 776† 6 9 — 1 — 3 1 — 52 74 17 97 1 2 4 8 1 9 70 163 3 15 73 178 1 1 11 41 Heart Vision .Nurses, matrons, etc. — 5 — 8 — 6† ... ... ... ... — 1 — 1 ... ... ... — 2 ... — 2 ... ... Schoolkeepers, caretakers, etc. 32 — 40 — 35* — ... 1 — ... ... 5 — ... ... ... ... 5 — ... 5 — ... 1 — Total 339 815 430 972 348* 782† 6 9 1 1 — 3 1 — 57 75 17 98 1 2 4 8 1 9 75 165 3 15 78 180 1 1 12 41 * In the case of 22 males (18 teachers, 4 schoolkeepers), the figures for the first examination were included in the report for the 12 months ended 31st December, 1911. † In the case of 9 females (8 teachers, 1 nurse), the figures for the first examination were included in the report for the 12 months ended 31st December, 1911. APPENDIX V. SCHOLARSHIP CANDIDATES EXAMINED AND THE CONDITIONS FOUND. Scholarships. Number examined. Number of examinations. Fit. Vaccination. Referred back. Rejected. Withdrawn before re-examination or not yet reported. Not vaccinated. No marks. Want of cleanliness. Throat. Teeth, Vision. 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 l6 A.—County Scholarships. m. F. m. f. m. f. m. f, m. F. m. F. m. f. m. f. m. f. m. f. m. f. m. F. m. f. M f. m. F. Junior County 858 788 1,228 1,249 835 771 75 58 7 23 17 121 30 28 204 218 152 123 16 18 298 323 58 (5 for 3) 90 (o for 3) 356 413 5 10 18 7 Supplementary Junior County 122 159 170 242 *121 + 159 16 18 11 ... ... 15 1 3 33 39 18 28 1 ... 41 63 6 10 (2 for 3) 47 73 1 2 1 ... Intermediate County 116 54 151 61 115 54 2 ... 1 ... ... ... ... ... 24 3 14 4 ... 32 7 3 ... 35 7 1 ... ... ... Senior County 29 16 33 20 29 15 ... ... ... ... ... ... 1 ... 3 2 1 2 ... ... 3 4 1 ••• 4 4 ... 1 ... ... Total 1,125 1,017 1,582 1,572 1,100 +999 93 76 19 23 17 136 32 31 264 262 185 157 17 18 374 397 68 (5 for 3) 100 (7 for 3) 442 497 7 13 19 7 B.—Trade Scholarships. 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 ... 12 ... 14 ... 11 ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... 2 ... 1 ... ... Artificers, Boy 18 ... 20 ... 7 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... 2 ... 11 ... ... ... Beaufoy Institute 26 ... 35 ... 23 ... ... ... 1 ... ... ... 1 ... 9 ... ... ... ... ... 10 ... ... ... 10 ... 1 ... 2 ... Borough Polytechnic 22 ... 27 ... 20 • •• ... ... ... ... ... ... 1 ... 6 ... 1 ... ... ... 6 ... 1 ... 7 ... ... ... 2 ... Book production 12 ... 17 ... 11 ... ... ... ... ... 1 ... ... ... 3 ... 3 ... ... ... 3 ... 2 ... 5 ... ... ... 1 ... Building 40 ... 57 ... 39 ... ... ... ... ... 1 ... 1 ... 9 ... 7 ... ... ... 14 ... 2 ... 16 ... ... ... 1 ... Cookery 5 9 6 16 5 9 ... ... ... ... ... 4 1 ... ... 1 ... ... ... ... 1 5 ... ... 1 5 ... ... ... ... Corset-making ... 6 ... 10 ... 4 ... ... ... ... ... 3 ... ... ... 3 ... 3 ... ... ... 1 ... (2 for 3) 3 ... 4 ... 2 ... ... Dressmaking ... 70 ... 110 ... 64 ... 10 ... ... ... 13 ... 2 ... 18 ... 6 ... 3 ... 30 ... 6 ... 36 ... 5 ... 1 Electro-plating 2 ... 3 ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... ... Engineering 51 ... 66 ... 49 ... ... ... ... ... 1 ... 1 ... 11 ... 3 ... ... ... 16 ... 1 ... 17 ... ... ... 2 Free place (trade) 32 7 35 11 27 6 5 ... ... ... ... ... 1 ... 5 5 2 ... ... 1 8 4 ... 1 8 5 ... 5 1 Free place (Imperial College of Science and Technology 2 1 2 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture 19 ... 22 ... 19 ... 4 ... ... ... ... ... ... ... 2 ... 1 ... ... ... 3 ... ... ... 3 ... ... ... ... ... Laundry work ... 14 ... 23 ... 14 ... 1 ... ... ... 4 ... ... ... 3 ... 3 ... 1 ... 2 ... (1 for 3) 4 ... 6 ... ... ... ... Millinery ... 25 ... 34 ... 25 ... 3 ... ... ... 3 ... 2 ... 1 ... 3 ... ... ... 5 ... 2 ... 7 ... ... ... ... Photography ... 9 ... 13 ... 7 ... ... ... ... ... 2 ... ... ... 3 ... ... ... ... ... 3 ... 1 ... 4 ... 2 ... ... Beady-made clothing ... 37 ... 64 ... 33 ... 10 ... ... ... 11 ... 2 ... 14 ... 10 ... 1 ... 14 (2 for 3) ( 1 for 4) 10 ... 24 ... 1 ... 3 ShoreditchTechnical Institute 9 ... 9 ... 8 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... Salters' Company 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Silversmithing 5 ... 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tailoring, ladies' ... 30 ... 37 ... 27 ... 2 ... ... ... 1 ... ... ... 6 ... 1 ... ... ... 6 ... 1 ... 7 ... 3 ... ... Upholstery ... 33 ... 48 • • • 31 ... 7 ... ... ... 6 ... ... ••• 12 ... 6 4 ... 7 ... (3 for 3) 9 ... 16 ... 1 ... 1 Waistcoat making ... 9 ... 15 ... 8 ... ... ... ... ... ... ... ... ... 3 ... 1 ... 1 ... 5 ... ... ... 5 ... 1 ... ... Waiters 11 ... 16 ... 11 ... ... ... 1 ... ... ... ... ... 4 ... 2 ... ... 4 ... 1 ... 5 ... ... ... ... ... Woodcarving 3 ... 3 ... 2 ••• ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... Total 258 262 324 396 231 240 19 34 4 ... 3 47 6 6 53 71 20 33 2 11 70 84 7 37 (1 for 4) (8 for 3) 77 121 12 16 15 6 C.—Special Scholarships. 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 21 17 27 23 21 17 1 1 ... ... ... ... ... ... 6 4 ... 3 ... 6 5 ... 1 6 6 ... ... ... ... Blind 4 3 4 3 4 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cripple 12 7 12 7 9 6 2 ... ... ... ... ... ... ... 1 ... 1 1 • •• ... 2 1 ... 2 1 1 ... 2 1 Deaf ... 6 ... 6 ... 5 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 Junior Domestic Economy ... 531 ... 840 ... 491 ... 38 ... 7 ... 133 ... 17 ... 123 ... 84 ... 15 ... 197 ... 80 (13 for 3) (1 for 4) ... 277 ... 11 ... 29 Science 9 • •• 11 ... 9 ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... 2 ... ... ... ••• ... Trust Fund 3 2 3 2 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 49 566 57 881 46 524 4 39 ... 7 ... 133 ... 17 9 128 I 88 ... 15 10 204 ... 81 (13 for 3) (1 for 4) 10 285 1 11 2 31 18820 * In the case of 1 male the figures for the first examination were included in the report for the 12 months ended 31st December, 1911. t In the case of 2 females the figures for the first examination were included in the report for the 12 months ended 31st December, 1911. IX Appendix VI APPENDIX VI. 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 41 383 55 482 39 373 ... 14 ... 3 1 2 1 ... 9 43 5 47 ... 12 ... 3 14 90 1 8 (1 for 3) 15 98 1 3 1 7 Domestic economy training ... 7 ... 7 ... 7 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pupil teachers, handicraft 11 ... 14 ... 11 ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 3 ... ... ... 3 ... ... ... ... ... Student teachers 65 322 81 338 60 313 7 8 ... ... 2 7 ... 1 10 29 8 31 1 6 ... 3 12 61 4 (1 for 3) 7 (2 for 3) 16 68 5 4 ... 5 Training college students 217 507 295 665 196 488 3 9 ... 2 ... 13 2 ... 76 98 19 52 2 7 6 15 81 139 12 22 (2 for 3) 93 161 6 10 15 9 Totals 334 1,219 445 1,542 306 1,181 10 32 ... 5 3 22 3 1 97 170 33 130 3 25 6 21 110 290 17 (1 for 3) 37 (5 for 3) 127 327 12 17 16 21 x Annual Report of ike London County Council, 1912 APPENDIX VII. DIETARY TABLES AT RESIDENTIAL INDUSTRIAL SCHOOLS AND PLACES OF DETENTION. A.—Dietary Table foe 30 Younger Children (under 8). Day. Breakfast. Dinner. Tea. Sunday Cocoa ½ lb. Meat 6 lbs. Tea 2 ozs. Bread 8 lbs. Bread 2 lbs. Butter 12 ozs. Butter 12 ozs. Potatoes 12 lbs. Milk 8 pints Milk 8 pints Sugar 1 lb. Sugar 1 lb. Sugar 1 lb. Milk 8 pints Bread 5 lbs. Cornflour 1 lb. Cake, small piece. Monday Milk 15 pints Soup Milk 15 pints Butter or dripping 12 ozs. Bread 2 lbs. Sugar 1 lb. Sugar 1 lb. Raisin pudding Bread 8 lbs. Bread 8 lbs. Butter 12 ozs. Tuesday Milk 15 pints Irish stew Sugar 1 lb. Bread 2 lbs. Milk 15 pints Bread 8 lbs. Rice, sago or tapioca 1 lb. Sugar 1 lb. Butter or dripping 12 ozs. Sugar 1 lb. Bread 8 lbs. Milk 8 pints Butter 12 ozs. Wednesday Milk 15 pints Meat (roast) 6 lbs. Milk 15 pints Sugar 1 lb. Potatoes 12 lbs. Sugar 1 lb. Bread 8 lbs. Vegetables 6d. Bread 8 lbs. Butter 12 ozs. Bread 2 lbs. Butter 12 ozs. Rice, sago or tapioca 1 lb. Sugar 1 lb. Prunes 4 lbs. Thursday Milk 15 pints Minced meat 5 lbs. Milk 15 pints Sugar 1 lb. Potatoes 12 lbs. Sugar 1 lb. Bread 8 lbs. Bread 2 lbs. Bread 8 lbs. Butter 12 ozs. Rice 1 lb. (boiled) with jam (3 lbs. jam or rhubarb 6d.) Butter 12 ozs. Friday Milk 15 pints Fish 12 lbs. Milk 15 pints Sugar 1 lb. Potatoes 12 lbs. Sugar 1 lb. Bread 8 lbs. Bread 2 lbs. Bread 8 lbs. Butter or dripping 12 ozs. Suet pudding Butter or dripping 12 ozs. Saturday Milk 15 pints Bread 12 lbs. Milk 15 pints Sugar 1 lb. Fruit 2s. Sugar 1 lb. Bread 8 lbs. Butter 1 lb. Bread 8 lbs. Butter 12 ozs. Eggs 30 Butter 12 ozs. Ingredients and variations—- Cake—Flour, 3 lbs. ; sugar, 1 lb. ; lard, 1 lb. ; peel, 1/2lb. ; currants, £ lb. ; sultanas, f lb. One egg and 1 teaspoonful of baking powder to be added for each lb. of flour. Soup—Meat, 4 lbs. ; peas or lentils, 1 lb. ; vegetables, 6d. Irish stew—Meat, 6 lbs. ; potatoes, 12 lbs. Raisin pudding—Flour, 3 lbs. ; sugar, 1 lb ; raisins, 1 lb. ; suet, 11 lbs. Suet pudding—Suet, 11/2 lbs. ; flour, 3 lbs. ; treacle, 2 lbs. Porridge may be given occasionally for breakfast. Jam, marmalade or fresh fruit may be substituted occasionally for butter or dripping for tea. Fruit may occasionally be substituted for puddings at times of the year when it can be done with advantage. For children under 3 years of age this dietary may be varied by the provision of further milk and eggs. All ingredients are uncooked. Occasionally other recipes or methods of cooking may be employed provided the general quantities of ingredients are utilised, XI Appendix VII. B.—Dietary table for elder children (over 8). Week A. Day. Biscuits. Breakfast. Dinner. Tea. Supper orlunch* Cocoa. Margarine. Bread. Porridge. Jam or Syrup. Milk. Beef or mutton. Cold meat. Soup or Irish stew. Cornish pie. Fish. Pudding (jam. etc., milk, suet). Stowed fruit. Potatoes. Vegetables. Bread. Cheese. Cocoa. Tea or coffee. Margarine or dripping. Bread. Cake. Bread. Margarine. pt. oz. oz. pt. oz. pt. oz. oz. pt. oz. oz. oz. oz. oz. oz. oz. oz. pt. pt. oz. oz. oz. oz. oz. Sunday 1 ¾ ½ 7 ... ... ... 4½ ... ... ... ... ... 5 6 ... 3 ... ... ½ ½ 4 4 2 1/6 Monday 1 ... ... 4 ½ ... ½ 4½ ... ... ... ... 4 ... 4 6 2 ... ½ ... ½ 6 ... 2 1/6 Tuesday 1 ¾ ... 7 ... 1½ ... ... ... 1 ... ... ... ... ... ... 3 1 ... ½ ½ 6 ... 2 1/6 W ednesday 1 ... ... 4 ½ ... ½ 4½ ... ... ... ... 4 ... 4 6 2 ... ½ ... ½ 6 ... 2 1/6 Thursday 1 ¾ ½ 7 ... ... ... ... ... ... 12 ... ... ... ... 6 2 ... ... ½ ½ 6 ... 2 1/6 Friday 1 ... ... 4 ½ ... ½ ... ... ... ... 8 4 ... 6 ... 2 ... ½ ... ½ 6 ... 2 1/6 Saturday 1 ¾ ... 7 ... 1½ ... ... 4 ... ... ... ... ... 6 ... 3 1 ... ½ ½ 6 ... 2 1/6 Week B. Day. Biscuits. Breakfast. Dinner. Tea. Supper or iunch Cocoa. Margarine. Bread. Porridge. Jam or syrup. Milk. Beef or mutton. | Corned beef. t«oup or Irish stew. Stewed meat and rice. Fish. Pudding (jam, etc., milk. suet). Stewed fruit. Potatoes. Vegetables. Bread. Cheese. Cocoa. Tea of coffee. Mai g<t rin j or dripping. Bread. Cake. Bread. Margarine. pt. oz. oz. pt. oz. pt oz. oz. pt. oz. oz. oz. oz. oz. oz. oz. oz.. pt. pt. oz. oz. oz. oz. OZ. Sunday 1 ¾ ½ 7 ... ... 44 ... ... ... ... ... 5 6 ... 3 ... ... ½ ¼ 4 4 2 1/6 Monday 1 ... ... 4 ½ ... 1/2 44 ... ... ... ... 4 ... 4 6 2 ... ½ ... ½ 6 ... 2 1/6 Tuesday 1 ¾ ... 7 ... 1½ ... 1 ... ... ... ... ... ... 3 1 ... ½ ½ 6 ... 2 1/6 Wednesday 1 ... ... 4 ½ ... 1/2 4b ... ... ... ... 4 ... 4 6 2 ... ½ ... ½ 6 ... 2 1/6 Thursday 1 ¾ ½ 7 ... ... ... ... 8 ... ... ... ... 6 2 ... ... ½ ½ 6 ... 2 1/6 Friday 1 ... ... 4 ½ ... 4 ... ... ... 8 4 ... 6 ... 2 ... ½ ... ½ 6 ... 2 1/6 Saturday 1 ¾ ... 7 ... 1½ •• 4 ... ... ... ... ... 6 ... 3 1 ... ½ ½ 6 ... 2 1/6 Week c. Day. Biscuits. Breakfast. Dinner. Tea- Supper or lunch* Cocoa. Margarine. Bread. Porridge. Jam or syrup. Milk. Beef or Mutton. Bacon. Soup or Iri9h stew. Stewed meat and haricots. Fish. Pudding (jam, etc., milk, suet). Stewed fruit. Potatoes. Vegetables Bread. Cheese. Cocoa. Tea or coffee. Margarine or dripping. Bread. Cake. Bread. Margarine. pt. oz. oz. pt. oz. pt. oz. oz. pt. oz. oz. oz. oz. oz. oz. oz. oz. pt. pt. oz. oz. oz oz. oz. Sunday 1 ¾ ½ 7 ... ... 41/2 ... ... ... ... ... 0 6 ... 3 ... ... ½ 1 /4 4 4 2 1/6 Monday 1 ... ... 4 ½ ... 11/2 4 a ... ... ... ... 4 ... 4 6 2 ... 1/2 ... ... 0 ... 2 1/6 Tuesday 1 ¾ ... 7 ... 1½ ... 1 ... ... ... ... ... ... 3 1 ... 11/2 ... 6 ... 2 1/6 Wednesday 1 ... ... 4 ½ ... 11/2 41/2 4 ... 4 6 2 ... 1/2 ... ½ 6 ... 2 1/6 Thursday 1 ¾ ½ 7 ... ... ... ... ... 8 ... ... ... ... 6 2 ... ... 1/2 ... 6 ... 2 1/6 Friday 1 ... ... 4 ½ ... 1/2 ... ... ... 8 4 ... 6 ... 2 ... 1/2 ... 1/2 6 ... 2 1/6 Saturday 1 ¾ ... 7 ... 1½ ... ... 4 ... ... ... ... ... 6 ... 3 1 ... 1/2 ... 6 ... 2 1/6 Biscuits to be issued on mornings when children have to work, or are in school before breakfast. If given at bed time tooth brush drill compulsory after. Breakfast— ½oz. cocoa, I oz. sugar, A pint milk = 1 pint cocoa. Porridge—2 ozs. oatmeal, 1/3oz, sugar per child. 2 ozs, bread may be substituted for porridge if desired. xii Annual Report of the London County Council, 1912. Dinner— Meat, fish, potatoes and vegetables, weights uncooked. Roast and boiled pork to be at times substituted for roast or boiled beef or mutton, etc. 4 ozs.t shin beef, 2 ozs. split peas, 1/4oz. oatmeal or 1/2 oz tapioca, 1 oz. carrots, etc. = to each pint soup. 4 ozs.t shin beef, 1 oz. pearl barley, 1 oz. tapioca or sago, 1 oz. seasoning vegetable to each pint soup. 11/2 ozs. mutton, oz. pearl barley, 1 ozs. onions, 1 oz, carrots, 10 ozs. potatoes, etc. = 1 pint Irish stew. Cornish pie—41/2 ozs. beef, 3 ozs. potatoes, 1/5 pint milk, 3 ozs. flour, f oz. dripping, etc. Steived meat and rice—41/2 ozs. beef, ozs. rice, 1 oz. onions. Stewed meat and haricot beans—41/2 ozs. beef, 1 oz. haricot beans, 1 oz. onions, etc. 2 ozs. haricot beans may be substituted for 6 ozs. green vegetables on Monday. £ oz. jam, raisins, dates, figs or syrup, 13/4 ozs. flour, 1/2 oz. suet = 4 ozs. pudding ; if rice, sago or tapioca substituted = 11/8 ozs. rice, etc., 1/2 oz. sugar, 9/16 pint milk. 2 ozs. flour,2/3oz. suet = 4 ozs. suet pudding. Flour, dripping, etc., as necessary, to be used with fish. 4ozs. fruit uncooked, 3/4oz. sugar with water — 5 ozs. stewed fruit; rhubarb, apples, plums, prunes, etc., to be substituted at times of the year when it can be done with advantage. An apple or orange may at certain seasons be given in place of stewed fruit. Quantities of condiments which may be required for various dishes are not specified, N.B.—An additional allowance of 1 oz. of bread per child is to be issued at dinner. Such allowance, however, is not to be served out in the ordinary course, but is to be available only in case children ask for an additional amount of bread, and is to be disposed of at the discretion of the superintendent. The bread if not used is to be returned to store. Where alternatives are stated for dinner this is not to be understood as meaning that a permanent selection is to be made of one of the alternatives to be used throughout the year. It should also be understood that in exceptional local circumstances the superintendent may vary the order of the days of the week on which daily menus are prescribed or may continue some special article of diet without alternation, provided that this is exceptional and not a regular event. An a case in point, it might be convenient during the continuance of a spell of cold weather to give pea soup each week. Tea— oz. tea or coffee, 1/7 pint milk, 1/4 oz. sugar = 1/2 pint tea or coffee. 1/2oz. sugar, 1/8oz. peel, 1/16oz. carraway seeds or 3/4 oz. currants or sultanas, 21/2 ozs. flour, 1/2oz. dripping = 4-oz. cake. 1 egg and 1 teaspoonful of baking powder to be added for each pound of flour. *Supper or lunch— Supper for older children. Lunch for children who retire at an earlier hour. For children under 10, 1/4pint milk to drink. An apple or salad to be given occasionally, margarine then omitted. xiii. Appendix VIII APPENDIX VIII. NECESSITOUS SCHOOL CHILDREN. 1. Menus of meals supplied (under contract with the Council) by the Alexandra Trust, City Road, London, E.C. Menu No. DINNER MENUS—Winter. 1. Haricot bean soup, bread, treacle pudding. 2. Fish and potato pie, bread, baked raisin pudding. 3. Pea soup, bread baked in dripping, fruit pudding. 4. Stewed beef or mutton, suet roll, steamed potatoes, bread. 5. Beef stewed with peas, suet roll, potatoes, bread. 6. Mutton stewed with haricot beans, steamed potatoes, bread, suet pudding. 7. Meat and potato pie, bread. 8. Meat pudding, potatoes, bread. 9. Toad-in-the-hole, potatoes, bread. 10. Rice pudding, 2 slices currant or sultana bread and butter. DINNER MENUS—Summer. 11. Rice pudding, two slices bread and butter. 12. Toad-in-the-hole, potatoes, bread, 13. Meat pies, potatoes, bread. 14. Meat pudding, pocatoes, bread. 15. Cold meat pie, fruit roll. 16. Meat sandwich, piece of cake. 17. For infants, hot milk and bread, fruit roll. Menu No. DINNER MENUS—For infants. 18. The same as Winter Dinner Menu No. 4. 19. do. do. No. 5. 20. do, do. No. 6. 21. Rice, tapioca, macaroni or barley pudding, with two slices of sultana bread and butter. 22. Stew—very fine mince. 23. Baked custard, with bread and butter. 24. Savoury custard, with bread and butter. BREAKFAST MENUS. 25. Cocoa, porridge and two slices bread and butter. 26. Cocoa, three slices bread and dripping. 27. Hot milk and bread, two slices bread and jam or marmalade. NOTE.—The summer dinner menus are ordinarily supplied to the dining centres from 1st June to 30th September, and the winter menus during the other months. If desired, however, the winter menus will be supplied at any time during the year. 2. Ingredients of the meals supplied (under contract with the Council) by the Alexandra Trust. (The quantities stated are the quantities to be used for each 100 meals.) DINNER MENUS—Winter. (Meals to be supplied at an inclusive rate of 15s. 8dper 100). Menu No. 1.—Haricot bean soup, bread, treacle pudding. Ingredients : (а) Soup. 14 lbs. Haricot beans (large white), lentils or dried green peas. 1 lb. Tapioca, 11/2 lbs. rice and 1 lb. barley. 25 qts. water. 1 teaspoonful celery seed, a small handful of parsley, a little pepper and salt. 1/2 gallon milk, whole milk best quality. 10 lbs. bread, best household. 1 lb. dripping, beef or mutton. (б) Pudding. 7 lbs flour, best household. or 14 lbs. 7 lbs. bread crumbs best household / flour. 31/2 lbs. suet, beef. 4 lbs. treacle, pure cane syrup, or 6 lbs. jam. 1/4 lb. baking powder. 2.—Fish and potato pie, bread, baked raisin pudding. Ingredients : (a) Fish Pie. 21 lbs. hake or cod, fresh. 36 lbs. potatoes. Parsley, pepper, salt. 1 lb. margarine. 10 lbs. bread, best household. (b) Pudding. 9 lbs. flour, best household or 16 lbs, 7 lbs. bread, best household/ flour. 31/2 lbs. margarine. 3 lbs. raisins. 3 lbs, sugar. 16 eggs. Water to mix. 3.—Pea soup, bread baked in dripping, fruit pudding. Ingredients ; (a) Soup. 14 lbs. peas, yellow split. 11/2 lbs. rice. 1 lb. tapioca. 1 lb. pear] barley. 18820 Menu No. 25 qts. water. 6 lbs. onions, Spanish or Egyptian. 6 lbs. carrots and turnips, best quality. Celery, salt and pepper. (When celery is not obtainable celery seed may be used.) 10 lbs. bread, best household. 1 lb. dripping. (b) Pudding. 7 lbs. flour, best household or 14 lbs. 7 lbs. bread, best household flour. 31/2 lbs. suet, beef. 4 lbs. fruit, dried, 1/4 lb. baking powder. 4.—Stewed beef or mutton, suet roll, steamed potatoes, bread. Ingredients ; (a) Stew. 16 lbs. of beef or mutton, without bone. 6 lbs. dried peas or haricot beans. 6 1bs, onions, Spanish or Egyptian. 6 lbs. carrots, best quality. 1 lb. flour, best household. 4 qts. water. Seasoning (1/2 pt. vinegar, salt, pepper). 12 peppercorns, 3 cloves, 1 blade mace36 lbs. potatoes. 10 lbs. bread, best household. (b) Dumplings. 2 lbs. suet. 8 lbs. flour, best household, 1/4 lb. baking powder. 5,—Beef stewed with peas, suet roll, potatoes, bread. Ingredients : 20 lbs. beef. 6 lbs. onions, Spanish or Egyptian. 6 lbs. dried green peas, English marrowfat. 1 lb. flour, best household. Seasoning (celery seed, salt, pepper). 10 qts. water. 8 lbs. flour, best household. 2 lbs. suet. 2 ozs. baking powder. 36 lbs. potatoes. 10 lbs. bread, best household. ii xiv. Annual Report of the London County Council, 1912. APPENDIX VIII -(Contd.) Menu No. 6.—Mutton stewed with haricot beans, steamed potatoes, bread, suet pudding. Ingredients : (a) Stevt, 20 lbs. neck and breast of mutton. 3 lbs. onions, Spanish or Egyptian. 10 qts. water. Seasoning (parsley, pepper, salt). 1 lb. flour, best household. 6 lbs. haricot beans, large white. 36 lbs. potatoes. 10 lbs. bread, best household. b) Pudding. 8 lbs. flour, best household. 2 lbs. suet, beef. 2 ozs. baking powder. 7.—Meat and potato pie, bread. Ingredients ; 16 lbs. beef and mutton, 6 lbs. haricot beans. 1 lb. onions. 8 pints of water, 36 lbs. potatoes. Seasoning pint vinegar pepper, salt, mace). 14 lbs. flour, best household. 31/2 lbs. dripping, beef. 5 lb, baking powder,??? 5 lbs. bread, best household. 8.—Meat pudding, potatoes, Bread. Ingredients : 18 lbs. beef, without bone. 5 qts. water, 1 lb. onions. 6 lbs. haricot beans, large white. 14 lbs. flour, best household. 31/2 lbs. suet, beef or mutton. 36 lbs. potatoes. 10 lbs. of bread, best household. Seasoning (pepper, salt). 9.-—Toad-in-the-hole, potatoes and bread. Ingredients : (a) Toad-in-the-hole. 161bs. beef, 4 quarts water, 14 lbs. flour, 4 quarts milk, 8 eggs, with seasoning of finest vinegar, pepper and salt, (b) 36 lbs. potatoes, (c) 5 lbs. bread. 10.—Rice pudding, 2 slices currant or sultana bread and butter. Ingredients : 9 lbs. rice, 4 lbs. custard powder, 6 gallons skimmed milk, 4 gallons water, 3 lbs. sugar, 2 lbs. sultanas, 3 lbs. suet, 20 lbs. bread, 2 lbs. butter. DINNER MENUS—Summer. (Meals to be supplied at an inclusive rate of 15s, 8d, per 100 meals), 11.—Rice pudding, 2 slices bread and butter. Ingredients : As for meal No. 10. 12.—Toad-in-the-hole, potatoes and bread. Ingredients : As for meal No. 9. 13.—Meat pies, potatoes and bread, Ingredients : As for meal No. 7. 14.—Meat pudding, potatoes and bread. Ingredients : .As for meal No. 8. Menu No. 15.—Cold meat pie, fruit roll, Ingredients : (a) Meat pie. 10 lbs. flour, 14 lbs, meat, 21/2 lbs. dripping, baking powder, pepper and salt, (b) Fruit roll. 10 lbs. flour, 21/2 lbs. suet, 2 ozs. baking powder, 21/2 lbs, dried fruit. 16.—Meat sandwich, piece of cake. Ingredients : (ci) Meat sandwich. 18 lbs. meat, beef or ham, 20. lbs, bread, 2 lbs., butter. (b) Cake 12 lbs. 17.—Hot milk and bread and fruit roll. Ingredients : Hot milk and bread. 6 gallons milk, 10 lbs. bread. Fruit roll, same as for Meal 15. DINNER MENUS FOR INFANTS—Winter. (Meals to be supplied at an inclusive rate of 15s, 8d. per 100 meals), 18.—Winter dinner Menu No. 4. 19. do. No. 5. 20. do. No. 6. 21.—Rice, tapioca, macaroni or barley pudding, with two slices of sultana bread and butter. Ingredients : 9 lbs. rice, 4 lbs. custard powder, 6 gallons skimmed milk, 4 gallons water, 3 lbs. sugar, 3 lbs. suet, 20 lbs. bread, 2 lbs. butter, 2 lbs. sultanas. 22.—Stew--very fine mince. Ingredients : Dinner Menus No. 4, 5 or 6, minced up finely, 23.—Baked custard, with bread and butter. Ingredients : 4 gallons milk, 64 eggs, 1 lb. sugar, 20 lbs. bread, 2 11 s. butter. 24.—Savoury custard, with bread and butter. Ingredients : 64 eggs, 4 gallons good stock, 20 lbs. bread, 2 lbs. butter. BREAKFAST MENUS. (Meals to be supplied at an inclusive rate of 12s. per 100 meals.) 25.—Cocoa, porridge and 2 slices of bread and butter. Ingredients: (a) Cocoa, 1 lb, cocoa, 3 lbs. sugar, 1 gallon milk. (b) Porridge. 5 lbs. rolled oats. 3 lbs. sugar. 1 gallon milk. (c) Bread and butter. 20 lbs. bread, 2 lbs. butter. 26.—Cocoa, three slices bread and dripping. Ingredients: (a) Cocoa, as for Meal No. 1. Bread and dripping. 36 lbs. bread, 4 lbs. dripping. 27.—Hot milk and bread, two slices of bread and jam or marmalade. Ingredients : 9 gallons milk, 30 lbs. bread. 7 lbs. jam or marmalade. xv Appendix IX. APPENDIX IX. General Terms oF Agreement with Hospitals, Committees op Medical Practitioners, and Nursing Associations for the Treatment of the Several Ailments included in the Council's Scheme:— The following are the conditions and terms of the agreements between the Council and hospitals for the treatment of eye, ear, nose and throat defects and of ringworm in the administrative county of London— (i.) No cases shall be received for treatment by the hospitals except such as are found on inquiry to be from their circumstances and the nature of their disease suitable for special hospital treatment. (ii.) The hours of attendance shall be made to suit the convenience of the hospital, but special arrangements shall be made within the hospital for passing the children through the routine of the hospital apart from the arrangements made for dealing with other out-patients. (iii.) Any assistants appointed for the work shall be fully qualified, and shall be appointed by and be under the sole control of the governing body of the hospital. They shall devote the whole of the time for which their services are paid for by the Council to the work of dealing with children referred to the hospital by the Council. (iv.) Each clinical assistant shall be required to deal with twelve new eye cases or twelve new ear, nose and throat cases (viz., a total of approximately 500 children a year), or two new ringworm cases (viz., a total of 88 children a year), a half-day of not more than three hours in addition to such old cases as he may have instructed to attend for further treatment. An anesthetist shall be allowed in ear, nose and throat cases on one half-day a week for each 1,000, or part thereof, children agreed to be treated at the hospital. (v.) A payment by the Council of £50 a year for each clinical assistant or anaesthetist working one half-day a week, and a capitation fee of 2s. for eye, ear, nose and throat cases, and 7s. for the treatment of ringworm cases by means of X-rays shall be accepted by the hospital in full discharge of any extra expense incurred by them. The capitation payment for the treatment of ringworm by means of ointment or lotion shall be 2s. Any payment made by the Council for the services of medical staff shall be paid proportionately to the doctors doing the work. (vi.) No payment given shall entitle the Council to representation on the governing body of the hospital nor to interference in any way with the work of the departments concerned, but the hospital shall allow the attendance of an officer of the Council at the hospital for the purpose of regulating the attendance of the children and of supplying to the Council such particulars as will enable the Council to ensure that every child referred to the hospital shall continue in attendance at the hospital until discharged, and that any home treatment or spectacles ordered by the hospital doctors are satisfactorily provided. (vii.) Each child patient shall be taken to the hospital by the parent or guardian or other responsible person and the prescription in each case shall be given to the child or its parent. Medicines or drugs required for the treatment of the special defect for whch children are referred to the hospital shall be supplied by the hospital to the patient free of charge. In oases in which spectacles are prescribed and children are referred to a particular optician, the prescription card shall contain a staetment of the prices charged for the spectacles. (viii.) Each child patient referred to the hospital by the Council shall present at the hospital a card issued by the Council, directing the child named thereon to attend the hospital on a specified date, which shall be handed to the hospital authorities by the person presenting the child. The card shall be the voucher for the capitation payment. (ix.) The hospital shall, if required by the Council, certify whether a child patient is fit to attend school during the treatment. (x.) Agreements shall be for one year, and shall be subject to annual revision and to termination at the end of each year by three months' notice on either side. The following are the conditions and terms of the agreements between the Council and the committees of local medical practitioners formed for the establishment of medical treatment centres in the administrative county of London— (i.) The committee of medical practitioners shall provide a medical treatment centre in a central position in premises to be approved by the Council, for the maintenance of which the committee of medical practitioners shall be responsible. Administrative control of the arrangements for supplying the centre with patients, " following up " and generally the supervision of the work of the centre shall be vested in the Council. The centre shall be available without extra payment by the Council for use in connection with the Council's system of medical inspection of school children and for the further examination of children. (ii.) The classes of cases to be dealt w th at the centre shall, unless otherwise arranged, include eye cases for errors of refraction, ear, nose and throat cases requiring operation, ringworm oases for X-rays treatment, and minor ailments, including discharging ears, external eye diseases, such as blepharitis and conjunctivitis, skin disease such as impetigo and sores, and such other conditions as require the daily services of a nurse, and arrangements shall also be made for home visits by district nurses after operations for adenoids, tonsils, etc. (iii.) No cases shall be received for treatment by the committee of medical practitioners except such as are found on inquiry to be from their circumstances and the nature of their disease suitable for treatment at the centre. The committee of the centre reserve to themselves the right to refuse treatment in any particular case. (iv.) The hours of attendance shall be made to suit the convenience of the children and of the committee, (v.) The medical staff appointed for this work shall be selected by the Council from nominations received from the local medical practitioners. The dootors shall devote the whole of the time for which their services are paid for by the Council to the work of dealing with children referred to the centre by the Council. Each doctor shall be required to deal with an average of ten new eye (refraction) cases or ten new ear, nose and throat cases each half-day of two and a-half hours (viz., a total of 440 oases a year), in addition to suoh old cases as he may have instructed to attend for further treatment. An anaesthetist shall be allowed in the ear, nose and throat department on one halfday a week for each 880, or part thereof, children agreed to be treated at the centre. Doctors appointed to deal with ringworm cases shall treat two new oases a half-day (viz., 88 cases a year), except where any inclusive capitation payment is made. Doctors appointed to deal with minor ailments shall see 15 new cases a session (660 a year). (vi.) A payment by the Council of £50 a year for each medical practitioner or ansesthetis working one half-day a week, and a capitation payment of 2s. for eye (refraction), ear, nose and throat cases, of 7s. for X-rays treatment of ringworm cases, shall be accepted by the committee in full discharge of any expense incurred by them. For the treatment of minor ailments, the capitation payment shall be 4d., which shall be accepted by the committee of medical practitioners as covering the full cost of dealing with these cases, including the provision of the medicine and drugs necessary for the treatment at the centre. The capitation payment [with the exception of that for minor ailments] shall be made upon the number of cases arranged to be treated, whether or not that number actually attends the centre. This payment shall be made quarterly in advance about the middle of the quarter. In the first year a 18820 1 1 2 xvi. Annual Report of the London County Council, 1912. payment will be made by the Council for equipment (excluding structural alterations) on condition that it shall be purchased through the Council's stores, shall be maintained in satisfactory condition by the committee of medical practitioners and shall remain the property of the Council. This payment shall not exceed £100 in respect of the treatment of eye, ear, nose and throat cases and a further sum of £75 where X-rays apparatus is provided. (vii.) The Council shall, for the purpose of assisting the doctors in the treatment of refraction cases and ear, nose and throat cases requiring operation, and ringworm cases, provide a nurse employed in the public health department of the Council to attend the centre while treatment is being given. In connection with the treatment of these cases the Council will also provide an officer who will attend the centre to regulate the attendance of children and to supply information to enable the Council to ensure that every child attends the centre until discharged, and that any home treatment or spectacles ordered by the doctor are satisfactorily provided. (viii.) For the nursing treatment of minor ailments the Council shall make arrangements for the daily attendance at the centre of a nurse from a local nursing association or elsewhere to carry out the instructions of the doctor, and shall pay the local nursing or other association a sum of £100 for the equivalent of the services of a full-time nurse and her equipment, drugs, lotions, etc., necessary for the treatment in the homes and travelling expenses. (ix.) The Council's representatives shall from time to time visit the premises while treatment is being given. Any lay officer who may be required to visit the centre shall not in any way interfere in respect of the treatment prescribed or given. (x.) The vouchor for the capitation payment shall be a card issued by the Council directing the child named thereon to attend the medical treatment centre on a specified date, which shall be handed to the medical centre authorities by the person presenting the child. (xi.) Each patient shall be taken to the medical treatment centre by the parent or guardian or other responsible person, and the prescription, in each case, shall be given to the child or its parent. Medicines or drugs required for the immediate treatment of the defects (other than minor ailments, which are provided for in clause (vi.) ) for which children are referred to the treatment centre will be supplied by the committee free of charge. In cases in which spectacles are prescribed and children are referred to a particular optician the prescription card shall contain a statement of the prices charged for the spectacles. (xii.) The committee shall, if required by the Council, certify as to whether a child patient is fit to attend school during the treatment. (xiii.) Agreements shall be for one year and shall be subject to annual revision and to termination at the end of each year by four months' notice on either side. The following are the conditions and terms of the agreements between the Council and the committees of voluntary institutions other than hospitals for the establishment of dental treatment centres in the administrative county of London— (i.) The committee of the centre shall provide a dental treatment centre in a central position in premises to be approved by the Council, for the maintenance of which the committee of the centre shall be responsible. Administrative control of the arrangements for supplying the centre with patients, " following up " and generally the supervision of the dental work of the centre under the agreement with the Council shall be vested in the Council. (ii.) No cases shall be received for treatment at the centre except such as are found on inquiry to be, from their circumstances, suitable for treatment at the centre. The committee of the centre reserve to themselves the right to refuse treatment in any particular case. (iii.)Treatment shall be provided for children of six, seven and eight years of age, and, in urgent cases, for children of other ages. The consent of the parents or guardians shall be obtained in each case before treatment is given. (iv.) The hours of attendance should be made to suit the convenience of the committee of the centre and the children. (v.) Any dentist or ansethetist appointed for this work shall be fully qualified (the dentist being registered on qualifications approved by the British Dental Association), and shall be selected by the Council from nominations received from the committee of the centre. The dentist and anaesthetist shall devote the whole of the time for which their services are paid for by the Council to the work of dealing with children referred to the centre by the Council. (vi.) Each dentist shall be required to deal with an average of 10 new cases each half-day of 2J hours, viz., 440 cases a year, in addition to such old cases as he may have instructed to attend for further treatment, except on half-days allotted to the treatment of cases requiring an ansethetist when no new cases shall be referred to the centre. [An anaesthetist shall attend at each centre on one half-day a fortnight.] (vii.) Payment shall be made by the Council either (a) at the rate of £50 a year for each dentist and ansethetist working on one half-day a week, or (6) at the rate of £400 a year for a whole-time dentist working on 10 half days a week, or £200 a year for a half-time dentist working five half-days a week, whichever is the more favourable to the Council, and at the rate of £50 a year for each anaesthetist working one half-day a week. These payments and a capitation fee of 2s. upon each child referred by the Council to the centre for dental treatment shall be accepted by the committee of the centre in full discharge of any expenses incurred by them in providing the treatment. The Council shall guarantee the capitation payment upon two-thirds of the cases agreed to be treated at the centre, whether or not that number actually attend the centre. This part of the capitation payment shall be paid quarterly in advance at about the middle of each quarter. (viii.) A sum not exceeding £50 shall be allowed in the first year of the scheme only for the provision of the necessary equipment on the understanding that any equipment so provided shall be purchased through the Council's stores, and shall remain the property of the Council, and shall be maintained by the committee of the centre in a fair condition. This payment shall not cover the cost of the materials for the treatment or the carrying out of any structural alterations to the premises which may be necessary. (ix.) The voucher for the capitation payment shall be a card issued by the Council directing the child named thereon to attend the centre on a specified date, which card shall be handed to the authorities of the centre by the person presenting the child for treatment. (x.) The committee of the centre shall, if required by the Council, certify as to whether a child patient is unfit to attend school during the treatment. (xi.) Nothing in this agreement shall prevent the inspection of the work of the dentist by an officer appointed by the Council, or the visit of a representative of the Council to the surgery while treatment is being given. The Counoil shall provide a nurse employed in the public health department on each half-day that the children attend for treatment. The committee of the centre shall allow an officer of the Council to attend the centre for the purpose of regulating the attendance of the children, and of supplying the Council with such particulars as will enable it to ensure that every child referred to the centre shall continue in attendance until discharged. (xii.) The Council will at its own expense arrange for a duly qualified nurse employed in the publio health department of the Counoil to be in attendance at the oentre on eaoh half-day that the children are being received by the Association for treatment. (xiii.) Agreements shall be for one year dating from 1st August, and shall be subject to annual renewal and to termination at the end of each year by four months' notioe on either side. xvii. Appendix IX.—(Contd.) The following arc the conditions and terms of the agreements between the Council and hospitals for the dental treatment of children attending public elementary schools— (i) No cases shall be received for treatment by the hospital except such as are found on inquiry to be from their circumstances suitable for special treatment. (ii.) The hours of attendance shall be made to suit the convenience of the hospital and the children. (iii.) Any dentist or anaesthetist appointed for the work shall be fully qualified and, for the purposes of treatment, be appointed by, and be under the sole control of the hospital. (iv.) Payment shall be made by the Council at the rate of £400 a year in respect of the services of a full-time dentist, working on 10 half-days of 21/2 hours each a week, or £200 a year in respect of the services of a dentist working on 5 half-days of 21 hours each a week, subject to any necessary adjustment of salary being made from time to time in regard to dental inspection and treatment, and at the rate of £50 a year for the anaesthetist working one half-day a week, and a capitation fee of 2s. shall be accepted by the hospital in full discharge of any extra expense incurred by them in providing treatment. (v.) The voucher for the capitation payment shall be a card, issued by the Council, directing the child named thereon to attend the hospital on a specified date, which card will be handed to the authorities at the hospital by the person presenting the child. (vi.) The hospital authorities shall, if required by the Council; certify as to whether a child patient is fit to attend school during the treatment. (vii.) The consent of the parent shall be obtained in every case before treatment is given, and the responsibility for the treatment shall rest with the hospital. (viii.) The hospital shall allow an officer of the Council to attend the hospital for the purpose of regulating the attendance of the children and of supplying the Council with such particulars as will enable it to ensure that every child referred to the hospital shall continue in attendance until discharge. (ix.) The hospital shall provide treatment for children 6, 7 and 8 years of age, and in urgent cases for children of other ages. Ten new cases a session may be referred to the hospital for treatment each half-day by the Council, except on half-days allocated for the treatment of cases requiring an anaesthetic when no new cases shall be referred to the hospital. (x.) Agreements shall be for one year dating from 1st August, and shall be subject to annual renewal and to termination at the end of each year by three months' notice on either side. The following are the conditions and terms of the agreements between the Council and nursing associations in connection with the nursing treatment of children attending public elementary schools— (i.) The scope of the work shall include nursing treatment of children suffering from discharging ears, external eye diseases, viz., blepharitis and conjunctivitis, skin diseases, such as impetigo, and sores, and such other conditions as require the daily services of a nurse, and also home visits after operations for adenoids, tonsils, etc. (ii.) The work shall be carried on partly at a suitable centre and partly in the homes of the children. (iii.) The association shall allocate a nurse, who should attend daily at the centre from 12.15 to 1.45 and from 4.30 to 6.30, and on Saturdays from 9 to 12, and shall give such treatment as the doctor in charge of the case may direct, and also arrange for the necessary home visiting. (iv.) The Committee shall appoint a doctor to be selected by the Council from nominations received from the committee or association, and the doctor shall attend at the centre on one half-day a week to see the children and supervise the work of the nurse. (v.) The Council shall pay the association £100 a year for the equivalent of the whole-time services of one nurse. Such payment should include the cost of equipment, drugs, lotions, etc., necessary for the treatment in the homes, and arrangements for home visiting, ncluding travelling expenses. (vi.) The work shall be carried on under the supervision of the Council's school medical officer. (vii.) Not less than fifteen new cases shall be referred to the centre by the Council each session. xviii. • xviii. Annual Report of the London County Council, 1912, APPENDIX X. Statement showing the various hospitals and centres included in the Council's scheme, and the annual provision made as from the 1st January, 1913, for the treatment of the specified ailments. Hospital or centre. Eyes. Ear, Nose and Throat. Ringworm. Minor Ailments. Teeth. Total No. provided for in agreements. Belgrave 500 1,000 1,500 Charing Cross 250 500 70 — 820 Deptford Children's Health Centre 440 1,320 — — 2,860 4,620 Fulham School Treatment Centre 440 880 — 1,100 1,400 3,820 Hackney School Treatment Centre 440 1,760 — 1,100 — 3,300 Home and Infirmary, Lower Sydenham 250 250 — — — 500 Islington School Treatment Centre 440 1,320 176 1,100 1,540 4,576 London 3,000 3,500 350 — — 6,850 Metropolitan Ear, Nose and Throat — 250 — — — 250 Metropolitan, Kingsland-road 500 500 — — — 1,000 Miller General 500 500 88 — — 1,088 Norwood School Treatment Centre 880 440 176 1,100 1,540 4,136 Peckham School Treatment Centre 440 1,320 88 1,100 1,540 4,488 Poplar Hospital — — — — 1,760 1,760 Poplar School Treatment Centre 880 1,320 — 1,100 — 3,300 Royal Eye 4,000 — — — — 4,000 Royal London Ophthalmic 5,000 — — — — 5,000 St. Cecilia's School Treatment Centre — — — 440 — 440 St. George's Dispensary — 440 — — 1,980 2,420 St. George's Mission — — — 1,100 — 1,100 St. Marylebone General Dispensary — — — — 1,050 1,050 St. Mary's 500 500 176 — — 1,176 St. Mary's Ringworm School, Eltham — — 44 — — 44 St. Pancras School Treatment Centre 880 880 — 1,100 1,540 4,400 South London Nursing Treatment Centre — — — 1,100 — 1,100 Wandsworth School Treatment Centre 880 880 220 1,100 2,100 5,180 Women's Hospital for Children 500 500 — 1,100 — 2,100 Woolwich and Plumstead Cottage Hospital .. 500 1,000 1,540 3,040 Totals 21,220 19,000 1,388 12,540 18,850 73,058 Appendix XI. xix. APPENDIX XI. PARENTS PRESENT, 1912. Routine examinations and urgent cases. Boys. Girls. Infants. Number examined. Parents present. percentage. Number examined. Parents present. Percentage. Number examined. Parents present. Percentage. West— Paddington 2,042 1,028 50.3 1,990 1,206 60.6 2,696 1,923 71.3 Kensington 1,876 789 42.0 2,263 1,049 46.3 2,606 1,565 60.0 Hammersmith 2,036 1,056 51.9 1,856 1,189 64.1 2,435 1,756 72.1 Fulham 2,973 1,621 54.6 3,071 1,953 63.6 3,561 2,558 71.8 Chelsea 1,088 474 43.6 902 549 60.9 1,146 816 71.2 Westminster 1,531 839 54.8 1,490 932 62.5 1,902 1,502 79.0 North— St. Marylebone 1,464 744 50.8 1,539 839 54.5 2,114 1,511 71.5 Hampstead 770 348 45.2 804 370 46.0 1,153 729 63.2 St. Pancras 3,653 2,027 55.5 3.615 2,404 66.5 4.649 3.534 76.0 Islington 4,914 3,153 64.2 4,805 3,294 68.6 6,857 5,508 80.3 Stoke Newington 1,263 743 58.8 463 326 70.4 637 524 82.3 Hackney 3,789 2,397 63.3 3,805 2,744 72.1 4,604 3,656 79.4 Central Holborn 883 363 41.1 817 406 49.7 1,049 585 56.7 Finsbury 1,755 929 52.9 1,676 1,107 66.1 2,417 1,743 72.1 City of London 339 210 61.9 349 232 66.5 342 273 79.8 East— Shoreditoh 3,002 1,726 57.5 2,253 1,516 67.3 3,036 2,319 76.4 Bethnal Green 2,977 1,812 60.9 2,807 2,006 71.4 3,552 2,857 80.4 Stepney 3,793 2,294 60.5 6,833 4,107 60.1 7,968 5,883 73.8 Poplar 3,319 2,053 61.9 3,089 2,188 70.9 3,879 3,042 78.4 South— Southwark 4,700 2,277 48.4 3,829 2,607 68.1 4,794 3,760 78.4 Bermondsey 2,617 1,481 56.6 2,727 1,786 65.5 3,413 2,647 77.5 Lambeth 4,346 2,648 60.9 4,646 3,132 67.4 5,509 4,157 75.4 Battersea 2,929 1,669 57.0 2,942 1,965 66.8 3,864 3,087 79.9 Wandsworth 5,145 3,198 62.2 5.298 3,695 69.7 6,893 5,487 79.6 Camberwell 4,731 2,982 63.0 4,749 3,271 68.9 6,105 4,812 78.8 Deptford 1,824 1,126 61.7 1,874 1,294 69.0 2,413 1,856 76.9 Greenwich 1,850 1,144 61.8 1,872 1,261 67.4 2,395 1,889 78.9 Lewisham 2,389 1,500 62.8 2,308 1,640 71.0 2,726 2,083 76.4 Woolwich 2,672 1,724 64.5 2,413 1,768 73.2 2,910 2,307 79.3 London County 76,670 44,349 57.8 77,085 50,836 65.9 97,625 74,369 76.1 xx. Annual Report of the London County Council, 1912 APPENDIX XII. Classification of children examined as to condition of clothing, nutrition, cleanliness and condition of teeth. Percentage of children in each class. Boroughs arranged topographically. Number of children examined. Condition of clothing. Condition as regards nutrition. Condition of cleanliness. Condition of Teeth. Good. Fair. Poor. Good. Fair. Poor. Good. Fair. Poor. Good. Fair. Poor. A.—ENTRANTS—BOYS— West— Paddington 1,279 56.6 37.5 5.9 43.2 49.0 7.8 65.0 27.5 7.5 62.5 24.2 13.3 Kensington 1,306 45.6 46.6 7.8 34.9 58.8 6.3 53.4 33.4 13.2 63.5 26.1 10.4 Hammersmith 1,183 50.6 45.8 3.6 24.2 70.1 5.7 81.3 15.9 2.8 55.5 25.4 19.1 Fulham 1,753 60.9 33.1 6.0 42.6 51.4 6.0 70.8 24.0 5.2 59.9 26.4 13.7 Chelsea 573 52.0 40.3 7.7 52.0 37.0 11.0 61.8 32.6 5.6 59.2 31.7 9.1 Westminster 967 61.4 33.1 5.5 48.5 38.6 12.9 71.9 24.9 3.2 52.0 40.0 8.0 North— St. Marylebone 1,010 52.3 43.6 4.1 40.5 55.5 4.0 60.4 33.4 6.2 60.7 25.1 14.2 Hampstead 529 53.9 43.3 2.8 62.6 31.4 6.0 63.3 34.6 2.1 63.7 29.3 7.0 St. Pancras 2,307 55.9 40.2 3.9 42.2 51.6 6.2 70.4 24.8 4.8 62.4 28.6 9.0 Islington 3,382 47.4 46.7 5.9 42.9 49.1 8.0 65.7 30.2 4.1 65.2 24.1 10.7 Stoke Newington 324 50.3 48.2 1.5 35.2 58.9 5.9 67.3 30.2 2.5 71.9 15.1 13.0 Hackney 2,241 52.4 44.5 3.1 31.3 58.8 9.9 62.9 33.4 3.7 74.1 21.5 4.4 Central— Holborn 453 45.7 47.2 7.1 35.6 57.6 6.8 69.1 26.6 3.3 54.8 30.0 15.2 Finsbury 1,221 26.4 61.5 12.1 36.4 54.3 9.3 40.0 48.4 11.6 60.5 31.5 8.0 City of London 170 53.5 44.7 1.8 48.3 43.5 8.2 65.3 31.8 2.9 42.9 47.1 10.0 East— Shoreditch 1,428 41.6 52.0 6.4 49.3 45.9 4.8 59.3 37.1 3.6 78.5 12.7 8.8 Bethnal Green 1,754 39.3 52.8 7.9 43.0 44.4 12.6 47.7 45.7 6.6 62.4 30.3 7.3 Stepney 3,890 39.5 51.9 8.6 47.0 43.2 9.8 49.2 42.0 8.8 50.7 37.3 12.0 Poplar 1,908 30.3 61.1 8.6 29.1 60.2 10.7 47.5 44.9 7.6 65.7 22.6 11.7 South— Southwark 2,342 33.8 57.6 8.6 32.1 56.5 11.4 45.3 48.2 6.5 54.4 31.5 14.1 Bermondsey 1,600 33.5 53.6 12.9 23.9 60.1 16.0 49.3 42.9 7.8 74.7 18.7 6.6 Lambeth 2,719 55.5 40.6 3.9 56.5 37.1 6.4 62.6 32.7 4.7 66.6 21.2 12.2 Battersea 1,971 47.7 45.8 6.5 18.7 72.4 8.9 59.6 34.3 6.1 43.2 43.5 13.3 Wandsworth 3,443 63.0 33.5 3.5 36.4 59.7 3.9 72.7 24.4 2.9 56.9 34.7 8.4 Camberwell 3,000 56.7 40.5 2.8 55.0 41.8 3.2 64.2 32.8 3.0 66.7 25.2 8.1 Deptford 1,160 51.6 40.7 7.7 47.3 45.5 7.2 55.1 39.6 5.3 71.0 22.0 7.0 Greenwich 1,161 34.4 60.4 5.2 33.1 60.5 6.4 41.9 52.4 5.7 67.2 26.2 6.6 Lewisham 1,375 64.4 33.2 2.4 44.6 48.8 6.6 73.5 25.3 1.2 71.2 24.7 2.4 Woolwich 1,431 51.1 44.1 4.8 54.2 41.5 4.3 72.8 24.0 3.2 56.3 27.2 16.5 London County 47,880 48.5 45.5 6.0 40.9 51.3 7.8 60.5 34.1 5.4 61.9 27.8 10.3 B.—ENTRANTS—GIRLS— West— Paddington 1,305 59.6 36.8 3.6 47.1 47.9 5.0 64.3 25.4 10.3 64.5 22.5 13.0 Kensington 1,230 47.2 45.4 7.4 34.1 62.0 3.9 54.3 33.2 12.5 60.0 27.2 12.8 Hammersmith 1,212 51.5 45.4 3.1 30.5 65.0 4.5 82.5 14.6 2.9 54.1 25.8 20.1 Fulham 1,685 61.0 34.8 4.2 43.2 50.3 6.5 71.6 22.9 5.5 62.5 26.6 10.9 Chelsea 543 46.2 43.3 10.5 49.7 40.5 9.8 58.8 33.5 7.7 57.8 34.3 7.9 Westminster 862 58.1 35.6 6.3 42.0 50.9 7.1 73.1 21.8 5.1 62.3 26.9 10.8 North— St. Marylebone 984 51.0 44.8 4.2 41.0 54.2 4.8 60.7 32.5 6.8 60.1 26.0 13.9 Hampstead 469 58.4 40.1 1.5 56.5 39.2 4.3 67.0 30.2 2.8 58.4 35.4 6.2 St. Pancras 2,210 56.1 40.0 3.9 46.9 49.2 3.9 69.3 26.5 4.2 64.9 26.0 9.1 Islington 3,258 51.0 45.4 3.6 46.2 46.8 7.0 66.1 29.3 4.6 67.4 22.6 10.0 Stoke Newington 289 55.7 42.9 1.4 47.1 48.1 4.8 65.7 32.2 2.1 73.4 16.9 9.7 Hackney 2,217 56.0 40.9 3.1 34.2 56.8 9.0 64.3 31.5 4.2 74.0 21.3 4.7 Central— Holborn 467 41.3 55.7 3.0 36.0 58.0 6.0 66.8 27.6 5.6 58.7 28.5 12.8 Finsbury 1,109 26.4 65.4 8.2 38.5 51.6 9.9 39.8 47.1 13.1 60.3 31.8 7.9 City of London 170 62.4 34.7 2.9 46.5 47.6 5.9 75.9 22.3 1.8 45.9 42.3 11.8 East— Shoreditch 1,497 47.6 48.1 4.3 55.7 41.2 3.1 59.1 38.4 2.5 79.0 12.7 8.3 Bethnal Green 1,664 44.2 48.8 7.0 46.4 43.1 10.5 49.3 42.6 8.1 63.9 30.3 5.8 Stepney 3,850 42.9 50.1 7.0 48.6 41.3 10.1 47.1 43.9 9.0 51.1 37.7 11.2 Poplar 1,794 35.2 58.2 6.6 35.5 55.8 8.7 47.0 45.7 7.3 66.1 23.0 10.9 South— Southwark 2,289 37.1 56.5 6.4 38.1 52.1 9.8 48.1 46.1 5.8 55.9 31.5 12.6 Bermondsey 1,671 34.0 53.4 12.6 27.0 59.8 13.2 47.9 44.1 8.0 74.9 17.3 7.8 Lambeth 2,551 55.8 40.9 3.3 55.2 39.5 5.3 62.2 32.0 5.8 67.0 20.9 12.1 Battersea 1,820 47.7 46.5 5.8 20.2 72.3 7.5 56.9 37.2 5.9 42.6 44.3 13.1 Wandsworth 3,327 66.5 30.7 2.8 35.9 60.2 3.9 74.9 22.9 2.2 58.0 32.9 9.1 Camberwell 2,930 59.8 38.7 1.5 56.7 40.6 2.7 63.7 33.3 3.0 64.4 26.9 8.7 Deptfor 1,145 52.9 40.5 6.6 48.8 45.6 5.6 55.9 38.4 5.7 66.8 25.8 7.4 Greenwich 1,196 40.0 56.5 3.5 38.4 57.0 4.6 50.6 45.4 4.0 66.0 25.7 8.3 Lewisham 1,274 63.7 34.7 1.6 50.1 42.5 7.4 76.5 22.4 1.1 73.5 22.8 3.7 Woolwich 1,420 53.6 43.6 2.8 53.0 43.7 3.3 72.8 23.5 3.7 58.0 28.1 13.9 London County 46,438 50.6 44.6 4.8 43.1 50.3 6.6 60.9 33.5 5.6 62.6 27.3 10.1 XXI. APPENDIX XII. MEDICAL INSPECTION OF SCHOOL CHILDREN—ENTRANTS. SUMMARY OF DEFECTS REPORTED BY SCHOOL DOCTORS. AGE GROUP—ENTRANTS—BOYS. F.=Defects found. (x) =Defects referred for treatment. Borough. Number of children examined. Clothing and footgear. Nutrition. Cleanliness and condition of skin. Skin defects. Teeth. Nose and throat. Enlarged glands. Eyes. Ears. Speech. Circulation. Defects of lungs. Defects of nervous system. Tuberculosis. Rickets. Deformities. Infectious diseases. Malnutrition. Enlarged glands (other than throat). 3rd term only. Other defects. Cards issued. Tonsils. Adenoids. Tonsils and adenoids. Other defects. External disease. Squint & defective sight 1st & 2nd terms. Squint. 3rd term only. Defective sight. 3rd term only. Disease and defects. Disease. Hearing. Disease and hearing. 1. 2 3. Defect. Stammering. Other defects. Heart defects. Anæmia. Phthisis. Other. 1. 2. 3. 1. 2. 3. 4.* 3rd term only. 1. 2. 3. F. (x) (x) F. F. (X) F. (x) F. (x) F. F. F. f. (X) F. f. (X) f. (X) f. (x) F. (x) F. (X) F. (x) F. (X) f. (X) F. (x) F. (x) F. (x) F. (x) f. (X) F. (x) f. (X) Battersea 1,971 940 902 129 368 1,428 173 2 1,174 677 120 27 20 852 856 263 181 201 128 249 24 7 96 8 31 29 8 52 30 23 41 1 4 1 15 12 10 8 49 40 6 4 5 3 4 2 73 5 9 4 2 2 5 4 3 47 24 579 Bermondsey 1,600 535 858 207 383 961 247 9 789 687 124 77 34 1,195 300 105 111 182 181 190 73 7 246 33 81 37 11 94 52 17 48 2 18 80 8 48 18 139 80 22 8 4 3 2 76 16 26 11 5 2 11 11 4 204 76 539 Bethnal Green 1,754 690 925 139 754 779 214 7 837 802 115 36 19 1,094 532 128 85 77 56 91 81 19 42 3 67 43 10 1 93 34 4 28 4 1 5 19 49 9 69 25 5 3 4 3 6 1 34 4 31 6 4 1 10 10 1 33 15 371 Camberwell 3,000 1,702 1,213 85 1,651 1,252 97 1,926 984 90 37 24 2,002 756 242 78 251 152 273 59 17 80 10 47 31 20 11 78 60 26 65 8 1 13 1 31 14 48 30 85 46 10 3 8 8 1 1 16 5 37 17 4 2 7 5 48 36 777 Chelsea 573 298 231 44 298 212 63 354 187 32 9 3 339 182 52 31 61 46 75 4 4 14 5 12 14 2 14 7 2 6 2 9 1 5 47 10 1 2 2 1 17 1 4 1 2 1 2 7 7 144 City 170 91 76 3 82 74 14 111 54 5 12 2 73 80 17 13 20 7 11 4 1 1 1 11 1 8 3 2 5 3 2 2 1 2 39 Deptford 1,160 599 472 89 549 527 84 639 459 62 37 14 823 256 81 153 138 158 164 50 16 117 33 30 25 5 43 41 14 50 10 6 21 19 1 19 4 53 19 11 5 5 3 1 1 11 34 2 2 2 56 17 424 Finsbury 1,221 322 751 148 444 663 114 488 591 142 25 15 739 385 97 99 102 42 72 25 16 288 5 33 21 2 35 28 4 24 2 2 6 43 2 49 6 75 18 14 2 10 3 7 4 83 3 8 2 1 32 12 275 Fulham 1,753 1,067 581 105 747 900 105 1 1,240 421 92 53 21 1,049 463 241 161 178 141 196 37 12 93 11 49 38 3 1 70 42 12 33 12 4 8 27 11 30 17 111 52 7 3 9 7 8 7 51 7 22 7 5 13 13 27 14 552 Greenwich 1,161 399 701 61 384 703 74 487 608 66 21 17 780 304 77 82 68 47 100 17 9 24 19 30 12 3 1 39 35 10 44 1 2 16 13 26 19 16 10 1 1 2 6 1 7 6 3 3 31 11 282 Hackney 2,241 1,174 998 69 701 1,319 218 3 1,409 749 83 41 21 1,661 482 98 65 247 220 206 53 14 184 17 89 47 10 3 83 67 42 46 8 1 40 1 105 5 33 19 152 50 27 6 4 2 5 1 183 9 41 13 7 7 75 41 506 Hammersmith 1,183 599 542 42 287 829 66 1 962 188 33 25 6 657 300 226 157 149 137 137 26 1 123 4 20 12 4 1 26 34 7 25 5 2 59 1 28 2 47 9 4 1 3 3 3 24 3 29 17 1 2 2 88 24 356 Hampstead 529 285 229 15 331 166 32 335 183 11 5 2 337 155 37 26 37 24 31 13 3 23 9 7 5 2 6 11 2 10 7 18 2 11 7 28 3 13 3 35 2 11 1 6 6 3 13 6 105 Holborn 453 207 214 32 161 261 31 313 125 15 23 7 248 136 69 49 67 97 40 26 3 148 2 23 5 7 1 13 27 12 F9 3 16 13 2 28 8 42 14 2 2 2 2 2 24 7 3 17 5 136 Islington 3,382 1,602 1,580 200 1,451 1,662 266 3 2,221 1,022 139 69 23 2,208 811 363 325 326 310 435 35 17 152 26 86 53 10 1 118 75 60 91 20 8 64 48 8 83 45 112 51 17 4 4 2 11 2 91 13 38 8 1 11 10 51 27 1,009 Kensington 1,306 596 608 102 456 768 82 697 437 172 29 11 829 341 136 57 112 79 101 38 7 108 27 29 23 6 2 34 34 9 25 1 5 21 38 12 60 11 9 4 1 2 1 55 7 35 7 1 1 1 19 15 275 Lambeth 2,719 1,509 1,103 107 1,536 1,008 172 3 1,703 889 127 61 45 1,810 578 331 386 316 278 347 43 17 94 30 70 36 11 86 71 23 72 2 2 9 31 7 48 34 67 45 28 6 2 2 13 5 62 6 14 6 2 10 9 ] 126 69 981 Lewisham 1,375 885 457 33 613 671 91 1,010 348 17 13 2 979 339 57 62 63 95 113 7 24 4 17 10 3 18 19 7 20 1 1 9 2 ' 6 1 15 5 1 1 1 11 2 12 3 1 1 1 3 14 9 225 Paddington 1,279 723 480 76 553 626 100 831 352 96 16 8 799 310 170 94 101 67 106 13 4 93 11 11 17 4 i 15 25 6 24 3 2 1 20 4 23 6 52 13 15 5 2 1 2 1 23 1 8 5 2 2 13 2 31 18 292 Poplar 1,908 578 1,166 164 555 1,148 204 1 907 857 144 60 18 1,254 431 223 183 179 141 209 56 26 150 9 70 36 6 i 83 49 10 34 2 8 47 4 23 13 112 52 7 3 4 2 7 49 9 22 5 12 7 75 32 604 St. Marylebone 1,010 528 441 41 409 561 40 610 337 63 6 2 613 254 143 71 71 48 81 3 2 27 4 13 14 7 i 29 16 16 29 2 7 19 4 13 4 13 3 15 1 2 1 2 1 16 7 3 1 4 4 9 15 10 230 St. Pancras 2,307 1,290 927 90 974 1,191 142 1,624 573 110 40 17 1,441 659 207 129 178 169 136 66 6 182 17 52 33 19 75 59 31 46 12 41 1 45 5 91 47 146 55 24 1 4 3 2 61 4 40 8 7 7 4 52 37 526 Shoreditch 1,428 594 742 92 704 655 68 1 847 529 52 61 42 1,121 182 125 140 206 127 230 51 19 93 67 60 32 7 73 62 30 61 5 12 1 45 19 37 26 158 105 13 7 3 3 2 51 16 45 13 2 2 1 1 58 33 567 Southwark 2,342 792 1,348 202 752 1,323 262 5 1,062 1,127 153 89 31 1,273 738 331 367 300 228 310 69 12 187 47 46 43 17 76 85 43 89 3 10 1 37 11 78 57 159 96 26 12 4 2 4 1 32 7 31 11 1 1 14 14 5 93 55 955 Stepney 3,890 1,538 2,019 333 1,829 ' 1,678 378 5 1,916 1,633 341 219 41 1,971 1,452 467 320 419 287 387 181 33 202 18 202 88 32 2 190 109 49 71 9 1 18 61 15 145 25 210 60 35 9 15 8 16 5 141 6 63 3 4 12 12 5 1 89 51 1,074 Stoke Newington 324 163 156 5 114 191 19 218 98 8 9 5 233 49 42 2 61 60 37 7 2 20 1 9 1 2 7 5 4 1 2 6 1 4 1 10 2 6 1 17 10 1 1 3 55 Wandsworth 3,443 2,170 1,152 121 1,252 2,057 134 2,505 839 99 43 24 1,958 1,195 290 379 366 293 423 33 17 50 17 43 23 22 65 54 21 56 10 26 12 30 20 70 37 11 4 4 4 6 2 30 3 22 14 3 2 7 7 2 64 35 973 Westminster 967 594 320 53 469 373 125 695 241 31 25 8 503 387 77 60 83 63 79 5 3 12 6 11 4 6 14 18 15 1 11 2 4 2 16 1 9 2 49 14 1 1 1 1 1 1 19 3 8 2 1 1 16 9 206 Woolwich 1,431 731 631 69 775 594 62 1,042 343 46 43 33 805 389 237 281 247 244 311 9 6 22 21 39 16 13 11 57 34 24 42 8 4 49 6 17 12 13 13 32 27 11 6 2 2 1 1 34 7 29 28 4 3 13 13 36 26 698 47,880 23,201 21,823 2,856 19,582 24,580 3,677 41 28,952 16,340 2,588 1,211 513 29,646 13,302 4,932 4,147 4,806 3,925 5,140 1,108 300 2,895 464 1,278 759 251 52 1,593 1,185 510 1,106 126 32 384 19 888 164 1,020 447 2,191 961 357 110 109 69 113 39 1,327 147 648 203 43 19 164 153 55 3 1,422 714 13,755 AGE GROUP—ENTRANTS—GIRLS. Battersea 1,820 869 846 105 367 1,316 137 1,036 676 108 48 21 775 807 238 144 207 94 235 14 4 84 5 29 21 8 57 28 19 35 2 1 2 14 10 7 6 41 27 2 5 5 5 4 43 2 5 3 6 6 2 1 44 17 522 Bermondsey 1,671 569 892 210 452 999 210 10 801 737 133 132 32 1,252 289 130 155 156 132 143 68 17 211 32 70 45 10 82 50 18 38 3 14 92 4 59 28 146 85 33 16 7 1 1 39 9 8 2 11 11 3 158 63 549 Bethnal Green 1,664 735 813 116 772 718 166 8 821 709 134 44 17 1,063 505 96 82 68 41 78 78 19 32 4 59 35 10 1 65 34 11 35 3 27 4 30 6 78 40 9 4 2 2 3 1 16 2 6 2 3 2 10 10 29 14 336 Camberwell 2.930 1,751 1,134 45 1,661 1,191 77 1 1,868 975 87 45 16 1,888 787 255 248 219 140 235 52 10 63 10 53 43 15 10 90 52 24 55 3 6 37 20 41 32 99 50 14 6 8 3 2 12 4 30 11 3 2 7 6 1 1 40 35 733 Chelsea 543 251 235 57 270 220 53 319 182 42 9 2 314 186 43 35 35 23 31 3 17 4 17 14 5 23 7 3 4 2 9 3 6 2 39 7 2 2 4 2 1 5 5 2 1 1 9 5 110 City 170 106 59 5 79 81 9 129 38 3 14 4 78 72 20 21 19 4 11 1 1 1 7 5 1 1 9 1 1 1 5 1 2 1 1 1 1 2 1 1 1 2 1 42 Deptford 1,145 606 463 76 559 522 64 640 440 65 28 5 765 295 85 147 133 127 137 37 16 69 23 26 23 4 30 51 17 65 1 12 1 15 28 14 54 26 25 12 2 16 2 16 3 3 3 1 51 18 401 Finsbury 1,109 293 725 91 427 572 110 442 522 145 31 7 668 253 88 83 94 67 74 21 4 245 6 20 22 4 34 35 9 28 2 41 3 31 5 60 14 11 6 4 2 2 19 1 10 3 I 1 26 16 241 Fulham 1,685 1,028 587 70 729 847 108 1 1,207 386 92 51 14 1,054 448 183 147 131 116 125 25 7 70 9 37 20 3 5 43 37 16 37 3 14 18 3 23 13 90 39 10 4 11 8 3 1 28 10 10 4 11 11 24 16 422 Greenwich 1,196 478 676 42 459 682 54 1 605 543 48 16 8 790 307 99 103 69 43 93 24 12 22 13 14 22 7 40 32 10 42 4 1 3 1 6 4 23 17 13 8 5 4 1 1 1 6 3 8 8 20 12 292 Hackney 2,217 1,242 906 69 757 1,260 198 2 1,426 699 92 138 21 1,641 471 105 75 280 203 171 34 8 178 12 91 43 10 83 51 42 43 4 23 1 65 7 43 22 138 48 37 6 10 7 1 84 8 22 9 7 7 2 2 78 39 471 Hammersmith 1,212 624 550 38 370 788 54 1,000 177 35 30 9 656 312 244 167 130 129 126 37 1 112 1 14 8 4 3 23 33 13 25 1 6 36 3 18 1 36 11 4 2 2 2 3 3 14 7 8 4 2 2 1 1 104 34 352 Hampstead 469 274 188 7 265 184 20 314 142 13 11 7 274 166 29 12 35 16 33 8 1 16 4 6 3 3 7 15 4 9 1 3 16 11 1 36 11 11 1 1 2 27 7 3 1 1 2 11 4 61 Holborn 467 193 260 14 168 271 28 312 129 26 36 1 274 133 60 48 75 86 30 25 167 1 16 1 4 6 43 13 12 1 24 6 3 35 14 50 12 2 2 1 1 1 1 14 2 11 4 2 2 13 2 115 Islington 3,258 1,661 1,479 118 1,504 1,525 227 2 2,151 956 151 96 17 2,195 735 328 73 305 282 348 26 9 131 10 67 55 22 118 85 50 77 9 5 34 2 39 6 46 25 90 40 17 3 7 3 2 1 41 5 14 2 4 10 10 53 33 847 Kensington 1,230 581 558 91 419 763 48 668 408 154 49 10 739 335 156 56 115 57 79 21 3 120 40 30 8 4 11 27 42 4 34 1 5 17 30 4 48 6 4 5 4 1 37 14 5 1 2 1 21 13 231 Lambeth 2,551 1,424 1,044 83 1,407 1,008 136 1,587 816 148 91 26 1,709 533 309 399 296 178 288 31 14 64 14 64 51 10 . 1 87 69 35 59 4 11 27 4 43 21 88 44 28 6 2 1 5 22 1 8 2 6 6 81 59 866 Lewisham 1,274 811 442 21 638 542 94 975 285 14 30 3 936 291 47 54 57 66 72 3 13 2 16 20 15 2 32 17 10 26 1 4 5 2 18 2 4 3 2 1 4 1 4 3 4 3 180 Paddington 1,305 778 480 47 615 625 65 839 331 135 22 3 842 293 170 76 99 56 84 8 1 75 7 6 21 6 2 21 25 10 25 2 21 1 22 7 45 14 10 5 3 3 18 2 4 3 3 20 13 266 Poplar 1,794 631 1,045 118 637 1,001 155 1 844 819 131 54 20 1,186 413 195 182 177 106 160 44 21 127 7 60 39 3 1 76 51 23 46 4 1 6 41 4 9 9 99 40 11 2 5 3 3 1 27 4 19 7 6 1 54 25 542 St. Marylebone 984 502 441 41 404 533 46 1 597 320 67 10 7 591 256 137 71 67 45 73 2 54 5 12 15 8 22 10 15 20 3 18 3 9 4 14 4 6 2 1 6 4 4 4 2 3 3 7 1 15 13 219 St. Pancras 2,210 1,240 884 86 1,036 1,088 86 1,532 586 92 37 21 1,435 575 200 155 171 146 139 38 9 153 12 39 23 36 44 54 31 65 8 29 34 5 100 34 146 51 12 3 3 8 2 46 1 27 5 1 1 1 60 31 490 Shoreditch 1,497 713 720 64 834 617 46 884 575 38 56 28 1,183 190 124 142 217 110 224 46 23 65 43 54 37 8 75 41 48 59 5 2 8 2 39 14 37 23 145 108 18 7 11 9 5 2 27 10 27 10 7 4 47 26 595 Southwark 2,289 849 1,294 146 873 1,192 223 1 1,100 1,056 133 117 23 1,279 722 288 370 295 210 279 48 18 159 43 61 29 11 3 69 88 42 92 1 1 8 1 44 23 67 35 154 93 26 11 4 4 5 21 10 16 7 1 1 6 6 4 75 39 905 Stepney 3,850 1,652 1,927 271 1,872 1,589 379 10 1,815 1,688 347 262 39 1,966 1,452 432 317 387 203 296 126 15 153 19 164 85 22 1 150 98 49 72 6 1 6 71 13 140 29 193 57 34 10 18 10 16 5 53 4 28 7 2 29 28 84 55 972 Stoke Newington 289 161 124 4 136 139 14 190 93 6 13 1 212 49 28 2 48 46 27 1 13 6 4 1 5 7 6 2 2 1 6 1 2 1 5 1 3 4 1 39 Wandsworth 3,327 2,214 1,019 94 1,195 2,001 130 1 2,493 760 74 61 17 1,928 1,096 303 419 361 206 383 26 2 47 14 44 40 19 71 42 18 37 3 6 1 41 15 19 12 49 29 g 4 4 3 5 1 12 2 11 6 4 1 2 1 4 1 47 23 919 Westminster 862 501 307 54 362 439 61 630 188 44 32 4 537 232 93 56 60 42 64 10 5 9 3 16 13 3 26 18 6 13 4 1 13 2 8 2 37 14 2 2 4 1 1 1 7 2 2 2 1 10 7 197 Woolwich 1,420 761 619 40 752 621 47 1,034 333 53 44 12 823 399 198 253 176 189 237 12 7 13 8 28 13 12 50 27 26 41 4 2 40 2 13 9 13 11 46 37 18 6 4 1 8 3 25 10 16 13 2 2 17 17 12 10 555 46,438 23,498 20,717 2,223 20,019 23,334 3,045 40 28,259 15,569 2,610 1,607 395 29,053 12,702 4,683 4,092 4,482 3,163 4,275 869 226 2,483 352 1,126 758 272 44 1,465 1,142 572 1,096 69 13 276 12 803 161 897 368 2,066 927 373 117 139 85 95 34 669 100 342 122 34 12 157 147 28 7 1,196 627 12,470 xxii. APPENDIX XII.— (Contd.) MEDICAL INSPECTION OF SCHOOL CHILDREN.—Boys and Girls born in 1904. SUMMARY OF DEFECTS REPORTED BY SCHOOL DOCTORS. AGE GROUP BOYS BORN IN 1904. F. =Defects found. (x)=Defects referred for treatment. [####]Borough. Number of children examined. Clothing and footgear. Nutrition. Cleanliness and condition of skin. Skin defects. Teeth. Nose and throat. Enlarged glands. Eyes. Ears. Speech. Mental condition. 3rd term only. Circulation. Defects of lungs. Defects of nervous system Tuberculosis. Rickets. Deformities. Infectious diseases. Malnutrition. Enlarged glands (other than throat). 3rd term only. Other defects. Cards Issued. Tonsils. Adenoids. Tonsils and Adenoids. Other defects. External disease. Squint & fective sight 1st and 2nd terms. Squint 3rd term only. Defective sight. 3rd term only. Disease and defects. Disease. Hearing. Disease and Hearing. Defects. Stammering. * Other defects. Heart defects. Anaemia. Phthisis. Other. 1. 2. 3 1. 2 3. *4. 3rd term only 1. 2. 3. F. (x) 1 2. 3. (x) F. F. (x) F. (x) F. (x) F. F. F. F. (x) F. F. (x) F. (x) F. (x) 1. 9 3. 4. Mentallj deficient. F. 1 (x> F. (x) F. (x) F. (X) F. (x) F. (x) F. (x) F. (x) F. (x) F. <x) F. (x) F. (x) Battersea 1,399 597 675 127 205 1,023 170 1 818 515 66 17 10 407 570 422 404 131 70 146 21 9 28 2 44 26 23 662 136 26 35 42 4 13 3 114 905 88 3 14 6 23 20 18 15 4 5 3 2 32 10 2 1 1 1 1 4 1 25 16 690 Bermondsey 1,101 371 568 162 147 631 301 22 606 405 90 86 13 611 365 125 212 150 142 92 87 5 209 30 90 31 16 700 150 42 30 38 3 1 19 217 472 167 35 66 4 57 11 79 27 17 2 1 3 1 61 1 42 2 1 17 17 2 46 10 489 Bethnal Green 1,350 543 590 217 166 532 563 89 620 610 120 23 11 447 799 104 150 60 37 46 161 42 74 1 43 37 37 787 183 20 29 33 7 1 14 240 534 230 69 2 39 2 57 8 48 8 13 1 3 1 4 1 59 40 6 96 96 1 13 3 361 Camberwell 2,013 1,274 682 57 1,063 872 77 1 1,477 461 75 26 6 1,202 606 205 355 140 98 142 79 10 48 2 32 23 17 583 160 40 20 15 11 17 687 1,000 65 11 3 10 4 40 28 35 17 10 6 6 4 5 2 15 1 26 7 2 10 8 1 48 39 777 Chelsea 457 194 209 54 175 221 60 1 275 149 33 5 3 232 158 67 46 39 30 45 8 1 5 3 21 1 164 36 4 5 1 2 3 2 43 123 55 3 10 1 5 1 15 3 3 1 2 2 3 1 1 1 1 1 1 143 City 136 69 64 3 45 71 20 94 40 2 6 1 33 84 19 27 6 3 7 6 1 1 1 1 12 1 30 16 2 1 2 2 2 39 7 2 4 3 4 1 47 Deptford 846 449 336 61 218 482 146 555 242 49 26 5 447 282 117 164 130 87 81 67 7 138 17 25 15 13 331 63 26 30 38 4 11 161 401 71 12 20 1 20 10 27 10 21 10 6 3 2 8 54 2 l 1 4 1 31 8 348 Finsbury 774 136 494 144 153 488 133 268 420 86 15 8 348 359 67 112 80 42 39 33 7 168 10 18 14 12 422 52 17 23 15 4 12 168 389 74 5 18 1 11 3 20 7 18 4 2 2 2 1 17 21 6 2 2 32 18 246 Fulham 1,239 755 441 43 305 770 163 1 977 223 39 18 14 548 474 217 223 92 72 106 35 9 22 36 37 7 384 129 23 9 13 5 19 17 879 33 2 26 8 12 6 63 10 10 5 4 2 5 3 10 2 27 5 5 5 1 23 20 467 Greenwich 867 409 419 39 332 454 76 5 440 391 36 7 4 421 367 79 109 48 15 42 16 5 22 4 7 8 10 415 54 4 12 16 5 1 4 1 80 499 109 11 3 2 2 7 4 7 3 2 1 1 5 3 5 3 7 7 12 7 246 Hackney 1,519 662 814 43 407 931 176 5 1,019 442 58 138 14 976 470 73 65 122 86 78 29 7 41 10 34 10 16 634 121 20 18 22 11 14 480 557 263 17 42 4 12 6 38 16 23 6 8 4 3 2 50 2 27 16 1 1 7 7 3 3 59 38 396 Hammersmith 853 357 436 60 121 627 101 4 723 107 23 18 6 335 363 155 86 63 66 73 27 3 24 4 6 12 5 290 59 4 9 3 3 4 5 557 18 1 4 26 1 14 1 1 28 2 1 4 4 29 12 238 Hampstead 349 194 142 13 159 165 25 230 111 8 16 2 102 203 44 35 22 2 8 22 5 11 1 8 7 4 140 33 4 3 4 45 194 6 17 4 7 2 22 3 10 1 2 1 36 2 7 5 2 91 Holborn 355 107 217 31 45 271 39 228 111 16 24 5 143 115 97 81 73 51 17 29 2 157 2 22 9 5 150 51 35 17 10 5 10 138 49 2 8 5 31 13 22 2 1 1 15 2 10 1 12 3 154 Islington 2,306 1,052 1,119 135 450 1,419 427 10 1,676 544 86 47 11 1,149 729 428 426 266 182 293 24 6 204 16 59 53 23 1,055 271 46 71 60 29 4 49 531 810 323 53 31 3 56 28 54 15 22 6 10 3 6 1 23 2 43 3 23 21 24 10 1,009 Kensington 792 322 405 65 196 517 79 386 311 95 11 4 291 349 152 68 76 35 47 22 1 57 23 16 34 6 306 98 18 10 13 1 1 43 272 109 9 4 29 3 31 8 6 5 2 1 37 1 17 3 2 2 11 5 233 Lambeth 1,877 916 883 78 710 917 241 9 1,228 558 91 33 15 944 491 442 630 284 177 227 53 13 141 13 49 66 22 717 215 33 28 23 21 9 15 475 710 126 10 34 6 51 25 38 9 21 6 4 1 3 1 20 1 28 8 13 12 53 31 1,014 Lewisham 1,177 825 323 29 214 723 236 4 992 166 19 10 1 789 307 81 112 33 69 49 7 1 22 4 17 15 11 695 58 7 2 7 1 215 632 110 22 8 1 11 1 3 6 2 1 1 9 4 3 3 6 4 249 Paddington 904 511 345 48 337 473 93 1 565 259 80 16 6 386 351 167 61 63 44 60 9 69 4 9 35 4 232 92 15 10 6 6 9 1 76 390 17 24 2 18 1 20 21 6 16 2 3 3 2 9 13 1 1 3 23 11 304 Poplar 1,425 459 836 130 105 995 302 23 728 579 118 54 29 646 449 330 292 178 106 160 59 14 126 7 48 31 28 753 216 37 40 25 8 10 800 303 41 28 2 9 3 36 6 8 4 2 9 1 27 2 7 2 1 29 25 35 11 795 St. Marylebone 566 356 185 25 224 293 48 1 414 126 26 3 1 256 208 102 82 34 24 29 3 3 46 4 6 17 1 197 70 6 10 6 2 10 304 7 22 3 10 8 2 8 2 1 2 1 1 1 8 3 189 St. Pancras 1,501 763 640 98 422 959 120 1,160 285 56 26 12 631 596 274 129 149 104 36 96 4 211 2 31 22 11 613 101 60 28 23 25 1 20 298 614 47 3 57 9 53 21 72 14 28 4 3 3 2 57 1 47 5 2 2 3 43 23 428 Shoreditch 1,011 170 732 109 188 690 124 9 281 689 41 103 35 728 150 133 146 181 116 196 90 21 25 19 60 7 33 674 168 60 56 76 14 36 1 124 558 159 16 6 73 10 25 10 160 67 36 15 7 5 6 6 21 4 21 4 1 1 15 14 52 25 563 Southwark 1,722 442 1,040 240 268 1,072 375 7 821 717 184 64 12 668 643 411 544 250 105 181 78 23 113 20 64 36 11 1,031 248 43 61 52 6 10 506 747 138 26 41 11 64 36 81 35 23 4 4 4 4 23 3 22 5 1 27 27 3 58 28 936 Stepney 2 831 1,202 1,389 240 1,030 1,424 337 40 1,521 1,111 199 212 24 660 1,654 517 367 351 170 231 242 24 99 8 142 130 42 1,427 402 64 36 46 17 54 277 1,215 299 43 3 140 13 211 15 261 19 69 9 13 6 22 6 229 1 73 2 2 31 29 3 1 62 23 1,079 Stoke Newington 214 101 108 5 78 124 12 156 52 6 4 3 176 28 10 7 12 5 12 8 5 2 5 2 100 28 4 2 5 2 1 143 38 1 1 1 2 3 1 20 1 10 5 54 Wandsworth 2,355 1,448 816 91 526 1,661 166 2 1,700 587 68 31 6 1,215 710 430 812 259 196 249 38 11 48 10 26 39 25 893 175 17 14 13 6 1 8 291 1,438 89 7 18 4 33 23 36 9 20 5 4 2 2 1 7 25 3 1 2 2 31 18 1,146 Westminster 611 333 234 44 177 333 100 423 159 29 9 5 278 220 113 80 36 29 42 10 2 7 1 11 29 3 154 45 10 5 11 1 2 28 165 41 8 14 10 1 18 4 6 1 1 3 1 2 13 2 1 1 18 8 183 Woolwich 1,098 611 452 35 502 510 86 775 294 29 24 14 275 481 342 505 148 178 214 3 1 17 12 42 35 15 473 147 29 29 39 4 4 65 7 50 532 100 16 2 13 7 9 6 35 32 25 8 10 7 5 2 12 2 35 25 1 1 28 27 2 2 19 18 782 33,648 15,628 15,594 2,426 8,968 19,648 4,797 235 21,156 10,664 1,828 1,072 280 15,344 12,581 5.723 6,360 3,476 2,341 2,948 1,362 242 2,135 229 954 813 402 15,012 3,577 716 640 656 207 24 424 15 6,264 15,316 2,794 427 18 778 106 900 283 1,262 348 435 104 107 60 101 30 830 31 630 115 14 8 327 314 30 8 790 410 13,657 AGE GROUP. GIRLS BORN IN 1904. Battersea 1,282 564 625 93 201 914 164 3 788 419 75 28 9 339 579 364 356 116 57 123 11 7 25 4 12 25 10 591 119 21 48 56 3 2 179 763 37 3 21 12 22 20 22 19 2 2 7 4 5 3 12 2 11 8 1 2 2 6 3 24 16 626 Bermondsey 1,153 518 514 121 192 668 276 17 614 436 103 140 5 685 344 124 177 170 98 96 55 8 171 14 90 30 19 684 168 38 21 28 1 5 240 483 138 32 70 4 46 15 64 27 18 4 3 4 1 28 1 43 6 1 20 20 6 63 10 507 Bethnal Green 1,313 569 624 120 260 552 455 46 655 575 83 166 8 467 722 124 180 75 36 52 117 24 87 3 54 35 33 835 200 19 25 20 3 3 243 519 228 47 2 57 1 34 2 41 9 21 4 2 2 4 1 24 30 2 2 46 46 2 22 11 469 Camberwell 2,063 1,414 610 39 1,096 899 68 1,433 563 67 77 4 1,205 657 201 381 165 98 178 74 14 49 9 40 27 27 706 216 44 30 41 5 8 792 872 103 14 1 13 2 54 45 22 12 11 8 7 6 3 10 1 38 9 1 8 5 20 14 844 Chelsea 349 137 166 46 143 164 42 209 104 36 6 2 176 131 42 23 32 18 23 4 2 3 1 7 14 3 131 23 10 2 8 1 45 100 21 6 3 6 2 13 1 2 2 1 1 5 1 4 1 85 City 155 88 65 2 65 74 16 91 57 7 28 2 20 108 27 16 17 3 8 1 1 1 3 10 1 48 20 2 1 1 4 44 7 1 1 1 2 2 1 41 Deptford 805 469 308 28 268 420 116 1 529 239 37 48 4 487 232 86 131 128 70 58 48 6 140 7 40 16 18 452 117 21 35 40 1 14 158 474 72 6 14 2 21 8 21 5 14 3 1 3 10 43 8 2 2 3 27 4 352 Finsbury 753 118 533 102 183 462 108 248 406 99 59 5 309 354 90 124 101 45 48 23 5 155 5 25 14 10 437 66 21 27 22 4 4 175 357 72 2 25 1 16 3 28 1 28 4 4 3 4 1 31 31 8 1 2 1 39 16 258 Fulham 1,258 815 391 52 427 717 113 1 1,000 217 41 98 31 608 442 208 222 127 58 92 21 7 33 1 51 12 9 484 106 27 12 10 3 9 53 980 22 2 32 5 15 6 41 14 7 3 10 5 2 1 5 30 3 1 4 3 27 19 443 Greenwich 825 340 472 13 327 445 53 532 275 18 14 10 427 324 74 118 66 21 55 3 2 18 16 17 8 396 75 20 18 33 9 82 447 69 17 2 4 3 1 1 2 1 6 4 2 2 2 4 4 7 4 276 Hackney 1,623 743 849 31 463 1,013 146 1 1,021 530 72 258 11 1,030 480 113 118 161 79 71 45 6 26 3 34 26 15 743 159 25 28 28 3 1 5 602 526 263 21 37 7 17 11 65 30 31 9 4 1 1 42 3 15 4 4 2 2 66 49 500 Hammersmith 818 374 403 41 149 562 106 1 682 125 11 28 1 343 347 128 72 71 45 53 23 2 28 1 7 11 3 298 51 10 6 6 4 1 20 532 20 1 7 3 31 2 13 1 1 1 2 1 16 3 2 2 2 23 11 195 Hampstead 375 215 146 14 179 167 29 236 131 8 5 3 103 217 55 40 30 13 23 8 1 6 3 7 11 3 100 25 8 4 2 23 163 2 23 2 7 1 17 2 10 3 3 2 3 2 16 13 4 3 2 1 18 5 101 Holborn 298 115 165 18 68 202 28 209 70 19 49 1 135 102 61 43 68 27 16 19 2 146 3 17 7 4 126 46 31 10 3 2 3 114 39 1 4 37 20 9 1 1 2 2 1 4 14 2 1 1 4 1 109 Islington 2,183 1,005 1,087 91 549 1,209 414 11 1,589 505 89 259 8 1,074 722 387 371 307 184 281 28 2 141 9 63 62 23 1,072 276 52 59 52 9 2 30 453 811 291 37 32 10 66 29 41 14 16 4 9 6 5 1 12 28 2 1 11 10 32 21 951 Kensington 915 381 444 90 278 564 73 456 318 141 23 4 310 400 205 56 108 45 62 21 1 113 17 16 40 4 448 86 13 10 12 1 47 383 94 9 2 10 1 35 7 16 5 9 2 3 1 1 11 13 1 19 3 256 Lambeth 1,874 993 838 43 783 893 196 2 1,263 539 72 63 14 971 498 405 597 239 130 189 28 4 79 16 39 63 14 823 177 48 25 29 4 2 3 537 602 117 11 28 9 48 30 21 9 16 7 4 3 3 11 2 22 9 1 1 2 2 1 1 47 34 1,037 Lewisham 1,125 822 286 17 221 668 236 991 126 8 29 1 712 337 76 108 40 58 40 4 8 19 8 12 677 50 9 10 11 232 899 116 33 6 19 2 2 3 1 2 8 3 4 5 4 227 Paddington 877 563 287 27 374 449 54 568 245 64 39 3 368 331 178 128 57 30 54 5 1 91 2 10 28 2 319 86 13 9 14 1 4 1 59 479 32 3 1 42 1 19 9 15 4 14 1 2 2 1 9 7 1 1 1 1 19 9 278 Poplar 1,446 531 844 71 140 1,017 279 10 785 561 100 43 8 617 450 379 379 154 86 122 28 4 73 9 54 19 18 886 246 38 27 22 1 7 938 228 59 6 1 34 3 12 10 47 9 25 3 12 5 7 17 1 13 2 1 20 13 41 25 776 St. Maryebone 601 317 257 27 201 355 45 375 181 45 4 1 248 247 106 73 41 25 41 3 1 31 5 11 41 4 170 75 19 12 22 19 247 8 2 16 1 11 1 10 6 3 2 2 3 1 1 8 3 198 St. Pancras 1,511 830 627 54 504 897 110 1,117 334 60 55 6 647 597 267 179 191 88 77 62 5 182 4 30 47 16 662 152 62 30 29 16 11 1 360 477 33 43 5 63 23 50 3 25 4 4 3 5 3 40 57 8 1 1 3 37 12 468 Shoreditch 992 198 740 54 248 653 88 3 296 665 31 98 22 728 142 122 177 187 112 208 61 11 26 14 73 17 12 708 178 73 72 71 1 22 3 114 544 152 21 10 103 22 29 15 163 75 28 8 9 8 5 2 13 1 28 10 4 4 2 1 64 38 534 Southwark 1,669 400 1,081 188 282 1,048 333 6 812 719 138 207 15 646 597 426 584 264 86 167 45 5 154 18 83 30 17 1,140 271 52 59 72 2 12 2 561 715 140 17 55 1 1 62 38 76 34 9 4 6 4 5 1 12 4 24 9 4 2 16 16 3 47 38 1,017 Stepney 2,863 1,435 1,276 152 1,192 1,330 307 34 1,668 1,007 188 377 13 834 1,568 461 358 381 172 223 159 11 110 11 143 125 48 1,480 399 67 53 58 2 42 1 360 1,169 268 45 4 162 16 222 25 248 11 57 5 4 3 44 7 99 1 79 10 4 30 24 49 14 1,031 Stoke Newington 215 105 103 7 77 125 12 1 155 53 7 20 1 158 34 23 18 14 10 14 1 1 4 8 2 82 24 2 9 3 138 18 2 2 4 2 1 3 3 9 5 2 3 3 5 3 62 Wandsworth 2,218 1,434 703 81 609 1,477 131 1 1,648 510 60 75 11 1,217 650 351 690 246 177 265 35 7 40 17 54 21 916 182 18 20 22 4 5 243 1,292 74 3 29 16 41 26 25 6 14 3 7 5 1 ] 2 33 8 2 2 32 13 1,150 Westminster 618 382 198 38 214 324 80 452 135 31 20 7 316 194 108 60 47 24 46 3 2 6 1 14 32 2 151 49 11 2 9 2 20 163 16 1 9 10 3 19 1 5 1 1 3 2 3 8 1 1 12 6 169 Woolwich 1,012 623 371 18 457 490 65 723 254 35 32 9 246 464 302 477 130 162 174 6 4 7 6 28 24 12 512 108 26 39 32 3 2 42 52 541 131 18 13 9 26 17 34 26 30 12 6 6 6 5 13 1 47 40 1 1 34 34 16 16 709 33,189 16,498 15,013 1,678 10,150 18,758 4,143 138 21,145 10,299 1,745 2,348 219 15,426 12,270 5,493 6,256 3,733 2,057 2,859 941 145 1,949 167 1,007 853 370 16,177 3,750 880 698 758 69 7 248 8 6,864 14,867 2,658 351 23 897 149 975 373 1,127 320 412 90 121 77 123 36 454 17 655 162 20 4 223 203 37 7 759 401 13,669 * During the 3rd term nutrition was analysed under 4 heads, in the earlier terms under ?. Appendix XIII.—(Contd.) xxiii. APPENDIX XIII(Contd.) Classification of children examined as to condition of clothing, nutrition, cleanliness and condition of teeth. Percentage of children in each class. Boroughs arranged topographically. Number of children examined. Condition of clothing. Condition as regards nutrition. Condition of cleanliness Condition of teeth. Good. Fair. Poor. Good. Fair. Poor. Good. Fair. Poor. Good. Fair. Poor. A.—BOYS BORN IN 1904. West— Paddington 904 56.5 38.1 5.4 37.3 52.3 10.4 62.5 28.7 8.8 42.7 38.8 18.5 Kensington 792 40.7 51.1 8.2 24.7 65.3 10.0 48.7 39.3 12.0 36.7 44.1 19.2 Hammersmith 853 41.8 51.1 7.1 14.2 73.5 12.3 84.8 12.5 2.7 39.3 42.5 18.2 Fulham 1,239 60.9 35.6 3.5 24.6 62.2 13.2 78.9 18.0 3.1 44.2 38.3 17.5 Chelsea 457 42.5 45.7 11.8 38.3 48.4 13.3 60.2 32.6 7.2 50.8 34.6 14.6 Westminster 611 54.5 38.3 7.2 29.0 54.5 16.5 69.2 26.1 4.7 45.5 36.0 18.5 North— St. Marylebone 566 62.9 32.7 4.4 39.6 51.8 8.6 73.2 22.3 4.5 45.2 36.7 18.1 Hampstead 349 55.6 40.7 3.7 45.6 47.3 7.1 65.9 31.8 2.3 29.2 58.2 12.6 St. Pancras 1,501 50.8 42.6 6.6 28.1 63.9 8.0 77.3 19.0 3.7 42.0 39.7 18.3 Islington 2,306 45.6 48.5 5.9 19.5 61.5 19.0 72.7 23.6 3.7 49.8 31.6 18.6 Stoke Newington 214 47.2 50.5 2.3 36.5 57.9 5.6 72.9 24.3 2.8 82.3 13.1 4.6 Hackney 1,519 43.6 53.6 2.8 26.8 61.3 11.9 67.1 29.1 3.8 64.3 30.9 4.8 Central— Holborn 355 30.2 61.1 8.7 12.7 76.3 11.0 64.2 31.3 4.5 40.3 32.4 27.3 Finsbury 774 17.6 63.8 18.6 19.8 63.0 17.2 34.6 54.3 11.1 45.0 46.4 8.6 City of London 136 50.7 47.1 2.2 33.1 52.2 14.7 69.1 29.4 1.5 24.3 61.8 13.9 East— Shoreditch 1,011 16.8 72.4 10.8 18.6 68.3 13.1 27.8 68.2 4.0 72.0 14.8 13.2 Bethnal Green 1,350 40.2 43.7 16.1 12.3 39.4 48.3 45.9 45.2 8.9 33.1 59.2 7.7 Stepney 2,831 42.5 49.1 8.4 36.4 50.3 13.3 53.7 39.2 7.1 23.3 58.4 18.3 Poplar 1,425 32.2 58.7 9.1 7.4 69.8 22.8 51.1 40.6 8.3 45.3 31.5 23.2 South— Southwark 1,722 25.7 60.4 13.9 15.6 62.2 22.2 47.7 41.6 10.7 38.8 37.3 23.9 Bermondsey 1,101 33.7 51.6 14.7 13.3 57.3 29.4 55.0 36.8 8.2 55.5 33.2 11.3 Lambeth 1,877 48.8 47.1 4.1 37.9 48.9 13.2 65.4 29.7 4.9 50.3 26.2 23.5 Battersea 1,399 42.6 48.3 9.1 14.6 73.2 12.2 58.5 36.8 4.7 29.1 40.8 30.1 Wandsworth 2,355 61.5 34.6 3.9 22.3 70.6 7.1 72.2 24.9 2.9 51.6 30.1 18.3 Camberwell 2,013 63.3 33.9 2.8 52.8 43.3 3.9 73.4 22.9 3.7 59.7 30.1 10.2 Deptford 846 53.1 39.7 7.2 25.8 57.0 17.2 65.6 28.6 5.8 52.8 33.3 13.9 Greenwich 867 47.2 48.3 4.5 38.3 52.4 9.3 50.7 45.1 4.2 48.6 42.3 9.1 Lewisham 1,177 70.2 27.4 2.4 18.2 61.4 20.4 84.3 14.1 1.6 67.1 26.1 6.8 Woolwich 1,098 55.6 41.2 3.2 45.7 46.4 7.9 70.6 26.8 2.6 25.1 43.8 31.1 London County 33,648 46.5 46.3 7.2 26.6 58.4 15.0 62.9 31.7 5.4 45.6 37.4 17.0 B.—GIRLS BORN IN 1904. West— Paddington 877 64.2 32.7 3.1 42.6 51.2 6.2 64.8 27.9 7.3 42.0 37.7 20.3 Kensington 915 41.6 48.5 9.9 30.4 61.6 8.0 49.8 34.8 15.4 33.9 43.7 22.4 Hammersmith 818 45.7 49.3 5.0 18.2 68.7 13.1 83.4 15.3 1.3 41.9 42.5 15.6 Fulham 1,258 64.8 31.1 4.1 33.9 57.0 9.1 79.5 17.2 3.3 48.3 35.1 16.6 Chelsea 349 39.3 47.5 13.2 41.0 47.0 12.0 59.9 29.8 10.3 50.5 37.5 12.0 Westminster 618 61.8 32.0 6.2 34.6 52.4 13.0 73.1 21.9 5.0 51.1 31.4 17.5 North— St. Marylebone 601 52.7 42.8 4.5 33.4 59.1 7.5 62.4 30.1 7.5 41.3 41.1 17.6 Hampstead 375 57.3 38.9 3.8 47.7 44.5 7.8 63.0 34.9 2.1 27.5 57.9 14.6 St. Pancras 1,511 54.9 41.5 3.6 33.4 59.4 7.2 73.9 22.1 4.0 42.8 39.5 17.7 Islington 2,183 46.0 49.8 4.2 25.1 55.4 19.5 72.8 23.1 4.1 49.2 33.1 17.7 Stoke Newington 215 48.8 47.9 3.3 35.8 58.2 6.0 72.1 24.6 3.3 73.5 15.8 10.7 Hackney 1,623 45.8 52.3 1.9 28.5 62.4 9.1 62.9 32.6 4.5 63.5 29.5 7.0 Central— Holborn 298 38.6 55.4 6.0 22.8 67.8 9.4 70.1 23.5 6.4 45.3 34.2 20.5 Finsbury 753 15.7 70.8 13.5 24.3 61.4 14.3 32.9 53.9 13.2 41.0 47.0 12.0 City of London 155 56.8 41.9 1.3 42.0 47.7 10.3 58.7 36.8 4.5 12.9 69.7 17.4 East— Shoreditch 992 20.0 74.6 5.4 25.0 65.8 9.2 29.8 67.1 3.1 73.4 14.3 12.3 Bethnal Green 1,313 43.3 47.5 9.2 19.8 42.0 38.2 49.9 43.8 6.3 35.6 55.0 9.4 Stepney 2,863 50.1 44.6 5.3 41.6 46.5 11.9 58.2 35.2 6.6 29.1 54.8 16.1 Poplar 1,446 36.7 58.4 4.9 9.7 70.3 20.0 54.3 38.8 6.9 42.7 31.1 26.2 South— Southwark 1,669 24.0 64.8 11.2 16.9 62.8 20.3 48.6 43.1 8.3 38.7 35.8 25.5 Bermondsey 1,153 44.9 44.6 10.5 16.7 57.8 25.5 53.3 37.8 8.9 59.4 29.8 10.8 Lambeth 1,874 52.9 44.8 2.3 41.8 47.7 10.5 67.4 28.8 3.8 51.8 26.6 21.6 Battersea 1,282 44.0 48.8 7.2 15.7 71.3 13.0 61.5 32.7 5.8 26.4 45.2 28.4 Wandsworth 2,218 64.7 31.7 3.6 27.4 66.6 6.0 74.3 23.0 2.7 54.9 29.3 15.8 Camberwell 2,063 68.5 29.6 1.9 53.1 43.6 3.3 69.5 27.3 3.2 58.4 31.9 9.7 Deptford 805 58.3 38.2 3.5 33.3 52.2 14.5 65.7 29.7 4.6 60.5 28.8 10.7 Greenwich 825 41.2 57.2 1.6 39.5 54.0 6.4 64.5 33.3 2.2 51.7 39.3 9.0 Lewisham 1,125 73.1 25.4 1.5 19.6 59.4 21.0 88.1 11.2 0.7 63.3 29.9 6.8 Woolwich 1,012 61.6 36.6 1.8 45.1 48.4 6.5 71.5 25.1 3.4 24.3 45.8 29.9 London County 33,189 49.7 45.2 5.1 30.6 56.5 12.9 63.7 31.0 5.3 46.5 37.0 16.5 18820 KK xxiv. Annual Report of the London County Council, 1912. , APPENDIX XIII—(contd.) Classification of children examined as to condition of clothing, nutrition, cleanliness and condition of teeth. Percentage of children in each class. Boroughs arranged topographically. Number of children examined. Condition of clothing. Condition as regard 3 nutrition. Condition of cleanliness. Condition of teeth. Good. Fair. Poor. Good. Fair. Poor. Good. Fair. Poor. Good. Fair. Poor. A.—LEAVERS, BOYS. West— Paddington 1,071 53.0 42.3 4.7 38.1 54.4 7.5 62.1 30.5 7.4 52.4 32.8 14.8 Kensington 1,013 40.1 44.1 15.8 32.7 59.9 7.4 50.6 33.6 15.8 45.5 36.6 17.9 Hammersmith 1,149 41.1 50.5 8.4 27.4 66.1 6.5 80.1 15.7 4.2 48.0 35.7 16.3 Fulham 1,640 51.8 39.8 8.4 30.7 60.4 8.9 66.6 25.3 8.1 46.8 37.8 15.4 Chelsea 592 45.6 45.7 8.7 48.3 44.3 7.4 61.7 32.3 6.0 46.8 39.2 14.0 Westminster 908 55.6 39.0 5.4 36.4 55.9 7.7 69.9 26.2 3.9 53.4 34.8 11.8 North— St. Marylebone 790 51.0 42.5 6.5 31.8 62.7 5.5 58.0 33.3 8.7 40.1 40.3 19.6 Hampstead 386 60.4 37.8 1.8 59.9 33.4 6.7 65.3 33.4 1.3 37.8 43.5 18.7 St. Pancras 2,116 55.6 39.8 4.6 41.6 52.5 5.9 70.7 26.1 3.2 51.9 36.5 11.6 Islington 2,464 45.1 48.4 6.5 33.4 57.0 9.5 64.1 31.3 4.6 50.9 37.9 11.2 Stoke Newington 211 43.1 54.0 2.9 26.1 65.4 8.5 49.3 47.4 3.3 51.7 37.4 10.9 Hackney 2,085 47.7 45.6 6.7 30.8 57.7 11.5 54.2 39.1 6.7 59.6 32.5 7.9 Central— Holborn 470 38.3 50.0 11.7 25.5 66.6 7.9 62.3 31.3 6.4 49.2 39.1 11.7 Finsbury 928 20.4 64.7 14.9 32.7 55.1 12.2 35.2 51.7 13.2 50.5 40.3 9.2 City of London 182 57.2 36.8 6.0 33.0 61.5 5.5 58.8 34.1 7.1 35.7 47.3 17.0 East— Shoreditch 1,175 30.2 56.7 13.1 40.9 54.1 5.0 52.4 41.7 5.9 64.6 29.5 5.9 Bethnal Green 1,541 36.1 49.3 14.6 27.4 54.4 18.2 44.6 47.6 7.8 42.9 48.4 8.7 Stepney 3,127 38.6 51.8 9.6 41.6 50.8 7.6 51.1 41.8 7.1 35.4 50.7 13.9 Poplar 1,774 29.3 57.8 12.9 24.6 63.7 11.7 43.7 46.2 10.1 48.9 33.9 17.2 South— Southwark 1,784 30.9 60.4 8.7 36.3 55.2 8.5 39.1 54.4 6.5 40.9 46.9 12.2 Bermondsey 1,414 31.7 54.1 14.2 20.4 65.2 14.4 48.2 44.3 7.5 57.0 32.4 10.6 Lambeth 2,282 54.8 41.0 4.2 45.0 48.2 6.8 60.4 35.3 4.3 52.7 33.2 14.1 Battersea 1,415 45.5 45.2 9.3 16.9 73.2 9.9 54.1 38.9 7.0 32.6 55.8 11.6 Wandsworth 2,592 60.9 33.5 5.6 29.5 64.9 5.6 67.6 27.2 5.2 39.2 43.4 17.4 Camberwell 2,484 45.8 48.6 5.6 42.3 52.9 4.8 58.5 38.1 3.4 48.5 39.2 12.3 Deptford 885 44.2 44.7 11.1 40.9 49.4 9.7 47.5 45.5 7.0 58.1 36.4 5.5 Greenwich 939 35.5 59.8 4.7 32.6 58.0 9.4 39.5 54.6 5.9 47.0 42.8 10.2 Lewisham 1,120 60.4 37.6 2.0 56.6 39.6 3.8 70.3 28.3 1.4 55.4 39.5 5.1 Woolwich 1,498 48.6 45.5 5.9 49.2 44.7 6.1 72.9 23.2 3.9 34.1 43.9 22.0 London County 40,035 44.8 47.1 8.1 35.6 56.0 8.4 57.5 36.3 6.2 47.3 39.8 12.9 B.—LEAVERS, GIRLS. West— Paddington 1,037 59.1 36.9 4.0 36.4 56.5 7.1 59.7 30.0 10.3 52.6 33.1 14.3 Kensington 1,218 44.7 49.2 6.1 35.9 57.0 7.1 49.8 36.6 13.6 46.5 38.3 15.2 Hammersmith 981 39.1 56.1 4.8 28.9 64.4 6.7 73.4 23.9 2.7 52.5 32.1 16.4 Fulham 1,730 57.1 39.4 3.5 37.6 55.7 6.7 67.6 25.0 7.4 54.9 33.5 11.6 Chelsea 499 41.7 49.5 8.8 47.3 44.3 8.4 61.1 30.1 8.8 49.9 36.5 13.6 Westminster 813 55.5 38.6 5.9 40.7 50.4 8.9 67.8 27.7 4.5 55.2 32.5 12.3 North— St. Marylebone 787 50.2 44.7 5.1 37.9 56.1 6.0 55.1 33.6 11.3 43.0 37.6 19.4 Hampstead 361 64.8 34.4 0.8 59.8 34.6 5.6 67.0 29.9 3.1 34.9 44.6 20.5 St. Pancras 1,963 57.2 39.9 2.9 45.9 47.7 6.4 71.2 24.8 4.0 54.6 34.2 11.2 Islington 2,407 50.9 45.0 4.1 37.6 52.7 9.7 63.4 31.4 5.2 54.1 35.8 10.1 Stoke Newington 211 64.5 32.7 2.8 35.1 61.1 3.8 66.8 31.3 1.9 63.1 28.4 8.5 Hackney 2,012 57.6 38.3 4.1 35.8 54.0 10.2 64.4 30.0 5.6 63.5 28.8 7.7 Central— 52.6 Holborn 454 33.7 60.8 5.5 37.0 57.9 5.1 59.2 34.6 6.2 37.5 9.9 Finsbury 853 25.3 64.0 10.7 42.9 50.1 7.0 36.1 49.8 14.1 54.9 36.4 8.7 City of London 160 43.1 53.8 3.1 42.5 49.4 8.1 51.9 44.4 3.7 33.8 50.6 15.6 East— Shoreditch ... 1,127 47.8 44.4 7.8 44.0 50.8 5.2 57.5 36.3 6.2 67.9 25.6 6.5 Bethnal Green 1,380 40.8 49.1 10.1 39.1 48.8 12.1 51.1 41.1 7.8 49.0 44.7 6.3 Stepney 3,165 38.7 54.2 7.1 46.0 45.7 8.3 46.9 44.7 8.4 40.9 46.5 12.6 Poplar 1,470 31.8 61.1 7.1 35.8 57.5 6.7 42.7 47.8 9.5 53.7 30.1 16.2 South— 45.1 43.6 11.3 Southwark 1,972 33.8 59.9 6.3 39.7 53.9 6.4 42.3 51.2 6.5 Bermondsey 1.463 31.3 55.6 13.1 20.4 64.6 15.0 45.2 48.3 6.5 62.4 28.0 9.6 Lambeth 2,446 60.8 36.4 2.8 47.8 45.9 6.3 65.0 31.1 3.9 56.7 31.1 12.2 Battersea 1,531 48.4 46.0 5.6 18.1 70.8 11.1 57.8 37.3 4.9 35.4 52.8 11.8 Wandsworth 2,842 63.3 33.0 3.7 34.0 60.3 5.7 70.2 25.8 4.0 42.8 39.2 18.0 Camberwell 2,440 52.5 45.0 2.5 44.6 51.8 3.6 57.3 38.9 8.8 53.3 38.0 8.7 Deptford 938 49.4 44.1 6.5 42.2 47.6 10.2 54.5 39.5 6.0 57.4 36.0 6.6 Greenwich 971 44.4 51.6 4.0 37.1 54.3 8.6 53.4 42.6 4.0 48.3 41.9 9.8 Lewisham 1,058 58.0 40.4 1.6 50.9 46.2 2.9 67.8 31.1 0.9 52.9 44.0 3.1 Woolwich 1,285 54.5 41.6 3.9 47.0 46.8 6.2 74.8 21.8 3.4 32.9 46.9 20.2 London County 39,574 48.8 45.9 5.3 39.2 53.2 7.6 58.7 35.2 6.1 50.6 37.6 11.8 XXV. APPENDIX XIII—(Contd.) MEDICAL INSPECTION OF SCHOOL CHILDREN. SUMMARY OF DEFECTS REPORTED BY SCHOOL DOCTORS. AGE GROUP— LEAVERS—BOYS, F.=Defects found. (x)=Defects referred for treatment. Borough Number of children examined Clothing and footgear. Nutrition. Cleanliness and condition of skin. Skin defects. Teeth. Nose and throat. Enlarged glands. Eyes. Ears. Speech. Mental condition. 3rd term only. Circulation. Defects of lungs. Defects of Nervous system. Tuberculosis. Rickets. Deformities. Infectious diseases. Malnutrition. Enlarged glands (other than throat). 3rd term only. Other defects. Cards issued. Tonsils. Adenoids. Tonsils and adenoids. Other defects. External disease. Squints defective sight 1st & 2nd terms. Squint. 3rd term. Defective sight. 3rd term only. Disease and defects. Disease. Hearing. Disease and hearing. Defects. Stammering. Other defects Heart defects. Anæmia. Phthisis. Other. 1. 2. 3. 1. 2. 3. 4.* 3rd term only. 1. 2. 3. f. (x) 1. 2. 3. (x) F. F. (x) f. (x) F. (x) F. F. F. F. (x) F. F. (x) F. (x) F. (x) 1. 2. 3. 4. Mentally deficient. F. (x) F. (x) f. (x) F. (x) F. (x) F. (x) F. (x) F. (x) F. (x) F. (x) F. (x) F. (x) Battersea 1,415 644 640 131 240 1,035 140 765 551 99 27 461 789 165 154 92 43 110 14 8 89 10 10 134 2 68 166 22 49 62 3 3 17 132 9 23 21 2 1 6 4 6 4 5 4 4 3 39 2 4 2 1 1 42 11 467 Bermondsey 1,414 449 764 201 289 921 202 2 682 627 105 30 17 806 458 150 233 107 85 136 48 8 98 25 41 176 6 178 231 45 40 60 11 1 11 1 120 117 26 6 71 10 23 8 43 17 7 2 3 3 1 1 15 1 23 1 5 5 1 143 32 599 Bethnal Green 1,541 556 759 226 422 839 273 7 688 733 120 24 14 661 746 134 110 62 49 94 58 12 29 1 35 269 3 116 291 26 34 37 8 1 4 65 123 43 9 31 4 19 3 26 12 12 3 4 2 4 3 18 1 19 3 7 7 24 10 640 Camberwell 2,484 1,139 1,204 141 1,051 1,315 118 1,453 946 85 24 1,205 974 305 574 127 76 175 52 1 56 10 27 290 4 118 335 47 31 59 10 1 6 125 269 10 31 25 19 12 13 10 9 4 ' 4 2 5 2 4 1 28 14 1 1 3 3 51 39 997 Chelsea 592 270 271 51 286 262 44 365 191 36 7 2 277 232 83 63 25 14 31 1 8 2 11 55 1 107 71 7 7 6 2 1 91 88 21 1 18 3 1 1 15 3 3 1 1 1 6 14 1 1 1 1 11 5 177 City 182 104 67 11 60 112 10 107 62 13 3 65 86 31 40 8 6 10 1 1 7 31 16 38 2 1 2 3 20 3 1 2 3 3 1 1 2 1 5 3 78 Deptford 885 391 396 98 362 437 86 420 403 62 13 6 514 322 49 228 87 101 120 42 18 47 18 14 125 1 64 151 20 26 45 7 5 66 59 16 1 23 3 13 4 18 6 11 3 2 1 4 21 5 2 2 35 8 475 Finsbury 928 190 600 138 304 511 113 327 480 121 15 5 469 373 85 171 81 42 62 9 4 266 2 10 171 51 138 19 24 22 1 5 17 86 1 40 1 19 1 18 4 7 7 3 8 2 13 2 44 7 27 6 361 Fulham 1,640 849 652 139 503 990 146 1 1,091 416 133 42 15 767 620 253 39 130 74 138 39 19 74 6 35 191 5 128 220 18 14 20 22 13 6 6 356 6 26 8 19 12 27 6 12 8 10 4 7 1 11 38 9 5 5 1 1 20 11 625 Greenwich 939 333 562 44 306 545 88 371 513 55 9 9 441 402 96 131 63 28 81 16 10 23 17 10 117 2 80 132 15 20 34 3 3 13 118 5 3 2 1 7 4 9 8 3 3 3 3 2 2 2 2 24 6 337 Hackney 2,085 994 950 141 643 1,202 240 1,130 814 141 74 9 1,242 678 165 178 169 156 163 39 10 122 3 50 260 116 294 39 79 45 11 1 32 181 86 59 2 68 5 35 10 57 16 40 9 17 7 1 92 2 37 3 4 4 74 28 667 Hammersmith 1,149 472 580 97 315 759 71 4 920 181 48 9 6 551 410 188 77 79 64 68 22 7 19 1 15 117 3 115 134 21 17 22 5 7 7 317 8 40 4 20 1 8 3 1 1 18 17 2 1 1 100 19 417 Hampstead 386 233 146 7 231 129 26 252 129 5 3 3 146 168 72 88 20 9 25 12 3 2 1 1 38 1 38 45 7 2 6 1 27 53 3 1 15 2 4 3 2 1 3 1 1 1 1 1 2 8 2 4 4 5 1 153 Holborn 470 180 235 55 120 313 37 293 147 30 13 2 231 184 55 77 60 29 30 40 4 150 1 10 39 6 93 74 21 25 19 10 1 5 125 24 12 5 8 1 14 2 3 1 4 1 4 2 12 16 1 1 I 11 1 188 Islington 2,464 1,112 1,192 160 822 1,404 236 2 1,579 771 114 36 17 1,254 933 277 36 182 138 206 23 8 64 9 47 366 5 122 382 48 63 66 22 10 8 100 105 33 7 35 11 34 14 30 15 13 3 9 5 7 31 1 36 7 3 3 32 18 940 Kensington 1,013 406 447 160 331 607 75 513 340 160 21 9 461 371 181 118 76 43 74 22 8 46 16 11 104 109 123 23 16 24 4 3 3 34 142 49 4 22 4 24 2 14 3 3 2 2 1 1 21 19 2 12 6 335 Lambeth 2,282 1,251 937 94 1,026 1,100 154 2 1,378 805 99 44 30 1,203 759 320 524 229 153 233 36 8 69 14 45 259 6 220 310 40 49 36 6 4 132 205 62 12 46 25 46 29 17 6 16 5 3 2 1 24 2 28 8 7 7 l 70 39 1,028 Lewisham 1,120 676 421 23 634 444 42 788 316 16 5 3 621 442 57 264 26 47 65 7 2 4 2 26 138 74 149 6 7 13 3 1 30 64 12 5 2 3 1 3 5 2 1 17 8 4 3 427 Paddington 1,071 568 453 50 408 583 80 665 327 79 17 11 561 351 159 29 68 33 55 8 2 33 4 18 131 3 88 147 10 17 21 9 1 64 136 2 40 1 31 7 11 4 3 ] 4 1 8 8 2 1 1 3 3 17 6 358 Poplar 1,774 520 1,025 229 437 1,130 201 6 775 820 179 53 23 868 602 304 386 147 95 151 42 19 89 8 51 237 11 195 313 17 49 40 6 2 8 265 90 24 7 44 11 7 7 40 5 19 3 10 5 5 35 2 25 4 10 9 49 19 824 St. Marylebone 790 403 336 51 251 495 44 458 263 69 3 1 317 318 155 145 33 22 29 2 2 12 8 96 111 120 14 19 25 4 2 23 177 13 1 28 5 1 4 1 12 3 5 4 1 4 9 4 1 1 9 5 293 St. Pancras 2,116 1,176 843 97 881 1,110 125 1,497 552 67 15 7 1,098 773 245 319 169 68 80 98 6 213 6 22 197 11 285 240 71 51 45 26 1 11 278 267 7 43 13 41 23 27 8 16 6 2 2 3 1 29 52 8 1 3 3 40 23 665 Shoreditch 1,175 355 667 153 481 635 59 616 490 69 32 17 759 347 69 114 139 72 151 33 14 49 30 26 162 2 102 198 45 78 78 8 4 38 99 15 1 1 37 16 21 9 48 25 9 5 9 6 4 1 15 1 32 18 1 1 31 22 482 Southwark 1,784 551 1,077 156 648 985 148 3 697 970 117 30 13 730 836 218 311 174 102 182 56 12 134 32 41 299 2 128 369 56 38 58 11 2 8 118 103 11 2 39 21 43 18 41 25 16 6 9 3 4 I 6 1 24 3 7 7 68 26 835 Stepney 3,127 1,206 1,619 302 1,300 1,589 236 2 1,597 1,309 221 58 19 1,107 1,585 435 380 277 121 232 44 19 63 4 73 523 6 324 546 44 40 42 17 3 12 25 300 94 5 82 15 76 15 99 8 27 8 9 4 15 5 33 2 50 11 5 5 48 15 1,116 Stoke Newington 211 91 114 6 55 138 18 101 100 7 2 1 109 79 23 1 28 21 14 3 8 1 23 22 6 4 7 1 1 1 5 3 1 1 7 7 3 42 AVandsworth 2,592 1,578 867 147 765 1,683 144 1,751 705 136 30 10 1,016 1,126 450 610 179 119 221 35 14 39 3 21 1 112 293 23 23 35 2 2 99 191 8 33 19 15 9 8 4 16 7 8 2 5 4 10 2 18 14 9 9 27 20 1,063 Westminster 908 505 354 49 330 508 70 635 238 35 17 9 485 316 107 99 47 31 53 11 3 4 1 15 63 4 154 88 16 16 21 8 93 179 26 4 23 3 3 5 2 5 3 2 2 12 12 3 1 12 9 269 Woolwich 1,498 728 682 88 739 669 89 1 1,091 348 59 18 15 510 658 330 500 134 116 182 13 10 13 12 32 163 4 163 213 34 46 60 7 3 26 1 39 345 25 3 17 11 7 6 15 13 18 9 7 4 6 3 5 2 36 33 24 24 14 ... 32 19 813 40,035 17,930 18,860 3,245 14,240 22,450 3,315 30 23,008 14,547 2,480 674 273 18,936 15,938 5,161 5,999 3,018 1,990 3,171 826 231 1,854 239 712 5,040 89 3,475 5,833 792 885 1,010 228 42 183 6 2,201 4.251 591 70 1 897 249 549 201 621 209 301 99 143 74 92 32 477 24 646 178 5 2 107 105 18 l 1,026 410 15,671 AGE GROUP—LEAVERS—GIRLS. Battersea 1,531 741 704 86 277 1,084 170 884 572 75 43 12 542 809 180 166 135 41 151 9 6 69 3 12 151 3 105 184 28 63 82 3 2 1 31 185 10 32 23 15 14 9 5 4 2 3 3 4 2 40 14 6 1 1 47 19 553 Bermondsey 1,463 458 813 192 299 944 220 661 707 95 78 9 912 410 141 203 162 77 155 39 12 113 22 73 236 7 141 298 41 34 48 4 108 88 36 3 88 14 38 24 24 13 23 10 2 2 3 8 31 7 4 4 1 163 40 651 Bethnal Green 1,380 563 677 140 539 673 165 3 705 567 108 16 3 676 617 87 243 48 34 61 23 10 17 1 28 325 2 94 328 31 36 47 2 8 1 51 62 25 10 35 1 32 9 23 4 15 2 3 1 8 27 5 3 3 28 7 593 Camberwell 2,440 1,280 1,097 63 1,088 1,264 88 1,399 948 93 19 13 1,301 926 213 459 158 75 183 34 10 36 5 32 260 3 128 312 38 26 46 7 2 225 243 43 2 35 14 29 19 13 8 9 3 6 4 2 16 42 26 1 1 2 I 41 23 954 Chelsea 499 208 247 44 236 221 42 305 150 44 20 1 249 182 68 7 34 17 35 3 1 9 1 11 55 2 74 71 8 5 5 39 66 13 1 15 2 3 1 5 2 2 6 12 1 6 5 161 City 160 69 86 5 68 79 13 83 71 6 9 1 54 81 25 23 15 7 10 1 1 31 20 26 1 20 5 4 1 2 1 1 1 1 1 3 1 57 Deptford 938 463 414 61 396 446 95 1 511 371 56 16 4 538 338 62 259 95 85 96 30 11 56 24 22 136 4 106 160 23 21 39 1 5 63 129 22 3 16 3 35 17 17 11 7 3 3 3 1 4 30 6 1 1 4 I 51 18 501 Finsbury 853 216 546 91 366 427 60 308 425 120 31 2 468 311 74 168 89 39 80 15 5 200 2 16 127 32 126 16 20 19 1 12 40 3 54 3 20 8 20 10 9 1 5 1 4 1 14 67 16 3 3 25 6 386 Fulham 1,730 988 682 60 651 963 115 1 1,169 432 129 66 13 950 580 200 260 126 34 100 22 12 56 9 35 206 4 173 255 23 16 21 3 1 12 1 8 410 4 35 12 20 14 24 7 14 9 5 3 4 2 5 43 9 9 9 1 36 19 646 Greenwich 971 431 501 39 360 527 84 518 414 39 8 6 469 407 95 124 77 25 91 15 13 18 10 20 142 94 162 27 25 47 2 1 37 131 5 2 1 11 8 7 4 8 6 2 1 2 2 7 4 23 7 394 Hackney 2,012 1,159 770 83 720 1,086 206 1,296 603 113 111 15 1,277 579 156 174 196 115 126 33 12 115 3 62 252 68 298 48 67 41 3 2 15 185 23 4 88 11 48 15 34 13 27 6 11 9 4 51 1 51 11 5 5 62 34 628 Hammersmith 981 384 550 47 283 632 66 720 234 27 31 7 505 315 161 176 101 61 89 22 7 42 21 82 116 114 17 11 18 5 1 1 3 251 5 50 14 21 10 11 4 4 2 2 21 7 2 75 17 377 Hampstead 361 234 124 3 216 125 20 242 108 11 5 126 161 74 95 17 5 19 2 1 4 2 3 38 1 29 41 2 1 1 1 12 49 27 2 12 11 4 9 1 1 5 1 10 2 4 4 2 5 3 156 Holborn 454 153 276 25 168 263 23 269 157 28 63 4 239 170 45 58 72 16 16 22 2 125 13 44 6 113 82 27 20 15 2 113 24 8 1 15 6 6 4 1 2 3 18 3 1 1 2 16 6 164 Islington 2,407 1,224 1,083 100 904 1,269 232 2 1,526 756 125 40 11 1,301 861 245 420 247 155 288 15 4 58 11 36 379 6 94 423 38 63 63 7 5 10 73 100 15 8 53 15 42 25 18 8 15 5 7 3 5 11 1 40 10 4 4 31 12 1,025 Kensington 1,218 544 600 74 437 695 86 607 446 165 33 3 566 467 185 112 113 42 81 25 3 58 29 16 132 5 193 182 21 15 17 3 3 35 207 40 34 2 41 9 14 2 16 7 3 2 10 56 6 1 1 25 6 378 Lambeth 2,446 1,487 890 69 1,169 1,123 150 4 1,590 760 96 43 16 1,386 761 299 666 286 108 252 35 8 86 18 46 313 1 275 386 43 48 51 3 6 170 261 45 6 68 16 76 48 17 13 30 9 12 7 5 12 34 12 5 5 2 96 58 1,214 Lewisham 1,058 614 427 17 538 489 31 717 331 10 82 3 560 465 33 209 55 58 87 3 3 4 1 23 152 1 73 176 8 9 14 1 19 120 11 2 17 5 8 3 2 1 1 1 12 4 3 3 426 Paddington 1,037 613 383 41 377 586 74 619 311 107 31 4 546 343 148 103 69 29 57 6 2 49 1 7 123 110 131 13 12 17 1 14 187 16 41 9 17 7 10 3 13 4 5 3 2 7 26 8 7 7 14 8 321 Poplar 1,470 468 898 104 526 845 99 627 703 140 70 12 790 442 238 285 122 70 114 19 10 93 5 73 224 4 113 276 38 45 30 1 8 4 165 21 3 62 11 26 10 27 5 15 8 4 2 11 36 9 1 1 56 17 644 St. Marylebone 787 395 352 40 298 442 47 434 264 89 4 4 338 296 153 125 66 18 48 1 10 2 16 102 3 92 120 12 17 18 2 30 134 2 1 27 6 13 2 5 2 2 ] 1 3 2 2 1 8 7 281 St. Pancras 1,963 1,122 784 57 901 936 126 1,397 487 79 28 7 1,071 672 220 321 189 73 136 48 5 104 9 41 212 3 271 291 74 58 69 9 10 3 269 210 2 67 22 66 35 35 14 26 5 3 3 1 11 63 16 2 o 6 38 25 810 Shoreditch 1,127 539 500 88 496 573 58 648 409 70 20 13 765 289 73 132 152 54 168 27 12 58 42 30 212 1 56 229 39 68 72 3 1 4 1 15 57 12 1 32 23 32 26 27 15 7 5 5 4 5 38 27 1 1 15 11 557 Southwark 1,972 666 1,181 125 783 1,062 127 833 1,010 129 57 14 890 860 222 327 215 101 211 38 9 108 25 32 401 131 417 61 59 66 1 4 109 63 11 1 43 24 76 43 26 12 30 11 5 3 1 9 23 10 5 5 79 23 932 Stepney 3,165 1,226 1,715 224 1,456 1,447 260 2 1,485 1,415 265 123 14 1,295 1,470 400 62 313 103 227 79 11 81 10 108 534 13 371 552 57 45 41 4 22 92 323 88 13 1 154 23 125 30 129 15 40 11 10 6 2 36 106 27 i 2 2 72 29 1,140 Stoke Newington 211 136 69 6 74 129 8 141 66 4 10 1 133 60 18 11 24 22 16 6 8 5 30 7 35 2 3 2 1 10 1 6 5 5 5 2 1 6 60 Wandsworth 2,842 1,800 937 105 967 1,713 162 1,995 733 114 85 11 1,216 1,113 513 763 275 152 296 27 7 58 3 24 297 1 247 372 22 28 34 o 7 116 417 16 2 54 28 29 12 20 6 8 4 3 1 3 1 6 1 43 16 3 3 6 70 27 1,291 Westminster 813 451 314 48 331 410 72 551 225 37 29 449 264 100 88 51 21 49 11 2 4 20 68 1 122 99 12 7 11 4 2 66 147 22 19 2 12 3 16 6 6 1 2 1 1 9 23 6 1 1 12 5 237 Woolwich 1,285 701 534 50 604 602 79 961 280 44 26 13 422 603 260 404 149 144 191 5 2 13 6 35 160 2 137 225 36 45 69 4 15 23 279 50 2 26 18 18 14 17 13 23 14 7 5 3 2 2 1 52 52 25 25 1 I 30 20 749 39,574 19,333 18,154 2,087 15,528 21,055 2,978 13 23,201 13,955 2,418 1,197 216 20,034 14,852 4,688 6,443 3,651 1,781 3,433 614 180 1,653 244 861 5,424 73 3,585 6,371 805 868 1,003 72 11 144 11 2,093 4,248 508 57 1 1,191 305 887 424 561 192 369 117 121 74 61 10 317 7 919 302 2 1 90 90 29 4 1,134 455 10,296 XXVI. APPENDIX XIV. SUMMARY OF FIGURES FOR AGE GROUPS. F=Number of Defects found. (x)=Number of Defects referred for treatment. The figures in italics are the percentages of the numbers examined. Age group. Number of children examined, 1912. Number of children examined, 3rd term. Clothing and footgear. Nutrition. Cleanliness and condition of skin. Skin defects. Teeth. Nose and throat. Enlarged Glands. Eyes. Ears. Speech. Circulation. Defects of Lungs. Defects of Nervous system. Tuberculosis. Rickets. Deformities. Infectious diseases. Malnutrition. Enlarged Glands (other than throat) 3rd term only. Other defects. Cards Issued, i.e., No. of children referred for treatment. Tonsils. Adenoids. Tonsils and Adenoids. Other defects. External disease. Vision. Disease and defects. Disease. Hearing. Disease and Hearing. Stammering. Other. Heart defects. Anæmia. Phthisis. Other. 1. 2. 3. Defects. Squint and defective sight, 1st and 2nd terms. Squint 3rd term only. Defective sight, 3rd term only. 1. 2 3. 1. 2. 3. 4* 3rd term only. 1 2 3 F. (x) (X) F. F. (X) F. (X) F (X) F. (x) F. F. (x) F. (X) F. (X) F. (x) F. (x) F. (x) F. (x) F. (x) F. (X) F. (x) F. (X) F. (X) F. (X) F. (X) F. (X) Entrants Boys 47,880 13,144 23,201 21,823 2,856 19,582 24,580 3,677 41 28,952 16,340 2,588 1,211 513 29,646 13,302 4,932 4,147 4,806 3,925 5,140 1,108 300 2,895 464 1,278 759 251 1,593 1,185 510 1,106 126 32 384 19 888 164 1,020 447 2,191 961 357 110 109 69 113 39 1,327 147 648 203 43 19 164 153 55 3 1,422 714 13,755 48.5 45.5 6.0 40.9 51.3 7.8 60.5 34.1 5.4 2.53 1.07 61.9 27.8 10.3 8.66 10.18 8.20 10.73 2.31 .63 6.05 .97 2.67 2.18 1.91 3.33 2.47 1.06 2.31 .26 .07 .80 .04 1.85 .34 2.13 .93 4.58 2.01 .75 .23 .23 .14 .24 .08 2.77 .31 1.35 .42 .09 .04 .34 .32 .42 2.97 1.49 28.73 „ Girls 46,438 13,269 23,498 20,717 2,223 20,019 23,334 3,045 40 28,259 15,569 2,610 1,607 395 29,053 12,702 4,6S3 4,092 4,482 3,163 4,275 869 226 2,483 352 1,126 758 272 1,465 1,142 572 1,096 69 13 276 12 803 161 897 368 2,066 927 373 117 139 85 95 34 669 100 342 122 34 12 157 147 28 7 1,196 627 12,470 50.6 44.6 4.8 43.1 50.3 6.6 60.9 33.5 5.6 3.46 .85 62.6 27.3 10.1 8.81 9.65 6.81 9.20 1.87 .49 5.35 .76 2.42 2.28 2.05 3.15 2.46 1.23 2.36 .15 .03 .59 .03 1.73 .35 1.93 .79 4.45 2.00 .80 .25 .30 .18 .20 .07 1.44 .22 .74 .26 .07 .03 .34 .32 .21 2.58 1.35 26.85 8-9 Boys 33,648 24,801 15,628 15,594 2,426 8,968 19,648 4,797 235 21,156 10,664 1,828 1,072 280 15,344 12,581 5,723 6,360 3,476 2,341 2,948 1,362 242 2,135 229 954 813 402 15,012 3,577 716 640 656 207 24 424 15 778 106 900 283 1,262 348 435 104 107 60 101 30 830 31 630 115 14 8 327 314 30 8 790 410 13,657 46.5 46.3 7.2 26.6 58.4 15.0 62.9 31.7 5.4 3.19 .83 45.6 37.4 17.0 18.90 10.33 6.96 8.76 4.05 .72 6.35 .68 2.83 9.19 1.62 60.51 10.63 2.13 1.90 1.95 .62 .07 1.26 .04 2.31 .32 2.67 .84 3.75 1.03 1.29 .31 .32 .18 .30 .09 2.47 •09 1.87 .34 .04 .02 .97 .93 .12 .03 2.35 1.22 40.59 „ Girls 33,189 24,740 16,498 15,013 1,678 10,150 18,758 4,143 138 21,145 10,299 1,745 2,348 219 15,426 12,270 5,493 6,256 3,733 2,057 2,859 941 145 1,949 167 1,007 853 370 16,177 3,750 880 698 758 69 7 248 8 897 149 975 373 1,127 320 412 90 121 77 123 36 454 17 655 162 20 4 223 203 37 7 759 401 13,669 49.7 45.2 5.1 30.6 56.5 12.9 63.7 31.0 5.3 7.08 .66 46.5 37.0 16.5 18.86 11.25 6.20 8.61 2.84 .44 5.87 .50 3.04 10.09 1.50 65.39 11.30 2.65 2.10 2.28 .21 .02 .75 .02 2.70 .45 2.94 1.12 3.40 .96 1.24 .27 .36 .23 .37 .11 1.37 .05 1.97 .49 .06 .01 .67 .61 .75 .03 2.29 1.21 41.20 11-12 Boys 40,035 7,113 17,930 18,860 3,245 14,240 22,450 3,315 30 23,008 14,547 2,480 674 273 18,936 15,938 5,161 5,999 3,018 1,990 3,171 826 231 1,854 239 712 5,040 89 3,475 5,833 792 885 1,010 228 42 183 6 897 249 549 201 621 209 301 99 143 74 92 32 477 24 646 178 5 2 107 105 18 1 1,026 410 15,671 14.8 47.1 8.1 35.6 56.0 8.4 57.5 36.3 6.2 1.68 .68 47.3 39.8 12.9 14.98 7.54 4.97 7.92 2.06 .58 4.62 .60 1.78 15.31 1.25 48.85 14.57 1.98 2.21 2.52 .57 .11 .46 .01 2.24 .62 1.37 .50 1.55 .52 .75 .25 .36 .18 .23 .08 1.19 .06 1.61 .44 .01 .27 .26 .25 2.56 1.02 39.13 „ Girls 39,574 6,906 19,333 18,154 2,087 15,528 21,055 2,978 13 23,201 13,955 2,418 1,197 216 20,034 14,852 4,688 6,443 3,651 1,781 3,33 614 180 1,653 244 861 5,424 73 3,585 6,371 805 868 1,003 72 11 114 11 1,191 305 887 424 561 192 369 117 121 74 61 10 317 7 919 302 2 1 90 90 29 4 1,134 455 16,286 48.8 45.9 5.3 39.2 53.2 7.6 58.7 35.2 6.1 3.02 .55 50.6 37.6 11.8 16.28 9.23 4.50 8.68 1.56 .45 4.17 .62 2.18 16.91 1.06 51.91 16.10 2.03 2.19 2.53 .18 .03 .36 .03 3.01 .77 2.24 1.07 1.42 .49 .93 .30 .31 .19 .15 .03 .80 .02 2.32 .76 .23 .23 .42 2.87 1.15 41.15 Total children examined in detail 210,764 89,973 116,088 110,161 14,515 88,487 129,825 21,955 497 145,721 81,374 13,669 8,109 1,896 128,439 81,645 30,680 33,297 23,166 15,257 21,826 5,720 1,324 12,969 1,695 5,938 13,647 1,457 38,249 22,589 5,520 1,173 5,629 771 129 1,659 71 5,454 1,134 5,228 2,096 7,828 2,957 2,247 637 740 439 585 181 4,074 326 3,840 1,082 118 46 1,068 1,012 197 30 6,327 3,017 85,508 48.2 45.8 6.0 36.8 53.9 9.3 60.5 33.8 5.7 3.37 .79 53.4 33.9 12.7 13.83 9.63 6.34 9.07 2.38 .55 5.39 .70 2.47 905 1.61 60.18 9.38 2.29 1.73 2.34 .32 .05 .69 .03 2.26 .47 2.17 .87 3.25 1.23 .93 .26 .31 .18 .24 .08 1.69 .14 1.59 .45 .05 .02 .44 .42 .22 .03 2.63 1.25 35.52 Special Junior Boys 1,769 105 64 154 205 245 314 75 23 90 32 196 154 33 30 307 127 83 167 10 1 19 4 37 10 67 34 80 43 58 21 16 14 16 8 36 9 36 12 6 2 6 5 2 1 100 50 1,186 „ „ Girls 1,538 104 56 134 192 201 228 43 16 70 21 160 131 48 50 302 112 64 152 5 1 8 1 36 9 40 19 59 35 36 16 28 13 13 6 27 4 35 24 3 3 3 3 77 41 966 „ Senior Boys 2,987 166 105 329 324 360 452 175 61 106 30 223 557 37 384 741 217 147 317 22 8 24 3 185 35 97 48 123 42 117 52 66 35 30 15 42 2 74 38 5 4 27 25 5 3 191 116 2,075 ,, Girls 4,322 184 90 429 456 364 555 150 49 167 36 272 675 39 538 971 225 201 364 7 2 39 2 289 59 194 92 148 45 131 53 78 49 49 12 39 3 109 46 3 1 35 31 7 1 237 132 2,589 10,616 3,191 559 315 1,046 1,177 1,170 1,549 443 149 433 119 851 1,517 157 1,002 2,321 681 495 1,000 44 12 90 10 547 113 398 193 410 165 342 142 188 111 108 41 144 18 254 120 17 10 71 64 14 5 605 339 6,816 5.27 2.97 9.85 11.10 11.02 14.60 4.17 1.44 4.08 1.12 8.02 20.43 4.92 31.40 21.87 6.42 4.66 9.42 .41 .11 .85 .09 5.15 1.06 3.75 1.81 3.86 1.55 3.22 134 1.77 1.05 1.02 .39 1.36 .17 2.39 1.13 .16 .09 .67 .60 .44 .16 5.70 3.19 64.22 * During the 3rd term Nutrition was analysed under 4 heads ; in the earlier terms under 3. Appendix X V. xxvii. APPENDIX XV. RETURN SHOWING THE RESULTS OF RE-INSPECTION OF CHILDREN BETWEEN AUGUST AND, CHRISTMAS, 1912. Number of children re-inspected, 23,344. Defects found requiring treatment. Number of defects under revision. Form of treatment in cases in which treatment was obtained. Total numbers treated. No treatment received By private doctor or dentist. Under Council's scheme. At other hospitals or institutions. Completed and satisfactory. Still under treatment. Discontinued treatment before remedied, or from other causes uncured. Total. Completed and satisfactory. Still under treatment. Discontinued treatment before remedied, or from other causes uncured. Total. Completed and satisfactory. Still under treatment. Discontinued treatment before remedied, or from other causes uncured. Total. Completed and satisfactory. Still under treatment. Discontinued treatment before remedied, or from other causes uncured. Total. Condition irremediable or treatment no longer considered necessary. Still require treatment (1) (2) (3) (1) (2) (3) (1) (2) (3) (1) (2) (3) Refraction 6,304 66.4 12.5 21.1 60.4 25.2 14.4 51.7 28.7 19.6 58.2 25.5 16.3 106 20 34 160 1,404 587 336 2,327 486 269 184 939 1,996 876 554 3,426 293 2,585 4.6 68.0 27.4 54.4 4.6 41.0 Minor ailments 2,229 73.2 15.6 11.2 49.3 321 18.6 58.2 22.8 19.0 59.2 23.7 17.1 216 46 33 295 177 115 67 359 361 142 118 621 754 303 218 1,275 426 528 23.1 28.2 48.7 57.1 19.2 23.7 Ears, nose and throat 7,651 48.6 18.7 32.7 76.3 11.2 12.5 70.0 14.3 15.7 70.1 13.6 16.3 169 65 114 348 973 144 161 1,278 1,030 211 231 1,472 2,172 420 506 3,098 1,037 3,516 11.2 41.3 47.5 40.4 13.5 46.1 Teeth 7,749 52.8 15.5 31.7 70.0 19.0 11.0 64.9 10.7 24.4 63.0 14.0 23.0 335 98 200 633 408 111 64 583 741 123 278 1.142 1,484 332 542 2,358 571 4,820 26.7 24.7 48.6 30.5 7.3 62.2 Other ailments 4,098 49.5 38.3 12.2 18.8 77.2 4.0 42.8 43.9 13.3 42.7 44.9 12.3 259 200 64 523 28 115 6 149 535 549 167 1,251 822 864 237 1,923 1,041 1,134 27.2 7.7 65.1 46.9 25.4 27.7 Total 28,031 55.4 220 22.7 63.7 22.8 13.5 58.2 23.8 18.0 59.8 23.1 17.0 1,085 429 445 1,959 2,990 1,072 634 4,696 3,153 1,294 978 5,425 7,228 2,795 2,057 12,080 3,368 12,583 16.2 38.9 44.9 43.1 12.0 44.9 xxviii. Annual Report of the London County Council, 1912. APPENDIX XVI. COUNCIL SCHEME AILMENTS, i.e., EYE, EAR, NOSE, AND THROAT DEFECTS AND MINOR AILMENTS. Return showing the results of the re-inspection of Children from August, 1912, to Christmas, 1912. Number of defects under revision. Form of treatment in cases in which treatment was obtained. Total number treated. No treatment received. Percentage of defects treated. * By private doctor. Under Council's scheme. At other hospitals or institutions. Completed and satisfactory. Still under treatment. Discontinued treatment before remedied, or from other causes uncured. Total. Completed and satisfactory. Still under treatment. Discontinued treatment before remedied, or from other causes uncured. Total. Completed and satisfactory. Still under treatment. Discontinued treatment before remedied, or from other causes uncured. Total. Completed and satisfactory. Still under treatment. Discontinued treatment before remedied, or from other causes uncured. Total. Condition irremediable, or treatment no longer considered necessary. Still requiring treatment. 1 2 3 1 2 3 1 2 3 1 2 3 Battersea 530 15 5 10 30 51 11 12 74 85 11 17 113 151 27 39 217 66 247 46.8 Bermondsey 640 23 4 3 30 37 14 11 62 109 47 40 196 169 65 54 288 102 250 53.5 Bethnal Green 730 20 4 14 38 140 73 49 262 50 15 28 93 210 92 91 393 65 272 59.1 Camberwell 749 19 8 6 33 109 37 18 164 69 44 20 133 197 89 44 330 72 347 48.7 Chelsea 93 3 1 5 9 3 1 4 19 9 3 31 25 11 8 44 13 36 55.0 City of London 23 2 1 — 3 5 1 3 9 1 — 1 2 8 2 4 14 — 9 60.9 Deptford 351 12 5 2 19 93 14 12 119 16 7 2 25 121 26 16 163 84 104 61.0 Finsbury 497 8 5 1 14 54 27 14 95 103 40 33 176 165 72 48 285 66 146 66.1 Fulham 418 14 4 4 22 18 4 3 25 101 37 21 159 133 45 28 206 58 154 57.2 Greenwich 225 7 3 1 11 58 20 9 87 14 4 3 21 79 27 13 119 53 53 69.2 Hackney 1,079 41 10 8 59 174 21 50 245 166 33 26 225 381 64 84 529 166 384 57.9 Hammersmith 249 14 2 - 16 12 1 - 13 63 17 6 86 89 20 6 115 36 98 54.0 Hampstead 65 2 - - 2 8 1 1 10 10 7 1 18 20 8 2 30 11 24 55.6 Holborn 158 - - 1 1 12 8 - 20 31 16 20 67 43 24 21 88 16 54 62.0 Islington 1,472 35 4 19 58 238 77 68 383 198 36 35 269 471 117 122 710 59 703 50.2 Kensington 174 16 5 1 22 15 9 6 30 27 16 3 46 58 30 10 98 17 59 62.4 Lambeth 620 15 6 4 25 124 34 15 173 121 23 25 169 260 63 44 367 51 202 64.5 Lewisham 505 41 13 5 59 148 35 9 192 29 5 1 35 218 53 15 286 89 130 68.7 Marylebone 198 1 - 3 4 7 5 4 16 5 7 10 22 13 12 17 42 7 149 22.0 Paddingtone 188 6 2 - 8 17 12 7 36 16 15 8 39 39 29 15 83 16 89 48.3 Pancras 628 24 3 4 31 17 9 5 31 129 55 50 234 170 67 59 296 82 250 54.2 Poplar 898 13 6 3 22 141 53 30 224 55 13 11 79 209 72 44 325 140 433 42.9 Shoreditch 873 5 1 18 24 44 47 49 140 85 39 62 186 134 87 129 350 99 424 45.2 Southwark 1,010 19 5 19 43 111 32 27 170 163 45 58 266 293 82 104 479 131 400 54.5 Stepney 1,840 48 10 27 85 470 182 129 781 84 44 30 158 602 236 186 1,024 113 703 59.3 Stoke Newington 130 1 - 1 2 9 5 6 20 19 1 6 26 29 6 13 48 17 65 42.5 Wandsworth 1,007 58 11 15 84 231 45 18 294 49 15 6 70 338 71 39 448 70 489 47.8 Westminister 227 9 5 14 25 12 2 39 35 14 5 54 69 26 12 107 26 94 53.2 Woolwich 607 20 13 2 35 183 56 7 246 25 7 2 34 228 76 11 315 31 261 54-7 16,184 491 131 181 803 2,554 846 564 3,964 1,877 622 533 3,032 4,922 1,599 1,278 7,799 1,756 6,629 590 * In the calculation of these percentages, the eases reported " condition irremediable, or treatment no longer considered necessary " have been disregarded. APPENDIX XVII. WORKING CLASS DWELLINGS ACCOUNTS. ♦ 18820 Lt xxx Annual Report of the London County Council, 1912. | Housing of the Working Classes—Accounts. xxxi APPENDIX XVII. WORKING CLASS DWELLINGS ACCOUNTS, YEAR END|NG 31st MARCH, 1913. A-HOUSING OF THE WORKING CLASSES ACT, 1890 Dr. Cr. EXPENDITURE INCOME I—REVENUE ACCOUNT. PART I Working Expenses and Debt Charges £ s. d. Income— £ s. d. Boundary-street Estate (Bethnal Green and Shoreditch)— Boundary-street Estate (Bethnal Green and Shoreditch)— Tenements (including laundry) £21,192 19 10 Tenements (including laundry) £23,052 7 5 Automatic gas supply 2,668 18 4 Automatic gas supply 2,980 1 2 23,861 18 2 26,032 8 7 Cable-street Dwellings (Stepney) 2,708 8 3 Cable-street Dwellings (Stepney) 2,917 12 - Shelton-street Dwellings (Holborn) 1,462 1 8 Shelton-street Dwellings (Holborn) 1,502 11 3 Millbank Estate (Westminster)—Proportion 5,267 14 1 Millbank Estate (Westminster)—Proportion 6,524 6 9 Church way Dwellings (St. Pancras) 3,198 4 9 Churchway Dwellings (St. Pancras) 3,860 12 - Hardy Cottages, Trafalgar-road, Greenwich 854 5 3 Hardy Cottages, Trafalgar-road (Greenwich) 832 13 - Duke's-court Dwellings (Westminster)—Proportion 1,530 14 - Duke's-court Dwellings (Westminster)—Proportion 1,799 1 3 York-street Dwellings (Westminster)—Proportion 995 16 8 York-street Dwellings (Westminster)—Proportion 1,125 2 7 Preston's-road Estate (Poplar)—Proportion 855 5 3 Preston's-road Estate (Poplar)—Proportion 573 - 6 St. Luke's Dwellings (Finsbury)— St. Luke's Dwellings (Finsbury)— Wenlake Buildings 1,667 12 4 Wenlake Buildings 1,891 - 6 Chadworth Buildings 2,870 8 1 Chadworth Buildings 3,073 19 4 Clerkenwell and Holborn Dwellings — Clerkenwell and Holborn Dwellings — Mallory Buildings (Finsbury) 776 15 11 Mallory Buildings (Finsbury) 888 4 7 Nigel Buildings, etc. (Holborn) 5,588 8 10 Nigel Buildings, etc. (Holborn) 5,730 12 11 Webber-row Dwellings (Southwark) 3,937 17 1 Webber-row Dwellings (Southwark) 4,785 6 10 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 9 - Brook-street Dwellings (Stepney) 973 13 - Goldsmith's-row Cottages (Shoreditch) 480 2 7 Goldsmith's-row Cottages (Shoreditch) 454 4 6 Hughes-fields Cottages (Greenwich) 2,158 6 3 Hughes-fields Cottages (Greenwich) 1,533 - 8 59,267 8 2 64,497 10 3 Surplus carried to Appropriation Account 5,496 11 5 Interest on cash balances (less income tax, including arrears) 266 9 4 64,763 19 7 64,763 19 7 PART II. Working Expenses and Debt Charges— £ s. d. Income— £ s. d. Cranley Buildings, Brooke's-market (Holborn) 239 14 3 Cranley Buildings, Brooke's-market (Holborn) 274 16 6 Borough-road Dwellings (Southwark) 1,726 18 7 Borough road Dwellings (Southwark) 1,833 1 - Cobham Buildings, Rushworth- (late Green)-street and Pocock-street (Southwark) 1,001 15 3 Cobham Buildings, Rushworth- (late Green-) street and Pocock-street (Southwark 1,117 14 - Ann-street Dwellings (Poplar) 1,895 16 3 Ann-street Dwellings (Poplar) 1,990 11 6 Sylva Cottages, Mill-lane (Deptford) 416 19 5 Sylva Cottages, Mill-lane (Deptford) 466 14 6 5,281 3 9 5,682 17 6 Surplus carried to Appropriation Account 421 - 9 Interest on cash balances (less income tax, including arrears) 19 7 - 5,702 4 6 5,702 4 6 PART III. PART III. (a) Dwellings. £ s. d. (a) Dwellings. Working Expenses and Debt Charges— Income — £ s. d. Parker-street House (Holborn) 3,123 10 5 Parker-street House (Holborn) 3,242 8 -. Carrington House (Deptford) 5,825 13 9 Carrington House (Deptford) 4,289 8 8 Dufferin-street Dwellings (Finsbury) 573 3 9 Dufferin-street Dwellings (Finsbury) 597 - - Rushworth- (late Green ) street and Boyfield-street Dwellings (Southwark) 1,584 14 9 Rushworth- (late Green-) street and Boyfield-street Dwellings (Southwark) 1,735 12 _ Millbank Estate (Westminster)—Proportion 810 18 3 Millbank Estate (Westminster)—Proportion 976 19 2 Holmwood Buildings, 97, Southwark-street (Southwark) 353 6 2 Holmwood Buildings, 97, Southwark-street (Southwark) 335 17 6 Totterdown-fields Estate (Wandsworth) 26,202 12 11 Totterdown-fields Estate (Wandsworth) 27,722 3 3 Preston's-road Estate (Poplar)—Proportion 2,883 17 2 Preston's-road Estate (Poplar)—Proportion 2,204 15 3 Hughes-fields Dwellings (Deptford and Greenwich)—Proportion 1,164 16 - Hughes-fields Dwellings (Deptford and Greenwich)—Proportion 971 9 10 White Hart-lane Estate (Tottenham, Wood Green and Edmonton) 17,511 8 3 White Hart-lane Estate (Tottenham, Wood Green and Edmonton) 18,228 12 2 Wessex Buildings, Wedmore-street (Islington) 3,803 16 4 Wessex Buildings, Wedmore-street (Islington) 4,025 14 6 Norbury Estate (Croydon) 10,316 2 2 Norbury Estate (Croydon) 10,744 10 - Caledonian Estate (Islington) 4,820 2 7 Caledonian Estate (Islington) 5,320 10 3 Briscoe Buildings (Lambeth) 2,443 10 11 Briscoe Buildings (Lambeth) 2,447 7 9 Old Oak Estate (Hammersmith) 1,290 15 - Old Oak Estate (Hammersmith) 1,258 16 3 82,708 8 5 84,101 4 7 Surplus carried to Appropriation Account 1,645 4 - Interest on cash balances (less income tax, including arrears) 252 7 10 84,353 12 5 84,353 12 5 18820 LL 2 xxxii Annual Report of the London County Council, 1912. Housing of the Working Classes—Accounts. xxxiii A.—HOUSING OF THE WORKING CLASSES ACT, 1890-continued. Dr. Cr. EXPENDITURE. INCOME. I —REVENUE ACCOUNT—continued. PART III,—continued. (b) Estates in Course of Development. (b) Estates in Course of Development. Expenses and Debt Charges— £ s. d. Income— £ s.. d. £ s. d. White Hart-lane (Tottenham, Wood Green and Edmonton) 2,982 19 1 White Hart-lane (Tottenham, Wood Green and Edmonton) 389 12 - Norbury (Croydon) 160 3 4 Old Oak (Hammersmith) 59 15 4 Old Oak (Hammersmith) 1,057 15 8 4,200 18 1 Less—Interest on overdrawn cash balances (after allowing for arrears of income tax) 449 7 4 Supervision and Parliamentary expenses (£55 12s. 8d.) in connection with the leasing of cottages 555 12 8 15 10 7 433 16 9 Sundry Revenue Accounts (Old Oak Estate) for transfer in respect of debt charges (interest £817 -s. 5d., sinking fund £146 5s. 7d.) on expenditure met out of the Acquisition of Lands Fund, applied towards deficiency arising under Part III.— Dwellings (part of £1,290 15s., page xxx) 711 11 - Estates in courses of development (part of £1,057 15s. 8d., page xxx) 251 15 - 963 6 - Deficiency carried to Appropriation Account (below) 4,322 14 Less—Transfer from Sundry Revenue Accounts (as above) 963 6 - 3,359 8 - 4,756 10 9 4,756 10 9 II.—APPROPRIATION ACCOUNT. £ s. d. Amount brought from Revenue Account Special Counts Account for contribution to Rates, as contra 4,203 8 2 Surplus- £ s. d. Part I. 5,496 11 5 Part II 421 - 9 Part III.—Dwellings 1,645 4 - 7,562 16 2 Less—Deficiency—Part III.—Estates in course of development (above) 3,359 8 - 4,203 8 2 4,203 8 2 4,203 8 2 III.- REPAIRS AND RENEWALS FUND Actual Expenditure— £ s. d. £ s. d. Balance—1st April, 1912— £ b. d. £ s. d. Part I 6,668 2 10 Part I 20,615 3 3 Part II 669 6 11 Part II 2,944 15 6 Part III 9,170 14 1 Part III 18,409 8 - 16,508 3 10 41,969 6 9 Balance—31st March, 1913 (of which £38,899 5s. 10d. is invested) carried to Balance Sheet— Transfers from Revenue Account 16,943 18 7 Dividends on investments and interest on cash balances (less income tax, including arrears, in respect of the latter)— Part I.—Including £20,494 9s. 1d. invested 20,616 6 3 Part. I 592 4 11 Part II.—Including £2,400 10s. invested 2,953 6 7 Part II 84 18 - Part III.—Including £16,004 6s. 9d. invested 20,123 1 11 Part III 610 10 4 43,692 14 9 1,287 13 3 60,200 18 7 60,200 18 7 IV.—CAPITAL ACCOUNT PART I. Erection of Dwellings— £ s. d. £ s. i. Clerkenwell and Holborn Dwellings—Nigel (late Union) Buildings 495 16 3 Balance carried to Capital (Aggregate) Account 749 7 5 St. Luke's Dwellings—Chadworth Buildings 84 4 9 Tabard street and Crosby-row 169 6 5 749 7 5 749 7 5 xxxiv Annual Report of the London County Council, 1912. Housing of the Working Classes—Accounts. xxxv A.-HOUSING OF THE WORKING CLASSES ACT. 1890-continued. Dr. Cr. EXPENDITURE. INCOME. IV. CAPITAL ACCOUNT—continued. PART III Schemes for the erection of lodging houses for the working classes. A. Acquisition and Laying-out of Sites. £ s. d. £ s. d. £ s. d. White Hart-lane, Tottenham, Wood Green and Edmonton 4,594 14 11 White Hart-lane, Tottenham, Wood Green and Edmonton—Sir Samuel Montagu (Lord Swaythling) Gift Fund Account to meet expenditure during year on public garden 3 11 1 Norbury, Croydon 1,380 18 1 Old Oak, Hammersmith 2,003 18 5 Old Oak Estate— Totterdown-fields, Wandsworth 767 12 5 Acquisition of Lands Fund Account to meet expenditure during year 3,478 18 5 Parks and Open Spaces Capital Account in respect of land utilised for addition to Wormwood Scrubs 475 - - 8,747 3 10 3,953 18 5 Balance carried to capital(Aggregate)Account (below) 16,148 18 1 Working Class Dwellings Account for value of sites appropriated for dwellings— Totterdown-Fields Estate, Wandsworth 767 12 5 White Hart-lane Estate, Tottenham, Wood Green and Edmonton 5,433 _ - Norbury Estate, Croydon 2,547 _ - Old Oak Estate, Hammersmith 12,191 _ _ 24,896 1 11 20,938 12 5 24,896 1 11 B. Working Class Dwellings. £ s. d. £ s. d. £ s. d. Totterdown-fields Estate, Wandsworth 304 10 11 Old Oak Estate—Acquisition of Lands Fund to meet expenditure during year 17,952 _ 10 Add—Value of site appropriated for dwellings 767 12 5 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 2,249 13 4 1,072 3 4 White Hart-lane Estate, Tottenham, Wood Green and Edmonton 17,426 8 7 Add—Value of site appropriated for dwellings 5,433 - - 22,859 8 7 20,201 14 2 Norbury Estate, Croydon 2,776 2 6 Add—Value of site appropriated.for dwellings 2,547 - - Balance carried to Capital (Aggregate) Account 41,149 15 7 5,323 2 6 Old Oak Estate, Hammersmith 19,902 - 10 Add—Value of site appropriated for dwellings 12,191 - - 32,093 - 10 Briscoe Buildings, Brixton-hill, Lambeth 3 14 6 61,351 9 9 61,351 9 9 V- CAPITAL (AGGREGATE) ACCOUNT. £ s. d. £ s. d. £ s. d. Balance—1st April, 1912 - Balance—31st March, 1913, carried to Balance Sheet 2,217,380 ] 17 Part I 883,668 - 7 Part II 80,014 6 7 Part III.— Estates in course of development 119,546 4 5 Dwellings 1,108,401 _ 6 2,191,630 12 1 Expenditure in 1912-13— Part I. (page 11) 749 7 5 Part III.—Dwellings 41,149 15 7 41,899 3 _ less—Part III.—Estates in course of development (above) 16,148 18 1 25,750 4 11 2,217,380 17 - 2,217,380 17 - VI—LOAN ACCOUNT. (A) CONSOLIDATED STOCK. £ s d £ s. d. £ s. d. Stock cancelled during year—Cost 1,452 4 - Balance—1st April, 1912 (moneys raised) 2,023,311 5 8 Balance —31st March, 1913 (Stock at par value), carried to Balance Sheet 2,094,846 13 9 Stock Issue Expenses, 31st March, 1913— In respect of original stock created 82,937 - - Less—In respect of stock cancelled 9,949 7 11 2,096,298 17 9 — — — 72,987 12 1 2,096,298 17 9 (B) ADVANCES FROM CONSOLIDATED LOANS FUND. £ s. d. £ s. d. £ s. d. £ .s. d. Amount repaid during year (as page xxx)— Balance—1st April, 1912 - - - Sinking fund instalments and interest on accumulations 1,090 17 3 Amount advanced during- year— Proceeds of sales 2,555 - - in lespect or expenditure in 1910-11, previously met by London County Bills 86,478 13 7 3,645 17 3 In respect of expenditure in 1912—13 25,750 4 11 Balance—31st March, 1913, carried to Balance Sheet 108,583 1 3 112,228 18 6 112,228 18 6 112,228 18 6 xxxvi Annual Report of the London County Council, 1912. Housing of the Working Classes—Accounts. xxxvii. A.-HOUSING OF THE WORKING CLASSES ACT. 1890—continued. Dr.Cr. EXPENDITURE. INCOME. VII—SINKING FUND ACCOUNT (Accumulating). [Transactions of the Consolidated Loans Fund in respect of Dwelling under the Housing Act,1890.] £ s. d. £ s. d. £ s. d £ 3. d Amount applied during year— Balance—1st April, 1912 135,897 - 1 Purchase and cancellation of stock 1,452 4 — Amount provided during year for redemption— 3,645 17 3 5,098 1 3 Sinking Fund instalments provided out of Revenue 14,227 16 7 Balance- 31st March, 1913, carried to Balance Sheet 161,958 3 9 Less—In respect of expenditure met out of Acquisition of Lands Fund 146 5 7 14,081 11 - Interest on accumulations of Sinking Fund 4,466 13 11 18,548 4 11 Stock issue expenses—Amount provided to 3lst March, 1913, for redemption of stock represented by this item 12,611 - - 167,056 5 - 167,056 5 - VIII. SIR SAMUEL MONTAGU (LORD SWAYTHLING) GIFT FUND. [Contribution of £10,000 from Sir Samuel Montagu, Bt., (afterwards Lord Swaythling.to be utilised in connection with White hart Lane Estate .] CONTRIBUTION ACCOUNT.. £ s. d. £ s. d. £ s. d. Outlay Account to close the Gift Account, the balance of moneys available having been utilised during the year 12,041 8 1 Balance—1st April, 1912 11,970 10 2 Dividends on investment 61 12 11 Interest on uninvested portion (less income tax, including arrears) 9 5 - 12,041 8 1 70 17 1 1 12,041 8 1 OUTLAY ACCOUNT. £ s. d. £ s. d. . £ s. d. Balance—1st April, 1912 9,788 3 8 Capital Account for amount transferred to meet expenditure during year on the White Hart_lane Estate— Contribution Account to close the Gift Account, the balance of moneys available having been utilised during the year 12,041 8 1 Laying out public garden 3 11 1 Erection of Cottages—Tower Gardens section 2,249 13 4 2,249 4 5 12,041 8 1 12,041 8 1 IX.—ACQUISITION OF LANDS FUND(PART III) Transfer of £50 000 from the Thames Embankment Extension and Improvements at Westminster Account, under 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 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.] CONTRIBUTION ACCOUNT. £ s. d. £ s. d. £ s. d. Balance—31st March, 1913 (including £10,125 invested in Victoria Government 4 per cent. Loan 1883, Inscribed Stock (1913), carried to Balance Sheet 55,041 1 11 Balance—1st April, 1912 54,041 19 6 Dividends on investment 628 6 8 Interest on uninvested portion (less income tax, including arrears) 370 15 9 55,041 1 11 999 2 5 55,041 1 1 OUTLY ACCOUNT. Balance—1st April, 1912 23,014 13 3 6 Balance—31st March, 1913, carried to Balance Sheet 44,445 2 9 Capital Account for amount transferred to meet expenditure during year on 3,478 18 5 17,952 - 10 21,430 19 3 44,445 12 9 44.445 l2 9 18820 MM. xxxviii. Annual Report of the London County Council, 1912. I Housing of the Working Classes—Accounts. xxxix. A.—HOUSING OF THE WORKING CLASSES ACT. 1890-continued. Dr.Cr. X.-BALANCE SHEET 31st MARCH, 1913. £ s. d. £ 8. d. £ s. d Liabilities. Assets and Capital Outlay. Loans raised and outstanding— Capital Outlay — Consolidated Stock—Par value— Part I. 884,417 8 - Metropolitan— 2½ per cent. 237,179 10 - Part II. 80,014 6 7 London County— Part III.—Dwellings 1,149,551 16 1 2½ per cent. 183,666 - 6 Estates in course of development 103,397 6 4 3 per cent. 1,211,503 5 8 2,217,380 17 - 3½ per cent. 462,497 17 7 Less—Proceeds of sales (Part III.—Dwellings and estates in course of development) 12,684 16 3 2,094,846 13 9 2,204,696 _ 9 Advances from Consolidated Loans Fund—Balances outstanding 108,583 1 3 London County Bills 55,554 19 - Acquisition of Lands Fund—Outlay Account 44,445 12 9 *2,258,984 14 - 2,249,141 13 6 Sundry Creditors 2,611 10 2 Property (Permanent Assets) acquired otherwise than by capital expenditure—Sir Samuel Montagu (Lord Swaythling) Gift (£10,000 with interest accumulations thereon)—Expended on the White Hart-lane Estate 12,041 8 1 Special Account—Acquisition of Lands Fund (Part III.)—Contribution Account 55,041 l 11 Stock Issue Expenses, including difference between par value of stock outstanding and net cash proceeds 72,987 12 1 Repairs and Renewals Fund— Sinking Fund Assets—Loans to local authorities and other investments 161,958 3 9 Part I. 20,616 6 3 Part II. 2,953 6 7 Sundry Debtors 1,310 15 2 Part III. 20,123 1 11 43,692 14 9 Appropriation Account (after taking into account net contributions from Rates amounting to £61,422 2s. 2d., page liv.) - - - Norbury Estate—Ballast, etc 160 - - Excess of Assets and Capital Qutlay over Liabilities— Investments on Special Accounts at Cost Price— Advances repaid and Stock cancelled (cost) 31,383 15 1 Repairs and Renewals Fund [Market value at 31st March 1913, £33,379] £38,899 5 10 Sinking Fund balance £161,958 3 9 Acquisition of Lands Fund (Part III.) [Market value at 31st March, 1913, £9,900] 10,125 - - Less— Proceeds of sales, deducted from capital outlay (contra) 12,684 16 3 49,024 5 10 149,273 7 6 Cash in Hand— Property (Permanent Assets) acquired otherwise than by capital expenditure (as contra) 180,657 2 7 Revenue Accounts 5,891 9 c 12,041 8 1 Special Accounts— 192,698 10 8 Sir Samuel Montagu (Lord Swaythling) Gift Fund £8 17 5 Acquisition of Lands Fund (Part III.) 504 6 2 513 3 7 6,404 13 1 2,553,028 11 6 2,553,028 11 6 Loans raised and outstanding £2,258,984 14 - Lea—Sinking Fund balance 161,958 3 9 Net Debt 2,097,026 10 3 18820 , xl. Annual Report of the London County Council, 1912. Housing of the Working Classes—Accounts. xli. B—DWELLINGS UNDER IMPROVEMENT ACTS. Dr.Cr. Note.—For statutes under which these dwellings have been erected, see Appendix XX., page lvii. EXPENDITURE. INCOME. I—REVENUE ACCOUNT. £ s. d. £ s. d. Working Expenses and Debt Charges— Income— Battersea Bridge Dwellings (Battersea) 880 9 — Battersea Bridge Dwellings (Battersea) 886 _ _ Cotton-street- Dwellings (Poplar) 1,044 6 1 Cotton-street Dwellings (Poplar) 1,010 3 _ Durham Buildings, York-Road(Battersea) 1,397 18 4 Durham Buildings, York-road (Battersea) 937 9 3 Duke's-court Dwellings (Westminster)—Proportion 510 4 6 Duke's-court Dwellings (Westminster)—Proportion 599 13 9 York-street Dwellings (Westminster)—Proportion 331 19 1 York-street Dwellings (Westminster)—Proportion 375 - 11 Herbrand-street Dwellings (Holborn) 2,316 18 2 Herbrand-street Dwellings (Holborn) 2,744 9 6 Bruce House, Kemble-street (Westminster) 6,898 19 2 Bruce House, Kemble-street (Westminster) 7,542 13 8 Millbank Estate (Westminster)—Proportion 9,136 3 3 Millbank Estate (Westminster)—Proportion 11,315 12 10 Bourne Estate (Holborn) 11,727 13 - Bourne Estate (Holborn) 13,088 7 7 Swan-laiie Dwellings (Bermondsey) 3,963 7 1 Swan-lane Dwellings (Bermondsey) 3,247 13 2 Valette Buildings (Hackney) 1,453 13 4 Valette Buildings (Hackney) 1,582 5 6 Hughes-fields Dwellings (Deptford and Greenwich)—Proportion 582 8 - Hughes-fields Dwellings (Deptford and Greenwich)—Proportion 485 14 11 Bearcroft Buildings (Fulham) 745 8 9 Bearcroft Buildings (Fulham) 842 3 9 Dwellings on sites compulsorily appropriated for rehousing, on the working of which a deficiency was anticipated owing to the character or situation of the site. Council Buildings (Poplar) 980 19 - Council Building (Poplar) 765 9 - Westview, Armitage and Collerston Cottages (Greenwich) 1,719 13 7 Westview, Armitage and Collerston Cottages (Greenwich) 1,286 17 - Idenden Cottages (Greenwich) 1,103 9 6 Idenden Cottages (Greenwich) 1,104 7 6 Barnaby Buildings, Leroy-street (Bermondsey) 1,362 3 7 Barnaby Buildings, Leroy-street (Bermondsey) 1,358 9 - Brightlingsea Buildings, Ropemaker's-fields (Stepney) 991 19 10 Brightlingsea Buildings, Ropemaker's-fields (Stepney) 892 3 6 Bekesbourne Buildings (Stepney) 1,258 14 8 Bekesbourne Buildings (Stepney) 1,213 16 6 Darcy Buildings, London Fields (Hackney) 714 10 11 Darcy Buildings,London-fields (Hackney) 713 - 6 Wandsworth-road Dwellings (Lambeth) 845 - 8 Wandsworth-road Dwellings (Lambeth) 887 1 - 49,965 19 6 52,878 11 10 Surplus carried to Appropriation Account 3,093 18 9 Interest on cash balances (less income tax, including arrears) 181 6 5 53,059 18 3 53,059 18 3 II — APPROPRIATION ACCOUNT £ s d. £ s. d. Amount brought from Revenue Account—Surplus 3,093 18 9 General County Account for contribution to Rates 3,190 11 10 Tramways Account for contribution 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 96 13 1 3,190 11 10 3,190 11 10 Ill.-REPAIRS AND RENEWALS FUND. £ s. . d. £ s. d. Actual Expenditure 6,443 15 1 Balance- 1st April, 1912 19,880 16 7 Balance—31st March. 1913 (of which £19,103 4s. 2d. is invested), earned to Balance Sheet 19,316 10 9 Transfers from Revenue Account 5,293 1 5 25,760 5 10 Dividens on investments and interest on cash balances (less income tax, including arrears, in respect of the latter) 586 7 10 25,760 5 10 xlii. Annual Report of the London County Council, 1912. Housing of the Working Classes—Accounts. xliii. B-DWELLINGS UNDER IMPROVEMENT ACTS—continued. Dr.Cr. EXPENDITURE. INCOME. IV—CAPITAL ACCOUNT. £ s. d. £ s. d. £ s. d. erection of Dwelling:— Balance—31st March, 1913, carried to Capital (aggregate) Account. 45 3 10 Rotherhithe Tunnel— Bekesbourne Buildings 19 5 11 Holborn to Strand improvement— Bourne Estate—proportion 13 4 1 Brucc House 3 18 8 17 2 9 Southampton-row improvement — Bourne Estate—proportion 2 4 11 St. John-street, Clerkenwell, improvement— Bourne Estate—proportion - 10 9 Goswell-road widening— Bourne Estate—proportion - 10 8 Central-street, St. Luke, widening— Bourne Estate—proportion 1 10 6 Fulham Palace-road improvement— Bearcroft Buildings 3 18 4 45 3 10 45 3 10 V.—CAPITAL (AGGREGATE) ACCOUNT. £ s. d. £ s. d. Balance—1st April, 1912 743,306 - 2 Balance—31st March, 1913, carried to Balance Sheet 743,351 4 - Expenditure in year 1912-13 45 3 10 743,351 4 - 743,351 4 - VI.-LOAN ACCOUNT. (A) CONSOLIDATED STOCK. £ s d. £. s. d. £ s d. Stock cancelled during year (cost) 310 11 3 Balance—1st April, 1912 (moneys raised) 736,127 13. 9 Less-transferred to General County Loan Account in adjustment of allocation 593 16 7 Balance—31st March, 1913 (Stock at par value), carried to Balance Sheet 780,560 15 3 735,533 17 2 Stock Issue Expenses, 31st March, 1913— In respect of original stock created 47,904 _ _ Less—In respect of stock cancelled 2,566 10 8 45,337 9 4 780,871 6 6 780,871 6 6 (B) ADVANCES FROM CONSOLIDATED LOANS FUND. £ s. d. £ s. d. £ s. d Amount repaid during year--Sinking fund instalments and interest on accumulations 7 13 - Balance-1st April, 1912 - - - Amount advanced during year— Balance 31st March, 1913, carried to Balance Sheet 425 5 7 In respect of expenditure in 1910-11 previously met by Loudon County Bills 387 15 6 In respect of expenditure in 1912-13 45 3 10 432 19 4 432 19 4 432 19 4 VII. SINKING FUND II ACCOUNT (Accumulating). [ Transaction, of the Consolidated Loans Fund in respect of Dwelling under Improvement Acts.] £ s. d. £ s. d. £ s. d. £ s. d. Amount applied during year— Balance—1st April, 1912 46,200 10 3 Purchase and cancellation of stock (as above) 310 11 3 Repayment of advances from Consolidated Loans Fund (as above) 7 13 9 Amount provided during year for redemption— 318 5 9 sinking Fund instalments provided out of Revenue 4,762 4 6 Interest on Accumulations of Sinking Fund 1,568 - 7 Balancf.—31st March, 1913, carried to Balance Sheet 59,875 10 4 6,330 5 1 Stock Issue Expenses—Amount provided to 31st March, 1913, for redemption of stock represented by this item 7,663 - - 60,193 15 4 60,193 15 4 Housing of the Working Classes—Accounts. xlv xliv. Annual. Report. of the London Courts Council. 1912. B—DWELLINGS UNDER IMPROVEMENT ACTS—continued. Dr.Cr. VIII.—BALANCE SHEET 31ST MARCH, 1913 Assets and Capital Outlay £ s. d. £ s. d. £ s. d. Liabilities. Capital Outlay, including £8,614 19s. 8d. for Drake Buildings, Hughes Fields (rehousing in connection with Tramways) 743,351 4 - Loans raised and outstanding— Less—Proceeds of sales—Disposal of right of light (Bourne Estate) 1,000 - - Consolidated Stock—Par value— 742,351 4 - Metropolitan— 2½ per cent. 64,363 12 5 Stock Issue Expenses, including difference between par value of stock outstanding and net cash proceeds 45,337 9 4 London County— 2½ per cent. 31,930 9 6 3 per cent. 632,254 5 9 3½ per cent. 52,012 7 7 Sinking Fund Assets—Loans to Local Authorities and other investments 59,875 10 4 780,560 15 3 Advances from Consolidated Loans fund-Balance outstanding 425 5 7 London County Bills 253 16 3 Sundry Debtors 579 1 10 *781,239 17 1 Sundry Creditors 57' 14 10 Repairs and Renewals Fund Investment Account [Market value at 31st March, 1913, £16,756 ] 19,103 4 2 Repairs and Renewals Fund 19,316 10 9 Cash in Hand 210 19 7 Appropriation Account (after taking into account net contributions to Rates and from Tramways Account, amounting to £11,747 6s. 4d., - - - Excess of Assets and Capital Outlay over Liabilities- Advances repaid and Stock cancelled (cost) 7,448 16 3 Sinking Fund balance £59,875 10 4 Less—Proceeds of sales, deducted from capital outlay (contra) 1,000 - - 58,875 10 4 66,324 6 7 867,457 9 3 867,45 1 9 3 * Loans raised and outstanding £781,239 17 1 Less—Sinking Fund balance 59,875 10 4 Net Debt 721,364 6 9 18820 NN xlvi Annual Report of the London County Council, 1912. Housing of the Working Classes—Accounts. xlvii C—DWELLINGS UNDER THE HOUSING OF THE WORKING CLASSES ACT. 1890, AND IMPROVEMENT ACTS COMBINED Dr.Cr. EXPENDITURE. INCOME. REVENUE ACCOUNT. (Apportionment calculated on basis of accommodation) Millbank Estate (Westminster)— £ s. d. £ s. d Millbank Estate (Westminster)— £ s. d. £ s. d. Working expenses and debt charges 15,214 15 7 Income 18,816 18 9 Less—Charged to the following accounts— Less—Credited to the following accounts 18,816 18 9 Housing of the Working Classes Act, 1890— Housing of the Working Act. 1890 Part I. 5,267 14 1 Part I. 6 524 6 9 Part III 810 18 3 Part III. 976 19 2 Dwellings under Improvement Acts 9,136 3 3 Dwellings under Improvement Acts 11,315 12 10 15,214 15 7 18,816 18 9 - - - - - - Duke's-court Dwellings (Westminster)— £ s. d. Duke's-court Dwellings (Westminster)— £ s. d. Working expenses and debt charges 2,040 18 6 Income 2,398 15 - Less—Charged to the following accounts— Less—Credited to the following accounts— Housing of the Working Classes Act, 1890—Part I. 1,530 14 - Housing of the Working Classes Act, 1890—Part I. 1,799 1 3 Dwellings under Improvement Acts 510 4 6 Dwellings under Improvement Acts 599 13 9 2,040 18 6 2,398 15 - - - - _ - _ York-street Dwellings (Westminster)— £ s. d. York-street Dwellings (Westminster) — £ s. d. Working expenses and debt charges 1,327 15 9 Income 1,500 3 6 Less—Charged to the following accounts— Less—Credited to the following accounts- Housing of the Working Classes Act, 1890—Part I. 995 16 8 Housing of the Working Classes Act, 1890—Part I. 1,125 2 7 Dwellings under Improvement Acts 331 19 1 Dwellings under Improvement Acts 375 - 11 1,327 15 9 1,500 3 6 - - - - - - Preston's-road Estate (Poplar)— £ s. d. Preston's Road Estate (Poplar)- £ s. d. Working expenses and debt charges 3,739 2 5 Income 2,777 15 9 Less—Charged to the following accounts— Less-Credited to the following accounts- Housing of the Working Classes Act, 1890— Housing of the Working Classes Act, 1890— Part I. 855 5 3 Part I. 573 - 6 Part III. 2,883 17 2 Part III. 2,204 15 3 3,739 2 5 2,777 15 9 - - - - - - Hughes-fields Dwellings (Deptford)— £ s. d. Hughes-fields Dwellings (Deptford)— £ s. d. Working expenses and debt charges 1,747 4 - Income 1,457 4 9 Less—Charged to the following accounts- Less—Credited to the following accounts— Housing of the Working Classes Act, 1890—Part III. 1,164 16 - Housing of the Working Classes Act, 1890—Part III. 971 9 10 Dwellings under Improvement Acts 582 8 - Dwellings under Improvement Acts 485 14 11 1,747 4 1,457 4 9 - - - - _ - 18220 MN2 xlviii Annual Report of the London County Council, 1912. Housing of the Workina Classes—Accounts xlix D-DETAILS OF REVENUE ACCOUNT. Dwellings. Income. Expenditure. Result of Year's Working, 1912-13. Surplus (+). Deficiency ( -). Deductions. Maintenance and Management. Debt Charges. Total. (Columns 13 and 18.) Gross Rental. Empties. takers' Quarters. Amounts irrecoverable. Total. Net Rental. Supervision and Collection of Rent. Rates and Taxes. (l) Lighting, Heating, Water and Insurance. Stores and Incidentals Transfer to Repairs and Renewals Fund. Total. (m) 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 1.—Housing of the Working Classes Act, 1890 (pages xxx to xxxiii). Part I. £ s. d. £ s, d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d £ s. d. £ s d. Boundary-street (including laundry) 23,394 7 11 179 3 - 141 13 6 21 4 _ 342 _ 6 23,052 7 5 1,687 7 5 4,053 - 11 1,276 15 9 23 19 3 2,123 - - 9,164 3 4 1,899 9 6 7,919 13 5 405 4 7 1,804 9 _ 12,028 16 6 21,192 19 10 +1,859 7 7 Do. Automatic Gas Supply 2,980 1 2 — — — - 2,980 1 2 170 - - - 2,073 11 3 - 2 - 150 - - 2,393 13 3 - 222 9 - - 52 16 1 275 5 1 2,668 18 4 +311 2 10 Cable-street 2,963 4 6 19 8 6 25 — _ 1 4 _ 45 12 6 2,917 12 — 137 7 4 578 12 7 110 - 6 — 319 - - 1,145 - 5 112 14 - 1,158 16 7 25 14 9 266 2 6 l,563 7 10 2,708 8 3 +209 3 9 Shelton-street 1,564 3 6 37 17 3 23 16 6 - 1 6 61 12 3 1,502 11 3 64 1 3 255 10 3 59 12 5 27 7 6 146 - - 552 11 5 153 - - 578 15 5 36 11 4 141 3 6 909 10 3 1,462 1 8 +40 9 7 Millbank (proportion) 6,582 4 5 25 1 9 30 5 7 2 10 4 57 17 8 6,524 6 9 317 15 4 1,049 16 - 214 8 8 - 6 2 607 9 4 2,189 15 6 335 3 6 2,229 16 4 62 15 5 450 3 4 3,077 18 7 5,267 14 1 + 1,256 12 8 Churchway 3,905 13 6 17 14 - 27 7 6 - 45 1 6 3,800 12 _ 203 10 3 696 16 1 122 11 10 349 _ - 1,371 18 2 277 17 6 1,248 17 5 53 3 4 246 8 4 1,826 6 7 3,198 4 9 + 662 7 3 Hardy 878 12 - 27 17 - 16 19 - 1 3 - 45 19 - 832 13 - 36 10 6 147 12 3 29 9 9 — 127 - - 340 12 6 32 10 - 398 4 9 6 4 4 76 13 8 513 12 9 854 5 3 — 21 12 3 Duke's-court(proportion) 1,818 9 9 2 5 9 16 12 3 - 10 6 19 8 6 1,799 1 3 89 9 10 296 5 2 55 8 2 — 190 10 - 631 13 2 136 10 - 613 9 7 26 2 5 122 18 10 899 - 10 1,530 14 - +268 7 3 York-street (proportion) 1,143 4 6 - 17 8 16 12 3 - 12 - 18 1 11 1,125 2 7 54 16 - 174 17 9 35 19 2 — 102 - - 367 12 11 101 5 - 424 - 2 19 13 1 83 5 6 628 3 9 995 16 8 +129 5 11 Preston's-road (proportion) (a) 821 18 8 233 - 7 10 4 4 5 13 3 248 18 2 573 - 6 42 4 2 152 19 5 27 2 2 - 7 5 114 1 7 336 14 9 47 12 4 389 15 4 8 19 2 72 3 8 518 10 6 855 5 3 —282 4 9 St. Luke's— Wenlake 1,929 12 - 13 16 - 24 15 6 — 38 11 6 1,891 - 6 99 15 8 325 3 6 60 14 - — 177 - - 662 13 2 175 — — 672 10 5 31 15 7 125 13 2 1,004 19 2 1,667 12 4 + 223 8 2 Chadworth 3,401 7 6 308 7 8 22 3 — 3 2 6 327 8 2 3,073 19 4 153 12 ~ 468 5 3 95 7 — — 273 - - 990 4 3 260 - - 1,341 3 8 50 16 11 228 3 3 1,880 3 10 2,870 8 1 +203 11 3 Clerkenwell and Holborn— Mallory 912 12 7 _ 19 _ 23 9 - — 24 8 — 888 4 7 38 - - 105 3 4 23 7 11 — 64 - - 230 11 3 60 15 - 402 14 9 10 5 11 72 9 — 546 4 8 776 15 11 +111 8 8 Nigel,etc 6,067 14 10 281 3 _ 54 15 _ 1 3 11 337 1 11 5,730 12 11 273 4 10 896 9 2 195 13 3 — 478 - - 1,843 7 3 545 12 6 2,656 10 7 92 9 7 450 8 11 3,745 1 7 5,588 8 10 +142 4 1 Webber-row 4,929 3 4 82 3 - 61 8 6 - 5 - 143 16 6 4,785 6 10 270 4 6 841 17 4 145 4 10 — 428 - - 1,691 6 8 316 17 6 1,592 1 3 61 19 5 275 12 3 2,246 10 5 3,937 17 1 +847 9 9 63,292 10 2 1,229 14 2 495 1 11 31 2 - 1,755 18 1 61,536 12 1 3,043 19 1 10,042 9 — 4,525 6 8 52 2 4 5,648 - 11 23,911 18 - 4,454 6 10 21,848 18 8 891 15 10 4,468 11 - 31,663 12 4 55,575 10 4 +5,961 1 9 Dwellings on sites compulsorily appropriated for rehousing, on the working of which a deficiency was anticipated owing to the character or situation of the site. Brook-street 1,016 15 6 18 19 - 19 11 _ 4 12 6 43 2 6 973 13 - 42 3 9 181 17 6 41 16 10 — 146 - - 411 18 1 55 10 - 470 3 2 12 4 5 103 13 4 641 10 11 1,053 9 _ —79 16 - Goldsmith's-row 484 14 6 10 19 - 19 11 - — 30 10 - 454 4 6 19 - - 87 3 2 15 11 10 — 55 - - 176 15 - 30 - - 213 14 11 7 1 11 52 10 9 303 7 7 480 2 7 —25 18 1 Hughes-fields (cottages) 2,053 13 4 499 9 8 16 19 — 4 4 — 520 12 8 1,533 — 8 65 — - 336 5 10 60 15 5 — 228 - - 690 1 3 111 12 - 1,072 4 11 26 8 - 258 — 1 1,468 5 — 2,158 6 3 —625 5 7 3,555 3 4 529 7 8 56 1 - 8 16 6 594 5 2 2,900 18 2 126 3 9 605 6 6 118 4 1 — 429 - - 1,278 14 4 197 2 - 1,756 3 - 45 14 4 414 4 2 2,413 3 6 3,691 17 10 —730 19 8 Interest on cash balances — - — — - - - - - — - - - - - - - +266 9 4 66,847 13 6 1,759 1 10 551 2 11 39 18 6 2,350 3 3 64,497 10 3 3.770 2 10 10,647 l5 6 4,643 10 9 52 2 4 6,077 - 11 25,190 12 4 4,651 8 10 23,605 1 8 937 10 2 4,882 15 2 34,070 15 10 59.267 8 2 + 5,496 11 5 Part II. Cranley 289 6 6 12 7 6 2 2 6 14 10 - 274 16 6 18 13 2 49 10 10 9 7 11 - 28 _ _ 105 11 11 22 10 _ 88 13 2 4 10 5 18 8 9 134 2 4 239 14 3 +35 2 3 Borough-road 1,869 6 6 10 4 - 26 1 6 — 36 5 6 1,833 1 - 105 - 6 325 3 11 61 7 6 — 165 - - 656 11 11 162 10 - 725 7 6 32 3 11 150 5 3 1,070 6 8 1,726 18 7 +106 2 5 Cobham 1,131 10 - 13 17 — — — 1 — 13 16 - 1,117 14 - 71 6 1 204 9 9 37 2 8 — 104 - — 416 18 6 68 5 — 422 14 7 12 19 2 80 18 — 584 16 9 1,001 15 3 +115 18 9 Ann-street 2,135 4 6 121 — 6 19 11 — 4 1 6 144 13 - 1,990 11 6 121 10 3 469 3 - 61 8 8 — 247 - - 899 1 11 73 9 - 756 13 4 14 1 1 152 10 11 996 14 4 1,895 16 3 +94 15 3 Sylva 469 5 6 3 8 6 — - 17 6 2 11 - 466 14 6 20 - - 99 14 2 12 18 2 — 49 - - 181 12 4 33 15 - 162 18 10 6 11 - 32 2 3 235 7 1 416 19 5 +49 15 1 Interest on cash balances - - — — - - - - - — - - - - - - - - +19 7 - 5,894 13 - 160 17 6 45 12 6 5 5 6 211 15 6 5,682 17 6 336 10 - 1,148 1 8 182 4 11 — 593 - - 2,259 16 7 360 9 - 2,156 7 5 70 5 7 434 5 2 3,021 7 2 5,281 3 9 +421 - 9 Part III. Dwellings. Parker-street House (b) 3,266 5 6 23 9 _ - 8 6 — 23 17 6 3,242 8 - 883 16 9 337 13 5 411 16 5 66 18 - 417 - - 2,117 4 7 110 9 10 704 17 4 24 19 1 165 19 7 1,006 5 10 3,123 10 5 +118 17 7 Carrington House (c)7,687 6 8 g 3,306 18 - 91 - - — 3,397 18 - 4,289 8 8 1,517 4 7 602 4 8 687 19 7 102 19 4 662 - - 3,572 8 2 74 5 - 1,811 15 10 14 8 3 352 16 6 2,253 5 7 5,825 13 9 —1,536 5 1 Dulferin-street 630 18 — 9 17 — 22 16 _ 1 5 — 33 18 — 597 — — 60 2 11 120 5 5 25 17 3 — 128 — — 334 5 7 55 19 8 138 18 2 12 12 10 31 7 6 238 18 2 573 3 9 +23 16 3 Rushworth (late Green)-street and Boyfield-street 1,788 15 6 30 19 - 22 3 - - 1 6 53 3 6 1,735 12 - 99 18 6 322 5 7 62 4 5 3 - 6 190 - - 677 9 - 115 16 - 623 10 10 30 - 8 137 18 3 907 5 9 1,584 14 9 +150 17 3 Millbank(proportion) 985 12 6 3 15 1 4 10 8 - 7 7 8 13 4 970 19 2 47 11 8 156 1 5 32 2 2 - - 11 90 19 3 326 15 5 67 17 9 335 11 4 12 14 3 67 19 6 484 2 10 810 18 3 +166 - 11 Holmwood 385 15 9 31 13 3 18 5 - 49 18 3 335 17 6 15 15 6 72 8 4 12 13 6 - 62 _ _ 162 17 4 12 18 9 144 15 11 2 15 1 29 19 1 190 8 10 353 6 2 —17 8 8 Totterdown-field 29,427 2 3 1,597 11 - 73 9 6 33 18 6 1,704 19 - 27,722 3 3 1,224 1 - 4,986 18 - 654 7 2 -_ 7 5 3,344 - - 10,209 13 7 2,538 2 1 10,961 11 4 470 8 1 2 022 17 10 15,992 19 4 26,202 12 11 +1,519 10 4 Preston's-road (proportion) (d)3,162 9 1 896 11 11 39 6 2 21 15 9 957 13 10 2,204 15 3 162 7 11 609 14 - 104 5 11 1 8 8 438 18 5 1,316 14 11 183 3 11 1,137 10 9 34 9 6 211 18 1 1,507 2 3 2,883 17 2 —679 1 11 Hughes-fields (dwellings)(proportion) 1,278 19 - 287 5 - 11 6 _ 8 18 2 307 9 2 971 9 10 52 16 2 213 10 2 43 3 8 — 148 — — 457 10 - 28 17 1 569 1 4 5 7 11 103 19 8 707 b _ 1,164 16 _ —193 6 2 White Hart-lane 18,706 1 3 (h) 391 12 9 72 9 9 13 6 7 477 9 1 18,228 12 2 974 1 6 4,322 - 3 472 2 4 1 - - 2,133 - - 7,902 4 1 1,662 9 1 6,497 17 9 295 2 3 1,153 15 1 9,609 4 2 17,511 8 3 +717 3 11 wessex 4,153 5 6 102 8 23 9 6 1 13 6 127 11 - 4,025 14 6 222 10 7 721 17 1 134 16 5 - 397 _ _ 1,476 4 1 384 5 4 1,574 6 2 73 11 7 295 9 2 2,327 12 3 3,803 16 4 +221 18 2 Norbury 10,999 11 - (A) 195 16 9 52 _ - 7 4 3 255 1 - 10,744 10 - 497 15 10 1,698 1 10 442 7 2 4 2 8 1,289 - - 3,931 7 6 1,125 15 10 4,292 16 9 200 14 4 765 7 9 6,384 14 8 10,316 2 2 +428 7 10 Caledonian 5,584 9 - 224 13 0 29 19 6 9 5 9 263 18 9 5,320 10 3 298 14 9 1,008 10 8 188 5 6 — 529 - - 2,024 10 11 491 6 - 1,865 5 2 98 15 2 340 5 4 2,795 11 8 4,820 2 7 +500 7 8 Briscoe 2,536 16 9 63 4 - 27 7 6 1 2 6 89 9 - 2,447 7 9 141 5 11 459 18 - 94 12 7 — 255 - - 950 16 6 241 9 2 1,023 10 5 45 3 — 182 11 10 1,492 14 5 2,443 10 11 +3 16 10 Old Oak 1,327 6 9 (h) 28 4 6 40 6 - — 68 10 6 1,258 16 3 152 6 7 192 19 - 41 15 - 2 3 5 190 - - 579 4 - 116 3 10 487 6 2 20 16 1 87 4 11 711 11 - 1,290 15 - —31 18 9 Interest on cash balances - - — — - - - - - — - - - — - - - - +252 7 10 91,920 14 6 7,193 18 9 528 17 1 96 14 1 7,811 9 11 84,101 4 7 6,350 10 2 15,824 7 10 3,408 9 1 182 - 11 10,273 17 8 36,039 5 8 7,208 19 4 32,168 15 3 1,341 18 1 5,949 10 1 46,669 2 9 82,708 8 5 +1,645 4 _ Total for dwelling 164,663 1 - 9,113 18 1 1,125 12 6 141 18 1 10,381 8 8 154,281 12 4 10,457 3 - 27,620 5 - 8,234 4 9 234 3 3 16,943 18 7 63,489 14 7 12,220 17 2 57,930 4 4 2,349 13 10 11,266 10 5 83,767 5 9 147,257 - 4 +7,562 16 2 Part III. 70,151 1 6 13,616 4 3 Estates in course of development. White Hart-lane 390 8 9 - — - 16 9 - 16 9 389 12 - - 97 17 5 - 262 13 1 - 164 15 8 2,389 6 11 - 428 16 6 - 2,818 3 5 2,982 19 1 —2,593 7 1 Norbury - - — — - - - 8 6 - - - 13 - - 7 13 - 157 15 2 - 10 1 2 - 167 16 4 160 3 4 —160 3 4 Old Oak (e) 59 16 10 - —* - 1 6 - 6 (e) 59 15 4 - 53 17 5 5 10 11 - 48 6 6 933 7 6 - 172 14 8 - 1,106 2 2 1,057 15 8 —998 - 4 Supervision, etc - - — — - - 500 - - - - 55 12 8 - 555 12 8 - - - - - 555 12 8 —555 12 8 Interest on cash balances - - — — - - - - - — - - - - - - - — —15 10 7 Sundry Estates (n) 963 6 - - — — - (n)963 6 - - - - - - - - - - - - — + 963 6 - 1,413 11 7 - — - 18 3 - 18 3 1,412 13 4 500 - - 160 - 10 - 324 9 8 - 664 8 10 3,480 9 7 - 611 12 4 - 4,092 1 11 4,766 10 9 —3,359 8 - Total-Housing of the Working Classes 166,076 12 7 9,113 18 1 1,125 12 6 142 16 4 10,382 6 11 155,694 5 8 10,957 3 - 27,460 4 2 8,232 4 9 558 12 11 16,943 18 7 64,154 3 5 15,701 6 9 57,930 4 4 2,961 6 2 11,260 10 5 87,859 7 8 152,013 11 1 +4,203 8 2 Act, 1890 Add—Interest on cash balances 522 13 7 (i) 156,216 19 3 (o) 73,631 11 1 (o) 14,227 16 7 II.—Improvement Acts.(pages xl and xli). £ s. d. £ s. d. £ s. d. £ s. d. £ s. d £ s. d. £ s. d. £ s. . d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d Battersea bridge 965 19 - 61 14 - 18 5 - - 79 19 - 886 - - 38 - - 8 19 4 45 1 11 - 130 — - 222 1 3 43 17 6 508 — 8 8 7 11 98 1 8 658 7 9 880 9 — +5 11 - Cotton-Street 1,187 6 - 149 2 6 20 17 _ 7 3 6 177 3 - 1,010 3 - 62 6 11 261 10 1 35 8 10 - 143 — — 502 5 10 40 5 — 412 8 3 8 4 — 81 3 — 542 — 3 1,044 6 l —34 3 1 Durham 1,348 7 6 394 2 6 14 7 _ 2 8 9 410 18 3 937 9 3 54 2 8 13 14 10 61 5 3 — 197 - - 298 3 1 80 6 6 843 16 - 15 11 10 159 10 11 1,099 5 3 1,397 18 4 —460 9 1 Duke's-court (proportion) 606 3 3 - 15 3 5 10 9 - 3 6 6 9 6 599 13 9 29 16 7 98 15 1 18 9 4 63 10 - 210 11 — 45 10 — 204 9 10 8 14 1 40 19 7 299 13 6 510 4 6 +89 9 3 York-street (proportion) 381 1 6 - 5 10 5 10 9 - 4 - 6 - 7 375 - 11 18 5 4 58 5 11 11 19 9 34 - - 122 11 - 33 15 - 141 6 10 6 11 - 27 15 3 209 8 1 331 19 l +43 1 10 Herbrand-street 2,775 6 - 7 15 6 22 3 - - 18 - 30 16 6 2,744 9 6 144 6 8 452 10 4 90 18 6 - 268 - - 955 15 6 236 5 - 906 3 7 45 17 ?. 172 16 11 1,361 2 8 2,316 18 2 +427 11 4 Bruce House (j)7,678 9 8 (i) 31 16 - 104 - - - 135 16 - 7,542 13 8 2,226 10 - 735 13 1 918 10 10 85 _ 2 589 _ _ 4,554 14 1 331 2 6 1,657 12 10 56 2 5 299 7 4 2,344 5 1 6,898 19 2 +643 14 6 Millbank (proportion) 11,416 - 7 43 10 2 52 10 3 4 7 4 100 7 9 11,315 12 10 551 2 5 1,820 15 - 371 18 3 - 10 8 1,053 11 5 3,797 17 9 581 6 4 3,867 6 9 108 17 5 780 15 - 5,338 5 6 9,136 3 3 +2,179 9 7 Bourne 13,489 8 2 283 16 5 114 10 6 2 13 8 401 - 7 13,088 7 7 666 3 1 1,970 14 1 434 10 11 - 7 2 1,066 - - 4,137 15 3 1,430 - - 4,945 - 1 271 17 8 943 - - 7,589 17 9 11,727 13 - +1,360 14 7 Swan-lane 4,119 6 - 842 17 - 19 11 - 9 4 10 871 12 10 3,247 13 2 185 7 11 715 16 5 150 14 6 — 474 - - 1,525 18 10 177 4 6 1,871 15 4 28 16 9 359 11 8 2,437 8 3 3,963 7 1 —715 13 11 Valette 1,677 19 - 68 16 - 23 9 6 3 8 - 95 13 6 1,582 5 6 80 3 8 301 11 7 57 4 5 - 152 _ _ 590 19 8 112 10 _ 615 12 3 19 1 4 115 10 1 862 13 8 1,453 13 4 +128 12 2 Hughes-fields (dwelling)(proportion) 639 9 6 143 12 6 5 13 - 4 6 1 158 14 7 485 14 11 26 8 1 106 15 1 21 11 10 - 74 _ - 228 15 - 14 8 6 284 10 9 2 14 — 51 19 9 353 13 - 582 8 - —96 13 1 Bearcroft 879 5 - 13 11 9 23 9 6 - 37 1 3 842 3 9 36 - - 154 5 4 26 15 5 - 81 - - 298 - 9 26 5 - 355 18 9 4 9 - 60 15 3 447 8 - 745 8 9 +96 15 - 47,164 1 2 2,041 15 5 429 17 3 35 - 8 2,506 13 4 44,657 7 10 4,118 13 4 6,671 16 6 2,244 9 9 85 18 - 4,325 1 5 17,445 19 - 3,152 15 10 16,614 1 11 585 4 7 3,191 6 5 23,543 8 9 40,989 7 9 +3,668 - 1 Dwellings on sites compulsorily appropriated for rehousing, on the working of which a deficiency was anticipated owing to the character or situation of the site. Council 799 2 6 31 4 - - 2 9 6 33 13 6 765 9 - 54 10 7 164 13 10 29 13 10 - 101 _ _ 349 18 3 18 12 7 492 4 9 4 4 7 115 18 10 631 _ 9 980 19 - —215 10 _ Westview, etc. 1,311 8 - 23 17 - - - 14 - 24 11 - 1,286 17 - 55 - - 204 18 1 40 4 6 - 179 - - 479 2 7 34 9 1 968 17 2 7 4 2 230 - 7 1,240 11 - 1,719 13 7 —432 16 7 Idenden 1,135 14 - 9 3 6 22 3 - - 31 6 6 1,104 7 6 47 - - 197 - 11 34 10 10 - 125 - - 403 11 9 45 - - 513 17 - 11 13 5 129 7 4 699 17 9 1,103 9 6 +- 18 - Barnaby 1,431 6 - 51 - - 20 17 - 1 - - 72 17 - 1,358 9 - 71 16 9 309 16 5 43 19 - - 143 — — 568 12 2 97 — 7 573 9 4 18 4 2 104 17 4 793 11 5 1,362 3 7 —3 14 7 Brightlingsea 1,085 17 6 174 1 6 19 11 - - 1 6 193 14 - 892 3 6 41 17 6 184 19 6 38 8 3 - 125 _ _ 390 5 3 33 15 - 474 17 5 6 7 1 86 15 1 601 14 7 991 19 10 —99 16 4 Bekesbourne 1,243 12 - 7 8 6 22 3 - - 4 - 29 15 6 1,213 16 6 66 12 7 220 3 10 44 9 8 - 134 - - 465 6 1 36 8 - 637 12 - 7 2 4 112 6 3 793 8 7 1,258 14 8 —44 18 2 Darcv 743 - 6 6 17 6 22 3 - - 19 6 30 - - 713 - 6 30 - - 137 19 11 27 1 11 - 72 - - 267 1 10 42 3 9 335 11 4 7 18 11 61 15 1 447 9 1 714 10 11 —1 10 5 W andsworth-road 921 12 6 10 19 6 22 3 - 1 9 - 34 11 6 887 1 - 38 - - 166 5 3 29 2 10 - 89 - - 322 8 1 54 2 - 386 2 3 9 11 2 72 7 2 522 12 7 845 — 8 +42 - 4 8,671 13 - 314 11 6 129 - - 6 17 6 450 9 - 8,221 4 - 404 17 5 1,5 85 17 9 287 10 10 - 968 _ _ 3,246 6 _ 362 1 _ 4,382 11 3 72 5 10 913 7 8 5,730 5 9 8,976 11 9 —755 7 9 Interest on cash balances - - - - — — — — - - - - - - - - - - +181 6 5 55,835 14 2 2,356 6 11 558 17 3 41 18 2 2.957 2 4 52,878 11 10 4,523 10 9 8,257 14 3 2,532 _ 7 85 18 _ 5,293 1 5 20,692 5 - 3,514 16 10 20,996 13 2 657 10 5 4,104 4 1 29,273 14 6 49,965 9 6 + 3,093 18 9 Add-Interest on each balance 181 6 5 (k) 53,059 18 3 24,511 10 - 4,762 4 6 (a) Including 8s. 10d. receipts for baths. (b) Including £18 5s. 6d. miscellaneous receipts for baths, storage of parcels, etc. (c) Including £39 6s. 10d., as in note (a). (d) Including £1 14s. 1d. as in note (a). (e) Including 16s. 6d., sale of top spit, etc. (/) Including £63 8s. 11d., as in note (a). (g) Excluding £6 59. 8d., rebate on weekly tickets. (h) Including new cottages handed over on completion (t) Excluding £572 12s. 4d., as in note (g). (j) Local wages of caretakers, etc., £4,553 17s. 6d. ; central office, £6,403 5s. 6d. (k) Local wages of caretakers, etc. £2,486 14s. 1d. ; central office, £2,036 16s. 8d. (l) After deducting tax on interest on debt recovered, see Dote (m). (m) Tax on interest recovered is deducted from rates and taxes (col. 9). See note (I). (n) Transfers from sundry revenue accounts in respect of debt charges on expenditure met out ot Acquisition of Lands Fund as on page xxxiii. (o) Comprising : (1) Transfers to Consolidated Loans Fund—Interest, £72,814 10s 8d., Sinking Fund on £14,081 l1s. ; (2) Transfers to Dwellings Rcvcnue Account (as page xixiii) in respect of expenditure met out of Acquisition of Lands Fund—Interest £817 0s. 5d, sinking Fund £140 5s. 7d. 1 Annual Report of the London County Council, 1912. 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. Deductions. Net Rental. Maintenance and Management. Transfer to Repairs and Renewals Fund. Total. Debt Charges. Total (cols. 13 and 18) (d) Interest (gross). Sinking fund. Total. Surplus. Defi- ciency. Empties. Caretaker's Quarters. Amounts irrecoverable. Total. Supervision and Collection of Rent. Rates and Taxes. (c) Lighting, Heating, Water and Insurance. Stores and Incidentals. Land. Buildings. Land. Buildings. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1.—Housing of the Working Classes Act, 1890 Part i. £ % % % % % % % % % % % % % % % % % % % Boundary-street (including laundry) 23,394 .76 .61 .09 1.46 98.54 7.21 17.33 5.46 .10 9.07 39.17 8.12 33.86 1.73 7.71 51.42 90.59 7.95 Do. (automatic gas supply) 2,980 — — — —- 100.00 5.71 — 69.58 — 5.03 80.32 — 7.47 — 1.77 9.24 89.56 10.44 — Cable-street 2,963 .66 .84 .04 1.54 98.46 4.63 19.53 3.71 — 10.77 38.64 3.80 39.11 .87 8.98 52.76 91.40 7.06 — Shelton-street 1,564 2.42 1.52 — 3.94 96.06 4.10 16.33 3.81 1.75 9.33 35.32 9.78 37.00 2.34 9.03 58.15 93.47 2.59 — Millbank 6,582 .38 .46 .04 .88 99.12 4.83 15.95 3.26 — 9.23 33.27 5.09 33.88 .95 6.84 46.76 80.03 19.09 Churchway 3,906 .45 .70 — 1.15 98.85 5.21 17.84 3.14 8.94 35.13 7.11 31.98 1.36 6.31 46.76 81.89 16.96 — Hardy 879 3.17 1.93 .13 5.23 94.77 4.16 16.80 3.36 — 14.45 38.77 3.70 45.32 .71 8.73 58.46 97.23 — 2.46 Duke s-court 1,818 .13 .91 .03 1.07 98.93 4.92 16.29 3.04 — 10.48 34.73 7.51 33.73 1.44 6.76 49.44 84.17 14.76 — York-street 1,143 .08 1.45 .05 1.58 98.42 4.79 15.30 3.15 — 8.92 32.16 8.86 37.09 1.72 7.28 54.95 87.11 11.31 — Preston's-road 822 28.35 1.24 .69 30.28 69.72 5.14 18.61 3.30 .04 13.88 40.97 5.79 47.42 1.09 8.78 63.08 104.05 — 34.33 St. Luke's— Wenlake 1,930 .72 1.28 —. 2.00 98.00 5.17 16.85 3.15 — 9.17 34.34 9.07 34.85 1.65 6.51 52.08 86.42 11.58 — Chad worth 3,401 9.07 .65 .09 9.63 90.37 4.51 13.77 2.80 — 8.03 29.11 7.64 39.43 1.50 6.71 55.28 84.39 5.98 — Clerkenwell and Holborn— Mallory 913 .10 2.57 — 2.67 97.33 4.17 11.52 2.57 — 7.01 25.27 6.65 44.13 1.13 7.94 59.85 85.12 12.21 — Nigel, etc 6,068 4.63 .90 .02 5.55 94.45 4.50 14.77 3.23 — 7.88 30.38 8.99 43.78 1.53 7.42 61.72 92.10 2.35 — Webber-row 4,929 1.67 1.24 .01 2.92 97.08 5.60 17.08 2.95 — 8.68 34.31 6.43 32.30 1.26 5.59 45.58 79.89 17.19 Brook-street 1,017 1.86 1.92 .46 4.24 95.76 4.15 17.89 4.11 — 14.36 40.51 5.46 46.24 1.20 10.20 63.10 103.61 7.85 Goldsmith's-row 485 2.26 4.03 — 6.29 93.71 3.92 17.98 3.21 — 11.35 36.46 6.19 44.10 1.46 10.84 62.69 99.05 — 5.34 Hughes-fields Cottages 2,054 24.32 .83 .20 25.35 74.65 3.17 16.37 2.96 — 11.10 33.60 5.43 52.21 1.29 12.56 71.49 105.09 Cranley 289 4.28 — .73 5.01 94.99 6.45 17.12 3.25 9.68 36.50 7.77 30.65 1.56 6.37 46.35 82.85 12.14 — Borough-road 1,869 .55 1.39 — 1.94 98.06 5.62 17.40 3.28 8.83 35.13 8.69 38.80 1.72 8.04 57.25 92.38 5.68 — Cobham 1,132 1.22 — — 1.22 98.78 6.30 18.08 3.28 — 9.19 36.85 6.03 37.36 1.14 7.15 51.68 88.53 10.25 — Ann-street 2,135 5.67 .91 .19 6.77 93.23 5.69 21.97 2.88 — 11.57 42.11 3.44 35.44 .66 7.14 46.68 88.79 4.44 — Sylva 469 .73 — .19 .54 99.46 4.26 21.25 2.75 — 10.44 38.70 7.19 34.72 1.40 6.84 50.51 88.85 10.61 — Parker-street House 3,266 .72 .01 — .73 99.27 27.06 10.34 12.61 2.04 12.77 64.82 3.38 21.58 .77 5.08 30.81 95.63 3.64 — Carrington House 7,687 43.02 1.18 — 44.20 55.80 19.74 7.83 8.95 1.34 8.61 46.47 .96 23.57 .19 4.59 29.31 75.78 — 19.98 Dufferin-street 631 1.56 3.61 .20 5.37 94.63 9.53 19.06 4.10 — 20.29 52.98 8.88 22.02 2.00 4.97 37.87 90.85 3.78 — Rushworth (late Creen)-street and Boyfield-street 1,789 1.73 1.24 — 2.97 97.03 5.58 18.04 3.48 .17 10.60 37.87 6.47 34.86 1.68 7.71 50.72 88.59 8.44 — Millbank 986 .38 .46 .04 .88 4.83 15.83 3.26 — 9.23 33.15 6.88 34.05 1.29 6.90 49.12 82.27 16.85 — Holmwood 386 8.21 4.73 12.94 87.06 4.09 18.77 3.29 — 16.07 42.22 3.35 37.54 .71 7.76 49.36 91.58 — 4.52 Totterdown-fields 29,427 5.43 .25 .11 5.79 94.21 4.16 16.95 2.22 — 11.36 34.69 8.63 37.25 1.60 6.87 54.35 89.04 5.17 — Preston's-road 3,162 28.35 1.24 .69 30.28 69.72 5.14 19.28 3.30 .04 13.88 41.64 5.79 35.97 1.09 6.70 49.55 91.19 — 21.47 Hughes-fields Dwellings 1,279 22.46 .88 .70 24.04 75.96 4.13 16.69 3.38 — 11.57 35.77 2.26 44.49 .42 8.13 55.30 91.07 — 15.11 White Hart-lane 18,706 (a)2.09 .39 .07 2.55 97.45 5.21 23.10 2.52 .01 11.40 42.24 8.89 34.73 1.58 6.17 51.37 93.61 3.84 — Wessex 4,153 2.47 .56 .04 3.07 96.93 5.36 17.39 3.25 — 9.56 35.56 9.25 37.90 1.77 7.11 56.03 91.59 5.34 — Norbury 11,000 (a)l.78 .47 .07 2.32 97.68 4.53 15.43 4.02 .03 11.72 35.73 10.24 90.03 1.82 6.96 58.05 93.78 3.90 — Caledonian 5.585 4.02 .54 .17 4.73 95.27 5.35 18.06 3.37 — 9.47 36.25 8.80 33.40 1.77 6.09 50.06 86.31 8.96 — Briscoe 2,537 2.49 1.08 .04 3.53 96.47 5.57 18.13 3.73 — 10.05 37.48 9.52 40.34 1.78 7.20 58.84 96.32 .15 — Old Oak 1,327 (a)2.13 3.03 — 5.16 94.84 11.48 14.54 3.15 .16 14.31 43.64 8.75 36.71 1.57 6.57 53.60 97.24 — 2.40 Total for Housing of the Working Classes Act, 1890 164,663 5.54 .68 .08 6.30 93.70 6.35 16.77 5.00 .14 10.20 38.55 7.42 35.18 1.43 6.84 50.87 89.42 4.28 — li —improvement Acts. Battersea-bridge 966 6.39 1.89 — 8.28 91.72 3.93 .93 4.67 — 13.46 22.99 4.54 52.59 .87 10.16 68.16 91.15 .57 — Cotton-street 1,187 12.56 1.76 .60 14.92 85.08 5.25 22.03 2.99 — 12.04 42.31 3.39 34.74 .69 6.83 45.65 87.96 — 2.88 Durham 1,348 29.23 1.06 .18 30.47 69.53 4.02 1.02 4.54 — 14.61 22.15 5.96 62.58 1.15 11.83 81.52 103.67 — 34.14 Duke's-court 606 .13 .91 .03 1.07 98.93 4.92 16.29 3.04 — 10.48 34.73 7.51 33.73 1.44 6.76 49.44 84.17 14.76 — York-street 381 .08 1.45 .05 1.58 98.42 4.79 15.30 3.15 — 8.92 32.16 8.86 37.09 1.72 7.28 54.95 87.11 11.31 — Herbrand-street 2,775 .28 .80 .03 1.11 98.89 5.20 16.30 3.28 — 9.66 34.44 8.51 32.65 1.65 6.23 49.04 83.48 15.41 — Bruce 7,679 (b) .42 1.35 — 1.77 98.23 29.00 9.58 11.96 1.11 7.67 59.32 4.31 21.59 .73 3.90 30.53 89.85 8.38 — Millbank 11,416 .38 .46 .04 .88 99.12 4.83 15.95 3.26 — 9.23 33.27 5.09 33.88 .95 6.84 46.76 80.03 19.09 — Bourne 13,490 2.10 .85 .02 2.97 97.03 4.94 14.61 3.22 — 7.90 30.67 10.60 36.66 2.02 6.99 56.27 86.94 10.09 — Swan-lane 4,119 20.46 .48 .22 21.16 78.84 4.50 17.38 3.66 — 11.51 37.05 4.30 45.44 .70 8.73 59.17 96.22 — 17.38 Valette 1,678 4.10 1.40 .20 5.70 94.30 4.78 17.97 3.41 9.06 35.22 6.70 36.69 1.14 6.88 51.41 86.63 7.67 — Hughes-fields Dwellings 640 22.46 .88 .70 24.04 75.96 4.13 16.69 3.38 — 11.57 35.77 2.26 44.49 .42 8.13 55.30 91.07 — 15.11 Bear croft 879 1.55 2.67 — 4.22 95.78 4.09 17.55 3.05 — 9.21 33.90 2.98 40.48 .51 6.91 50.88 84.78 11.00 — Council 799 3.90 — .31 4.21 95.79 6.82 20.61 3.72 — 12.63 43.78 2.33 61.60 .53 14.51 78.97 122.75 — 26.96 Westview, Armitage and Collerston 1,311 1.82 — .05 1.87 98.13 4.19 15.62 3.07 — 13.65 36.53 2.63 73.88 .55 17.54 94.60 131.13 — 33.00 Idenden 1,136 .81 1.95 — 2.76 97.24 4.13 17.35 3.04 — 11.01 35.53 3.96 45.25 1.03 11.39 61.63 97.16 .08 — Barnaby 1,431 3.56 1.46 .07 5.09 94.91 5.02 21.65 3.07 — 9.99 39.73 6.78 40.06 1.27 7.33 55.44 95.17 — .26 Brightlingsea 1,086 16.03 1.80 .01 17.84 82.16 3.85 17.03 3.54 — 11.51 35.93 3.11 43.74 .58 7.99 55.42 91.35 9.19 Bekesbourne 1.244 .60 1.78 .02 2.40 97.60 5.36 17.70 3.58 — 10.78 37.42 2.93 51.27 .57 9.03 63.80 101.22 — 3.62 Darcy 743 .93 2.98 .13 4.04 95.96 4.04 18.57 3.65 — 9.69 35.95 5.68 45.16 1.07 8.31 60.22 96.17 — .21 Wandsworth-road 922 1.19 2.40 .16 3.75 96.25 4.13 18.04 3.16 9.66 34.99 5.92 41.89 1.04 7.85 56.70 91.69 4.56 — Total for Improvement Acts 55,836 4.22 1.00 .08 5.30 94.70 8.10 14.79 4.53 .15 9.49 37.06 6.30 37.60 1.18 7.35 52.43 89.49 5.21 — Total for dwellings 220,499 5.20 .77 .01 6.05 93.95 6.79 16.27 4.88 .15 10.09 38.18 7.14 35.79 1.36 6.97 51.26 89.44 (e) 4.51 — (n) See note (h) on page xlviii, (6) Excluding 7.46 for rebate on weekly tickets. (c) After deducting income tax on interest on capital outlay (cols. 14 and 15). (d) See Note (c) (e) Percentage on surplus of £9,937 4s. 4d., which excludes interest on cash balances amounting to £719 10s. 7d. 1ii liii Annual Report of the London Courty Council, 1912. Housing of the Working Classes-Accounts. F-SUMMARY OF FINANCIAL RESULTS. Dwellings, Borough. Accommodation persons) Persons inoccupation 31st March, 1913. Date of opening Aggregate Capital Expenditure to 31st March, 1913. Aggregate Balance on Revenue Account, 1st April 1912. Surplus (+ ) Deficiency (—). Result of Year's Working. Surplus (+) Deficiency (—) (page 27, col. 20). Aggregate Balance on Revenue Account, 31st March, 1913. Surplus (+) Deficiency (—). Accumulations of Sinking Fund to 31st March, 1913, including proceeds of Sales). Repairs and Renewals Fund. 1912-13 Land. Buildings. Total. Unspent Accumulations on 1st April, 1912 Transfers from Revenue Account (page 27, col. 12). Actual Expenditure. Difference, being further amount set aside Unspent Accumulations on 31st March, 1913 1 2 3 4 5 6 7 8 9 10 11 12 13 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. £ s. d. Boundary-street Bethnal Green and Shored itch 5,380 4,443 1895-1900 62,010 - - 275,526 6 - 337,536 6 - + 21,902 12 9 + 2,170 10 5 + 24,073 3 2 45,375 15 1 Cab'e-street Stepney 798 603 1896, 1901 3,660 - - 37,592 8 7 41,252 8 7 + 1,722 19 9 +209 3 9 +1,932 3 6 6138 13 6 16,411 6 11 6,077 - 11 6,668 2 10 591 1 11 15,820 5 - Shelton-street Holborn 284 226 1896 5,100 - - 19,292 7 5 24,392 7 5 + 322 14 - + 40 9 7 + 363 3 7 4,136 14 8 Millbank (proportion) Westminster (City) 1,536 1,047 1899-1902 11,906 12 - 70,390 13 1 82,297 5 1 + 13,036 3 5 + 1,256 12 8 + 14,292 16 1 7,674 14 - Church way St. Pancras 832 607 1901-2 8,550 - - 39,126 14 - 47,676 14 - + 7,395 14 11 + 662 7 3 + 8,058 2 2 3,977 18 3 Hardy Greenwich 306 234 1901 1,000 - - 12,298 9 - 13,298 9 - — 1,013 1 1 — 21 12 3 — 1,034 13 4 1,126 14 1 Duke's-court (proportion) Westminster (City) 458 350 1902 4,200 - - 19,193 16 1 23,393 16 1 + 2,713 17 7 + 268 7 3 + 2,982 4 10 1,896 1 10 York-street (proportion) Westminster (City) 293 217 1903 3,000 - - 12,950 6 7 15,950 6 7 + 1,156 3 9 + 129 5 11 + 1,285 9 8 1,096 17 8 Preston's-road (proportion) Poplar 269 141 1904 1,433 14 1 11,412 17 5 12,846 11 6 — 2,424 3 4 — 282 4 9 — 2,706 8 1 789 8 7 St. Luke's— Wenlake Finsbury 496 364 1905 5,000 - - 19,774 2 7 24,774 2 7 + 1,527 15 1 +223 8 2 +1,751 3 3 1,338 8 2 Chadworth Finsbury 720 555 1907 8,000 - - 35,897 15 3 43,897 15 3 + 693 12 3 +203 11 3 +897 3 6 1,834 9 - Clerkenwell and Holborn— Mallory Finsbury 164 120 1906 1,620 - - 11,479 2 3 13,099 2 3 + 669 8 2 +111 8 8 +780 16 10 603 - 2 Nigel, etc. Holborn 1,260 861 1908 14,550 - - 71,772 18 5 86,322 18 5 + 96 3 9 + 142 4 1 + 238 7 10 2,775 12 7 Webber-row Southwark 1,143 797 1906-7 9,750 - - 43,041 8 1 52,791 8 1 + 3,421 9 8 +847 9 9 +4,268 19 5 2,243 17 5 Dwellings on sites compulsorily appropriated for rehousing, on the working of which a deficiency was anticipated owing to the character or situation of the site. Brook-street Stepney 308 243 1894, 1900 1,800 - - 15,314 - 9 17,114 - 9 — 1,950 7 11 — 79 16 - — 2,030 3 11 2,752 17 1 Goldsmith's-row Shoreditch 144 101 1895 1,000 - - 7,128 8 11 8,128 8 11 — 543 16 1 — 25 18 1 — 569 14 2 1,505 1 3 Hughes-fields cottages Greenwich 666 374 1895 3,720 - - 35,756 1 1 39,476 1 1 — 10,043 19 7 — 625 5 7 — 10,669 5 2 7,411 8 5 Part II Cranley Holborn 60 44 1897 750 - - 3,017 8 10 3,767 8 10 + 617 2 2 +35 2 3 +652 4 5 469 7 2 2,436 5 11 592 - - 669 6 11 76 6 11 2,359 19 - Borough-road Southwark 400 288 1900 5,000 - - 24,014 4 1 29,014 4 1 + 923 8 4 +106 2 5 +1029 10 9 2928 9 6 Cobham Southwark 279 209 1900 2,100 - - 13,007 1 5 15,107 1 5 + 1,303 2 3 +115 18 9 +1419 1 - 1416 16 5 Ann-street Poplar 630 452 1901-2 2,260 - - 23,812 4 8 26,072 4 8 — 828 - 10 +94 15 3 —733 5 7 2094 13 4 Sylva Deptford 144 91 1903 1,000 - - 5,053 7 7 6,053 7 7 + 554 2 2 + 49 15 1 +603 17 3 430 5 9 Part III. Dwellings. Parker-street House Holborn 345 345 1893 3,750 - - 23,159 9 - 26,909 9 - + 575 9 - +118 17 7 +694 6 7 5,175 3 4 16,214 1 18 - 10,27 3 17 8 9,17C 14 1 1.103 7 17,318 1 7 Carrington House Deptford 803 438 1903 2,200 - - 54,936 17 7 57,136 17 7 — 12,148 15 2 —1536 5 1 —13685 - 3 3921 - 11 Dufferin-street Finsbury 174 155 1892 1,900 - - 4,714 10 11 6,614 10 11 — 106 8 9 +23 16 3 —82 12 6 1,398 11 8 Rushworth (late Green) street and Boyfieldstreet Southwark 418 317 1897 3,860 - - 21,074 18 4 24,934 18 4 + 1,986 18 - + 150 17 3 +2137 15 3 3575 13 5 Millbank (proportion) Westminster (City) 230 157 1899-1902 2,411 14 5 10,540 5 3 12,951 19 8 + 1,810 7 4 +166 - 11 +1976 8 3 1214 1 11 Holmwood Southwark 72 37 1900 450 - - 4,777 13 6 5,227 13 6 — 291 16 4 —17 8 8 —309 5 - 531 16 5 Totterdown-fields Wandsworth 8,733 4,644 1903-11 77,539 16 8 316,319 16 8 393,859 13 4 + 1,362 3 4 +1519 10 4 —309 5 - 531 16 5 Preston's-road (proportion) Poplar 1,035 541 1904 5,516 5 11 33,552 19 10 39,069 5 9 — 6,011 6 - —679 1 11 —6690 7 11 2448 11 7 Hughes-fields-dwellings (proportion) Deptford and 440 287 1904 855 6 8 16,374 12 9 17,229 19 5 — 1,875 8 2 —193 6 2 —2068 14 4 989 - 6 White Hart-lane Tottenham, Wood Green and Edmonton (U.D.C.) 6,599 3,079 1904-12 50,187 - - 184,322 9 8 234,509 9 3 — 4,898 3 3 +717 3 11 —4180 19 4 ║ 9656 1 8 Wessex Islington 1,050 723 1904-5 11,818 13 2 46,060 9 11 57,879 3 1 — 1,175 4 7 +221 18 2 —953 6 5 3595 17 6 Norbury Croydon 3,472 1,667 1906-12 29,023 - - 125,950 5 2 154,973 5 2 — 897 16 11 +428 7 10 —469 9 1 ║ 3651 9 - Caledonian-road Islington 1,384 1,027 1906 15,763 12 7 53,192 — 8 68,955 13 3 + 475 12 10 +500 7 8 +976 - 6 3571 3 6 Briscoe Lambeth 718 365 1906 7,154 7 2 27,971 17 1 35,126 4 3 — 1,548 14 11 +3 16 10 —1544 18 1 1678 16 8 Old Oak Hammersmith 637 353 1912 14,141 - - t 32 13 7 t 14,173 13 7 —12 17 2 —31 18 9 —44 15 11 ║10,058 10 - Total—Dwellings .. - 26,502 - 383.981 2 8 1,729,833 1 7 2,113,814 4 3 + 18,497 - 5 +7024 12 - +25521 12 5 170318 1 6 35062 10 10 16.948 18 7 16508 3 10 435 14 9 35,498 5 7 Interest on cash balances .. .. .. .. - - - +2,988 17 9 + 538 4 2 + 3,527 1 11 - - - - - - 383,981 2 8 1,729,833 1 7 2,113,814 4 3 +21,485 18 2 +7562 16 2 +29048 14 4 - - - - - - Dwellings in course of erection—******************************************************************************************************************************************************************************************************** Part I. .. .. .. .. - 169 6 5 169 6 5 — 6,613 17 1 - — 6,613 17 1 - - - - - - Part III .. .. .. .. - - - —5,601 17 3 - — 5,601 17 3 - - - - - - - 169 6 5 169 6 6 — 12,215 14 4 - — 12,215 14 4 - - - - - 383.981 2 8 1.730.002 8 - 2,113,983 10 8 + 9,270 3 10 +7,562 16 2 +16,833 - - - - - - - - Dividends (less expenses of investment) and Interest (Repairs and Renewals Fund) - - - - - - - 6,906 15 11 - —1,287 13 3 1,287 13 3 8,194 9 2 Part III. Estates in course of development ‡§103,397 6 4 — ‡§103,397 6 4 —74,895 14 2 —3,359 8 - — 78,255 2 2 10,412 17 4 — — — — — 487,378 9 - 1,730,002 8 - 2,217,380 17 - —65,625 10 4 +4,203 8 2 — 61,422 2 2 ¶180,730 18 10 41,969 6 9 16,943 18 7 15,220 10 7 1,723 8 - 43,692 14 9 Add—Net contributions from rates to 31st March, 1913 (page 82) 61,422 2 2 II—Improvement Acts.********************************************************************************************************* £ s, d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. Battersea Bridge Battersea 286 198 1901 1,350 - - 15,704 7 8 17,054 7 8 +507 19 1 +5 11 - + 513 10 1 1,445 15 5 16,808 6 11 5,293 1 5 6,443 15 1 1,150 13 8 15,657 13 3 Cotton-street I'opiar 360 216 1901 1,400 - - 12,768 12 5 14,168 12 5 —487 8 7 —34 3 1 — 521 11 8 1,285 - 9 Durham Battersea 536 319 1904 2,380 - - 24,684 13 - 27,064 13 — — 3,637 13 6 -460 9 1 — 4,098 2 7 1713 11 5 Duke's-court (proportion) Westminster (City) 152 116 1902 1,400 - - 6,397 18 9 7,797 18 9 +904 12 9 +89 9 3 + 994 2 - 632 - - York-street (proportion) Westminster (City) 97 72 1903 1,000 - - 4,316 15 5 5,316 15 5 +385 7 7 +43 1 10 +428 9 5 365 13 2 Herbrand-street Holborn 680 545 1904 7,000 - - 26,659 2 2 33,659 2 2 + 3400 15 8 +427 11 4 + 3,828 7 - 2,203 12 8 Bruce House Westminster (City) 708 708 1906 8,830 - - 47,109 3 1 55,939 3 1 + 4,243 12 6 +643 14 6 + 4,887 7 - 2,426 3 5 Millbank (proportion) Westminster (City) 2,664 1,815 1899-1902 20,650 10 2 122,083 15 11 142,734 6 1 + 22,652 2 3 + 2,179 9 7 + 24,831 11 10 13,310 15 6 Bourne Holborn 2,642 1,S49 1902-4 44,000 - _ 149,363 18 6 193,363 18 6 + 8,182 6 6 +1,360 14 7 + 9,543 1 1 13,412 6 8 Swan-lane Bermondsey 1,270 914 1902-4 6,000 - - 55,870 5 - 60,870 5 - — 8,846 2 3 —715 13 11 — 9,561 16 2 3,894 9 7 Valette Hackney 416 282 1905 3,000 - - 18,172 11 1 21,172 11 1 +826 5 5 +128 12 2 +954 17 7 1,035 7 6 Hughes-fields (dwellings) (proportion) Deptford and Greenwich 220 144 1904 427 13 4 8,187 6 4 8,614 19 8 — 937 14 2 —96 13 1 — 1,034 7 3 494 9 9 Bearcroft Fulham 220 119 1906 700 - - 9,566 17 4 10,266 17 4 — 211 14 7 +96 15 - -114 19 7 425 12 10 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 Poplar 240 156 1894 621 - - 16,420 7 - 17,041 7 - —4602 - 3 —215 10 - -4,817 10 3 3,256 18 - Westview, etc. Greenwich 464 347 1894 1,148 9 3 32,307 14 11 33,456 4 2 —8506 12 4 -432 16 7 — 8,939 8 11 6,372 4 2 Idenden Greenwich 400 242 1896 1,500 - - 17,156 10 6 18,656 10 6 — 855 13 1 +- 18 - —854 15 1 3,208 10 7 Barnaby Bermondsey 400 320 1904 2,875 - - 16,516 17 1 19,391 17 1 — 85 — 187 12 10 —3 14 7 —191 7 5 1,134 11 1 Brightlingsea Stepney 340 245 1904 1,000 - - 13,671 5 10 14,671 5 10 — 1,540 8 1 -99 16 4 —1,640 4 5 863 9 10 Bekesbourne Stepney 380 238 1907 1,120 - - 17,095 15 9 18,215 15 9 — 302 19 2 -44 18 2 —347 17 4 758 9 5 Darcy Hackney 190 137 1904 1.250 - - 9,741 12 3 10,991 12 3 — 174 1 9 -1 10 5 —175 12 2 660 17 7 Wandsworth-road Lambeth 238 147 1905 1,560 - - 11,343 1 3 12,903 1 3 + 279 10 - +42 - 4 +321 10 4 711 7 3 Total—Dwellings in occupation .. - 9,129 - 108,212 12 9 635,138 11 3 743,351 4 - +11,092 11 2 +2,912 12 4 +14,005 3 6 59,661 6 7 16,808 6 11 5,293 1 5 6,443 15 1 1,150 13 8 15,657 13 3 Interest on cash balances .. .. .. .. - - - +1,458 4 2 +181 6 5 +1,639 10 7 — - - - - - Dwellings in course of erection .. .. .. .. - - - + 12,550 — 3,897 15 7 4 9 +3,093 - 18 - 9 - +15,644 —3,897 14 7 1 9 — - - — — — Dividends (less expenses of investment) and interest (Repairs and Renewals Fund) .. - - - + 8,653 - 7 - 7 - +3,093 - 18 - 9 - +11,747 - 6 - 4 - - 3,072 9 8 — —586 7 10 586 7 10 3,658 17 6 108,212 12 9 635,138 11 3 743,351 4 - + 8,653 7 7 +3,093 18 9 +11,747 6 4 ¶59,661 6 7 19,880 16 7 5,293 1 5 5,857 7 3 564 5 10 19,316 10 9 Deduct—Net contributions to rates, after deducting contributions from Tramways Account, to 31st March, (page liv) 11,747 6 4 *The accommodation is arrived at genei ally by calculating two persons to a room. The census taken iD March, 1913. showed an average of - - - 1.32 persons per room. † After deducting expenditure of £32,325 8s. l0d. met out of the Acquisition of Lands Fund. ‡After deducting expenditure of £12,120 3s. 11d. as in note †. § White Hart-lane £81,412 18s. 4d.; Norbury £4,133 10. 4d.; Old Oak 18820 £17,850 17s. 8d. ║Including proceeds of sales. ¶If The total accumulations (£240,392 5s. 5d shown in this column do not take account of Stock Issue Expenses (£20,274), and the amount applied in repayment of debt (Stock £35,179 0s. 4d., Consolidated Loans liv Annual Report of the London County Council, 1912. G-REPAIRS AND RENEWALS ACCOUNT-DETAILS OF INVESTMENTS. Name of Stock. Amount of Stock. Cost Price. Market Value on 31st March, 1913 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 Country Consolidated- 2½ percent. 24,570 14 9 12,693 9 1 1,000 - - 1,603 16 9 15,297 5 10 5,702 14 2 21,000 - - 15,910 3 per cent. 12,246 9 8 1,000 - - 500 - - 4,500 - - 6,000 - - 5,000 - - 11,000 - - 9,683 New South Wales Government- 3½ per cent. Inscribed (1918) 11,148 17 2 3,000 - - 500 - - 4,000 - - 7,500 - - 3,500 - - 11,000 - - 10,675 Dominion of Canada— 3½ per cent. Registered (193050) 13,026 4 1 3,000 - - - 5,500 - - 8,500 - - 4,500 - - 13,000 - - 12,131 London, Brighton and South Coast Railway Company— 5 per cent. Consolidated Guaranteed 1,500 - - 801 - - 400 10 - 400 10 - 1,602 - - 400 10 - 2,002 10 - 1,836 20,494 9 1 2,400 10 - 16,004 6 9 38,899 5 10 19,103 4 2 58,002 10 - *50,135 *Housing Act, 1890 £33,379 Improvement Acts 16,756 50,135 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 £ 8. d. £ s. d. £ s. d. £ s. d. 1894-5—1911-12 3,167 17 6 — 30,579 14 7 76,286 2 8 5,097 5 4 115,131 - 1 1912-13 — — — 3,359 8 - — 3,359 8 - 3,167 17 6 - 30,579 14 7 79,645 10 8 5,097 5 4 118,490 8 1 Contributions to Rates. 1894-5—1911-12 37,228 10 8 2,967 9 3 2,821 16 - †1,390 8 6 14,805 7 1 59,213 11 6 1912-13 5,496 11 5 421 - 9 1,645 4 - — 3,190 11 10 10,753 8 - 42,725 2 1 3,388 10 - 4,467 - - †l,390 8 6 17,995 18 11 69,966 19 6 Net Contributions— From rates — — 26,112 14 7 78,255 2 2 — 48,523 8 7 To rates 39,557 4 7 3,388 10 - — — 12,898 13 7 Contributions from tramways account. Proportion of deficiency on Hughes-fields (Deptford) Dwellings, Drake Buildings, allocated for rehousing persons displaced by the Generating Station, Greenwich— To 31st March, 1912 1,054 14 2 1912-13 96 13 1,15l 7 3 Net contributions from rates and tramways account- Housing of the Working Classes Act, 1890 61,422 2 2 Less—Dwellings under Improvement Acts 11,747 6 4 49,674 15 10 † In respect of Norbury Brickfield, being amount charged to the Brickfield Account in 1907-8 for interest on outlay in previous years met out of rates. lv Housing of the Working Classes—Accounts. APPENDIX XVIII. 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 dweiings for the housing values of the sites appropriate J for that purpose. Under Part II. they include contributions from Local Authorities. Clearance Scheme. Date of Act sanctioning Scheme Capital Expenditure to 31st March, 1913. 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-theMartyr, Southwark ,, 66,785 10 8 14,342 5 9 52,443 4 11 Bedfordbury, St. Martin-in-the-Fields ,, 87,212 8 4 11,701 14 4 75,510 14 — Great Wild-street, St. Giles-in-the-Fields ,, 124,278 7 10 18,627 15 9 105,650 12 1 Pear Tree-court, Clerkenwell ,, 27,426 6 5 6,556 11 6 20,869 14 11 Whitecross-street, St. Luke ,, 391,302 19 2 76,360 5 3 314,942 13 11 High-street, Islington ,, 44,775 11 3 6,588 16 7 38,186 14 8 Old Pye-street, Westminster ,, 79,389 4 10 29,493 ,, 4 49,896 4 6 Bowman's-buildings, St. Marylebone 1878 52,348 6 6 15,889 15 6 36,458 11 - Essex-road, Islington ,, 115,108 - - 17,209 6 2 97,898 13 10 Little Coram-street, Bloomsbury 1879 14,358 19 3 871 8 8 13,487 10 7 Wells-street, Poplar ,, 75,771 8 7 11,651 19 8 64,119 8 11 Great Peter-street, Westminster ,, 235 5 3 22 12 7 212 12 8 Tench-street, St. George-in-the-East 1883 52,636 16 4 645 17 9 51,990 18 7 Brook-street, Limehouse ,, 23,794 14 11 3,988 2 6 19,806 12 5 Windmill-row, Lambeth ,, 13,212 5 8 3,433 12 11 9,778 12 9 Trafalgar-road, Greenwich ,, 20,700 4 - 3,023 12 8 17,676 11 4 Tabard-street, Newington 1885 18,629 13 7 10,400 7 8 8,229 5 11 Hughes-fields, Deptford ,, 91,978 3 5 8,083 5 10 83,894 17 7 Cable-street, Shadwell 1887 46,390 10 6 5,155 8 2 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 10 278,997 — 7 Goldsmith's-row, Shoreditch ,, 4,885 7 10 1,090 17 6 3,794 10 4 Churchwav, 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 1900 194,105 15 - 18,948 4 6 175,157 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 ,, 120,769 7 10 13,860 11 6 106,908 16 4 Webber-row, Wellington-place and King's Bench-walk, Southwark ,, 107,839 9 2 10,293 9 ~ 97,546 - 2 Nightingale-street, St. Marylebone ,, 702 1 - 702 1 - — Providence-place, Poplar 1902 12,752 3 6 145 7 1 12,606 16 5 Tabard-street and Grotto-place, Southwark, and Crosby-row, Bermondsey — 1,695 - 10 - 1,695 - 10 General — 449 3 7 — 449 3 7 Total for Part I. 3,257,439 2 8 866,173 17 10 (a)2,391,265 4 10 Part II. (I.) Schemes carried out by the Council— Brooke's-market, Holborn 1892 3,929 15 6 3,857 14 10 5.072 - 8 Mill-lane, Deptford 1894 23,341 1 11 14,174 16 4 9,166 5 7 Ann-street, Poplar ,, 11,089 10 5 6,735 2 - 4,354 8 5 Falcon-court, Borough 1898 50,951 6 10 15,798 10 1 35,152 16 9 (II.) Contributions to schemes carried out by the Local Authorities— Green-street and Gun-street, Southwark 1893 1,568 14 10 — 1,568 14 10 Moira-place and Plumber's-place, Shoreditch 1894 27,500 - — — 27,500 — — Queen Catherine-court, Ratcliff 1895 2,787 2 8 — 2,787 2 8 London-terrace, St. George-in-the-East ,, 682 8 - - 682 8 - King John's-court, Limehouse 1899 6,429 - 8 — 6,429 — 8 Fulford-street and Braddon-street, Rotherhithe 1900 14,560 — - — 14,560 — — Brantome-place and Prospect-terrace, St. Pancras 1904 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 Total for Parts I. and II. 3,424,865 3 2 906,740 1 1 2,518,125 2 1 (a) Before deducting proceeds of sales carried to Consolidated Loans Fund. lvi : Annual Report of the London County Council, 1912. APPENDIX XIX. STATEMENT AS TO THE COMMERCIAL AND HOUSING VALUES OF SITES UTILISED FOR THE ERECTION OF WORKING CLASS DWELLINGS. St.tenment showing difference between the commercial vaiue and the housing value of sites (a) sold by the Metropolitan Board of Works :so Dwellings'Companies and others, with the obligation to erect dwellings for the working classes thereon, or (b) acquired or appropriated by the Council for the erection of working class dwellings. Note.—The figures in the column headed "Commercial value," except m 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 actuallv 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. (b) Sites acquired or appropriated by the Councillor the erection of working class dwellings. Cleaiance 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 chaiged to Dwellings Accounts, page 30, 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. £ £ £ Housing of the Working Classes act, 1890. Part I. £ £ £ Part I —Clearance Schemes. Boundary-street 131,670 62,010 69,660 Goldsmith's-row (Supplemental to Boundary Street) *4,795 1,000 3,795 Whitechapel and Limehouse .. .. .... 73,000 24,900 48,100 Cable-street 8,500 3,660 4,840 Shelton-street 24,465 5,100 19,365 Goulston-street and Flower and Dean-street, Whitechapel .. 80,000 32,106 47,894 Clare Marlet— Elizabeth-place, King-street and Mint-street, St. George* the-Martyr, Southwark 27,000 12,300 14,700 Millbank *16,202 11,907 4,295 Duke's-court *61,181 4,200 53.981 Bedfordbury, St. Martin-in-the-Fiel Is 15,000 7,886 7,114 York-street 3,000 Great Wild-street, St. Giles-in-the-Fields 35,000 15,840 19,160 Churchway 25,000 8,550 16,450 Pear Tree-court, Clerkenwell .. 12,000 5,925 6,075 Hardy 4,000 1,000 3,000 Whitecro63-street, St. Luke 105,000 36,882 68,118 Preston's-road 1,434 1,434 - High-street, Islington . 11,000 5,650 5,350 St. Luke's—Wenlake 25,900 5,000 20,900 Old Pye-street, Westminster 40,000 20,410 19,590 Do. Chadworth 20,800 8,000 12,800 Bowman's-buildings, St. Marylebone 16,500 10,000 6,500 Clerkenwell and Holborn — Mallory 10,000 1,620 8,380 Essex-road, Islington 30,000 13,306 16,694 Do. Nigel, etc 53,000 14,550 38,450 Wells-street, Poplar 12,000 5,000 7,000 Webber-row 28,500 9,750 18,750 6,000 3,050 2,950 †Parker-street 14,035 3,750 10,285 7,000 4,200 2,800 Brook-street 3,600 1,800 1,800 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. Street Improvements. Cranley 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 1,634 465,804 163,361 302,443 §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 Theobald's-road) 38,400 10,860 27,540 Durham 5,000 2,380 2,620 Duke's-court *20,668 1,400 18,268 Willow-walk, Great Eastern-street 26,305 14,272 12,033 York-street 1,000 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— Bourne *201,469 44,000 157,469 Camberwell and Peckham 1,500 600 900 Millbank *27,901 20,651 7,250 Charing-cross-road and Shaftesbury-avenue 77,000 *33,715 43,285 Swan-lane 6,850 5,000 1,850 Gray's Inn-road (including Elm-street, Acts of 1884 and 1887) 22,730 14,335 8,395 Valette 8,600 3,000 5,600 Hughes-field *428 428 — Jamaica-road and Union-road 10,700 5,300 5,400 Bearcroft 2,229 700 1,529 Kentish Town-road 2,500 2,300 260 Council 3,000 621 2,379 Marshalsea-road (Southwark Bridge-road) 4,200 1,900 2,300 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— Darcy 2,350 1,250 1,100 Rosebery-avenue 30,000 24,775 5,225 Wandsworth-road *4,596 1,560 3,036 Total for Street Improvements 156,436 131,007 124,428 416,277 108,213 308,064 Total 727,535 329,922 397,613 882,081 271,574 610,507 * 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. ‡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 opposite lvii Housing of the Working Classes—Appendix XX. 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 Buildings 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) Acts, 1899—Holborn to Strand Improvement. York-street Dwellings Herbrand-street Dwellings Bruce House 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. 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. Swan-lane Dwellings L.C.C. Thames Tunnel (Rotherhithe and Ratcliff) Act, 1900. Brightlingsea Buildings Bekesbourne Buildings Darcy Buildings L.C.C. (Improvements) Act, 1900—Mare-street, Hackney, Improvement. Valette Buildings Wandsworth-road Dwellings L.C.C. (Improvements) Act, 1900—Nine Elms-lane widening. Hughes-fields Dwellings L.C.C. (Tramways and Improvements) Act, 1902—Tramways — Greenwich generating station. Bearcroft Buildings L.C.C. (Tramways and Improvements) Act, 1902—Fulham Palaceroad and High-street widening. 1viii Annml BePort of the London Council, 1912.Housing of the Working Classes Statitics lix APPENDIX XXI. housing statistics. A.—Number of Tenements Comprised in the Dwellings in Occupation on 31st March, 1912, together with Particulars of the Dwellings Opened between that date and 31st March, 1913. Dwellings. Metropolitan Borough. Data opened. Number of tenements of Total tenements. Total rooms. Cubicles. Number of persons provided for. Shops. Workshops. Stables Sheds. Cupboaida. 1 room. 2 rooms. 3 rooms 3 rooms with additional small bedroom. 4 rooms 5 rooms 6 rooms Total number of tenements, etc. in occupation on 31st March, 1912 .. .. 192(a) 3,458 3,785 293(b) 1,067 474(c) 3 9,272 26,291 1,856 54,078 104 97 12 202 36 Dwellings opened during the year 1st April, 1912, to 31st March, 1913— Norbury Estate— Croydon Newlands-road April, 1912 .. .. 7 .. 1 .. .. 8 25 .. 50 2 .. .. .. .. Norton-garden July,1912 .. .. .. 13 2 .. .. 15 60 .. 107 .. .. .. .. .. 7 13(b) 3 23 85 157 2 Old Oak Estate— Hammersmith Ducane-road May, 1912 to Mar., 1913 .. .. .. .. 9 10 .. 19 86 .. 168 .. .. .. .. .. Erconwald-street July, 1912 to Mar. 1913 .. 7 8 .. 9 2 .. 26 84 .. 164 2 .. .. 5 .. Fitzneal-street April to June, 1912 16 20 21 1 7 .. .. 65 151 .. 299 .. .. .. .. 3 16(f) 27 29 1(b) 25 12(d) 110 321 631 2 5 3 White Hart-lane— Tottenham Risley-avenue .. May to July, 1912 .. .. 34 2 8 .. .. 44 142 .. 282 .. .. .. .. .. Tower-gardens-road .. Oct., 1912 to Mar., 1913 .. .. 33 1 20 .. .. 54 183 .. 365 .. .. .. .. .. Wadlen-road Nov. and Dec 1912 .. .. .. .. 8 .. .. 8 32 .. 64 .. .. .. .. .. 67 3(b) 36 106 357 711 Total number of cottages, etc., opened during year to 31st March, 1913. .. .. 16 (f) 27 103 17(b) 64 12(d) .. 239 763 .. 1,503 4 .. .. 5 3 Conversion of 1-3 room tenement at Prestons-road Estate into bathrooms .. .. .. .. -1 .. .. .. .. —1 —3 .. —6 .. .. .. .. .. Additional sheds brought into charge:— Briscoe-buildings .. June, 1912 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 .. .. .. 16 (f) 27 102 17(b) 64 12(d) .. 238 760 .. 1,497 4 .. .. 10 .. Total number of tenements, etc., open on 31st March, 1913. 208(a) (f) 3,485 3,887 310(b) 1,131 486(e) 3 9,510 27,051 1,856 55,571 108 97 12 212 39 (a) Five 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) Seven of these lettings contain 1 small room, reckoned as accommodating 1 person only. (d) Five of these cottages contain 4 rooms with a small additional bedroom, each reckoned as containing 5 rooms accommodating 9 persons. (e) Twelve of these lettings contain 1 small room and each is reckoned as accommodating one person only. (f) Sixteen of these lettings also contain a bed recess, and each is reckoned as accommodating 2 persons. lx Annual Report of the London County Council, 1912. Housing of the Working Classes—Statistics.1xi B.—Accommodation Provided in all the Council's Dwellings open on 31st March, 1913. Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total tenements Total rooms. Cubicles. Number of persons provided for. Shops Work shops. stables Sheds Cupboards 1 room. 2 rooms. 3 rooms. 3 rooms with small additional bedroom. 4 rooms 5 rooms 6 rooms A n n -street, dwellings— Poplar 1 * Adelaide-buildings Sept., 1901 .. 25 15 .. .. .. .. 40 95 .. 190 Melbourne-building3 Nov., 1902 .. 30 10 .. .. .. .. 40 90 .. 180 Sydney-builders Dec., 1902 .. 35 20 .. .. .. .. 55 130 .. 260 90 45 185 315 630 Barnaby-buildings Bermondsey Sept., 1904 .. 40 40 .. .. .. .. 80 200 .. 400 12 Battersea-bridge-buildings Battersea Oct., 1901 10 44 15 .. .. .. .. 69 143 .. 286 .. .. .. .. 1 Bearcroft buildings Fulham Sept., 1906 .. 10 30 .. .. .. .. 40 110 .. 220 .. .. .. .. Bekesbournebuildings Stepney July, 1907 .. 45 20 .. 10 .. .. 75 190 .. 380 Borough-road-dwellings— Southwark Gardiner-buildings May, 1900 .. 8 .. .. .. .. .. 8 16 .. 32 Hunter-buildings May, 1900 .. 20 20 .. .. .. .. 40 100 .. 200 Murphy-buildings Oct., 1900 .. 24 12 .. .. .. .. 36 84 .. 168 52 32 84 200 400 Boundry-street estate- Streatley-builders Bethnal-green April 1895 .. 32 24 .. .. .. .. 56 136 .. 272 .. 12 .. .. 4 Cleeve-buildings Shoreditch July, 1896 .. 7 12 .. 12 1 .. 32 103 .. 206 8 16 .. 8 Culham-buildings Bethnal-green Nov., 1896 15 20 .. .. .. .. .. 35 55 .. 110 Sonning-buildings ” Nov., 1896 .. 10 15 .. 15 .. .. 40 125 .. 250 Hurley-buildings ” Jan., 1897 .. 5 5 .. .. .. .. 10 25 .. 50 Sandford-buildings ” Jan., 1897 .. 5 5 .. .. .. .. 10 25 .. 50 Henley-buildings ” March, 1897 .. 45 25 .. .. .. .. 70 165 .. 330 .. .. .. .. 5 Walton-buildings ” March, 1897 .. 40 35 .. .. .. .. 75 185 .. 370 .. .. .. 6 Marlow-buildings ” March, 1897 .. .. 12 .. 17 5 .. 34 129 .. 258 6 17 Shiplake-buildings ” March, 1897 .. .. .. .. 25 .. 1 26 106 .. 212 4 Taplow-buildings ” May, 1897 .. 25 25 .. .. .. .. 50 125 .. 108 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-build ings ” March, 1899 .. .. 18 .. 2 .. .. 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 Abi ngdon-buildings ” May, 1900 .. 75 10 .. .. .. .. 85 180 .. 360 Laleham-buildings ” May, 1900 .. 35 40 .. .. .. .. 75 190 .. 380 15 533 388 .. 98 7 8 1044 2690 .. 5380 18 77 .. 8 17 Bourne-estate- Holborn Denys-buildings .. Oct., 1902 .. 40 15 .. .. .. .. 55 125 .. 250 g Frewell-buildings .. Jan., 1903 .. 40 15 .. .. .. .. 55 125 .. 250 © Scrope-buildings .. Jan., 1903 .. 50 5 .. .. .. .. 55 115 .. 230 Skipwith-buildings .. Feb., 1903 .. 40 15 .. .. .. .. 55 125 .. 250 Ledam-buildings .. March, 1903 .. 50 5 .. .. .. .. 55 115 .. 230 25 Shene-buildings .. May, 1903 .. 30 .. .. .. .. .. 30 60 .. 120 25 Redman-buildings .. Oct., 1904 11 31 58 .. 27 .. .. 127 355 .. 710 Radcliff-buildings .. June, 1904 5 25 54 .. 21 .. .. 105 301 .. 602 23 .. .. .. 16 306 167 48 537 1321 2642 23 50 Union-buildings area— Holborn Buckridge-buildings .. Oct., 1908 .. 10 20 .. 10 .. .. 40 120 .. 240 Kirkeby-buildings .. Aug., 1908 .. 10 15 .. 20 .. .. 45 145 .. 290 Laney-buildings .. April, 1908 4 29 32 .. 5 1 .. 71 183 .. 366 15 14 2 Nigel-buildings .. Dec., 1907 11 20 29 .. 11 .. .. 71 182 .. 364 15 69 96 46 1 227 630 1260 15 14 2 Briglitlingsea-buildings Stepney Sept., 1904 5 20 35 .. 5 .. .. 65 170 .. 340 Briscoe-buildings Lambeth Oct., 1906 .. 10 73 .. 30 .. .. 113 359 .. 718 15 Brook-street-dwellings— Stepney Beachcroft-buildings .. Sept., 1894 .. 20 20 .. .. .. .. 40 100 .. 200 Cranford -cottages .. July, 1900 .. .. 18 .. .. .. .. 18 54 .. 108 20 38 58 154 308 Cable-street dwellings— Stepnev Bewley-buildings .. March, 1896 .. 20 30 .. .. .. .. 50 130 .. 260 Dellow-build ings .. March, 1896 .. 20 30 .. .. .. .. 50 130 .. 260 Lowood-buildings .. May, 1901 (a)11 29 .. .. .. .. .. 40 69 .. 139 Chancery-buildings .. May, 1901 (a)11 29 .. .. .. .. .. 40 69 .. 139 22 98 60 180 398 798 Caledonian-estate— Islington Burns-buildings .. July, 1906 .. .. 30 .. .. .. .. 30 90 .. 180 Scott-buildings .. July, 1906 .. .. 30 .. .. .. .. 30 90 .. 180 Wallace-buildings .. July, 1906 .. 40 30 .. .. .. .. 70 170 .. 340 Knox-buildings .. July, 1906 .. 36 26 .. 4 .. .. 66 166 .. 332 Bruce-buildings .. Oct., 1906 6 40 30 .. .. .. .. 76 176 .. 352 6 116 146 4 272 692 1384 Chad worth-buildings Finsbury April, 1907 .. 58 68 .. 10 136 360 720 19 Churehwav-dwellings— St. Pancras Wellesley-buildings March, 1901 .. 60 20 .. .. .. .. 80 180 .. 360 Seymour-buildings July, 1902 2 48 10 .. .. .. .. 60 128 .. 256 Somerset-buildings .. Aug., 1902 .. 16 20 .. 4 .. .. 40 108 .. 216 2 124 50 4 180 416 832 18820 (a) One of the one-roomed tenements in each of these buildings contains a bed iecess, and is reckoned as accommodating three persons. Ixii Annual Report of the London County Council, 1912. Housing of the Working Classes—Statistics, Ixiii B.—Accommodation Provided in all the Council's Dwellings open on 31st March, 1913—(continued). Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total enement^ Total rooms. Cubicles. Number of persons provided for. Shops. Workshops. Stables Sheds. Cup boards. 1 room. 2 rooms. 3 rooms. rooms 1th small . Iditional >edroom. rooms .r rooms jf rooms 1 Cobham-buildings Southwark Oct., 1900 (a)l 39 20 .. .. .. .. 60 139 .. 279 Cotton-street-dwellings— Poplar Montreal-buildings Sept., 1901 .. 25 25 .. .. .. .. 50 125 .. 250 Toronto-buildings Sept., 1901 .. 5 15 .. .. .. .. 20 55 .. 110 30 40 70 180 360 Council-buildings, Poplar Poplar April, 1894 .. 30 20 .. .. .. .. 50 120 .. 240 Cranley-buildings Holborn Oct., 1897 .. 6 6 .. .. .. .. 12 30 .. 60 Darcy-buildings Hackney July, 1904 .. 25 15 .. .. .. .. 40 95 .. 190 Dufierin-street dwellings Finsbury April, 1892 29 23 4 .. .. .. .. 56 87 .. 174 .. .. 12 12 Duke's-court -dwellings— Westminster Fletcher-buildings April, 1902 .. 35 15 .. .. .. .. 50 115 .. 230 Beaumont-buildings May, 1902 10 15 5 .. 10 .. .. 40 95 .. 190 Sheridan-buildings Aug., 1902 .. 25 15 .. .. .. .. 40 95 .. 190 10 75 35 10 130 305 610 Durham-buildings Battersea July, 1904 .. 56 52 .. .. .. .. 108 268 .. 536 .. East Greenwich cottages— Greenwich Collerston-cottages May, 1894 .. 12 8 .. 4 .. .. 24 64 .. 123 Armitage-cottages June, 1894 .. 12 8 .. 16 .. .. 36 112 .. 224 Westview-cottages Aug., 1894 .. 6 4 ... 8 .. .. 18 56 .. 112 3O 20 28 78 232 464 Goldsmith's-row-cottages Shoreditch Sept., 1895 .. 8 12 .. 5 .. .. 25 72 .. 144 Hardy-cottages Greenwich July, 1901 .. .. 51 .. .. .. .. 51 153 .. 306 ! Herbrand-street-dwellings— Holborn Coram-builders Feb., 1904 .. 50 .. .. .. .. .. 50 100 .. 200 Dickens-buildings March, 1904 20 30 10 .. .. .. .. 60 110 .. 220 Thackeray-buildings . March, 1904 .. 20 30 .. .. .. .. 50 130 .. 260 .. .. .. 28 20 100 40 160 340 680 28 Holmwood-buildings Southwark April, 1900 .. 12 4 .. .. .. .. 16 36 .. 72 Hughes-fields-cottages Greenwich Jan., 1895 .. 71 61 .. 2 .. .. 134 333 .. 666 Hughes-fields-dwellings— Drake-buildings Deptford Sept., 1904 .. 10 30 .. .. .. .. 40 110 .. 220 Raleigh-buildings ” Nov., 1904 .. 18 24 .. 8 .. .. 50 140 .. 280 .. .. .. .. 1 Benbow-buildings Greenwich Oct., 1904 .. 10 20 .. .. .. .. 30 80 .. 160 .. .. .. .. 1 38 74 8 120 330 660 2 ldenden-cottages Greenwich Aug., 1896 .. .. .. .. 501 .. .. 50 200 .. 400 Mallory-buildings Finsbury July, 1906 1 15 17 .. .. .. .. 33 82 .. 164 5 Millbank estate- Westminster Hogarth-buildings May, 1899 .. 21 22 .. 10 1 .. 54 153 .. 306 .. .. .. .. 2 Millais-buildings June, 1900 .. 15 10 .. .. .. .. 25 60 .. 120 .. .. .. .. 1 Leighton-buildings July, 1900 .. 15 10 .. .. .. .. 25 60 .. 120 .. .. .. .. 1 Romney-build ings Nov., 1900 .. 35 25 .. .. .. .. 60 145 .. 290 Turner-buildings Dec., 1900 .. 43 39 .. 3 .. .. 85 215 .. 430 .. .. .. .. 3 Ruskin-buildings March, 1901 .. 43 39 .. 3 .. .. 85 215 .. 430 .. .. .. .. 4 Rossetti-buildings April, 1901 .. 35 25 .. .. .. .. 60 145 .. 290 .. .. .. .. 1 Reynolds-buildings Oct., 1901 .. 39 40 .. .. .. .. 79 198 .. 396 .. .. .. 12 Mulready-buildings Dec., 1901 .. 20 25 .. .. .. .. 45 115 .. 230 Maclise-buildings Feb., 1902 .. 50 16 .. .. .. .. 66 148 .. 296 .. .. .. .. 1 Landseer-buildings March, 1902 .. 20 25 .. .. .. .. 45 115 .. 230 Lawrence-buildings April, 1902 .. 50 16 .. .. .. .. 66 148 .. 296 .. .. .. .. 1 Morland-build ings May. 1902 .. 30 30 .. .. .. .. 60 150 .. 300 .. .. .. 18 Wilkie-buildings July, 1902 .. 30 30 .. .. .. .. 60 150 .. 300 .. .. .. 18 Gainsborough-buildings Aug., 1902 2 38 40 .. .. .. .. 80 198 .. 396 .. .. .. 12 2 484 392 16 1 895 2215 4430 60 14 Norbury estate— Croydon Bavant-road May, 1906 .. .. 8 9 16 6 .. 39 154 .. 295 Bulkeley-road Feb., 1908 .. .. .. 16 .. 20 .. 36 164 .. 308 Newlands-road May, 1906 .. .. 62 16 9 8 .. 95 326 .. 636 4 Northborough-road April, 1906 .. .. 30 .. 103 12 .. 145 562 .. 1124 Norton-gardens Oct., 1910 .. .. 4 13 24 .. .. 41 160 .. 307 Palmers-road Feb., 1906 .. .. .. 6 8 2 .. 16 66 .. 124 Tylecroft-road June, 1910 .. .. 42 38 20 .. .. 100 358 .. 678 146 98(b) 180 48(e) 47 2 1790 3472 4 Old Oak-estate— Hammersmith Ducane-road May 1912 .. .. .. .. 9 10 .. 19 86 .. 168 .. Erconwald-street July, 1912 .. 7 8 .. 9 2 .. 26 84 .. 164 2 .. .. 5 Fitzneal-street April, 1912 16 20 21 1 7 .. .. 65 151 .. 299 .. .. .. .. 3 16(c) 27 29 1(b) 25 12(d) 110 321 631 2 5 3 Preston's-road estate Poplar St. Lawrence-cottages March, 1904 .. .. 14 .. .. .. .. 14 42 .. 84 Ottawa-buildings Marchj 1904 .. 25 25 .. .. .. .. 50 125 .. 250 Baffin-buildings March, 1904 .. 20 4 .. .. .. .. 24 52 .. 104 Ontario-buildings Aug., 1904 .. 25 25 .. .. .. .. 50 125 .. 250 Hudson-builders July,1904 .. 20 5 .. .. .. .. 25 55 .. 110 Winnipeg-builders Sept., 1904 .. 25 25 .. .. .. .. 50 125 .. 250 Quebec-buildings Sept., 1904 .. 25 25 .. .. .. .. 50 125 .. 250 140 123 263 649 1298 18820 FF 2 (a) The one-roomed tenement at these buildings also contains a bed recess and is reckoned as accommodating three persons. (b) These cottages are reckoned as containing 4 rooms, accommodating seven persons. (c) These cottages contain a bed recess, and each cottage is reckoned as accommodating two persons. (d) Five of these cottages contain four rooms with a small additional bedroom, each reckoned as containing five rooms accommodating nine persons. (e) Ten of these cottages contain four rooms with a small additional bedroom, each reckoned as containing five rooms accommodating nine persons. Ixiv Annual Report of the London County Council, 1912. Housing of the Working Classen—Statistics. Ixv B.—Accommodation Provided in all the Council's Dwellings open on 31st March, 1913—(continued). Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total tenements Total rooms. Cubicles. Number of persons provided for. Shops. W orkshops. Stables Sheds. Cupboards 1 room. 2 rooms. 3 rooms. 3 roomt. with smal additiona bedroom 4 rooms 5 rooms 6 rooms Rushworth-street and Boy field-street (late Green street and Gun-street dwellings— Southwark Albury-buildings June, 1897 6 24 6 .. .. .. .. 36 72 .. 144 Clandon-buildings June, 1897 6 18 6 .. .. .. .. 30 60 .. 120 Merro w-bu ildings Aug., 1897 .. 12 6 .. .. .. .. 18 42 .. 84 Ripley-builders Aug., 1897 1 17 .. .. .. .. .. 18 35 .. 70 .. .. .. 8 13 71 18 102 209 418 8 Shelton-street-d wellings— 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 5 255 635 1270 Sylva-cottages Deptford March, 1903 .. .. 24 .. .. .. .. 24 72 .. 144 Totterdown-feilds estates- Wandsworth Blakenham-road Aug., 1903 .. .. 26 .. 8 .. .. 34 110 .. 220 Church-lane May, 1905 .. .. .. .. 11 16 .. 27 124 .. 248 Coteford-street June, 1903 .. .. 165 82 1 .. .. 248 827 .. 1572 Cowick-road May, 1903 .. 48 228 8 1 .. .. 285 816 .. 1624 Derinton-road Aug., 1903 .. .. 159 64 67 23 .. 313 1116 .. 2168 Franciscan-road.. Jan., 1907 .. .. .. .. .. 41 .. 41 205 .. 387 4 Lessingham-avenue May, 1903 .. .. 18 .. 113 95 .. 226 981 .. 1930 Ruislip-street May, 1903 .. .. 29 .. 4 .. .. 33 103 .. 206 Okeburn-road Oct., 1909 .. .. .. 54 .. .. 54 216 .. 378 48 625 208(b) 205 175(c) 1261 4498 8733 4 Valette-buildings Hackney May, 1905 .. 39 34 .. 7 .. .. 80 208 .. 416 Wandsworth-road-dwellings— Lambeth Lennox-buildings May, 1905 3 17 20 .. .. .. .. 40 97 .. 196 Clere-cottages May, 1905 .. .. 7 .. .. .. .. 7 21 .. 42 3(a) 17 27 47 118 288 Webber-row estate— Southwark Delarcli-buildings Nov., 1906 .. 20 25 .. .. .. .. 45 115 .. 230 Overy-buildings Nov., 1906 .. 20 25 .. .. .. .. 45 115 .. 230 Algar-buildings Dec., 1906 .. 20 25 .. .. .. .. 45 115 .. 230 Dauncy-buildines Jan., 1907 1 18 26 .. .. .. .. 45 115 .. 230 Mawdley-buildings March, 1907 3 13 16 .. 3 5(d) .. 40 114 .. 223 10 4 91 117 3 5 (d) 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 Ke veli oc-road Apr., 1909 .. .. .. .. 18 22 .. 40 182 .. 364 Risley-avenue Sept., 1904 .. .. 44 2 105 59(e) .. 210 855 .. 1706 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 .. .. 47 1 75 71 .. 194 800 .. 1599 Walden-road Nov., 1912 .. .. .. .. 8 .. .. 8 32 .. 64 Walteof-avenue June, 1906 .. .. .. .. .. 37 .. 37 185 .. 370 Wateville-road Oct., 1904 .. .. 12 .. 9 18 .. 39 162 .. 324 291 3(b) 308 287(e) 839 3302 8145 York-street dwellings— Westminster Stirling-buildings June, 1903 5 20 15 .. .. .. .. 40 90 .. 180 Siddons-buildings June, 1903 5 10 20 .. 5 .. .. 40 105 .. 210 10 30 35 5 80 195 390 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 208(f) (h) 3,485 3,887 310(b) 1,131 486(g) 3 9,510 27,051 1,856 55,571 108 97 12 212 39 Note.—In reckoning the number of rooms in the cottages on the Totterdown-fields, White Hart-lane and Norbury estates, kitchen sculleries have been omitted. (a) Two 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 seven persons. (c) Fifty-five of these cottages contain four rooms with a small additional room each reckoned as containing 5 rooms accommodating nine persons only. (d) Five tenements in Mawdley-buildings have one additional small room, reckoned as accommodating one person only. (e) Two cottages contain 4 rooms with a small additional bedroom, each reckoned as containing 5 rooms, accommodating 9 persons. (f) Five of these tenements also contain a bed recess, and each ii reckoned as accommodating three persons. (g) Sixty-seven of these lettings contain 1 small room reckoned as accommodating one person only. (h) Sixteen of these lettings also contain a bed recess, and each is reckoned as accommodating 2 persons. lxvi Annual Report of the London County Council, 1912. Housing of the Working Classes—Statistics. lxvii C.—Rents Charged at the Council's Dwellings. Dwellings Borough. Rent per week of tenements. Rent per night of cubicles. Uent per week of workshops. Rent per week of tables. Rent per week of sheds. Rent per week of cupboards. Gross rent per annum on 31st March, 1913. 1 room. 2 rooms. 3 rooms. 3 rooms witli small additional bedroom. 4 rooms. 5 rooms. 6 rooms. £ s. d. Ann-street-dwellings Poplar .. 5/- & 6/- 6/6 & 7/6- .. .. .. .. .. .. .. .. .. 2,129 8 - Barnaby-buildings Bermondsey .. 5/6 & 6/- 7/6 & 8/- .. .. .. .. .. .. .. .. .. 1,427 8 - *Battersea-bridge-building 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 - Bekesbourne-buildings . Stepney .. 5/- to 6/- 6/6 to 7/6 .. 8/- & 8/6 .. .. .. .. .. .. .. 1,240 4 - Borough-road-dwellings Southwark .. 6/6 to 8/- 9/6 & 10/- .. .. .. .. .. .. .. .. .. 1,864 4 - Boundary-street-estate . Bethnal-green 3/- to 4/- 5/- to 8/- 7/- to 10/6 .. 9/- to 13/- 10/6 to 14/- 12/6 & 13/6 .. 3/6 to 6/6 .. 6d. 3d. 23,085 9 - Bourne estate (including shops) Holborn 4/6 to 6/- 7/6 to 8/6 9/6 to 11/- .. 11/-to 13/- .. .. .. .. .. 3d. .. 13,571 10 - Brightlingsea-buildings Stepney 3/6 & 4/- 5/- &;5/6 6/6 to 7/6 .. 8/- & 8/6 .. .. .. .. .. .. .. 1,081 12 — Briscoe-buildings.. Lambeth .. 6/6 & 7/- 7/6 to 8/6 .. 10/-toll/6 .. .. .. .. .. 3d. .. 2,530 9 - Brook-street-dwellings Stepney .. 5/6 7/- to 8/- .. .. .. .. .. .. .. .. .. 1,014 - - Bruce-house (including shops) Westminster .. .. .. .. .. .. .. 6d., 7d., .. .. .. .. 7,678 9 8 l/-&l/2 Cable-street-dwellings Stepney 4/6 & 5/- 5/6 to 6/6 7/6 .. .. .. .. .. .. .. .. .. 2,955 4 - Caledonian-estate Islington 4/6 & 5/- 6/6 to 7/6 8/- to 9/6 .. 11/6 .. .. .. .. .. .. .. 5,569 4 - Carrington-house (including shops) Deptford .. .. .. .. .. .. .. 6d. and 1/- .. .. .. .. 7,687 6 8 Chadworth-buildings (including shops) Finsbury 6/- to 7/- 8/- to 9/6 .. 10/-to11/- .. .. .. .. .. .. .. 3,393 10 - Churchway-dwellings St. Pancras 4/6 & 5/- 7/- to 8/- 9/6 to 10/6 .. 11/6 .. .. .. .. .. .. .. 3,893 10 - Cobham-buildings Southwark 6/- 6/- & 6/6 8/6 & 9/- .. .. .. .. .. .. .. .. .. 1,128 8 - Cotton-street-dwellings . Poplar .. 5/6 7/- to 8/- .. .. .. .. .. .. .. .. .. 1,181 14 - Council-buildings, Poplar Poplar .. 5/- to 5/9 7/- & 7/6 .. .. .. .. .. .. .. .. .. 796 18 - Cranley-bui ldings 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 4/- 6/6 8/6 .. 106 .. .. .. .. .. .. .. 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/- .. .. .. .. .. .. .. 481 13 - 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/- 10/6& 11/6 .. .. .. .. .. .. .. .. .. 383 10 - £ s d Hughes-fields-cottages Greenwich .. 5/- & 5/6 6/- to 6/6 .. 7/- .. .. .. .. .. .. 2d. 2,044 18 - Idenden cottages Greenwich .. .. .. .. 8/6 & 9/- .. .. .. .. .. .. .. 1,132 12 - 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. 18,933 16 - Norbury-estate Croydon .. .. 7/- to 8/- 8/6 to 9/6 8/6 to 10/6 0/6 toll/6 .. .. .. .. .. .. 11,081 8 - Old Oak-estate .. Hammersmitl 4/- 4 /6 & 5 /- 6/6 to 8/- 8/6 8/6 to 10/6 10/6 to 12/- .. .. .. .. .. .. 2,117 7 - Parker-street-house (in eluding shops) Holborn .. .. .. .. .. .. .. 6d. .. .. .. .. 3,266 5 6 Preston's-road-estate Poplar .. 4/6 & 5/- .. .. .. .. .. .. .. .. .. 3,965 - - Raleigh, Drake and Ben bow-buildings (Hughes fields-dwellings) Greenwhich and Deptford .. 5/- & 5/6 6/ & 6/6 .. 7/- & 7/6 .. .. .. .. .. .. .. 1,913 3 4 Rushworth-street am Boyfield - street (lat Green-street and Gun street) dwellings Southwark . 4/6 & 5/- 6/6 & 7/- 81- & 8/6 .. .. .. .. .. .. .. 6d. .. 1,783 12 - Shelton-street-dwellings Holborn 5/- 6/6 to 8/- 9/6 .. 11/- & 11/6 .. .. .. 4/6 to 6/- . .. .. .. 1,554 16 - Swan-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/- to 10/- 9/- to 11/— 10/6 tol4/- .. .. .. .. .. .. 29,332 14 - Union-buildings (including shops) Holborn 4/6 & 5/- 7/- to 8/- 9/- to 10/- 10/6 to 11/6 12/- .. .. .. .. 4d. 3d. 6,046 2 8 Valette-buildings .. Hackney .. 6/6 &. 7/- 8/- to 9/- .. 10/6 .. .. .. .. .. .. .. 1,671 16 - 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 .. .. .. .. .. .. 4,915 2 - W enlake-buildings Finsbury .. 6/6 & 7/- 8/6 to 9/6 .. 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 . . 6/3 to 8/6 9/- 8/3 to 11/- 9/3 to 13/- .. .. .. .. .. .. 19,873 15 - York-street-d wellings Westminster 4/6 6/6 8/6 .. 10/6 .. .. .. .. .. .. .. 1519 6 - Total £218,925 17 10 * At these buildings the local rates are paid by the tenants. Ixviii Annual Report of the London County Council, 1912. D.—Accommodation Provided in the Council's Dwellings, and the Gross Rent per annum on 31st March, 1892, and each subsequent Year. Y ear. Tenements. Rooms. Cubicles. Persons provided for. Gross annual rent. £ s. d. 1892 56 87 — 174 629 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 1896 602 1,485 324 3,294 12,910 1 8 1897 984 2,603 324 5,530 22,020 9 8 1898 1,263 3,261 324 6,846 27,943 5 8 1899 1,355 3,525 321 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 62,780 8 8 1903 3,881 9,552 324 19,428 81,087 19 8 1904 4,666 11,661 1,147 24,469 103,090 10 2 1905 5,929 15,098 1,147 31,343 129,129 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 10 2 1913 9,510 27,051 1,856 55,571 218,925 17 10 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, 1912. Duiing year 1912-3. Total. Ann-street-dwellings Poplar 25 Nil. 25 Bekesbourne-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 Herbrand-street dwellings Holborn 91 91 Millbank estate Westminster 174 174 Preston's-road-d wellings Poplar 8 8 Rushworth-street and Boyfield-street (late Green-street and Gun-street) dwellings Southwark 13 13 Swan-lane-dwellings Bermondsey 186 186 Russell-court-dwellings Westminster 323 323 Webber-row estate Southwark 12 12 Wenlake-buildings Finsbury 41 41 Totals 1,756 1,756 lxix Housing of the Working Classes—Statistics. 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 1912-1913. Dwellings. Metropolitan Borough. Number of tenements Number of lettings effected. Number of vacations, excluding transfers. Number of Transfers not included in number of lettingn or vacations) Tenant's notice. Council's notice. Total. Percentage. Ann-street-dwellings Poplar 135 74 56 9 65 48 9 Barnaby-buildings Bermondsey 80 40 39 4 43 54 13 Battersea-bridge-buildings Battersea 69 31 29 4 33 48 11 Bearcroft-buildings Fulham 40 5 4 1 5 13 6 Bekesbourne-buildings Stepney 75 19 19 1 20 27 1 Borough-road-dwellings Southwark 84 18 20 .. 20 24 7 Boundary-street-estate Bethnal-green 1,044 253 239 15 254 24 59 Bourne-estate Holborn 537 112 108 5 113 21 60 Brightlingsea-buildings Stepney 65 35 24 2 26 40 10 Briscoe-buildings Lambeth 113 37 34 4 38 34 12 Brook-street-dwellings Stepney 58 20 19 .. 19 33 2 Cable-street-dwellings Stepney 180 28 21 5 26 14 18 Caledonian-estate Islington 272 139 121 13 134 49 54 Chadworth-buildings Finsbury 136 39 37 2 39 29 9 Churchway estate St. Pancras 180 42 42 .. 42 23 24 Cobham-buildings Southwark 60 13 13 .. 13 22 1 Cotton-street-dwellings Poplar 70 45 31 11 42 60 13 Council buildings, Poplar Poplar 50 15 12 2 14 28 6 Cranley-buildings Holborn 12 11 11 .. 11 92 2 Darcy-buildings Hackney 40 6 6 .. 6 15 1 Dufferin-street-dwellings Finsbury 56 12 10 2 12 21 9 Duke's-court dwellings Westminster 130 10 7 3 10 8 1 Durham-buildings Battersea 108 54 38 4 42 39 23 East Greenwich-cottages Greenwich 78 23 17 4 21 27 3 Goldsmith's-row-cottages Shoreditch 25 8 6 1 7 28 1 Hardy-cottages Greenwich 51 20 15 7 22 44 5 Herbrand-street-dwellings Holborn 160 6 5 1 6 4 21 Holmwood-buildings Southwark 16 2 2 .. 2 13 .. Hughes-fields-cottages Greenwich 134 40 27 14 41 31 19 Hughes-fields-dwellings Deptford 120 84 54 29 83 69 14 Idenden-cottages Greenwich 50 9 9 .. 9 18 1 Mallory-buildings Finsbury 33 2 2 .. 2 6 2 Millbank-estate Westminster 895 136 127 6 133 15 45 *Norbury estate Croydon 472 156 116 2 118 25 45 *01d Oak Estate Hammersmith 110 108 1 1 2 2 4 Preston's-road estate Poplar 263 105 43 42 85 32 46 Rushworth-street and Boyfield-street dwellings (late Greenstreet and Gun-street Southwark 102 27 27 1 28 27 11 Shelton-street-dwellings Holborn 63 12 11 1 12 19 1 Swan-lane-dwellings Bermondsey 255 108 70 22 92 36 29 Sylva-cottages Deptford 24 7 7 7 29 .. Totterdown-fields-estate Wandsvrorth 1,261 470 328 19 347 28 88 Union-buildings Holborn 227 56 51 5 56 24 11 Valette-buildings Hackney 80 43 39 2 41 51 3 Wandsworth - road - dwellings Lambeth 47 19 18 1 19 40 2 Webber-row-estate Southwark 220 61 56 2 58 26 16 Wenlake-buildings Finsbury 86 21 22 .. 22 26 5 Wessex-buildings Islington 225 75 78 1 79 35 9 *White-Hart-lane estate Tottenham 839 316 152 8 160 19 20 York-street-dwellings Westminster 80 3 2 1 3 4 8 Totals 9,510 2,975 2 225 257 2,482 26 760 * New cottage3 were opened at these estate 5 during the year. lxx Annual Report of the London County Council, 1912. G.—Percentage of Total Outgoings for Maintenance on the Rent Receivable for the last Five Years. Dwellings. Metropolitan Borough. 1908-9. 1909-10. 1910-11, 1911-12. (a) 1912-13. (b) Ann-street-dwellings Poplar 42 45 45 41 42 Barnaby-buildings Bermondsey 43 44 43 40 40 Battersea-bridge-buildings Battersea 39 40 39 30 (c)23 Bearcroft-buildings Fulham (c)21 (c) 21 (c)23 34 34 Bekesbourne-buildings Stepney 39 39 39 37 37 Borough-road-dwellings Southwark 41 42 41 36 35 Boundary-street estate Bethnal-green 41 42 42 38 39 Bourne estate Holborn 35 35 35 31 31 Brightlingsea-buildings Stepney 40 41 40 37 36 Bruce house Westminster 55 54 58 58 59 Briscoe-buildings Lambeth 34 41 40 39 37 Brook-street-dwellings Stepney 43 43 44 40 41 Cable-street-dwellings Stepney 42 41 41 39 39 Caledonian estate Islington 36 37 37 39 36 Carrington house Deptford 48 47 47 47 46 Churchway-dwellings St. Pancras 37 37 37 35 35 Clerkenwell & Holborn-dwellings Mai lory-buildings Holborn (a)32 30 37 25 25 Union-buildings 34 32 31 30 Cobham-buildings Southwark 42 43 43 39 37 Cotton-street-dwellings Poplar 41 44 44 40 42 Council-buildings, Poplar Poplar 41 45 47 44 44 Cranley-buildings Holborn 39 40 41 37 37 Darcy-buildings Hackney 38 40 38 35 36 Dufferin-street-dwellings Finsbury 57 59 58 53 53 Duke's-court-dwellings Westminster 38 37 36 34 35 Durham-buildings Battersea 39 39 40 30 (c)22 East Greenwich-cottages Greenwich 41 41 40 35 37 Goldsmith's-row - cottages Shoreditch 41 42 41 36 36 Hardy-cottages Greenwich 41 40 40 37 39 Herbrand-street-dwellings Holborn 37 37 37 35 34 Holmwood-buildings Southwark 45 49 48 40 42 Hughes-fields-cottages Greenwich 36 42 34 32 34 Hughes-fields-dwellings Deptford 38 39 36 33 36 Idenden-cottages Greenwich 37 38 37 34 36 Millbank estate Westminster 36 36 36 34 33 Norbury estate Croydon 32 (a)34 (a)35 (a)33 (a)36 Old Oak estate Hammersmith .. .. .. .. 44 Parker-street house Holborn 68 67 69 64 65 Preston's-road-dwellings Poplar 38 41 40 36 41 Rushworth-street and Boyfieldstreet (late Green-street and Gun-street) dwellings Southwark 42 43 42 39 38 Shelton-street-dwellings Holborn 37 37 37 34 35 St. Luke's-dwellinga— Wenlake-buildings Finsbury 34 38 37 34 34 Chadworth-buildings 32 32 29 29 Swan-lane-dwellings Bermondsey 41 43 43 36 37 Sylva-cottages Deptford 37 40 40 36 39 Totterdown-fields estate Wandsworth (a) 33 (a)35 (a)33 (a)31 35 Valette-buildings Hackney 37 38 37 34 35 Wandsworth-road-dwellings Lambeth 38 39 38 35 35 Webber-row estate Southwark 38 40 39 35 34 Wessex-buildings Islington 39 39 39 36 36 White Hart-lane estate Tottenham (a)(c) 27 (a)(c)24 (a)(c)25 (a)37 (a)43 York-street-dwellings Westminster 35 35 34 32 32 (a) New buildings were opened during this year. (b) After deducting income tax on interest on capital outlay from maintenance outgoings. Formerly gucli tax was deducted from debt charges. (c) Rates paid by tenants direct to local authorites. lxxi Housing of the Working Classes—Statistics. H.—Population of the Council's Dwellings According to the Enumeration taken in March, 1913. Dwellings. Metropolitan Borough. Accommodation. Number of persons in occupation (including children). Number of children under 14 years of age in dwellings. Teneirents. Rooms. e oys. Girl*. Anil-street-dwellings Poplar 135 315 452 76 76 Barnaby-buildings Bermondsey 80 200 320 71 55 Battersea-bridge-buildings Battersea 69 143 198 33 31 Bearcroft-buildings Fulham 40 110 119 23 22 Bekesbourne-buildings Stepney 75 190 238 34 41 Borough-road-dwellings Southwark 84 200 288 43 51 Boundary-street estate Bethnal-green 1,044 2,690 4,443 856 787 Bourne estate Holborn 537 1,321 1,849 283 268 Brightlingsea-buildings Stepney 65 170 245 33 71 Briscoe-buildings Lambeth 113 359 365 63 66 Brook-street-dwellings Stepney 58 154 213 53 44 Bruce-house Westminster (a) 708 (a) 708 708 . . , . Cable-street-dwellings Stepney 180 398 603 99 85 Caledonian estate Islington 272 692 1,027 170 178 Carrington-house Deptford (a) 803 (a) 803 438 .. • . Chadworth-buildings Finsbury 136 360 555 100 85 Churcbway-dwellings St. Pancras 180 416 607 89 90 Cobham-buildings Southwark 60 139 209 26 40 Cotton-street-dwellings Poplar 70 180 216 27 28 Council-buildings, Poplar Poplar 50 120 156 33 28 Cianley-buildings Holborn 12 30 44 10 5 Darcy-buildings Hackney 40 95 137 22 21 Dufferin-street-dwellings Finsbury 56 87 155 23 17 Duke's-court-dwellings Westminster 130 305 466 82 58 Durham-buildings Battersea 108 268 319 65 63 East Greenwich-cottages Greenwich 78 232 347 76 73 Goldsmiths'-row-cottages Shoreditch 25 72 101 12 6 Hardy-cottages Greenwich 51 153 234 52 69 Herbrand-street-dwellings Holborn 160 340 545 105 93 Holmwood-buildings Southwark 16 36 37 2 3 Hughes-fields-cottages Greenwich 134 333 374 70 72 Hughes-fields-dwellings Deptford 120 330 431 94 87 Idenden-cottages Greenwich 50 200 242 47 42 Mallory-buildings Finsbury 33 82 120 8 12 Millbank estate Westminster 895 2,215 3,019 489 493 Norbury estate Croydon 472 1,790 1,667 295 287 Old Oak estate Hammersmith 110 321 353 59 51 Parker-street-house Holborn (a) 345 (a) 345 345 .. .. Preston's-road estate Poplar 263 649 682 106 128 Rushworth-street and Boyfield-street (late Green-street and Gun-street) dwellings Southwark 102 209 418 46 53 Shelton-street-dwellings Holborn 63 142 226 41 33 Swan-lane-dwellings Bermondsey 255 635 914 200 187 Sylva-cottages Deptford 24 72 91 19 15 Totterdown-fields estate Wandsworth 1,261 4,486 4,644 932 864 Union-buildings Holborn 227 630 861 116 136 Valette-buildings Hackney 80 208 282 44 42 Wandsworth-road-dwellings Lambeth 47 118 147 25 22 Webber-row estate Southwark 220 574 797 123 140 Wenlake-buildings Finsbury 86 248 364 44 40 Wessex-buildings Islington 225 525 723 135 114 White Hart-lane estate Tottenham 839 3,302 3,079 599 584 York-street dwellings Westminster 80 195 289 41 41 Totals 11,366 28,907 35,631 6,094 5,867 (a) Cubicles. 18820 QQ 2 lxxii Annual Re-port of the London County Council, 1912. J.—Particulars of Cases of Infectious Diseases Reported by Superintendents and Care takers as having been removed from the council's dwellings during the year ended 31st March, 1913. Dwellings. Metropolitan Borough. 1 Erysipelas. Measles. Scarlet Fever. Consumption Diphtheria. Chickenpox. Enteric Fever. Ann-street-dwellings Poplar ... 1 1 ... ... ... ... Barnaby-buildings Beimondsey ... ... 1 ... ... 1 ... B attersea-brid ge-buildings Battorsea ... ... 1 1 ... 1 ... Bearcroft-buildings Fulham ... 3 ... ... 2 ... ... Bekesbourne-buildings Stepney ... 1 ... ... ... ... ... Borough-road-dwellings Southwark ... ... ... ... ... ... ... Boundary-street estate Bethnal-green ... ... 9 ... 15 ... 1 Bourne estate Holborn ... ... ... ... 1 ... ... Brightlingsea-buildings Stepney ... 4 1 ... 1 ... ... Briscoe-buildings Lambeth ... 10 1 ... ... 1 ... Brook-street-dwellings Stepney ... ... ... ... ... ... ... Cable-street-dwellings Stepney ... 3 1 ... ... ... ... Caledonian estate Islington ... ... 7 ... 2 ... ... Chadworth-buildings Finsbury ... 5 ... ... ... ... ... Church way-buildings St. Pancras ... 3 ... ... ... 3 ... Cobham-buildings Southwark ... ... ... ... 2 ... ... Cotton-street-dwellings Poplar ... ... ... ... ... ... ... Council-buildings Poplar ... ... ... ... ... ... ... Cranley-buildings Holborn ... ... ... ... ... ... ... Darcy-buildings Hackney ... ... ... ... ... ... ... Dufferin-street-dwellings Finsbury ... ... ... ... ... ... ... Duke's-court-dwellings Westminster ... ... ... ... ... 1 1 Durham-buildings Battersea ... 6 1 ... 2 ... ... East Greenwich-cottages Greenwich ... ... ... ... 1 ... ... Goldsmith's-row-cottages Shoreditch ... 1 3 ... ... ... ... Hardy-cottages Greenwich ... ... ... ... 3 ... ... Herbrand-street-dwellings Holborn ... 1 13 ... 3 ... 1 Holmwood-buildings Southwark ... ... ... ... ... ... ... Hughes-fields-cottages Greenwich ... 1 ... ... 1 1 ... Hughes-fields-dwellings Deptford ... 2 1 ... ... 1 ... Idenden-cottages Greenwich ... ... ... ... 1 ... ... Mallory-buildings Finsbury ... 1 ... ... ... ... ... Millbank estate Westminster ... ... 8 ... 8 ... ... (a)Norbury estate Croydon 1 ... 9 ... 5 ... ... (a)Old Oak estate Hammersmith ... ... ... ... ... ... ... Preston's-road estate Poplar ... 2 3 ... 1 ... ... liushworth-street and Boyfieldstreet (late Green-street and Gun-street) dwellings Southwark ... ... 1 ... ... ... ... Shelion-street-dwellings Holborn ... 5 1 ... ... ... ... Swan-lane-dwellings Bermondsey ... ... 1 ... 2 ... ... Sylva-cottages Deptford ... ... ... ... ... ... ... Totterdown-fields estate Wandsworth ... ... 4 ... ... ... ... Union-buildings Holborn ... ... ... ... ... ... ... Yalette-buildings Hackney ... ... 1 ... ... ... ... Wandsworth-road-dwollings Lambeth ... 1 ... ... ... ... ... "Webber-row estate Southwark ... 1 ... ... 1 ... ... Wenlake-buildings Finsbury ... 5 1 ... ... ... ... Wessex-buildings Islington ... ... ... ... 1 1 ... (a)WhiteHart-lane estate Tottenham ... 3 8 ... 2 ... ... York-street-dwellings Westminster ... ... ... ... 2 ... ... Totals 1 59 77 1 56 10 3 (a) New cottages at these e3tate3 were opened during the year. lxxiii Housing of the Working Classes—Statistics. K.—Particulars of Births and Deaths in the Council's Dwellings during the Year ended 31st March, 1913. (a) Dwellings. Borough. Births. Deaths. Occurring in the dwellings. Occurring in institutions. Total. Ann-street-dwellings Poplar 15 3 5 8 Barnaby-buildings Bermondsey 11 2 1 3 Battersea-bridge-buildings Battersea 3 1 .. 1 Bearcroft-buildings Fulham 3 .. .. .. Bekesbourne-buildings Stepney 11 .. 2 2 Borough-road-dwellings Southwark .. 4 2 1 3 Boundary-street estate Bethnal-green 109 17 18 35 Bourne estate Holborn 59 17 7 24 Brightlingsea-buildings Stepney 10 2 3 5 Briscoe-buildings Lambeth 14 2 .. 2 Brook-street-dwellings Stepney 6 .. .. .. Bruce-house Westminster .. 1 26 27 Cable-street-dwellings Stepney 17 7 1 8 Caledonian estate Islington 25 4 5 9 Carrington house Deptford .. .. 15 15 Chadworth-buildings Finsbury 18 2 6 8 Churchway estate St. Pancras 16 3 1 4 Cobham-buildings Southwark 7 1 .. 1 Cotton-street-dwellings Pqplar 8 2 2 4 Council-buildings, Poplar Poplar 6 .. 1 1 Cranley-buildings Holborn 1 .. 1 1 Darcy-buildings Hackney 1 .. .. .. Dufferin-street-dwellings Finsbury 5 1 3 4 Duke's-court-dwellings Westminster 13 4 5 9 Durham-buildings Battersea 5 2 1 3 East Greenwich-cottages Greenwich 3 1 1 2 Goldsmith's-row-cottages Shoreilitch .. .. .. .. Hardy-cottages Greenwich 11 2 .. 2 Herbrand-street-dwellings Holborn 17 2 4 6 Holm wood-buildings Southwark .. .. .. .. Hughes-fields-cottages Greenwich 1 .. .. .. Hughes-fields-dwellings Deptford 13 5 2 7 Idenden-cottages Greenwich 6 3 .. 3 Mallory-buildings Finsbury 3 •• .. .. Millbank estate Westminster 38 15 13 28 Norbury estate Croydon 52 11 2 13 Old Oak estate Hammersmith 4 .. .. .. Parker-street house Holborn .. .. 16 16 Preston's-road-dwellings Poplar 24 7 5 12 Rushworth-street and Boyfield-street (late Green-street and Gun-street) dwellings Southwark .. 13 1 1 2 Shelton-street-dwellings Holborn 2 1 1 2 Swan-lane-dwellings Bermondsey 41 2 1 3 Sylva-cottages Deptford 3 .. .. .. Totterd own-fields estate Wandsworth.. 72 24 10 34 Union-buildings Holborn 23 4 4 8 Valette-buildings Hackney 2 1 1 2 Wandsworth-road-dwellings Lambeth 5 .. .. .. Webber-row estate Southwark 23 7 6 13 Wenlake-buildings Finsbury 2 .. 1 1 W essex-buildings Islington 26 .. 1 1 White Hart-lane estate Tottenham 109 10 .. 10 York-street-dwellings Westminster 4 •• .. .. Totals 864 169 173 342 (a) The particulars comprised in this table for estates within tho County have been supplied by the Medical Officer of Health, and for estates outside the county by the registrars of the districts. lxxiv Annual Report of the London County Council, 1912. L.—Occupations of the Tenants. Nature of occupation. No. Agent 74 Artist and draughtsman 30 Attendant 122 Baker and confectioner 92 Barman and Barmaid 21 Basket and brush maker 14 Billiard marker 11 Boilermaker 15 Bookbinder 46 Bootmaker 99 Boxmaker 17 Brass finisher 30 Bricklayer, mason and plasterer 85 Butcher 64 Butler 20 Cabdriver 16 Cabinet maker 203 Carman, carrier and coachman 214 Carpenter and joiner 160 Carpet planner 22 Cellarman 16 Charwoman and cleaner 293 Checker 40 Chemist and analyst 13 Cigar and cigarette maker 138 Clergyman and churchworker 42 Clerk, etc. 609 Coach and motor builder 33 Collector 25 Commercial traveller 113 Commissionaire 62 Compositor 127 Conductor 115 Cook 89 Costermonger 28 Cutter 44 Decorator, painter etc. 141 Domestic servant 16 Dressmaker and milliner 105 Electrician 75 Engine and crane driver 44 Engineer 123 Engraver17 Nature of occupation. No. Farrier 31 Fireman 48 Fitter and plumber 154 Florist 12 Flusher and sewerman 12 Foreman 72 Furrier 23 Gardener and park keeper 28 Gas worker 19 General dealer and hawker 60 Glazier and glassworker 22 Hairdresser 38 Hat and cap maker 40 Horsekeeper 26 Housekeeper 55 Independent 122 Inspector 43 Instrument maker 49 Jeweller 14 Journalist 14 Labourer 583 Lamplighter 13 Laundry worker 14 Leather worker 40 Machinist and machine minder 71 Manager and manageress 37 Mechanic 38 Messenger 70 Metal worker 45 Milkman and dairyman 41 Miscellaneous 154 Musician and artiste 34 Newsagent 23 No occupation 136 Nurse 48 Omnibus and motor driver 231 Packer 120 Pavior 13 Nature of occupation. No. Pensioner 103 Platelayer 16 Police constable, sergeant and detective 361 Polisher 53 Porter 373 Postman 134 Printer 170 Railway worker, guard and signalman 67 Reader 10 Salesman 258 Sawyer 13 Seaman and coastguard 33 Shipwright 18 Silversmith and goldsmith 32 Soldier 16 Sorter and Post Office Worker 81 Stevedore 27 Stoker 60 Storekeeper 52 Superintendent and caretaker 81 Tailor and tailoress 211 Teacher 39 Telegraphist 36 Theatre worker 26 Timekeeper 25 Tinsmith 23 Turner 22 Umbrella and stickmaker 19 Upholsterer 36 Waiter and valet 135 Waitress 12 Warehouseman 194 Watchmaker 15 Watchman 49 Waterman, boatman, and lighterman 55 Wheelwright 15 Wireman and linesman 20 Woodcarver 22 '