AC 4349 PAD 14 Metropolitan Borough of Paddington annual report of the council FOR THE YEAR 1909. APPENDIX. REPORT OF THE Medical Officer of Health. LONDON: MORTON & BURT, Ltd., Printers, 187, EDGWARE ROAD, PADDINGTON, W. PAD 14 Metropolitan Borough of Paddington REPORT ON The Vital Statistics AND Sanitary Work For the Year 1909. BY REGINALD DUDFIELD, M.A., M.B., D.P.H., F.S.S., Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. CONTENTS. Page Alcoholism, Mortality from 38 Animal Diseases 20 Anthrax 21 Arlidge v. Islington Borough Council 78 Bacteriological Examinations, Results of 60 Bakehouses, Inspection of 68 Births and Birth-Rates 3 Births, Notification of 5 ,, Hopeless 41 Canals, Canal Boats Acts 63 Cancer, Mortality from 31 Cerebrospinal Fever 20 Chickenpox 38 Child Rearing 49 Childbed, Mortality in 19 Childhood, Mortality of 39 "Clarendon Street Area" 74 Combined Drainage 62 Common Lodging Houses 76 "Consumption," Mortality from 21 „ Notification of 24 Consumptives, Occupations of 30 „ Contacts 29 „ Segregation of 23 Cream, Preservatives in 81 Dairies and Milkshops 77 Deaths and Death-Rates 8 Deaths in Institutions 54 Death-rates, Factor Corrected 10 Diarrhœa, Deaths from 46 „ Contact Cases 47 Diphtheria 13 Disinfection 55 Dispensary for the Prevention of Consumption 26 Drains, Private, Re-laid 61 Enteric Fever 17 Erysipelas 20 Factory and Workshop Act, 1901, Work Under 64 Food Analysis, Summary of Samples taken 80 „ Summary of Proceedings 86 Food Supervision 76 „ „ New powers of 78 Food Purveyors 77 Glanders 20 Health Visiting 49 Home Work 64 House Refuse 61 Houses let in Lodgings, Annual Cleansing of 70 „ „ Sickness, etc., in 74 „ „ Registration of 68 „ „ Overcrowding in 73 „ „ Vital Statistics 74 Hydrophobia 21 Ice Cream, Inspection of places where made 79 Illegitimates, Births of 3 „ Deaths of 48 Index Numbers of Infantile Mortality 40 Infants, feeding of 49 ,, mortality among 39 ,, „ in Insula 43 „ „ in Wards 40 Page Influenza, Mortality from 38 Inhabited House Duty, Exemption from 76 Inquests held 53 Institutions, Deaths in 54 Internotification 60 Legal Proceedings, Summary of 84 Manure, Removal of 61 Measles 31 „ Seasonal Influence on Fatality of 33 Meat Condemned in Slaughterhouses 77 „ Seized in Shops, &c. 79 Meteorology 2 Mumps 38 Milkshops, Trades carried on at 78 Milkvendors, New Powers re Registration of 78 Mortality among Infants 40 „ ,, „ " Hopeless Births" 41 „ at ages 1—5 years 52 Mortuaries 57 Notification of Births 5 ,, ,, Sickness 6 „ „ Phthisis (" Consumption "). 24 Offensive Refuse, Removal of 61 Office Work 82 Order of Local Government Board re Consumption 25 Other Infectious Diseases 38 Other Septic Diseases w-. 20 Other Tubercular Diseases 21 Outworkers 64 Phthisis, Mortality from 21 Population, Estimated 1 Preservatives, Use of in foods 81 Prevention of Infectious Diseases 55 Puerperal Fever 18 Respiratory Diseases, Mortality from 38 Ringworm 38 Scarlet Fever 16 Schools and Infectious Diseases 57 Segregation of Consumptives 23 Septic Diseases, Mortality from 20 Slaughterhouses, Inspection of 78 Small-pox 12 Smoke Prevention 62 Suicide, Mortality from 38 Trade Refuse 61 Tuberculous Diseases, Mortality from 21 Unsound Food seized 79 Vaccination 12 Water Supply, Cutting off of 57 Wharves, Inspection of 63 Whooping Cough 35 „ „ Seasonal Influence on Fatality of 36 Workshops, Overcrowding in 67 „ Registration of 64 ,, Sickness on premises of 67 APPENDIX. Tables (Local Government Board, Home Office, and London County Council) 88 NOTI FICATION CHART. TO HIS WORSHIP THE MAYOR, THE ALDERMEN AND THE COUNCILLORS OF THE BOROUGH OF PADDINGTON. Mr. Mayor, Ladies, and Gentlemen, I have the honour to present to you my annual report dealing with the health of the Borough, and the work of vour Public Health Department during the past year-—as bv law required. I have continued the series of vital statistics with which you have been made familiar through earlier reports, but I have not that confidence in those statistics which I could desire to possess. Rather more than eight years having elapsed since the last census, the estimates of the number of inhabitants of the Borough have in consequence lost much of the reliability requisite for critical study. It may be necessary to recalculate many of the statistics given in this report when the results of the next census are known. The birth-rate in 1908 showed a trifling increase in comparison with that of 1907, due in all probability to the disturbance in the normal course of the registration of births consequent upon the introduction of notification. Last year this rate showed a decrease amounting to 1.47 per 1,000. In no previous vear has there been so large a fall. Of the infectious diseases which are notified, scarlet fever alone was undulv prevalent during the past year. The fatality of that disease was, however, below the average, and the increase in the mortality rate from it, but trifling. There was a very slight increase last year in the death-rate from all causes in comparison with the preceding vear, but the corrected rate for the year, 12.96 per 1,000, was well below the decennial mean rate (14.01). The contrasts between the rates for 1899 and 1909—16"63 and 12.96—is very satisfactory. The greater part of that difference is due to the reduction in the infantile mortality rate, which was 153 per 1,000 births in the former year, and 107 last year—the lowest on record. If the rate of 1899 had prevailed last year, the total death-rate in 1909 would have been 15.88 instead of 12.96, so that of the total reduction in last year's rate (3.65 per 1,000), a reduction equal to 2.92 per 1,000, was due to lower infantile mortality, leaving a balance equal to 0.75 per 1,000 due to reduced mortality at other ages. The decline in the mortality at ages under one year (infantile mortality) has been continuous since 1904, when the rate was 136 per 1,000 births. It would be gratifying if one could unreservedly place the credit for that reduction to the efforts of the Council and the Department to check the waste of infant life. Part of the reduction may, I think, be unhesitatingly attributed to those efforts, but I feel that the test of the work has yet to be applied. I await with considerable interest the occurrence of a summer with weather favourable to a severe epidemic of infantile diarrhoea. That disease (or those diseases, for I am uncertain whether " infantile diarrhoea " is really one disease, or many) has been very low in prevalance for some five years. Last year the mortality at all ages from diarrhoeal diseases was 0.25 per 1,000, which figure may be compared with the rate of 1.52 per 1,000 recorded in 1899. If, after a hot dry summer, an infantile mortality rate anywhere below 110 per 1,000 births be recorded, then I think it will be possible to proclaim the success of the preventive—or rather, educative—measures in use. Attention may here be directed ii. to the remarks re "Hopeless Births " (see page 41). The deaths of the children there referred to are due to ante-natal causes, and not to maternal ignorance or neglect. The figures given suggest an increase in the mortality rate from such deaths, accompanying a decrease in that due to post-natal causes. Much, it would appear, remains to be attempted to secure the preservation of infant life-—a work rendered increasingly urgent by the continued, and apparently accelerating, fall in the birth-rate. In earlier (special) reports attention has been directed to the need of supplementing the crusade, on general sanitary lines, against consumption, by the adoption of special efforts directed against the disease itself. For that reason the Order of the Local Government Board requiring the notification of pulmonary consumption in persons in receipt of medical relief, is to be welcomed not onlv for the greater knowledge of the disease which will accrue from the working of the Order, but also as an earnest of further steps towards the general notification of the disease. Last vear was, as far as the Borough is concerned, signalized by the opening of the Dispensary for Consumption—the first in England. I regard that event as one of the first importance, believing that the " Dispensary System," worked on proper lines, will do much to limit the spread of the disease, and be of great utility in its treatment. I do not think that that system is, of itself, able to stamp out the disease ; it can only do its part in the co-ordinated scheme for so doing. Dispensary work will give more certain information of the prevalence of the disease, and will make it easier to understand what steps are necessary to be taken in the direction of hospital provision, &c. Last year there were 161 deaths from consumption. The total number of known cases ("definite" and "suspect ") was 801, 72 of the patients dying during the year. From a comparison (not given in the report) of the age-distribution of the remaining 89 deaths, and of the occupations of those deceased persons, it seems reasonable to conclude that the 89 deaths represent cases in much the same stations of life as the 72 deaths which occurred among the reported living patients (801). If that conclusion be right, it is possible to tentatively suggest that the 161 deaths represent some 1,600 cases of consumption; in other words that the number of consumptives living in the Borough at any time—in various stages of the disease, not all necessarily capable of spreading infection—is ten times the number of deaths recorded during the year. Last vear was marked by the passing of legislation from which much is expected—I mean the Housing, Town Planning, &c., Act, 1909. The transference of certain important administrative work under the Housing Acts from the Police Courts to the Council, will greatlv facilitate the task of dealing with unhealthy houses. It will, however, take some little time to find out what powers the new Act gives. Indeed it is very probable that an amending and codifying measure will be necessary to render workable the new machinery provided. I think it will be advisable to proceed very cautiously in making use of the Act, and I trust that, should the results appear to be disproportionately small during the first year or two, the seeming inactivity will be attributed to caution, and not to neglect. The Staff of the Department underwent some changes last year, two of the Inspectors retiring under the Council's Standing Order relating to age. Neither of the vacancies was filled up, the retiring Inspectors'duties being distributed among the rest of the Staff. Until last year the Department has been able to secure the services of Women Students, who have greatly helped the Women Inspectors, but during the greater part of last year no Students were available. If Students cannot be relied upon, much of the work with reference to infants will, of necessity, have to be given up, as, even with the help of the Health Society's Visitors, the Women Inspectors cannot do sufficient visiting to ensure a continuance of the progress in the improvement of child-rearing which has taken place. iii. In conclusion I desire to tender my thanks to the Chairman and Members of the Public Health Committee, and to the Council, for the support which has been continuously accorded to me during my term of office—now over fifteen years—and for the consideration with which the advice it falls to me to tender, is received. Acknowledgments are also due, and hereby sincerely tendered, to my medical confreres outside the Council, and to those voluntary organisations which have done so much to forward the work entrusted to me. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your most obedient servant, m.a., m.b., d.p.h., f.s.s., Medical Officer of Health. Town Hall, Paddington, W. 2nd July, 1910. 1 REPORT. THE BOROUGH. The area of the Borough, 1,356 acres, includes 20 acres of waterways and (approximately) 175 of open spaces. At the census of 1901 there were 17,684 inhabited houses occupied by 33,661 families, 21,815 of the latter total living in homes of less than five rooms. In 1891 16'7 per cent, of the inhabitants of the Parish, which did not include the present Queen's Park Ward, were living in homes where the average number of occupants exceeded two per room, who were, therefore, described as " overcrowded." Such designation is not, however, taken to imply that those persons wereovercrow de dwithin the meaning of the law. In 1901 the proportion had decreased to 13.5 per cent. The Borough constitutes a single Registration District, comprising three Sub-Districts, viz., North, Central and South Paddington. For administrative purposes, the Borough is divided into eight Wards, viz., Queen's Park, Harrow Road and Maida Vale (constituting the North Sub-District), Westbourne and Church (the Central Sub-District), Lancaster Gate, East and West, and Hyde Park (forming the South Sub-District). In this Report the Wards have been, in accordance with previous practice, selected as the unit areas. POPULATION. Assuming that the rate of increase in the population, as determined by the Census of 1891 and 1901, has been maintained, the number of inhabitants of the Borough at the middle of last year is estimated to have been 151,437,. comprising 64,904 males and 86,553 females." That estimate shows an increase of 7,461 persons above the total for the last Census, while the natural increment of the population, being the excess of the births over the deaths between April, 1901, and June of last year was 10,084. Changes due to migration cannot be determined. The estimates of the populations of the Wards of the Borough are given below :— Estimated Population. 1909. Males. Females. Persons. Queen's Park 8,149 8,110 16,259 Harrow Road 14,329 15,907 30,236 Maida Vale 8,183 12,249 20,432 Westbourne 10,070 15,284 25,954 Church 13,487 14,876 28,363 Lancaster Gate, West 2,835 5,585 8,420 ,, ,, East 2,280 5,627 7,907 Hyde Park 4,971 8,895 13,866 Borough 64,904 86,533 151,437 * The Registrar-General's estimate was 151,955. 2 meteorology. After an interval of over eight years any estimate of the population must be regarded with more or less suspicion. The statistics included in an annual report are of the nature of a balancing of accounts; but with the census at decennial intervals one is in much the same position as would be a commercial firm endeavouring to make up annual balance sheets without the annual stocktaking. If the natural increment is to be relied upon as even approximately accurate, the estimates of population used in this report are too low, and the rates, consequently, too high. It has, however, to be borne in mind that there has been for some few years a progressive increase in the proportion of "empties," the effect of which in reducing the population cannot be gauged, owing to the difference between the definition of a "house " for census and for rating purposes. The establishment of a quinquennial census is much to be desired. Until really reliable estimates of the population are provided for the calculation of vital statistics, little progress can be made in the study of the results of municipal sanitary work. METEOROLOGY. In Table 1 will be found the principal meteorological data for 1909, in comparison with those for the preceeding four years. The mean temperature (morning readings) was 48.7, the lowest recorded in any of the five years, and the difference between the wet and dry bulb readings (2.6°) the smallest during the same period. The range between the maximal and minimal temperatures was not so marked as in previous years. There was a considerable increase both in the total rainfall and in the number of days on which rain fell, and, although the number of days on which sunshine was recorded shows a considerable reduction (from 285 days in 1908 to 273 in 1909), yet there was but a slight decrease in the total number of hours of bright sunshine (1,401 hrs. 48 mins. in 1908; 1,460 hrs. 07 mins. in 1909). TABLE I. Meteorological Elements. Means at 9 a.m. Extreme Temperatures. Rain. Sunshine. Barometer reduced to sea level Thermometer. Shade. Max. in Sun. F.° Min. on Grass. F.° Depth of, Inches. No. of Days. Number of Hours. Number of Days. Dry Bulb. F.° Wet Bulb. F.° Maximum. F.° Minimum. F.° H. M. 1909. Totals - - - - - - - - - 27.08 192 1,460 07 273 Means 29.96 48.7 461 - - - - - - - - - - Highest — — — 85.5 Aug. - — 124.0 — — — — — Lowest — — — — — 19.0 Mar. — 14.0 — — — — 1908. Totals - - - - - - - - - 24.49 173 1,461 48 285 Means 30.01 50.4 46.5 - - - - - - - - - - Highest — — — 85.0 July — — 128.0 - — — — — Lowest — — — — - 16.5 Dec. — 11.0 — — — — 1907. Totals - - - - - - - - - 23.86 177 1,304 07 280 Means 29.96 49.5 46.2 — - — — — - — — — — Highest — — — 80.0 May — 122.0 — — — — — Lowest - - - - - 22.0 Jan. — 170 — — — — 1906. Totals - - - - - - - - - 24.42 145 1,580 12 292 Means 29.99 51.1 47.6 - - - - - - - - - - Highest - - - 94.0 Sept. - - 128.0 - - - - - Lowest - - - - - 20.0 Dec. — 15.0 — — — — 1-905. Totals - - - - - - - - - 23.35 151 1,344 59 270 Means 29.96 500 46.9 - - - - - - - - - — Highest - - - 80.3 July — - 135.0 — — - - - Lowest - - - - - 22.0 Jan. - 15.0 - - - - births. 3 BIRTHS. In the 52 weeks taken as the statistical year 2,895 births were registered in the Borough, 254 fewer than in 1908 (53 weeks). The uncorrected birth-rate was 19.11 per 1,000 persons in 1909 as compared with 20.58 in 1908 (due allowance being made for the extra week). The average annual number of births during the ten years 1889-1908 was 3,264, and the birth rate 22.24 (Table I., Appendix,). Last year's figures indicate a decline in the number of births of 364 and in the rate, of 3.13 per 1,000. In 1899 the rate, even then the lowest on record, was 24.22 per 1,000, or more than 5 per 1,000 above that of last year. The 2,895 births comprised 1,481 births of boys and 1,414 of girls, of whom 103 (58 boys and 45 girls) were dead when their births were registered. The children dying before registration of their births constituted 3.5 per cent. of all children born in the Borough, the proportion in 1908 having been 3.3 per cent. There were 27 twin births registered, 7 of males, 9 of females and 11 of mixed sexes. Three sets of twins and four other children of twin births died at or very shortly after birth. The births in the Workhouse Lying-in Wards numbered 77, 18 of the children being born to non-resident parents. The total number of children born in the Borough to non-resident parents was 62, while 198 births of children of residents were reported from other parts of the Metropolis.. The corrected number of births is, therefore, 3,031, equal to a rate of 20.01 per 1,000 persons, or 1.47 less than the rate for 1908, and nearly 1 per 1,000 less than that for 1906. It will be seen from Table 2 that the rates in all the Wards, except Church and Hvde Park, were below those for 1908. According to the figures published in the Quarterly Reports of the Registrar-General (Table 3), the local rate was 19.04 last year, or 2.18 less than the quinquennial average, decreases being recorded in the whole Metropolis and in each of the districts circumjacent to the Borough. The greatest decrease (3.88 per 1,000) was recorded in Willesden. Rates based on the estimated numbers of women of child-bearing ages (15 to 45 years) are given in both the tables mentioned, but those figures are included for the sake of continuity rather than for the value which is thought to belong to them. Illegitimate Births.—The 2,895 births registered within the Borough included 143 of illegitimate children (70 boys and 73 girls), of whom 48 were born in the Workhouse. In 1908 the illegitimate births numbered 149, and in 1907 123. Five of the 149 children were dead at the date of registration of their births (equal to 3.5 per cent.). Twenty-two (22) children were born to non-resident mothers, while 19 others were born to resident mothers in outside districts. The nett total of such births during the year was, therefore, 140, as compared with 151 in 1908 and 134 in 1907. Last year's total formed 4.6 per cent. of the total births (corrected for non-residents, etc.), the proportions in 1908 and 1907 having been 4.5 and 4.0 respectively. In four out of the eight Wards the proportions of illegitimate births were higher last year than in 1908 (see Table 2), the most notable increase being recorded in Lancaster Gate West, Ward, where the proportions rose from 7.3 per cent. in 1908 to 11.1 last year. * Of the 198 children, 191 were born in Queen Charlotte's Hospital, 3 in other Maternity Hospitals and 4 at private addresses. 4 Births. TABLE 2. Births. Paddington. Corrected as fully as possible. All Births. Illegitimate Births. Corrected Totals. Birth Rates. Corrected Totals. Percentage of all Births. Per 1,000 persons. Per 1,000 females, aged 15-45 years. 1909. 1909. 1908. 1909. 1908. 1909. 1909. 1908. Borough. 3,031 20.01 21.48 62.19 66.73 140 4.6 4.5 Queen's Park 382 23.49 27.27 100.69 116.85 11 2.8 3.9 Harrow Road 741 24.50 28.13 91.90 105.49 14 1.8 2.6 Maida Vale 392 19.18 20.72 54.26 58.61 27 6.8 4.6 Westbourne 470 18.10 19.29 55.59 59.23 31 6.5 4.5 Church 743 26.19 25.80 98.12 96.54 34 4.5 6.6 Lancaster Gate, West 63 7.48 7.91 16.52 17.47 7 11.1 7.3 „ East 48 6.07 8.06 11.91 15.80 1 2.0 3.0 Hyde Park 192 13.84 12.67 33.24 30.37 15 7.8 6.1 TABLE 3. Births and Birth.Rates. Births Registered.* Birth.Rates. Per 1,000 persons. Per 1,000 females, 15-45 years. 1909. 1909. 1904-08. 1909. 1904-08. Paddington 2,895 19.04 21.22 58.95 65.71 London 117,547 24.31 26.49 88.82 96.78 Kensington 3,188 17.35 18.57 48.17 51.57 Westminster 2,518 14.90 16.10 45.26 48.93 Marylebone 2,534 20.10 20.44 61.06 62.10 Hampstead 1,282 13.61 15.49 35.92 40.90 Willesden 1 4,039 25.17 29.05 90.58 104.56 * From Quarterly Reports of the Registrar.General. The total for Marylebone given above has been corrected for births in Queen Charlotte's Lying.in Hospital not belonging to that Borough. Note.—According to the figures given in the Annual Supplement to the Weekly Reports of the Registrar-General the corrected births and birth-rates for 1909 are— Paddington. London. Kensington. Westminster. Marylebone. Hampstead Births. 3,120 116,559 3,362 2,730 2,595 1,328 Rates. 20.6 24.2 18.4 16.2 20.6 14.1 births. 5 Notification of Births.—The Notification of Births Act, 1907 was adopted by the Council in February, 1908. The Act provides for the notification to the Medical Officer of Health of every birth—whether the child be alive or dead—within 36 hours of its occurrence. Miscarriages at any date subsequent to the twenty-eighth week of pregnancy are to be notified. The duty of notification is imposed upon— (a) The father of the child, if actuallv residing in the house where the child is born; and (b) Any person (i.e., medical attendant, midwife, or other person) in attendance at the birth, or called in to attend on the mother within six hours of the birth taking place. Failure to fulfil the duty entails a penalty not exceeding twenty shillings. The notification of a birth is additional to and not in substitution for the registration thereof, the legal provisions with reference to the latter remaining unaltered. Full information of the adoption of the Act and its provisions was given during 1908 bv public notices, advertisements in the local papers, and in January of the current year by inclusion in the "house sheets'' issued annually by the Council to every house in the Borough. During the past year 2,407 notifications were received relating to 2,360 births, 35.5 per cent. of the notifications being received from parents, 18.4 per cent, from medical practitioners, and 38.3 from midwives. One hundred and eighty notifications, equal to 7.4 per cent. of the total were received from persons other than those already mentioned. Of the 2,360 children, 2,292 were stated to be alive and 68 still-born, equal to 2.8 per cent. of the total. The illegitimate births numbered 87 (3.6 per cent. of the total) 5 of the children (5'7 per cent.) being still-born. Ninety births were notified from the Workhouse, 3 (3.3 per cent.) of the children being still-born. Notifications were received with respect to 31 multiple births, 30 being twin births and one a quadruplet. The twin births comprised 12 of males, 10 of females and 8 of mixed sexes, and the quadruplet, three males and one female. In 24 instances both twins were reported alive, and in two both dead. In the remaining four cases, one child was still-born. All four children born at the quadruplet birth were reported still-born, but two of them were subsequently registered as alive. The proportion of still-births among children born at multiple births was 15.3 per cent. A comparison of the returns of births registered in the Borough shows that of 2,895 births registered, 2,122 (or 73.2 per cent.) were notified in accordance with the Act. The proportion for the individual quarters of the year were 66.1 per cent. in the first, 73.2 in the second, 77.9 in the third, and 76.7 in the fourth, showing a decided improvement in the second half of the year. Of the 143 illegitimate births 102 (71.3 per cent.) were notified, but the proportions in the four quarters of the year exhibit greater irregularities than are to be observed in those already given for all births. In the first quarter of the year 69.7 per cent. of the registered illegitimate births had been notified, in the second, 64T, in the third, 80.0 and in the fourth, 75.0. The proportion of notifications to registered births (per cent.) was highest in the North Registration Sub-District, and lowest in the South. (See below). Notification of Births. Registration Sub-District. North. Central. South. All Births. 79.1 71.6 49.0 Illegitimate Births. 53.1 78.8 42.7 6 sickness. Summonses were issued during the year with respect to l6 failures to comply with the Act. (See Legal Proceedings). Some account of the work undertaken in connection with the births of children will be found under Infant Rearing. SICKNESS. The cases of infectious disease reported during the past year in pursuance of Section 55 of the Public Health (London) Act, 1891, numbered 942 (allowance being made for duplicate certificates only), and were 28 fewer than in the previous year. Table 4 shows that there were increases in the number of cases of diphtheria (31) and erysipelas (1) and decreases in those of all the other diseases. Comparing last year's morbidity rates with those for the quinquennium 1904-8, the only diseases showing a prevalence above the average are diphtheria (rate last year 1.14 per 1,000; mean, 0.95), and scarlet fever (rate, 1909,4.15; mean, 3.49). The rates from enteric and puerperal fevers show satisfactory reductions, that in the former case being really better than it appears, as will be seen later. TABLE 4. Notifications. Paddington. Corrected for duplicate certificates only. Smallpox. Diphtheria. Membranous Croup. Erysipelas Fevers, Totals. Scarlet. Enteric. (Typhoid) Continued. Puerperal Cases certified— 1909 — 173 2 106 629 29 — 3 942 1908 — 142 4 105 681 31 1 6 970 1909 - 1.14 0.01 0.69 4.15 0.19 - 0.01 6.21 1904-08 0.00 0.95 0.01 0.82 3.49 0.25 0.00 0.05 5.62 * Per 1,000 persons all ages. For the purpose of comparisons with the Metropolis and the districts circumjacent to the Borough, the figures given by the Registrar-General in his Quarterlv Reports are used. (See Table 5). In Paddington and Westminster only were the rates from diphthcrin above the respective means, but of last year's rates those recorded in the Metropolis (1.38), Westminster (1.33) and Willesden (1.29) were above the local rate (1.21). All the rates from erysipelas were below the means, and in three districts last year's rates were below that of Paddington (0.69), viz., Westminster (0.00), Hampstead (0.31) and Willesden (0.59). Of the scarlet fever rates, only those in the Metropolis and Hampstead were below the quinquennial means, the local rate (4"14) being the highest noted in the past year. In Kensington only did the rate from enteric fever exceed the mean, while of last year's rates those of Westminster (0.14), Marylebone and Hampstead (0'16 in each case) were below that for the Borough (0.19). With the exception of that in Hampstead all the rates from puerperal fever were below the means, last year's rates in the Borough (0.01) being the lowest of the series. sickness. 7 TABLE 5. Morbidity Rates.* Metropolis, Borough, and Districts Circumjacent to the Borough. Disease. Paddington. London. Kensington. Westminster. Marylebone. Hampstead. Willesden. 1909 Mean 1904-8 1909 Mean 1904-8 1909 Mean 1904-8 1909 Mean 1904-8 1909 Mean 1904-8 1909 Mean 1904-8 1909 Mean 1904-8 Smallpox - 0.00 0.00 0.02 - 0.00 0.00 0.00 - 0.01 - 0.00 - 0.01 Diphtheria 1.21 0.99 1.38 1.63 0.96 1.07 1.33 0.92 0.89 0.98 0.49 0.87 1.29 1.93 Erysipelas 0.69 0.83 0.86 0.99 0.73 0.77 0.60 0.64 1.06 1.16 0.31 0.53 0.59 0.57 Fevers Scarlet 4.14 3.48 3.56 4.25 2.28 2.26 3.49 2.58 3.63 2.80 2.74 2.95 3.92 3.75 Enteric 0.19 0.25 0.21 0.32 0.26 0.24 0.14 0.25 0.16 0.32 0.16 0.25 0.25 0.26 Puerperal 0.01 0.05 0.05 0.05 0.03 0.04 0.02 0.03 0.02 0.04 0.05 0.03 0.04 0.06 * Compiled from Registrar-General's Quarterly Reports. Rates per 1,000 persons. † Including Membranous Croup. ‡ Including Continued Fever. The sex-age distribution of the cases reported last year in the Borough is given in Table 6. Of the sex morbidity rates given in the last lines of that table, increases have to be noted in those due to diphtheria (males, 0.56; females, 0.01), membranous croup (males, 0.01), and scarlet fever (males, 0.87 ; females 0.51). TABLE 6. Notifications : Sex-Age Distribution. Paddington. Ages. (Years.) Smallpox. Diphtheria. Membranous Croup. Erysipelas. Fevers, Scarlet. Enteric. Continued. Puerperal. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 0— ... ... 2 1 ... ... 2 3 2 2 ... ... ... ... . . . 1 — ... ... 6 2 ... ... ... 3 15 14 ... ... ... ... ... 2- ... ... 6 6 ... ... ... 1 19 18 1 ... ... ... ... 3— ... ... 11 7 ... ... ... ... 27 26 ... ... ... ... ... 4— ... ... 5 11 1 ... ... ... 25 29 ... ... ... ... ... 5— ... ... 50 33 1 ... 2 2 174 180 2 2 ... ... ... 13— ... ... ... 4 ... ... ... 1 13 16 ... ... ... ... ... 15— ... ... 9 11 ... ... 2 9 20 23 5 6 ... ... 2 25— ... ... 2 7 ... ... 34 42 8 18 8 5 ... ... 1 65— ... ... ... ... ... ... 2 3 ... ... ... ... ... ... ... All Ages. ... ... 91 82 2 ... 42 64 303 326 16 13 ... ... 3 Rates,* 1909 ... ... 1.40 0.94 0.03 ... 0.64 0.73 4.66 3.76 0.24 0.15 ... ... 0.03 1904-08 0.01 0.00 0.96 0.93 0.02 0.00 0.89 0.78 3.79 3.25 0.26 0.24 ... 0.00 0.09 * Per 1,000 individuals of each sex. 8 deaths. The Ward distribution (Table 7) shows that there were last year fewer cases of all diseases in Queen's Park, Harrow Road, Maida Yale and Lancaster Gate, West, Wards, more in the remaining four. Diphtheria was more prevalent last year than in 1908 in Queen's Park and Church Wards; scarlet fever in Westbourne, Church and Hyde Park, and enteric fever in Church Ward. The morbidity rates were lower last year in Queen's Park, Maida Vale and Lancaster Gate, West, Wards, while of the increases recorded in the others the greatest were those in Westbourne and Church Wards. TABLE 7. Notifications : Ward Distribution. Disease. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Smallpox —(-) -(-) -(-) —(-) —(—) -(-) —(-) —(-) Diphtheria 21(9) 41(43) 22(21) 27(26) 45(24) 2(8) 6(6) 9(5) MembranousCroup -(2) 2(1) —(-) —(1) -(-) -(-) -(-) -(-) Erysipelas 9(9) 23(14) 16(11) 22(23) 29(43) 1(-) 1(3) 5(2) F evers Scarlet 61(86) 166(251) 45(74) 107(104) 171(152) 19(16) 12(9) 48(25) Enteric 3(5) 2(5) 5(4) 2(1) 10(6) —(4) 2(1) 5(5) Continued -(-) -(1) -(-) -(-) -(-) -(-) -(-) -(-) Puerperal -(2) -(1) -(1) 1(1) 2(1) -(-) -(-) -(-) Totals 94(113) 234(280) 88(111) 159(756) 257(226) 22(28) 21(19) 67(37) Rates*, 1909 5.78 7.73 4.30 6.12 9.06 2.61 2.65 4.83 „ 1904-08 6.82 7.43 5.38 4.71 6.96 3.21 2.53 3.38 * Per 1,000 persons all ages. DEATHS. During the past year 2,154 deaths from all causes were registered in the Borough, 75 more than in 1908 (53 weeks), but 71 fewer than the annual average (2,225) for the ten years 1899-1908. The gross mortality was at the rate of 14.22 per 1,000 persons of all ages last year, as compared with 13.58 in the preceding year and a mean rate of 15.16 for the decennium. The gross rates for three of the four quarters of the year exceeded the mean rates for the five years 1904-8, as may be seen from the figures given below. Gross Mortality Rates. (All Causes). Quarters. 1 2 3 4 1909. 18.96 14.05 10.64 13.40 Mean 1904-8 16.76 13.23 12.71 15.15 The mean annual rate for the quinquennium was 14*36, and there is little doubt that but for the exceptionally low rate which prevailed in the third quarter of the year, a most unusual time for the rate to be low, last year's rate (14.22) would have exceeded the mean. In Table I, Appendix, will be found the figures for each year since 1899. Included in the total of 2,154, were 409 deaths of non-residents, while in out-lying public institutions in the Metropolis and other parts of the country 219 deaths of residents of deaths. 9 the Borough were recorded. The deaths of non-residents in the Borough were 37, and those of residents beyond the Borough, 16 in excess of the decennial averages. (See Table I., Appendix.) The nett total of deaths of residents during the year was 1,964, 92 below the decennial average (2,056), but 18 above the quinquennial (1,946). Last year's nett mortality rate was 12.96 per 1,000 persons, as compared with 12.36 in 1908, and means of 14.01 and 13.04 for the preceding decennium and quinquennium respectively. The nett rates for the first and second quarters of the year were in excess of the quinquennial means, those for the third and fourth below. Nett Mortality Rates. (All Causes). Quarters. 1 2 3 4 1909 17.51 12.94 8.86 12.58 Mean 1904-08. 15.38 11.90 11.54 13.71 The reduction in the rate for the third quarter was very considerable, equal to a drop of 23'3 per cent, of the mean, and due to the absence of any epidemic of infantile (summer) diarrhoea. In Table II, Appendix, are given the annual numbers of deaths (nett totals) in the Borough and each Ward since 1901, and in Tables III. and IV., the numbers of deaths during the past year from the more important causes of death. The 1,964 deaths comprised 923 of males and 1,041 of females, the corresponding mortality rates being 14.22 and 12.03 per 1,000 individuals of each sex. The rate for males was 0.49 below the quinquennial mean and that for females, 0.25 above. (See Table 8). The rates (persons) for last year were above the means in four Wards, below in the others. (Table 8). The greatest increase (8.2 per cent.) was in the rate for Lancaster Gate West, Ward (rate, 1909, 8.66 ; mean, 8.00), and the greatest decrease (9.8 per cent.) in that of Queen's Park (rate, 1909, 12.30; mean, 13.63). In Maida Vale and Church Wards only were the rates for males above the means, while of those for females, all were above the means, except in Queen's Park, Harrow Road and Church Wards. TABLE 8. Nett Totals of Deaths and Mortality Rates. Deaths, All causes, all ages. 1909. Mortality Rates.* 1909. 1904-08. Males. Females. Persons. Males. Females. Persons. Males. Females. Persons. Borough 923 1,041 1,964 14.22 12.03 12.96 14.71 11.78 13.04 Wards. Oueen's Park 107 93 200 13.13 11.46 12.30 13.91 13.56 13.63 Harrow Road 182 194 376 12.70 12.19 12.43 13.34 12.50 12.90 Maida Vale 132 143 275 16.13 11.67 13.45 15.93 11.31 13.16 Westbourne 134 190 324 12.55 12.49 12.48 14.58 11.66 12.86 Church 252 239 491 18.68 16.06 17.31 17.47 16.14 16.77 Lancaster Gate, West 25 48 73 8.81 8.57 8.66 10.03 6.97 8.00 Lancaster Gate, East 22 40 62 9.64 7.10 7.85 12.83 5.97 7.95 Hyde Park 69 94 163 13.88 10.56 11.75 14.08 9.50 11.27 * Per 1,000 individuals. 10 deaths. Of the sex-age mortalities (Table 9) the most striking features are the universal, and generally considerable, decreases in the rates at ages under one year, and the increases in those at ages over 65 years, the increases being greater for females than for males. TABLE 9. Sex-Age Mortality Rates.* Sex. Age. Period. Borough. Wards, Queen's Park. Harrow Rd. Maida Vale. Westbourne. Church. Lancaster Gate Hyde Park. West. East. Males. 0— 1909 105.16 93.75 73.22 88.88 101.26 174.14 37.03 74.07 66.66 1904-08 140.22 157.23 117.10 151.05 125.43 163.50 96.15 103.54 154.87 1— 1909 13.09 13.27 6.51 15.62 15.87 23.25 - 9.17 - 1904-08 17.23 16.98 13.25 22.07 17.29 21.90 7.90 18.30 11.33 5— 1909 2.10 3.46 2.61 1.42 1.80 1.88 - - 1.51 1904-08 2.14 2.13 1.99 1.45 3.21 2.15 3.02 2.02 1.20 15— 1909 2.27 2.89 2.69 2.37 2.22 2.23 - 6.23 - 1904-08 2.59 3.61 2.86 2.08 2.28 2.80 1.86 0.82 2.57 25— 1909 12.70 13.18 12.34 13.97 11.34 15.40 10.86 4.91 13.45 1904-08 11.79 11.45 10.32 12.89 12.48 14.09 7.28 10.24 10.77 65— 1909 95.50 116.66 98.85 131.96 52.45 130.00 58.38 69.93 106.55 1904-08 89.55 109.65 88.18 97.78 63.49 117.37 85.77 76.61 91.48 Females. 0— 1909 97.39 55.24 57.28 117.64 109.70 146.67 66.66 44.44 151.89 1904-08 110.83 104.72 86.33 128.25 114.55 152.89 39.90 62.04 90.84 1— 1909 14.14 10.21 7.91 17.45 10.08 30.05 - 7.40 7.01 1904-08 15.00 15.97 13.18 13.04 14.49 20.40 5.40 4.44 14.69 5— 1909 2.41 — 2.20 2.60 3.83 3.39 4.97 — 1.27 1904-08 2.26 2.10 1.88 1.47 2.13 2.85 2.47 3.43 3.05 15— 1909 1.45 2.61 1.15 1.01 0.88 2.81 1.89 1.30 0.45 1904-08 1.83 3.30 3.03 1.39 1.58 2.52 0.50 0.90 1.08 25— 1909 8.23 10.71 8.55 7.91 8.33 9.71 7.05 5.70 6.68 1904-08 8.26 9.98 8.41 8.17 8.40 11.75 5.28 4.11 6.45 65— 1909 84.82 100.30 96.84 84.87 70.00 101.84 62.50 67.51 91.47 1904-08 74.63 101.46 77.31 77.98 55.36 95.22 62.99 58.95 74.14 * Per 1,000 individuals in each Sex-Age group. In comparison with the Metropolis and circumjacent districts (Table 10), the Borough rate (12.87) was higher than those of Hampstead (8.90) and Willesden (10.40) but below all the others. The highest rate was that of Marylebone (14.56). In every case last year's rate was below the quinquennial mean. Comparisons of nett rates take no count of the variations ir. rates due solely to sex-age composition of the populations. Such variations can be eliminated by the use of appropriate "correction factors." The corrected rates thus obtained are given in Table 11, the upper half of which is based on the Department's records, and the lower, on figures obtained from deaths. 11 TABLE 10. Mortality Rates. * Borough, Metropolis and Districts circumjacent to the Borough. District. Period. All Causes Smallpox. Measles Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever Diarrhceal Dis. Phthisis. Other Tub. Dis. Cancer. Infantile tality† Paddington 1909 12.87 ... 0.24 0.09 0.07 0.24 0.03 0.24 1.08 0.28 1.03 100 1904-08 13.03 0.00 0.26 0.09 0.10 0.19 0.04 0.58 1.08 0.38 1.11 113 London 1909 13.99 0.00 0.48 0.08 0.13 0.26 0.03 0.33 1.31 0.44 1.06 108 1904-08 14.88 0.00 0.39 0.11 0.15 0.30 0.05 0.71 1.44 0.53 1.01 127 Kensington 1909 13.28 ... 0.32 0.05 0.10 0.22 0.04 0.27 0.96 0.37 1.11 113 1904-08 13.71 0.00 0.30 0.06 0.11 0.21 0.04 0.56 1.17 0.48 0.99 132 Westminster 1909 13.09 0.01 0.15 0.11 0.11 0.11 0.04 0.10 1.34 0.31 1.13 95 1904-08 13.14 ... 0.13 0.07 0.07 0.12 0.04 0.33 1.40 0.38 1.01 107 Marylebone 1909 14.56 ... 0.26 0.06 0.07 0.20 0.01 0.23 1.35 0.16 1.23 99 1904-08 15.11 ... 0.27 0.11 0.09 0.17 0.03 0.47 1.47 0.34 1.12 116 Hampstead 1909 8.90 ... 0.15 0.04 0.05 0.19 0.05 0.04 0.61 0.23 0.90 75 1904-08 9.69 ... 0.12 0.06 0.06 0.10 0.04 0.17 0.76 0.25 0.89 83 Willesden 1909 10.40 ... 0.26 0.10 0.06 0.26 0.03 0.33 0.81 0.40 0.74 96 1904-08 11.04 ... 0.29 0.06 0.10 0.26 0.04 0.60 0.95 0.31 0.82 109 * Compiled in part from figures published by the Registrai-General, and in part from figures supplied by the Medical Officers of Health of the circumjacent Districts. Rates per 1,000 persons, estimated population, except Infantile Mortality, per 1,000 births. TABLE 11. Corrected Mortality Rates: All Causes. District Standard Rate. Corrected Rate, 1909. Excess ( + ) Defect (— ) Mean Corrected Rate, 1904-08. Increase ( + ) Decrease(—) Borough 17.10 13.84 —3.26 13.92 + 0.08 Wards. Queen's Park 16.43 13.62 —2.81 15.10 —1.48 Harrow Road 19.02 11.89 —7.13 12.33 —0.44 Maida Vale 16.62 14.72 —1.90 14.41 +0.31 Westbourne 18.96 11.97 —6.99 12.35 —0.38 Church 17.03 18.49 +1.46 17.92 +0.57 Lancaster Gate, West 15.01 10.49 —4.52 9.70 +0.79 „ East 14.76 9.67 —5.09 9.80 —0.13 Hyde Park 16.18 13.21 —4.97 12.67 +0.54 London 17.31 14.70 —2.61 15.65 —0.95 Paddington 17.10 13.74 —3.36 13.92 —0.18 Kensington 16.88 14.31 —2.57 14.78 —0.47 Westminster 16.22 14.68 —1-54 14.72 —0.04 Marylebone 17.08 15.51 —1.57 16.10 —0.59 Hampstead 16.13 10.04 —6.09 10.93 —0.89 Willesden 16.98 11.15 —5.83 11.85 —0.70 12 smallpox. the Registrar-General's Reports. In Church Ward only was last year's corrected rate above the standard rate, but in four of the Wards (viz.: Maida Vale', Church, Lancaster Gate, West, and Hyde Park) last year's rate exceeded the quinquennial mean rates. Comparing the figures for the whole districts (lower half of table) all last year's rates were below the "standard rates" and the quinquennial means. It must be observed that these corrected rates have to be received with some caution, as, owing to the long interval since the last census, it is impossible to be certain that verv material changes in the sex-age compositions of the populations have not taken place. SMALLPOX. 1 lie last case of this disease in the Borough was reported in 1900 in the person of a woman just arrived from Plymouth where the disease was at that time prevalent. Last year 21 cases were reported in the Metropolis, of which an unknown proportion were erroneously so diagnosed. In the 255 extra-Metropolitan cities, towns and sanitarv districts from which weekly returns are received by the Local Government Board, having a population at the Census of 1901 of nearly 15 millions, 67 cases were reported during the vear. The subjoined comparison of the returns for each of the four quarters of the years 1903-09 shows that there was a tendency during the past vear to increased prevalence of the disease. Smallpox. Uncorrected Returns. Metropolis. Extra-Metropolitan Districts. Quarters—1. 2. 3. 4. Year. 1. 2. 3. 4. Year. 1909 6 — 1 14 21 37 12 2 16 67 1908 2 — 1 1 4 4 5 5 7 21 1907 2 3 1 3 9 69 32 16 2 119 1906 14 16 1 — 31 545 275 100 70 990 1905 34 36 6 1 77 1,093 602 310 271 2,276 1904 181 251 42 23 497 1,345 1,519 1,098 1,283 5,245 1903 38 162 121 96 417 2,118 3,210 1,424 691 7,443 There were two deaths from smallpox in the Metropolis during the year as compared with 25, 10, 0, 0, and 0, in each of the five years 1904-08. The Registrar-General states in his Annual Summary that 85 cases of smallpox were notified during the year in 13 of the 70 Great Towns, 35 occurring in Bristol, 21 in London, G in Hull, and 5 each in Liverpool and Bolton, and that there were 14 deaths from the disease. Vaccination.—It may be surmised, and past experience tends to confirm such surmise, that smallpox is about to enter on a period of increased activity. Additional interest attaches therefore to the vaccination returns, an analysis of which for the years 1901-08 is given below with the preliminary figures for the first half of 1909, the latest returns available. Vaccination Returns : Paddington. Births. Successfully Vaccinated. Insusceptible Vaccination. Died Unvaccinated. Per cent. of Births. Cols. 2, 3, & 4. Vaccination Postponed. Certificates under the Act. Remainder.* Per cent., of Births. Cols. 6, 7, & 8. Cols. 1 2 3 4 5 6 7 8 9 1901 3,364 2,676 5 313 89.0 23 34 313 11.0 1902 3,262 2,629 12 291 89.8 35 19 276 10.1 1903 3,315 2,621 10 296 88.2 48 32 308 11.7 1904 3,311 2,578 8 307 87.4 52 22 344 12.6 1905 3,188 2,495 11 261 86.8 61 40 320 13.2 1906 3,174 2,545 9 224 87.5 36 41 319 12.5 1907 3,093 2,349 7 255 86.4 28 97 356 15.6 1908 3,098 2,346 8 244 83.8 28 201 271 16.1 19091† 1,517 1,143 7 103 82.5 44 113 107 17.4 Jan -June * Including " gone away," " apprisals to other districts," " false addresses," &c. † Provisional return only. diphtheria. 13 The use of certificates of " conscientious objection " shows a marked growth, dating from 1907, when the number of certificates issued was 97, more than twice the number issued in 1906 (41). In 1908, 201 certificates were taken out, and in the first half of 1909, 113, the total for the whole year being 245. On the other hand, the proportion of children born who were either successfully vaccinated or died before vaccination, has, with the exception of a very triflng increase in 1906, steadily diminished. DIPHTHERIA. During the past year 180 persons were certified to be suffering with this disease, but 7 of them were subsequently reported by the Staff of the Metropolitan Asylums Board to have scarlet fever. Such cases have been dealt with in this report as scarlet fever. The total of 173 cases thus obtained represent an increase of 31 above the total for 1908 (142), and of 19 above that of 1907 (154). In 1906 182 cases were reported. Two (2) cases of membranous croup were also reported last year, such cases being regarded and dealt with as cases of diphtheria. The morbidity rate from diphtheria, after including membranous croup, was 1.15 per 1,000 persons, an increase of 0'20 above the quinquennial mean (0.95). (See Table 4.) The numbers of cases reported from the whole Borough in the first and third quarters of the year, were below the averages for the five vears 1904-08. (See Table 12.) That table also shows the variations from the averages for each quarter of the year in each Ward. According to the Registrar-General (Table 5), the morbidity rate for the Borough was 1.21 per 1,000 last year, and the quinquennial mean rate, 0.99. Higher rates were recorded in Westminster (1.33, mean 0.92) and Willesden (1.29, mean 1.93). The lowest rate was that of Hampstead (0.49, mean 0.87). The 175 cases included 27 cases erroneously diagnosed, in addition to the seven already referred to. Neglecting the latter, the errors formed 15.4 per cent. of the total, more than 3 per cent. above the average for the preceding five vears (12.2). Six of the genuine cases were reported from hospitals, in patients admitted for previous attacks of scarlet fever. Deducting the 27 errors and the six cases contracted in hospital, there remain 142 cases, of which 15 were apparently due to infection derived from sources outside the Borough, and one to the recent discharge of a patient from hospital. The 142 cases comprised 127 primary and 15 (10.5 per cent. as compared with 10.3 in 1908) secondary. The 175 notifications came from 160 houses, the incidence of multiple notifications during the six years being given below. Diphtheria. (Including Membranous Croup). No. of 1909 . 1908. 1907. 1906. 1905. 1904. Houses with 2 cases 10 8 13 13 5 6 ,, 3 ,, 1 3 3 1 1 5 ,, 4 ,, 1 1 — — — 1 ,, 5 ,, — — — 1 — — If the cases erroneously diagnosed be eliminated, the distribution of multiple cases during the past year was as follows:— Houses with 2 cases, 7 ; with 3 cases, 1 ; and was exactly the same as in 1908. In two instances two cases were reported on the same day from the same house, and in three other instances the infection spread to a second family in the house. 14 diphtheria. TABLE 12. Notifications in each Quarter of the Year. Borough. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Quarters 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Diphtheria (and Membranous Croup) 1909 30 33 36 66 4 2 6 9 14 7 7 15 5 5 3 9 5 10 4 8 8 7 15 15 2 — — — 2 1 1 2 — 1 - 8 1904-08 35 27 41 42 4 2 3 5 9 7 11 13 4 4 9 6 5 6 7 5 8 5 9 7 1 1 1 2 2 1 0 2 2 1 1 2 Scarlet Fever 1909 137 181 176 135 12 17 13 19 45 53 45 23 9 6 19 11 31 22 29 25 33 47 53 38 3 3 5 8 1 6 2 3 3 27 10 8 1904-08 106 116 133 168 12 18 23 28 30 32 36 46 11 17 13 19 15 15 21 20 22 20 30 39 4 4 2 5 2 2 3 3 8 8 5 8 Enteric Fever (and Continued Fever) 1909 7 13 4 5 — 1 — 2 1 1 — — — 2 2 1 — 2 — — 2 6 1 1 — — — — 1 — 1 — 3 1 — 1 1904-08 7 5 11 16 0 0 1 2 1 1 3 2 1 1 2 3 1 1 2 2 2 0 2 4 0 1 0 2 1 0 0 0 1 1 1 1 Puerperal Fever 1909 - - - - - - - - - - - - - - - - - - 1 - - - 1 1 - - - - - - - - - - - - 1904-08 2 2 1 3 0 0 0 1 0 0 0 0 1 0 — 0 — 0 0 1 0 0 0 1 — — — — - - — — 0 0 — — "0" Represents average less than unity. "—" Represents no case reported during period, diphtheria. 15 Of the 175 cases reported, 164 were removed to hospital, including the 27 cases erroneously diagnosed. The percentage of patients treated in hospital was 93.7 as compared with an average of 82.7 during the five preceding years. The percentages of cases removed from the different Wards varied from 83.3 in Lancaster Gate, East, to 100 in Lancaster Gate, West. The deaths among the 175 patients notified as having diphtheria numbered 15, four, however, as being certified as due to causes other than that disease. Of the 11 deaths from diphtheria, one occurred at home and 10 in hospital. After making due corrections for the errors of diagnosis and for deaths not due to diphtheria, the fatality becomes 7.4 per cent., or 3.3 below the mean for the preceding five years (10.7). Among cases treated at home the fatality was 9.0 per cent. (mean 12.7), and among those removed to hospital 7.4 (mean 10.2). (See Table 14.) TABLE 13. Ward. Diphtheria (including Membranous Croup). Scarlet Fever. Enteric Fever (including Continued Fever.) Cases. Deaths. Cases. Deaths. Cases. Deaths. Total Reported. Removed to Hospital. At Home. In Hospital. Total Reported. Removed to Hospital. At Home. In Hospital. Total Reported. Removed to Hospital. At Home. In Hospital. Queen's Park 21(4) 19(4) - 1 60(3) 56(3) - 2(1) 3 2 - - Harrow Road 43(4) 42(4) - 1 167(8) 159(7) - 1 2 1 - — Maida Vale 22(3) 20(3) - — 45(7) 41(7) - — 4(1) 3(1) - — Westbourne 27(7) 25 (7) 1 3(1) 107(7) 103(0) - 1 3(1) 2(1) 1 — Church 45(9) 43(9) - 8(3) 171(12) 170(12) - 10(1) 10 (3) 9(2) - — Lancaster Gate, West 2 2 - — 19 18 - 1 — — - — „ East 6 5 - — 12(3) 12(3) - — 2 1 - — Hyde Park 9 8 - 1 48 46 - - 5 3 - 2 TABLE 14. Diphtheria. Scarlet Fever. Enteric Fever. 1909. Mean. 1901-08. 1909. Mean. 1904-08. 1909. Mean. 1904-08. Removed to Hospital. 93.7 82.7 96.1 91.0 72.4 71.4 Fatality† At Home 4.0 12.7 — 0.8 14.2 24.9 In Hospital 7.3 10.2 2.2 2.3 11.7 13.2 Total 7.4 10.7 2.2 2.4 12.5 16.4 Mortality‡ 0.07 0.09 0.09 0.07 0.01 0.04 * Per cent, of all cases reported. † Per cent, of attacks, after correction for erroneous diagnosis. ‡ Per 1,000 persons, all ages—based on deaths recorded during the year.. The mortality from diphtheria was 0.07 per 1,000 persons, as compared with a quinquennial mean rate of 0.09. Taking the Registrar-General's figures (Table 10) the local rate was 0.07, lower rates being recorded in Willesden (0.06) and Hampstead (0.05). The mortality rates, corrected for sex-age composition of the population, are given in Table 15, the correction being based on the metropolitan rates for 1891-1901. 16 scarlet fever. SCARLET FEVER. This disease continues to be unduly prevalent in the Borough. During the past year 629 notifications were received, equal to a morbidity rate of 4.15 per 1,000 persons. In 1908 the notifications numbered 681 and the rate was 4.43. The mean rate for the five years 1904-08 was 3.49. Nine years have passed since the Borough was constituted with its present limits. That period may be divided into two four-year periods, viz., 1901-04 and 1906-09, separated by the year 1905. In the middle year the morbidity rate from scarlet fever was as low as 1.87 per 1,000. In the four years 1901-04 the rate averaged 2.80, and in the second four years 4'31. No reason can be assigned for those differences, except a theory as to periodic recrudescence of the disease. Owing to the alterations in the boundaries which were made in 1900, there is much uncertainty attaching to the records and rates for years anterior to 1901: and consequentlv they are not referred to. In the Metropolis and districts circumjacent to the Borough (Table 5), the morbidity rates from this disease were above the quinquennial mean rates, except in the Metropolis as a whole (rate, 1909, 3.56; mean, 4'25) and Hampstead (rate, 1909, 2.74; mean, 2.95). Fewer cases were reported last year than in 1908 in Oueen's Park, Harrow Road, and Maida Vale Wards (Table 7), the greatest decrease (39 per cent.) being recorded in the last named. The cases reported in each of the first three quarters of the year exceeded the average for those quarters (Table 12). The autumnal increase in prevalence usually noted in the fourth quarter did not occur in the Borough. The 629 cases recorded last year included (in addition to the seven cases certified in the first instance as diphtheria), 40 cases which were erroneously certified as scarlet fever. The cases erroneously diagnosed constituted 6.3 per cent of the total, the average percentage for the five years 1904-08, being 4.5. Of the 589 genuine cases of the disease 31 were deemed to be due to infection acquired outside the Borough, and 40 to patients recently discharged from hospital. The frequency of multiple notifications from individual houses during the past five years is indicated by the subjoined figures :— No. of Notifications. 1909. 1908. 1907. 1906. 1905. 2 62 57 63 77 31 3 26 30 21 23 6 4 3 13 7 7 3 5 1 5 2 4 — 6 — 1 2 2 — 7 — 2 2 1 — Two or more notifications were received from the same house on the same day on 24 occasions, viz., two cases on 23, and three on one. In 22 houses two families were infected in the same house, and in one three. After elimination of cases erroneously diagnosed, the frequency of multiple cases observed during the past year was as follows:— Cases 2 3 4 5 In houses 59 22 3 1 In families 51 14 4 — enteric fever. 17 Of the 629 reported cases 605 (including 38 errors of diagnosis) were removed to hospital, equal to 96.1 per cent, of all notified cases, as compared with an average percentage of 91.0 during the preceding five years. (Table 14). All the cases reported from Lancaster Gate, East Ward and all, save one, from Church were removed. After correcting the notifications for errors of diagnosis and deducting deaths among such, the fatality was at the rate of 2.2 per cent. last year, or 0'2 less than the mean rate for 1904-08. The whole of the deaths occurred in hospital, the fatality among hospital cases being 2.2 per cent. Last year the crude mortality was 0.09 per 1,000 persons, 0.02 above the mean rate (Table 14), which rate was exceeded only by those of Westminster (O'll) and Willesden (0.10) (Table 10). The local corrected mortality rate (Table 15) was O'll, and was exceeded by the rate in Westminster (0.15) only. In Paddington, Westminster, and Willesden last year's corrected rates exceeded the means. TABLE 15. Corrected Mortalities. District. Diphtheria. Scarlet Fever. Enteric Fever. Standard Rate. Corrected Rate. Standard Rate. Corrected Rate. Standard Rate. Corrected Rate. 1909. Mean. 1904-08. 1909. Mean. 1904-08. 1909. Mean. 1904-08. Paddington 0.39 0.07 0.11 0.13 0.11 0.09 0.14 0.01 0.03 London 0.50 0.12 0.14 0.17 0.07 0.10 0.14 0.03 0.04 Kensington 0.36 0.13 0.13 0.12 0.05 0.07 0.14 0.04 0.03 Westminster 0.32 0.15 0.10 0.11 0.15 0.09 0.15 0.03 0.02 Marylebone 0.37 0.09 0.11 0.12 0.08 0.13 0.14 0.00 0.02 Hampstead 0.36 0.06 0.07 0.12 0.05 0.06 0.14 0.04 0.03 Willesden 0.56 0.05 0.09 0.19 0.08 0.05 0.14 0.02 0.03 ENTERIC FEVER. During the past year 29 cases were reported as "enteric fever" and none as " continued fever." In 1908 the total number of cases was 32, and in each of the years 1907 and 1906,35; the annual average for the five years 1904-08 being 39. Last year's morbidity rate was 0.19 per 1,030, or 0 08 less than the rate for 1903 and the mean for the quinquennium 1901-08Lower rates were recorded last year (Table 5) in Westminster (0.14), Marylebone and Hampstead (0.16 in each). In Kensington alone was last year's rate in excess of the quinquennial mean. . In these reports " continued fever " is considered to be but a synonym of enteric fever, and the numbers of cases of "enteric fever" include cases reported under the other designation. 18 SEPTIC DISEASES. The seasonal distribution of the cases in the Borough was somewhat anomalous. As a rule, more cases are recorded in the second than in the first half of the year, and there is what is termed an autumnal increase in the disease. Last year there were 20 cases reported in the first six months (Table 12), as compared with a quinquennial average of 12 and 9 in the second, the average being 27. More than half (13) of the 20 cases in the first two quarters of the year were recorded in the second quarter. In comparison with 1908 (Table 7) the cases reported last year showed increases in four Wards, viz., Maida Vale, Westbourne, Church and Lancaster Gate, East, the greatest proportional increases being noted in Westbourne and Lancaster Gate, East. Of the 29 cases reported, 5 proved to have been erroneously diagnosed, equivalent to 17.2 per cent. of the whole, the average proportion for the five years being 12.5. The Widal reaction was resorted to in 11 instances, negative results being obtained in four cases. Two of those four cases are included in the five "errors," and if the other two be so dealt with, the proportion of erroneous diagnoses during the year becomes 24T per cent. It must be observed, however, that failure to obtain the Widal reaction does not necessarily mean that the patient is not suffering with enteric fever, and hence the smaller proportion of errors (viz., 17.2 per cent.) is probably the more correct. In 8 (of the 24 correctly diagnosed) cases, the infection was contracted outside the Borough, there being also an undetermined number of patients who partook of food (the commonest channel of infection) beyond the Borough limits, whose cases are not classed as "imported." Enquiries as to the origin of infection in isolated cases of this disease are very unsatisfactory and almost always unsuccessful. In only three instances was any suggestion obtained as to the possible sources of infection, viz., mussels and (or) watercress, periwinkles, and a contaminated surface well (one case each). Secondary cases occurred in two households during the year. Twenty-four cases (including 4 errors) were removed to hospital last year, constituting 72.4 per cent. of the total, as compared with an average of 71.4 per cent. during the preceding five years. (Table 14.) Three cases terminated fatally, 2 in hospital and 1 at home, the total fatality being at the rate of 12.5 per cent , 4 per cent. less than the average. (Table 14.) The decrease in the fatality among home-treated cases was much greater than that among patients removed to hospital. According to the Departmental records, the mortality was at the rate of 0.01 per 1,000, one-fourth of the mean rate for the previous quinquennium. According to the figures issued by the Registrar-General, the mortality in the Borough was 0.03 last year, and the mean 0.04. The only district with a lower rate last year was Marylebone, while the rate in Hampstead was the only one which exceeded the mean. SEPTIC DISEASES. Puerperal Fever.—Three (3) cases of this disease were reported during the year as compared with 6 in each of the years 1908 and 1907. The morbidity rate per 1,000 persons was 0.01 last year, 0.03 in 1908, and 0.05 during the five years 1904-08. The rates for last year in all the districts included in Table 5 were in excess of that in the Borough. Calculating the morbidity rate on the births registered during the year a rate of 0.10 per cent. is obtained for last year less than half the mean (0.25), and notably less than the corresponding rates in the circumjacent districts, with the exception of that in Marylebone, which was 0.11. (Table 16.) 19 SEPTIC DISEASES. TABLE 16. Childbed Morbidity and Mortality. District. Year. Puerperal Fever. Mortality per 1,000. Puerperal Fever. Accidents & Diseases of Parturition. Total in Childbed. Morbidity per 100 Births. Fatality per 100 Cases. Births. Women, Aged 15-45 yrs. Births. Women, Aged 15-45 yrs. Births. Women, Aged 15-45 yrs. Paddington 1909 0.10 66.6 0.69 0.03 3.79 0.21 4.48 0.24 1904-08 0.25 43.8 1.12 0.06 2.70 0.16 3.82 0.22 London 1909 0.24 62.7 1.53 0.10 1.47 0.10 3.00 0.20 1904-08 0.21 64.9 1.39 0.10 1.38 0.10 2.77 0.20 Kensington 1909 0.21 54.2 1.25 0.05 3.76 0.16 5.01 0.21 1904-08 0.23 72.1 1.30 0.04 1.71 0.06 3.01 0.10 Westminster 1909 0.19 40.0 0.89 0.03 3.57 0.15 4.46 0.18 1904-08 0.24 55.1 1.27 0.04 1.91 0.07 3.18 0.11 Marylebone 1909 0.11 133.3 1.57 0.09 2.76 0.14 4.33 0.23 1904-08 0.20 25.5 0.69 0.04 2.85 0.16 3.54 0.20 Hampstead 1909 0.38 60.0 2.34 0.07 2.34 0.07 4.68 0.14 1904-08 0.26 43.3 1.43 0.04 4.15 0.18 5.58 0.22 Willesden 1909 0.19 25.0 0.49 0.03 2.47 0.21 2.96 0.24 1904-08 0.22 67.3 1.48 0.13 2.15 0.21 3.63 0.34 Two of the three cases reported last year appeared to be due to the conveyance of infection direct from patient to patient by one of the attendants. In the third case there was a strong suspicion that the patient's mother was the source of infection. The mother, who had leucorrhœa, slept with the patient before and after her confinement, and there was a history of an attack of puerperal fever in a sister of the patient, whose bed the mother had similarly shared. Two deaths were certified as due to puerperal fever, which number gives a fatality equal to 66.6 per cent., as compared with an average of 43.8 per cent. during the preceding quinquennium (Table 16.) The fatality was higher in the Borough during the past year than in any of the circumjacent districts, except Marylebone, where the deaths recorded exceeded the cases notified. Mortality in Childbed.—In addition to the deaths from puerperal fever, those from accidents and diseases of parturition (11) have to be taken into account, and the rates are calculated on the estimated numbers of women at fecund ages, viz., 15 to 45 years. Last year's mortality (0.24) was 0.02 above the mean rate (0.22), and exceeded any of the rates in the circumjacent districts (Table 16), except Willesden (0.24). Taking the registered 20 CEREBRO-SPINAL FEVER. births as the basis of rates, the figure for Paddington for last year is 4.48 per 1,000, as compared with a quinquennial mean rate of 3.82. The local rate for last year was exceeded by that recorded in Hampstead, where the rates were—1909, 4.68; mean, 5.58. Erysipelas.—One hundred and six (106) cases were reported during the year, one more than the total for 1908. The morbidity rate was 0.69, or 0.13 less than the quinquennial mean rate. More cases were reported last year than in 1908 in Harrow Road, Maida Vale, Lancaster Gate (West), and Hyde Park Wards. There were four deaths during the year, equal to a fatality of 3.8 per cent. In one house only (a tenement house) did multiple cases occur during the year—two females in different families being attacked, with an interval of about six weeks between the two cases. Two patients suffered from recurrent attacks, the intervals between the notifications being three and seven weeks respectively. Seven patients were treated away from their homes, 5 at the infirmary and 2 at the hospitals where they were employed. Other Septic Diseases.—From these diseases—they are not included in the schedule of diseases to be notified—there were 10 deaths, viz., 2 from pyaemia (both males), 3 from infective endocarditis (1 male, 2 females), 3 from cellulitis (2 males, 1 female), and one each from stomatitis (male) and carbuncle (female). In these reports deaths from erysipelas are included in the mortality rates for "other septic diseases." The mortality last year was 0.07 per 1,000, as compared with a quinquennial mean rate of 0.09. CEREBRO-SPINAL FEVER. The notification of this disease was continued for a further period of a year in March last. The Order requires the notification of cases of "Epidemic cerebro-spinal meningitis," which term is held to include cases of posterior-basic meningitis, but not those of meningitis due to tubercle, syphilis, or middle ear disease. During the past year four cases were reported, viz., 2 males, æt 5 months and 31 years (the latter subsequently pronounced to be a case of septicaemia) and 2 females, æt 10 months and 2 years. Two of the cases (removed to hospital) terminated fatally, both females; and two other cases, viz., females æt 8 months and 2 years, were discovered on registration of death. Only two of the deaths are entered under "cerebro-spinal fever," the others being scheduled as "meningitis." ANIMAL DISEASES. Glanders.—By an Order of the London County Council, which became effective on April 26th last, cases of this disease occurring in man have to be notified. One such case was reported during the year, the patient having contracted the disease some months previously in the course of experimental work. The case terminated in death, outside the Borough, during the autumn. In pursuance of the London (Notification of Glanders) Order, 1907, outbreaks of the disease among horses, which are notified to the veterinary inspectors, are reported to the medical officers of health of the districts in which such outbreaks occur. TUBERCULOUS DISEASES. 21 During 1908, 23 outbreaks, in 14 stables, were reported in the Borough, and 11 outbreaks, an the same number of stables, during the past year. Anthrax, Hydrophobia.—Cases of these diseases occurring in man became notifiable by the Order of the County Council of April last, already mentioned. No cases have as yet been reported. TUBERCULOUS DISEASES. The deaths from the various forms of tuberculosis numbered 204 during the past year, being 14 more than in 1908, but 15 less than in 1907. Last year's total included 161 deaths from pulmonary tuberculosis (consumption), 17 from cerebral (tubercular meningitis), 8 from abdominal (tabes mesenterica), 12 from generalised, and 6 from other forms of the disease. (Table 17.) The total mortality was at the rate of 1.34 per 1,000 persons last year, or 0.03 less than the mean rate for the five years 1904-08; but while the rate for females shows a decrease from 0.95 (mean rate) to 0.91, that for males shows an increase of 0.07, from 1.85 to 1.92. The mortality from consumption was 1.06, or 0.04 above the mean, the greater part of the increase falling upon males. The combined mortality from the other forms of tuberculosis was 0.28 last year, as compared with a mean rate of 0.35, the rate for females (0.20) showing a much greater shrinkage (0.16) than that for males (rate, 0.40, decrease, 0.01). The Registrar-General (Table 10) gives last year's rate from consumption as 1.08, the same as the mean rate, which rate was exceeded by those for Westminster (1.34) and Marylebone (1.35) only. In every case last year's rates show decreases, in comparison with the mean rates. The local rate from other tuberculous diseases (0.28) was lower than those in the other districts except Marylebone (0.16) and Hampstead (0.23). In Willesden only was last year's rate (0.40) in excess of the mean (0.31). TABLE 17. Site of Disease. Deaths. Mortality Rates. 1909. 1909. 1904-08. Males. Females. Persons. M. F. P. M. F. P. Pulmonary 99 62 161 1.52 0.71 1.06 1.46 0.69 1.02 Cerebral 10 7 17 0.15 0.08 0.11 0.17 0.12 0.15 Abdominal 4 4 8 0.06 0.04 0.05 0.04 0.04 0.05 General 9 3 12 0.13 0.03 0.07 0.10 0.05 0.08 Other forms 3 3 6 0.04 0.03 0.03 0.08 0.05 0.06 All Forms 125 79 204 1.92 0.91 1.34 1.85 0.95 1.37 The corrected mortality rate from pulmonary tuberculosis for the Borough (Table 19) was 1.02 in 1909, as compared with a mean rate of 1.04, that rate being exceeded by those of Westminster (1.18) and Marylebone (1.25) only. The deaths from these diseases in the individual Wards in the Borough were too few to permit of any sub-division, except into "pulmonary" (consumption) and "other forms of tuberculosis." (Table 18.) In Harrow Road, Maida Vale, and Westbourne Wards last year's rates from pulmonary tuberculosis were above the mean rates, in the other Wards below. The maximum rate was that in Church Ward (1.41) which, however, was 0.09 below the mean (1.50). The rates from "other forms" of tuberculosis were below the means, except in Maida Vale (increase 0.01) and Church (rate, equal to mean, 0.52). 22 tuberculous diseases. TABLE 18. Phthisis. Other Tuberculous Diseases. Deaths, 1909. Mortality. Deaths, 1909. Mortality. 1909. 1904-08. 1909. 1904-08. Borough 161 1.06 1.02 43 0.28 0.35 Wards. Queen's Park 21 1.29 1.37 5 0.30 0.53 Harrow Road 34 1.12 0.89 9 0.29 0.43 Maida Vale 24 1.17 0.87 7 0.34 0.33 Westbourne 29 1.11 1.09 6 0.23 0.30 Church 40 1.41 1.50 15 0.52 0.52 Lancaster Gate, West 3 0.35 0.35 - - 0.07 Lancaster Gate, East 2 0.25 0.47 - - 0.07 Hyde Park 8 0.57 0.70 1 0.07 0.20 TABLE 19. Fully Corrected Mortality Rates. (London experience). Locality. Persons per acre (1901). Percentage of total population (Census 1901). Pulmonary Tuberculosis. Cancer. "Overcrowded." Living in homes of less than 5 rooms. Standard Rate. Fully Corrected Rate. Standard Rate. Fully Corrected Rate. 1909. 1904-08. 1909. 1904-08. Paddington 106 13.6 50.9 1.80 1.02 1.04 0.98 0.91 0.99 Wards. Queen's Park 152 9.1 51.7 1.73 1.29 1.22 0.83 1.09 0.95 Harrow Road 182 11.5 75.5 1.77 1.10 0.87 0.88 1.10 0.94 Maida Vale 68 12.6 43.4 1.82 1.11 0.83 1.01 1.09 1.24 Westbourne 104 13.4 46.3 1.80 1.06 1.05 1.17 0.71 0.80 Church 131 32.8 61.3 1.68 1.45 1.55 0.87 0.91 1.15 Lancaster Gate, West 70 2.6 15.2 1.84 0.33 0.33 1.02 1.01 0.96 Lancaster Gate, East 56 2.1 16.2 1.84 0.23 0.45 1.02 0.96 0.85 Hyde Park 108 5.2 25.3 1.88 0.52 0.64 1.07 0.52 1.00 London 61 16.0 54.0 1.74 1.31 1.43 0.87 1.06 1.02 Kensington 77 14.8 41.7 1.78 0.92 1.13 1.02 0.95 0.84 Westminster 73 13.0 45.7 1.95 1.18 1.25 0.96 1.03 0.92 Marylebone 90 21.1 55.6 1.85 1.25 1.36 0.99 1.08 1.00 Hampstead 36 6.4 29.6 1.75 0.59 0.74 0.92 0.85 0.84 Willesden 21 11.6 50.7 1.65 0.84 1.00 0.71 0.91 0.96 The corrected rates from pulmonary tuberculosis (Table 19) for the Wards ranged from 1.45 (Church) to 0.23 (Lancaster Gate, East). Rates in excess of the quinquennial means were recorded in the four more northern Wards. Below are given the sex-age mortalities from consumption during the past year in comparison with the mean rates for the five years 1904-08. It will be seen that in five TUBERCULOUS DISEASES. 23 groups of ages among males, the most valuable ages, the rates recorded last year exceeded the means, while increases were recorded at three ages only among females. The increase in the mortality among males at all ages was equal to 4 per cent., and that among females to 3 per cent. of the mean total rate for each sex. Pulmonary Tuberculosis. Ages 0— 15— 20— 25— 35— 45— 55— 65— 75— Males. 1909 0.16 0.67 0.54 2.00 2.97 3.47 2.46 3.29 — 1904-08 0.16 0.54 1.36 1.44 2.78 3.42 2.80 2.23 0.31 Females. 1909 0.16 0.12 0.37 0.99 1.32 1.73 0.52 0.92 — 1904-08 0.18 0.35 0.57 0.71 1.02 1.21 1.31 1.18 0.73 Although the mortalities at all ages from other forms of tuberculosis showed decreases in both sexes last year, when compared with the quinquennial means, there were increases at five ages among males and three among females. (See below.) Other Forms of Tuberculosis. Ages 0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— Males. 1909 4.46 1.92 0.51 0.18 0.16 — 0.16 — — 0.49 — 1904-08 5.34 1.80 0.34 0.22 0.10 0.02 0.15 0.20 0.12 0.14 0.41 Females 1909 0.66 1.52 0.16 0.16 0.12 0.16 0.11 0.17 — 1904-08 4.36 1.35 0.46 0.33 0.09 0.11 0.06 0.13 0.13 0.10 0.30 Much importance is attached by certain authorities to the segregation of consumptives in institutions during the last stages of the disease. Of the 161 deaths due to the disease which were recorded last year, 74 took place in institutions, viz.:— In Paddington Workhouse and Infirmary 46 Other Infirmaries 4 Lunatic Asylums 9 General Hospitals 7 Special (Chest) Hospitals 3 St. Luke's Home 4 Sanatorium 1 Private Nursing Homes 2 (not included in total of 74). The proportion of males dying in institutions (47.4 per cent.) was slightly higher than that of females (43.5 per cent.) Enquiries have been made to ascertain the length of segregation before death. The only results which can be given relate to the deaths in the Paddington Workhouse and Infirmary, in lunatic asylums, and in St. Luke's Home. As regards the Workhouse and Infirmary patients the Medical Superintendent examined the case papers relating to each of the 46 deceased persons (32 males, 14 females). He found that 37 of the deceased persons had not been inmates of either institution before being admitted for the illness which ended in death and that those patients were segregated from the day the disease was notified in each case until death. There is no evidence of the actual duration of the disease. The average interval between notification and death was, for 25 males 67.4 days, with a maximum period of 212 days, and a minimum of 1 day (1 case each); and for 12 females, 19.0 days, with a maximum period of 93 days (1 case) and a minimum of 24 TUBERCULOUS DISEASES. 0 days (2 cases). The 37 cases have been analysed to show the frequencv of certain selectedperiods. (See below). Less than 1 week — 6 cases. „ 1 month (30 days)-14 „ 1-3 months (91 days) - - 8 „ 3-6 months (182 days) - - 7 „ 6 months and over — 2 „ Of the remaining 9 patients, 1 (a male) had been in the Workhouse for 7 years and 6 others (5 men and 1 woman) were "ins and outs "—3 men having been out once between the dates of diagnosis (notification) and death, 2 (1 man and 1 woman) twice, and 1 man 6 times. Three of the 6 patients were recognised as consumptives some long time before the introduction of notification. With regard to the 2 cases, not included in the above figures, the information is incomplete. Of the 9 persons dying in lunatic asylums, 2 were known to be consumptive on admission and another was possibly so, the remainder contracting the disease after admission.. Particulars of the cases are appended— Sex. Age. Date of reception. Consumptive on reception. Date of diagnosis. Date of death. m. 28 7, ii. '07 no ? 24, i. '09 m. 65 13, x. '08 yes — 18, viii. '09 m. 32 1, iv. '08 no 8, xii. '09 17, xii. '09 f. 18 25, v. '09 yes — 28, iii. '09 f. 54 7, xii. '04 no 20, i. '09 1, ii. '09 f. 69 15, vi. '04 no "not in life" 29, xi. '09 f. 25 18, ii. '05 no 2, iii. '09* 22, iv. '09 f. 48 13, ii. 07 ? 2, iv. '07 7, vii. '09 f. 31 4, vi. '98 no "a few weeks before death." 14, i. '09 * "Suspected long before." As regards lunatics it may be said that diagnosis is a matter of considerable difficultv,. that the proper supervision of consumptives to control indiscriminate infection is almost impossible, and that the risk of spread of the disease when once introduced is very great. Of the 4 patients dying in St. Luke's Home, the following are the notes furnished by the Medical Officer:— Sex. Age. Stay in home. History of duration of disease. m. 23 26 days 18 months m. 25 10 „ 12 „ m. 18 175 „ several months f. 43 12 „ Diagnosed January, 1909 Notification.—Although no system of voluntary notification of consumption has ever been formally adopted in the Borough, cases have been reported to the Department since 1903. The numbers reported and the recorded movements of the cases during the six years 1903-& are given below. 25 TUBERCULOUS DISEASES. Total cases reported. Died during 1903. 1904. 1905. 1906. 1907. 1908. Reported recovered. First diagnosis of consumption not confirmed. Lost sight of, removed, & c. Living at end of year 1908. 1903 4 2 - 2 ... ... ... — — — - 1904 20 ... 5 1 1 1 1 - - 9 2 1905 18 ... ... 10 3 1 - - - 3 1 1906 57... ... ... 17 5 7 - 2 13 13 1907 84 ... ... ... ... 14 12 - 5 19 34 1908 173... ... ... ... ... 25 2 27* 6 113 * 26 suspected to be consumptive: 1 suffering from tuberculous disease (not pulmonary). There were 163 "survivors" known to the Department at the beginning of 1909. During the year 10 patients previously recorded as "lost by removal, &c." were traced, bringing the total of "survivors" to 173. Forty-three (43) of those patients were removed from the record during the year—19 by death, 16 owing to removal, and 7 by reason of further examination leading to a review of the diagnosis. In one patient the disease was reported to be arrested. (See Table 20). TABLE 20. Consumption. Cases reported prior to 1909. Year of First Report. During 1909. Survivors, 1Q10. Living at end of 1908. Old cases re-entered (Informal Reports). Reported to have recovered. Arrested. Lost sight of by removal. Original diagnosis not verified. Errors. Died—cause of death, pulmonary consumption. Living at end of 1909. Medically certified. "Definite." Not medically certified. "Suspects." Attending Dispensary. Survivors. Survivors. "Definite.'' "Suspect." 1904 2 - - - - - 2 1 1 - - 1905 1 - - - - 1 - - - - - 1906 12 3 - 2 - 1 12 7 5 3 - 1907 35 1 - 1 3 6 26 11 15 7 - 1908 113 6 1 13 4 11 90 39 51 27 4 Totals 163 10 1 16 7 19 130 58 72 37 4 In addition to the informal notification referred to above, cases were reported during the past year by the Poor Law Service under the provisions of the Order known as "The Public Health (Tuberculosis) Regulations, 1908," issued by the Local Government Board on December 18th last, and by the Medical Officer of the Paddington Dispensary for the Prevention of Consumption (here referred to as "The Dispensary.") These innovations constitute so marked an advance in the administrative procedure with regard to pulmonary tuberculosis that a short account of both will be of interest. The Order of the Local Government Board requires every medical officer in charge of a Poor Law Institution or District, within forty-eight hours of his first recognition of the symptoms of pulmonary tuberculosis in a "poor person"* under his care, to enter certain *A "poor person" is defined to be "a person who is or has been in receipt of relief from the Poor Rate. 26 TUBERCULOUS DISEASES. particulars on the prescribed form and thus to certify the case to the medical officer of health. In the case of persons in institutions the information is to be sent to the medical officer of health of the district in which the poor person last resided before entering the institution. The discharge of a consumptive person from an institution is to be reported by the superintending officer thereof, and any change of address of a patient in receipt of out-relief by the relieving officer. It is expressly laid down that the Regulations do not empower any local authority, or authority's official, "to put in force any enactment which renders the poor person liable to a penalty, or subjects the poor person to any restriction, prohibition, or disability affecting himself, or his employment, occupation or means of livelihood, or residence, on the ground of his suffering from pulmonary tuberculosis." Subject to that reservation the local authority is authorised to (i) Use the legal enactments relating to other infectious diseases, to secure the proper disinfection and destruction of infected articles, and the cleansing and disinfection of rooms; (ii) take any steps deemed desirable to prevent the spread of infection by sputum; (iii) "afford or supply all such assistance, facilities, or articles, as within such reasonable limits as the circumstances of the case require and allow, will obviate or remove, or diminish the risk of infection" in connection with the occupation of any room by a consumptive poor person; and (iv) "furnish on loan, or otherwise, any appliance, apparatus or utensil "suitable to prevent the spread of infection. Further, the authority is expressly authorised to issue "summaries of information and instruction" respecting consumption in the form of placards, handbills or leaflets. The Order does not deal with the provision of special accommodation for consumptives. The Guardians possess sufficient powers to set apart wards and rooms in their institutions for that purpose, and, by Sec. 22 of the Poor Law Amendment Act, 1867, they can detain any person who, in the opinion of the Board's Medical Officer, cannot be discharged without risk of spreading infection. The Paddington Dispensarv for the prevention of Consumption is a voluntary institution founded on the lines of the Royal Victoria Dispensarv in Edinburgh. The objects of the Institution are the treatment in their homes of persons suffering with pulmonary consumption, such treatment being coupled with special instruction as to the means to be adopted to promote the cure of the disease and the prevention of the spread'of infection. These ends are to be obtained by consultation with the Medical Officer at the Dispensary and by visits of instruction at the patients' homes by the Medical Officer and the Nurse. Except when a patient is too ill to attend at the Dispensary, the home visits are intended solely for instruction in domestic hygiene and preventive precautions, the opportunity being taken to note any specially undesirable circumstances of home life for remedy either by persuasion (assisted by philanthropy if the case be a deserving one) and by the intervention of the sanitary authority. No one under the care of a medical practitioner can attend the Dispensary except with the consent of the practitioner. The Dispensary is not, however, content with treating only those known to be consumptive and seeking its assistance. Every member of the family of each consumptive patient, his relatives outside his immediate family circle, and every other person living in the same house with him is medically examined, if consent to do so can be obtained. By such examination of "contacts" unrecognised cases of the disease are discovered—to the advantage of the sufferers in that they secure a better hope of recovery bv immediate TUBERCULOUS DISEASES. 27 treatment, and to the advantage of the public through such sufferers being duly instructed in the precautions they must observe to prevent the spread of infection and by their being saved from future incapacity from neglected disease. The Dispensary is not a centre for the distribution of relief in kind, but the help of other philanthropic agencies is invoked on behalf of those who need material assistance—other than medicines, &c.—to secure their restoration to health, the guidance of the Charity Organisation Society being sought in such cases. The Dispensary has supplies of spittoons and paper handkerchiefs for sale or distribution, and lends shelters (suitable for day and night use) to be put up in gardens or flat roofs. Patients who are suitable cases for sanatorium treatment are sent away, but it has been, so far, comparatively rare to find cases which need to be sent away. It is found that treatment can in most cases be successfully carried on in the patient's home, if the "open window policy" be adopted and generously practised. When circumstances indicate the need of so doing, patients in the last stage of the disease are sent to Homes for the Dying. The Dispensary is intended to work in close co-operation with the Public Health Department, the two organisations to be mutually helpful to each other. The Dispensary also desires to be a centre of instruction for the public generally as well as for the patients attending. During the past year information of cases of consumption was therefore received by the Department from the following sources:— The Dispensarv, The Poor Law Service, Hospitals and private medical practitioners ("Other Medical Sources"), and Lay Agencies (Lay Reports). It was to be expected that certain cases would be reported by more than one agency. As a matter of fact the difficulty of sorting out the cases and correcting the overlapping proved to be considerable. In making the necessary adjustments the list of survivors from 1908 was first taken, and all other lists corrected by exclusion therefrom of survivors. The Dispensary lists (2) were then compared successively with the remaining three and the necessary adjustments made. The results are given in Table 21. The Dispensary cases were divided by the Medical Officer into "definite" (those in which there were clear evidences of the disease) and "suspects" (those furnishing a presumption, more or less strong, that the disease was present). The total number of consumptive patients residing in Paddington treated by the Medical Officer during the year numbered 493,* 248 being "definite" cases and 245 "suspect." Forty-six (46) of the patients were already known to the Department, so that the new cases numbered 447—206 "definite" and 241 "suspect." (Table 21,) *The total number of patients attending at the Dispensary during the year was 857, the total attendances numbering 5,310. In addition, 20 other patients were visited and treated at their homes. The visits of the Staff (Medical Officer and Nurse) to the patients' homes numbered 2,379. The patients resident in Paddington numbered according to the Medical Officer 700, 203 being non-tuberculous and the remainder tuberculous. It was found, however, that the entries of definitely and suspect consumptive patients, the only two groups examined, required adjustment both for inclusion of non-residents and for omission of residents. The corrected numbers are as given in the text. 28 TUBERCULOUS DISEASES. TABLE 21. New Cases of Consumption. 1909. Dispensary. Poor Law. Other Medical Sources. Lay Reports. Totals. "Definite." (D) "Suspect." (S) Total Cases Certified 248 245 176 31 72 772 Deduct Survivors—1908 42 4 34 3 3 Dispensary—D 16 8 11 „ — S 8 1 11 Poor Law — 3 Other Medical - Total New Cases 206 241 118 19 44 628 Died during 1909 20 1 38 1 5 65 Phthisis 13 1 36 1 2 53 Other causes 7 — 2 - 3 12 Lost by removal, &c. 2 - 26 1 3 32 Diagnosis reviewed - - - - 4 4 Survivors, 1909 184 240 54 17 32 527 The certificates received from the Poor Law Service numbered 319 relating to 176 patients, 34 of whom had been eported prior to 1909 ("survivors"), and 24 were included in the Dispensary lists. From Other Medical Sources 31 certificates were received relating to the same number of patients, of whom 19 only were new; and the Lay Reports numbered 72 yielding 44 new cases. The total number of patients covered by the certificates and reports was 772, of whom 628 were not previously known to the Department, 343 of the cases being "definite" and 285 "suspect"—the lay reported cases ranking in that category. The new cases have been distributed according to sex and ages of the patients in Table 22, while the occupations of all cases known during the year are to be found in Table 23. The deaths among the new cases (Table 21) numbered 65, 53* being due to pulmonary tuberculosis and 12 to other causes. Thirty-two (32) patients were lost sight of before the close of the year, while in 4 cases the original opinion (not supported by medical certificate) was varied, and such cases were consequently set aside. The number of new patients remaining on the record at the close of the year was 527, to which must be added the 130 patients reported prior to 1909 and still alive, giving a grand total of 657 cases on record at the end of 1909 and carried forward—313 having been definitely certified as cases of pulmonary tuberculosis and 344 being, as regards all except 32, certified as suspected of being cases of that disease. * Of the 53 deaths due to pulmonary tuberculosis, 6 occurred in patients classed as "suspects." It may be taken as certain that the majority of the "suspects" are suffering from consumption. 29 TUBERCULOUS DISEASES. TABLE 22. Cases and Deaths: Sex-age Distribution. 1909. Ages (years). All ages. 0- 1- 5- 10- 15- 25- 35- 45- 55- 65- 75- Males. Females Persons m f M f m f m f m f m f m f m f m f m f m f "Definite." Dispensary - - 1 - 21 6 16 13 14 16 11 35 12 31 6 13 5 1 1 4 - - 87 119 206 Poor Law - - 2 2 - 4 3 2 1 3 15 14 21 13 10 10 10 2 6 — - - 68 50 118 Other Medical - - - - - - - - - 3 3 - 4 5 2 1 - 1 — — - - 9 10 19 Totals - - 3 2 21 10 19 15 15 22 29 49 37 49 18 23 15 4 7 4 — — 164 179 343 Deaths — — — - - 1 1 - 4 2 15 6 9 3 6 4 4 — 3 1 - - 42 17 59 Phthisis - - - - - - 1 - 2 2 13 4 9 3 6 4 3 - 3 - - - 37 13 50 Other causes - - - - - 1 - - 2 - 2 2 — — — — 1 - — 1 - - 5 4 9 "Suspect." Dispensary - 2 24 18 31 46 21 19 9 8 9 20 8 14 2 8 1 1 - - - - 105 136 241 Lay Reports - - 2 - 4 5 2 2 1 — 3 4 3 4 3 4 — — — 2 - - 19 25 44* Totals — 2 26 18 35 51 23 21 10 8 12 24 11 18 5 12 1 1 — 2 — - 124 161 285 Deaths — - 1 - - 1 — — - - - - - - 2 1 - — — 1 — — 3 3 6 Phthisis - - 1 - - - - - - - - - - - 2 - - - - - - - 3 - - 3 Other causes - - - - - 1 - — - — - - - - - 1 - - — 1 - — - - 3 3 * Ages not stated: male, 1; females, 4. This part of the report should not be left without referring to the work of searching for contacts, which, as has already been stated, is one of the most important objects of the Dispensary. The Medical Officer of the Dispensary reports that, after examining 472 patients resident in the Borough and finding 184 "definite" and 154 "suspect" cases of consumption, and 8 cases of tuberculosis of other forms than the pulmonary, he examined 228 "contacts," of whom 50 were found to be suffering with the disease, 98 suspected to be so suffering, and 3 had other forms of tuberculosis. In other words, while 71.6* per cent. of the patients who went to the Dispensary because they believed themselves to be consumptive were found to have the disease, no less than 64.9 per cent. of those who fell in with the request to allow themselves to be examined were found to be affected. Doubtless a very large proportion of the latter were quite unconscious of the presence of the disease in their system, and many were innocently helping to spread the infection. * These percentages are obtained by taking the "definite" and "suspect" cases together. The percentages of "definite" cases are—among original patients 38.9, and among contacts 21.9. 30 TUBERCULOUS DISEASES. TABLE 23. Occupations of Consumptive Persons. 1909. Occupations. Survivors 1908. Dispensary Poor Law. Other Medical. Lay Reports. Totals. Died Removed, &c. Survivors, 1909. "Definite" "Suspect" "Definite" "Suspect" (173) (206) (241) (118) (19) (44) (801). (84). (60). (313). (344.) Indoor m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. Domestic duties Housewives — 22 — 64 - 28 - 19 - 4 — 9 - 146 - 15 - 4 - 83 - 44 Servants — 6 - 15 — 10 2 5 - 1 — — 2 37 — 2 - 1 2 19 - 15 Charwomen - 3 - 8 - 4 - 1 - - - 2 - 18 - 1 - 2 - 9 - 6 Laundry workers - 3 - 1 - 4 - 5 - - - 1 - 14 - 3 - 1 - 3 - 7 Clerks 5 - 3 1 1 - 1 - - - 1 - 11 1 4 - - 1 4 - 3 - Shop Assistants 5 2 3 2 1 - 3 1 1 - — - 13 5 3 1 1 1 6 2 3 1 Dressmakers, Tailors 1 4 1 5 — 4 2 1 1 2 - - 5 16 1 - 1 1 2 9 1 6 Bootmakers 3 - - - - - 3 - - — - - 6 - 4 - 1 - - - 1 - Skilled Artizans 10 - 4 - 3 - 7 1 1 — - — 26 1 7 - 2 - 11 1 6 — Outdoor Building Trades 5 - 2 - 1 - 11 - 1 — 1 — 21 - 9 - 5 - 4 — 3 - Painters 5 - 3 - 1 - - - - - 1 - 10 - 1 - - - 4 - 5 - Labourers 8 - 1 - 5 - 3 - - - - - 17 - 3 - 3 - 5 - 6 - Road traffic 6 - 6 - — - 3 - - — — — 15 - 6 - 1 - 6 - 2 - Carmen 3 - 3 - 4 - 3 - 1 — - - 14 - 1 - 2 - 7 - 4 - Stable hands 3 - 3 - 2 - 3 - - - - - 11 - 5 - - - 3 - 3 - Railway traffic 4 - 8 - 1 - - - 2 - - - 15 - 2 - 1 - 11 - 1 - Postmen - - - - — - - - 1 — — — 1 - — - - - 1 - - - Gardeners 1 - - - — - 2 - - - - - 3 - 1 - — - 2 - - - Road workers 1 - 1 - 1 - - - - - 1 — 4 - 1 - — - 1 - 2 — Hawkers 1 - — - 1 - 4 1 - — 1 — 7 1 2 - - - 3 1 2 — Miscellaneous School life 13 32 39 21 60 65 4 7 - - 7 7 123 132 1 3 6 6 48 36 68 87 Church officers — - — 1 — - — — - — — — — 1 — — — - — 1 — — Stage - - - - - - - 1 - - - - - 1 - - - - - 1 - - Sick nurses — - — — — - — — - — 1 — 1 — — — — - — — 1 — Musicians - - 1 - - - - - - — - - 1 - - - - - 1 - - - Soldiers 1 - - — — — — - — — 1 — 2 — - — — — - — 2 — Sailors — - 1 — — - — — - — — — 1 — 1 — — - — — — — Butcher, Fishmongers 1 - 1 — 1 - — — - — — — 3 - - — — - 2 — 1 — Baker 1 - — — 1 - - — - — - — 2 - - — 1 - — — 1 — Potman — - — — 1 - 1 — - — — — 2 — 1 — — - — — 1 — Woodyard workers 1 2 1 1 1 - - - - — 1 — 4 3 1 — — - 2 1 1 2 Odd jobs 2 - 1 — 1 - 3 — - - — — 7 — 2 — 1 - 1 - 3 — Shop Porter — — 1 — 5 - — — - — — — 6 — — — — - 1 — 5 — Rag Sorter 1 — — — — - - - - — — — 1 — — — — - 1 — - — Commercial Travellers - — 1 — — - - — - - — — 1 — — - - - 1 — — — Dairy Trade — — — — 1 - - — - — — — 1 — — - - - — — 1 — No occupation, occupation not stated 10 8 3 — 16 18 14 7 1 3 4 5 48 41 2 1 14 4 10 8 22 28 Totals 91 82 87 119 108 133 69 49 9 10 20 24 384 417 58 26 39 21 139 174 148 196 CANCER. 31 CANCER. The deaths from the various forms of malignant disease included under this loose heading decreased from 185 in 1908 to 156 last year, the smallest total recorded since 1904. The mortality last year was 1.03 per 1,000 persons, as compared with 1.20 in the previous year and 1.11 in the years 1904-8. Last year's total included 60 deaths of males (mortality 0.92, mean, 0.98) and 96 of females (mortality, 1.10, mean, 1.20). The crude rates (Table 10) recorded last year in Kensington (1.11), Westminster (1.13), and Marylebone (1.23) were above the local rate; but if the corrected rates be considered (Table 19), that of Hampstead (0.85) was the only one below the local (0.91). The corrected rates recorded last year were above the mean rates, except in Paddington and Willesden. The crude rates of mortality in the Wards ranged from a minimum of 0.64 in Hyde Park to a maximum of 1.27 in Maida Vale. (Sec below.) The maximum corrected rate (Table 19) was recorded in Harrow Road (1.10), and the minimum in Hyde Park (0.85). Last year's corrected rates were in excess of the means in four of the eight Wards. Cancer. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate Hyde Park. West. East Deaths, 1909 17 34 26 25 26 10 9 9 Mortality, 1909 1.04 1.12 1.27 0.96 0.91 1.18 1.13 0.64 „ Mean, 1904-08 0.91 0.95 1.44 1.08 1.15 1.13 1.00 1.23 The changes in the sex-age mortality rates (whole Borough) are shown below:— Ages: 25- 35- 45- 55- 65- 75- 85- Males. 1909 0.25 0.34 1.73 4.68 8.77 8.91 22.99 1904-08 0.08 0.46 2.59 4.61 7.99 12.72 7.03 Females. 1909 0.22 1.07 2.07 4.36 5.52 12.58 5.05 1904-08 0.21 0.95 2.42 4.85 7.93 9.57 9.31 Table 24 gives the distribution of deaths according to the locality of the disease, description of same, and ages of the deceased, distinguishing the sexes. MEASLES. According to previous experience 1909 should have been an epidemic year for this disease, but fewer cases were recorded during the past than in the previous year, the figures (corrected totals) being 709 during 1909 and 779 in 1908. From the appended statement it will be seen that more than half of the cases reported during the past year were in the second quarter. Quarters 1. 2. 3. 4. Year Uncorrected. Corrected. 1904 ... 723 94 18 23 858 896 1905 ... 227 895 292 288 1,702 1,714 1906 ... 105 204 199 89 597 592 1907 ... 109 303 276 548 1,236 1,284 1908 ... 413 301 32 74 820 779 1909 ... 133 366 76 27 702 709 32 CANCER. TABLE 24. Deaths from CANCER. 1909. Seat of Disease. Carcinoma. Cancer. Epithelioma. Scirrhus. Sarcoma Malignant Disease. Other Forms. All Forms. m. f. m. f. M. f. m. f. m. f. m. f. m. f. M. f. I. Nervous System. (a) Brain ... ... ... ... ... ... ... ... ... ... ... ... ... 1(a) ... 1 (b) Spinal cord ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... II. Organs of Special Senses. III. Respiratory System. (a) Larynx 3 ... ... ... 1 ... ... ... ... ... ... ... ... ... 7 ... (b) Lung 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... IV. Circulatory System. V. Digestive System. (a) Mouth. (i) Tongue 2 ... 2 ... 1 ... ... ... ... ... ... ... ... ... 5 ... (ii) Glands,etc. ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... (b) Throat. (ii) Œsophagus 4 ... ... 1 ... ... ... ... ... ... ... ... ... ... 4 1 (c) Intestines. (i) Stomach 6 7 1 ... ... ... ... ... ... ... 2 2 ... ... 9 9 (ii) Bowel 7 4 ... 2 1 1 ... ... ... ... 2 ... ... ... 10 7 (iii) Rectum 4 9 1 1 ... ... ... ... ... ... ... 2 ... ... 5 12 (d) Organs. (i) Liver 1 5 3 2 ... ... ... ... ... 1 ... 3 ... ... 4 11 (ii) Pancreas 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 VI. Lymphatic System. (b) Thorax. (i) Mediastinal Glands ••• ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... VII. Urinary System. (a) Kidney ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 2 (b) Bladder 1 1 2 ... ... ... ... ... ... ... 1 ... ... ... 4 1 VIII. Generative System. (a) Testicle, Ovary ... 3 ... ... ... ... ... ... ... ... ... 1 ... ... ... 4 (b) Uterus ... 12 ... 3 ... ... ... ... ... ... ... 1 ... ... ... 16 (c) External Genitals ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 1 (d) Breast ... 11 ... 8 ... ... ... 2 ... 1 ... 1 ... ... ... 23 IX. Osseous System. (a) Head and Neck ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... (b) Thorax ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... (c) Abdomen ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 (d) Extremities. (ii) Lower ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 X. Cutaneous System. (a) Head and Neck ... ... ... ... ... ... ... ... ... ... ... ... ... 1(b) ... 1 XI. Not sufficiently described ... ... ... ... ... ... ... ... ... 1(c) ... 2 ... ... ... 3 Totals 33 53 10 17 5 2 ... 2 6 7 6 13 ... 2 60 96 Ages at Death. 0— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10— ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... ... 15— ... ... ... ... ... ... ... ... 1 ... ••• ... ... ... 1 ... 20- ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 25— 1 1 ... ... ... ... ... ... 2 3 ... ... ... ... 3 4 35— 1 7 ... 4 ... ... ... ... 2 ... ... 2 ... ... 3 13 45— 5 5 2 5 3 1 ... 1 ... ... 1 5 ... 1 11 18 55— 14 18 4 3 ... ... ... ... ... 2 1 1 ... l 19 25 65— 7 15 4 2 2 ... ... ... 1 ... 2 1 ... ... 16 18 75- 5 7 ... 3 ... 1 ... 1 ... ... 2 4 ... ... 7 16 (a) Glioma. (b) Rodent ulcer. (c) Disseminated melanotic sarcoma. 33 MEASLES. The 709 cases were reported from 390 houses, giving an average of 1.8 cases per house, as compared with 1.6 in 1908. The frequency of multiple cases in each of the last six years is shown below: 1909. 1908. 1907. 1906. 1905. 1904. Houses with 2 cases 104 130 194 100 257 166 „ 3 „ 55 55 97 48 143 59 „ 4 „ 21 15 30 15 43 25 „ 5 „ 9 6 19 4 16 5 „ 6 „ — — 7 — 4 3 „ 7 „ 1 — 2 1 — 1 „ 8 „ — — 1 — — — „ 9 „ — 1 — — — — The secondary cases numbered 319 and formed 44.9 per cent. of all the cases, the proportion in 1908 having been 40.9. The deaths numbered 36 last year, the same as in 1908 and comprise 18 of each sex, all the deceased persons being under the age of five years. The fatality of this disease was 5.0 per cent., the highest recorded since statistics of this disease were first collected (1903). The fatality among males last year (5.3) was the same as that of the previous year but that among females (4.8) showed an increase of 0.7 per cent. The rates recorded during the past six years are appended: Measles. Fatality at all ages, per 100 cases. 1909. 1908. 1907. 1906. 1905. 1904. Males 5.3 5.3 3.3 3.4 2.9 5.2 Females 4.8 4.1 2.5 2.0 4.2 3.5 Persons 5.0 4.6 2.8 2.7 3.6 4.3 The increased fatality is somewhat surprising and (it may be said) disappointing. It is thought that it cannot be ascribed to a smaller proportion of the actual total of cases being reported, as it is believed that a steady improvement has been made in that direction. Neither, judging by past experience, can the increase be put down to seasonal influence. It will be admitted that a fatal issue is, on the whole, more frequent after attacks occurring in the first and fourth quarters of the year. That assumption is borne out by the tabular statement given below, in which it will be seen that, until last year, a low fatality was associated with a small proportion of attacks in the first and fourth quarters, and vice versa. Proportion per cent. of all attacks reported in Year. 1st and 4th Quarters. 2nd and 3rd Quarters. Fatality per 100 cases. 1903 54.7 45.0 4.1 1904 86.8 12.9 4.3 1905 30.2 69.6 3.6 1906 31.9 67.4 2.7 1907 53.1 46.8 3.1 1908 59.3 40.6 4.6 1909 36.9 62.9 5.0 The progressive decline in fatality from 1903 to 1906, since followed by a progressive increase, suggests that the disease has entered a phase of increasing severity, an occurrence which has been noted in almost all diseases which are epidemic in character. 34 MEASLES. The sex-age-group fatalities are given in Table 25, the most notable fatality (32.8 per cent.) being that recorded among males under one year. In the three southern Wards (Table 26) no death was recorded, while the fatality of the disease in the remaining five (central and northern Wards) ranged from 9.1 per cent. in Church to 3.2 in Westbourne Ward.* TABLE 25. Measles. 0— 1— 2— 3— 4— 5— 13— 15— M. F. M. F. M. F. M. F. M. F. M. f. m. F. M. f. Cases 22 18 42 53 41 55 46 39 40 62 139 138 2 - 4 8 Deaths 7 3 0 10 1 4 1 - - 1 - - - - - - Fatality- 1909 31.8 16.6 21.4 18.8 2.4 7.2 2.1 - - 1.6 - - - - - - 1908 15.3 16.6 26.1 19.0 2.3 - 2.0 5.4 3.2 - - 0.5 - - - 8.0 1907 17.3 15.1 8.7 4.7 6.5 5.7 1.1 - 0.9 0.7 0.4 1.1 - - - - 1906 17.6 7.1 19.4 10.2 - 2.9 - - - - - - - - - - 1905 13.5 16.9 9.3 15.1 5.8 2.6 - 4.1 1.8 0.6 0.3 0.5 - - - - 1904 26.9 20.9 13.6 3.8 1.7 3.8 3.1 4.7 1.2 1.2 2.2 1.2 - - - 5.5 1903 7.1 12.9 19.1 7.6 14.7 9.6 - - - 1.2 — - - - - - TABLE 26. Measles. Locality. 1904. 1905. 1906. 1907. 1908. 1909. Mean 1904-08. Queen's Park C. 288 244 134 184 148 50 D. 15 3 1 2 8 2 F. 5.2 1.2 0.7 1.0 5.4 4.0 2.7 Harrow Road C. 231 461 127 332 152 160 D. 10 20 4 8 6 7 F. 4.3 4.3 3.1 2.4 3.2 4.3 3.5 Maida Vale C. 69 185 40 203 63 97 D. 6 5 3 5 1 5 F. 8.7 2.7 7.5 1.4 1.5 5.1 4.4 Westbourne C. 79 187 136 133 73 155 D. 1 7 4 4 9 5 F. 1.2 3.7 2.2 3.0 12.3 3.2 4.5 Church C. 129 434 72 374 160 186 D. 5 25 4 15 9 17 F. 3.8 5.7 5.5 4.0 5.6 9.1 4.9 Lancaster Gate, West C. 54 27 41 16 29 38 D. 1 — — — 1 — F. 1.8 — — — 3.4 — 1.0 Lancaster Gate, East C. 27 65 14 9 48 11 D. 1 1 — — — — E. 3.7 1.5 — — — — 1.0 Hyde Park C. 19 111 28 33 106 12 D. — 2 — 3 2 — F. — 1.8 — 9.0 1.8 — 2.5 Borough C. 896 1714 592 1284 779 709 D. 39 63 16 40 36 36 F. 4.3 3.6 2.7 3.1 4.5 5.0 3.6 C.—Cases. D.—Deaths. F.— Fatality per cent. * The fatality in the former Ward (91) was nearly double the mean (4.9) for the five years 1904-08. 35 WHOOPING COUGH. The mortality was 0.23 per 1,000 persons of all ages (an unsatisfactory basis of calculation for this disease), or 0.02 less than the quinquennial mean rate, 0.25, a somewhat remarkable fact having regard to the increased fatality. Higher (crude) rates were recorded (Table 10) in Kensington (0.32), Marylebone and Willesden (0.26 each), while the rate for the Metropolis was exactly double that noted in the Borough. The corrected rate for the Borough (Table 27) was 0.29, and was exceeded by the rates in Kensington (0.38) and Marylebone (0.35). In Paddington and the Metropolis only were last year's rates above the means. TABLE 27. Locality. Measles. Whooping Cough. Standard Rate. Corrected Rate. Standard Rate. Corrected Rate. 1909. 1904-08. 1909. 1904-08. Paddington 0.43 0.29 0.31 0.39 0.29 0.23 London 0.58 0.48 0.38 0.50 0.25 0.29 Kensington 0.47 0.38 0.39 0.35 0.30 0.29 Westminster 0.36 0.22 0.18 0.31 0.17 0.18 Marylebone 0.42 0.35 0.35 0.36 0.26 0.21 Hampstead 0.40 0.20 0.16 0.34 0.27 0.14 Willesden 0.66 0.22 0.25 0.57 0.22 0.23 The nett mortality rates in Maida Vale, Westbourne and Church Wards were in excess of their respective mean rates, the maximum rate (0.59) being recorded in Church Ward. (Table 28.) TABLE 28. Locality. Measles. Whooping Cough. 1909. 1904-8. 1909. 1904-08. Borough 0.23 0.25 0.23 0.19 Queen's Park 0.12 0.34 0.12 0.27 Harrow Road 0.23 0.33 0.23 0.26 Maida Vale 0.24 0.20 0.24 0.18 Westbourne 0.19 0.19 0.23 0.17 Church 0.59 0.41 0.56 0.19 Lancaster Gate, West — 0.04 — 0.04 Lancaster Gate, East — 0.04 — 0.02 Hyde Park - 0.09 — 0.11 WHOOPING COUGH. In 1906, 589 cases of this disease were reported, the highest total since any records were kept, in 1908, 170 and last year, 561, the second largest total. The attacks in males numbered 263 and those in females, 298. The (uncorrected) numbers of cases recorded in each quarter of the year are given on next page. 36 WHOOPING COUGH. Year. Quarters 1. 2. 3. 4. Uncorrected. Corrected. 1904 23 27 45 98 193 196 1905 241 255 38 36 570 540 1906 57 65 26 26 174 171 1907 189 305 73 48 615 589 1908 34 65 37 35 171 170 1909 243 243 72 26 584 561 The cases occurred in 325 houses, giving an average of 1.7 cases per house, not materially different from the average in 1908 (1.6). The frequency of multiple cases is given below. The secondary cases numbered 236, equal to 42.0 per cent. of the total (40.5 per cent. in 1908). 1909. 1908. 1907. 1906. 1905. 1904. Houses with 2 cases 98 22 99 31 93 29 „ 3 „ 41 16 49 17 44 12 „ 4 „ 12 5 12 4 13 5 „ 5 „ 2 — 4 1 3 6 „ 6 „ 1 — 1 — — 2 „ 7 „ — — — — 1 — „ 8 „ 1 - - — - — There were 36 deaths during the year, 17 of males and 19 of females, giving a fatality of 6.4 per cent., practically the same as in the previous year. The fatality in males decreased from 8.8 per cent. to 6.4 while that in females, increased from 4.3 to 6.3. (See below). Whooping Cough. Fatality per 100 cases. 1909. 1908. 1907. 1906. 1905. 1904. Males 6.4 8.8 9.2 8.3 9.6 8.0 Females 6.3 4.3 7.8 6.9 10.2 8.3 Persons 6.4 6.5 8.4 7.6.9.9 8.1 The sex-age-group fatalities are given in Table 29 but they exhibit no marked changes calling for comment. The total fatality (6.4) shows a decrease from the mean (7.9) but increases were recorded in Westbourne and Church Wards. (Table 30.) As in the case of measles, whooping cough may be expected to end fatally more frequently in the first and fourth quarters of the year, but premising that there is reason to think that whooping cough is not so completely and systematically reported as is measles, the appended figures tend to show that the fatality is less influenced by the seasonal occurrence of the disease than is measles. Further, the changes in the annual fatality do not exhibit that steady rise and fall which was not noted in the other disease. Proportion (per cent.) of total attacks reported in— 1st and 4th 2nd and 3rd Fatality. Year. Quarters. Quarters. per 100 cases. 1903 86.3 13.5 9.9 1904 62.6 37.2 8.1 1905 48.5 51.3 9.2 1906 47.6 52.2 7.6 1907 38.5 61.3 8.4 1908 40.2 59.6 6.4 1909 46.0 53.9 6.4 37 WHOOPING COUGH. TABLE 29. Whooping Cough. 0— 1— 2— 3— 4— 5— 13— 15— m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. Cases 23 32 24 24 17 28 41 37 45 45 113 130 - - - 2 Deaths 6 8 6 2 2 1 - 5 1 1 2 2 - - - - Fatality- 1909 26.2 25.0 25.0 8.2 11.6 3.5 - 13.3 2.2 2.2 1.7 1.5 - - - - 1908 28.5 42.8 30.0 - 10.0 - 16.6 8.3 — — — — - - - — 1907 36.0 36.6 29.4 20.6 8.3 7.4 8.1 9.0 - 1.6 - 1.4 - - - - 1906 18.1 9.0 28.5 40.0 7.7 8.3 - - — - - - - - - — 1905 44.4 46.1 15.1 42.8 13.3 5.1 6.2 - — 1.7 - 2.9 - - - — 1904 8.3 - 21.0 8.3 16.2 11.8 6.6 7.1 — - - — - - - — 1903 60.0 - 24.1 39.3 10.3 15.0 - 2.2 - — - - - - - 50 .0 TABLE 30. Whooping Cough. Locality. 1904. 1905. 1906. 1907. 1908. 1909. Mean Fatalitv, 1904-08. Queen's Park C. 8 126 31 112 41 113 D. 2 10 1 9 1 2 F. 25.0 7.1 3.2 8.0 2.4 1.7 9.1 Harrow Road C. 58 165 27 224 38 153 D. 3 12 3 17 4 7 F. 5.1 7.2 11.1 7.5 10.5 4.5 8.3 Maida Vale C. 4 48 22 65 16 51 D. 1 8 1 7 1 5 F. 25.0 16.6 4.5 10.7 6.2 9.8 12.6 Westbourne C. 45 39 17 76 13 58 D. 6 5 2 9 — 6 F. 13.3 12.8 11.8 11.8 — 10.3 9.9 Church C. 65 99 56 75 40 152 D. 3 8 4 7 5 16 F. 4.6 8.0 7.1 4.0 12.5 10.5 1.2 Lancaster Gate, West C. 7 — — 13 2 7 D. — 1 — 1 — — F. — ? — 7.6 — — 9.0 Lancaster Gate, East C. 4 17 — 1 9 3 D. 1 — — — — — F. 25.0 — — — — — 3.2 Hyde Park C. 5 46 18 23 11 24 D. — 6 2 — — — F. — 13.0 11.1 — — — 4.8 Borough C. 196 540 171 589 170 561 D. 16 50 13 50 11 36 F. 8.1 9.2 7.6 8.4 6.4 6.4 7.9 * C.—Cases. D.—Deaths. F.—Fatality per cent. 38 OTHER INFECTIOUS DISEASES. The crude mortality was 0.23 per 1,000 persons, or 0.04 above the mean rate (Table 10), higher rates being recorded in the Metropolis and Willesden (0.26 in each case). The corrected mortality (0.29) was 0.6 in excess of the mean (Table 27), and was exceeded by the rate in Kensington (0.30) only. The nett mortality rates for the Wards are given in Table 28. OTHER INFECTIOUS DISEASES. In addition to measles and whooping cough, german measles, mumps and ringworm are reported to the Department by the Staffs of the Public Elementary Schools. Last year 10 cases of german measles, 344 of chickenpox (corrected total 338), 176 of ringworm, and 420 of mumps were so reported. In the weekly tabulation of the cases german measles is not distinguished from measles, owing to the frequency with which the two diseases are confused by unprofessional persons. The quarterly totals of the other diseases are given below. The only death from any of these causes was that of a male, aged 25-35 vears, from mumps. Years. Quarters 1. 2. 3. 4. 1909 1908 Chickenpox 100 73 43 128 344 241 Ringworm 45 49 40 42 176 93 Mumps 211 114 30 65 420 56 OTHER DISEASES. The mortality rates from the remaining diseases which are selected for special tabulation are given in Table 31. Increased mortalities from epidemic influenza (rate, 1909, 0.46 per 1,000; mean, 0.31), respiratory disease—bronchitis and pneumonia—(rate, 1909, 2.44; mean, 2.18), and suicide (rate, 1909, 0.14; mean, 0.09) were recorded. The mortality from alcoholic excess—the sum of the mortalities from alcoholism (acute and chronic) and cirrhosis of the liver—showed a satisfactory decrease from a mean rate of 0.24 to a rate of 0.12 for last year. TABLE 31. Locality. Epidemic Influenza. Respiratory Diseases. Alcoholism. Cirrhosis of Liver. Suicide. 1909. 1904-8. 1909. 1904-8. 1909. 1904-8. 1909. 1904-8 1909. 1904-8. Borough 0.47 0.31 2.44 2.18 0.07 0.08 0.05 0.16 0.14 0.09 Queen's Park 0.30 0.31 2.58 2.61 0.12 0.05 0.06 0.09 0.24 0.06 Harrow Road 0.62 0.26 2.33 2.07 ... 0.04 ... 0.17 0.13 0.08 Maida Vale 0.58 0.35 2.34 1.84 ... 0.11 ... 0.21 0.14 0.10 Westbourne 0.38 0.29 3.03 2.08 0.11 0.11 0.03 0.23 0.11 0.12 Church 0.35 0.28 3.52 2.85 0.14 0.08 0.10 0.12 0.14 0.05 Lancaster Gate, West 0.23 0.32 1.29 1.36 0.11 0.04 0.23 0.09 0.35 0.12 Lancaster Gate, East 0.50 0.40 1.25 1.18 0.12 0.12 ... 0.21 0.12 ... Hyde Park 0.72 0.33 2.22 1.70 ... 0.11 0.07 0.11 ... 0.16 MORTALITY OF CHILDHOOD. 39 MORTALITY IN CHILDHOOD. Under this general heading the wastage of life among infants under one year of age, and that at ages between one and five years, will be considered. An account of the work in connection with "Infant Rearing" forms a natural pendant to the first of the two subjects. Infantile Mortality. During the past year 348 deaths of infants under one year (of whom 53 were children of non-resident parents) were recorded in the Borough, or 26 less than the total for 1908 (374— the latter year including 53 weeks instead of 52). The crude infantile mortality was 119 per 1,000 births registered locally, showing an increase of 1 above the figure for the previous year (118). The crude mean rate for the ten years 1899-1908 was 139 (Table I., Appendix), the corresponding rates for the two quinquennia included therein being 146 and 132 respectively. The statement given below shows the variations from the quinquennial mean rates exhibited in the returns for each of the quarters of last year. Crude Infantile Mortality. Quarters 1. 2. 3. 4. Year. 1909 135 99 117 129 120 1904-08 134 105 155 133 132 Prior to 1905 the only corrections possible in this rate were those for deaths for nonresidents, and deaths of residents in out-lying institutions, the rate having to be calculated on the number of births registered within the Borough. The corrected total of deaths last year was 311, and the rate, per 1,000 births registered within the Borough, 107, as compared with 110 and 115 in 1908 and 1907 respectively. The corresponding mean rate for the five years 1904-08 was 119, which contrasts very favourably with that for 1894-98 (153). Since 1905 it has been possible to correct the births more or less completely. According to the Department's records the corrected number of births was 3,031 last year, which gives an infantile mortality of 102 per 1,000 births. The Registrar-General, however, gives the number of births as 3,120 and the mortality as 100 (and the mean rate for 1904-08 as 113). Lower rates were recorded last year (Table 10) in Westminster (93), Marylebone (99), Hampstead (75), and Willesden (96). For the purposes of local comparisons, the Department's totals, viz., births 3,031 and deaths 311, are used. The 311 deaths comprised 165 of males and 146 of females, the average numbers for the preceding quinquennium being—males 216 and females 163. (See Table VII., Appendix). The rates recorded in each of the five years 1905-09 are given in Table 32. Owing to the absence of means of correcting the births in 1904, the fully corrected rate cannot be given for the quinquennium 1904-08. The sex mortality rates were 106 for males and 99 for females. As in previous years, the minimum rate (for persons) was recorded in Lancaster Gate, West, Ward, and the maximum in Church, the latter rate being the highest recorded during the whole period. The same observation applies to the rates for males, but among females the lowest rate recorded last year was that of Harrow Road Ward, Church Ward still retaining the maximum for the year, that Ward's rate for 1906 being, however, the maximum (female) rate in the series. 40 mortality of childhood. TABLE 32. Infantile Mortality : Fully corrected rates. Per 1,000 births. Locality. Males. Females. Persons. 1909. 1908. 1907. 1906. 1905. 1909. 1908. 1907. 1906. 1905. 1909. 1908. 1907. 1906. 1905. Borough 106 118 131 115 128 99 92 87 99 109 102 105 110 107 118 Wards. Queen's Park 85 110 115 96 164 58 69 92 87 76 73 90 105 92 122 Harrow Road 92 113 137 90 116 58 68 75 58 113 74 92 106 75 115 Maida Vale 81 101 118 145 116 102 99 96 69 124 91 100 108 107 120 Westbourne 101 99 102 123 111 111 118 98 120 120 106 108 100 121 112 Church 165 149 154 140 151 146 126 99 155 141 154 138 128 146 146 Lancaster Gate, West 30 29 97 62 83 100 29 64 32 28 63 29 83 48 55 „ East 61 69 125 86 41 133 58 60 83 71 83 61 92 85 55 Hyde Park 59 163 163 103 130 131 74 47 154 41 93 122 107 126 86 The changes in the annual rates given in Table 32 are too erratic to permit of any study of the differences in the mortalities in the Wards. "Index numbers" have, therefore, been calculated (Table 33) based on the experience of the past five years, during which the births and deaths have been corrected as fully as possible. The favourable position of Lancaster Gate, West, Ward is well shown. The contrast between the numbers for that Ward and Church Ward are striking. The numbers for the two most northern Wards— Queen's Park and Harrow Road—are surprisingly low, and compare favourably with those for Hyde Park. Some allowance must, doubtless, be made in the case of the last named Ward for the small numbers from which the " index numbers" are derived. TABLE 33. Mean Infantile Mortality: Index Numbers. Locality. Total Births. 1905.-09 Corrected. Total Deaths. 1905-09 Corrected. Mean Mortality. Index Numbers. M. F. M. F. M. F P. M. F. P. Queen's Park 1,137 1,022 130 79 114 77 96 168 124 148 Wards. Harrow Road 2,043 2,015 225 151 110 74 92 161 119 141 Maida Vale 1,059 1,037 120 102 113 98 106 166 158 163 Westbourne 1,209 1,197 130 134 107 112 110 157 181 169 Church 2,001 1,778 304 237 151 133 143 222 214 220 Lancaster Gate, West 176 162 11 8 62 49 56 91 79 86 Lancaster Gate, East 178 162 13 12 73 74 73 107 119 112 Hyde Park 498 444 61 40 122 90 107 179 145 165 Borough 8,301 7,817 994 763 120 98 109 179 158 168 Lancaster Gate, East and West 354 324 24 20 68 62 65 100 100 100 mortality of childhood. 41 Hopeless Births. It has to be admitted that under present-day conditions a certain proportion of infants are born without any reasonable prospect of attaining their first birthday. To such births the designation which heads this paragraph has been given. It has a more limited application than that of the term frustra-nes, suggested by Mons. A. Guillard.* "Hopeless births" (frustra nati) should be limited to children who are born only to die within the first year of life, whose lives there is no prospect of conserving by any preventive measures at present known. The amelioration of ante-natal condition is the only method which offers any prospect of checking this wastage. There are two ways of arriving at estimates of these "hopeless births." The first is by counting the children who are dead at the date of registration of their births (method "A"), and the second by taking out the numbers of deaths at ages under one month—the earliest date at which conservative intervention can usually become effective—but excluding alt deaths at those ages from overlaying, and adding thereto the deaths at ages under one year from" premature birth "and" congenital malformations or defects" (method "B.") Inasmuch as "A" depends on local registration of birth, the correction should be applied to the crude totals of births registered in the Borough. "B," on the other hand, being independent of the registration of birth can be applied to the corrected totals of births. Below is a statement showing the varying percentages of "hopeless" to all births of each sex for each of the five years 1905-09 according to the two methods. The mean proportions for the two sexes combined (persons) are—Method "A," 3.3 per cent.; method "B," 3.9 per cent. By both methods the proportions show a tendency to increase. Total Births uncorrected. Hopeless Births (Method "A.") Percentage of total Births. Total Births corrected. Hopeless Births (Method " B.") Percentage of total Births. m. f. m. f. m. f. m. f. m. f. m. f. 1905 1,628 1,556 53 54 3.2 2.8 1,687 1,618 62 59 3.6 3.6 1906 1,633 1,519 42 47 2.5 3.0 1,719 1,567 56 56 3.2 3.5 1907 1,586 1,488 79 45 4.9 3.0 1,665 1,541 88 48 5.2 3.1 1908 1,609 1,540 53 46 3.2 2.9 1,678 1,618 75 64 4.3 3.9 1909 1,481 1,414 58 45 3.9 3.1 1,558 1,473 73 50 4.6 3.4 Means 3.5 3.0 4.2 3.5 The causes of death of the "hopeless births" (Method "A") are given in Table 34. One-third of the children died within twenty-four hours of their birth, and more than twothirds (65) within the first week. Three of the deaths were due to an absolutely preventable cause, viz., "overlaying," and three others to a possibly preventable, viz., diarrhoea. For the remaining 97 children an early death appears to be the only issue which could have been looked for. In judging what would be the effect of eliminating the hopeless births from all calculations of infantile mortality, the partially corrected rate (that is the rate obtained for the uncorrected births and corrected deaths) has to be used with Method "A," and the fully corrected rate (that from the corrected births and deaths) with "B." The reductions in the two rates for each year since 1905, according to the method employed, are shown on next page. The mean *The designation frustra-nes (born in vain) was first applied to sterile flowers by Linnoeus, and later suggested by M. Achille Guillard to designate children who died without progeny (Bertillon Cours Elencntaire de Statisque, p. 526). Inasmuch as a fair proportion of mankind pass through a lifetime of normal duration and leave no progeny, it seems desirable that the designation should be limited as suggested here. 42 MORTALITY OF CHILDHOOD. TABLE 34. "Hopeless Births" 1909. Method "A" (See text). Cause of Death. Days. Weeks. Months Total. 0— 1— 2— 3— 4— 5— 6— 1— 2— 3— 1—2 Males. Females Persons m. f. m. f. m. f. m. F. m. f. m. f. m. f. m. f. m. f. m. f. m. f. Not certified — 1 - — - — — — — — - - - - - - - - - - - - - 1 1 Diarrhœa - — - - - — — — - — 1 - — - - — - — 1 - - 1 2 1 3 Premature Birth 9 10 4 3 4 1 2 2 - 1 7 - 1 1 - 2 1 25 23 48 Congenital Defects. — 1 1 - - - 3 - - - - - - - 1 - - 1 - 1 - - 5 3 8 Injury at Birth 2 1 — — — - — - — - - - - - - — - - - - - - 2 1 3 Want of Breast Milk — — — — — - — - — - - - - - - — — - - - - - - - - Atrophy, Debility - — — — — - — — — - - - - — 2 — — 1 1 - 1 - 4 1 5 Atelectasis 2 2 — — — - 1 - - - - - - - - — — - - - - - 3 2 5 Debility at Birth 3 2 2 - — - 2 - — - - — 1 - - — 1 - - - - — 9 2 11 Syphilis 1 - - - - - - - - - - - - - - - - - - - - 1 1 1 2 Meningitis — — — — — - — - — - - - - - 1 — — - - - - - 1 - 1 Convulsions - - - - - - - 2 - - - - - - 2 - - - - - - - 2 2 4 Respiratory Diseases — — — — — - — - — - - - - 1 — — 1 1 - 1 2 2 3 5 8 Suffocation laid) - - - - - - - 1 - - - - - - - - - - - - 1 1 1 2 3 Other causes — — - — - - - - - - - — - - - - - - - 1 — - — 1 1 Totals 17 17 7 3 4 1 8 3 2 - 1 - 1 1 7 7 2 4 3 3 6 6 58 45 103 partially corrected rate for the five years is reduced from 113 to a residual rate of 80, and the fully corrected from 109 to a residual of 69. The differences between the rates for 1905 and last year represent decreases amounting to 13 per cent. in the partially and 14 per cent. in the fully corrected rates, and 23 and 24 per cent. in the residual, according as Method "A" or "B" is used. Total partially Residual Total fully Residual corrected. "A." corrected. "B." 1905 122 92 118 81 1906 112 83 107 73 1907 115 74 110 68 1908 110 79 105 63 1909 107 71 102 62 It will be seen from Table VII., Appendix, that the annual average numbers of deaths at ages under one year during 1904-08 were—males 216, females 163, no allowances being made for the diminution in the numbers of births. Last year's deaths—males 165, females 146— represent savings of 51 male and 17 females' lives, or 68 in all. On grouping the deaths according to ages (see opposite page) it is found that there were fewer deaths in all groups save two, viz., 1—3 and 6—9 months (females). MORTALITY OF CHILDHOOD. 43 Lives gained (—). 1909. 1904-08. Lost ( + ). M. F. M. F. M. F. Under one month 63 45 65 53 —2 —8 Aged 1-3 months 30 33 48 33 —18 ±0 Under 3 months 93 78 113 86 —20 —8 Aged 3-6 „ 27 26 43 33 —16 —7 6-9 „ 27 24 31 21 —4 +3 9-12 „ 18 18 29 23 —11 —5 Grouping the deaths according to causes of death (see below) it is seen that there was a notable decrease in the numbers of deaths attributed to "diarrhœal diseases," and a fair reduction in those due to the "tubercular diseases." Actual increases are observed only from the "common infectious diseases" (males) and "wasting diseases" (males), and other causes (females). Lives gained (—). 1909. 1904-08. Lost ( + ). Group. Diseases. M. F. M. F. M. F. I.—"Common Infectious" 14 11 11 11 +3 —0 II.—"Diarrhœal" 19 20 52 36 —33 —16 III.—"Wasting" 75 53 74 54 +1 —1 IV.—"Tubercular" 7 1 9 6 —2 —5 V.—Other 50 60 69 55 —19 +5 Cause not certified — 1 1 1 -1 ±0 A comparison of the mortality rates instead of the numbers of deaths makes the corrections necessary to adjust for the difference between the number of births during the past year and the annual average for the quinquennium. Bv this method it is found (see below) that reductions were recorded in the mortalities from the "diarrhceal" and "tubercular" diseases, and increases in all the others, both among males and females, except other diseases (males). Infantile Mortality. Per 1,000 Births registered within the Borough. 1909. 1904-08. Group. Diseases. M. F. M. F. I.—"Common Infectious" 9.45 7.77 7.13 7.41 II.—"Diarrhceal" 12.82 14.14 33.72 24.25 III.—"Wasting" 50.64 37.48 47.99 36.39 IV.—"Tubercular" 4.72 0.70 5.83 4.04 V.—Other 33.76 42.43 44.74 37.06 Special Areas.—The total infantile mortality in the six special areas, or insulœ, selected on account of the marked characteristics (see Table 35), was 136 per 1,000 births (corrected),, or 16 per 1,000 above the rate for the previous year (120). The highest rate recorded last year was 221 ("Clarendon Street,") which rate was equalled by that of "Hall Park" in 1906. The lowest rate was that of "Queen's Park" (81), which is however higher than the rate for that insula in the previous year (58). The effect of the elimination of the births and deaths (0-1 year) in the insulæ from the calculation of the infantile mortality rates in the Wards in which the insulæ are respectively situated is shown in the appended figures. It will be seen that last year all the residual rates were lower than the total, whereas in previous years that for Queen's Park Ward has been higher. (See next page.) 44 MORTALITY OF CHILDHOOD. Ward No. 1909. 1908. 1907. 1906. I.—Queen's Park- Total rate 73 90 105 92 Residual rate 57 161 129 176 III.—Maida Vale— Total rate 91 100 108 107 Residual rate 90 93 79 98 IV.—Westbourne— Total rate 106 108 100 121 Residual rate 111 90 86 125 V.—Church— Total rate 154 138 128 146 Residual rate 99 114 89 87 TABLE 35. Special Insulce. Infantile Mortality Ward. Special Areas.— Insulæ. 1909. Infantile Mortality. Births. Deaths, 0—1. 1909. 1908. 1907. 1906. 1905. V. "Hall Park" 157 18 144 118 107 221 196 V. "North Wharf" 101 14 138 123 94 141 150 IV. "Alfred Road" 127 12 94 152 132 115 146 III. "Amberley Road" 71 7 98 132 107 153 192 V. "Clarendon Street" 293 65 221 170 146 151 165 I. "Queen's Park" 260 21 81 58 96 89 134 In Table 36 are given the causes of death in the "Combined Insulæ" and the "Rest of the Borough," and the ages at death. The mortality from each group of diseases (see below) except" other diseases" was higher last year in the " Combined Insulæ" than in 1908, all being higher than (most of them nearly double) the rates recorded last year in the "Rest of the Borough." The rates (Table 36) for diarrhoea (14.86) and respiratory diseases (29.73) were the two highest recorded in the insulæ last year, the former rate showing an increase of nearly 3per 1,000 above that for last year (ll.97) although the rate for the whole Borough decreased from 14.26 to 8.90. Infantile Mortality. Per 1,000 Births (corrected) Combined Rest of Whole Insulæ. Borough. Borough. Group. Diseases. 1909. 1908. 1909. 1908. 1909. 1908. I.—"Common Infectious" 12.93 4.60 5.92 4.52 8.24 5.76 *II.—"Diarrhœal" 21.79 19.33 8.40 20.1 12.86 20.32 III._"Wasting" 46.56 29.45 40.03 46.51 42.23 41.56 IV.—"Tubercular" 3.99 1.84 1.97 2.71 2.63 2.42 V.—Other 50.53 64.45 29.14 21.27 38.27 34.58 mortality of childhood. 45 TABLE 36. Special Insulœ. Causes of Death. Cause of Death. No. of Deaths. Mortality. Combined Insulœ Rest of Borough. Combined Insulœ. Rest of Borough. Not Certified — 1 — 0.49 Measles 5 5 4.95 2.47 Scarlet Fever — 1 — 0.49 Whooping Cough 8 6 7.98 2.96 Diarrhœa 15 12 14.86 5.93 Enteritis 7 5 6.93 2.47 Premature Birth 14 42 13.87 20.77 Congenital Defects 13 7 12.88 3.46 Injury at Birth — 2 — 0.98 Want of Breast Milk 1 3 0.99 1.48 Atrophy, Debility 9 12 8.91 5.93 Atelectasis - 5 - 2.47 Debility at Birth 10 10 9.91 4.94 Tubercular Diseases 4 4 3.99 1.97 Erysipelas - 1 - 0.49 Syphilis 5 2 4.95 0.98 Rickets — 1 - 0.49 Meningitis 3 5 2.97 2.47 Convulsions 5 5 4.95 2.47 Respiratory Diseases 30 27 29.73 13.35 Suffocation (overlaid) 2 3 1.99 1.48 Other Causes 6 15 5.94 7.41 All Causes 137 174 135.77 86.05 Under 1 month 37 71 36.66 35.11 1—3 months 33 30 32.70 14.83 Under 3 months 70 101 69.37 49.95 3- „ 23 28 22.79 13.84 6- „ 28 25 27.75 12.36 9- „ 16 20 15.85 9.89 The mortalities at groups of ages (sec next page) were notably higher in the "Combined Insula;" than in the "Rest of the Borough" last year except at ages under one month. The greatest difference was that at ages 6-9 months. Last year's rates in the insulœ were below those for the previous year except at ages in the second half of the year of life. The rate for ages 6-9 months recorded last year (27.75) was more than double the rate for 1908 (11.04). 46 mortality of childhood. Infantile Mortality. Per 1,000 Births (corrected). Combined Insulœ. Rest of Borough. Whole Borough. 1909. 1908. 1909. 1908. 1909. 1908. Under one month 36.66 41.43 35.11 35.74 35.63 37.62 1-3 months 32.70 32.22 14.83 20.81 20.78 24.57 Under 3 months 69.37 73.66 49.95 56.56 56.41 62.19 3-6 „ 22.79 23.94 13.84 18.55 17.48 20.32 6-9 „ 27.75 11.04 12.36 10.40 16.82 10.61 9-12 „ 15.85 14.73 9.89 11.31 11.87 12.43 Diarrhœa.—There was a marked decrease in the mortality from this cause during the past year, the deaths at ali ages numbering only 38 according to the Department's records— 36 according to the Registrar-General. Such a small number has never been previously recorded, the next lowest total for any year being that of 1907, when 47 deaths were attributed to this cause. During the five years 1904-08 the annual average number of deaths was 92, which contrasts very favourably with the average for the five years 1894-98, viz., 150. The mortality (per 1,000 persons of all ages) was 0.25 last year as compared with a rate of 0.39 recorded in 1908 and mean rates of 0.62 and 1.07 recorded during the five years 1904-08 and 1894-98 respectively. The third quarter of the year being the time when the mortality is highest the following statement of the numbers of deaths recorded in each of the third quarters since 1899 will be of interest. It will be seen that the deaths recorded last year (19) exceeded those recorded in 1907 (10), although the year's total in the latter year (47) was greater than that of the former (38). Deaths from Diarrhœa* during the Third Quarter of the Year. 1899 137 1900 100 1901 108 1902 58 1903 36 1904 110 1905 62 1906 95 1907 10 1908 36 1909 19 * The figures include deaths certified as due to diarrhœa and to epidemic (zymotic) enteritis. The prevalence of the disease(s) during this quarter of the year depends in some way, not yet clearly demonstrated, on the meteorological phenomena of the summer. High temperatures and deficient rainfall are generally held to be the principal factors, acting, it is now thought, indirectly by favouring the breeding of flies which act as the carriers of the materies morbi. Striking an average of the rainfall recorded during the past eleven years (5.97 in.) and grouping the years according as the rainfall of the quarter is in excess of or below that figure, it becomes fairly evident (see below) that an excess of rain tends to reduce and a high temperature to increase the prevalence of the disease(s). Diarrhœa and Meteorological Elements in Third Quarter of Year. Average rainfall for Quarter (1899-1909)—5.97 in. Years with excess of rainfall. Total Mean temperature. Total rainfall. Air. Earth. deaths. 1903 12.32 59.0 60.18 36 1908 8.15 59.3 60.35 36 1909 7.43 58.7 59.25 19 1901 6.02 61.8 62.06 107 Average for quarter, four years. 50. With deficient rainfall. Total Mean temperature. Total rainfall. Air. Earth. deaths. 1902 5.91 59.1 59.68 58 1905 5.65 60.0 61.61 62 1904 4.88 60.9 61.47 110 1900 4.38 61.9 61.35 100 1899 3.83 63.1 64.03 137 1906 3.78 62.4 62.08 95 1907 3.36 58.8 59.15 10 Average for quarter, seven years. 82. mortality of childhood. 47 Between the 26th of July and the last day of October, 205 children were reported to the Department as suffering with diarrhoea, but the actual number of cases investigated was only 163, 82 being in boys and 81 in girls. The sources of information were : St. Mary's Hospital, 89 cases; Children's Hospital, Paddington Green, 34; Poor Law Service, 13; Staff of Department (cases discovered in course of other work), 11; and other (lay) sources, 16. There were six (6) deaths among the 163 children, one being due to a cause other than diarrhoea. The fatality works out at 3 per cent., which is a remarkably low rate, but not much below that given in connection with the notification of the disease in 1908 (3.6 per cent.). It is difficult to reconcile such low fatalities with the experience of Woolwich, where a mean fatality of 15'8 per cent. was observed during the four years 1905-08. The number of cases dealt with last year was too small for a detailed analysis. It will suffice to call attention to the small proportion of breast-fed children attacked and dying of the malady. (See Table 37 page 49). In 42 cases there was a historv of the consumption of fruit or some unwholesome comestible. The most interesting information collected last year related to the frequency of multiple cases (reported and not reported) in houses, the facts relating to which are set out in the appended statements. The infectious, or contagious, character of the disease(s) seems to be fairly demonstrated. MULTIPLE CASES REPORTED. No. of Case Initials. Sex. Age. Yr. Dates of No. of Case Initials. Sex. Age. Yr. Dates of Onset. Recovery(R) Death (D) Onset. Recovery(R) Death (D) 1 G.P. M 1 30, viii. R. 13, ix. 10 C.P. F 1 2, viii. R. 24, viii. F.J. M 1 10, x. R. 20 x. K.B. F 10/12 22, viii. P. 7, ix. 2 W.H. M 8/12 23, viii. R. 30, viii. 11 J.M. M 8/12 20 viii. R. 30, viii. A.E. M 11/12 5, ix. R. 7, ix. G.M. M 8/12 24, viii. R. 30, viii. 3 J.S. M 1 5, ix. D. 9, ix. 12 G.A. F 3/12 30, viii. R. 13, x. A.M. M 7/52 11, ix. R. 20, ix. A.A. M 3/12 1, ix. D. 24, ix. 4 F.McC. M 10/12 21, viii. R. 3, ix. 13 F.F. M 1 14, viii. R. 1, ix. M.A. F 1 2, x. R. 8, x. W.A. F 1 22, viii. R. 1, ix. 5 E.M. M 10/12 19, vii. R. 29, vii. 14 L.H. F 6/12 19, ix. R. 29, ix. M.W. F 6/12 11, ix. R. 4, x. D.W. F 1 11, ix. R. 3, xii. 6 A.M. M 1 15, viii. R. 6, ix. 15 F.G. F 1 20, viii. R. 30, viii. R.B. F 2 13, ix. R. 27, ix. E.G. F 1/12 10, xi. D. 13, xi. 7 A.J. F 3 5, vii. R. 10, vii. L.G. F 1/12 13, xi. D. 17, xi. A.H. M 5/12 ? D. 12, ix. 16 K.C. F 11/12 12, ix. R. 24, ix. 8 V.Ba. F 5/12 5, ix. R. 27, ix. A.W. F 11/12 8, x. R. 18, x. W.Bu. M 1 12, ix. R. 22 x. 17 F.A. F 1 20, viii. D. 6, x. 9 E.H. F 1 12, ix. R. 12, xi. J.B. M 6/12 26, viii. R. 16, ix. E.D. M 1 17, ix. R. 29, ix. Notes.—Case No. 11.—The father of the patients reported to have had an attack of diarrhoea about 17th August. Case No. 14.—Recovery of D.W. delayed by relapse. L.H. also had a relapse after September 29th, and did not finally recover until October 19th. 48 mortality of childhood. MULTIPLE CASES—NOT REPORTED. No. of Case Initials. Sex. Age. Yr. Date of Onset. Notes of attacks not reported. 1 F.M. M 6/12 2, x. F.M.'s brother (ætat. 3) reported to have had diarrhœa just previously to 2, x. 2 F.N. M 10/12 14, viii. E.C., f, 11/12, sickened with diarrhœa 15, viii. 3 W.B. M 3/12 18, x. Mother suffering from diarrhœa when Inspector called on 25, x. 4 M.M. F 1 21, x. History of father having had diarrhœa. 5 W.D. M 4/12 25, ix. A sister, ætat. 9, had diarrhœa 28, ix. 6 E.G. F 6/12 29, viii. An elder child had diarrhæa 5, ix., and E.G. a relapse on same day. 7 V.B. F 1 13, ix. Father of V.B. had diarrhœa, 8, ix. 8 L.W. F 1 24, viii. L.W. played with a child who died of diarrhœa on 17, viii. 9 F.P. m 1 11, viii. F.P.'s brother (ætat. 9) and mother had diarrhœa about 4, viii. 10 S.W. M 10/12 3, viii. An infant living on another floor of same house attacked at about 3, viii. 11 R.R. m 1 5, ix. R.R.'s mother had diarrhœa at same date. Three other persons (not R. family) also ill about same date. 12 H.W. M 8/12 30, ix. A child (ætat. 1) living in house had diarrhœa 27, ix. 13 W.B. M 1 12, ix. A child living on floor below W.B. had diarrhœa prior to 12, ix. 14 J.F. m 11/12 30, viii. Mother had diarrhœa 21, viii., and a sister (ætat 3) 22, viii. 15 E.W. m 2/12 9, x. Children of D. family in same house had diarrhœa prior to 9, x. 16 J.S. F 1 24, viii. G.S., m (ætat. 5), attacked 24, viii. 17 C.A. m 1/12 17, ix. E.E., f (ætat. 2), attacked 22, ix. 18 N.E. F 1 13, x. History of earlier case in another family living in the house. 19 T.P. M 2 27, ix. All children of P. family had diarrhæa prior to 27, ix. A child of F. family, the same house, sickened 4, x. 20 S.B. M 6 1, ix. E.B. had attack of diarrhæa 6, vii. 21 D.P. F 5 23, viii. L.P., f (ætat. 3), and W.P., f (æt. 7/12), had diarrhœa prior to 2, ix. (date of call by Inspector). 22 I.N. m 1 18, viii. Child from floor above, ill with diarrhœa, nursed by mother of I.N. in her rooms just prior to 18, viii. 23 F.W. M 1 12, viii. Mother and 3 children of family R. in same house had diarrhœa, 6, viii. 24 H.E. M 1 (?) 22, ix. A.E., m (ætat. 2), and B.E., m (ætat. 4) taken ill about same date. Mortality among Illegitimate Children.—Forty-five (45) illegitimate children, 12 of whom were non-residents, died at ages under five years in the Borough last year, one more than in 1908. Two (2) children belonging to Paddington died outside the Borough, making a nett total of 35 deaths (7 less than in 1908), 19 of the children being males and 16 females. Twenty-eight (28) of the children were under one year old. Calculated on the number of illegitimate births registered locally, last year's illegitimate infantile mortality was at the rate of 244 per 1,000 births, as compared with 214 in 1908, and a quinquennial mean rate of 246. The corresponding rates for legitimate children are—1909, 99; 1908, 105; and 1904-08,. 112. The fully corrected mortality was 250 per 1,000 births among illegitimate children and 95 among legitimate, the mean rates (1904-08) being 222 and 109 respectively. On the opposite page will be found particulars as to the mortality rates for the two sexes, occupations of the mothers, and causes of death. mortality of childhood. 49 Deaths of Illegitimate Children. 1909. (Corrected.) Ages (yrs.) Males. Females. Total. 0— 14 14 28 1— 5 2 7 5— — — Totals 19 16 35 Causes of Death. 1909. 0— 1—5 m. f. m. f. Measles 1 - 1 - Whooping Cough - - - 2 Diarrhœal Diseases 4 3 - - Enteritis 2 1 - - Premature Birth 2 2 - - Developmental Diseases 2 1 - - Tuberculous Diseases 1 - 1 - Convulsions - 1 - - Respiratory Diseases - 4 3 - Other Diseases 2 2 - - Infantile Mortality. Fully corrected. Males. Females. Persons. I. L. I. L. I. L. 1909 273 97 225 92 250 95 1904-08 248 121 195 96 222 109 I—Illegitimate. L—Legitimate. Occupations of Mothers. Domestic Service 20 Cook 3 "Servant" 9 Housemaid 5 General Servant 3 Other occupations— 11 Laundress 4 Shop Assistant 1 Dressmaker 2 Schoolmistress 1 Charwoman 2 Weaver 1 No occupation, occupation not stated 4 TABLE 37. Diarrhœa, 1909. Methods of Feeding. Months. Years. Totals. 0— 1— 3— 6- 9- 0— 1— 2- 3— M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. All notified cases. Breast 1 5 3 5 1 2 5 1 4 13 14 - - - - - - 13 14 Bottle - - - 4 3 6 8 3 4 6 15 19 7 1 - - - - 22 20 Breast and Bottle - - 2 1 - 1 3 1 8 2 13 5 5 6 - - - - 18 11 "Anything" - - — — — — — — 2 4 2 4 21 25 5 2 1 5 29 36 Fatal notified cases. Breast 1 - - - - - - - - - 1 - - - - - - - 1 Bottle - - - - 1 1 - - - 1 1 2 - 1 - - - - 1 3 Breast and Bottle - - - - - - - - - - - - - - - - - - - - "Anything" - - - - - - - - - - - - - - - - - - - - Deaths, not notified. Breast 1 - - - 1 - - - - - 2 - - 2 - - - - 2 2 Bottle 2 - 2 1 2 - 1 - - — 7 1 2 — - — - - 9 1 Breast and Bottle — - — 3 — 2 — 2 - 1 — 8 1 - - - - - 8 1 "Anything" - - — — — 1 — — - - — 1 - 1 - — - - — 2 Notes.—One f. aetat. 3 months notified with diarhœa died of simple enteritis. In 6 reports relating to deaths (not notified) the method of feeding was not stated, viz.: — Males—3, ætant 7 and 8 months and 1 year. Females—3 „ 1 and 4 months and 1 year. Infant Rearing (Health Visiting).—Last year 2,478 births were noted for visits, 1,284 being referred to the Paddington Health Society. In 381 instances the visits proved noneffective, 25 (one per cent.) by reason of the parents' refusal to receive the visitor, 38 through 50 mortality of childhood. death of the children before the visitor called, and 261 on account of removal or wrong address being given. From the 2,097 reports handed in, 97 have to be excluded on account of uncertainty in the most important detail—the manner of feeding of the children—thus leaving 2,000 effective reports, an increase of 44 above the total for 1908. During 1908 the Staff of the Department and the Health Visitor of the Society paid 3,727 visits. Last year the Staff of the Department made 1,498 visits, but the number of visits by the Society's Visitor cannot be given owing to changes in the appointment. Except in special cases, it is not desirable that the first visit should be made before the third week of the child's life, and it should not be delayed much after the fourth week. Last year 721 children were visited during those weeks, equal to 36 per cent. of the total, whereas in 1908 the percentage was 23'9. The number of children visited before reaching the age of one month was 914 (or 46 per cent.) last year, as compared with 578 (or 29.5 per cent.) in 1908. Although the proportion of late visits (those after an interval of a month) decreased from 70 per cent. in 1908 to 54 per cent. last Year, it is felt that there is still room for much improvement in the timing of the first visit. Method of Feeding. Age at first visit. At the Breast. Entirely by Hand. Mixed. Totals. Weeks. 0— 20 4 — 24 1— 157 9 3 169 2— 371 21 16 408 3— 274 18 21 313 Months. 0— 822 52 40 914 1— 327 52 36 415 2— 116 25 10 151 3—and over 267 93 60 420 Not stated 71 18 11 100 Totals 1,603 240 157 2,000 Per cent. of children visited 80 12 8 Feeding.—Of 1,480 children visited before reaching the age of three months, 1,265 were reported as being fed at the breast only, equal to 85 per cent., as compared with 81 per cent. in 1908. The increase in the proportion, though slight, may be considered satisfactory. During the third month of life—that is, at ages 2-3 months—76.8 per cent. of the children were similarly fed, or nearly 8 per cent. more than 1908 (69.2 per cent.). The total proportion of children artificially reared (by bottle) decreased from 17.2 per cent. in 1908 to 12 per cent. last year; but that of those on a mixed diet (breast supplemented by bottle, etc.) increased from 7 per cent. to 8 per cent. The proportions of children under three months of age so fed were 5.3 in 1908 and 5.8 last year. Other Conditions.—The state of health of the child visited was noted in 1,802 reports, being described as "good" in 1,563 instances (86.6 per cent. of all) and as "indifferent" in 239. Satisfactory home conditions were reported in 1,488 out of 1,548 homes concerning which any comment was made, equal to 93.9 per cent. of such homes. Family Histories.—Four hundred and twenty-one (421) of the children visited were first born, equal to 21 per cent. of ail the children visited. From information given by the parents it appeared that 4,360 children had been born alive in 1,312 families, that number being exclusive of the children visited during the year. In 443 families 808 children had died, nearly all in childhood. The average number of children per family, including those born mortality of childhood. 51 during the year was 4.3, while 33.0 per cent. of the families had lost children, the deaths being equivalent to a rate of 185 per 1,000. That figure does not represent an annual mortality, but the force of mortality spread over an unknown number of years. Mortality among Children visited.—Of the 2,478 children noted for visits during the year 194 were dead when these figures were put together, 110 of the deaths occurring among the 381 children who were not, and 83 among the 2,000 who were, visited. To mark the incompleteness of the mortality rates obtainable from the figures just given, it is desirable to style them fatality, and not mortality, rates. The total of 194 deaths may therefore be said to represent a fatality rate of 78 per 1,000 infants, the corresponding rates among the unvisited and visited infants being 289 and 42 respectively. Information as to the method of feeding of 15 of the infants visited was not available. Such deaths have in consequence been treated as occurring among breast-fed children, giving 54 deaths among such children (1,603), as compared with 14 among those entirely fed bv hand (240), and 15 among those on a mixed diet (157), Those numbers represent fatality rates of 33, 58 and 95 per 1,000 children respectively. Of the children visited during 1908 (1,956) 151 died before they attained the age of one year, giving an infantile mortality of 77 per l,000. There is such a remarkable difference between that rate and those reported among the children visited in 1907 and 1906 (viz., 42 and 47 per 1,000 respectively) that it is suspected that a change must have been made, quite unconsciously, in the collection of the data. There is some foundation for such suspicion in the fact that the total infantile mortality has decreased in each of the three years mentioned. The percentage distribution of the principal causes of death, according to the recorded method of feeding, brings out with great clearness the advantage of breast-feeding. (See below). It will be noted that among such children the greatest mortality is due to the "common infectious diseases" and "respiratorv diseases, "whereas among children who are artificially fed, either entirely so or in combination with the breast, "wasting diseases" and "diarrhœal diseases" prevail. Both the latter classes of disease may be said to be incidental to the method of rearing, except as regards premature birth and congenital defects, which causes of death are included in the group "wasting diseases." Children visited during Diseases. Breast. 1908 Artificial. Mixed. Breast. 1909 Artificial. Mixed. Common Infectious 21.6 3.5 - 30.7 7.1 6.6 Diarrhœal 8.3 14.3 10.0 5.1 21.4 26.6 Wasting 11.6 35.6 50.0 20.5 21.4 33.3 Tuberculous 10.0 — — 5.1 — 13.3 Respiratory 31.6 14.3 10.0 25.6 35.7 20.0 Infant Consultations.—The Health Society's Consultations were maintained in full activity during the past year, the attendances totaling 1,440. At the North Centre 135 children were in attendance, of whom 116 were newly admitted during the year. The 135 children attended 666 times. At the South Centre 168 children were seen, 139 being new cases, with a total attendance of 774, From personal observation it can be stated that the improvement manifested in many (apparently) hopeless cases has been very striking. There can be no doubt that the Consultations are of very great value. It should be added that medical treatment, in the usual sense of the words, is not given at the Consultations, only advice as to the best method of feeding and as to maternal care of the children. The deaths of 11 of the 52 mortality of childhood. 303 children attending the Consultations are known to have occurred, equal to a mortality of 36 per 1,000. It is believed that all the deaths have been traced, but it is not possible to be certain on the point. Mortality at ages One to Five Years. The total mortality at these was 13.87 per 1,000 persons last year, as compared with a mean rate of 16.17 for the five years 1904-08. The rate among males was 13.09 and that among females 14*14 as compared with mean rates of 17.23 and 15.00 respectively. Since 1904 the figures necessary to calculate the rates for each of the four years included in the group have been extracted. The rates for persons are given below in comparison with the quinquennial means (except at ages 4-5, where the mean is for four years only). Mortality Rates Ages. 1— 2— 3— 4-5 1909 26.43 11.90 6.08 6.53 (1904-08) (1905-08) Mean Rates 31.03 12.42 8.23 4.77 The corresponding rates recorded in the Wards cannot be ascertained prior to 1906 the year following the receipt of the first returns of registration of births. It is useless, at present, to determine any mean rates and the annual figures for the years at present available are therefore set out in Table 38. The principal causes of death at these ages are given in Table 39. TABLE 38. Mortality Rates: One to Five Years. Per 1,000 Survivors. Locality. 1— 2— 3— 4—5 1909 1908. 1907. 1906. 1909. 1908. 1907. 1909. 1908. 1909. m. F. m. F. m. F. m. f. m. f. m. F. m. F. m. F. m. F. m. F. Borough 28.3 23.8 30.4 25.6 44.0 29.0 26.6 24.9 8.5 15.3 14.4 8.0 16.8 17.7 5.5 6.5 7.8 13.0 5.0 8.0 Queen's Park 24.8 9.3 32.7 22.7 46.0 45.2 16.3 36.2 9.6 17.4 19.3 5.2 11.1 10.7 — — 5.5 5.4 11.5 10.9 Harrow Road 10.0 13.1 23.2 21.7 30.3 15.5 16.4 30.6 5.9 8.3 7.8 7.8 16.7 20.1 2.6 — 8.4 14.6 5.7 8.9 Maida Vale 30.9 34.8 40.0 16.8 65.5 9.9 32.9 5.2 10.4 11.4 17.5 5.0 11.3 21.1 5.9 10.1 — 21.6 — — Westbourne 44.2 17.4 29.7 36.5 38.6 41.8 25.9 9.0 5.1 9.4 10.0 5.4 22.2 9.0 10.1 10.9 18.1 18.3 — — Church 50.1 50.3 31.9 36.9 60.7 44.2 47.3 45.0 15.0 35.1 23.5 14.2 12.4 30.3 12.0 14.4 9.4 10.4 9.5 17.5 Lancaster Gate, West - - 27.0 - 33.3 - - - - - - - - - - - - - - - „ East 37.1 - 35.7 - 31.2 - 21.2 - - - - - 21.7 - - 30.3 - - - - Hyde Park — 13.3 25.9 12.0 10.4 39.0 11.4 10.7 - — 10.5 13.5 46.5 10.8 - - - 10.9 - 11.1 The mortality at these ages fluctuates very much from year to year, depending largely on the periodic return of measles and whooping cough. The data available at present have been collated for so few years that it would be useless to speculate on the meaning of the changes. It must suffice to note that it is satisfactory to find that the rates for three out of four ages were lower last year than the mean rates. inquests. 53 TABLE 39. Causes of Death One to Five Years. Cause of Death. Ages (Years). 1— 2— 3— 4—5 1909. 1904-08. 1909. 1904-08. 1909. 1904-08. 1909. 1905-08. Smallpox - - - - - 0 - - Measles 19 15 5 5 1 3 1 2 Scarlet Fever 4 1 1 2 — 3 4 1 Whooping Cough 8 9 3 3 5 2 2 1 Diphtheria - 2 2 3 3 2 1 1 Diarrhœa 9 12 — 1 - 1 - - Influenza 1 1 1 1 - - - 0 Syphilis 1 — — 0 - - - — Rickets 1 2 - — - - - - Tuberculous Diseases 7 8 7 5 2 3 4 3 Congenital Malformations 1 0 — — — — — — Convulsions 2 2 1 1 - 1 - - Respiratory Diseases 20 27 10 8 2 2 3 2 Dentition — — — 1 - - - - Gastro-Enteritis — 1 — - - 1 - 0 Accident, Violence 1 2 1 2 3 3 - 2 Atrophy, Debility — 1 — 0 — — — — Other Causes 3 7 2 4 1 3 3 2 All Causes 77 92 33 36 17 24 18 14 Estimated Living 2,948 2,956 2,772 2,892 2,792 2,873 2,755 2,873 A commencement has been made to collate similar figures for the special insulœ and the results so far obtained are given below for the sake of record. Except to call attention to differences in the rates for the Borough and for the insulœ, to the disadvantage of the latter, no comment can be made with reference to the figures in question. Mortality Rates in Combined Insulœ. Ages. 1 2 3-4 1907 1908 1909 1908 1909 1909 Males 52 35 53 21 14 9 Females 24 28 39 6 29 13 Persons 38 31 46 14 21 11 INQUESTS. There were 198 deaths during the year which formed the subjects of Coroners' inquests, as compared with 227 in the previous year, and a quinquennial average of 166. Sixty-seven (67) of the deceased persons were non-residents, while in other parts of the Metropolis 20 54 deaths in institutions. inquests were held with reference to deaths of parishioners. The nett total of deaths of residents certified after Coroner's inquisition was 152, 37 less than in 1908, and equal to 7*7 per cent. of the corrected total of deaths during the year, as compared with a mean proportion of 8.4 during the preceding quinquennium. A classification of the findings of the juries is given in Table 40, last year's numbers being compared with the averages for the five years 1904-08. There were fewer findings of "natural'' and "accidental" causes, but more of "misadventure" and "neglect." The number of deaths from "suicide" increased from an average of 14 to 21 last year. TABLE 40. Inquests Held. 1909. 1904-08. Males. Females. Males. Females. Natural Causes 38 32 41 43 By Misadventure 8 4 4 3 Accidental Causes 21 15 31 23 Murder — 1 1 0 Suicide 11 10 10 4 "Open" 4 — 2 2 "Neglect" 3 3 1 1 Execution 2 — - - The deaths inquired into included 3 which are classed under "alcoholism," 2 under "injury at birth," and 1 from food poisoning. The deaths by accident and violence comprised 13 from vehicular traffic; 2 accidental to building operations; 6 from burns and scalds; 4 from poisons of various descriptions; 4 by drowning; 5 by overlaying; 5 from suffocation through other agencies; 8 through falls; and 5 from other accidents. The 21 suicides were effected by poison in 7 cases; by suffocation (mostly coal gas) in 3; by shooting in 1; by knife (razor) in 4; by precipitation in 4; and by crushing in 1. DEATHS IN INSTITUTIONS. In 1907 there were 770 deaths in the local public institutions; in 1908, 815; and last year, 813. The deaths in each of these institutions during the past year exceeded the annual average for the preceding ten years. (See Table V., Appendix.) The causes of deaths are given in Table VI., Appendix, with the numbers of non-residents in each case. The total deaths of non-residents was 352, and of residents in out-lying institutions, 193, so that the nett total of deaths of residents in institutions was 628, or 34 less than the number in 1908, and equal to 31.9 per cent. of the corrected total of deaths during the year. In 1908 the proportion was 35 per cent., and the mean proportion for the five years 1904-08, 31.6 per cent. The proportions of institutional to all deaths in the Wards are given below in comparison with the mean proportions. The only Ward in which there was a material decrease in the proportion was Lancaster Gate, West. In four Wards there were increased proportions, that in Queen's Park (9.2 per cent.) being the greatest. Percentages of all Deaths of Residents. 1909 1904-08 1909 1904-08 Queen's Park 39.5 30.4 Church 20.5 40.3 Harrow Road 29.0 29.9 Lancaster Gate, West 43.1 21.6 Maida Vale 27.0 27.7 „ „ East 25.7 22.5 Westbourne 33.6 30.8 Hyde Park 24.2 26.8 administrative work. 55 Distributing the deaths according to the characters of the institutions (see below) it appears that there was a slight decrease in the proportion of deaths in the Hospitals of the Metropolitan Asylums Board, and increases in all others. The increase in Voluntary Institutions was nearly 10 per cent. Deaths Percentages of all Deaths (corrected) Kate maintained— 1909. 1909. 1904-08. Hospitals of Metropolitan Asylums Board 25 1.2 1.3 Poor Law Institutions and Infirmaries 356 18.1 17.3 Lunatic Asylums 57 2.9 2.4 Supported by Voluntary Contributions— Hospitals and Homes (excluding Nursing Homes) 216 11.0 10.5 ADMINISTRATIVE WORK* Prevention of Infectious Disease.—The calls made by the Staff with reference to all kinds of infectious disease, numbered 6,325 last year, as compared with 6,712 in 1908, and 5,734 in 1907. The District Inspectors made 3,010 calls with reference to diseases formally notified, except puerperal fever, as compared with 2,747 in the previous year, and the Women Inspectors and Students, 3,315 (3,965 in 1908) calls with reference to puerperal fever and diseases not on the schedule for notification. In 1907 the latter made 3,292 calls. Last year's calls by the Women Inspectors related to— Measles 1,005 (1,285) Chicken-pox 285 (202) Whooping Cough 479(163) Diarrhœa 546 (1,188) Consumption 991 (1,119) Puerperal Fever 9(8) (Italic figures—records for 1908.) The total number of visits of all kinds by the whole Staff in each quarter of the past three years is given below— Quarters 1st 2nd 3rd 4th 1909 1,539 1,905 1,488 1,393 1908 1,440 1,509 1,901 1,862 1907 1,411 1,590 1,223 1,510 The number of patients removed to hospital for isolation and treatment, was 797 last year, against 821 in 1908, and 694 in 1907. "Letters of Advice," covering extracts from Public Health (London) Act, 1891, and the Factory and Workshop Act, 1901, with memoranda of precautions requisite to prevent the spread of infection, were sent out with reference to 41 patients who were treated at home, the number of such letters having been 46 in 1908, and 55 in 1907. In addition, 1 special communication was addressed to a midwife in charge of a case of puerperal fever, as compared with 3 in the preceding year, and 6 in 1907. Disinfection.—The disinfection of rooms occupied by persons suffering with infectious disease is carried out by the Department, the formaldehyde spray being used. The rooms dealt with during the year numbered 2,351 (including 227 after consumption), as compared with 2,223 in 1908, and 2,552 in 1907. In 10 instances the necessary disinfection was done privately, the efficiency of the processes employed being duly certified by the attendant practitioners. * Table 41 summarises the work of the District Inspectors not specially dealt with in the following paragraphs. 56 administrative work. TABLE 41. Report of the Work of the District Inspectors during the year 1909. Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Drainage, &c. Water Supply. Dust Receptacles. Miscellaneous. Quarters. No. of Complaints received. "House-to-House." On Complaint or after Illness. Cellar Dwellings. Re-inspection of all kinds. Entire Reconstruction. Drains Relaid, Trapped, or Ventilated. Waste Pipes Disconnected. Rain-water Pipes Disconnected. W.C's., New Provided, Repaired, &c. Soil Pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New, Provided. Cisterns Cleansed, Repaired, &c. Cistern Overflows Disconnected. New, Provided. Repaired, &c. Drains Cleared, Flushed, &c. Houses or Rooms Cleansed, Whitewashed, &c. Cases of Overcrowding Abated. Cellar Dwellings Closed. Yards and Areas Paved and Drained. Manure Receptacles Reconstructed, &c. Accumulations Removed. Improperly-kept Removed. First 116 178 573 - 4,265 101 45 35 24 89 33 4 3 25 - 29 5 14 22 3 14 13 Second 157 90 529 - 4,628 117 32 63 34 139 42 9 3 1 45 1 17 13 26 39 — - 27 2 24 2 Third 140 52 543 - 3,936 102 42 68 29 142 40 6 - 1 34 — 15 7 17 29 2 - 12 6 12 — Fourth 125 109 446 - 3,648 88 27 63 24 113 29 6 2 - 25 — 18 11 11 44 3 — 19 — 7 2 Year 538 429 2,091 — 16,477 408 146 229 111 483 144 25 8 2 129 1 79 36 68 134 8 — 72 8 56 4 administrative work. 57 The popular use of disinfectants is held to be of little value and far less efficient than "domestic cleansing," hence the distribution of disinfectants by the Department has for some years been of insignificant dimensions. To encourage cleanliness small quantities of chloride of lime and a fair amount of carbolic soap are issued. The expenditure for disinfectants last year amounted to about 12 guineas, say one-fourth of what it was ten or twelve years ago, that amount including the cost of the formaldehyde used for spraying rooms. The disinfection of bedding, personal clothing, etc., is still carried out under contract by Messrs. Armfield. The goods removed during the past year weighed 54¼ tons, as compared with 53¼ tons in 1908, 48½ tons in 1907, and 56 in 1906. The cost of the work amounted to £1,106 last year, £1,082 in 1908, £1,087 in 1907, and £1,148 in 1906. Complaints of any description are rare, only 12 (none of any importance) being received during the past year. All complaints were promptly remedied by the Contractors. In Annual Report for 1908 mention was made of a scheme for the erection of a disinfec tion station, to be used and owned jointly bv the Councils of the Boroughs of Kensington anil Paddington, came to no result. In the meantime the site selected by the Council, for the purchase of which a loan was required and applied for, was disposed of. At the close of 1909 the Council were in the same position as in 1907, that is, had agreed to erect a disinfection station, but had not secured a suitable site. Water Supply.—There was a slight decrease in the number of notices of discontinuance of water supply, from 88 in 1908 to 84 last year. In 1907 the notices numbered 81. The Inspectors reported the cutting off to be due to— Empty premises 67 Unpaid rates, etc. 5 Defective fittings 9 Premises in course of demolition 3 Notices demanding restoration of the supply were served with respect to 9 houses, and one summons was issued. Three of the fourteen inhabited houses were subsequently vacated, while the water was restored to 11 after the following intervals— 1 day 1 house 4 days 3 houses 2 days 2 houses 5 ,, 1 house 3 „ 1 house 7 „ 3 houses Mortuaries.—During the year 288 bodies were deposited at the Mortuaries, 4 less than in 1908. (See below.) Paddington Green. Kensal Road. Number of bodies deposited 271 17 Coroners' cases 191 17 Awaiting burial:— Infectious 2 - Non-infectious 78 - P.M. examinations made 90 17 No proceedings have been necessary under the By-laws relating to the Mortuaries. Schools.—In Table 43 will be found an analysis of the incidence of cases of infectious diseases among scholars attending the local Public Elementary Schools—cases in the persons of scholars being given under the "P.A." columns, those among other members of the scholars' families, under the "P.N.A." columns. Cases occurring in the adjacent districts in 58 administrative work. connection with local schools ("N.R." columns) could not be distinguished in that manner. A new system of co-operation was agreed to between the Medical Officers of Health of Kensington, Marylebone, Hampstead, and Willesden (the districts whence children attend local schools), and this Borough, whereby a more complete record of school incidence will be secured, the cases being dealt with by class-rooms and not by the schools as a whole. TABLE 42. Notified Diseases. Non-notified Diseases. Scarlet Fever. Diphtheria. Measles. Chicken Pox. Whooping Cough. p.a. p.n.a. n.r. p.a. p.n.a. n.r. Provided — ' Amberley Road 32 7 - 5 2 1 35 24 55 Beethoven Street 21 5 3 3 ... ... 37 26 32 Campbell Street 11 5 ... 2 3 ... 14 6 22 Droop Street 16 3 1 2 3 ... 3 8 6 Essendine Road 24 5 1 7 2 ... 22 42 41 Harrow Road 30 13 2 3 6 2 27 28 14 Kilburn Lane 11 ... 10 6 1 ... 1 15 26 Royal Oak 17 2 ... 1 ... ... 19 7 5 Saltram Crescent (Tech.Instit.) ... ... ... ... ... ... ... ... 3 Non-Provided— Bayswater Jewish 2 1 ... 3 ... 2 2 2 ... Desborough Street (R.C.) 15 1 ... 4 1 ... 6 4 15 Holy Trinity 12 ... ... 11 1 ... 21 4 1 St. Augustine 1 ... 19 ... ... 4 9 1 3 St. James 4 2 ... 5 ... ... 2 1 ... St. John, Kilburn Lane ... ... 2 ... ... ... ... ... 1 St. John, Titchborne Street 4 ... ... 4 ... ... 6 15 21 St. Luke 8 2 4 2 ... ... 12 2 13 St. Mary 2 2 1 1 ... ... ... ... ... St. Mary of the Angels (R.C.) 1 ... 4 ... ... 1 2 1 5 St. Mary Magdalene 9 1 ... 2 ... ... ... 2 1 St. Matthew 11 2 2 1 ... ... 24 1 1 St. Michael, Star Street 31 7 3 2 ... ... ... 4 13 Do. Westmoreland Rd. 2 ... ... ... ... ... ... ... ... St. Paul 26 8 1 3 2 ... 12 11 18 St. Peter 25 4 1 6 2 ... 6 3 2 St. Saviour 4 1 ... 1 1 ... 3 15 4 St. Stephen 11 5 1 3 2 ... 51 5 1 Wilberforce 13 3 1 2 ... 1 2 14 20 Others— St. Hilda ... ... 4 1 ... 1 ... ... ... Westbourne 4 ... 2 ... ... 1 1 ... ... Woodfield ... ... ... ... ... ... 11 ... ... P.A.—Patient a scholar of the school. P.N.A.—Patient not a scholar. N.R.—Patient resident beyond Borough: not known whether scholar or not. The notices issued for the exclusion of children from school, numbered 2,430 last year, as compared with 1,883 in 1908, and 2,238 in 1907. Owing to different practice as to sending notices to re-admit after cases of the non-notified diseases, the numbers of exclusion and re-admission notices with respect to those diseases do not balance. The complete figures for the last two years (those for 1908 in italics), are given below:— In connection Notices Issued. with Exclusion. . Re-admission. Notified diseases 1,070 (1,083) 1,070 (1,083) Other diseases 1,360 (800) 447 (502) administrative work. 59 During nearly the whole of the year scarlet fever was a source of much anxiety and the subject of frequent consultation with the Medical Officer (School) of the County. The bare numbers of cases given in Table 42 give an unsatisfactory statement of the facts, owing to the varying sizes of the schools, and to there being only a yearly total number of cases. To give the full details would take up far more space than can be spared for the subject. It may be stated that at St. Michael's (Star Street), Holy Trinity, and St. Paul's Schools the cases were so distributed, both in time and in classes, as to suggest definite school infection. Complete closure of two departments of the first named school was resorted to, but as regards the other two—and certain other schools in the Borough—inspection of the children in the schools and exclusion of doubtful cases sufficed to keep the disease fairly well under control. The exclusion of unprotected children is now regarded as a matter of routine following on the report of the first case of measles in any class room in the infant department of a school. Closure of classes or departments of schools was resorted to on 8 occasions last year, 13 less than in 1908. In addition there were 35 cases of exclusion of "unprotected children" from classes in which cases of measles occurred. All closures and exclusions were effected by the Medical Officer (Education) of the County, at the request of the Medical Officer of Health of the Borough, such procedure ensuring promptitude of action, a most essential part of such closure. School Closures. School. Class-room. Closure. Disease. Date of. Duration of. St. Augustine's (Infants') E and F Mar. 26th 14 days Measles. „ „ All rooms Apr. 8th 18 „ „ Moberly (Harrow Rd.) „ „ June 10th 1 day Scarlet Fever. St. Michael's, Star St. „ „ „ 17th 21 days „ „ ,, (Girls') „ „ „ „ „ St. Matthew's (Infants') I. and II. Sept. 13th 4 days Measles. Holy Trinity „ I. „ 29th 12 „ Scarlet Fever. St. Mary of the Angels (Infants') C Dec. 16th 4 „ Measles. "Unprotected" Children Excluded. School. Class-room. Exclusion. Disease. Date of. Duration of. St. Peter's (Infants') B and D Jan. 25th 4 days Measles. „ B June 28th 4 „ „ Essendine Road „ B Jan. 25th 4 „ „ „ „ B May 11th 6 „ „ „ „ A June 23rd 2 „ „ St. Luke's „ 3 Feb. 12th 7 „ „ „ „ 2 and 3 May 12th 8 „ „ Beethoven Street (Infants') A Mar. 1st 12 „ „ „ „ B „ 11th 8 „ „ Holy Trinity „ 2 „ 29th 4 „ „ Moberly (Harrow Road) „ E Apr. 4th 6 „ „ „ „ D ,, 30th 7 „ „ „ „ F May 11th 6 „ „ „ „ F June 10th 8 „ „ „ „ E „ „ 4 „ „ „ „ E July 6th 7 „ „ Our Lady of Dolours (Desborough Street) „ B Apr. 30th 7 „ „ 60 administrative work. "Unprotected" Children Excluded—continued. School. Class-room. Exclusion. Disease. Date of. Duration of. Amberley Road (Infants') C May 4th 10 days Measles. „ „ D „ 13th 7 „ „ „ „ B „ „ 8 „ „ „ „ A „ 18th 8 „ „ „ „ B Nov 1st 4 „ „ St. Paul's „ G May 17 th 4 „ „ „ „ „ June 16th 9 „ „ „ „ „ July 8th 8 „ „ Campbell Street „ D May 20th 8 „ „ „ „ „ June 14th 8 „ „ St. Saviour's „ 1 and 2 „ 7th 4 „ „ St Michael's „ C „ 10th 8 „ „ St. Augustine's „ F „ 18th 7 ,, „ Bayswater Jewish „ All rooms July 12th 10 „ „ St. Matthew's „ III. Sept. 20th 7 „ „ „ „ I. and II. „ 27th 4 „ „ St Stephen's „ B Oct. 22nd 7 „ „ St. John's, „ I Dec. 20th 4 „ „ Internotification.—Duplicate notices relating to non-resident patients attending local schools, are received from the Medical Officers of Health of the circumjacent districts, similar information relating to their schools being forwarded to them. The numbers of cases of scarlet fever and diphtheria so reported are given in Table 35 ("N.R." cols.). A complete list of the 123 notices received from Kensington, Hampstead, Willesden, and Marylebone is given below:— Kensington. Willesden. Hampstead. Marylebone. Scarlet fever 20 66 9 4 Diphtheria 9 6 2 - Enteric fever 1 - - - Measles — 2 - - Whooping Cough — 1 - - Chickenpox — 2 - - Cerebro-Spinal Fever 1 - - - 31 77 11 4 Bacteriological Examinations.—The specimens received during the year numbered 177 (see below), as compared with 137 in 1908, 135 in 1907, 127 in 1906, and 61 in 1905. Positive results were obtained in 51 instances (22.0 per cent.), the percentages in 1908, 1907 and 1906 having been 41.6, 42.2 and 32.2 respectively. The increase in specimens of sputum is satisfactory from an administrative point of view. No. of specimens received. Results. Positive. Negative. Diphtheria 122 37 85 Enteric fever 27 7 20 "Consumption" 26 7 19 Cerebro-Spinal Meningitis 2 — 2 Totals 177 51 126 administrative work. 61 Offensive Refuse: Trade Refuse.—The distinction between "trade" and "domestic" (house) refuse is now so fine that it is difficult to say what "trade" refuse really is. The waste stuffs from fishmongers', greengrocers' and other shops, which are generally in a more or less offensive state, are here dealt with as "trade " refuse. Some of such refuse is removed by the Council, the bulk, by the contractors engaged by the producers of the refuse. Daily removal by the Council would, it is believed, be the most satisfactory method of getting rid of this class of refuse. Complaints arising from offensive offal are, however, comparatively rare, only 9 being received during the year, viz.: five relating to offal at fishmongers' premises, and one each, at a butcher's and a greengrocer's. Periodical visits by the Inspectors is found to be the best means of dealing with the causes of complaint. One complaint was lodged with reference to a canal boat in transit, and one of offal on some waste land. Manure.—The usual notices were posted throughout the Borough during May, the Inspectors being instructed to keep a close inspection of stable premises. Fourteen complaints were received during the year, such complaints arising more from the removal (of peat moss litter) rather than the non-removal of manure. House Refuse.—During the year 86 complaints were addressed to the Department relating to irregularity or (more frequently) insufficiently frequent removal of house refuse. Such complaints were investigated by the Department and after 33 of the complaints a second collection was recommended to be made each week, at the cost of the Council, in accordance with the resolution of the Works Committee of 27th October, 1908. Drainage Work.—The reconstructions of drainage of existing premises during the past year numbered 554, the numbers in the preceding years having been 605 in 1908, 584 in 1907, 696 in 1906 and 669 in 1905. In addition to the drains reconstructed to stand the water test, 97 others of earlier construction were so tested and found sound. Queen's Park Estate.—The reconstruction of the combined drainage on the Estate is still in progress the drainage of 153 houses having been dealt with during the year. Altogether 1,453 houses on the Estate have been re-drained since the work was commenced in 1902. The systems for the following blocks were dealt with during the past year. Nos. 2-72, Oliphant Street Nos. 201-263, Droop Street Nos. 142-156, Ilbert Street Commenced in 1908 Nos. 9-23, Third Avenue Nos. 1-53, Farrant Street Nos. 2-54, Enbrook Street Nos. 26-40, Fourth Avenue Nos. 1-39, Enbrook Street Nos. 10-24, Fourth Avenue Nos. 2-40, Droop Street Nos. 2-48, Galton Street Nos. 9-57, Fourth Avenue Nos. 42-48, Droop Street Nos. 69-79, Ilbert Street Nos. 1-67, Ilbert Street Nos. 2-64, Farrant Street Nos. 25-39, Third Avenue Nos. 50-56, Droop Street Nos. 1-47, Galton Street Nos. 10-66, Fifth Avenue Nos. 85-91, Ilbert Street Nos. 100-114, Fifth Avenue Nos. 1-85, Marne Street Nos. 2-90, Lothrop Street Nos. 71-85, Third Avenue Not completed at close of 1909 Of 62 drains on the Estate specially tested after infectious illness, 10 proved defective, 45 had been recently relaid, and, with 7 old drains, gave negative results. Complaints led to the testing of 14 other drains, 8 proving to be defective. 62 administrative work. The administrative work relating to the deposit of plans and notices for reconstruction of drainage, is in the hands of the Department. The notices received during the year numbered 367, involving the despatch of 728 letters and communications. Proceedings with reference to infringements of the by-laws, relating to the deposit of plans, were necessary in 6 instances, as compared with 11 in 1908. Since the by-laws relating to the deposit of plans and notices in pursuance of Sec. 202 of the Metropolis Management Act 1855 were introduced, the builder or contractor has been, until last year, deemed to be the person responsible for the sending in of those documents. The decision given on appeal in Kershaw v. Brooks on the 8th February last, throws that responsibility on the person who actually gives the order for the work to be done. Amendment of the by-laws was suggested by the Hampstead Borough Council to restore the original practice, but the proposal did not meet with approval. It was thought that the fact of "owners" and not "builders" being liable to penalties for not giving notices and depositing plans, would result in more complete notification of works and the deposit of better plans. Experience has confirmed that view. Combined Drainage.—Apart from the Queen's Park Estate 12 defective combined systems were discovered and reconstructed during the year—eleven by the Council and one by the owners. (See below). Reconstructed by Council. Nos. 3, 4, 5 and 6, Orme Square and Nos. 45 to 58, Porchester Gardens Mews. No. 44a, Bark Place. Nos. 215 and 217, Edgware Road. Nos. 55, 57 and 59, Richmond Road. Nos. 24 to 58, Alfred Road. Nos. 5, 7 and 9, Portsdown Road. Nos. 13 and 15a Connaught Street. No. 3, Lanark Place and No. 24 Clarendon Nos. 49 and 51, Talbot Road. Terrace. Nos. 30 to 40, Courtnell Street. Nos. 5, 6 and 7, Warwick Crescent. Reconstructed by Owners. Nos. 11 to 19, Westbourne Park Road. Five new systems of combined drainage were sanctioned by the Council under Sec. 74 of the Metropolis Management Act, 1855, viz.:— Nos. 1 to 110, Wymering Mansions. No. 558, Harrow Road. Nos. 3 and 4, Tamplin Mews. Nos. 23, 25 and 27, Formosa Street. Nos. 2 and 4, Woodfield Road. Smoke Prevention.—Twenty-four (24) premises (see opposite) were under observation during the past year, the total time of watching being 118 hours. In 1908, 28 premises were under observation for 149 hours. The emissions of "black" smoke observed amounted to a total of 50 minutes last year, as compared with 59 minutes in 1908. Other shades of smokes were recorded with a total emission of 81¼ hours, as compared with 110.2 in the preceding year. The appended comparative statement of the proportions of "black smoke," "smoke," and "no smoke," shows clearly the improvement which has taken place in the Borough, and at the same time affords evidence of the need of legislation to control the emission of "smoke." In 100 hours' observations. 1909 1908 1907 1906 1905 1904 "Smoke" 69 74 65 67 79 82 "Black Smoke" 0.5 0.6 1.2 1.7 3.4 5.3 No Smoke 30.5 25.3 33.3 31.3 17.6 12.7 administrative work. 63 Six complaints of smoke nuisance were received during the year, two from factory laundries, and one each from a bakehouse, ironworks, a brewery and a restaurant. The records of the observations made by the Department indicate that while there has been a notable diminution in the production of " black " smoke, too much smoke of other shades (densities) is allowed to escape. It is satisfactory to record that the County Council have given notice of their intention to promote legislation during the current year to strengthen the law relating to smoke nuisance. The principal amendment proposed is the deletion of the qualification "black" thus making the emission of any smoke (in excessive quantity) a nuisance. 1909. Smoke Observations. Address. Business. Chimney Shaft of 27, Beethoven Street Factory Laundry Steam Boiler 29, „ „ „ „ „ „ 8, Bishop's Road Refreshment Rooms Kitchen Stove — Braden Street L.C.C. New Sewerage Works Warming Stove 16, Craven Terrace Bakehouse Baker's Oven — Eastbourne Terrace Dining Club Kitchen Stove and Steam Boiler 75-7, Edgware Road Restaurant „ „ 189, „ „ Bakehouse Baker's Ovens 377, „ „ „ „ „ 401, „ „ „ „ „ — Goods Yard, G.W.R. Hydraulic Works Steam Boilers 76-8, Herries Street Factory Laundry „ „ 90, „„ „ „ „ „ — London Street Station Works Travelling Crane 7, North Wharf Refuse Destructor Destructor 18-19, „ „ Iron Works Furnace — Praed Street Hotel Kitchen Stove 25, Queen's Road Restaurant „ „ 70-2, „ „ Bakehouse Baker's Ovens 80, „ „ „ „ „ 120, Shirland Road Dairy Steam Boilers 8, South Wharf Builder's Merchant Travelling Crane 3, Spring Street Bakehouse Baker's Ovens 33, Westbourne Grove General Stores Steam Boilers Canals, Wharves—On the retirement of Inspector Biorn in September of last year, the supervision of the canal traffic was passed on to Inspector Potter. The wharves round the Basin are visited at least once a week throughout the year and at more frequent intervals as the season or other cause demands. The Basin was run off at Easter, when some 600 tons of mud and refuse were cleared away and repairs to the bottom (concrete) and walls carried out. The one clearance was sufficient as the weather during the summer was too cool to affect the water. Two complaints were received during the year with reference to the traffic, one relating to barges held up during the Easter cleansing—the boats had been moved on by the Department before the complaint was received—and one to smells arising in the course of loading a barge, fish offal having been mixed with the manure before it was brought to the wharf. On the 1st April of last year one of the Dust Contractors to the Willesden U.D.C. commenced to load barges with house refuse from a vacant strip of land lying between Hormead Road and the Grand Junction Canal. Complaints of smells and dust from the wharf 64 workshop supervision. were received from the beginning of the operations. A report on the case was submitted to the Public Health Committee under date of 20th of the same month, in which an opinion was given as to the total unsuitability of the place for the purpose. Proceedings were instituted against the Contractor under Section 21 of the Public Health (London) Act, 1891, which, although without any decided result (that is, a conviction) were effective in securing the erection of a high fence between the wharf and the road, and the exercise of much care to obviate nuisance. The summer weather proving somewhat unseasonable, the nuisance due to smells and flies which was anticipated was comparatively slight.* Canal Boats.—Inspector Potter was appointed to succeed Inspector Biorn as Inspector of Canal Boats on the latter's retirement in September of last vear. The annual report of the Examiner of Canal Boats was submitted to the Council, and forwarded to the Local Government Board at the end of January. There were a few trifling breaches of the Act, which were all remedied. No legal proceedings were necessary. The number of boats at present on the Register is 150, 49 boats having been struck off. Of the 150 only 37 can at present be traced but the remaining 113 are kept on the Register pending further enquiries. One case of erysipelas (f., aetat. 8) but no deaths occurred among the occupants of the boats. WORKSHOP SUPERVISION. This subject is dealt with in pursuance of Section 132 of the Factory and Workshop Act, 1901, which requires the Medical Officer of Health to "report specifically" on the adminstration of the Act within his district. The Home Office issues a memorandum on the subjects to be included in such report. In addition to the tables prepared by the Department, which are included in the text, a special form is required by the Home Office, which will be found in the Appendix (Table VIII). Registration.—To the Registers of the Department, which contained 1,532 premises at the close of 1908, there were added 230 premises during 1909, and 74 premises were removed, leaving 1,688 effective entries at the close of last year, a nett increase of 156. The premises then on the Registers, included 149 factories, 979 workshops, 25 domestic workshops, 69 workplaces, and 466 premises occupied by "single workers," 306 of the last being included in the Register of Outworkers' premises. Table 43 gives an analysis of the businesses, and an approximation of the numbers of employees, the figures relating to homeworkers being shown in parentheses. The Home Office forwarded to the Department 53 notices relating to the opening of new workshops, 32 of which had, however, been previously inspected by the Staff of the Department. Home Work.—Employers of homeworkers (outworkers) forwarded 96 lists in February and 81 in August of last year, making a total of 177, as compared with 150 in 1908 and 101 in 1907. The addresses included in the returns numbered 716, of which 426 had to be forwarded to other districts in accordance with the Act. From other districts 309 (359 in 1908) addresses (contained in 57 lists) were received. (See next page). *The use of the "wharf" was discontinued at the end of March of the current year, the Contract not being renewed on its termination. workshop supervision. 65 Kensington 7(5) London County Chelsea 3(2) Hampstead 10(10) Council 1(2) Lambeth 3(1) Westminster 6(5) Willesden 3(8) Holborn 1(2) Finsbury 6(4) Hammersmith 3(1) Chiswick 1(0) City of London 7(9) Marylebone 3(3) Islington 1(1) St. Pancras 2(0) Note.—Figures in parentheses are the numbers for 1908. TABLE 43. Factories, Workshops, and Work-places. 1909. Business. No. of Premises. No. of Rooms. Employees. Women. Young Persons. Men. Totals. Clothing— Boot-making 163(89) 164(89) 11(7) 6(3) 256(102) 273(112) Corset-making 8 11 29 3 — 32 Dressmaking 477(82) 661(90) 1,879(178) 364(43) 19(1) 2,262(222) Mantle-making 14(9) 19(12) 48(19) 1 — 49(19) Millinery 48(5) 69(3) 272(5) 27 — 299(5) Millinery and Dressmaking 21 55 391 73 - 464 Outfitting and Plain Needlework 41(26) 44(27) 136(57) 9(2) 145(59) Tailoring 240(167) 250(179) 183(112) 15(6) 256(185) 454(303) „ Ladies' 17(3) 34(6) 134(3) 16(3) 43(3) 193(9) Various 10(7) 10(7) 19(7) — 1 20(7) Fancy Work— Embroidery and Art Needlework 15(8) 18(9) 47(17) 7(1) 7(1) 61(19) Cleansing— Dyers and Cleaners' Receiving Offices 16 16 34 6 1 41 Laundries 114(8) 378(8) 1,071(9) 18 128 1,217(9) ,, —Receiving Offices 40 40 49 3 1 53 Mangling 19(1) 19(1) 19(1) — — 19(1) Various 4(1) 4(1) 9(1) 1 1 11(1) Other Businesses— Blind-making 6 8 5 1 27 33 Bookbinding and Printing 43 66 99 15 343 457 Carpentry and Joinery 27 44 — 22 238 260 Chaff-cutting 18 22 - - 61 61 Coach Building 51 82 — — 333 333 Cycle and Motor Making and Repairing 34 53 - 8 136 144 Florists 10 11 45 1 4 50 Jewellery and Clock-making. 8 9 — 2 22 24 Metal-working 35 40 — 1 142 143 Saddlery 13 15 — 1 46 47 Sign and Ticket Writing 8 8 3 7 17 27 Trunk-making 11 14 — — 40 40 Umbrella-making 8 9 13 — 11 24 Undertaking 11(2) 17(4) 1(1) — 22 23 Upholstery 59(24) 88(27) 105(33) 20(4) 170(4) 295(41) Various 99(4) 143(4) 198(5) 114 684 996(5) 1,688(436) 2,421(467) 4,800(455) 742(62) 3,008(296) 8,550(813) 66 workshop supervision. TABLE 44. Inspections of Workshops, &c. 1909. (See also Appendix, Table VIII.) 1909. 1908. Workshops— On register beginning of year 1,532 1,436 added during year 230 173 removed „ „ 74 77 On register end of year 1,688 1,532 Inspections 270 179 Re-inspections and miscellaneous calls 2,010 1,404 Rooms measured 95 42 Workrooms used as bedrooms 97 86 Workrooms without Abstracts 11 5 Notices served, totals 3 12 Written intimations 3 7 Under Sec. 41 Public Health — — 37 (London) — 1 38 Act, 1891. — 3 By-laws, under same Act 1 Nuisances dealt with— Discovered. Abated. Discovered. Abated. Overcrowding 2 2 9 5 Dirty Conditions 26 26 34 32 Deficient Ventilation — — 6 7 Temperature too high — — — — Temperature too low — — 1 — Sanitary conveniences— Insufficient — — 2 1 Not separately provided 2 2 2 2 Badly placed 1 1 3 2 Unventilated - — — — Defective 13 13 11 13 Vapour, effluvia not removed Steam in washhouses — — — — Gas fumes 2 2 1 — Drains — — — — Wet floors, laundries — — — — Accumulations of refuse — — — — Other nuisances or offences 1 1 7 5 Totals 47 47 76 67 At the close of the year the Register of Home Workers contained 436 effective entries, a nett increase of 87 above the number for 1908, comprising:— Workshops, 136; "Single" workers, 306. WORKSHOP SUPERVISION. 67 Inspections.—The inspections of workshops made during the year numbered 2,280, as compared with 1,583 in 1908. The principal results of the inspections are set out in Table 44. Notices are required but infrequently, a verbal request to set matters right being usually sufficient. Complaints.—The Home Office forwarded 18 complaints during the year (see below), seven more than in 1908. Home Office C omplaints — Dirty conditions 8 Overcrowding 2 Other matters 8 From other sources 2 complaints were received, as compared with 8 in 1908 and 2 in 1907. Overcrowding.—No cases of overcrowding were reported by the Inspectors and only 2 by the Home Office during the year. In 1908, 9 cases were discovered by the Department and four reported bv the Home Office. Deficient Ventilation.—In 1906, 3 workshops were reported as insufficiently ventilated, in 1907, 4, in 1908, 6, and last year, none. Warming.—This matter is under the jurisdiction of the Home Office, but the Inspectors of the Department are instructed to report premises which are either too hot or without adequate means of maintaining a reasonable temperature in cold weather. The latter always receives special attention whenever there is a marked fall in the temperature, but only once was a workshop reported as too cold during the year. Sanitary Conveniences.—The general improvement which has taken place is manifest from the appended statement. Water-closet Accommodation. 1902. 1904. 1906. 1907. 1908. 1909. Insufficient 9 2 2 — 2 — Not separately provided 33 4 2 1 2 2 Badly placed 18 13 — — 3 1 Unventilated 8 - - - - - Defective 29 23 23 15 11 13 Sickness.—The cases of infectious disease, of all descriptions, reported during the year on "workshop premises," numbered 90, including 8 cases in the homes of outworkers, shown in parentheses in the appended statement. Scarlet Fever 20(2) Erysipelas 2(—) Chickenpox 18(1) Diphtheria 9(1) Measles 24(3) Whooping Cough 17(1) The deaths from the foregoing diseases numbered 3, viz., one each from diphtheria, measles and whooping cough, none of which took place on outworkers' premises. There were also 14 deaths from "consumption," including 2 on outworkers' premises. On receipt of information of any case of infectious illness the premises are specially visited. Inasmuch as practically all cases of the notified diseases are removed to hospital it is only necessary to see that any articles liable to convey infection are properlv dealt with. No orders, to prohibit work were required during the year, and nothing transpired leading to a suspicion of any spread of infection from such source. 68 housing. Bakehouses.—There were 75 such premises on the special Register at the close of the year, 17 being "level" and 58 "underground." Baking was given up during the year in 3 underground bakehouses, and 2 were re-opened. When a bakehouse is reopened after closure, a special inspection is made to see that the place is in accordance with the prescribed requirements, and that cleansing, usually with some improvements, is carried out. Of the 75 bakehouses on the Register, 10 are "factories," but are nevertheless under the jurisdiction of the Department, the special provisions of the Public Health (London) Act, 1891, over-riding the general rule under the Factory Act. Sixty-nine (69) inspections were made of the " factory bakehouses," and 373 of the remaining 65 premises. HOUSING. Houses Let in Lodgings. Registration.—At the close of 1908, 1,343 houses were on the Register. During the year26 were added to and 49 removed from the Register, leaving 1,320 effective entries at the end of 1909. The registration of the 26 houses involved 538 visits. The streets in which houses were registered during the year are set out below, in three groups, viz.:— (a) Those inspected for the first time with a view to registration; (b) Those in which houses previously passed over were registered; and (c) Those in which one or more houses were specially marked for registration, in sequence of the density of inhabitants, dirty conditions, &c. Houses Registered. 1908. (a) Nil. Amberley Road. Braden Street. Church Place. Campbell Street. Hall Place. (b) Hermitage Street. Hethpool Street. Kensal Road. North Wharf Road. South Wharf Road. (C) Bristol Gardens. Irongate Wharf Road. Sale Street. Hall Place, West. The housing conditions in the premises added to the Register were as below:— No. of Houses visited 26 Houses Registered 26 „ Exempt — „ Empty — Inhabitants (Registered Houses). In Registered Rooms, Persons 222 Under 10 years of age 64 Aged 10 years and over 158 In other Rooms, Persons 45 Under 10 years of age 11 Aged 10 years and over 34 Grand Total, Inhabitants 267 No. of Rooms Registered 120 For living only 25 For sleeping 54 For living and sleeping 41 Other Rooms in Registered Houses 62 Occupied by landlords 42 Exempt by rent 4 Occupied, not inhabited 6 Empty 10 Grand Total, Rooms 182 housing. 69 Table 45 shows how the tenements in the houses registered during the year were occupied. It will be seen that 22 tenements were "overcrowded," that is, were inhabited by persons in excess of an average of two persons per room (the ages of the occupants not being taken into account). On the standards imposed by the by-laws, 13 families comprising 51 persons were overcrowded, but in 7 cases the deficiency in the cubic space was so small that it was thought unnecessary to take any action, for the present at least, with reference thereto. Overcrowding, at Registration. In Registered Rooms— Families 13 Persons 51 ,, under 10 years of age 16 „ aged 10 years and over 35 Overcrowding abated 6 By Re-adjustment of Occupants 3 By Removal 2 Under Notice 1 Cases held over 27 TABLE 45. Numbers of Tenements and Inhabitants therein. Registered during 1909. Rooms to Tenement. 1 2 3 4 5 6 7 8 T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P 1 17 17 ... 13 24 2 7 14 7 4 9 7 1 2 3 1 2 4 ... ... ... 2 ... ... ... 6 12 ... 10 24 6 3 9 3 4 15 5 1 4 1 2 5 3 ... ... ... 1 2 ... 2 5 1 2 5 3 1 2 3 ... ... ... 1 3 4 2 9 7 T—number of Tenements containing (P/10) Persons over 10 years of age, and (10/P) Persons under 10 years of age. The table may be summarised thus:— Tenements of— Total. Occupants. Average persons per room. Houses registered 1908. Borough Census 1901. 1 room 43 91 2.1 1.8 2 rooms 25 87 1.5 1.7 3 „ 9 44 1.6 1.3 4 „ .— — — 1.1 Supervision.—The work connected with the "annual cleansing" occupies nearly the whole of the time of the two Inspectors in charge of houses let in lodgings from March to September or later. During that time all houses on the Register are inspected 3, 4, or more times. At other times a general supervision is exercised over the whole, and full inspections made once a quarter of houses known to be badly kept and likely to be overcrowded. The numerous complaints received involve many inspections. The inspections made last year numbered 2,487, that total not including the inspections in connection with the "annual cleansing," registration, or sickness. The defects and infringements of the by-laws discovered (including those at annual cleansing) are set out in Table 46. Apart from those required in connection with the actual cleansing, notices to the 70 housing. number of 1,223 were served during the year, viz.: written intimations, 386; statutory notices, 61; notices under the various by-laws, 674 and notices pursuant to provisions of the London County Council (General Powers) Acts, 233, viz.: verminous rooms, 152, abolition of dustbins, 5 ; and additional supplies of water, 76. TABLE 46. Sanitary Defects Remedied in Registered Houses. 1909. 1908. Drain defective 10 34 „ choked 7 9 „ untrapped — 7 „ unventilated or improperly ventilated 2 24 Manhole cover defective 4 1 Surface inlet improperly trapped 2 9 Gully choked 13 9 Ventilating pipe improperly constructed - 1 Soilpipe defective - 2 „ improperly constructed - 2 „ unventilated or improperly ventilated - 2 Water-closet choked 56 39 „ defective 72 49 ,, flushed from drinking water cistern - 2 „ insufficiently flushed 37 42 „ flushing apparatus defective 71 36 „ without water supply 21 8 „ foul. 41 20 „ improperly constructed — 14 „ accommodation insufficient 44 14 ,, without door 19 9 „ without external light or ventilation - 1 Rain-water pipe not disconnected from drain or soilpipe 1 18 „ defective 45 24 „ choked 15 3 Waste pipe not disconnected - 4 „ defective 2 7 „ choked 1 - ,, not provided 3 3 Other drainage defects 2 3 Cistern defective 7 2 „ dirty 58 70 „ improperly placed — - „ without proper cover 4 12 „ cover defective 13 27 Dustbin defective 72 105 ,, not provided 8 4 „ insufficient 1 — „ disused and not abolished 5 5 Paving defective in area or yard 79 85 „ „ washhouse 51 40 Guttering defective 27 21 Premises damp 16 10 „ dirty 13 9 Rooms verminous 213 258 Roof defective 179 142 Accumulation of refuse 16 3 Animals improperly kept 4 6 Water supply to premises insufficient 78 42 Other defects or nuisances 35 13 Annual Cleansing.—There were 1,254 houses on the Register in March of last year, all of which required to be inspected in connection with the "annual cleansing" which the bylaws provide shall be carried out during the month of April of each year. Although the work was divided among five Inspectors, it was not completed until October. The inspections made numbered 4,933, 1,920 rooms being reported to be in need of cleansing. housing. 71 The corresponding figures for 1908 were 4,611 and 2,154, and for 1907, 5,250 and 2,376. The notices served as a result of these inspections numbered 3,088 (2,771 in 1908), viz.: cleansing notices, 2,355; for verminous rooms, 145 : and for defects of all descriptions, 588.* One hundred and forty-two (142) cases were referred to the Solicitor, but only 21 summonses were issued. An enumeration of the occupants of registered tenements was made in connection with the annual cleansing. The enumeration covered 4,563 tenements, comprising 7,536 rooms, occupied by 15,195 persons, averaging 3.3 persons to a tenement, and 2.0 to a room. The distribution of occupants according to tenement was:— Per room. Per tenement Registered tenements. Borough Census, 1901. In 2,155 tenements of one room, 4,647 persons, averages 2.1 2.1 1.8 1,882 two rooms, 7,795 „ 4.1 2.0 1.7 491 three „ 2,547 „ 5.1 1.7 1.3 31 four „ 178 „ 5.7 1.4 1.1 4 five „ 28 „ 7.0 1.4 ? A complete analysis of the tenements of less than five rooms is given in Table 47, the numbers of children under 10 years being shown separately. TABLE 47. Numbers of Registered Tenements (of less than five rooms) and Inhabitants therein. 1909. Rooms to Tenement. 1 2 3 4 5 6 7 8 9 10 T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P T P/10 10/P 1 729 729 ... 733 1430 36 420 864 396 200 400 400 54 111 159 13 29 49 4 15 13 2 7 9 ... ... ... ... ... ... 2 37 37 ... 284 564 4 370 932 178 451 1242 562 357 1016 769 245 717 753 94 297 361 34 122 150 9 42 39 1 4 6 3 7 7 ... 28 56 ... 64 162 30 77 237 71 95 318 157 106 398 238 62 238 196 34 139 133 13 64 53 5 29 21 4 ... ... ... ... ... ... 3 9 ... 6 23 1 4 18 2 12 60 12 1 6 1 1 5 3 2 12 6 2 10 10 T—number of Tenements containing (P/10) Persons over 10 years of age, and(10/P)Persons under 10 years of age. The enumeration made in 1906, dealt with 4,372 tenements and 14,862 inhabitants, and that made in 1908 with 4,902 tenements and 15,168 inhabitants. The appended statement shows a considerable increase in the number of one-room tenements. Rooms in tenement 1 2 3 4 5 1906 43.6 45.0 10.0 1.2 0.04 1908 44.0 45.4 9.7 0.6 0.04 1909 47.2 41.2 10.8 0.6 0.09 per cent. of all tenements enumerated. * The notices for verminous rooms and defects of all description are included in the totals given in the paragraphs—Supervision. 72 housing. Last year there were slight increases in the average number of inhabitants per room in tenements of 2, 3, and 5 rooms. Rooms in tenement 1 2 3 4 5 1906 2.1 2.2 1.7 1.5 1.3 average number of occupants per room. 1908 2.1 1.7 1.6 1.5 1.2 1909 2.1 2.0 1.7 1.4 1.4 The children enumerated in 1906 constituted 30.4 per cent. of the total inhabitants, in 1908 31.6 per cent., and last year 31.7. These proportions are of importance in connection with the averages of inhabitants (of all ages) per room, and in connection with the " theoretical overcrowding." Taking the usual theoretical standard of overcrowding—viz., an average exceeding two persons per room—it appears that, in 1906, 1,470 tenements and 7,526 persons were " overcrowded," in 1908, 1,820 tenements and 7,523 persons, and in 1909, 1,551 tenements and 7,639 persons. Reducing those figures to percentages, they compare thus:— "Overcrowded." 1906. 1908. 1909. Percentage of all tenements 33.6 37.1 33.9 Percentage of all inhabitants 50.6 49.3 50.2 Percentage of children under 10 years 74.6 72.5 73.0 The average numbers of occupants per room in each class of tenement, as found on registration and as determined last summer in houses already on the Register, are given below. It will be seen that the averages for houses on the Register in tenements of two and three rooms were very slightly higher last year than those for houses added to the Register. Doubtless that is due to the closer aggregation of inhabitants which has been noted in the preceding paragraphs. No. of rooms 1 2 34 Houses registered, 1909 2.1 1.7 1.6 — „ „ previously 2. 1 2. 0 1.7 1.4 The percentages of tenements in each group of houses in which the inhabitants exceeded an average of two persons per room were— " Overcrowding." Tenements. Inhabitants all ages. under 10. Houses registered, 1909 28.5 46.8 71.8 „ „ previously 33.9 50.2 73.0 The task of securing the annual cleansing of houses let in lodgings (or " tenement dwellings " as they ought to be styled) has been rendered more difficult by the decision given in March of last year in the Appeal Court (King's Bench) case of Arlidge v. Islington Borough Council. Under the Islington by-laws relating to houses let in lodgings the responsibility of carrying out the annual cleansing required under by-law No. 15 was placed upon the owner, the definition of "landlord" in the by-laws being that of "owner" in the Public Health (London) Act, 1891. The definition of " landlord " in the Paddington by-laws is much narrower, the person who lets the tenements or on whose behalf such tenements are let, being made the responsible person. The Islington case was decided on the point that a " landlord "— irrespective of definition—could not, unless he reserved a special right to do so, enter a tenement to carry out the cleansing without committing a trespass. On that account the case of Borough Council of Paddington v. Walkley—for not performing the customary cleansing— housing. 73 was dismissed with the costs against the Council. That was the first case under the by-laws which had been given against the Council. The Magistrate granted a case for appeal, but shortly after the hearing of the summons, the Housing, Town Planning, &c. Bill of last year became law and the appeal was not proceeded with. Section 1(5 of that Act appears to meet the difficulty created by Arlidge v. Islington Borough Council. The Section referred to authorises the making of by-laws in relation to " houses intended for the working classes " which are let in tenements, imposing on the " owner " of such house, as defined by the Public Health Act, the duty of execution of anv works which can be required by by-law in addition to or substitution for any person (e.g., the " landlord ") at present responsible for such work, and, what is more important, expressly provides that the "owner" shall have the power of entry to carry out such works. The usefulness of the Section will depend on the interpretation given to the words " intended for the working classes." It should be mentioned that there is no definition of "working classes" in the Housing Acts, except for one special purpose. So far as can be ascertained the Legislature has not enacted such definition anywhere, unless the imperfect description of "working classes" given in Section 18 of the Settled Lands Act, 1890, can be used. Overcrowding.—The actual cases of legal overcrowding reported during the year numbered 432, as compared with 300 in 1908, 344 in 1907 and 412 in 1906, showing a relapse from the improvement recorded last year. Of the 432 cases, in 202 (46.7 per cent.) the degree of overcrowding—i.e., deficiency in cubic space prescribed by by-law—was slight and the cases were reserved for observation. None of the cases of overcrowding in the Clarendon Street Area were allowed to remain unabated. The full analvsis of cases is given below. OvKliCKOWDING, 1909. Registration. Annual Cleansing. Other Visits. Totals. Tenements overcrowded 13 267 152 432 Rooms overcrowded 13 288 170 471 Occupants, total 51 1,206 792 2,049 Under 10 years 16 471 389 876 Ten and upwards 35 735 403 1,173 Overcrowding abated (rooms)— By re-arrangement 3 22 7 32 By voluntarv removal 2 46 5 53 Under notice 1 54 90 145 Cases held over 7 145 50 202 The figures for the whole vear do not give a true criterion of the state of the tenement houses on the Register of Houses let in Lodgings, at any particular time. The best criterion is afforded by the returns obtained at the annual cleansing, which, as already explained, involves the visiting of every house on the Register. In the course of that work 267 cases of overcrowding were discovered in 4,563 tenements and 1,254 houses. The occupants of the overcrowded tenements numbered 1,206 living in 288 rooms, the total numbers of rooms and inhabitants being 7,536 rooms and 15,195 persons. The percentages recorded for tenements and inhabitants last year and in 1908 are given below. Overcrowding At Annual Cleansing. Percentages. 1909. 1908. Tenements 5.8 4.1 Persons over 10 7.9 5.8 74 HOUSING. The slight increases reported above occurred mainly outside the Clarendon Street Area, and are in part due, it is thought, to allowing cases to remain oyer in past years. More stringent instructions have been given for the current year and it is hoped that the proportion of overcrowding will decrease in future years. The Inspector in special charge of the Clarendon Street Area and the district on the opposite side of Harrow Road* reports that in the whole (combined) district there were 2,545 registered tenements (in the whole district only 31 houses are exempt from registration) occupied by 8,839 persons, including 2,807 children under 10. He found 63 overcrowded tenements at the annual cleansing, occupied by 280 persons, or 2.5 per cent. of tenements and 3*2 per cent, of the inhabitants. There were 391 tenements occupied by single persons and 560 by childless couples. The following comparison of the figures for 1908 and 1909 shows that some improvement in the housing of children has been effected. 1909. 1908. Children in homes of one room 64.3 653 two rooms 2,412 2,482 three „ 949 893 four „ 116 115 five „ 20 8 Vital Statistics.—The morbidity rate for the " Registered Streets " (14.62 per 1,000, see Table 48) was rather more than 2 per 1,000 above the rate for 1908 (12.58), and nearly three times the 1909 rate for the "Rest of the Borough" (5.06). Last year's rate for "Registered Streets " showed an increase of 16 per cent, above that for 1908, while that for the " Rest of the Borough" a decrease of 11 per cent. In the "Registered Streets" erysipelas alone showed a decreased morbidity last year, while in the " Rest of the Borough " diphtheria was the only disease with an increased morbidity. The mortality rate in the "Registered Streets" increased from 23.55 to 26.32, but the ratio of the rates for the two years to those of the "Rest of the Borough" was very little changed, the former rates being in each year a little more than twice the latter. (Actual ratios: 1909, 2.3: 1 ; 1908, 2.1: 1). The most noteworthy contrasts in the rates are furnished by the higher mortalities from measles, whooping cough, scarlet fever, and diarrhoeal diseases in " Registered Streets " in comparison with the lower rates in the " Rest of the Borough." On the other hand decreased mortalities were recorded from phthisis, accidents and disease of parturition and suicide in the former group and increased in the latter. The infantile mortality in the "Streets" was 166 per 1,000 births, while that in the " Rest " was 71, the corresponding rates for 1908 having been 148 and 91 respectively. Clarendon Street Area.—The number of one-room tenements found in occupation at the "annual cleansing" last year was 787, occupied by 1,889 persons of all ages, including 501 children under 10 years old. The numbers reported in 1908 were 835 tenements with 1,973 inhabitants, and in 1901, 662 with 1,556 inhabitants. Those figures represent averages of 2.4 persons (irrespective of ages) per room in 1909, and 2*3 in 1908 and 1901. The "annual cleansing " is the only occasion when all the tenements are visited in turn. In the course of that work 57 tenements, equal to 3.4 per cent, of all tenements, were found to be overcrowded, the occupants numbering 237 (3.9 per cent, of all inhabitants), of whom 8.5 (4.2 per cent, of all) were children under 10 years. * The boundaries of this district are—The Canal, G.W.R., Torquay (late Marlboro') Street and Harrow Road. housing. 7 5 TABLE 48. Disease. Registered Streets. Rest of Borough. 1908. 1909. 1908. 1909. Morbidity*— Small-pox - — — — Diphtheria and Membranous Croup 1.36 2.01 0.89 1.03 Erysipelas 1.68 1.57 0.53 0.57 Scarlet Fever 9.33 10.58 3.74 3.27 Enteric (and Continued) Fever 0.21 0.37 0.20 0.16 Puerperal Fever - 0.05 0.03 0.01 All Diseases 12.58 14.62 5.44 5.06 Mortality.— Small-pox - — — — Measles 0.63 1.03 0.17 0.12 Scarlet Fever 0.31 0.43 0.05 0.04 Whooping Cough 0.21 1.25 0.04 0.09 Diphtheria 0.15 — 0.09 0.08 Enteric Fever 0.06 — 0.01 0.02 Diarrhœal Diseases 1.25 1.41 0.26 0.09 Erysipelas — — 0.02 0.03 Puerperal Fever — — 0.00 0.01 Phthisis ... 2.10 2.06 0.80 0.92 Other Tuberculous Diseases ... 0.63 0.76 0.21 0.21 Alcoholism — 0.32 0.05 0.03 Cancer 1.52 1.35 1.15 0.98 Premature Birth 0.63 0.76 0.31 0.31 Developmental Diseases 1.57 1.46 0.46 0.40 Bronchitis 2.57 3.26 0.91 1.09 Pneumonia 1.94 2.39 0-83 0.91 Cirrhosis of Liver 0.16 0.10 0.08 0.04 Accidents and Diseases of Parturition 0.16 0.05 0.04 0.07 Suicides 0.21 0.10 0.08 0.15 Other Causes 9.53 9.51 4.90 5.44 All Causes 23.55 26.32 10.78 11.12 * Rates per 1,000 persons. The vital statistics of the "Area" (Table 49) do not show a continuance of the improvement recorded last year. There was increased morbidity from diphtheria and enteric fever, but decreased from erysipelas and scarlet fever. The mortality at all ages rose from 23.08 to 30.04 per 1,000; that at ages under 10 years from 32.11 to 50.96, and that at ages 10 years and upwards from 18.88 to 20.17. The infantile mortalitv increased from 173 to 220. The greater mortality was mainly due to measles, scarlet fever, whooping cough, bronchitis, and pneumonia. Increased mortality from the two last-named diseases is always noted when measles and whooping cough are prevalent. From those four causes there were 24 more deaths (at all ages) during 1909 than in 1908, that increase being equivalent to a mortalityrate of 3.69 per 1,000. Inasmuch as the primary diseases—measles and whooping cough— are specially diseases of childhood, it is but fair to assume that nearly the whole of the increase fell on children under 10 years of age. The 24 deaths would be equivalent to a rate of 11.5 per 1,000. The deaths from scarlet fever numbered 5 last year (2 in 1908), and those from diarrhoea 11 (7 in 1908). It may therefore be concluded that the marked increase in the mortality last year was more of an accident than due to deterioration of the condition of the area. 76 Food supervision. TABLE 49. "Clarendon Street Area" Rest of Borough. 1908. 1909. 1908. 1909. Morbidity*— Diphtheria 0.71 2.00 0.96 1.11 Erysipelas 2.55 1.84 0.58 0.64 Scarlet Fever ... ... 14.17 13.55 3.92 3.73 Enteric Fever 0.42 0.92 0.19 0.15 Puerperal Fever - — 0.03 0.02 Mortality—All Causes— All ages * 23.08 30.04 11.78 12.20 0—10 years 32.11 50.96 19.57 16.67 10- „ 18.88 20.17 10.38 11.35 Infantile Mortality † 173 220 99 89 Institution Deaths ‡ 63.1 48.1 32.3 31.7 * Rates per 1,000 persons. † Per 1,000 births, fully corrected. ‡ Per 100 deaths. Common Lodging Houses. At the Licensing Session of last year 7 houses were licensed in the Borough—6 for men (195 beds) and 1 for women (40 beds). Such premises are under the supervision of the County Council, but the Inspectors of the Department visit them from time to time. No cases of infectious illness occurred during the year among the lodgers. There were 6 deaths, the causes of which were:— Tubercular Disease Old Age Cancer Heart Disease 1 each. Respiratory Diseases 2 Inhabited House Duty. Six applications, relating to 6 houses containing 31 tenements, for Certificates under Section 11 of the Revenue Act, 1903, were received last year, 4 certificates being issued, 1 refused (the value of the house exceeded the limit), and 1 was held over. The 4 certificates related to 18 tenements. FOOD SUPERVISION. Slaughterhouses.—There were seven (7) slaughterhouses in use during the past year, situate as described below :— Bishop's Mews, No. 1. Portsdown Mews (No. 249 Maida Vale). Southwick Mews, No. 15. Harrow Road, No. 125. Edgware Road, No. 275. Upper Brook Mews, No. 6. Chippenham Mews, No. 18. FOOD SUPERVISION. 77 The Inspector visited the slaughterhouses on 492 (582) occasions when killing was in progress, and examined 4,676 (5,363) carcases in process of dressing, viz.— 131 (152) of bullocks, 4,536 (5,206) of sheep, and 9 (5) of calves. The numbers of animals slaughtered continues to decline. The following organs (total weight, 350 [1,800] lbs.) were destroyed during the year, for the reasons assigned in each case :— Sheep. Livers, 12—parasites 8, cirrhosis 2, and abscesses 2. Pluck, 1—pleuro-pneumonia. Bullocks. Livers, 11—parasites 6, abscesses 4, tuberculosis 1. Lungs, 4— ,, 1, abscesses 1, tuberculosis 2. Hearts, 2—tuberculosis. Heads and tongues, 4—Tuberculosis. Mesentery, 1—Tuberculosis. Food Purveyors' Premises.—The appended statement gives the numbers of the different classes of premises under the supervision of the Department, and of the occasions on which such premises were inspected during the year. Food Purveyors. Numbers of places where Food is sold:— Butchers 80 Milkshops and Dairies 183 ,, Pork 25 Refreshment Houses 113 Fishmongers 29 Fried Fish and Sausages 39 Game and Poultry 12 Ice Cream Makers & Vendors 120 Fruit and Greengrocery 80 Margarine Dealers 12 Inspections during the year :— Butchers' Shops 503 Milkshops, &c. 245 Greengrocers' Shops 15 Restaurants, &c. 200 Costers' Barrows 5 Ice Cream Shops and Barrows 57 Fishmongers' Shops 24 Fried Fish Shops 52 Miscellaneous.—In addition to the above, there are 4 premises where fish curing is carried on, and 9 where the manufacture of sausages takes place. Such premises are systematically inspected as to their construction, and maintenance in a proper state and as to the food materials dealt with thereat. Milk Supply. Cowsheds.—The only one in the Borough is situate at— Star Street, No. 39, is licensed for 10 cows, but not more than 5 are kept. The shed is always in excellent condition. The Inspector reports that he visited the premises 4 times during the past year. The Officers of the County Council make frequent inspections of the premises and the animals kept there. Dairies and Milkshops.—At the end of 1908, 176 names were on the Register. During the past year 14 names were added, 7 removed, and 12 changed, leaving 183 effective entries at 78 Food supervision. the close of the year. The businesses carried on at the premises where the milk is sold are indicated below:— Dairies: milk, eggs and butter only 81 „ wholesale dep6ts 4 Grocers' shops 10 General shops, selling oil 48 „ not „ 13 Sweet-stuff and confectionery 10 Provisions 2 Off-licensed premises 2 Refreshment 10 Bakers' shops 3 The above premises were inspected on 245 occasions during the year. Eight cases of scarlet fever were reported on premises where milk was sold; and 4 cases of scarlet fever and 2 of diphtheria in the families of milk carriers. All due precautions were taken to prevent the spread of infection, and no ill results were traced to any of the above cases. Additional powers for the regulation and supervision of milkshops and places where food is prepared, stored, or sold, are conferred on the Borough Council by the London County Council (General Powers) Act, 1908—Section 5 of which relates to the registration of milk vendors, and Section 8 to places where foods of all descriptions are sold. Much preparatory consideration was necessary before bringing Section 5 into operation. On December 5th last the Council, on the recommendation of the Public Health Committee, adopted the policv contained in the following resolutions:— (a) That all milk vendors be required to provide and use suitable gauze, or other approved covers, to counter pans and all receptacles for the storage of milk. (b) That the storage and sale on the same premises of the undermentioned commodities be held to be incompatible with the storage and sale of milk in a pure and wholesome condition, to wit:— Coal and Coke. Lamp Oils. Wood, except in bundles, provided the same be not kept in the milk store. Vinegar and Pickles, except when stored and sold in unopened bottles. Fish, Meat, Fruit and Vegetables. (c) That the proprietors of all " general shops " who are now on the Register be informed that, on and after 1st March next, their names will be removed from the Register of Milk Vendors if they continue to sell the proscribed commodities. (d) That in future no person dealing in any of the commodities set out in paragraph (b) be added to the Register of Milk Vendors. To give the milk vendors concerned (those keeping "general shops") the operation of the resolutions was postponed until March of the current year. Section 8 applies to milk vendors' premises as well as other shops where food is dealt in. I" or the purpose of this Section, 378 shops and premises were specially inspected during the year, viz.:— Coffee and Dining Rooms 33 Milk shops 177 Confectioners' shops 20 Butchers' shops 80 General Grocery & Provisions 56 Slaughterhouses 7 Poultry and Provisions 5 unsound and diseased food. 79 Eightv-one (81) notices were served, viz.—25 under Sec. 8 of the Act, 28 under Sec. 37 of the Public Health (London) Act, 1891, and 24 under By-laws pursuant to that Act and 4 "written intimations." A considerable number of premises remained to be inspected during the current year. Ice-cream Making. A special Register of the makers and vendors of this commodity is kept for the purpose of enforcing the provisions of Part VIII. of the London County Council (General Powers) Act, 1902. Twelve names were removed from the Register during the year, there being 124 effective entries at the end of the year. Of the makers and vendors on the Register, 120 are shop-keepers, and 4 Italian barrow-men. The businesses combined with the sale of ice-cream are indicated below :— Sweet shops 58 Newspapers and Tobacco 3 Bakers 24 Confectioners 5 Milk 4 Cook 1 Restaurants 15 General 10 In addition to the 4 local barrow-men, 12 from other districts have regular stands in the Borough :— From Marylebone 5 From Islington 1 „ Kensington 5 „ Willesden 1 UNSOUND AND DISEASED FOOD. In addition to the meat condemned and destroyed in the course of slaughter, 3,077 lbs. of foodstuffs were destroyed as unfit for human food, including 1,321 lbs. destroyed on requisition of the G.W.R. Co., while in course of transit. The various quantity of foods, and the causes of condemnation are set out below :— Meat (Butchers' Shops) :— Cause of Destructiort. Animal. Part Destroyed. Tuberculosis Bullock 1 set Lungs. Parasites Bullock 1 Liver. Pig 1 set Lungs. Rabbits 40 Livers. Decomposed Calf 4 Plucks. Turkeys 23 Fish :—(decomposed)— Herrings and Plaice 322 lbs. Vegetables :—(decomposed) — Apples 222 lbs. Pears 60 lbs. Tomatoes 406 „ Onions 6 „ Strawberries 26 „ Summary. Per G.W.R. Co. Meat 364 lbs. Meat 336 lbs. Fish 322 „ Plums 980 „ Vegetables and Fruit 720 „ Tomatoes 5 „ 1,406 1,321 Grand Total 3,077 lbs. 80 FOOD ADULTERATION. FOOD ADULTERATION. Mr. Parker, the Inspector for Food and Drugs, retired at the end of March last. The work under the Sale of Food and Drugs Acts was entrusted to Mr. Grivell, the Meat and Food Inspector. There was a slight increase in the proportion of adulterated samples last year, 52 out of a total of 600 (equal to 8.6 per cent.) being reported adulterated. In the years 1905-08 the proportions were 6.5, 10.2, 9.2 and 2.6 per cent. A list of the samples taken, with numbers and proportions of those found to be adulterated, is given in Table 50. TABLE 50. Total. Found Adulterated. Percentage Adulterated. Milk 301* 20 6.6 Butter 121 8 6.6 Butter on Bread 29 13 44.8 Coffee 15 — - Vinegar 15 — — Tinned Paste 15 — — Cheese 14 — — Cocoa 12 — - Cream 12 6 50.0 Sausages 11 4 36.3 Sal Volatile 10 — — Jam 8 1 12.5 Lard 6 — — Ammon. Tinct. Quinine 6 — — Golden Syrup 4 — — Margarine 4 — — Rice 4 — - Brawn 4 - - Salad Oil 2 - - Mustard 2 - - Oatmeal 2 — - Skim Milk 1 - - Pearksown Butter 1 — - Palmine Butter 1 — — 600 52 8.6 * Including 41 taken at Paddington (G.W.R.) Terminus in course of delivery ; 10 adulterated. Of 301 samples of milk, 41 were taken at the Paddington (G.W.R.) Terminus at the request of the consignees who had contracts with the farmers sending the milk to London. Of such samples, 10, or 24.3 per cent, were found to be adulterated, as compared with 32.3 in 1907 ; 30.6 in 1906; and 12.6 in 1905: Eighty-seven (87) samples were purchased on Sundavs, most of them in the streets, viz.: 82 milk, 4 butter and 1 margarine. Of the samples of milk 5, and of the butter2, were found to be adulterated. The sample of margarine was not supplied in a stamped wrapper as required by the Act. The adulterated samples constituted 8.0 per cent. of the whole number (87), as compared with 7.5 per cent. of all the samples purchased during the year, but excluding the railway samples. FOOD ADULTERATION. 81 Food Preservatives.—In four samples of sausages preservatives were found, viz.: 3 with boric preparations (in amounts equivalent to 11.9, 13 and 10.8 grains of boric acid per lb.) and one with sulphites (amount " too small to estimate "). The samples were purchased—3 from retail firms and 1 from a wholesale firm supplying the local trade during October, at a time when preservatives might be held to be unnecessary. When the cases were reported to the Committee, an appeal to the High Court was pending against the decision given by Mr. Wallace, K.C., at the Newington Sessions in June of last year, in the case of Hayward v. Westminster City Council. In that case a conviction for selling sausages containing 21 grains of boric acid per lb. was upheld, although the learned Chairman expressed the view that that amount of boric acid would not be injurious to health. The judgment was based on " prejudice to the purchaser" (Section 6). The Committee thought it undesirable to institute proceedings until after the appeal had been heard, and the vendors of the samples were cautioned. The appeal was ultimately dismissed, with costs. During October six samples of cream were purchased, which contained boron preservatives in the following amounts (expressed as boric acid).— No. 65. Cream, "14 per cent, boric acid No. 68. Cream, .26 per cent, boric acid No. 66. „ .08 „ „ No. 69 „ .22 No. 67. „ .04 „ „ No. 71 „ .05 „ The following is an extract from the report, in which the results of the analysis were laid before the Committee :— Cream.—Under date 11th August last, a report to the Local Government Board by Dr. J. M. Hamill, on the Use of Preservatives in Cream (Food Reports No. 10) was issued. In that Report, page 19, it is recommended that the Local Government Board should consider the question of issuing Regulations dealing with the use of boric acid in cream. One of the proposed Regulations would limit the amount of preservative to be used at the equivalent of 0.4 per cent. of boric acid from May to October, inclusive, and 0.25 per cent. during the remaining months of the year. It is fuither recommended (a) that cream containing the above limits of preservatives should contain at least 40 per cent. of milk fat ; and (b) that there should be a declaration of the preservative to the purchaser. It will be noted that Sample No. 68, containing 0'26 per cent, of boric acid, is the onlv one in excess of the amount suggested in Dr. Hamill's Report (0'25 per cent.) for the present period of the year. In no case, however, was any declaration made, and in one case (Sample No. 71, containing *05 per cent, of boric acid) the vendor informed the Inspector the cream had been purchased from a wholesale firm under warranty that it was free from preservative. In the course of the Report, it is recommended that there should be a differentiation between what may be called " preserved " (" jugged ") cream and the ordinary (" draught ") cream. It appears to me to be desirable that a circular letter should be issued to traders in the Borough, informing them that prosecutions will be taken wherever the amount of preservative exceeds the amounts suggested in the Report referred to; and, further requiring proper declaration as to the use of preservative—such declaration, I think, should state the amount of preservative which has been used. On the instruction of the Committee, the following circular letter was issued (dated 23rd December):— I am instructed to inform you that the Public Health Committee of this Borough have 82 OFFICE WORK. resolved that, on and after January 1st next, and until such time as the Local Government Board shall issue regulations dealing with the matter, the Committee will follow the recommendations with regard to the use of preservatives in cream set out in the Report of Dr. J. M. Hamill to the Local Government Board when deciding the action to be taken with reference to the Samples of Crcatu reported by the Public Analyst to contain preservatives. The recommendations referred to are to the following effect :— (1) Fresh cream, that is, cream sold by measure and not in pots or jugs, to contain no added preservative or sweetening agent of any description. (2) The only preservatives permissible in preserved cream to be boric acid, borax, or a mixture of the foregoing ; (3) Cream to which preservatives are added, to contain at least 40 per cent. butter fat. (4) The maximum amount of boron preservative permissible in any cream to be (a) during the months of May to October, the equivalent of 0.4 per cent. of boric acid ; and (b) during the months of November to April, the equivalent to 0.25 per cent. of boric acid ; and (5) The addition to the cream of any preservative or sweetening agent to be adequately declared to the purchaser of the cream, at the time of the sale of such cream. Proceedings under the Sale of Food and Drugs Acts will be instituted against any person selling cream if the above conditions have not been complied with. OFFICE (CLERICAL) WORK. The appended figures suggest the mass of work which has to be performed by the Clerical Staff, and give but a very imperfect idea of the very large amount of writing which is necessary, the bulk of which cannot be set out in the form of statistics. Letters received 4,337 (4,014) Complaints received 683 (817) „ dispatched 3,251 (2,836) Plans dealt with 367 (403) Entries in postage book 12,400 (12,341) New openings in Journals 627 (890) Cases of infectious disease entered in Register Notices sent re above and 948 (971) Disinfection Orders (duplicate) 2,135 (1,424) other diseases 6,443 (7,428) Notices to abate nuisances 1,736 (1,197) The figures in parentheses are the returns for 1908. LEGAL PROCEEDINGS. The results of the cases which were brought before the Police Magistrate are appended hereto. The Department is able to secure the abatement of nearly all nuisances by service of " written intimations" which are not, in the legal sense, "notices " at all, and the cases taken into Court form but a small proportion of the total dealt with during the year. The fines imposed during the year amounted to £89 17s. and the costs awarded to £48 16s. Those sums are paid to the Council's account. In one case only were costs (2 guineas) allowed against the Council. legal proceedings. 83 The following statement compares last year's amounts (fines and costs) with those received during the 5 years, 1904-08. Health Cases. Adulteration Cases. £ s. d. £ s. d. 1909 52 6 6 86 6 6 1908 43 10 0 55 17 6 1907 69 19 0 31 16 6 1906 34 15 0 63 1 0 1905 25 6 0 126 17 0 1904 62 2 6 101 2 6 Adulteration Cases. 1909. 1908. 1907. 1906 1905. 1904. Average per conviction Fine £1 3 9 £1 2 3 £0 17 0 £0 16 6 £3 8 7 £2 15 2 Costs 0 12 2 0 13 9 0 12 8 0 15 0 1 2 0 1 5 8 84 summary of legal proceedings. LEGAL PROCEEDINGS, 1909. Under Public Health (London) Act, 1891. Fines. Costs. Section 4. £ s. d. £ s. d. 1, Bark Place Drain defective Order made. 0 16 6 31, Edbrooke Road Work done. 1 1 0 52, Goldney Road ,, 0 10 6 49, Harrow Road ,, 0 10 6 69 and 70, Market Street Horse kept in an improper place Horse moved. 0 2 0 48, Northumberland Place No water supply to premises Supply re-instated. 0 3 0 44, Portsdown Road Drain defective Order made. 0 10 6 18, Sevington Street ,, 0 10 6 66, Westbourne Park Road Non-compliance with Magistrate's Order 5 10 0 — Section 21. Dust Wharf, Hormead Road Carrying on offensive business Summons dismissed. Section 35. Pressland Yard Expenses incurred in removal of manure Summons dismissed. Section 47. J. Buckingham, 598, Harrow Road Having diseased bullock's lungs on premises 5 0 0 0 12 6 J. Elliott, 29, Bell Street Selling diseased bullock's liver 20 0 0 — By-laws relating to Houses let in Lodgings. 60, Alfred Road Neglecting to complete annual cleansing Summons dismissed. Council ordered to pay £2 2s 0d. costs. 21, Campbell Street „ „ „ Work done. 0 10 6 5, Cuthbert Street „ „ „ ,, Summons withdrawn. 18, Hall Place „ „ „ ,, 0 10 6 37 „ „ „ ,, ,, 0 10 6 103 „ „ „ ,, ,, 0 10 6 108 „ „ „ „ ,, 0 10 6 128 „ „ „ „ ,, 0 10 6 4, Hethpool Street ,, „ „ „ ,, 0 10 6 7, Howell Street „ „ „ ,, ,, 0 10 6 40, Kensal Road „ „ „ ,, ,, 0 5 0 42 ,, ,, ,, ,, ,, 0 10 6 19, South Wharf Road ,, ,, ,, ,, 0 10 6 22 „ „ „ „ ,, 0 10 6 24 „ „ „ „ ,, 0 10 6 26 „ „ „ „ ,, 0 10 6 8, Welling's Place „ „ „ „ ,, Summons withdrawn. 9 „ „ „ „ ,, 0 10 6 10 „ „ „ „ ,, 0 10 6 21, Woodfield Place „ „ „ ,, 0 10 6 42 „ „ „ „ ,, 0 5 0 Other By-laws. 18, Alexander Street Constructing new closet without giving notice 0 5 0 0 10 6 60, Alfred Road Water-closet without supply of water Work done. 0 10 6 20, Amberley Road Paving, &c. defective ,, 0 10 6 20, Cirencester Street Paving defective ,, Summons withdrawn 146, Kensal Road Improperly fixing new water-closet - 0 10 6 44, Portsdown Road Dustbin defective Order made. 0 10 6 „ „ Cistern uncovered ,, 0 10 6 24, South Wharf Road Water-closet accommodation insufficient - 0 10 6 10, Welling's Place „ „ „ - 0 10 6 51, Westbourne Park Crescent Constructing new closet without giving notice 0 5 0 0 2 0 SUMMARY OF LEGAL PROCEEDINGS. 85 LEGAL PROCEEDINGS, 1909—Continued. Metropolis Management Act, 1855. By-laws pursuant to Section 202. £ s. d. £ s. d 37, Clarendon Street Neglecting to deposit plans of drainage works Summons dismissed. 24, Eastbourne Terrace „ „ „ 0 5 0 0 2 0 206, Gloucester Terrace „ „ „ 1 0 0 0 2 0 33, Spring Street „ „ „ Summons withdrawn. 0 10 6 23, Upper Westbourne Terrace „ „ „ ,, 0 2 0 75, Woodchester Street „ „ „ ,, - Notification of Births Act, 1907. H. J. Smither, 1, Lanark Villas Failing to notify birth of child 0 1 0 - G. T. Bright, 121, Westbourne Park Road „ „ „ 0 1 0 - S. B. Cowell, 53, Ashmore Road „ „ „ 0 1 0 - L. F. R. Young, 13, St. Luke's Road „ „ „ 0 1 0 - G. Levy, 37, Maida Vale „ „ „ - 0 2 0 A. Woodbridge, 15, Hampden Street ,, „ ,, 0 1 0 0 2 0 L. B. Brown, 87, Warwick Avenue „ „ „ 0 1 0 0 2 0 C. A. Eastman, 35, Queen's Road „ „ „ 0 L 0 0 2 0 H. E. Verey, 8, Talbot Square „ „ „ 0 1 0 0 2 0 C. B. Bryant, 62, Southwold Mansions „ „ „ 0 1 0 0 2 0 S. Tredwell, 77, Moscow Road „ „ „ 0 1 0 0 2 0 86 summary of legal proceedings. SUMMARY OF LEGAL PROCEEDINGS DURING 1909. Under Sale of Food and Drugs Acts, 1875-1907. Fines. Costs. £ s. d. £ s. d. Milk 9% added water 0 5 0 0 12 6 „ 10% „ 1 0 0 0 12 6- ,, 10% „ 1 0 0 0 12 6 ,, 4% „ 2 0 0 0 14 6 (1) „ 6% „ Summons dismissed: proved. warranty (2) „ 5% „ 0 10 0 0 12 6 „ 19% „ 2 0 0 0 12 6 (3) ,, 14% „ 0 10 0 0 12 6 ,, 3½% „ 1 0 0 0 12 6 (4) ,, 14% „ Summons dismissed: proved. warranty ,, 14% „ — 2 2 0 „ 10% „ and 8% fat abstracted 1 0 0 0 14 6 (5) „ 6% fat abstracted - 2 0 0 ,, 10% „ ,, 17% „ 0 10 0 0 12 & ,, 15% „ 1 0 0 0 12 6 „ 18% „ 1 0 0 0 12 6 ,, 8% „ 1 0 0 0 15 0 ,, 16% „ 1 0 0 0 15 6 (6) ,, 20% „ Summons dismissed; proved. warranty Butter 77½% foreign fat 1 0 0 0 12 6 (2) ,, 85% „ 3 0 0 0 12 6 (7) ,, 84% „ 2 0 0 0 12 6 (8) 74½% „ 2 0 0 0 12 6 (9) ,, 87% „ 5 0 0 0 12 6 „ 73% „ 1 0 0 0 12 6 „ 76½% „ 3 0 0 0 17 6 (1) „ 75% „ 3 0 0 0 17 6 „ 5⅓% water above legal limit 0 5 0 0 12 6 (10) Butter on Bread 84% foreign fat 2 0 0 0 12 6 ,, 86% „ 3 0 0 0 12 6 ,, 83½% 2 0 0 0 12 6 ,, 85% „ 2 0 0 0 12 6 ,, 78% „ 1 0 0 0 12 6 ,, 78% „ 0 10 0 0 12 6 ,, 81% „ 2 0 0 0 12 6 ,, 83% „ 2 0 0 0 12 6 ,, 83% „ 1 0 0 0 12 6 ,, 77% „ 1 0 0 0 12 6 (2) Exposing Margarine for sale unlabelled — 0 2 0 (7) Selling Margarine in an improper wrapper 2 0 0 0 12 6 (8) ,, ,, ,, 2 0 0 0 12 6 (9) ,, ,, ,, — 0 2 0 (11) f Selling Margarine from unlabelled bulk 0 5 0 0 12 6 „ „ in an improper wrapper 0 5 0 0 12 6 (12) ,, ,, ,, 1 0 0 0 2 0 Name and address not inscribed on milk can ... 0 5 0 0 2 a ,, ,, 0 3 0 0 2 0 ,, ,, 0 2 0 0 2 0 ,, ,, 0 2 0 0 2 0 ,, ,, 0 10 0 0 2 0 ,, ,, — 0 2 0 SUMMARY OF LEGAL PROCEEDINGS. 87 NOTES. (1) The same defendant. (2) Defendant fined £1 with 12/6 costs, October, 1908, for selling butter containing 76½ per cent, of foreign fat. (3) The same defendant. (4) The same sample. Second summons was issued against the giver of warranty. {5) The same defendant. (6) Defendant fined £1 with 12/6 costs on each of two summons heard on October 2nd, 1908, for selling butter containing respectively 78 and 80 per cent of foreign fat. (7) Two offences in respect of the same sample. (8) (9) ,, „ (10) Defendant fined £3 with 12/6 costs on August 7th, 1903, for selling butter on bread containing 81 per cent. of foreign fat. (11) Two offences in respect of the same sample. (12) Defendant fined £3 with 12/6 costs on December 28th, 1900, and £5 with 12/6 costs on April 17th, 1903, for selling butter containing respectively 81 and 82 per cent, of foreign fat. APPENDIX.— 88 TABLE I. Vital Statistics of Whole District during 1909 and Ten Previous Years. L, G. B. vital statistics. Year. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. 9 Deaths of Nonresidents registered in the District. 10 Deaths of Residents registered beyond the District. 11 Nett Deaths at all Ages belonging to the District. Number. 3 Rate* 4 Under 1 Year of Age. At all Ages. Number. 5 Rate per 1,000 Births registered. 6 Number. 7 Rate.* 8 Number. 12 Rate.* 13 1899 142,477 3,452 24.22 549 159 2,445 17.16 606 298 223 2,370 16.63 1900 143,318 3,370 23.51 524 155 2,519 17.57 708 401 218 2,336 16.29 1901 144,188 3,359 23.29 484 144 2,163 15.00 652 324 218 2,057 14.26 1902 145,052 3,305 22.41 474 144 2,311 15.67 735 366 207 2,152 14.58 1903 145,927 3,302 22.62 425 128 2,103 14.41 743 360 181 1,918 13.14 1904 146,815 3,295 22.44 490 148 2,228 15.17 780 387 173 2,014 13.71 1905 147,713 3,184 21.55 441 139 2,210 14.90 806 410 161 1,961 13.27 1906 148,621 3,152 21.22 395 125 2,041 13.73 775 395 197 1.843 12.40 1907 149,542 3,074 20.55 390 128 2,154 14.40 770 372 232 2,014 13.46 1908 150,489 3,149 20.58 374 118 2,079 13.58 825 400 217 1,896 12.36 Averages for years 1899-1908. 146,483 3,264 22.24 455 139 2,225 1516 740 372 203 2,056 14.01 1909 151,437 2,895 19.11 347 119 2,154 14.22 813 409 219 1,964 12.96 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Total population at all ages, 143,976 Area of District in acres (exclusive of area covered by water), 1,336. Number of inhabited houses, 13,221 At Census of 1901. Average number of persons per house, 8.9 estimated populations of and numbers of births and deaths in borough. 89 TABLE II. Estimated Populations of and Numbers of Births and Deaths (both corrected) in Borough and its Wards. L. G. B. Year. Borough. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Estimated Population. 1901 144,188 17,152 27,775 18,769 23,842 26,335 8,454 7,939 13,922 1902 145,052 17,038 28,071 18,969 24,096 26,579 8,449 7,935 13,915 1903 145,927 16,924 28,370 19,171 24,352 26,826 8,445 7,931 13,908 1904 146,815 16,813 28,672 19,375 24,612 27,076 8,441 7,926 13,900 1905 147,713 16,701 28,978 19,581 24,874 27,326 8,436 7,923 13,894 1906 148,621 16,589 29,286 19,790 25,138 27,580 8,432 7,919 13,887 1907 149,542 16,478 29,597 20,001 25,406 27,837 8,428 7,915 13,880 1908 150.489 16,368 29,917 20,216 25,680 28,100 8,428 7,911 13,873 Averages 147,438 16,760 28,846 19,492 24,761 27,217 8,441 7,925 13,897 1909 151,437 16,259 30,236 20,432 25,954 28,363 8,420 7,907 13,866 Births. 1901 3,499 not known. 1902 3,464 1903 3,465 1904 3,458 1905 3,299 428 818 423 510 760 72 91 197 1906 3,286 458 844 430 453 769 63 71 198 1907 3,206 436 797 424 468 768 72 65 176 1908 3,296 455 858 427 505 739 68 65 179 Averages 3,372 ... ... ... ... ... ... ... ... 1909 3,031 382 741 392 470 743 63 48 192 Deaths. All Ages. 1901 2,057 257 401 255 354 484 77 61 168 1902 2,152 270 433 264 373 539 59 70 144 1903 1,918 237 353 244 349 470 51 60 154 1204 2,014 249 402 260 310 482 68 66 177 1905 1,961 221 396 257 338 448 77 76 148 1906 1,843 206 319 250 297 487 58 57 169 1907 2,014 235 398 292 337 470 72 64 146 1908 1,896 225 381 249 343 434 64 53 147 Averages 1,982 238 385 259 338 477 66 63 156 1909 1,964 202 377 272 324 491 73 62 163 Under One Year. 1901 455 62 105 49 75 132 9 4 19 1902 433 76 101 49 63 117 3 8 16 1903 388 43 84 44 63 123 3 g 22 1904 449 71 96 52 62 131 7 23 1905 391 52 94 51 57 111 4 5 17 1906 353 42 63 46 55 113 3 f! 1907 354 46 85 46 47 99 6 6 19 1908 348 41 79 43 55 102 2 4 22 Averages 396 54 88 47 60 116 5 6 20 1909 311 28 55 36 50 116 4 4 18 90 CAUSES OF DEATH AT VARIOUS AGES IN EACH SEX. TABLE III. Causes of Death : Borough—Sex and Age Distribution. 1909. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond the Borough. L. G. B. Cause of Death. Age at Death. All Ages. 0— 1— 5— 15- 25— 65 and upwards. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Persons. 1909 1908 1907 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 7 3 11 15 ... ... ... ... ... ... ... ... 18 18 36 36 37 Scarlet Fever 1 ... 5 4 1 2 ... 1 ... ... ... ... 7 7 14 15 13 Epidemic Influenza ... ... ... 2 ... ... 3 1 15 17 7 27 25 47 72 63 52 Whooping-cough 6 8 9 9 2 2 ... ... ... ... ... ... 17 19 36 11 50 Diphtheria, Membr. Croup ... ... 3 3 2 2 ... ... ... 1 ... ... 5 6 11 16 20 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... 1 2 ... ... 1 2 3 4 5 Diarrhoea, Dysentery 8 13 2 4 ... ... ... ... ... 2 ... ... 10 19 29 37 21 Epidemic, Zym. Enteritis 4 2 2 1 ... ... ... ... ... ... ... ... 6 3 9 23 26 Enteritis 7 5 ... ... ... 2 1 ... ... 2 2 2 10 11 21 23 18 Other Continued Fevers— Mumps ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... Cerebro-Spinal Fever ... l ... 1 ... ... ... ... ... ... ... ... ... 2 2 ... ... Syphilis 4 3 ... 1 ... ... ... ... ... ... ... ... 4 4 8 11 12 Erysipelas ... 1 ... ... ... ... ... ... 2 ... ... 1 2 2 4 5 7 Puerperal Fever ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 2 4 Other Septic Diseases— Pyæmia ... ... ... ... 1 ... ... ... 1 ... ... ... 2 ... 2 ... ... Infective Endocarditis ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 3 ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... Stomatitis ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... Cellulitis ... ... ... ... ... ... ... ... 2 ... ... 1 2 1 3 ... ... Rheumatic Fever ... ... ... ... 1 2 1 3 2 1 ... ... 4 6 10 5 8 Tuberculosis— „ of Meninges 2 ... 5 4 3 1 ... 1 ... 1 ... ... 10 7 17 14 25 „ of Lungs ... ... 2 ... 1 2 8 5 82 52 6 3 99 62 161 149 157 „ (other forms) 5 1 5 4 1 1 1 ... 4 4 ... ... 16 10 26 27 37 Alcoholism ... ... ... ... ... ... ... ... 3 7 1 ... 4 7 11 9 10 Cancer ... ... ... ... ... ... 1 2 36 60 23 34 60 96 156 185 178 Premature Birth 29 27 ... ... ... ... ... ... ... ... ... ... 29 27 56 55 72 Developmental Diseases 48 29 1 1 ... 1 ... ... 1 ... ... ... 50 31 81 93 66 Old Age ... ... ... ... ... ... ... ... ... ... 29 88 29 88 117 105 111 Convulsions 6 4 1 2 ... ... ... ... ... ... ... ... 7 6 13 14 13 Meningitis 5 3 ... 1 ... 1 ... ... 1 1 ... ... 6 7 13 11 10 Inflam. & Softg. of Brain ... ... ... ... ... 1 ... ... 5 3 7 3 12 7 19 21 11 Apoplexy ... ... ... ... ... ... ... ... 3 3 6 7 9 10 19 20 20 Cerebral Hæmorrhage 1 ... ... 1 ... ... ... ... 11 9 9 16 21 26 47 41 35 Organic Diseases of Heart ... ... ... 1 ... 2 1 ... 14 15 8 12 23 30 53 58 79 Heart Disease ... ... ... 1 ... 1 ... ... 19 18 14 27 33 48 81 75 79 Bronchitis 7 18 1 3 1 ... ... ... 30 27 47 72 86 120 206 176 177 Lobar (Croupous) Pneumonia ... ... ... 2 ... ... 1 ... 7 7 4 3 12 12 24 26 19 Lobular (Broncho-) Pneumonia 10 11 13 9 1 ... ... ... 2 2 1 7 27 29 56 49 77 Pneumonia 3 7 5 2 1 ... 4 ... 22 19 7 16 42 44 86 74 72 Diseases of Stomach 1 2 ... ... 1 ... ... ... 10 6 ... ... 12 8 20 10 22 Obstruction of Intestines 1 ... ... ... ... 1 ... ... 3 3 2 1 6 5 11 10 11 Cirrhosis of Liver ... ... ... ... ... ... ... ... 2 3 1 2 3 5 8 16 29 Nephritis and Bright's Dis ... ... ... ... 2 1 1 ... 22 18 15 13 40 32 72 45 54 Tumours, &c., of Female Genital Organs ... ... ... ... ... ... ... 1 ... 5 ... 2 ... 8 8 8 7 Accid. and Dis. of Parturition ... ... ... ... ... ... ... 2 ... 9 ... ... ... 11 11 10 11 Accident and Negligence 4 6 2 3 1 1 1 1 17 5 6 4 31 20 51 71 57 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Suicide ... ... ... ... ... ... ... 2 12 7 ... 1 12 10 22 17 9 Ill-defined Causes 1 1 ... ... ... ... ... ... ... 1 ... ... 1 1 3 8 6 All other Causes 5 1 2 2 5 6 7 4 67 56 41 52 127 121 248 236 281 All Causes, 1909 165 146 69 76 24 29 30 27 399 367 236 396 923 1041 1964 1908 198 150 86 69 18 28 32 20 376 354 225 340 935 961 1896 1907 219 135 113 87 32 25 36 33 384 348 236 366 1020 994 2014 deaths at all ages. 91 TABLE IV. Causes of Death : All Ages, Persons.—In Wards. 1909. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond, the Borough. L.G.B Cause of Death. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Small-pox ... ... ... ... ... ... ... ... Measles 2 7 5 5 17 ... ... ... Scarlet Fever 1 1 ... 2 9 1 ... ... Epidemic Influenza 5 19 12 10 10 2 4 10 Whooping-cough 2 7 5 6 16 ... ... ... Diphtheria and Membranous Croup 2 1 ... 2 5 ... 1 ... Croup ... ... ... ... ... ... ... ... Enteric Fever ... ... ... 1 ... ... ... 2 Diarrhœa, Dysentery 2 4 3 7 12 ... 1 ... Epidemic, Zymotic Enteritis ... ... ... 3 6 ... ... ... Enteritis ... ... 7 3 6 4 ... 1 Other Continued Fevers— Mumps ... ... ... ... 1 ... ... ... Cerebro-Spinal Fever ... ... ... ... 2 ... ... ... Syphilis ... ... 2 ... 5 ... ... 1 Erysipelas 1 ... ... 1 1 1 ... ... Puerperal Fever ... ... ... ... 2 ... ... ... Other Septic Diseases— Pyæmia ... ... ... ... ... ... 1 1 Infective Endocarditis ... ... 2 ... ... ... 1 ... Carbuncle 1 ... ... ... ... ... ... ... Stomatitis ... ... ... ... 1 ... ... ... Cellulitis 2 ... ... 1 ... ... ... ... Rheumatic Fever ... 3 1 1 3 ... 1 1 Tuberculosis— „ Of Meninges ... 4 5 ... 7 ... ... 1 „ Of Lungs 21 35 23 29 40 3 2 8 „ Other Forms 5 5 2 6 8 ... ... ... Alcoholism 2 ... ... 3 4 1 1 ... Cancer 17 34 26 25 26 10 9 9 Premature Birth 6 13 6 11 10 1 ... 9 Developmental Diseases 8 16 6 10 33 ... 2 6 Old Age 11 23 14 24 20 4 3 18 Convulsions 2 4 ... 2 5 ... ... ... Meningitis 2 ... 1 5 4 ... ... 1 Inflammation andSofteningof Brain ... 5 2 4 5 1 1 1 Apoplexy 2 4 3 3 3 2 ... 2 Cerebral Hæmorrhage 8 6 9 7 11 2 1 3 Organic Diseases of Heart 4 12 10 11 12 ... 1 3 Heart Disease 6 20 11 15 18 1 3 7 Bronchitis 20 39 28 36 56 5 4 18 Lobar (Croupous) Pneumonia 2 5 4 2 5 1 1 4 Lobular (Broncho-) Pneumonia 8 13 7 7 17 2 1 1 Pneumonia 12 14 9 14 22 3 4 8 Diseases of Stomach 4 6 3 1 4 ... ... 2 Obstruction of Intestines ... 1 4 2 2 ... ... 2 Cirrhosis of Liver 1 ... ... 1 3 2 ... 1 Nephritis and Bright's Disease 4 19 15 11 9 5 2 7 Tumours, &c., of Female Genital Organs ... 2 3 3 ... ... ... ... Accidents and Diseases of Parturition 3 ... ... 2 3 1 1 1 Accidents and Negligence 5 14 3 3 20 2 2 2 Homicide ... ... ... ... ... ... ... ... Suicide 4 4 3 3 4 3 1 ... Ill-defined Causes ... 1 1 ... 1 ... ... ... All other Causes 27 36 37 42 43 16 14 33 All Causes— 1909 202 377 272 324 491 73 62 163 1908 225 381 249 343 435 64 53 146 1907 235 398 292 337 470 72 64 146 92 deaths in local institutions. TABLE V. Deaths in Local Institutions. Year. Paddington Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. 1899 255 280 69 2 1900 255 386* 63 4 1901 238 317 92 5 1902 298 359 76 2 1903 317 342 82 2 1904 327 360 92 1 1905 324 387 91 4 1906 314 356* 98* 7 1907 347 332 88 3 1908 373 351 91 - Averages 1899-1908 305 347 84 3 1909 350 362 88 5 * Closed part of year for repairs and alterations. TABLE VI. Causes of Deaths in Institutions. 1909. Causes of Death. Local Institutions. Deaths of Residents recorded beyond the Borough. Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital, Home of Compassion. Nursing Homes. Hospitals of Metropolitan Asylums Board. Special and General Hospitals. Lunatic Asylums. Poor Law Institutions. Elsewhere. Small-pox ... ... ... ... ... ... ... ... ... ... ... Measles 3 ... 1 ... ... ... 3 1 ... ... ... Scarlet Fever 1 ... ... ... ... ... 12 1 ... ... ... Influenza ... ... ... ... ... ... 1 ... 1 ... 1 Whooping-cough 8 ... ... 1 ... ... ... 1 ... 1 ... Diphtheria ... 3 1 ... ... ... 8 ... ... ... ... Enteric Fever ... 1 ... ... ... ... 1 ... ... ... ... Diarrhœa ... 5 13 ... ... ... ... 2 1 ... ... Epidemic Enteritis 4 ... ... ... ... ... ... ... ... ... ... Erysipelas 1 ... ... ... ... 1 ... ... ... ... ... Puerperal Fever ... 4 ... ... ... ... ... ... ... ... ... Other Septic Diseases 3 7 ... ... ... ... ... 2 1 ... ... Tuberculosis of Lungs 47 11 1 ... 3 2 ... 11 9 4 1 Other forms of Tuberculosis 11 31 13 ... ... 1 ... ... 1 2 ... Cancer 30 42 2 ... 3 12 ... 21 5 2 ... Premature Birth 2 1 ... ... ... ... ... 3 ... ... ... Developmental Diseases 3 11 14 ... ... 1 ... 4 ... ... ... Old Age 45 ... ... ... ... 2 ... ... 2 ... 1 Bronchitis 34 6 1 ... ... 1 ... 2 3 2 ... Pneumonia 21 33 12 ... ... 4 ... ... 1 ... 2 Cirrhosis of Liver 2 ... ... ... ... ... ... ... ... ... ... Accidents of Childbirth 1 ... ... ... ... ... ... 2 ... ... ... Accident and Violence 10 47 2 ... ... ... ... 6 ... 1 5 Suicide ... 5 ... ... ... ... ... 1 ... ... 2 All other Causes 124 155 28 4 3 22 ... 32 33 8 14 All Causes 350 362 88 5 9 46 25 91 57 20 26 Non-Residents* 13 263 65 4 7 27 * The deaths of 30 other non-residents took place either in the streets or houses in the Borough. Total deaths of non-residents—409. deaths of infants under one year. 93 TABLE VII. Deaths of Infants under One Year. L. G. B. Groups. Weeks. Months. Totals, under One Year. 0— 1— 2— 3- 0- 1— 2- 3— 4— 5— 6— 7— 8— 9— 10— 11— 1909 1904-08 m. f. m. f. m. f. m. f. m. f. m. f. nl. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. Not Certified ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 I. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... Measles ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 1 2 2 7 3 5 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 0 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 0 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... 1 2 4 1 ... 1 ... ... ... 1 ... ... 6 8 5 6 II. Diarrhœa (all forms) 1 ... 1 ... ... ... l ... 3 ... 1 5 ... l 3 ... l 2 1 3 1 ... 1 1 1 1 ... ... ... 2 ... ... 12 15 43 32 Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 3 1 1 1 ... 1 1 1 1 ... ... 1 ... ... ... ... 1 ... ... ... 7 5 9 4 III. Premature Birth 24 15 1 7 ... 1 l 1 26 24 2 2 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 29 27 34 24 Congenital Defects 4 1 1 ... ... 1 1 1 6 3 2 3 1 1 1 ... ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... 13 7 6 9 Injury at Birth 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 1 Want of Breast Milk 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 3 2 Atrophy, Debility ... ... 2 1 ... 1 1 ... 3 2 3 2 2 2 3 ... 1 ... ... ... ... 2 ... ... 1 ... ... ... ... ... ... ... 13 8 16 7 Atelectasis 3 2 ... ... ... ... ... ... 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 3 3 Debility at Birth 8 3 ... ... 1 ... 1 ... 10 3 ... 2 2 l 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 13 7 9 8 IV. Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... l ... ... ... 2 ... 4 3 Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 1 Other Tuberculous Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 3 1 3 2 V. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... l 1 0 Syphilis 1 1 ... ... ... ... ... ... 1 1 3 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 4 4 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 0 Meningitis ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... 1 1 ... ... 1 ... 1 1 ... ... ... 5 3 2 2 Convulsions ... 2 2 ... ... ... ... ... 2 2 ... ... ... 1 ... ... ... ... l ... 1 ... ... 1 1 ... ... ... 1 ... ... ... 6 4 7 6 Bronchitis ... 1 ... ... ... l 1 1 1 3 2 3 ... l ... 2 ... 1 l 2 ... l ... 3 1 ... ... 1 2 1 ... ... 7 18 12 11 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 0 Pneumonia ... ... ... ... 1 ... 1 ... 2 ... ] 1 1 2 1 2 ... 1 2 2 1 ... 2 2 ... 4 ... 1 2 3 1 ... 13 18 21 15 Suffocation (overlaid) ... 2 ... ... ... ... ... ... ... 2 1 l 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 7 5 Other Causes 2 1 ... ... ... 4 ... 1 2 2 1 ... 2 ... l 1 ... ... 1 1 l ... 1 1 1 1 1 1 ... 2 ... 1 11 10 14 12 All Causes, 1909 46 29 8 8 2 4 7 4 63 45 18 21 12 12 13 10 5 6 9 10 7 6 11 10 9 8 2 5 12 10 4 3 165 146 1904-08 38 29 10 8 9 8 8 8 65 53 28 21 20 12 14 13 14 11 15 9 12 8 10 8 9 5 12 9 8 8 9 6 216 163 Population— 151,437 (estimated) 1909 1909. 1904-08. Births registered M. 1,481 1,542 within Borough F. 1,414 1,484 1909. 1904-08. Deaths- M. 923 941 all causes, all ages F. 1,041 1,005 94 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. TABLE VIII. 1.—Inspection. Including Inspections made by Sanitary Inspectors. H.O. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 210 ... ... Workshops (including Workshop Laundries) 2,020 9 ... Workplaces (other than Outworkers' premises included in Part 3 of this Report) 50 ... ... Total 2,280 9 ... 3.—Home Nature of Work. Outworkers' Lists, Section 107. Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Notices served on Occupiers as to keeping or sending lists. Twice in the year. Once in the year. Lists. Outworkers- Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) making, &c 114 ... 579 23 ... 38 289 415 ... (2) cleaning and washing 14 ... 33 5 ... 6 10 7 ... Lace, lace curtains and nets 2 ... 3 ... ... ... 3 ... ... Artificial Flowers 2 ... 2 ... ... ... ... ... ... Furniture and Upholstery 12 ... 50 3 ... 3 6 4 ... Umbrellas, etc 2 ... 2 ... ... ... ... ... ... Electro-plate ... ... ... ... ... ... 1 ... ... Total 146 ... 669 31 ... 47 309 426 ... 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. Workshops on Register end of 1909 1,688 Bakehouses „ „ „ (including Level, Underground and Factory Bakehouses) 75 Total number of workshops on Register 1,763 Factories, workshops, laundries, workplaces and homework. 95 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of Cleanliness 22 22 ... ... Want of Ventilation ... ... ... ... Overcrowding 2 2 ... ... Want of drainage of floors ... ... ... ... Other nuisances 1 1 ... ... Sanitary accommodations insufficent ... ... ... ... unsuitable or defective 12 12 ... ... not separate for sexes 1 1 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) ... ... ... ... Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) ... ... ... ... Total 38 38 ... ... Work. Number of Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Prosecutions. Instances. Notices served. Prosecutions Instances. Orders made (S. 110). Prosecution (Section) 109, 110. Failing to keep or permit inspection of lists. Failing to send lists. ... ... 367 ... 1 ... 4 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 367 ... 1 ... 6 ... ... 5.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 11 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5) Notified by H.M. Inspector ... Reports (of action taken) sent to H.M. ... Inspector 15 Other ... Underground Bakehouses (S. 101):— Certificates granted during the year ... In use at the end of the year 58 96 PROCEEDINGS DURING 1909. TABLE IX. PROCEEDINGS DURING 1909. L.C.C. Premises. Number of Places— Number of Inspections, 1909. Number of Notices, 1909. Number of Prosecutions, 1909. On Register at end of 1908. Added in 1909. Removed in 1909. On Register at end of 1909. Milk premises 176 14 7 183 245 ... ... Cowsheds 1 ... ... 1 4 ... ... Slaughter-houses 7 ... ... 7 492 ... ... Other offensive trade premises ... ... ... ... ... ... ... Ice cream premises 136 ... 16 120 57 ... ... Registered houses let in lodgings 1,343 26 49 1,320 7,958 (a)136 (a)... (b)3,578 (b)26 (a) For overcrowding. (b) For other conditions (including annual cleansing). Total number of intimation notices served for all purposes 791 Overcroivding, 1909— Number of dwelling rooms overcrowded 440 Number remedied 215* Number of prosecutions — Underground rooms— Illegal occupation dealt with during year - Number of rooms closed - Insanitary houses— Number closed under the Public Health (London) Act, 1891 - Number closed under the Housing of the Working Classes Act — Number of premises cleansed under Sec. 20 of the L.C.C. (General Powers) Act, 1904 172 Shelters provided under Sec. 60 (4) of the Public Health (London) Act, 1891 — Number of persons accommodated during the year — Revenue ,Acts— Number of houses for which applications were received during year 6 Number of tenements comprised therein 31 (a) granted 18 Number of tenements for which certificates were < (b) refused 4 (c) deferred 9 Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, etc., of dwelling houses 2 (e) In connection with the removal of offensive matter, etc. — (f) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. 1 (h) With respect to water closets, earth closets, etc. — (i) With respect to sufficiency of water supply to water closets 1 (j) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) 5 Mortuaries— Total number of bodies removed 288 Total number of infectious bodies removed * In 225 cases no action was taken, the deficiency of air space being very slight. † Including 15 deferred from 1907.