I Metropolitan Bormigh of Paddington. annual report of the council FOR THE YEAR 1902. APPENDIX. RFPORT OF THE Medical Officer of Health. LONDON MORTON & BURT, PRINTERS, EDGWARE ROAD, P ALDINGTON, W. II III PAD 7 Metropolitan Bormgh of Paddington. REPORT ON The Vital Statistics AND Sanitary Work For the Year 1902. BY REGINALD DUDFIELD, M.A., M.B., D.P.H., Medical Officer ot Health. SALUS CIVILM CIVITATIS OPES. IV V CONTENTS. Page Page Alcoholism, Deaths from 31 Inquests held 36 Apoplexy, Deaths from 30 Institutions, Deaths in 37 Bacteriological Examinations, Results of 44 Kitchens, Inspection of, at Restaurants 61 Bakehouses 59 Laundries 58 Births and Birth-Rates for 1902 7 Legal proceedings, 1902, Summary of 65 Butter Standard 61 Letter from Home Secretary re Fines under Canals 47 Sale of Food and Drugs Acts 63 Canal Boats Acts 47 London County Council (General Powers) Cancer, Mortality from 29 Act, 1902 62 Childbirth, Mortality in 25 Manure, Removal of 45 Chicken-pox, Notification of 26 Measles, Mortality from 26 "Clarendon St. Area,"Statistics 1901 & 1902 52 Meteorology, 1902 6 Combined Drains, Re-laid 46 Milkshops, Trades carried on at 61 Do. do. Sanctioned 46 Mortuaries 42 Common Lodging Houses, Deaths in 51 Notifications 12 Dairies and Milkshops Registered 61 Offensive Refuse, Removal or 44 Do. do. Defects found at 62 "Overcrowding"in Wards, Census 1901 3 Deaths and Death-Rates for 1902 8 Do. in Houses let in Lodgings, Deaths in Institutions 37 1902 49 Death-Rate, Correction Factor 12 Outworkers 58 Diarrhoea, Mortality from 34 Diphtheria, Cases of 17 Phthisis. Mortality from 27 Do. Mortality from 19 Do. and"Overcrowding" 28 Disinfection and Disinfectants 39 Do. and age constitution of population 28 Drains, Private, Re-laid 46 Population, Estimates, 1902 5 Do. Proportions of Females and Enteric Fever, Cases of 23 Children, Wards, 1901 3 Do. Mortality from 24 Prevention of Infectious Diseases 39 Erysipelas 26 Puerperal Fever, Cases of 24 Factory and Workshop Act, 1901, Work Mortality from 25 Refreshment Houses, Inspection of 61 Family Shelter, Admissions to 40 "Repayments of Local Loans,"Report of "Fever" 22 Commons' Committee on 52 Food Analysis, Summary of Samples taken 63 Respiratory Diseases, Mortality from 30 do. Summary of proceedings 67 Food Supervision 59 Scarlet Fever, Cases of 20 Food Adulteration, Small fines for 63 Do. do. Mortality from 22 Fried Fish Shops, Inspection of 61 J Schools and Infectious Diseases 42 Septic Diseases, Mortality from 25 Gas stoves, Ventilation of 57 Slaughterhouses, Inspection of 59 Hospitals, Accommodation provided 39 Small-pox 17 Household Refuse, Removal of 45 Smoke Prevention 47 Houses let in Lodgings, Annual Cleansing of 48 Do. do. Infectious Illness in 50 Trade Refuse, Removal of 44 Do. do. Registration of in Tubercular Diseases, Mortality from 27 1902 48 Unsound Food seized 63 "Housing"in Wards, 1901 1 "Housing of Working Classes,"Report Vaccination 17 Joint Committee (Lords and Com-mons)°n 52 Water Supply, Cutting off of 41 Wharves, Inspection of 47 Do. do. Committee Work, 1902 51 Whooping Cough, Mortality from 27 Ice Cream, New Legislation re 62 Workshops, Inspected 54 Do. Inspection of places where made 63 Do. Nuisances at 55 Illegitimates, Births of 8 Do. Overcrowding in 56 Do. Deaths of 36 Do. Sanitary Conveniences 57 Infantile Mortality, 1902 31 Do. Ventilation of 56 Do. do. 1857-66 31 Windsor Gardens, Proceedings re combined Influenza, Mortality from 30 drainage of 65 VI VII TO HIS WORSHIP THE MAYOR, THE ALDERMEN, AND COUNCILLORS OF THE BOROUGH OF PADDINGTON. Mr. Mayor and Gentlemen, I have the honour to present my Ninth Annual Report on the Health of the Borough, and the work of the Public Health Department during the past year. I regret that the Report has not been presented earlier, as it has been complete some weeks, but the delay has been due to causes beyond my control. The death-rate during 1902 was lower than that of 1901, which was described in my last Annual Report as"the lowest recorded in the last eleven years."The statistics for the years prior to 1891, with reference to the Borough as now constituted, are not available. Last year's death rate was 1.55 per 1,000 below the mean rate for the preceding decennium, which represents a saving of 225 lives. The only regrettable feature in connection with this subject is the fact that the infantile mortality does not bear its proper proportion in the decline. Inasmuch as climatic conditions greatly influence this mortality it is of little use to compare individual years. The proper comparison is that of two groups of years at long intervals from each other. Such comparison is possible only with reference to the two Registration Sub-Districts, St. Mary and St. John. The figures given on page 32 of the Report show that the mortality during the decennium 1892-1901 was considerably higher than that for the earliest period on record, viz., 1857-60. With a declining birth rate and an increasing infantile mortality, the growth of the population of the country must, in the absence of effective measures to counteract the above, be dependent on immigration. If the immigrants be of a high class, such addition to the population is an advantage. The class of the immigrants at present arriving is a matter of general knowledge—and a cause of disquietude. The time has come when more efforts must be made to limit the waste of native-born children. Much may be done by Departmental work, aided by the co-operation of the medical profession, the clergy, district visitors, and others, but what is most wanted is better education of girls in those subjects which are requisite to fit them to be wives and mothers. Indeed, were such subjects as the principles of domestic economy (meaning housewifely management, and thrift) and hygiene included in the course of teaching in all public elementary schools, manv of the present day evils would be greatly minimised. I believe that, if the women of the poorer classes were better informed as to the great variety in cheap, nutritive, and appetising foods which are at their disposal, were trained in simple cookery and home management, the housing question would be in part solved, that intemperance would be less prevalent, and that children would come into the world with greater vitality, and be brought up in surroundings more favourable to their development as robust individuals and good citizens. The most interesting feature of the year has been the outbreak of small-pox which began in 1901. In the Borough the outbreak continued to the middle of last year, and was as abrupt in its termination as in its onset. Unfortunately I cannot say that there is no danger of a further outbreak. Cases of the disease have continued to occur in other parts of the Metropolis, and in many parts of the Provinces. Should there be a recrudescence of the disease, the Health Service of the Metropolis will be found even better organized to cope with it than it was in 1901. The Department has been able to carry out the various duties foreshadowed in my Report of last year. As time goes on the Staff will be able to find time to undertake other duties VIII which still require attention, e.g., the lowering of infantile mortality (already referred to) and the prevention of consumption. On the latter point attention may be directed to the statistics given 011 pages 27 and 28 of the Report. The phthisis rate in Old Paddington used to be one of the lowest in the Metropolis, and that of the Borough compares favourably with those of the adjacent districts (See Table 21, page 16).* Nevertheless, the loss of 153 persons at the most productive ages of life, from a disease which is very largely preventible, is a matter which cannot be neglected. The figures given on page 28 show that there is an intimate connection between the prevalence of this disease and the"housing"of the people, and, therefore, affords better hope of success attending measures of prevention. In conclusion, I desire to acknowledge my indebtedness to the Chairman and Members of the Public Health Committee for the very sympathetic manner in which they have received the recommendations I have placed before them. My thanks are due, and hereby heartily tendered, to the Members of the Medical Profession practising in the Borough, from whom I have received much useful information and help, especially in dealing with the outbreak of small-pox. I wish also to place on record my appreciation of the work of the Staff of the Department, no member of which has failed to respond to the calls for hard work, not only during the ordinary hours of duty but at all other times. I have the honour to be, Mr. Mayor and Gentlemen, Your most obedient Servant, Reuiaw Puriee m.a., m.b., d.p.h., Medical Officer of Health. Public Health Department, Howley Lodge, Harrow Road, Paddington, W. 24th July, 1903. *The rate in Willesden last year (omitted from the Table) was 0.90 per 1,000 persons. XI 1 THE BOROUGH. Full information as to the area, divisions, &c., of the Borough was given in the Report for 1901, and need not be repeated here.* During the past year additional information has been obtained as to the sex-age constitution and housing of the populations of the Registration Sub-Districts and Wards. The data as to housing will be found summarised in Tables 1 and 3. In Tables 2 and 4, the more important particulars for the whole Borough are contrasted with those for the Metropolis and districts immediately adjacent to the Borough. HOUSING. Of the inhabitants of the Borough, 50.86 per cent. resided in homes of less than 5 rooms (Table 1), and 49.14 per cent. in homes of 5 or more rooms. In the Registration Sub-District of St. Mary, the proportions were 01.34 and 38.60 respectively; in St. John, 21.40 and 78.00; and in North-West Paddington, 51.71 and 48.29. In the Wards the highest percentage residing in homes of less than 5 rooms was that of the Harrow Road Ward (75.47), and the lowest, that of Lancaster Gate, West, (15.22). The highest proportion of inhabitants residing in homes of one room was found in Church Ward (15.40), and the lowest in Lancaster Gate, East, (1.00); in homes of two rooms, the highest in Church Ward (32.39), the lowest in Lancaster Gate, East, (2.30); in homes of three rooms the highest in Harrow Road Ward (39.87), the lowest in Lancaster Gate, West, (3.85); and in homes of four rooms, the highest in Oueen's Park Ward (21.08), and the lowest in Lancaster Gate, East, (5.05). TABLE 1. Proportions (per cent.) of total population of each District (Ward) living in each class of home (tenement). Census, 1901. In Homes containing rooms. Borough. Registration Sub-Districts Wards. St. Mary. St. John. North-West Paddington* Harrow Rd. Maida Vale. Westbourne. Church. Lancaster Gate (West) Lancaster Gate (East) Hyde Park. 1 6.41 8.19 2.57 4.32 4.56 4.79 6.69 15.46 1.19 1.00 3.58 2 15.69 20.19 5.01 12.22 14.87 14.81 15.50 32.39 2.46 2.36 7.28 3 17.32 21.93 6.17 14.09 39.87 15.08 14.86 12.54 3.85 7.19 6.57 4 11.44 11.03 7.65 21.08 16.17 8.75 9.26 8.09 7.69 5.65 7.84 less than 5 50.86 61.34 21.40 51.71 75.47 43.43 46.31 61.29 15.22 16.20 25.27 5 or more 49.14 38.66 78.60 48.29 24.53 56.57 53.69 30.71 84.78 83.80 74.73 * Queen's Park Ward is co-terminous with this Sub-District. *It will be useful to recall the fact that the Borough contains three Registration Sub-Districts and eight Wards. The scheme of sub-division is as follows:— Registration Sub-Districts. Wards. St. Mary Harrow Road. Maida Vale. Westbourne. Church, part of. St. John Church, part of. Lancaster Gate, West ,, ,, East. Hvde Park. North-West Paddington Queen's Park. 1A 2 housing. TABLE 2. Proportions (per cent.) of total populations living in each class of home (tenement). Census, 1901. In Homes of rooms. Encircling Boroughs. BOROUGH. London. Kensington. Westminster St. Marylebone. Hampstead. Willesden. 1 0.41 6.72 6.42 7.65 12.31 2.22 2.59 2 15.69 15.46 15.74 16.58 22.13 8.86 9.70 3 17.32 16.58 11.44 13.56 13.32 10.70 20.82 4 11.44 15.24 8.09 7.90 7.86 7.82 17.59 less than 5 50.86 54.00 41.69 45.69 55.62 29.60 50.70 5 or more. 49.14 46.00 58.31 54.31 44.38 70.40 49.30 TABLE 3. Percentages of inhabitants of each class of home, and of total population of each District, "overcrowded." Census 1901. In Homes containing rooms. Borough. Registration Sub-Districts. Ward. St. Mary. St. John. North-West Paddington* Harrow Rd. ! Maida Vale. Westbourne Church. Lancaster Gate (West) Lancaster Gate (East) Hyde Park. 1 40.0 42.6 29.2 25.7 26.1 33.0 33.5 53.7 22.8 20.2 24.4 2 41.6 44.1 31.3 27.9 27.0 40.0 34.9 57.2 21.1 23.5 34.3 3 18.8 18.9 17.8 19.2 12.1 26.1 18.2 36.2 21.9 17.7 15.5 4 10.5 11.2 10.0 9.1 8.8 12.7 10.8 15.4 12.3 2.2 10.6 less than 5 26.67 28.96 19.54 17.68 15.20 28.90 24.55 47.28 17.01 13.29 20.68 Percentage of total population overcrowded. 13.56 17.76 4.18 9.14 11.47 12.55 13.36 32.76 2.58 2.15 5.22 * Queen's Park Ward is co-terminous with this Sub-District. 2A 3 housing. TABLE 4. Percentages of inhabitants of each class of home, and of total population,"overcrowded." Census, 1901. In Homes of rooms. Encircling Boroughs. BOROUGH. London. Kensington. Westminster St. Marylebone. Hampstead. Willesden. 1 40.0 48.4 45.3 41.3 45.2 33.7 44.0 2 41.6 42.3 47.2 35.3 46.9 33.9 40.3 3 18.8 24.9 29.6 22.7 28.6 18.1 23.7 4 10.5 13.5 13.7 11.5 16.0 9.1 9.1 less than 5 26.7 29.6 35.5 28.5 37.9 21.6 22.9 Percentage of total popul'n. overcrowded. 13.6 13.8 14.8 13.0 21.1 6.4 11.6 The"overcrowding"of inhabitants was highest in Church Ward (47.28 per cent. of those in homes of less than five rooms and 32.70 per cent. of all inhabitants) and lowest in Lancaster Gate, East, Ward (13.29 and 2.15 per cent. respectively). Attention is particularly directed to the proportions in each class of home in Church Ward (see Table 3). Queen's Park and Harrow Road Wards had on the whole less"overcrowding" than Hyde Park Ward, a somewhat unexpected discovery. More information has been applied for as to "housing" in the different Enumeration Districts. When that has been received, the question of "overcrowding" will be dealt with more fully. POPULATION. The incidence of disease and mortality is so greatly influenced by the proportions in any population of the two sexes and of the numbers thereof at various ages, that the brief analyses of these factors given in Tables 5 and 6 will be found of value in considering the prevalence of infectious illness and the mortality rates, not only in the Borough but in the districts selected for comparison therewith. While in the whole Borough there were at the last census 134 females to every 100 males (of all ages in each case), the proportion in the Registration Sub-Districts varied from an equality (100 males to 99.53 females) in North-West Paddington to 100:190 in St. John. Taking the figures for the Wards, it is found that they range from an equality in Oueen's Park Ward to a ratio of 100:247 in Lancaster Gate, West, Ward. An examination of a more extended table of proportions, not reproduced here, indicates that the bulk of the disparity in the latter Ward is due to the large excess of female servants and employees in commercial houses. This fact conduces to abnormally low rates of sickness and death, as it is usual for such persons to go to their homes, or to hospitals, when incapacitated from work. Comparing the Borough with the Selected Districts (Table 6) it is seen that the highest proportion of females to males was found in Hampstead (159:100), and the lowest in Willesden (114: 100), and that the proportions in all the districts were above that for the Metropolis as a whole (112: 100). 4 population. TABLE 5. Proportion of males to females, and of males and females at certain ages to total number of each sex. Census, 1901. Borough. Males to Females* Males. Per cent. of all males living at ages Females. Per cent. of all females living at ages Persons Per cent. of all persons living at ages Under 1 year. 1—5 years. 0-10 years. Under 1 year. 1—5 years. 0-10 years. Under 1 year. 1-5 years. 0—10 years. 134 2.40 7.96 19.41 1.72 6.04 14.73 2.01 6.86 16.73 Registration Sub-Districts St. Mary 125 2.66 8.63 20.47 2.00 6.94 10.74 2.29 7.69 18.40 St. John 190 1.50 5.30 13.90 0.86 2.97 7.50 1.08 3.77 9.73 North-West Paddington† 100 2.36 8.31 21.66 2.23 8.45 21.12 2.29 8.38 21.39 Wards. Harrow Road 111 3.05 9.64 22.46 2.52 8.73 20.40 2.77 9.15 21.37 Maida Vale 150 2.20 7.04 17.78 1.39 5.14 12.80 1.71 5.90 14.79 Westbourne 143 2.22 7.68 17.53 1.55 6.74 12.56 1.82 6.21 14.60 Church 110 2.80 8.89 21.71 2.28 8.01 19.58 2.53 8.43 20.58 Lancaster Gate (West) 197 0.95 4.43 12.70 0.80 2.64 6.63 0.85 3.24 8.33 Lancaster Gate (East) 247 1.18 4.70 13.06 0.80 2.39 6.15 0.90 3.07 8.13 Hyde Park 179 1.80 5.99 15.28 0.88 3.19 8.22 1.21 4.19 10.75 *No of females to every 100 males, at all ages in each case. †Co-terminous with Queen's Park Ward. TABLE 6. Proportion of males to females, and children (both sexes) at certain ages to total population. Census, 1901. Borough Males to Females.* Persons Per cent. of all persons living at ages Under 1 year 1-5 years. 0-10 years. 134 2.01 6.86 16.73 London 112 2.41 8.56 20.68 Kensington 156 1.09 6.31 15.49 Westminster 115 1.56 5.44 13.30 Marylebone 130 1.85 6.42 15.51 Hampstead 159 1.68 6.18 15.24 Willesden 114 2.80 10.22 23.99 *No. of females to every 100 males. 5 population. In dealing with the proportions of young children to total population it will be more convenient to take the figures in Table 0 first. Infants under one year of age formed 2.01 per cent. of the total population of the Borough as compared with 2.41 in the Metropolis. The highest proportion in any of the Selected Districts was that of Willesden (2.80), and the lowest that of Westminster (1.56). Children at ages 1—5 years formed 0.8(5 per cent. of the population of the Borough as against 8.56 for the whole Metropolis. The proportion was again highest in Willesden (10.22), and lowest in Westminster (5.44). Children at the combined ages of 0—10 years constituted 10.73 per cent. of the population of the Borough as compared with 20.08 in the whole Metropolis, the maximum and mininum proportions being found in the same two districts as at the other ages. The foregoing figures are of importance in connection with the question of "theoretical" overcrowding, which is any excess of an average of two persons per room. Such standard takes no count of the ages of the inhabitants or of the cubic space available. The latter cannot be determined under present conditions, but the former is always given in the census returns. The usual standards of cubic space allowed in houses let in lodgings are 400 cubic feet for adults and 200 for children under 10 years, thus making two such children equal to one adult. It is evident that, while the "theoretical" overcrowding may be equal in any two districts, a large excess of children under 10 in either district would materially impair the value of such comparison. The "theoretical" overcrowding really varies indirectly with the proportion of children under 10. No rule for correction in the manner indicated has been formulated at present.* The proportion of young children in any population will, other factors being ignored, affect the prevalence of sickness and the mortality. Such children are more liable to infectious illnesses, and their association in school tends to favour the spread of such diseases. Moreover, the mortality at ages under 5 years is higher than that at ages between 5 and (say) 00 years. In Table 5 the proportions of children (distinguishing the sexes) living at these young ages are set out. The largest proportions were in Harrow Road Ward, those in Church Ward closely approximating thereto. The lowest proportions were found in Lancaster Gate Wards. Population in 1902.—The estimate of the population of the Borough at the middle of 1902 was 145,052 persons, of whom 02,098 were males and 82,954 females. At the census of 1901 the enumerated population was 143,970 persons, showing an increase of 1,070 persons, during fifteen months. The estimates of the inhabitants of the various sub-divisions of the Borough are given in Table 7. TABLE 7. Estimated Population. Borough 1902. Males 62,098 Females 82,954 Persons 145,052. Registration Sub-Districts Persons. Wards. Persons. St. Mary 94,419 Queen's Park 17,038 St. John 33,595 Harrow Road 28,071 North-West Paddington 17,038 Maida Vale 18,969 Westbourne 24,090 Church 20,579 Lancaster Gate (West) 8,449 „ „ (East) 7,935 Hyde Park 13,915 *In an enquiry made in 1901, in an area containing 7,283 persons, of whom 2,334 (32 per cent.) were under 10 years of age, and 1,903 tenements, the cubic contents of which were known, the "theoretical" overcrowding was equal to 56 per cent. of the total population of the area and the "legal" overcrowding to 17 per cent. 6 meteorology. The following estimates of the population of the Borough of Paddington, as now constituted, are from the Summary Tables of the Census of 1901. Borough of Paddington. 1851 48,415 1881 120,118 1861 78,547 1891 135,955 1871 99,404 1901 143,976 The figures for the five censal years, 1851-91 are estimates, those for 1901 are from the Census itself. The rates of increase for the inter-censal periods were:— 1851-61 62.2% 1871-81 20.8 % 1891-1901 5.9% 1861-71 26.5% 1881-91 13.1% METEOROLOGY. In the appended table* will be found the results of observations taken at the Royal Botanical Gardens. The records kept there give a better account of the weather conditions prevailing at Paddington than do those taken at Greenwich. Month. Means at 8 a.m. Extreme Temperatures. Rain. Barometer reduced to sea level Thermometer. Shade. Max Sun. Min. Grass. Total Depth. No. of Days. Sunshine (bright). Number of Days Sunshine. Dry Bulb. Wet Bulb. Maximum. Minimum. January Inches. 30.15 Deg. 40.2 Deg. 38.3 Deg. 52 5 Date. 10th Deg. 24.0 Date. 14th Deg. 71.2 Deg. 18.0 In. 0.70 10 h. 31 m. 15 16 February 29.90 34.4 33.0 51.8 28th 20.0 15th & 20th 79.0 9.0 1.15 11 33 50 14 March 29.87 43.6 41.4 60.0 31st 30.0 6th 102.5 24.0 1.92 13 54 06 20 April 29.94 48.0 43.6 67.1 19th 30.0 Cth 110.0 21.0 0.43 8 98 21 25 May 29.98 50.7 461 70.0 27th 32.2 13th 122.0 24.0 2.43 24 149 42 27 June 29.95 601 54.8 81.2 29th 39.2 9th 124.0 31.0 3.13 15 146 33 24 July 3004 62.4 57.0 84.5 15th 44.5 11th 124.0 37.2 1.17 11 183 09 26 August 29.94 60.9 57.1 77.0 29th 44.0 10th 124.0 41.0 3.22 18 105 45 29 September 30.07 56.5 58.2 73.0 22nd 40.0 18th 116.5 34.0 0.86 9 128 06 29 October 29.97 49.9 47.2 63.5 10th 35.0 18th 98.0 29.0 1.46 17 39 31 18 November 29.90 44.8 43.4 58.5 6&7th 29.0 20th 84.0 24.0 1.74 11 25 33 13 December 30.05 41.4 38.9 56.0 17th 25.0 4th 71.0 20.0 1.48 12 21 14 10 Totals - - - - - - - - - 19.75 159 1,017 05 251 Means 29.98 49.4 40.1 - - - - - - - - - - — Highest — — — 84.5 July — — 124.0 — — — - - Lowest — - — — — 20.0 Feb. — 9.0 - — - — *The table appeared in The Times of 3rd or 4th January last. 7 births. BIRTHS. During the fifty-three weeks which made up the statistical year, 1902, 3,305 births were registered in the Borough (sec Table 8), equal to an annual rate of 22.41 per 1,000 persons of all ages*, or 0.88 less than the rate for 1901 (23.29). In Table I. in the Appendix will be found the number of births, and the birth-rates recorded in the Borough in each of the ten years, 1892-1901, and in Table II., the numbers for each Registration Sub-District†. Last year's rate for the Borough was 2.41 per 1,000 below the mean rate for the decennium (24.82). In the first quinquennium (five years 1892-9(5), the mean rate was 25.54 and in the second (five years 1897-1901), 24.11. In St. Mary's Sub-District the birth-rate last year was 25.45, being 1.G9 below that of 1901 (27.14), and 2.91 below the decennial mean rate (28.30). In the two quinquennia the mean rates were 28.92 and 27.80 respectively. In the Registration SubDistrict of St. John, last year's rate was 11.29, or 0.28 less than that of 1901 (11.57), and 1.32 below the decennial mean (12.61). The mean rates for the two quinquennial periods were 13.23 and 11.98 respectively**. In North-West Paddington the rate was 27.48, being 2.18 above that for 1901 (25.30), but 2.77 below the decennial mean (30.25), the quinquennial means being 32.34 and 28.15. TABLE 8. Births and Birth-Rates. Paddington. Births registered. (53 weeks) Borough. Registration Sub-Districts. St. Mary. St. John. North-West Paddington Males 1,691 1,266 184 241 Females 1,614 1,177 202 235 Totals 3,305 2,443 386 476 Birth-Rates. Per 1,000 1902 persons 1901 22.41 23.29 25.45 27.14 11.29 11.57 27.48 25.30 Per 1,000 females aged l5-45 years. 1902 71.6 87.0 26.0 119.7 In Table 9, the total number of births recorded in the Borough and each of the adjacent istricts are given together with the rates per 1,000 of the estimated population at all ages, nd per 1,000 females aged from 15 to 45 years. *All the Rates for last year being based on the statistics for 53 weeks have been adjusted to the calendar year of 365 days by the use of the factor 0.9838. †The births recorded in North-West Paddington prior to 1901, have been calculated from the births registered in the (old) Kensal Town Registration Sub-District of Chelsea, on the basis of the proportion of the population transferred to Paddington. The figures are consequently somewhat theoretical, but the best available. **The mean annual birth-rate in Old Paddington during 1857-00 was 28.93 per 1,000 persons, that of St. Mary's Registration Sub-District, 34.39, and that of St. John's, 23.07. Comparing the mean for 1857-66 with that for 1892-1901, there was a reduction of 0.09 per 1,000 in St. Mary and of 10.41 in St. John. 8 births. TABLE 9. Births and Birth-Rates. 1902. Borough Birth-rates. Births Registered. Per 1,000 persons at all ages. Per 1,000 females aged 15-45 years. 3,304* 22.39* 70.56 London 132,810 28.53 106.00 Kensington 3,488 19.31 54.52 Westminster 3,286 17.87 55.22 Marylebone† 3,976 29.60 87.36 Hampstead 1,549 18.19 48.83 Willesden 3,922 31.70 116.09 *Registrar-General's total and rate. †Correction necessary for births in Queen Charlotte Lying-in Hospital. The contrast between the rates, calculated per 1,000 females of reproductive ages (15-45 years), in the three Registration Sub-District is remarkable, thus while the birth-rate in NorthWest Paddington was 119.7, it was only 26.0 in St. John. Of course this difference is largely due to the very considerable excess of females at these ages in service in the wealthier part of St. John. It is feared, however, that the present tendency to small families has a no inconsiderable share in the lowness of the rate. Illegitimate Births.—Of the 3,305 births registered in the Borough, 149 were births of illegitimate children, equal to 4.5 per cent., an increase amounting to 0.6 per cent. above the proportion recorded in 1901 (3.9). In St. Mary's Sub-District, which includes the Workhouse and Infirmary, the proportion was 5.2 per cent. last year compared with 4.8 in 1901. In St. John the proportion rose from 0.5 per cent. in 1901 to 3.1 last year, and in North-West Paddington it fell from 2.0 to 1.6. (see Table 10.) TABLE 10. Illegitimate Births. Borough Registration Sub-Districts. St. Mary St. John North-West Paddington. Males 76 65 4 7 Females 73 64 8 1 Total 149 129 12 8 Per cent. of all births. 3.1 1.6 1902 4.5 5.2 1901 3.9 4.8 0.5 2.0 DEATHS. The deaths registered in the Borough during the past year (53 weeks) numbered 2,311, of which 1,188 were deaths of males, and 1,123 of females. In 1901 (52 weeks) the total 9 deaths. deaths registered locally numbered 2,103, or 148 fewer than last year, the deaths of males numbering 1,071, and those of females 1,092. The gross death-rate* last year was 15.67, or 0.67 higher than that of 1901 (15.00), and 1.22 below the decennial mean rate (16.89). See Table I., Appendix. Of infants under 1 year, 474 (484)† deaths were recorded, equal to a mortality of 144 (144) per 1,000 births registered, as compared with a decennial mean rate of 155. At ages 1—5 years, 243 (211) deaths were recorded; 5—15, 72 (85); 15—25, 114 (73); 25—65, 836 (702); and at 65 and upwards, 572 (518). The principal causes of death registered during 1902 within the Borough were— Infectious Diseases. Other Diseases or Causes. Measles 79 (9) Croup 2 (0) Scarlet Fever 1 (2) Cancer 149 (147) Whooping Cough 21 (52) Bronchitis 208 (192) Diphtheria and Membranous Pneumonia 208 (185) Croup 23 (30) Other Respiratory Diseases 25 (27) Enteric Fever 18 (8) Alcoholism 23 (15) Epidemic Influenza 61 (38) Cirrhosis of Liver 32 (26) Diarrhoea 61 (94) Premature Birth 75 (52) Zymotic Enteritis 28 (49) Accidents 108 (101) Puerperal Fever 5 (5) Suicides 17 (20) Other Septic Diseases 19 (25) Phthisis 141 (138) Other Tubercular Diseases 74 (81) The deaths in local public institutions numbered 735 last year, as compared with 652 in 1901, and a decennial average of (ill. (See Table I., Appendix.) The causes of death in the various institutions are set out in Table III., Appendix. Included in the 2,311 deaths registered within the Borough were 366 (324) deaths of nonresidents, chiefly in public institutions. In institutions and other places outside the Borough there were registered 207 (218) deaths of residents. (See Table III., Appendix.) By deducting the former and adding the latter deaths, the nett total of deaths of residents during the year is obtained, amounting to 2,152 persons, as compared with 2,057 in 1901, and a decennial average of 2,270. (See Table I., Appendix.) The nett death-rate for 1902 was 14.58 per 1,000 inhabitants, compared with a rate of 14.26 in 1901, and a decennial mean of 16.14. In the rest of this report, the deaths of residents only will be dealt with. Of the 2,152 deaths of residents, 1,066 were deaths of males, equal to a mortality of 16.88 per 1,000 males of all ages, and 1,086 of females, equal to a mortality of 12.87 per 1,000 females. The deaths of residents in the three Registration Sub-Districts, were of St. Mary, 1,556, equal to a mortality of 16.20 per 1,000 persons; of St. John, 326, mortality, 9.54; and of North-West Paddington, 270, mortality, 15.58. (See Table 11.) Distributing the deaths according to Wards, it appears (Table 11) that the highest mortalities among males, females, and persons were recorded in Church Ward (23.20, 16.98, and 19.95 respectively), and the lowest in Lancaster Gate, West, Ward (10.36, 5.08, and 6.86 respectively). In 1901 the lowest mortality, both sexes, was recorded in Lancaster Gate, East, Ward (7.67), and the highest in Church Ward (18.37). The differences between the highest and lowest rate for 1901 and 1902 were— Highest 1902, compared with highest 1901, an increase of 1.58. Lowest 1902, ,, „ lowest 1901, a decrease of 0.81. *See foot-note,* page 7. †The figures in parentheses in these paragraphs indicate the returns for 1901. 10 deaths. TABLE 11. Deaths from all causes at all ages and Death-rates, 1902. Borough. Deaths at all ages. Death-rates,* 1902. Deathrate,* 1901. Males. Females. Persons. Males. Females. Persons. Persons. 1,066 1,086 2,152 16.88 12.87 14.58 14.26 Registration Sub-Districts. St. Mary 766 790 1,556 17.94 14.77 16.20 15.54 St. John 142 184 326 12.06 8.21 9.54 10.35 North-West Paddington† 158 112 270 18.19 12.95 15.58 14.98 Wards. Harrow Road 213 220 433 15.83 14.64 15.17 14.45 Maida Vale 111 153 264 14.36 13.23 13.68 13.59 Westbourne 167 206 373 16.57 14.27 15.21 14.86 Church 298 241 539 23.20 16.98 19.95 18.37 Lancaster Gate (West) 30 29 59 10.36 5.08 6.86 9.08 Lancaster Gate (East) Hyde Park 28 42 70 12.03 7.30 8.67 7.67 61 83 144 12.02 9.13 10.17 12.04 *Per 1,000 estimated individuals of each sex, and of persons, in each district. †Co-terminous with Queen's Park Ward. The deaths and annual death-rates (the rates are in italic figures) in the four quarters of the last two years were— 1902. 1901. 1902. 1901. First Quarter 730 20.35 631 17.56 Third Quarter 418 11.56 469 13.05 Second „ 470 13.16 445 12.38 Fourth „ 522 13.40 512 14.24 Table II. in the Appendix contains the numbers of deaths recorded in each year of the decennium 1892—190.1 in the Borough and the three Registration Sub-Districts. Corresponding figures for the Wards are not available. From that Table it appears that the deaths recorded last year were in each case well below the decennial averages. Instead of correcting the averages for the changes in the populations, the following summary of the death-rates has been prepared:— Comparison of death-rates (per 1,000 persons at all ages). Ten years. Five years. Five years. 1902. 1892-1901. 1892-1890. 1897-1901. Borough 14.58 16.13 10.56 15.71 St. Mary 16.20 17.92 18.45 17.39 St. John 9.54 11.51 12.28 10.75 North-West Paddington 15.58 16.03 15.56 16.51 In Table 12 will be found the numbers of deaths of residents in each Ward tabulated in six sex-age-groups, together with the numbers dying in public institutions. It has not been thought necessary to calculate the mortality rates for all the sub-divisions of the Borough, but only for the Borough as a whole. The mortality rates for males and females in six sexage-groups for 1901 and 1902 will be found in Table 13. It will be seen from this Table that the changes in the rates have been very irregular and such as to allow of no conclusion being drawn. 11 deaths. 11 TABLE 12. Deaths at various ages from all causes, 1902. Borough Age Groups. Deaths in Institutions. 0 — 1 - 5 - 15— 25 - 65 and over. m. 269 f. 161 m. 107 f. 98 m. 37 f. 28 m. 49 f. 43 m. 389 f. 381 m. 215 f. 372 m. 331 f. 266 Registration Sub-Districts. St. Mary 204 121 80 75 31 17 30 30 272 278 149 269 232 193 St. John 22 10 6 10 3 1 8 8 60 73 43 82 43 36 North-West Paddington * 13 33 21 13 3 10 11 5 57 30 23 21 56 37 Wards. Harrow Road 69 32 16 20 12 7 10 9 75 75 31 77 49 46 Maida Vale 29 20 8 11 3 1 7 6 36 65 28 50 36 41 Westbourne 36 27 19 11 5 4 6 8 59 69 42 84 44 37 Church 74 13 37 33 11 5 7 8 115 84 54 68 114 80 Lancaster Gate (West) 3 — 2 1 — 1 4 1 11 8 10 18 8 3 Lancaster Gate (East) 6 2 1 — 2 - — 2 10 19 9 19 6 4 Hyde Park 9 7 3 6 1 - 4 4 26 31 18 35 18 18 *Co-terminous with Queen's Park Ward. TABLE 13. Mortalities at different ages per 1,000 estimated living in each age-group. Paddington, 1901 and 1902. Year. Males. Females. 0— 1— 5- 15— 25— 65 and over. 0— 1— 15- 25— 65 and over. 1902 177.36 21.25 3.33 3.81 12.83 89.76 112.96 19.22 2.38 2.35 8.76 82.65 1901 162.50 24.63 2.03 1.83 12.87 88.85 150.81 14.25 3.33 2.13 8.52 76.81 For the purpose of comparing the local death-rate with those prevailing in London and the districts adjacent to the Borough, Table 14 has been compiled. The most usual comparison to make is that of the nett rates (columns 1 and 2 of the Table). It will be seen that the Borough rate in 1902 (14.63) was lower than any of the rates in the four first districts selected for comparison, but above those in Hampstead (10.79) and Willesden (13.5). The increase in the rate for last year compared with the rate for 1901 (0.30) was higher than the corresponding increases in other districts, except Marvlebone (1.70) and Willesden (1.10). The foregoing comparison makes no allowance for the differences in sex-age-constitutions of the various populations. The Medical Officer of Health of the Countv has published factors based on the last census which enables the proper corrections for such differences to be made 12 notifications. in the Metropolitan districts. The factor for Willesden is not known. He has also calculated the "standard" rates for the Metropolitan districts (See Table 14). By the use of the factors referred to, the "corrected" rates given in the fourth column have been obtained. The "corrected" rate for the Borough (15.50) is notably below the rates for the other districts, Hampstead (12T2) alone excepted. Similarly it will be found that the "corrected" rate for the Borough was 1.54 below the "standard" rate, a difference (negative) exceeded only by that for Hampstead (4.07). The local rates therefore compare favourably with those of the Selected Districts. TABLE 14. Columns Death-rates all ages, persons. Standard Rate. Difference from Standard. Recorded.* Corrected. 1902. 1901. Increase. 1902. 1 9 3 4 5 0 Paddington 14.63 14.27 0.36 15.56 17.10 —1.54 London 17.20 17.08 0.12 18.07 17.31 +0.76 Kensington 15.32 15.11 0.21 16.34 17.05 —0.71 Westminster 16.06 15.89 0.17 18.90 15.46 +3.44 Marylebone 18.27 16.57 1.70 19.63 16.93 + 2.70 Hampstead 10.79 10.64 0.15 12.12 16.19 -4.07 Willesden 13.05 11.95 1.10 ? ? V *From Registrar-General's figures (Quarterly Reports). Tables showing the numbers of deaths from the more important causes of death in the whole Borough, Registration Sub-Districts and Wards will be found in the Appendix. (See Tables IV. and V.) NOTIFICATIONS. Excluding cases of chicken-pox, the notification of which was required during part of the year only, 921 cases of infectious disease were reported during 1002, as compared with 1,111 during 1001. The morbidity-rate was equal to 0.23 per 1,000 persons of all ages last year, or 1.47 less than the rate for 1001 (7.70). In the whole Metropolis the notified cases increased from 40,444 in 1001 to 46,171 last year, the rate rising from 8.86 to 0.91. The notifications of diphtheria, scarlet and enteric fevers in the Borough during 1902 were fewer than in 1001 (See Table 15), while in the Metropolis similar decreases occurred in the two first diseases only. The most notable feature of the year was the exceptional prevalence of small-pox. In Table 16 are given the numbers of cases reported in each Registration Sub-District, in the Borough and the Metropolis, the returns for last year being contrasted with the decennial averages for each disease adjusted for variations in the populations. In the whole Borough there were increases in the returns for small-pox (587 per cent.), enteric (6 per cent.) and puerperal (40 per cent.) fevers, while in the Metropolis, small-pox (808 per cent.) and puerperal fever. (6 per cent.) were the only diseases the notifications of which were in excess of the average. Table 17 shows the numbers of cases of each disease reported from each Ward during the past year, the corresponding numbers for 1001 being indicated by the figures in parentheses. In Table 18 the cases reported in the Borough as a whole have been distributed according to the sexes and ages of the patients, and in Table 10 will be found the total numbers of cases reported in the selected districts from each disease, and in Table 20 the morbidity-rates for each disease for the last two years. No information is at present available as to the sexes and ages of the patients in these districts. In the Charts facing this page the numbers of cases of small-pox, diphtheria, scarlet and enteric fevers reported in each week in the Borough are shown in relation to the averages for the preceding ten years. CURVES SHOWING THE NUMBER OF CASES NOTIFIED WEEK BY WEEK DURING 1902. 13 notifications. TABLE 15. Notifications and Notification Rates, 1901 and 1902. Paddington. London* Notification Rates† 1902 1901 Differences. Increase (+) Decrease (—) 1902 1901 Differences. Increase ( + ) Decrease (—) Borough. London. 1902 1901 1902 1901 Smallpox 110 22 + 88 7,814 1,700 + 0,108 0.73 0.15 1.67 0.38 Cholera 1 3 -2 o.oo Diphtheria 205 338 —133 10,551 11,970 —1,425 1.38 2.34 2.26 2.64 Membranous 6 5 + 1 192 189 + 3 0.03 0.03 0.04 0.04 Croup Erysipelas 143 141 + 2 5,554 4,620 + 928 0.90 0.98 1.19 1.02 Scarlet 359 503 —144 18,269 4 18,421 —152 2.42 3.49 3.91 4.05 Fevers Typhus 21 —17 0.00 0.00 Enteric 83 92 —9 3,421 3,202 +219 0.56 0.64 0.73 0.70 Relapsing 2 + 2 o.oo Continued 1 + 1 49 49 0.00 0.01 0.01 Puerperal 14 10 + 4 314 251 + 63 0.08 0.07 0.06 0.05 Totals 921 1,111 —190 46,171 40,444 + 5,727 6.23 7.70 9.91 8.86 *From Weekly Returns issued by the Metropolitan Asylums Board. †Per 1,000 persons (estimated) of all ages. TABLE 16. St. Mary. St. John. North-West Paddington. Borough. London. 1902. Dep. from Average. 1902. Dep. from Average. 1902 Dep. from Average. 1902. Dep. from Average. 1902. Dep. from Average. Smallpox 85 + 72 (555) 8 + 6 (300) 17 + 16 (1600) 110 + 94 (587) 7,798 +7,010(8.98) Cholera — 1 -29 (97) Diphtheria 128 —78 (38) 25 —12 (33) 52 —2 (4) 205 —92(31)* Membranous Croup 1 —6 (86) 2 + 1 (100) 3 + 2 (200) 6 -3 (34) 10,735 —1,852(15) 111 -19 (15) 16 -5 (24) 16 -3 (16) 143 -27 (18) 5,534 —777 (13) Erysipelas Fevers. Scarlet 201 —150 (37) 47 -35 (43) 51 —31 (38) 359 —216 (38) 18,258 —4,377(20) Typhus 4 -11 (74) Enteric 56 + 1 (1) 17 +3 (21) 10 + 1 (11) 83 + 5 (6) 3,412 -147 (5) Relapsing —2 (100) Continued 1 + 1 (50) 1 —1 (50) 47 —00 (56) Puerperal 7 -1 (13) 3 + 2 (200) 4 + 3 (300) 14 + 4 (40) 312 + 18 (6) All Diseases 650 —182 (22) 118 —40 (75) 153 -14 (9) 921 —236 (21) 40,101 -227 (1) The figures in parentheses indicate the increase (decrease) in 1902 per cent, of the average. * Jointly, 32 per cent, reduction. 14 notifications. TABLE 17. Notifications distributed according to Wards, 1902. Figures for 1901 in ( ). Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster West. Gate. East. Hyde. Park. Smallpox 17 (0) 11 (3) 12 (5) 14 (3) 50 (7) 1 (3) 1 (0) 4 (1) Diphtheria 52 (106) 61 (96) 23 (26) 24 (34) 24 (38) 7 (5) 6 (21) 8 (12) MembranousCroup 3 (1) 1 (0) — (1) — O(1) 1 (2) — (0) — (0) 1 (0) Erysipelas 16 (15) 35 (31) 10)15) 28 (20) 42 (48) 3(2) 3 (1) 6 (9) Fevers. Scarlet Enteric Continued Puerperal 51 (38) 99 (116) 31 (72) 73 (93) 65 (118) 14 (15) 9 (15) 17 (36) 10 (10) 13 (13) 11 (20) 17 (13) 20 (26) 1 (5) 4 (0) 7(5) — (0) 1 (0) — (0) -(0) -(0) — (0) — (0) — (0) 4 (1) 1 (1) 2(1) 3(6) 2(1) -(0) 2(0) -(0) Totals 153 (171) 222 (260) 89 (140) 159 (170) 204 (240) 26 (30) 25 (37) 43 (63) Rates,* 1902 8.82 7.77 4.61 6.57 7.46 3.01 3.09 3.03 „ 1901 9.36 9.37 7.46 7.13 9.11 3.54 4.65 4.51 *Per 1,000 persons of all ages. TABLE 18. Notifications Distributed according to sexes and ages of patients. Borough. 1902. Ages. Small-pox. Diphtheria. Membranous Croup. Erysipelas. Fevers. Scarlet. Enteric. Continued. Puerperal. m. f. m. f. m. f. m. f. m. f. m. f. m. f. f. 0—1 2 3 2 1 3 2 1— 7 5 1 1 1 10 4 2- 1 10 5 2 14 8 1 1 3- 1 11 9 2 19 17 3 4— 1 6 8 2 1 11 24 2 1 5— 4 3 38 49 4 5 79 86 1 4 13— 4 3 3 3 13 7 1 15- 10 18 12 16 13 9 19 28 16 13 4 25— 35 33 6 12 34 54 7 8 20 18 1 10 65 and over 9 5 1 1 All ages 56 54 95 110 3 3 65 78 175 184 44 39 1 14 Rates— 1902 0.88 0.63 1.49 1.29 0.03 0.02 1.02 0.92 2.76 2.17 0.68 0.46 0.00 0.15 1901 0.19 0.12 2.52 2.20 0.03 0.03 0.87 1.05 3.67 3.34 0.84 0.12 15 notifications. TABLE 19. Notifications, 1902. From Registrar-General's Quarterly Reports. Paddington. London. Kensington. Westminster. Marylebone. Hampstead. Willesden Smallpox 113 7,798 99 232 154 20 90 Diphtheria and Membranous Croup 222 10,735 186 285 237 98 444 Erysipelas 148 5,534 189 144 219 57 108 Fevers. Scarlet 364 18,258 378 475 414 255 474 Enteric 83 3,412 83 133 96 46 74 Continued 1 47 4 1 — 1 — Puerperal 14 312 15 6 14 7 8 Totals 945 46,096 954 1,276 1,134 484 1,198 Chickenpox (part year only) 457 25,011 671 723 463 388 ? TABLE 20. Morbidity Rates, 1902 per 1,000 persons of all ages. Paddington. London. Kensington. Westminster. Marylebone. Hampstead. Willesden. 1902 1901 1902 1901 1902 1901 1902 1901 1902 1901 1902 1901 1902 1901 Smallpox 0.76 0.14 1.67 0.37 0.54 0.08 1.26 0.54. 1.14 0.59 0.23 0.08 0.72 0.06 Diphtheria 1.49 2.35 2.30 2.67 1.02 1.41 1.54 1.39 1.76 1.94 1.15 1.85 3.58 3.42 Erysipelas 0.99 0.97 1.18 1.01 1.04 0.96 0.78 0.63 1.62 1.37 0.67 0.58 0.86 0.66 Scarlet ... 2.46 3.19 3.91 4.04 2.08 2.68 2.57 2.61 3.08 2.98 2.99 2.66 3.82 4.69 Fevers. Enteric 0.56 0.63 0.73 0.70 0.45 0.55 0.72 0.57 0.71 0.61 0.53 0.60 0.59 0.47 Continued 0.00 0.01 0.01 0.02 0.04 0.00 0.01 0.01 0.01 Puerperal 0.08 0.09 0.06 0.05 0.08 0.05 0.03 0.03 0.10 0.03 0.08 0.06 0.06 o.oo Chickenpox 3.09 5.37 3.71 3.92 3.44 4.55 16 notifications. TABLE 21. Dfath-Rates—Selected Causes, 1902. From Registrar-General's Quarterly Reports. All Causes Small- Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. Phthisis. Infantile Mortality. Paddington 14.63 0.13 0.55 0.06 0.22 0.15 0.08 0.50 1.04 132 London 17.20 0.28 0.51 0.12 0.25 0.40 0.11 0.53 1.59 139 Kensington 15.32 0.06 0.51 0.11 0.10 0.11 0.11 0.44 1.28 148 Westminster 16.06 0.21 0.22 0.08 0.16 0.18 0.11 0.28 1.79 136 St. Marylebone 18.27 0.18 0.72 0.10 0.20 0.17 0.11 0.49 1.91 107* Hampstead 10.79 0.03 0.17 0.08 0.12 0.12 0.13 0.14 0.84 87 Willesden 13.05 0.10 0.54 0.09 0.41 0.21 0.08 0.68 ? 135 Rates, other than Infantile Mortality, per 1,000 persons of all ages. Infantile Mortality per 1,000 births registered. *Correction required for births in Queen Charlotte's Lying-in-Hospital. TABLE 22. Death-Rates—Selected Causes. All Causes Smallpox. Measles Scarlet Fever. Diphtheria. Whoop ing Cough Fever. Diarrhoea. Infantile Mortality. England and Wales 1902 1892-01 16.3 17.9 0.08 0.01 0.38 0.39 0.15 0.15 0.23 0.27 0.29 0.36 0.13 0.18 0.38 0.75 133 154 76 Great Towns 1902 17.4 0.12 0.49 0.19 0.26 0.37 0.15 0.54 145 100 Smaller Towns 1902 15.3 0.08 0.37 0.14 0.24 0.22 0.13 0.35 135 Rest of England and Wales 1902 15.3 0.03 0.27 1.10 0.20 0.22 0.10 0.22 119 London 1902 1892-01 17.2 19.4 0.28 0.01 0.51 0.58 0.12 0.18 0.25 0.49 0.40 0.46 0.11 0.14 0.53 0.78 139 159 Paddington* 1902 1892-01 14.58 16.13 0.12 0.00 0.55 0.36 0.04 0.12 0.21 0.44 0.14 0.36 0.07 0.10 0.36 0.72 131 151 Rates, other than Infantile Mortality, per 1,000 persons of all ages. Infantile Mortality per 1,000 births registered. *Local Returns. 17 small-pox. SMALL-POX.* BOROUGH. London. 1902 1901 1902 1901 Cases 110 22 8814 1706 Deaths 20— 1314 229 †Morbidity 0.73 0.15 1.67 0.38 ‡Fatality 18.1 — 16.6 13.4 §Mortality 0.12 — 0.28 0.05 †Cases per 1,000 persons of all ages, ‡Deaths per 100 reported cases. §Deaths per 1,000 persons of all ages. The prevalence of this disease in the Borough during the past two years was dealt with at length in the Special Report presented to the Public Health Committee in February of this year. It will suffice, on this occasion, to state that the cases reported during the year, in the Borough, were equal to an increase of 587 per cent. of the decennial average, compared with one of 898 per cent, in the whole Metropolis. The mortality last year was 0.12 per 1,000 as compared with a mean-rate of 0.00 during the previous decennium. In the Metropolis the mortality was at the rate of 0.28 and the decennial mean rate 0.01. †Vaccination.—It appears that in 1901, the last year for which returns are complete, there were 2,676 infants (out of 3,304 born) successfully vaccinated, and that 313 died unvaccinated; of the remaining 375, 23 were still unvaccinated owing to medical certificates of postponement, 34 were exempted by certificate, and 28 had removed to other districts. During the half-year, January-June 1902, 1,213 vaccinations took place on 1,574 births. Infants dead unvaccinated numbered 126, postponements, 59 and removals to other districts, 23. The actual number of certificates of primary vaccination at all ages, received during 1902, was 3,408, or 439 more than in 1901 (3,029) when there was a great increase in vaccination owing to the fear of an epidemic of small-pox. The proportion of children escaping vaccination amounted to 9.4 per cent. of the births in 1901 and 7.0 per cent. of the births in the first half of 1902. In the corresponding period of 1901 the proportion amounted to 10.7 per cent. In Old Paddington the proportion of children escaping vaccination averaged 12.3 per cent. per annum during the five years 18961900, the highest proportion (14.7) being recorded in 1898. DIPHTHERIA.‡ BOROUGH. London. 1902. 1901. 1902. 1901. Cases 211 343 10743 12165 Death 32 46 1159 1330 Morbidity 1.41 2.37 2.30 2.68 Fatality 15.1 13.4 10.7 10.9 Mortality 0.21 0.31 0.25 0.29 Although there was a less prevalence of this disease during 1902 (211 cases, compared with 343 in 1901) the severity of the cases was somewhat greater, the fatality rising from 13.4 per cent. in 1901 to 15.1 last year. It is noteworthy that the fatality of cases in the whole Metropolis was a little lower in 1902 (10.7 per cent.) than in 1901 (10.9 per cent.) In comparison with the corrected decennial average the cases of diphtheria and membranous croup notified last year in the Borough showed a decline equal to 32 per cent., as compared with one of 15 per cent. in the Metropolis. (See Table 10). The decrease *Each disease is in this report dealt with under one head, including cases reported, and deaths, in lieu of pesarately under each head as in former years. †The latest returns of vaccination have been kindly furnished by the Vaccination Officer. Owing to change in District the figures for years previous to 1901 are useless for comparison, and have, in consequence, been omitted. ‡Including cases reported as "Membranous Croup." 18 diphtheria. was greatest in St. Mary's Sub-District, equal to .39 per cent. (38 per cent. reduction in diphtheria cases and 86 per cent. membranous croup). In North-West Paddington, the cases of diphtheria and membranous croup reported last year were equal to the average, while the decrease in diphtheria amounted to 4 per cent. only. There was an increase in membranous croup equal to 200 per cent., but the figures are too small to be of any use. It will be seen from Table 17 that the numbers of cases, both of diphtheria and of membranous croup, recorded last year in the various Wards were in nearly every case lower than those for 1901, the latter figures being indicated in parentheses. From Table 18 it will be seen that by far the largest proportion of cases occurred at school ages, viz.: 5—13 and 13—15. Both in 1901 and last year the cases from Oueen's Park and Harrow Road Wards formed more than half the total cases reported, viz. : 117 out of a total of 21 1 in 1902, and 203 out of 343 in 1901. During both these years there was a heavy incidence of diphtheria in Willesden, 400 cases being reported in 1901, and 444 in 1902. The morbidity-rates for that District were 3.42 and 3.58 respectively compared with rates of 2.37, and 1.41 for the Borough. Of the districts mentioned in Tables 19 and 20, Kensington (rate 1.02 per 1,000 of all ages), and Hampstead (1.15) were the only two in which the disease was less prevalent last year than in the Borough (rate 1.49 according to the Registrar-General's figures, 1.41 according to the Department). The 211 cases of diphtheria and membranous croup reported last vear occurred in 184 houses, 1(31 houses having one case each; 20, two cases; 2, three; and 1, four. For some years past a standard of three cases in a street has been adopted for special mention. Below will be found the lists of such streets, arranged according to Wards, with the figures for 1901 added for comparison. Diphtheria. Queen's Park Ward. Harrow Road Ward. 1902. 1901. 1902. 1901. C. H. C. H. C. H. C. H. Avenue—3rd 3 2 17 11 Ashmore Road 7 6 8 5 „ —5th 8 8 12 12 Bravington Road 6 6 13 10 Caird Street 4 3 — — Chippenham Rd. 3 3 2 2 Droop Street 3 3 4 4 Fernhead Road 2 2 9 8 Harrow Road 6 5 8 5 Portnall Road 11 7 10 9 Herries Street 3 2 4 3 Saltram Crescent 7 6 6 5 Kilravock Street 5 3 3 3 Shirland Road 9 7 10 5 Lancefield Street 3 2 3 3 Walterton Road 1 1 9 5 Lothrop Street 3 3 3 3 — — — — Marne Street 4 4 11 9 46 38 67 49 42 35 65 53 Other Wards. Maida Vale. Cliurcli. 1902. 1901. 1902. 1901. C. H. C. H. C. H. C. H. Amberley Road 3 3 7 6 Cirencester Street 3 3 Elgin Terrace 4 3 Clarendon Street 8 6 8 7 Lancaster Gate, East.—Gloucester Place Mews (1902), 3 cases in one house. The 211 notifications included 23 secondary cases, properly so-called, and of the remaining 188 cases, 18 were subsequently found to have been erroneously diagnosed. Of the 170 primary cases thus remaining, 15 were apparently due to imported infection, and in 3, the disease was contracted in hospital. There were ten instances of fresh attacks of diphtheria following the return home of previous patients from hospital. Of the total cases (211), 160 were treated in hospital and 51 at home. The proportion removed was equal to 75.8 per cent. of the notified cases, compared with 78.7 in 1901. Ninetytvvo per cent. of the cases notified in Church Ward were removed to hospital, 88 per cent. in Note—C., cases; H., houses. 19 diphtheria. 19 Hyde Park Ward, and 28 per cent. (the minimum for the year) in Lancaster Gate, West, Ward. Included among the 160 cases removed to hospital were twelve of mistaken diagnosis, while among the 51 cases treated at home, six were of the same nature. The deaths among hospital cases numbered 18, and those among home cases, 13. In calculating the fatality (See following Table) these erroneous diagnoses have been allowed for. In the Borough the fatality among home-treated cases was 28.8 per cent., among those treated in hospital, 12.1. The corresponding proportions in 1901 are given as 24.6 and 10.3 per cent. respectively, but the figures for that year were not corrected for errors of diagnosis. Diphtheria, 1902. Cases* Notified. To Hospital. Per cent. Notified Cases to Hospital Deaths. At Home. In Hospital Fatality. At Home. In Hospital Queen's Park 55 (3) 44 (2) 80 2 6 20.0 14.2 Harrow Road 62 (4) 47 (2) 75 3 6 23.0 13.3 Maida Vale† 23 (3) 15(1) 65 2 1 33.3 7.4 Westbourne 24 (2) 16 (1) 67 1 — 14.2 — Church 25 (3) 23 (3) 92 2 4 100 20.0 Lancaster Gate, West 7 (1) 2(1) 28 1 — 20.0 — „ East 6(1) 5 (1) 83 1 1 100 25.0 Hyde Park 9(1) 8(1) 88 1 — 100 — Borough— 1902 211 (18) 160 (12) 75.8 13 18 28.8 12.1 1901 343 270 78.7 18 28 24.6 10.3 *The figures in parentheses indicate the numbers of cases erroneously diagnosed as Diphtheria. †There were 4 deaths in all in this Ward, but one death, the illness not having been notified, has been excluded from this Table. The mortality from diphtheria was at the rate of 0.21 per 1,000 persons of all ages last year, being 0.09 less than in 1902 (0.31). In the Metropolis the mortality was 0.25) per 1,000, or 0.04 less than in 1901 (0.29). In comparison with the mortalities prevailing in the adjacent districts (See Table 21) the rate for the Borough last year (0.22) exceeded all the other rates except those of the Metropolis (0.25) and of Willesden (0.41). High as the mortality was, comparatively speaking, it compares favourably with any of the rates of the main sub-divisions of the country given in Table 22, being lower than all other rates except that of "Rest of England and Wales " i.e., the Rural Districts (0.20). The decennial mean rate for the Borough was 0.44, a trifle more than the double of the rate of last year (See Table 23). The mean rate for the five years 1892-1896 was 0.51, and that for the five years 1897-1901, 0.37. The decennial figures for the Wards are not available. In the Registration Sub-Districts the mean rates for each of the quinquennia and the decennium were, with one exception, considerably above those for last year, as appears from the appended tabular statement:— Diphtheria. Death-rates per 1,000 persons, all ages. 1902. Borough 0.21 St. Mary 0.49 St. John 0.44 North-West Paddington 0.45 Mean Rates. Ten years. Five years. Five years. 1892-1901. 1892-1896. 1897-1901. 0.44 0.51 0.37 0.56 0.08 0.45 0.19 0.30 0.08 0.60 0.53 0.67 20 diphtheria. The 32 deaths recorded in the Borough last year comprised 16 of each sex. From the following statement it will be seen that all rates for last year were below the corresponding rates for 1901, except in the cases of males 5—15 years and 25 years and upwards. Diphtheria. Deaths. Death-rates.* 1902. 1901. 1902. 1901. m. f. m. f. m. f. m. f. 0— 12—2 0.05 1.37 — 1.40 1— 8 9 19 9 1.58 1.75 3.80 1.80 5— 5 5 4 9 0.44 0.42 0.30 0.78 15— — — 1 — — — 0.07 — 25 and over 2 — — 2 0.05 — — 0.04 *per 1,000 estimated living at each age. The bulk of the mortality occurs at ages under 15 years, and, for brevity's sake, rates per 1,000 persons at those ages have been calculated for the Wards of the Borough, although full information of ages at death, sex, &c., has been collated. From the following statement it will be seen that in Lancaster Gate, East, Ward only, was there a higher mortality in 1902 than in 1901. Deaths. Death-rates.* 1902. 1901. 1902. 1901. Queen's Park 8 16 1.43 2.90 Harrow Road 9 12 1.04 1.45 Maida Vale 4 4 0.93 0.90 Westbourne 1 3 0.17 0.58 Church 6 9 0.74 1.15 Lancaster Gate (West) 1 1 0.90 0.92 „ (East) 2 — 2.03 — Hyde Park 1 1 0.44 0.45 *per 1,000 persons aged 0—15 years. Nothing is known of the ages and sexes of persons dying in the adjacent districts. Rates based on the estimated numbers of persons living at ages under 15 years have been calculated. The lowest rate was that of Kensington (0.46) and the highest that of Willesden (1.21). In Westminster alone was there an increased mortality (0.80 in 1902, 0.59 in 1901). Diphtheria. Deaths. Death-rates.* 1902. 1901. 1902. 1901. Paddington 33 66 0.91 1.88 London 1,159 1,330 0.82 0.97 Kensington 19 48 0.40 1.19 Westminster 29 21 0.80 0.59 Marylebone 27 33 0.95 1.17 Hampstead 10 20 0.51 1.07 Wilfesden 52 57 1.24 1.41 *per 1000 persons aged 0-15 years. SCARLET FEVER. BOROUGH. London. 1902. 1901. 1902. 1901. Cases 359 503 18,269 18,421 Deaths 8 11 560 584 Morbidity 2.42 3.49 3.91 4.05 Fatality 2.2 2.2 3.0 3.1 Mortality 0.04 0.07 0.12 0.12 21 scarlet fever. 21 The reported cases of scarlet fever were 144 fewer than in 1901, and 38 per cent. below the average, as compared with a decline of 20 per cent. in the whole Metropolis (See Table 16.) In point of numbers, the total for the Borough was lower than any of the totals recorded in the adjacent districts (Table 19) with the exception of Hampstead (255), but the morbidity rate of that district (2.99) was above that of the Borough (2.46), the latter being below all rates (Table 20), except that of Kensington (2.08). The cases reported from all the Registration Sub-Districts were well below the respective averages (Table 16), the greatest reduction being that of St. John's Sub-District (43 per cent). In comparison with the totals for 1901 the numbers for all the Wards (Table 17) were fewer, except in Queen's Park Ward, whence 51 cases were reported last year as against 38 in 1901. The 359 cases were reported from 280 houses, 223 having one case each, 42 two cases, 11 three, 1 four, and 3 five. Three or more cases were reported from the undermentioned streets:— Queen's Park Ward. Harrow Road Ward. 1902. 1901. 1902. 1901. c. h. c. h. c. h. c. h. Avenue—3rd 10 7 — — Ashmore Road 10 10 18 13 „ —4th 4 3 1 1 Bravington Place 3 3 — — „ —5th 4 3 2 2 „ Road 26 16 16 11 Galton Street 3 2 — — Chippenham Road 6 5 5 3 Harrow Road 5 3 — — Fernhead Road 7 7 7 7 Herries Street 4 4 3 3 Portnall Road 14 8 12 9 Marne Street 3 1 — — Saltram Crescent 4 4 9 4 Mozart Street 3 2 — — Walterton Road 5 4 3 3 30 25 6 6 81 57 70 50 Maida Vale Ward. Westbourne Ward. 1902. 1901. 1902. 1901. c. h. c. h. c. h. c. h. Amberley Road 5 4 15 12 Bishop's Road 5 1 — — Elgin Terrace 3 2 7 3 Brindley Street 3 3 4 4 Elnathan Mews 3 2 3 1 Elcom Street 5 4 3 1 Warrington Crescent 3 2 6 5 Fermoy Road 4 4 2 1 Warwick Road 5 4 1 1 Hampden Street 4 3 10 9 — — — — Harrow Road 4 2 9 4 19 14 32 22 Kensal Road 8 4 7 5 St. Luke's Road 3 1 1 1 Church Ward. Waverley Road 5 4 4 4 1902. 1901. Westbourne Grove 3 3 11 c. h. c. h. Westbourne Pk.Villas 4 3 1 1 Adpar Street 4 2 19 5 Woodfield Road 3 2 11 Arthur Mews 3 1 — — — — — — Cirencester Street 3 2 9 7 51 34 43 32 Clarendon Street 9 8 13 10 Harrow Road 7 3 11 Paddington Green 3 1 5 3 C Cases. H Houses. Park Place Villas 3 1 — — Woodchester Street 3 3 11 8 35 21 58 34 Included in the 359 cases notified were 57 true secondary cases. Of the remaining 302 cases, 4 were known to have been erroneously diagnosed, 22 were imported, 22 followed the return home of previous patients from hospital, and one was contracted in hospital. 22 fever. The cases removed to hospital numbered 29(5 and were equal to 82.4 per cent. of the notifications. The highest proportion of cases removed from any Ward was 88 per cent. (Queen's Park and Harrow Road Wards), and the lowest 55 (Lancaster Gate, East, Ward). Among the 296 patients removed there were 7 deaths, equal to a fatality of 2.3 per cent., as compared with 2T in 1901. The cases kept at home numbered 63, including 4 which were subsequently found to have been erroneously diagnosed. There was only one death among the patients remaining at home, an infant some three weeks old. The percentage mortality among home-treated cases was 1.7, as compared with 2.7 in 1901. Scarlet Fever. Cases* Notified. Removed to Hospital. Per cent. of Cases. Deaths. Fatality per 100 cases. At home. In hospital. At home. In hospital. Queen's Park 51 45 88 - 2 — 4.4 Harrow Road 99 88 88 - 2 — 2.2 Maida Vale 31 (2) 27 87 - 2 — 7.4 Westbourne 73 63 86 1 1 10.0 1.6 Church 65 50 76 — - — — Lancaster Gate (West) 14(2) 8 57 — - — — „ (East) 9 5 55 — - — — Hyde Park 17 10 59 — - — — Borough 1902 359 (4) 290 82.4 1 7 1.7 2.3 1901 503 439 87.2 9 9 2.7 2.1 * The figures in parentheses indicate number of cases erroneously diagnosed. The mortality was last year was equal to 0.04 per 1,000 persons of all ages, or a little more than half what it was in 1901 (0.07), and one-third the rate for the Metropolis (0.12, both years). The local rate was much lower than any of the rates mentioned in Tables 21 or 22. The Borough rate contrasts very favourably with all the rates given in the latter table. The comparison between last year's rate and those for the preceding decennium and quinquennia are equally satisfactory, except as regards North-West Paddington. (See appended statement).— Scarlet Fever. Death-rates per 1,000 persons of all ages. Mean Rates. Ten Years. Five Years. 1902 1892-1901 1892-1896 1897-1901 Borough 0.04 0.12 0.17 0.07 St. Mary 0.05 0.13 0.18 0.08 St. John — 0.07 0.11 0.03 North-West Paddington 0.51 0.19 0.28 0.11 "FEVER." BOROUGH. London. 1902 1901 1902 1901 Cases 84 92 3463 3263 Deaths 13 15 541 508 Morbidity 0.56 0.64 0.74 0.71 Fatality 15.4 16.3 15.6 15.5 Mortality 0.07 0.10 0.11 0.10 So far as the Borough is concerned the term "fever" includes enteric (typhoid) and simple continued fevers, while in the Metropolis typhus fever (4 cases) has to be added. Fever. 23 From Table 16 it will be seen that there were in the Borough last year 83 cases of enteric and 1 case of simple continued fever, and in the Metropolis, 3,412 cases of enteric, 4 cases of typhus, and 47 of simple continued fever. There was some increase in the prevalence of enteric fever in the Borough amounting to an excess of 6 per cent. above the decennial average (78 cases) whilst there was a slight reduction in the Metropolis as a whole amounting to 5 per cent. (Sec Table 16). Simple continued fever was less prevalent, but this disease, the true nature of which is always somewhat doubtful, is never very much prevalent. Typhus fever is unknown in the Borough. In the Metropolis the 4 cases reported last year were 11 below the average, a reduction equal to 74 per cent. of the average. In comparison with the adjacent districts (Table 20) the morbidity rate for the Borough last year (0.56) was above that for Kensington (0.45) and that for Hampstead (0.53) but below all the others. The highest rate was that of Westminster (0.72). As regards the Registration Sub-Districts, last year's total for St. John (17 cases) was the greatest in excess of the average (21 per cent.), and that for St. Mary, the lowest (1 per cent.). Distributing the cases according to Wards, increases were noted in last year's returns, compared with those for 1901, in Westbourne (increase 4 cases), Lancaster Gate, East, (4 cases), and Hyde Park (2 cases). The 84 cases reported in the Borough were reported from 76 houses, 73 houses having one case each, 2 houses two cases, and 1 house three. With the exception of the streets mentioned below the cases were distributed singly among the various streets of the Borough. Enteric Fever. c h c h c h Arthur Mews 3* 1 Harrow Road 4 3 Portsdown Road 2 2 Bravington Road 4 4 Kensal Road 2 1 Victoria Place 2 2 Droop Street 2 2 Lothrop Street 2 2 Waverley Road - 1 Edgware Road 3 3 Maida Vale 3 2 Westbourne Grove 2 9 Portnall Road 9 2 C Cases. H Houses. * All errors. The cases reported included 10, which were subsequently found to have been erroneously diagnosed, and of the remaining 74 cases, 16 were apparently infected beyond the Borough, 2 contracted their illness in hospitals, and 2 others from nursing patients ill with the disease. As the disease is probably always contracted from contaminated food or water, it is important to know how many of the patients had food outside the districts. A large number of those attacked during the year were employed in other parts of London, and in 9 cases it was ascertained that the patients were in the habit of taking their meals away from home. In 4 cases the patients were said to have had oysters within the period of the incubation of the disease, I cockles, and 1 "ice-cream." There of the patients were engaged in the wine and spirit trade, and one was a fishmonger. One patient was reported as a hard drinker; another, a horse dealer, was carrying on his usual avocation and travelling about the country for the greater part of his illness, a form of the disease known as typhoid ambulans, and a third, a male of advanced age, was reputed to be suffering from his third attack of the disease, but no history could be obtained of the earlier attacks. In two instances, which terminated fatally, the result of the bacteriological test was negative. In three cases the notification of enteric fever was received either after death or on the same day as the patient died, a somewhat unusual occurrence with this disease. 21 SEPTIC DISEASES. Fifty-four of the patients (including 6 cases erroneously diagnosed) were removed to hospital, equal to 64.2 per cent. of the notified cases. Of the 30 cases kept at home, 6 died, equal to a fatality of 25 per cent., after allowing for errors, while of the 54 removed to hospital, 8 died, equal to 16.6 per cent., after a similar correction. Enteric Fever. Cases Notified* Removed to Hospital* At Home. Deaths in Hospital. Queen's Park 10(1) 8(1) 1 3† Harrow Road 14 (2) 9(1) 1† 2 Maida Vale 11 (2) 6 — — Westbourne 17 14 2† — Church 20 (4) 13 (3) 1 3 Lancaster Gate (West) 1 — — — „ „ (East) 4 1 — - Hyde Park 7 (1) 3(1) — - Borough (1902) 84 (10) 54 (6) 5 8 „ (1901) 92 58 - - * Figures in parentheses indicate the numbers of cases erroneously diagnosed as Enteric Fever. † One " error " fatal. ‡ Another reported case (in a non-resident) proved fatal. The mortality decreased from 0.10 per 1,000 in 1901 to 0.07 last year, and was 0.04 below the rate for the Metropolis (0.11). The local rate (Table 21) was lower than that in any of the Selected Districts, Willesden excepted, where the rate equalled that of the Borough (0.08), and was lower than any of the rates of other areas given in Table 22. The decennial mean rate for the Borough was 0.10, or 0.03 in excess of last year's rate, the only rate for last year exceeding the corresponding mean was that of North-West Paddington (see below):— Enteric Fever. Death rates per 1,000 persons of all ages. Mean Rates. 1902. Ten years. Five years. 1892—1901. 1892—96. 1897—1901 Borough 0.07 0.10 0.11 0.09 St. Mary 0.07 0.11 0.13 0.09 St. John 0.02 0.08 0.11 0.05 North-West Paddington 0.22 0.12 0.07 0.16 SEPTIC DISEASES. Puerperal Fever. BOROUGH. London. 1902. 1901. 1902. 1901. Cases 14 10 312 251 Deaths 8 5 201 184 Morbidity* 0.28 0.21 0.23 0.21 Fatality† 35.71 50.00 64.32 73.30 Mortality* 0.10 0.10 0.10 0.15 * Rates per 1,000 females ages 15-45 years. † Per 100 cases reported. The notifications of puerperal fever rose from 10 in 1901 to 14 last year, an increase equal to 40 per cent., and were in excess of the decennial average to an equal amount (Table l6). In the Metropolis the cases reported rose from 251 in 1901 to 312 last year, being 18 (6 per SEPTIC DISEASES. 25 cent.) in excess of the average. As the disease is limited to females of child-bearing ages (15 to 45 years) the morbidity rates have been calculated per 1,000 females estimated living at those ages. In the Borough the rate was 0.28 last year, as compared with 0.21 in 1901, and in the Metropolis 0.23 and 0.21 respectively. The morbidity rates per 1,000 persons of all ages in the Borough and the Selected Districts are given in Table 20. The lowest rate was that of Westminster (0.03) and the highest that of Marylebone (0.10), that of the Borough being 0.08. Calculated on the numbers of females at ages from 15 to 45 years, the rates for last year in the Selected Districts were:— Kensington 0.22 Hampstead 0.21 Westminster 0.09 Willesden 0.22 Marylebone 0.30 The increase in the prevalence of the disease last year occurred in the Registration SubDistricts, St. John and North-West Paddington (See Table 16), there being a slight diminution in the number of cases in St. Mary (a decrease of one case, equal to 13 per cent. of the average). The figures for the Wards for the last two years will be found in Table 17. The prevalence of the disease may also be guaged by the number of births registered. For every 1,000 births registered in the Borough there were 4 (more exactly 4.23) cases of puerperal fever last year, as compared with 2.97 in 1901, the corresponding rates for the Metropolis being 2.35 and 1.91 respectively. The corresponding rates for last year in the adjacent districts were as below:— Kensington 4.30 Hampstead 4.51 Westminster 1.82 Willesden 2.04 Marylebone 3.52 The deaths registered under this head numbered 5 in each of the last two years, representing a fatality of 35.71 per cent. in 1902 and of 50 per cent. in 1901. In the Metropolis the deaths were equal to fatalities of 64.32 per cent. in 1902 and 73.30 in 1901. Such high fatalities seem almost incredible and suggest that all cases of this disease are not reported. Of the 14 cases reported, nine were attended by women who had received no training, a fact almost sufficient of itself to account for the illness. In three cases surgical intervention was necessary. In one of the cases included in the foregoing the confinement took place within a fortnight of the notification of a case of erysipelas, the patient sickening three days after her confinement. Two cases were reported from adjacent houses, an interval of nine months elapsing between the two. The houses overlook an underground stable belonging to a cab proprietor. Some two years ago proceedings were instituted to obtain an order prohibiting the use of the stables, but were unsuccessful. In addition to the deaths from puerperal fever, eight deaths took place during the year from other causes associated with confinements (scheduled (Table IV., Appendix) as "Diseases and Accidents of Childbirth"). Including the deaths from such causes, it appears that the total number of deaths in childbed last year was 13, as compared with 9 in 1901. The deaths were respectively equal to rates of 0.27 and 0.18 per 1,000 females aged 15 to 45 years. In the Metropolis the total number of deaths were 414 in 1902 and 403 in 1901, corresponding to rates of 0.33 and 0.32. Below will be found the corresponding figures for the three Registration Sub-Districts of the Borough. Nothing is at present known of the mortality from these causes in the adjacent districts. 1902. All Deaths in Childbed. Mortality Rates per 1,000 Females aged 15-45 years. Births Registered. BOROUGH 13 0.27 3.93 St. Mary 9 0.31 3.08 St. John 2 0.13 5.18 North-West Paddington 2 0.49 4.20 26 chicken-pox. Other Septic Diseases*.—The notifications of erysipelas numbered 143 last year and were 18 per cent. below the average. In the Metropolis the notifications last year (777) were 13 per cent. below the average. (Table 16). The notifications were below the average in each of the Registration Sub-Districts ( Table 16), but were higher in five of the Wards in 1902 than in 1901 (Table 17). It will be seen from Table 20 that there was a greater prevalence of this disease in all the Selected Districts last year than in 1901. Six of the cases notified last year in the Borough were treated in hospital. The deaths from these causes during the year numbered 12, viz.: three from erysipelas and 9 from other causes (Table IV., Appendix), the mortality being at the rate of 0.07 per 1,000 persons of all ages, as compared with a mean rate of 0.11 for the preceding decennium (Table 23). CHICKEN-POX. This disease was included for notification from the middle of January to the end of the year. According to the records of the Department 502 cases were notified, but the total according to the tables in the Registrar-General's Quarterly Reports was only 457 (See Table 19). There were two deaths during the year. Particulars as to the number of cases reported in the adjacent districts will be found in Tables 19 and 20. MEASLES. Owing to the prevalence of small-pox and to administrative changes, it was found impossible during last year to make an adequate effort to keep in touch with this disease to the extent effected during the last few years. The mortality (0.55 per 1,000 persons of all ages) indicates that the disease was very prevalent, but only 559 cases, 275 in males and 284 in females, were brought to the knowledge of the Department. A summary of the reported cases and of the deaths in the Wards will be found below. MEasles. 1902. Ages Cases reported Deaths. 0- 1- 5- 15- Total Persons 0- 1- 5- 15- Total Persons M. F. M. F. M. F. M. F. M. F. M. F. M. F. M F. Queen's Park Ward 7 9 27 29 27 21 — 1 114 1 1 5 2 - — — — 9 Harrow Road „ 1 1 22 14 25 21 — 1 85 1 1 1 1 — 1 — — 5 Maida Vale . „ - 1 16 14 10 10 — 1 52 — 1 2 3 — — — 0 Westbourne „ 2 3 14 15 6 15 - — 55 - 1 3 3 — — — 7 Church „ 8 8 58 74 29 33 1 1 212 5 5 17 18 1 2 — — 48 Lancaster Gate West Ward — — 1 - - — 1 — 2 — — 1 — — — — — 1 East „ — — 1 - 1 4 — — 6 — — — — — — — — - Hyde Park Ward 3 1 10 8 4 0 1 — 33 2 2 1 1 — — — — 6 Borough 21 10 1491 54 1021 10 3 4 559 9 11 30 28 1 3 — — 82 * Of the diseases included in the term "Other Septic Diseases," erysipelas alone is notified. whooping cough. 27 Last year's rate was the highest since 1898 when the rate was 0.79, was 0.19 in excess of the mean for the decennium (0.36) and more than twice the mean for the quinquennium, 1897-1900 (0.25). (Table 23.) The mean rates for the Wards are not known, those for the Registration Sub-Districts are set out below in comparison with the rates for last year. The rates for the adjacent districts will be found in Tables 21 and 22. Measles, 1902. Death-rates per 1,000 persons of all ages. Mean Rates. Ten years. Five years. 1902. 1892-1901. 1892-1896. 1897-1901. Borough 0.55 0.36 0.48 0.25 St. Mary 0.66 0.46 0.60 0.31 St. John 0.25 0.10 0.15 0.05 North-West Paddington 0.51 0.39 0.50 0.29 All the deaths recorded last year in the Borough occurred at ages under 15 years, the mortality per 1,000 persons at those ages being 0.31. The mortality rates calculated on the estimated numbers living at ages 0-15 years in the adjacent Districts were:— Kensington 2.26 Hampstead 0.50 Westminster 1.16 Willesden 1.60 Marylebone 3.42 London 1.68 WHOOPING COUGH. Nothing is known of this disease except the numbers of deaths, 22 during the past year. The mortality was at the rate of 0.14 per 1,000 persons of all ages, as compared with a mean rate of 0.36 in the preceding decennium. (Table 23.) The rates last year in the Registration Sub-Districts were, St. Mary, 0.18, St. John, nil, and North-West Paddington, 0.22, all being well below the means. The ages at death will be found in Table IV. Appendix, and the numbers of deaths in the Wards, in Table V. Appendix. The local rate was higher than the rates for Kensington (0*11) and Hampstead (0.12), but below the other rates given in Table 21, and was below all the rates for the districts mentioned in Table 22. TUBERCULAR DISEASES. Phthisis or Consumption.—The deaths from this disease numbered 153 last year (89 of males and 64 of females), being 2 more than in 1901. The numbers of deaths at various ages (males and females) will be found in Table IV. Appendix, and the numbers of deaths, at all ages, persons, in the Wards in Table V. Appendix. The mortality last year was 1.03 per 1,000 persons of all ages, as compared with a mean rate of 1.22 for the preceding decennium. The local rate was below all the rates given in Table 21, except that of Hampstead (0'84). The mortalities in the Registration Sub-Districts during last year are contrasted with the various mean rates below— Phthisis. Death-rates per 1,000 persons of all ages. Mean Rates. Ten years, Five years, 1902. 1892-1901. 1892-96. 1897-1901. Borough 1.03 1.22 1.27 1.16 St. Mary 1.15 1.41 1.48 1.34 St. John 0.75 0.74 0.81 0.67 North-West Paddington 0.91 1.25 1.21 1.29 28 tubercular diseases. It will be seen from Table IV. Appendix, that the greatest incidence was at ages 15-65 years. The mortality for the Borough calculated per 1,000 persons at those ages was 1.45. Assuming the same incidence in other districts the following rates have been calculated:— Kensington 1.73 Hampstead 1.13 Westminster 2.27 Willesden 1.40 Marylebone 2.53 London 2.37 In general terms it may be said that the better the housing conditions of any given population, the less will be the mortality from consumption. In the appended tables a comparison is instituted between the mortalities from this disease at all ages, and at ages from 15 to 65 years, and the housing conditions, both in the Borough the Selected Districts and the Wards of the Borough. As indices of the housing conditions, the percentages of the total populations living under conditions of overcrowding (an average exceeding two persons per room), and the proportions inhabiting homes of less than five rooms, have been taken. The comparison being based on the experience of one year only it is not to be expected that the series will show strict parallelism, but, allowing for accidental differences, it is very close. In the first table Hampstead heads the list as having the lowest phthisis rates and the lowest percentages of overcrowding, &c., while Marylebone is in each case at the bottom with the highest. In the second table Lancaster Gate, East and West, Wards share the honours of first place, and Church Ward, with the exception of the last column, is at the bottom. Borough and Adjacent Districts. Phthisis Mortality per 1,000 Persons Housing. All Ages. 15-05 years. Percentage of total population overcrowded. Percentage of total population occupying less than 5 rooms. Hampstead (0.84) Hampstead (1.13) Hampstead (6.4) Hampstead (29.6) Willesden (0.89) Willesden (1.40) Willesden (11.6) Kensington (41.7) Paddington (1.03) Paddington (1.41) Westminster (13.0) Westminster (45.7) Kensington (1.28) Kensington (1.73) Paddington (13.6) Willesden (50.7) Westminster (1.79) Westminster (2.27) Kensington (14.8) Paddington (50.9) Marylebone (1.91) Marylebone (2.53) Marylebone (21.1) Marylebone (55.6) Wards of Borough. Phthisis Mortality per 1,000 Persons Housing. All ages 15-05 years. Percentage of total population overcrowded. Percentage of total population occupying less than 5 rooms Lancaster Gate W. (0.69) Lancaster Gate W.(0.77) Lancaster Gate E. (2.1) Lancaster Gate W. (15.2) Hvde Park (0.69) „ „ E. (0.87) „ „ W. (2.6) „ „ E. (.16.2) Lancaster Gate E. (0.73) Hyde Park (0.87) Hvde Park (5.2) Hvde Park (25.3) Westbourne (0.89) Westbourne (1.22) Oueen's Park (9.1) Maida Vale (43.4) Oueen's Park (0.91) Maida Vale (1.24) Harrow Road (11.5) Westbourne (46.3) Maida Vale (0.92) Queen's Park (1.38) Maida Vale (12.6) Oueen's Park (51.7) Harrow Road (1.18) Harrow Road (1.77) Westbourne (13.4) Church (61.3) Church (1.51) Church (2.22) Church (32.8) Harrow Road (75.5) cancer. 29 Other Tubercular Diseases.—The deaths from the various forms of tuberculosis included in this group numbered 60, equal to a mortality rate of 0.40 per 1,000 persons of all ages, being 0.17 less than the decennial mean rate. It is not possible to deal with the mortality from these causes at any length here, and it will suffice to compare the mortalities in the three Registration Sub-Districts with the various mean rates. The numbers of deaths recorded at various ages will be found in Table IV., and of deaths in the Wards in Table V., both in the Appendix. Other Tubercular Diseases. Rates per 1,000 Persons of all Ages. Mean Rates. Ten years. Five years. Five years. 1902 1892-1901 1892-1896 1897-1901 Borough 0.40 0.57 0.60 0.53 St. Mary 0.42 0.68 0.74 0.62 St. John 0.08 0.30 0.32 0.29 North-West Paddington 0.91 0.59 0.59 0.60 CANCER. The deaths from the various forms of "malignant disease" which are included in the popular term "Cancer" numbered 134 last year, being 14 less than in 1901, 18 less than in 1900, and 31 less than in 1899. The mortality last year was equal to a rate of 0.90 per 1,000 persons of all ages, or 0.05 less than the mean rate for the preceding decennium. Below the rates recorded in the Registration Sub-Districts last year are compared with the mean rates. The numbers of deaths at various ages will be found in Table IV. and of deaths in the Wards in Table V. Appendix. Cancer. Rates per 1,000 Persons of all Ages. Mean Rates. Ten years. Five years. Five years. 1902 1892-1901 1892-1896 1897-1901 Borough 0.90 0.95 0.91 0.99 St. Mary 0.96 0.97 0.88 1.05 St. John 0.93 0.96 0.97 0.95 North-West Paddington 0.51 0.79 0.71 0.88 The 134 deaths included 63 certified as due to carcinoma, 34 to cancer, 21 to malignant disease, 7 to epithelioma, 0 to sarcoma, 2 to scirrhus, and 1 to "other forms" (deciduoma malignum). The parts affected are indicated in Table 23. In the Report for 1901 attention was called to the difference in the incidences of phthisis and cancer in the Wards. In the appended Table the Wards are arranged in two ascending orders for phthisis and cancer respectively. It will be noticed that Lancaster Gate, East. Ward, second in order for phthisis is bracketted sixth in order (with Westbourne Ward) for cancer. Church Ward is in each series last with the highest mortality. The subject is worth further investigation. Phthisis Mortality per 1,000 Persons aged from 15-65 years. Lancaster Gate W. (0.77) „ „ E. Hyde Park (0.87) Westbourne 1.22) Maida Vale (1.24) Queen's Park (0.38) Harrow Road (1.77) Church (2.22) Cancer Mortality per 1,000 Persons aged 25 years and upwards. Queen's Park (1.05) Maida Vale (1.28) Lancaster Gate W. (1.33) Hyde Park (1.46) Harrow Road (1.48) Westbourne (l.74) Lancaster Gate E. Church (2.42) 30 other diseases. At present no information is available as to mortality from cancer in the adjacent districts. From the Annual Reports of the Medical Officer of Health of the County for past years, it appeared that the mortality in Old Paddington was one of the highest in the Metropolitan Districts, whereas the phthisis rate, usually one of the lowest. TABLE 23. Cancer. 1902. St. Mary. St. John. North-West Paddington. C. O. C. O. C. O. m. f. m. f. m. f. m. f. m. f. m. f. 1. Nervous System, Brain 1 ... ... ... 1 ... . . . . . . ... ... ... ... 2. Organs of Special Sense, Ear ... 1 ... ... ... ... ... ... ... ... ... ... 3. Respiratory System, Larynx ... ... 1 ... ... ... ... ... 1 ... ... ... 4. Circulatory System ... ... ... ... ... ... ... ... ... ... ... ... 5. Digestive System, Tongue 2 ... 4 ... ... ... ... ... ... ... ... ... Glands of Mouth ... ... 1 ... ... ... ... ... ... ... ... ... Pharynx 1 ... ... ... ... ... ... ... ... ... ... ... Œsophagus 3 9 ... ... 9 ... ... ... 1 ... ... ... Stomach 6 4 ... ... 1 5 ... ... ... 9 ... ... Intestine 1 3 ... 1 ... ... ... . . . ... 1 ... ... Rectum 5 8 ... ... 1 1 ... 1 ... l ... ... Liver 3 5 ... ... 1 4 ... ... ... ... ... ... Peritoneum ... ... ... ... ... 1 ... ... ... ... ... ... Omentum ... 1 ... ... ... ... ... ... ... ... ... ... 6. Lymphatic System 1 2 ... ... ... 1 ... ... ... ... ... ... 7. Urinary System 1 ... ... ... ... ... ... ... 1 ... ... ... 8. Generative System, Uterus ... 13 ... ... ... 6 ... ... ... ... ... 1 External Organs ... 1 ... ... ... ... ... ... ... ... ... ... Breast ... 7 ... 2 ... 6 ... ... ... ... ... ... 9. Osseous & Muscular Systems ... 3 3 1 ... ... ... ... ... ... ... ... 10. Cutaneous System 1 ... ... ... ... ... ... ... ... ... ... ... 11. Insufficiently described 2 2 1 ... ... 1 ... ... ... ... ... ... Totals 27 52 10 4 6 25 ... 1 9 5 ... 1 "C." includes Cancer, Carcinoma, Malignant Disease. "O." includes Sarcoma, Scirrhus, Epithelioma, &.c. "M."—Males. "F."—Females. OTHER DISEASES* A few words will serve to dispose of the remaining causes of death. Influenza.—The 62 deaths from this disease were equal to a rate of 0'41 per 1,000 persons, 0.10 less than the decennial mean. In St. Mary's Sub-District the deaths numbered 47 (rate 0.48, or 0.03 less than the mean), in St. John, 8 (rate 0.22, or 0.33 less than the mean), and in North-West Paddington, 7 (rate 0.40, or 0.04 above the mean). Respiratory Diseases.—The deaths from bronchitis (210) and pneumonia (185) numbered 395 and were equal to a rate of 2.35 per 1,000 persons, being 0.60 less than the decennial mean (2.95). In St. Mary's Sub-District the rate last year was 3T4 (mean 3.35), in St. John's 1.21 (mean 2.04), and in North-West Paddington 2.86 (mean 2.74). Apoplexy.—Although the deaths from this cause last year numbered 72 and were 14 more than in 1901, the rate of mortality 0.48 was well below the decennial mean rate (0.67). The rates in all the Sub-Districts were considerably lower last year than the corresponding mean rates, indeed the shrinkage in the rates both for last year and for 1901 is such as to suggest that it must be due in part to some unconscious change in tabulation arising from the adoption of the new Schedule of Causes of Death in 1901. *"Diarrhoea" deaths will be considered under "Infantile Mortality." For particulars as to deaths at various ages and each Ward, see Tables IV. and V. in the Appendix. infantile mortality. 31 Alcoholism.—Twenty-three (23) deaths were due to acute and chronic alcoholism, equal to a rate of 0.14, just double the mean (0.07). In dealing with the question of alcoholic excess it is usual to include deaths certified as due to "cirrhosis of the liver," under which head 25 deaths were recorded during last year. There appears to be a tendency to an increased mortality from these causes, as will be seen from the following comparison. Deaths due to Alcoholic Excess. Rates per 1,000 persons of all ages. Mean Rates. Ten years. Five years. Five years. 1902 1892-1901 1892-1896 1897-1901 "Acute and chronic alcoholism" Borough 0.14 0.07 0.06 0.08 St. Mary 0.17 0.08 0.07 0.10 St. John 0.11 0.06 0.06 0.06 North-West Paddington 0.10 0.04 0.02 0.06 "Cirrhosis of Liver " Borough 0.16 0.14 0.12 0.16 St. Mary 0.20 0.14 0.12 0.16 St. John 0.11 0.16 0.16 0.15 North-West Paddington 0.05 0.07 0.02 0.13 INFANTILE MORTALITY. During the year 474 deaths at ages under one year were registered in the Borough, equal to a rate of 144 per 1,000 births, being 11 per 1,000 less than the decennial mean (See Table I., Appendix). The deaths of residents at these ages numbered 433, being 22 less than the total for 1901. The corrected mortality was 131, or 4 per 1,000 less than the rate in 1901, and 20 less than the mean for the preceding decennium (Table 22). The rate according to the Registrar-General was 132 per 1,000 and was lower than that of any of the Selected Districts, Hampstead excepted, where the rate was 87 (Table 21). The deaths of residents in St. Mary's Sub-District numbered 325, being 29 less than in 1901, and equal to a rate of 133, or 23 less than the decennial mean (156). In St. John they numbered 32, 7 less than in the previous year and equal to rate of 83 per 1,000 births, being 35 less than the mean (118). In North-West Paddington there were 70 deaths, 14 more than in 1901, and equal to 100 per 1,000 births, being 5 in excess of the mean (155). Full information as to numbers for the two sexes are given in the following Table:— TABLE 24. Deaths at ages under one year. Mortalities per 1,000 births registered. Borough. St. Mary. St. John NorthWest Paddn. Borough. St. Mary. St. John NorthWest Paddn. Males 269 204 22 43 159 161 120 178 Females 164 121 10 33 101 102 50 140 Persons, 1902 433 325 32 76 131 133 83 160 „ 1901 455 354 39 62 135 139 102 143 Attention has been already directed to the decrease in the birth-rate of Old Paddington. (See page 7). Not only has the birth-rate declined, but the infantile mortality shows an upward tendency, the rate for last year being, however, in the other direction. Thus the mean mortality among male infants in St. Mary during the ten years 1857-66 was 168 per 1,000 births, that during the ten years 1892—1901, 171; the rates for females were 137 and 141 respectively. In St. John's Sub-District, where the greater decrease in the birth-rate has occurred, the male rate was in the first period 140, in the second 190, the rates for females being 108 and 185 respectively. A complete comparison is given on the next page. 32 INFANTILE MORTALITY. Infantile Mortality per 1,000 births registered. St. Mary. St. John. Males. Females. Males. Females. Ten Years, 1857-66 168 137 146 108 „ 1892-1901 171 141 190 185 Napoleon said that wars were decided by big battalions. In the same way the race for supremacy, be it in commerce, territorial expansion, or other form of national progress, depends upon the steady increase in population. If the Nation is to maintain its position in international affairs, something must be done to counteract the decreasing rate of growth. There can be no doubt that a "crusade," to use a term rather in vogue just now, against the present heavy infantile mortality is the only method which promises to produce good results. In Tables 25 and 26 the question of incidence of infantile mortality is taken a step further. It will be seen that more than half the deaths occur at ages under three months. Splitting this period into two, viz., "under one month" and "from one to three months," the greater proportion of the deaths takes place in the former period, viz., under one month. Examining Table 25 it will be seen that in St. Mary's District the mortalities among males at ages under three months were higher in the second period (1892-1901) than in the first (1857-1866); those at the higher ages, lower. The same remark applies to the mortalities of females. In St. John's District the mortalities among males in the second period show increases up to the ages three to six months, after which they are lower, but the mortalities of females are higher in the second period at all ages. TABLE 25. Deaths and Death-rates at ages under One Year. 1902. Ages at Death. Weeks. Months. 0— 1— 0— 1— 3— 6— 9— Deaths— m. f. m. f. m. f. m. f. m. f. m. f. m. f. St. Mary 40 16 21 24 61 40 42 19 37 18 46 17 18 27 » St. John 5 3 5 — 10 o 2 3 2 1 4 2 4 1 North-West Paddington 9 4 8 4 17 8 9 9 10 5 3 6 4 5 Death-rates*— St. Mary 32 14 16 20 48 34 33 16 29 15 37 14 14 23 St. John 27 15 27 — 54 15 11 15 11 5 22 10 22 5 North-West Paddington 37 17 33 17 70 34 37 38 42 21 12 26 17 21 * Per 1,000 births of each sex registered. infantile mortality. 33 TABLE 20. Mean mortality-rates among Infants at ages under One Year. Ten years 1857-66. 1892-01. District. Ages at Death. Weeks. Months. 0— 1— 0— 1— 3— 6— 9— m. f. m. f. m. f. m. f. m. f. m. f. m. f. St. Mary A 21 16 18 15 39 31 47 42 32 26 29 22 21 10 B 29 23 22 19 51 42 40 39 31 27 27 20 16 13 St. John A 23 14 14 10 37 24 39 31 30 24 28 17 12 12 b 27 25 99 20 49 45 62 50 35 40 26 30 18 20 Paddington A 22 15 16 13 38 28 44 38 32 25 29 20 17 14 B 29 23 22 19 51 42 48 41 32 28 27 22 16 14 A—10 years, 1857-1866. B—10 years, 1892-1901. The numbers of births in the Wards are not known, and failing such information Table 27 has been constructed. Being based on the rates per 1,000 estimated living at ages under one year, the figures are not satisfactory, and the value of the rates can be judged by the following comparison:— Mortalities at ages under One Year, per 1,000 estimated living at ages under one year. per 1,000 births registered. Males. Females. Males. Females. Queen's Park Ward 209 170 178 140 Borough 177 112 159 101 TABLE 27. Deaths and Death-rates at Ages under One Year. Deaths registered. Death-rates.* 1902. 1901. 1902. 1901. m. f. m. f. m. f. m. f. Queen's Park 43 33 35 27 209 170 172 141 Harrow Road 69 32 67 38 100 83 166 103 Maida Vale 29 20 22 27 170 124 133 172 Westbourne 30 27 38 37 160 120 174 169 Church 74 43 63 69 200 133 179 219 Lancaster Gate, West 3 ... 5 4 109 185 88 „ „ East 6 2 ... 4 218 44 ... 88 Hyde Park 9 7 11 8 98 87 122 101 Borough 269 164 241 214 177 112 162 150 * Per 1,000 estimated living at ages under one year in each district. 34 diarrhoea. The causes of death are indicated in Table 28. It will be seen that the number of deaths from each cause was below the average, except in the case of "measles" (20 cases last year, compared with an average of 11), "injury at birth" (3 deaths, average 1), and "rickets" (3 deaths, average 1). TABLE 28. Causes of Death at Ages under One Year. 1902. Borough. Persons. St. Mary. St. John. North-West Paddington. 1902. Average. 18921901. m. f. m. F. m. f. Small-pox 1 ... ... ... ... ... 1 ... Measles 6 8 2 9 1 1 20 11 Scarlet Fever 1 ... ... ... ... ... 1 1 Whooping Cough 7 5 ... ... ... 1 13 23 Diphtheria 1 1 ... ... ... 1 3 3 Diarrhcea 37 23 2 1 5 2 70* 115 Syphilis 2 1 ... ... 2 ... 5 8 Tubercular Diseases 8 4 ... ... 4 2 18 30 Premature Birth 36 18 3 ... 8 8 63 69 Congenital Malformation 6 3 3 3 3 ... 18 22 Injury at Birth ... ... 2 1 ... ... 3 1 Dentition 1 3 ... ... ... 2 6 10 Rickets 2 ... 1 ... ... ... 3 1 Atrophy and Debility 30 16 1 2 3 3 55 62 Convulsions 7 11 2 ... 1 9 23 27 Respiratory Diseases 48 11 4 ... 8 8 79 87 Accident and Violence 1 7 2 1 3 ... 14 18 Other Causes 10 10 ... ... 5 3 28 41 All Causes 204 121 22 10 43 33 433 529 Births Registered 1,266 1,177 184 202 241 235 3,305 3,492 * Including 8 due to "Enteritis." Diarrhœa. Included under this heading are deaths from diarrhoea, epidemic or zymotic enteritis and enteritis, from which causes 99 deaths at all ages were recorded during the year. The death-rate was 0.65 per 1,000 persons. The deaths ascribed to diarrhoea numbered 55, and were equal to a rate of 0.36 per 1,000 persons of all ages, being just half the mean-rate diarrhcea. 35 for the ten years 1892-1901 (0.72). The rates for the Borough and the Registration SubDistricts are set out below:— Death rates from Diarrhoea per 1 ,000 persons at all ages. Mean Rates. Ten years. Five years. Five years. 1902 1892-1901 1892-1896 1897-1901 Borough 0.36 0.72 0.57 0.86 St. Mary 0.43 0.85 0.66 1.04 St. John 0.22 0.20 0.23 0.29 North-West Paddington 0.28 0.89 0.71 1.07 During the ten years 1,027 deaths were due to diarrhoea in the whole Borough, of which 82'! were deaths at ages under one year. The average numbers of deaths in the ten years and each quinquennium are given below, both for diarrhoea and for enteritis*:— Deaths at ages under One Year. Diarrhoea. Enteritis. Averages. Averages. 1902 1892-01 1892-90 1897-01 1902 1892-01 1892-90 1897-01 Borough 44 82 68 97 20 33 23 42 St. Mary 37 62 50 75 23 24 18 31 St. John 3 7 6 8 — 3 2 3 North-West Paddington 4 13 12 14 3 6 3 8 The deaths from these causes are always in excess during the third quarter of the year. Thus of 70 deaths recorded at ages under one year in 1902, 50 occurred in the third quarter, while in 1901, out of 124 deaths during the twelve months, 100 took place in the same quarter. The great difference in the numbers for the two years suggested an inquiry as to the cause of the disparity. The two factors, apart from artificial feeding, which are generally held to be effective, are high temperatures of air and soil, and rainfall, an excess of the latter favouring a decline, and of the former, an increase in the mortality. The figures for the two years are contrasted below, but they cannot be said to do more than indicate a much closer connection between high temperatures and mortality than between mortality and rainfall. The matter is being inquired into more particularly. Deaths from Diarrhœa and Enteritis* at Ages under One Year. 3rd Quarter. Deaths recorded. Temperature. Rainfall inch. Air Earth at 3ft. Mean. Maximum. Weeks. 1-4 1902 5 61.5 86.1 60.25 1.15 1901 18 64.6 87.9 62.50 2.35 5-10 1902 16 59.3 79.0 59.80 2.57 1901 65 62.6 84.2 63.20 2.32 11-13 1902 29 56.5 75.1 58.97 2.19 1901 17 56.3 76.9 60.21 1.36 Whole Quarter. 1902 50 59.1 86.1 59.69 5.91 1901 100 61.8 87.9 62.06 6.02 * In this case no distinction is made between epidemic enteritis and enteritis. 36 inquests. Mortality among Illegitimate Children.-Forty-three (43) deaths of illegitimate children were recorded during the year, 31 of the children being under one year of age. The infantile mortality was equal to a rate of 208 per 1,000 births registered, compared with a rate of 41.3 per 1,000 in 1901. The rates of mortality in the three Sub-districts last year were-St. Mary, 186; St. John, 250; and North-West Paddington, 500. Particulars as to sex, ages, causes of death, and occupations of mothers are appended. Deaths of Illegitimate Children. Ages at Death St. Mary. St. John. North-West Paddington years. m. f. m. f. m. f. 0-1 14 10 9 1 3 1 1-5 5 4 - - - 1 5- - 2 - - - - Totals 19 16 9 1 3 9 Causes of Death. Ages. 0-1 1-5 5- m. f. m. f. m. f. Measles 1 - 3 - - 1 Whooping Cough - 2 - - - - Diarrhoea 3 1 1 2 - - Syphilis 9 1 - - - - Tubercular Diseases 1 1 - - - - Premature Birth - 3 - - - - Developmental Diseases 3 2 - - - - Nervous Diseases 2 - - 1 - - Respiratory Diseases 3 - 1 1 - - Accidents and Violence 2 - - - - - Murder - 2 - - - - Other causes 9 - - 1 - 1 All causes 19 12 5 5 - 2 Inquests were held touching four deaths. Occupations of Mothers. Domestic Servants 24 Commercial Employments 10 "Servant" 3 Barmaid 1 Cook 6 Dressmaker 5 General Servant 7 Laundress 4 Housemaid 6 Occupation not known or not Charwoman 2 stated 7 No occupation 2 INQUESTS. In the Borough 242 deaths were registered after inquests, 74 of the deceased persons being non-residents. The total number of inquests held with reference to deaths of residents numbered 181 (equal to 8.4 per cent. of all deaths), being 14 more than in 1901. In Table 29 will be found particulars as to findings of the juries, while below the Table will be found a summary of the principal findings other than "natural causes." WORK OF THE DEPARTMENT. 37 TABLE 29. Inquests on Residents, 1902. Finding of Jury. Registration Sub-Districts. North-West Paddington. St. Mary. St. John. m. f. m. f. m. f. Natural Causes 32 37 8 13 4 3 By Misadventure 3 1 1 1 1 ... By Accident 19 15 9 3 2 1 Suicide 8 3 5 1 ... 1 Murder ... 3 ... ... ... ... Neglect ... 1 ... ... 1 ... "No evidence to show" 1 ... ... 1 1 ... Totals 63 60 23 19 11 5 Deaths by Misadventure-(7) Surgical narcosis, 2; suffocation by coal gas and carbon monoxide from anthracite stove, one each; sulphonal poisoning, railway accident, and revolver shot, one each. Deaths by Accident-(49)- Vehicular traffic 8 Overlaid in bed 9 Railway „ 4 Burns, not conflagrations 4 Falls, various 15 Suffocated 3 Miscellaneous causes, 6. Deaths by Suicide-(20)-all "of unsound mind" or "temporarily insane."- By poison, 5 (Prussic Acid, 2 ; hydrochloric acid, oxalic acid, and laudanum one each.) By hanging 5 By gunshot 3 By drowning 2 By cutting or stabbing 2 By jumping out of window 1 By jumping before train 1 Murder-(3)- Newborn children found dead, 2. Adult woman killed by husband. Open-(3)- Overdose of laudanum-2 (m. 26, 57). Suffocation, no evidence as to cause-1 (f. 22). DEATHS IN INSTITUTIONS. During the year 735 deaths were recorded in the Public Institutions within the Borough, viz., Workhouse, 51; Infirmary, 247; St. Mary's Hospital, 359; Children's Hospital, 76; and Lock Hospital, 2. In addition there were 30 deaths recorded in nursing homes, making a grand total of 765 deaths in places other than the homes of the deceased persons, 362 of the deceased persons being non-residents. In institutions, &c., outside the Borough, 207 deaths of residents of the Borough occurred. The deaths in local institutions were in excess of the averages, as will be seen by Table III. Appendix. Details of the causes of death will be found in Table III.a Appendix. The deaths of residents in institutions may be grouped thus:- In Poor Law Institutions 292 equal to 13.5 per cent. all deaths. In Hospitals belonging to the Metropolitan Asylums Board 52 „ „ 2. „ „ In Lunatic Asylums 55 ,, ,, 2. ,, ,, In Hospitals supported by voluntary contributions 194 „ „ 9.0 „ „ The gross total of deaths in institutions of all classes was 593, equal to 27.4 per cent. of all deaths. The proportions in the Wards ranged from 36 per cent. in Church Ward to 14 per cent. in Lancaster Gate, East, Ward. 38 work of the department. TABLE 30. Report of the Work of the District Inspectors during the year 1902. Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Drainage, &c. Water Supply. Dust Receptacles. Miscellaneous. 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., New, Provided, Repaired, &c. Soil Pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New, Provided Cisterns Cleansed, Repaired, &c. Cisterns 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. Quarters. No. 1 165 3 766 - 4779 153 109 45 63 139 46 10 14 3 17 - 17 6 15 65 5 - 27 - 16 - No. 2 178 9 717 - 3846 82 83 52 58 152 46 4 5 3 21 — 22 1 15 36 2 — 37 3 34 2 No. 3 163 15 717 - 3819 106 59 43 49 159 54 13 10 3 27 - 21 4 17 37 2 2 53 2 53 13 No. 4 94 20 770 - 5441 141 68 79 69 192 64 14 12 6 45 — 23 7 16 69 2 — 48 9 17 1 Year 600 47 2960 - 17885 482 319 219 239 642 210 41 41 15 110 - 83 18 63 207 11 2 165 14 120 16 WORK OF THE DEPARTMENT. 39 WORK OF THE DEPARTMENT. General. Staff.-The number of Inspectors was increased during the year from 5 permanent and 3 temporary officers to 13 permanent, two being females. Six of the Inspectors have districts, and perform what may be called the general duties under the various Acts, the remainder being reserved for special work as will appear later on. The usual summary of work performed by the District Inspectors will be found in Table 30. Owing to the re-arrangement of duties, last year's figures cannot be compared with those of previous years. Prevention of Infectious Diseasf..-The visits of the Inspectors with reference to infectious illness increased from 1,544 in 1900 to 1,855 in 1901, and 3,341 during the past year. The greater part of the increase was due to the prevalence of small-pox, the numbers for the four quarters being-1st Quarter, 1,922; 2nd Quarter, 721; 3rd Quarter, 294; 4th Quarter, 404. Small-pox prevailed during the first half of the year, before the staff had been increased. No record has been kept of the visits of the Medical Officer of Health, which were additional to the above numbers. "Letters of Advice" are sent out when patients are kept at home for treatment. In 1902, 114 of such letters were issued compared with 156 in 1901. A special warning is addressed to all women in charge of puerperal fever cases, nineteen (19) such warnings being issued last year. The Staff of the Department disinfected 1,020 rooms during the year, showing a considerable increase over the numbers for the three previous years, viz., 1,227 in 1901, 1,002 in 1900, and 707 in 1899. Hospital Work.-Last year 032 patients were removed to hospital for treatment, most of them to the hospitals of the Metropolitan Asylums Board. No delay was experienced in securing accommodation for any of the diseases. Cases were dealt with at all hours of the day and night, even as late (or early) as 1 a.m. during the prevalence of small-pox. The accommodation provided by the Metropolitan Asylums Board comprises 8,000 beds in all, allocated as here set out:- For "fever" cases (scarlet fever, diphtheria, typhus fever and enteric fever)- Permanent accommodation already provided-acute cases 4,598 beds in 10 hospitals. convalescent (552 „ 1 hospital. Accommodation to be provided*-convalescent 800 „ 1 „ 6,050 For small-pox- Accommodation provided, permanent hospitals 3,350 in5 hospitals. „ to be provided* „ „ 540 3,890 The use of the Hospital Ships has been given up during the past year. Disinfection.-The use of sulphur for room disinfection has been entirely abandoned. A spray of formaldehyde (2½-5 per cent. solution) is now used in every case before removal of infected bedding, etc. The spray has the advantages of being much quicker in use, of applying the disinfectant to the parts which require it (viz., walls, floors, ceilings, etc.,) in the most effective form (viz., liquid) and of doing no injury to any fabric, metal-work, etc., to which it is applied. It may be added that the sulphur process has been under suspicion for some time past. \\ here it appears necessary, disinfection of the sick room is followed bv an order to strip walls, cleanse and whitewash, etc. This work has been required after all cases of small-pox * Authorised and in course of erection. 40 WORK OK THE DEPARTMENT. but is not regarded as a routine procedure in other diseases. Many rooms, passages, etc., were treated thus on verbal request of the Officers, and only 12 notices were issued to secure the work being done. Section 60 of the Public Health (London) Act, 1891, the Section under which such notices are given, provides that when the owner neglects to do the required work within 24 hours of the issue of the notice, the Council is to do the work. Arrangements have been made for the Staff of the Works Department to act on requisition from the Public Health Department, but it was not necessary to give effect to the arrangement last year. In certain Boroughs permanent staffs of men are maintained who follow the disinfectors, and at once strip walls, whiten ceilings and wash paint. The contract with Messrs. Armfield for the disinfection and cleansing of bedding, etc., is still in force. Orders for disinfection of bedding, etc., were issued after 952 cases of infectious illness, viz.:- Small-pox 98 Erysipelas 4 Scarlet Fever 334 Chicken-pox 132 Diphtheria and Membranous Croup 200 Measles 73 Enteric Fever 59 "Consumption" 4 Puerperal Fever 17 Other Diseases 25 The weight of goods removed last year was 47 tons 7 cwt. 3 qrs., or 5 tons more than in 1901. The total cost was £968 12s. 10d., the cost in each of the preceding five years having been:- 1901 £991 1898 £1,203 1900 856 1897 1,109 1899 947 A few complaints were received during the heaviest time of non-return of articles, but they were all satisfactorily settled by the Contractors. In May last, the Local Government Board wrote with reference to the occurrence of small-pox among the Contractors' workmen and urged the Council to consider the advisability of doing the work with their own staff and plant. A reply was sent expressing the Council's satisfaction with the present system, and no further steps were taken. The matter was, however, brought forward again in December last by the London County Council, and now stands referred for report. The expenditure on disinfectants amounted to £33 during 1902, the bulk of the cost being for formaldehyde. In 1900 the expenditure was £76, and in 1901 £58. The use of disinfectants in a popular manner is not encouraged by the Department, and very little is distributed. Such use practically amounts to the homoeopathic treatment of offensive effluyia-the masking of one smell by another. The best disinfectants are a liberal use of soap and water, plenty of fresh air and as much sunlight as the climate allows. Indeed, did the public truly appreciate the grand results to be obtained by cleanliness of homes and of air, the need of a Public Health Department would soon disappear. Family Shelter.-Under Sub-Sec. 4 of Sec. 60 of the Public Health (London) Act, 1891, the Council is required to provide a house for the reception of persons displaced during the disinfection of their homes. A "shelter," containing 2 bedrooms, 1 sitting and 1 bath-room, together with caretaker's rooms, has been maintained since September, 1895. The place was of considerable utility during the earlier years while sulphur disinfection was practised, but with the introduction of the formaldehyde spray the need of a shelter appears to have vanished. Last year only five families (12 persons, 6 under 10) were admitted, as compared with 24 in 1901. The figures for each complete year since the opening of the shelter are as below:- 1896 43 families 77 adults 73 children 1897 52 „ 92 „ 52 1898 23 „ 42 „ 42 1899 21 „ 42 „ 38 1900 15 „ 21 „ 24 1901 24 „ 42 „ 57 1902 5 „ 6 „ 6 WORK OF THE DEPARTMENT. 41 But for the fact that the cost of maintenance is trifling, averaging about £50 per annum, and the Council is under statutory obligation to provide a shelter, a suggestion would have been put forward to give up the premises. Water Supply.-The year 1902 will be memorable for the passing of the Metropolitan Water Act, which is to effect the transfer of the various undertakings from the Water Companies to the Water Board. The Act is an attempt to place the inhabitants of "Water" London in a position similar to that of many provincial townships. "Water" London being an aggregation of many cities, towns and districts, a transference to one local authority was impossible, and a compromise was inevitable. The results will be watched with much interest. One change which it is hoped will be at once introduced is the abandonment of cutting off for any purpose except the prevention of waste or of pollution. It is manifestly anomalous that Legislature should declare (Sec. 49 Public Health Act (London), 1901) a house "without a proper and sufficient supply of water" to be a nuisance and unfit for habitation, and at the same time legalise the deprivation of such "proper and sufficient supply" from an inhabited house. Where the supply is for any purpose discontinued from an "inhabited dwelling-house," the water company is to give notice within twenty-four hours of such discontinuance of supply to the local authority. (Sec. 49 Public Health (London) Act, 1891). Under that provision notices are sent off when the water is cut off for a few hours only to effect repairs. On the other hand the supply may be discontinued on a house being vacated by the tenants, the house being reported as "empty" by the Inspector charged with the enquiry made on receipt of the company's notice, and subsequently caretakers be placed in charge of the house. A case of this kind occurred during the past year, where the caretakers were in the house for many months without a water supply. The caretakers were discharged on the Council's notice being served, but legal proceedings were found impossible. In consequence of the want of water, the combined drain to which the house and two others were connected became choked, and parts of two of the three houses flooded with sewage. The notices received during the year from the two Companies supplying the Borough numbered 121 in all, being 11 more than in 1901. The figures for the last six years have been:- Water Company- 1898 1899 1900 1901 1902 Grand Junction 100 86 100 77 52 West Middlesex 110 43 40 33 69 The reasons for discontinuing the supply were alleged to be:- Water Company. Grand Junction. West Middlesex. Repairs to fittings 31 9 Empty houses 17 45 Unpaid rates 4 10 Supply not required 2 Premises in demolition 3 The periods which elapsed between discontinuance and restoration of supply are sufficiently indicated below:- Grand Junction. West Middlesex. Supply restored on same day 15 3 next day 6 4 after 2 days 2 4 3 „ 2 - 4 „ 2 - 5 „ - - 0 „ - 2 7 or more 4 4 42 WORK OF THE DEPARTMENT. Notices to restore supply were required in 16 cases, but only one summons was required for not restoring supply (non-payment of rates). The house was vacated by the tenant. Mortuaries.-During the year 295 bodies were received at the two Mortuaries under the jurisdiction of the Council, viz., 280 at Paddington Green Mortuary and 15 at Kensal Road. The inquests held numbered 251, 113 being after postmortem examination-Sec below. Paddington Green. Kensal Road. Bodies Deposited 280 15 Inquest Cases 242 12 Postmortem Examinations 104 9 The new mortuary and postmortem rooms at Paddington Green were approaching completion at the close of the year.* The buildings newly erected include- (i.) Coronor's and General Mortuary, with postmortem room (2 tables), microscope room, view room, exhibition chamber, and lavatories; (ii.) Infectious Mortuary, exclusively for patients dying of infectious diseases; and (iii.) Mortuary Chapel, erected for reception of bodies awaiting burial. The London County Council's Coroners' Court is immediately adjacent to this Mortuary. The Mortuary at Kensal Road is on a smaller scale, but complete in itself. The large room at the Wedlake Street Offices has hitherto been used for Coroner's inquests. Schools and School Attendance.-Under Section 55(4) of the Public Health (London) Act, 1891, notice has to be sent to the head teacher of every school attended by children residing in the infected houses. The notices sent out last year numbered- For Notifiable Diseases 1,300 For other Diseases 390, or 1,690 notices in all. The first category includes small-pox, diphtheria, etc.; the second, measles, whooping cough, and (for part of the year) chicken-pox. The last disease was for the rest of the year in the first category. One hundred and forty-two (142) notices were also sent to the Librarian of the Queen's Park Public Library. In Table 31 (opposite) will be found the numbers of cases of scarlet fever and diphtheria which occurred either in children attending school ("P.A.") or in the members of families sending children to school ("P.N.A."). The records were kept in a new form last year, which enabled a more careful check to be kept on the prevalence of infectious disease in connection with each school. Last year's returns give a better idea of the frequency of cases in connection with each school, but are not comparable with those of earlier years. Arrangements have been made with the Medical Officers of Health of the adjacent districts to exchange copies of certificates sent to the schools in this Borough with reference to cases of illness in outside districts, and vice versa. * The buildings were handed over to the Department in February of this year. WORK OF THE DEPARTMENT. 43 TABLE 31. Borough Schools, 1902. Board Schools - Residents in Borough. Residing beyond Borough. Scarlet Fever. Diphtheria. Scarlet Fever. Diphtheria. p.a. p.n.a. p.a. p.n.a. P. P. Amberley Road 8 2 4 8 ... ... Beethoven Street 11 6 5 6 5 ... Campbell Street 4 3 1 ... ... ... Droop Street 15 11 18 8 ... ... Essendine Road 6 2 8 2 1 ... Harrow Road 29 13 14 11 7 1 Kilburn Lane 2 5 7 4 4 2 Totals 75 42 57 39 17 3 Voluntary Schools- Bayswater Jewish 1 ... ... ... 1 ... Cirencester Street R.C. ... 1 1 1 ... ... Holy Trinity 4 2 ... 2 ... ... St. Augustine 4 2 ... 2 9 12 St. James 2 ... 3 ... ... ... St. John, Kilburn Lane 1 ... 2 3 3 4 St. John, Titchborne Street 2 1 1 1 ... ... St. Luke, Kilburn 9 1 2 1 3 9 St. Luke, Westbourne Park ... ... ... ... ... ... St. Mary ... 1 2 ... ... ... St. Mary of the Angels ... ... ... ... 2 1 St. Mary Magdalene 5 1 4 5 1 ... St. Matthew 4 3 4 1 ... ... St. Michael 5 2 ... 3 ... ... St. Paul 12 6 2 1 ... ... St. Peter 4 ... 4 3 5 1 St. Saviour 3 1 ... 2 1 1 St. Stephen's 7 3 1 1 7 1 Saltram Crescent 3 1 1 1 1 ... Westbourne 1 1 2 2 ... 2 Wilberforce 5 3 3 3 7 2 Woodfield 1 2 2 1 ... ... Totals 73 31 30 33 40 33 P.A. Patients who were Scholars of the School. p.n.a.-Patients who were not Scholars of the School. P.-Patients, not distinguishing Scholars and Non-Scholars. 44 WORK OF THE DEPARTMENT. Under such arrangement 105 copies of certificates were received during the year.* The numbers of such certificates relating to scarlet fever and diphtheria are given in the Table, but it has not been possible to distinguish between scholars and non-scholars as has been for local cases. From inquiries addressed to the head teachers, it has been ascertained that at the Board Schools, 8,438 places are provided, and at the Voluntary Schools 14,560, the total average attendances, being 7,457 and 10,763 respectively. The case rates at the two classes of schools last year are set out below:- Case rates per 1,000 children attending. Scarlet Fever. Diphtheria. P.A. P.N.A. P.A. P.N.A. Board Schools 10.0 5.6 7.6 5.2 Voluntary Schools 6.7 2.8 3.3 3.0 There was no need for closing any school or part of a school during the past year. Bacteriological Examinations.-Sixty-five specimens were received from medical practitioners during the year, being almost exactly half the number (129) received in 1901, and three fewer than in 1900. Of the specimens received, 36 were for the diagnosis of diphtheria, and 29 of enteric fever. The results are tabulated below :- Diphtheria. Enteric Fever. Suspicion confirmed 15 13 „ negatived 21 16 Up to the end of the year the tests were limited to the two diseases mentioned, but it would be advantageous to commence the diagnosis of tuberculosis bv the examination of the sputum. Offensive Refuse.-This includes (a) trade refuse; (b) manure; and (c) household refuse. Trade Refuse.-No infringements of the Bye-laws relating to carrying of offensive refuse through the streets were reported last year. One complaint was received through the County Council as to the manner of removal of fish offal. Fresh arrangements were at once made and no further complaint has been received. At present anyone whose business involves the production of refuse can require the Council to remove the refuse on payment bv him of such charge as may be either mutually agreed upon or fixed by Petty Sessional Court. (Public Health (London) Act, 1891, Sec. 33.) In 1900 a Conference was held at Spring Gardens on the question of the collection of offensive trade and other refuse, when the following resolution was adopted:- "That, in the opinion of the Conference, the Sanitary Authority should be empowered to employ a sufficient number of scavengers for collecting and removing trade refuse of an offensive or noxious nature at a charge to be fixed by the Local Authority, or, in the event of dispute, by a police magistrate." The result of such a change in legislation would be not only to vest the refuse in the local authority but to enable them to take possession of it and charge the producer with the cost of collection. Some of the refuse has a commercial value, but it appears probable that the * The 105 duplicate notices related to the following diseases:- From Kensington. From Willesden. Small-pox lcase 8 cases Diphtheria 4 cases 29 „ Scarlet fever 18 „ 35 „ Enteric fever 4 „ 4 „ Chicken-pox - „ 2 „ 27 „ 78 „ WORK OF THE DEPARTMENT. 45 advantages to the producer arising from the change in collection would compensate him for any pecuniary loss. Manure.-The Order for removal every 48 hours was duly placarded throughout the Borough in the early part of the summer. Very few complaints were made of non-removal and no legal proceedings were required. Letters were received from certain horse owners asking the Council to undertake the removal of the manure. The Council has the power to enter into an agreement with any horse owner to remove the manure, but no provision has been made for any charge being imposed for such work. (Public Health (London) Act, 1901, Sec. 36.) At the Conference mentioned above, a resolution, mutatis mutandis identical with that quoted above, relating to the removal of manure was adopted. Certain difficulties which may be expected to attend the collection bv the local authority have been referred to in previous Annual Reports, but it is probable that the advantages which may be anticipated would compensate for such difficulties. Household Refuse.-Several complaints were received from residents during the hot weather of offensive effluvia from ash-pits belonging, in nearly every instance, to boarding houses. The dustmen also lodged complaints of the exceedingly offensive condition of some of the dustbins. The refuse was found to contain a large proportion of damp organic matter, both animal and vegetable, and undergoing rapid putrefaction. The complaints were not due to any irregularity in the removal of the refuse but to the nature of the contents of the receptacles, and more especially to the dampness of the refuse when thrown into the dustbin. At a few houses the dust was found in the old fashioned bins under the area steps, the bins being more or less defective. Notices were issued for repair, or (preferably) substitution of "sanitary" (iron) receptacles, but such action is not calculated to entirely obviate the nuisance. The only satisfactory remedy will be found in one of two alternatives:- (a) Making bye-laws forbidding the deposit in dustbins of any organic matters, animal or vegetable, in a condition liable to set up decomposition ; or (b) Removing the house refuse more frequently than once a week. If householders would only have all green refuse, bones, etc., put through the kitchen fire the nuisance would not occur, and they would find that, by skilful use of the refuse, there would be an economy in coal. It is doubtful whether the Local Government Board would sanction any bye-laws forbidding the deposit of organic refuse in dustbins, as the existing law appears to sanction the placing of household refuse of any and everv class in dustbins.* Moreover, the present habits of life would render such bve-laws a hardship. Gas cookerv is increasing year bv year, much to the advantage of the atmosphere which is thereby saved from smoke pollution. Flats are also increasing in popularity and coal ranges are not always available in the kitchens there. In 1901 the London County Council submitted to the Borough Councils a proposal to amend Bye-law 7† under Section 16(2) of the Public Health (London) Act, 1891, by substituting "twice" for "once." The proposal resulted from the following resolution, adopted at a Conference of Local Authorities held in 1900 at Spring Gardens, on streets and street traffic:- "(3) That in the opinion of this Conference, house refuse should be removed daily where practicable." * "House refuse" is defined by Section 141 of the Public Health (London) Act, 1891, as meaning and including "ashes, cinders, breeze, rubbish, night-soil and filth not being trade refuse." † Bye-law 7 is as follows :- "7.-The Sanitary Authority shall cause to be removed not less frequently than once in every week the house refuse produced on all premises within their district." 40 WORK OF THE DEPARTMENT. The proposal to require removal twice a week was so generally opposed that no further steps have been taken to alter the bye-law. Since 1900 a bi-weekly collection has been made from flats during the summer months, and last year the Works Committee were authorized to make collections at their discretion at intervals of less than seven days from any premises. It would be somewhat expensive to systematically remove all house refuse more frequently than once in seven days, but it is believed that to do so would mean not only the removal of nuisance from objectionable effluvia, but also improved health. There is reason to believe that the emanations from dustbins are in themselves dangerous to health, and that when they gain access to foods (the larder and dustbin are usuallv very near to each other) they can set up changes which will give rise to sickness and diarrhoea in those consuming the food. Milk is probably the most sensitive of all foods to this contamination, and summer diarrhoea is more common in hand-fed children than in others. It is impossible to resist the conclusion that the prevalence of summer diarrhoea and putrefying accumulations of refuse in the household dustbin are in some way correlated. Professor Delepine has shown that the deleterious properties of milk, as measured by the bacteriological test, vary directly with the temperature of the air, the time which has elapsed since taken from the cow and the opportunities of dirt contamination. Drainage Work.-To a certain extent the number of new drains laid in during any year depends on the prevalence of infectious disease, more particularly of diphtheria and enteric fever. Last year 573 new drains were constructed under the supervision of the Inspectors, each being water-tested twice, i.e., before and after "filling in." In 1901,572 new drains were constructed. During last year 01 drains, most of which were on the register of drains re-constructed under the Department, were tested and found sound. The Bye-laws to be made under the " Metropolis Management Acts Amendment (Byelaws) Act, 1899" have not yet been issued. The original draft was submitted by the London County Council in July, 1900. Combined Drainage.-The following systems of combined drainage, of which no records (with one exception) could be found, were proved defective and the reconstruction ordered. All were referred to the Works Department for reconstruction, except the first. Artesian Road, Nos. 55, 57, and 59. Victoria Place, Nos. 22 and 23. Alexander Street, Nos. 19 and 20. Windsor Gardens, Nos. 1-12. „ Nos. 28 and 29. Windsor Street, Nos. 8 & 9; 10&11; 16&17. Artesian Road, Nos. 2, 4, and 6. Jonson Mews, Nos. 10, 12, 13, and 14. Canterbury Terrace, Nos. 11-21 (odd). Porchester Terrace, Nos. 74-86 (even). Clarendon Gardens, Nos. 1-17. „ Square, Nos. 30-46 (consec.) Courtnell Street, Nos. 30 and 32. Portsdown Road, No. 59. Harrow Road, Nos. 291 and 293. Praed Street, Nos. 120 and 122. Hereford Road, Nos. 69 and 71. Arthur Mews, No. 150. Moscow Road, Nos. 75 and 77. A combined system serving Nos. 37, 39, and 41, Talbot Road was reconstructed on the owner's initiative and at his expense. New combined (private) systems were sanctioned by Orders under Section 74 of the Metropolis Management Act, 1855, at Kensal Road, Nos. 174, 176, and 178. Artesian Road, Nos. 55, 57, and 59. Kensington Gardens Square, Nos. 50-53 (incl.) In Queen's Park Ward the greater part of the drainage is bv combined systems at the backs of the houses. During the year 208 house drains, being branches connected to the combined systems, were tested with the chemical ferret, and 182 were found to be defective. Of housing. 47 the 26 drains which "passed" the chemical test, 3 were subsequently opened up and found to be defective. The reconstruction of all the combined systems is needed, and the work was commenced last year, the mains draining the following blocks of houses being reconstructed before the close of the year. All the new mains were water-tested :- Third Avenue, Nos. 178-224 (even). Fourth ,, ,, 34-40 (even). Fifth „ 110-130 (even). „ 156-170 (even). rarrant Street, Nos. 56-64 (even). Ilbert „ „ 20-46 (even). Kilravock ,, ,, 11-17 (odd). Peach „ „ 1-29 (odd). Counsel's opinion was taken during the year as to the possibility of the Council being able to get rid of future liability for maintenance of drains after amending a combined system. The gist of counsel's reply appeared to be that if the Council substituted new independent drains for a combined system, which by default of approval vested in the Council as a sewer, the Council would be free from all future liability. Smoke Prevention.- In consequence of complaints received, shafts and chimneys connected to the following premises were specially kept under observation:- Usher's Brewery, Queen's Road. Hydraulic Works Great Western Railway. Electric Light station Cafe, 180, Edgware Road. „ 25, Queen's Road. In all, 122 separate observations were taken, extending over 65½ hours. Much black smoke was reported at Usher's Brewery and at the Hydraulic Works. Proceedings were taken with respect to the Brewery, and a Prohibition Order obtained with five guineas costs. Canal Boats Acts.-The usual report of the Examining Officer was submitted to the Council on 17th February last. There was nothing in the work of the year calling for special comment. Three cases of infectious illness, viz., one each of smallpox (erroneously diagnosed), chicken-pox and erysipelas, and five deaths were recorded among the people working the boats. The amendment and codification of the Acts are being discussed. The reforms most needed are: (1) the exclusion of children above the age of five years from the boats; (2) alteration in the manner of determining the number of persons to inhabit the cabin. Canals.-The only complaint received relating to the canal water was that from the London County Council, based on chemical analysis of samples taken in July last. The sample was from the "Cut" (Paddington Basin) opposite one of the wharves. The "Cut" was emptied at Easter, when about 500 tons of mud were taken from the bottom, and quantities of water were drawn off periodically to bring in a supply from the upper reaches of the Canal. Wharves.-The various wharves have been frequently and systematically inspected during the year. No complaints have been made with reference thereto. HOUSING. It is proposed to deal with this subject under the following heads:- (i). Houses let in lodgings; (ii). Common lodging houses; - (iii). Housing of the Working Classes Act, 1890, and amending Acts. Houses Let in Lodgings.-Two Inspectors were placed in charge of the registration and general supervision of houses let in lodgings. These Inspectors do not, at present, deal with defects of a constructional character. Such matters are handed over to the District Inspectors, so as to leave the two Special Inspectors more time in which to attend to registration. 48 HOUSING. Annual Cleansing.-For some time after commencing work in May, the Inspectors were fully occupied in seeing that the annual cleansing required under the Bye-laws was properly carried out. Each year the belief grows stronger that this annual cleansing is of very great value. There were on the Register when the Special Inspectors commenced their work 392 houses, all of which required more or less cleansing. To secure this work 1,926 visits were necessary, and 27 summonses. The results of the summonses were almost nothing, judged by the fines and costs awarded, but the work was done. Houses Registered.-One hundred and ninety-four (194) houses were placed on the Register entailing in each case the issue of notice for statement of particulars and (in most cases) reminder notices, the measurement and the calculation of the cubic contents of every room in each house (1,058 rooms in all), inquiries as to inhabitants and inspection as to structural compliance with the Bye-laws. In addition there were forms required for submission to the Committee. The houses registered numbered at the close of the year, 586. The total number of inspections made by the two Inspectors was 1,178, in addition to those already mentioned. In the following table the conditions as to housing in the streets placed on the register are set out:- Summary of Particulars obtained at Registration, 1902. Housing. Group A. Group B. No. of Houses 100 120 Registered 94 104 Exempt 6 16 Empty - - No. of Rooms, registered 632 576 For living only 127 78 For sleeping only 218 191 For living and sleeping 287 307 Other Rooms 303 485 Occupied by landlords 135 205 Exempt by rent 50 244 Occupied not inhabited 105 14 Empty 13 22 Grand Totals, Rooms 935 1,961 Inhabitants. Group A. Group B. In Registered Rooms, Persons 1,257 1,228 Persons under 10 years 390 373 Persons 10 years and upwards 867 855 fn other Rooms, Persons 237 575 Persons under 10 years 45 131 Persons 10 years and upwards 192 444 Grand Totals, Persons 1,494 1,803 Overcrowding. In Registered Rooms- Group A. Group B. Families 16 34 Persons, all ages 57 172 „ under 10 years 23 82 „ 10 years and upwards 34 90 Abated by re-adjustment of occupants 9 19 Requiring removal 7 15 housing. 40 Group A (part of Clarendon Street Area). Group B. Dartington Terrace. Senior Street. Amberley Road. Desboro' Street. Stalham Street. Braden Street. Hasboro' Street. Netley Street. In Table 32 will be found particulars of the inhabitants in each class of home placed on the Register, following the form used by the Registrar-General in his Census Report, but distinguishing persons aged 10 years and upwards from those at younger ages. The table is of interest as showing the extent to which overcrowding on the standard prescribed by the Bye-laws differs from the overcrowding estimated by the Registrar-General. In the course of registration only 50 families were found to be overcrowded according to the former standard, while the Table shows that on the Registrar-General's standard, no fewer than 205 families would be held to be overcrowded. TABLE 32. Particulars as to Numbers of Tenements and Inhabitants therein, registered during 1902. Rooms to Tenement. Group of Streets.* 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 A 53 53 ... 48 92 4 29 58 29 10 24 10 3 10 5 1 2 4 ... ... ... ... ... ... ... ... ... ... ... ... B 59 59 ... 73 142 2 31 66 27 20 40 40 8 17 23 2 5 7 ... ... ... ... ... ... ... ... ... ... ... ... 2 A 4 4 ... 39 78 ... 33 78 21 38 106 46 33 98 67 20 59 61 14 50 48 6 23 25 1 3 6 ... ... ... B 6 6 ... 24 47 1 34 89 13 42 121 47 30 95 55 21 68 58 15 51 54 3 10 14 ... ... ... ... ... ... 3 A ... ... ... 4 8 ... 1 3 ... 4 14 2 4 18 2 2 7 5 5 23 12 3 13 11 3 13 14 ... ... ... B ... ... ... 1 2 ... ... ... ... ... ... ... 1 2 3 3 9 9 4 15 13 2 9 7 ... ... ... ... ... ... 4 A 1 1 ... 1 2 ... ... ... ... ... ... ... 2 8 2 ... ... ... ... ... ... 1 4 4 ... ... ... 1 6 4 B ... ... ... ... ... ... ... ... ... ... ... ... ... ....... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... T-number of Tenements containing P/10 Persons over 10 years of age, and 10/P Persons under 10 years of age. * See above for lists of Streets included in each Group. The particulars given in the preceding table may be summarised in the following form:— Tenements registered— Group A. B. One-room tenements 144 193 Two-room „ 188 175 Three-room „ 26 11 Four-room „ 6 — More than four-room tenements 2 — Inhabitants therein— Tenements of one room 297 430 „ two rooms 773 729 „ three rooms 145 69 „ four rooms 31 — ,, more than four rooms 11 — In the houses which were on the Register at the close of the year, 252 cases of infectious disease were known to have occurred, viz., 122 cases of notified disease and 130 of other 50 housing. diseases. The returns of the latter are almost certainly incomplete. The numbers of each disease were as follow:— Infectious Sickness In houses on the Register, 1902. Small-pox 39 Measles 91 Diphtheria and Membranous Croup 25 Whooping Cough — Erysipelas 16 Chicken-pox 39 Scarlet Fever 35 Enteric Fever 6 Puerperal Fever 1 The deaths registered numbered 228, viz., 127 of persons aged 10 years and upwards, and 101 of children under 10 years of age. The number of inhabitants is not known exactly, but has been estimated at 8,600 persons (residing in 579 houses), giving a death-rate of 20.25 per 1,000 persons, as compared with one of 14.58 for the Borough as a whole, and of 14.04 for the Borough. if the registered houses be excluded. The following were the principal causes of death:— Small-pox 10 Tuberculosis of Brain 6 Measles 19 „ Lungs 19 Scarlet Fever 1 Other forms of Tuberculosis 1 Diphtheria 4 Alcoholism 2 Whooping Cough 2 Cancer 8 Enteric Fever — Premature Birth 10 Puerperal Fever — Development Diseases 10 Other Septic Diseases 2 Respiratory Diseases 50 Diarrhoea, Enteritis 16 Violence of all forms 8 A summary of the defects discovered, and dealt with, in houses on the register is given in Table 3.3. There is nothing calling for special comment. Particulars of overcrowding are given separately in Table 34. The Department desires not so much to remedv overcrowding by legal process, as to prevent its occurrence by seeing that landlords do not give possession to tenants with families too large for the respective tenements. It will be noted that nearly one half of the families reported as overcrowded were able to comply with the Bye-laws by re-arranging the distribution of the members of their families. TABLE 33. Sanitary Defects Remedied in Registered Houses, 1902. Closets. Yard paving defective. Dustbin defective. Roof defective. Wash house paving defective. Sink waste pipe defective. Rain-water pipe defective or no guttering to roof. Drain choked. House dirty or damp. Cistern dirty or not properly covered. Other defects. Animals improperly kept. Accumulation of refuse. * Stopped. Insufficient flush. Defective. Without water. Insufficient accommodation. Other defects. 1st Quarter 7 6 2 ... 2 1 6 ... ... 11 3 6 1 ... ... 2 1 3 2nd Quarter 9 10 4 1 1 2 3 19 24 ... 2 6 1 3 ... 3 ... 5 3rd Quarter 3 5 7 4 20 1 2 13 11 2 ... 9 4 7 3 ... 1 7 4th Quarter 3 2 4 3 ... 3 9 6 6 1 ... 1 5 4 2 ... 1 3 22 23 17 8 23 7 13 38 41 14 5 15 11 14 5 5 3 18 housing. 51 TABLE 34. Overcrowding in Registered Houses, 1902. Families overcrowded. Rooms occupied. No. of occupants. Abated by re-arrangement of occupants. Abated by voluntary removal. Abated after service of notice. Night visits. P/10 10/P 1st Quarter 1 1 1 3 ... ... 1 ... 2nd Quarter 3 4 10 5 ... ... 3 ... 3rd Quarter 34 46 76 64 10 10 14 4 4th Quarter 23 33 57 54 13 7 3 ... 61 84 144 126 23 17 21 4 Common Lodging Houses.—The Common Lodging Houses are registered and supervised by the County Council. There are 9 registered houses in the Borough, 7 for men, certified to accommodate 225, one for women accommodating 34 lodgers and one for women and married couples for 45 lodgers. No case of infectious illness was reported from any of the houses during the year, but 14 deaths (13 of males and 1 of a female) occurred in them, being an increase of 3 deaths of males as compared with 1901. The principal causes of death during the two years:— 1901. 1902. Diarrhoea 1 — Tubercular Diseases 3 3 Cancer — 1 Respiratory Diseases 4 1 Other Diseases 3 9, including 3 from heart diseases. Under the London County Council (General Powers) Act, 1902, important powers of regulation have been obtained, including yearly licensing. Housing of the Working Classes.—The Committee specially appointed to deal with this subject have held several meetings and considered preliminary proposals for schemes. Certain sites have been viewed and one is now receiving special consideration as promising an opportunity of doing something towards solving the difficult problem of providing decent homes for the poorer classes without displacing too large a number of present inhabitants, or placing a heavy charge on the rates. No action has been proposed under the "Small Dwellings Acquisition Act, 1899," which authorises the local authority to make advances to enable persons to acquire ownership of small houses occupied by them. The price of houses in the Borough renders such procedure far too costly. In 1901 a special inquiry was made as to the conditions prevailing in the "Clarendon Street Area," the results being embodied in a Special Report issued in November of that year. A considerable amount of work has been done in that area during the last twelve months, and special attention has been given to the annual cleansing of those houses which are on the Register of Houses Let in Lodgings. In continuation of the statistics of morbidity and 52 housing. mortality given in the Special Report already mentioned, the figures for 1001 and 1902 have been extracted, the more important being set out below:— Rates of Morbidity and Mortality per 1,000 Persons of all ages, except where otherwise indicated. Clarendon Street Area. Rest of Borough. 1896-00. 1901. 1902. 1896-00. 1901. 1902. Notifications. Diphtheria 1.85 2.19 2.02 2.17 2.38 1.39 Erysipelas 2.07 2.33 1 .75 1.07 0.90 0.92 Scarlet Fever 5.21 5.76 2.69 3.99 3.36 2.42 Enteric Fever 0.95 1.78 0.40 0.54 0.57 0.57 Puerperal Fever 0.05 — 0.12 0.07 0.07 0.09 Deaths. At all ages 28.75 22.60 23.23 16.17 13.81 14.14 0—10 years ? 32.99 32.45 ? 27.79 20.87 10— ? 17.78 18.89 ? 11.17 11.72 Infants under 1 yr.* 308 290 250 288 215 197 In Institutions † 30.0 42.4 40.7 22.6 20.5 27.2 Infants under 1 yr. ‡ ? 62.3 55.8 ? 67.1 65.0 * Per 1,000 deaths at all ages. † Per 100 deaths at all ages. ‡ Per 100 deaths, 0—10 years. It was somewhat of a surprise to find that the proportion of deaths at ages under one year to all deaths at ages 0—10 years was lower in the Area than in the rest of the Borough. This, coupled with the comparatively small excess of mortality per 1,000 of those ages, suggests that the birth-rate of the Area is not so high as might be expected having regard to the class of inhabitants. Two important Reports have been issued during the year, namely, that of the Select Committee (House of Commons) on Repayment of Loans by Local Authorities, and that by the Joint Committee (Lords and Commons) on Housing of the Working Classes. Among the recommendations contained in the former Report are the following:— "That some postponement of the payment of the first instalment should be allowed in the case of certain works." "That the sanctioning authority should be empowered to fix the method of re-payment in all cases ; and to provide for the establishment of a repairs fund where necessary." "That the maximum period for the re-payment of loans for actual re-housing operations, under Parts 1. and II. of the Housing of the Working Classes Act, 1890, should be 80 years." "That, subject to the adoption of the instalment system of re-payment, the maximum period for the re-payment of loans for land under Part III. of the Housing of the Working Classes Act, 1890, should be extended to 80 years." The extension of the period of repayment is of doubtful value in the case of a loan of £25,000 at per cent. the decrease in amount paid each year on a 80 years' term by way of principal and interest in comparison with the corresponding payments on a 00 years' term, amounts to some- WORKSHOP SUPERVISION. 53 thing under £76, whereas the total amount of interest paid during the longer period is over £12,000 more than that paid for the shorter period. A postponement of the first instalment of repayment is of greater value, as any buildings erected are not likely to come into occupation and remunerative for one or more years. The recommendations of the Select Committee cannot be stated so simply. Briefly the proposal is to require a housing scheme in connection with every purchase of land involving the displacement of persons of the working class, such requirement to apply to all undertakings, whether by a company or a local authority. The Home Secretary is to be the judge of the scheme needed to house the people displaced and may require a guarantee sufficient to secure the carrying out of the scheme approved by him. Under certain conditions he may certify that the provision of new accommodation is unnecessary. As regards the first Report, legislation will be necessary to give effect to the recommendation, but as regards the second, the adoption of model clauses and some amendments of the Standing Orders of the Houses will be sufficient to make the recommendations effective. WORKSHOP SUPERVISION. By Sec. 132 of the Factory and Workshop Act, 1901, the medical officer of health of every district is required to "report specifically on the administration" of the Act in the workshops and work-places in his district. Domestic workshops and factories are here included as "workshops," while the term "work-place" is so wide as to include every place where people meet to earn their livelihood. The matters which are dealt with in workshop supervision under the Factory and Workshop Act are:— Cleanliness, including freedom from offensive effluvia; Cubic space, including overcrowding; Ventilation, both as to sufficiency and maintenance in good order; and Wetness of floors, principally in laundries. The provision of sufficient and suitable closet accommodation is secured under the Public Health (London) Act, 1891. The supervision of bakehouses and home workers are specially provided for under the Factory and Workshop Act, 1901. I he work of the Department was not satisfactorily organised until near the middle of June, and consequently the returns do not represent a full year's work. The supervision of workshops and work-places where women are employed is in the charge of Miss O'Kell and M iss Nicolas. The former has the northern part of the Borough and the latter the southern. The distribution of workshops in the Borough is so irregular that an arbitrary division has been found necessary. Mr. Wansbrough looks after workshops where males only are employed and assists in the inspection of other workshops as required. He has been specially employed on bakehouses, to which he has been obliged to devote the greater part of his time. Under Sec. 131 of the Factory and Workshop Act, 1901, registers have to be kept of all workshops in the Borough, and, under Sec. 107, records of the lists of homeworkers (outworkers) sent in by employers, together with particulars of information transmitted to or received from the officers of other districts. These duties involve a considerable amount of clerical work, which is carried out by the Inspectors themselves. The registers kept are in the form of books, inspection cards and manilla files. The cards serve more as memoranda for reference at subsequent inspections, the Register required by the Act being in book form. The files form the "dossiers" in which reports, &c., relating to each workshop are stored. Outworkers and work-places are recorded in the same way, as many of the rooms occupied by the former are workshops within the meaning of the Act, and the latter may at any date become so by the employment of additional workers. 54 WORKSHOP SUPERVISION. The home workers' lists as received are filed in the manilla files referred to, the names and addresses of all residing in outside districts being sent on to the proper officers. Copies of such communications are kept in a special press-copying book. With the inception of work practically new to the district, considerable difficulty might have been anticipated as to the rights of entry and inspection. It is satisfactory to be able to record that admission was refused at 7 workshops and workplaces only, and that in all but 2 instances, letters from the Medical Officer of Health explaining the law, removed all difficulty at a subsequent visit. One of the exceptions was found to be working alone and admission was not insisted on. In the other the workroom was given up before a second visit was paid. The total number of inspections made by the three Inspectors during the nine months was 3,628 (See Table 36). On April 1st there were 555 workshops of various descriptions on the Register of the Department. The Inspectors added 800 new workshops and removed (as closed, removed, etc.,) 138, leaving 1,217 workshops on the Register at the close of the year. The 1,217 workshops comprised 2,144 work-rooms in which 6,314 workers were employed, viz., 4,391 women, 1,269 men and 655 young persons. Dressmaking, laundry work, tailoring and millinery are the principal trades of the district. In Table 35 the workshops have been classified as much as appears useful. TABLE 35. Workshops. No. of Workshops. No. of Rooms. Employees. Women. Young Persons. Men. Total. Clothing— Boot-making 27 27 3 - 46 49 Corset-making 10 11 17 1 8 25 Dressmaking 385 496 1,531 310 35 1,876 Fur-sewing and Furriers 7 8 11 1 10 22 Millinery 33 55 223 41 9 273 Millinery and Dressmaking 14 61 332 42 — 374 Outfitting and Plain Needlework 11 12 16 — — 16 Tailoring 229 282 158 10 395 563 Various 14 35 262 24 — 286 Fancy Work— Various 10 12 38 8 6 52 Cleansing—- Dyers and Cleaners 4 4 — — 12 12 „ „ —Receiving Offices 13 15 33 4 — 37 Laundries 316 860 1,197 4 136 1,337 „ —Receiving Offices 27 27 20 0 — 32 Mangling 17 17 18 — — 18 Various 9 9 4 3 — 7 Other Businesses— Bookbinding 6 8 - - 31 31 Cycle-making 20 18 - - 33 33 Printing and Bookbinding 8 8 20 5 — 25 Trunk-making 9 8 - - 27 27 Umbrella-making 6 5 6 _ 8 14 Upholstery 24 37 56 6 20 82 Various 23 31 37 38 53 128 Mixed Occupations 2 105 403 152 440 995 1,217 2,144 4,391 655 1,269 6,315 WORKSHOP SUPERVISION. 55 The notices of new workshops received from the Home Office numbered 24, 19 of which related to workshops already on the Department's Register. Practically all the workshops added to the Register were discovered by the Inspectors. Miss O'Kell and Miss Nicolas examined the Home Office Registers in the autumn, but they found more workshops on their own Register than on those of the Home Office. The matters chiefly calling for attention (See Table 36) were overcrowding (44 cases), dirty conditions (194 cases), gas fumes (41 cases) and want of separate closet accommodation (33 cases). In a considerable proportion of the cases a verbal intimation sufficed to secure removal of the complaint,* but 274 notices of various character (See Table 36) were required. In certain instances two or more different notices were required to deal with one complaint. TABLE 36. Miss O'Kell. Miss Nicolas. Mr. Wansbrough. Workshops— On register, April 1st, 1902 146 214 195 added up to December 31st 348 231 221 removed ,, 29 98 11 On register „ 465 347 405 Inspections 1,402 1,366 860 Rooms measured 331 117 129 Workrooms used as bedrooms 40 17 ... Workrooms without Abstracts 216 112 6 Nuisances discovered 226 180 59 Nuisances abated 222 172 59 Notices served, totals 146 109 19 Written intimations 91 80 19 Under Sec. 4 Public Health 22 7 ... 37 (London) 5 1 ... 38 Act, 1891. 6 7 ... Bye-laws, under same Act 22 14 ... Nuisances dealt with— Discovered. Abated. Discovered Abated. Discovered. Abated. Overcrowding 6 6 36 36 2 2 Dirty Conditions 88 84 67 65 39 39 Deficient Ventilation 10 10 4 3 ... ... Temperature too high 2 2 1 1 ... ... Temperature too low 1 1 2 2 ... ... Sanitary conveniences— Insufficient 3 3 6 4 ... ... Not separately provided 19 16 14 14 ... ... Badly placed 11 11 7 7 ... ... Unventilated 5 5 3 1 ... ... Defective 18 18 4 4 7 7 Vapour, effluvia not removed Steam in washhouses 9 9 ... ... ... ... Gas fumes 5 5 32 31 4 4 Drains 2 2 ... ... ... ... Wet floors; laundries 10 10 ... ... ... ... Accumulations of refuse 2 2 1 1 ... ... Other nuisances 35 35 3 3 7 7 Totals 226 219 180 172 59 59 * Miss Nicholas reports that 58 nuisances (out of 180 discovered) were thus dealt with. 56 WORKSHOP SUPERVISION. The Home Office forwarded 28 complaints relating to 34 nuisances during the year. The following is an analysis of the nuisances complained of :— Dirty Conditions 11 Overcrowding 5 Want of Ventilation (Gas Fumes) 4 Closet Accommodation (Various) 6 Do. (Steam from Washhouse) 1 Damp Floors 3 Defective Roof 1 Gas used for Warming 1 Other Matters 2 From workers 23 complaints were received, touching various matters. These were duly attended to. Cubic Space, Overcrowding.—When each workshop is first visited, the dimensions of each workroom are taken by the Inspector, and its cubic contents calculated. Subsequently a card is issued for each room showing the number of workers the room can accommodate, both at ordinary hours and during overtime. In the former period the standard allowance of air space is 250 cubic feet and in the latter, 400 cubic feet. The latter standard has also been imposed by Order of the Home Secretary at all hours when artificial light other than electric is used, and also in workrooms used as bedrooms. Ventilation.—While the provision of adequate ventilation is under the supervision of the local authority, the maintenance of a proper temperature is seen to by the Home Office. It is almost impossible to regulate the one without dealing with the other, and consequently the Department has sought to work with the Officials of the Home Office. Fourteen workshops were reported as being insufficiently ventilated, but in the absence of air tests, it is difficult to determine whether the ventilation is really adequate or not. The question is not of the same importance in the summer as in the winter when there is a tendency to shut all windows partly on account of the dread of draughts and partly to keep up the temperature of the room. During the next winter air tests will be made as frequently as possible. In the matter of temperature there is a difference of opinion among experts. Some regard a temperature of 55° to 60° F as sufficient, others require 60° to 65°. The character of the work and the hours of employment should be considered, as well as the system of ventilation. Those engaged for long hours at sedentary occupations would feel cold at the lower temperatures, especially if, as so many are, they be but thinly clothed. If the air be admitted at high velocities, it must be at a fairly high temperature, otherwise draughts will be complained of. It is more difficult to secure the proper ventilation of small workrooms than of large, chiefly on account of the draughts falling more directly on the workers in smaller rooms. The Act requires that sufficient ventilation shall be provided and maintained, but in cold weather it is only too common to find the windows and doors shut and ventilation left to chance currents of air through badly fitting doors and windows. Sufficient means of ventilation may be provided but sufficient ventilation is not maintained. It is possible by determining the impurity of the air of the room to calculate the amount of fresh air provided by the ventilation at work. The proof of the efficiency or non-efficiency of the ventilation provided in any workroom is the amount of impurity present in the air. Given the cubic capacity of the room, the duration of the time it has been occupied and the amount of carbonic acid present, it is possible to determine all the facts necessary to determine the sufficiency of the means of ventilation. It is evident, therefore, that it is to the advantage of all concerned that some standard amount of impurity of the air of workshops, should be prescribed. The Home Secretary has the power under Sec. 7 of the Factory and Workshop Act, 1901, to prescribe such standard, and in July, 1900, a Departmental Committee was appointed by him to report on the subject. WORKSHOP SUPERVISION. 57 The Report of the Committee was issued toward the end of last year. The document is one of great interest, not only to officials but also to employers of all classes. It is hoped, however, that the standard of impurity which the Committee recommend will not be adopted. As already stated the simplest and readiest test of the impurity of the air is the determination of the amount of carbonic acid gas present. In the open air the amount of this gas averages from 3.5 to 4.0 vols. in 10,000 vols. of air. The theoretical limit of impurity prescribed by hygienists is 8 vols. per 10,000. Under the Cotton Cloths Acts (now repealed) the standard limit was 9 vols. The standards recommended by the Committee are:— (i) During daylight or after dark when only electric light is employed, 12 vols. (ii) When gas or oil is used for lighting, 20 vols. per 10,000 vols. of air. These standards are too high. The Report contains the results of a large number of determinations of carbonic acid in factories and workshops under various conditions, but does not give any tables of averages. From a survey of the tables, the impression left is that the results of the analysis in question do not justify the proposed standards. It may be noted that the proposal is a retrograde one as regard certain factories, viz., cotton cloth weaving sheds, where the present standard is 9 vols. per 10,000 vols. of air. It is also somewhat anomalous that in an electrically lighted workshop the occupier should be limited to 12 vols, whilst in a gas lighted shop the standard may be, at the same time, 20 vols. With such high standards, the health of workers is not likely to be improved—headache, lassitude, anaemia, etc., being produced by excess of carbonic acid, or by other impurities which are present. Moreover, employers who do not aim at lower standards will find that less work is done by the workers and the work done likely to be of an inferior quality. Gas Stores.—In several workshops gas stoves for heating smoothing irons or for warming the rooms were found unprovided with any means of carrying off the products of combustion, and there appears to be a general impression that there is no need to make any such provision. Such provision is very necessary for the sake of health as carbon monoxide gas is sometimes given off by gas stoves, especially by atmospheric stoves which have "lighted back." At all times large quantities of carbonic acid are given off, with a certain small amount of sulphur fumes. The close stuffy air of rooms where unventilated gas stoves are used, is easilv recognised, and workers in such places are specially prone to drowsiness, headache and anaemia. There has been very little difficulty in securing the proper ventilation of stoves for irons by hoods connected to flues and other means, but it has not always been so easy to deal with stoves provided for warming. Many advertisements relating to such stoves definitely state that special ventilation is not required. The erroneous nature of such statements are apparent to anyone giving the matter the slightest consideration. Sanitary Conveniences.—The provision of closet accommodation is enforced under the Public Health (London) Act, 1891, (Section 38). The provision must be sufficient and suitable and provide for the due separation of the sexes. Outside London Section 9 of the Factory and Workshop Act, 1901, applies, except in those districts where Section 22 of the Public Health Acts Amendment Act, 1890, is in force. Under Section 9 of the Factory Act the Home Secretary is authorised to make an Order* determining " what is sufficient and suitable accommodation," but such Order will not be applicable to the Metropolis, the Council of each Borough being left to deal with the matter within their own area. As so many of the workshops in this Borough are on premises not erected for the purpose, considerable difficulty is experienced from time to time in providing the extra closet accommodation or the due separation of the sexes. In other cases, it has been found almost impracticable to get the closets so arranged as to obviate all chances of effluvia escaping into the workrooms and to secure sufficient privacy. Nevertheless, some improvements have been effected during the past year and continuous supervision in the future will secure still better * An Order under this Section was made on 4th Februarv, 1003. 58 WORKSHOP SUPERVISION. arrangements. At the same time it is much to be regretted that no standard is in force for the Metropolis as a whole. In certain workshops where only one man has been found working, arrangements have been made for the exclusive use by the women of the only closet on the premises, and separate accommodation has not been insisted on. Outworkers.—The provisions of Sec. 107 of the Factory and Workshop Act, 1901, appear to be very little understood. A circular letter was issued in October last, drawing special attention to the Section, but at the close of the year only 184 outworkers—people working in the homes for contractors and others—were on the Register of the Department. As reported, the premises of each out-worker are visited and classified either as a workshop or a work-place, with a further differentiation of "domestic" or ordinary. The distinctions made are briefly that a work-place is one when the worker is alone and has no assistants, and a work-shop implies one or more employees. A domestic workshop is one where the occupier does not depend for a livelihood on the work carried on therein, but has other sources of income. Apart from the question of nuisances remediable under the Public Health Act which may be discovered by such inspection, the most important duty is that connected with the spread of infectious illness. During the year 19 cases of infectious disease occurred in the homes of outworkers, but as very few of the outworkers were on the Register, special action could rarely be taken. The diseases reported were:— January—December, 1002. Diphtheria and Membranous Croup 2 Puerperal Fever 1 Erysipelas 2 Measles 7 Scarlet Fever 4 Chicken-pox 3 The list of notifications is now compared daily with the Register of Outworkers, to enable any necessary action under Sections 109 and 110 of the Act and the Orders made pursuant thereto, to be prompty taken. Laundries.—In the northern part of the Borough there are a large number of laundries situated in a limited area, many of them being very small. Previous to last year they had not been subject to regular inspection and a good deal of work was found necessary. The special defects requiring attention were: (i) excessive amounts of steam in wash-houses; (ii) high temperatures and deficient ventilation of ironing rooms; (iii) bad conditions of drying grounds ; and (iv) wetness of floors. Steam.—Many of the wash-houses are nothing but the sculleries of houses built for occupation as dwellings, and are not provided with special means of removing steam from the coppers. These rooms are often found full of steam, a condition not favourable to the health of the workers. A most efficient remedy has been found in the provision of hoods either connected to the flue of the copper or to a shaft carried up independently through the roof. The lower edge of the hood is turned up to obviate the dripping of condensed steam on the workers. Ironing Rooms.—In laundries which are factories the stove for heating irons must be in a place separate from the ironing room, but there is no such provision for workshop laundries. It is a common practice, in the smaller laundries at least, to hang up clothes to dry in the ironing room. The room is consequently excessively hot and the ventilation very insufficient. Miss O'Kell reporting on such places says, "The contrast between the air in the ironing rooms of power laundries and in those of hand laundries, is very marked." To effect much improvement in the hand laundries structural alterations of an expensive character are often required. It would be simpler to prohibit the placing of heating stoves in the ironing rooms. The temperature would thus be kept down and there would be no reason for hanging clothes in these rooms. UNDERGROUND BAKEHOUSES, Chart: showing depths of floors below roadway. bakehouses. 59 Drying Grounds.—These have been found to be in some cases unpayed yards, which, owing to water from the washed clothes and to the rain, are often little better than quagmires. Under the Bye-laws pursuant to Section 10 (la) of the Public Health (London) Act, 1891, these yards should be " paved with a hard, durable and impervious pavement." The matter is receiving the attention of the Inspectors. Wet Floors.—Under Section 8 of the Factory Act, drainage must be provided to remove water from floors which are wet enough to allow water to flow. In some of the smaller laundries the floors have been found very wet, and, curiously enough, there is an objection to standing on a wooden grating or board. Occupiers of such laundries are being required to keep the wash-house floors in good condition, properly sloped to a gullev to carrv off the wet. Unfortunately, a good floor is in some laundries quickly broken up bv breaking coal or chopping wood for the copper fire. Bakehouses. Attention has been concentrated during the greater part of the nine months between April and the end of the vear on the underground bakehouses, of which 05 were found to be in use. A Special Report dealing with the subject of certification was presented to the Public Health Committee on December 11th and submitted to the Council with a "Schedule of Requirements" on December l6th.* Plans and sections, with detailed reports as to structural conditions, Sic., were prepared for all the underground bakehouses. The diagram facing this indicates the different levels of the floors of the 65 bakehouses.† Some particulars of the sebakehouses are given in the tabular statement on p. 60. The number of men working therein was returned at 305, 167 by day and 138 at night. There are also 13 "level" bakehouses in the Borough. Time did not allow of all of them being properlv inspected last year. More attention will be given to them during the current year. It seems not unlikely that after the structural alterations required for certificates have been carried out, the underground bakehouses will on the whole be better than the "level." Lists of underground bakehouses in use and out of use and of level bakehouses will be found in the Appendix (p. 74). FOOD SUPERVISION. This subject requires to be dealt with under the following heads:— (i.) Meat Supply—Slaughter-houses, Butchers' Shops; (ii.) Milk Supply—Dairies, Milkshops and Cowsheds; (iii.) Restaurants, and Eating-houses, and Fried Fish vendors; (iv.) Ice Cream makers and vendors; (v.) Miscellaneous Inspr. Grivell. (vi.) Analysis under Sale of Food and Drugs Acts Inspr. Parker. (i.)—Meat Supply: Slaughterhouses.—There are nine slaughterhouses in the Borough, situated as below:— Bishop's Mews, No. 1. Edgware Road, No. 275 (in rear of), Southwick Mews, No. 15, Portsdown Mews (in rear of No. 249, Maida Vale). Chippenham Mews, No. 18, Harrow Road, No. 125 (in rear of), Hero Place, Upper Brooks Mews, No. 6. Jonson Mews, No. 1. These premises were inspected by the Medical Officer of Health before the annual licensing, and during the nine months April to December of last year the Inspector made 743 * The "Schedule" was after reference hack to and amendment by the Committee adopted by the Council on 3rd February of this year. † Since the above was written two other underground bakehouses have been, on the advice of the Solicitor, added to the list of premises in use. This explains the discrepancy between this paragraph and the list on p. 74. 60 bakehouses. UNDERGROUND BAKEHOUSES. File No.* Level of B.H. below the nearest ground. Height of Ceiling above floor. Nett Cubic Space of B.H. File No.* Level of B.H. below the nearest ground. Height of ceiling above floor. Nett Cubic Space of B.H ft. ins. ft. ins. ft. ins. ft. ins. 1 8 8 8 2,564 34 8 9 8 2 2,519 2 9 9 9 9 6,906 35 7 3 9 9 3,942 3 9 10 8 7 2,012 36 9 9 9 1 1,975 4 8 6 7 10 4,519 37 7 9 7 9 2,404 5 8 6 8 0 2,436 38 8 3 7 10 2,502 0 8 4 8 3 4,436 39 8 5 7 8 6,049 7 6 2 8 8 1,590 40 9 6 9 3 1,997 8 8 8 7 8 3,781 41 7 9 7 3 1,390 9 9 4 8 5 1,301 42 7 0 6 9 889 10 8 3 9 3 2,576 43 8 0 7 7 24,443 11 8 4 8 1 2,643 44 9 1 7 11 2,096 12 7 6 7 0 2,253 45 7 5 7 3 1,796 13 9 6 8 2 1,784 46 9 0 8 2 1,859 14 9 7 7 0 1,469 47 8 2 7 9 1,266 15 9 11 9 5 24,912 48 9 3 8 9 1,527 16 9 6 12 0 9,714 49 8 6 7 10 1,348 16a 8 11 8 5 4,532 50 7 3 8 0 1,860 17 9 1 8 3 6,186 51 9 6 8 5 1,956 18 10 9 9 10 3,556 52 8 6 8 9 2,065 19 8 5 7 11 3,360 53 9 0 8 0 1,529 20 8 6 8 2 3,964 54 8 5 7 5 3,124 21 13 2 14 9 5,221 55 8 9 8 2 5,489 22 9 10 9 8 3,472 56 7 10 7 9 4,068 23 8 11 8 6 2,573 57 7 8 7 6 1,399 6 4 10 4 2,551 24 10 7 10 0 2,811 58 10 8 10 4 3,468 25 10 9 10 9 2,206 59 8 9 7 7 2,111 26 8 6 8 6 1,553 60 3 11 7 9 3,701 27 7 1 7 7 1,927 61 8 5 8 5 1,620 28 8 2 7 7 1,679 62 8 6 7 7 1,763 29 8 9 7 9 3,560 63 7 4 9 10 10 10 4,207 30 9 3 8 4 3,686 64 10 0 9 3 2,830 31 8 10 8 4 2,963 65 8 0 7 11 2,278 32 9 9 8 6 1,933 33 8 6 8 0 1,863 * These numbers refer to numbers on Chart. food supervision. 61 inspections. He reports that he examined during that period the carcases of 4,570 sheep, 130 bullocks, and 26 calves. No legal proceedings have been necessary with respect to the above premises, or to the carcases examined. Butchers' Shops.—The Inspector states that there are 80 butchers' and 26 pork butchers' shops in the Borough, at which he made 130 inspections to ascertain the condition of meat. (ii.)—Mii.k Supply: Cowhouses.-—There are only two cowsheds in the Borough, viz.:— Chichester Mews, Nos. 7 and 8 4 cows kept. Star Street, No. 39 4 cows kept. Fifty-five inspections are reported to have been made during the nine months. Dairies and Milk Shops—At the beginning of April last 35 milk vendors were on the local Register, while the list received from the London County Council on the transfer of supervision in 1900 contained 185 registrations, of which 27 were subsequently found to have lapsed. There were 13 new registrations and 29 changes of names, &c., during the year, the Register at the close of the year containing 173 effective entries. The following is a list of shops where milk is sold, classified according to the business carried on thereat:— Dairies: milk, eggs and butter only sold 85 Grocers' shops 11 General shops, not selling lamp oil 34 „ „ selling lamp oil 18 Sweet-stuff and confectionery 7 Provision dealers 8 Bakers 3 Off-licensed houses 2 Fish and grocery 2 Tailor, butcher each 1 Coal, wood and oil (combined) 1 At a large number of these premises the amount sold is very small, not amounting in some cases to a quart a day. Objection has been taken to the sale of milk from shops where oil, wood, and other strong-smelling commodities are sold, but it has been found impracticable to prevent the sale from such shops. The Inspector reports that he has made 300 inspections of places where milk is sold. A list of defects discovered is given in Table 37. Four cases of infectious illness were reported from premises registered for the sale of milk, one case each of diphtheria, erysipelas, and scarlet and enteric fevers. Due precautions were taken to prevent the sale of milk until the premises and things had been properly disinfected and cleansed. (iii.)—Refreshment Houses.—A special Register is kept of these premises, which includes 180 premises, 23 being fried fish shops and one a sausage shop. The supervision of such places is two-fold, they being "workplaces" as well as places where food is prepared and sold. At the 150 refreshment houses (variously described as "restaurants," "cafes," "eatinghouses," coffee-houses," &c.) 109 men and 233 women were found to be employed. At 35 the kitchens were underground, the kitchen floors being below the road levels as under:— 6ft. 3 7-8ft. 12 8-9ft. 20 From inquiries made at the fried fish shops it appears that dripping is used at all except three shops, where oil is used. Dripping is very suitable for this purpose if of good quality and derived from the proper source. It is, however, well-known that some of the dripping is obtained from hog-wash dealers. The hog-wash is boiled and the melted fat skimmed off, cooled and packed for sale. 62 food supervision. TABLE 37. Food Supervision. [####]Inspections:—[/####] Slaughterhouses 743 Cowhouses 55 Butchers' Shops 130 Milkshops, &c. 306 Greengrocers' Shops 137 Restaurants, &c. 231 Costers' Barrows 12 Ice Cream Shops and Barrows 51 Fish Curing Premises 9 Fried Fish Shops 24 Fishmongers' Shops 2 Defects found and remedied. [####] Milkshops and Dairies. Restaurants and Eating Houses. Premises occupied by Ice Cream Makers. [/####] Drains Defective 39 11 2 „ unventilated 22 7 2 Surface inlets improperly trapped 27 8 9 Open drains inside premises ... 11 5 Soilpipes defective 15 ... ... „ unventilated 8 4 ... Water-closets defective 55 14 3 „ dirty ... 3 ... Flushing apparatus defective ... ... ... Rain-water pipes connected to drain or soilpipe 31 6 2 Waste pipes, do. do. 13 4 ... „ defective ... ... ... Rain-water pipes defective 8 4 ... Roof defective ... ... ... Dirty conditions 10 19 3 Cisterns dirty ... 3 ... „ uncovered 17 2 ... „ defective 2 ... ... Water for flushing W.C.'s drawn direct from drinking water cisterns 2 2 ... Paving defective 10 2 4 No dustbin 2 ... ... Dustbins defective 24 4 Animals kept so as to be a nuisance 4 ... 4 Numbers of places where Food is sold:— Butchers 80 Milkshops and Dairies 171 „ Pork 20 Refreshment Houses 156 Fishmongers 30 Fried Fish and Sausages 24 Game and Poultry 12 Ice Cream Makers & Vendors 40 Fruit and Greengrocery 90 Sausage Factories 8 (iv)—Ice Creams: Under the London County Council (General Powers) Act, 1902, Part VIII (Ss. 42 to 44) the following special provisions came into force in November last:— (a) Prohibiting the manufacture and storage of ice-cream in any place where there is a drain opening, or in any living or sleeping room. (b) Requiring the proper protection of such commodity from infection or contamination. (c) Requiring the notification of all cases of infectious illness among persons employed in the business or living or working on the premises. (d) Requiring street barrows to be legibly marked with the name and address of the person making the ice-cream. X food supervision, 63 Penalties are provided for the infringement of the provisions. There is no definition of the term " ice-cream." At the close of the year 25 makers and vendors of ice-creams had been placed on the Register, 12 being Italians selling from street barrows. Of these 12— 3 were found to make ice-cream in stables where animals were kept; 1 was „ „ „ in a disused stable; 1 „ „ „ „ in living and sleeping room; 7 were „ „ „ in sculleries and open yards. The remaining 13 makers comprised 3 Italians, 4 Germans and 6 Englishmen. Two of the Italians made their ice-cream in disused stables and one in his scullery. The Germans and Englishmen made theirs in the shops. The Register was probably incomplete at the close of the year. (v)—Miscf.llanf.ous : The greengrocers' shops, costers' barrows, etc., have been inspected frequently. Several seizures of small parcels of unsound fruit, etc., were made. This work will receive more attention during the hot weather of the current year, as the Inspector now knows where bad or doubtful stuff may be looked for. Unsound Food.—The Inspector reports that he has dealt with the following quantities and descriptions of food unfit for the food of man :— By voluntary destruction. By seizure. 73 Livers. 33lhs. Meat. lOlbs. Plums. 45) Lungs. 170lbs. Haddocks. 231bs. Tomatoes. 16 Plucks. 37 Small parcels of fruit. l0lbs. Mushrooms. 2 Cows' heads. 31bs. Greengages. 4 Miscellaneous. 121bs. Mixed. The results of proceedings instituted with respect to the seizures made will he found under Legal Proceedings. (vi.)—Food Analysis.—The samples taken during the year under the Sale of Food and Drugs Acts numbered 529, of which 47 (8.8) proved to be adulterated. In 1901 the proportion adulterated was 10.9. A list of the samples taken and of those found adulterated will be found in Table 38, and the results of prosecutions under Legal Proceedings. The Home Secretary having had his attention directed by " a local authoritv charged with the enforcement of the provisions of the Sale of Food and Drugs Acts," to the inadequate fines imposed for breaches of these Statutes, addressed a circular letter on the subject to the Clerks of the Justices of all Petty Sessional Divisions. The letter is dated 24th July, 1902, and states that the representation referred to is "by no means the first of the kind" addressed to the Home Office, and that the Local Government Board have received other similar complaints. Attention is called to the Report of the Select Committee on Adulteration of Food Products of 1896, in which the small fines usually imposed are characterized as "trifling, and quite insufficient to serve as deterrents." In 1900 28½ per cent. of the penalties imposed were under 10s., amounts of 5s, and 1s. being common. The Home Secretary expressed the wish that Justices should consider whether the penalties proposed to be inflicted were such as would "deter the offenders from repeating and other persons from committing" offences under the Acts. It is believed that Magistrates will not deal effectively with adulteration until substantial minimum penalties, limited perhaps to second and subsequent offences, are provided for. The profit from adulteration is very great, and the chance of detection comparatively small. There is good reason to believe that at certain shops it is the rule to serve genuine goods to chance customers, thus freeing themselves from risk of the Inspector or his deputy getting an adulterated sample, and palm off adulterated goods on their regular customers. TABLE 38. Summary of Articles submitted to the Public Analyst during the year 1902. Total. Found Adulterated. Percentage Adulterated. Milk 313* 36 11.5 Butter 133 11 8.2 Coffee 24 ... ... Whisky 12 ... ... Lard 8 ... ... Gin 6 ... ... Rum 6 ... ... Brandy 6 ... ... Ale 6 ... ... Mustard 5 ... ... Cocoa 4 ... ... Pepper 3 ... ... Chocolate 3 ... ... 529 47 8.8 64 food supervision. There is a valuable provision of the Act which, so far as this Borough is concerned, is never used. Purchasers can have goods purchased by them sampled at their own houses, if they will notify the Department and thus enable the Inspector to be at the house when the goods are delivered. Moreover, the private purchaser can get his articles analysed and take proceedings in the case of adulteration without the full formality necessary in the case of official samples. * Including 78 taken at Paddington Terminus in course of deliver). Butter Standard.—On April 22nd last, the Board of Agriculture in virtue of their powers under Section 4 of the Sale of Food and Drugs Act, 1899, issued an Order (in effect) limiting the amount of water in butter to a maximum of 16 per cent. The Order was not effectual in checking the sale of " milk blended " butter containing water in any proportion up to 25 per cent., the limit prescribed by the Order being evaded by the use of a label. In consequence the "Food and Drugs Acts Amendment Bill, 1902," was introduced into Parliament in July of last year and came forward for discussion during the Autumn Session. So many amendments were proposed that the Bill was dropped. A Special Report on the provisions of the Bill was before the Public Health Committee in October. Colouring Matters and Preservatives.— The recommendations of the Departmental Committee on the use of preservatives (1899) are still under consideration. In May of last year the Council directed a communication to be sent to the President of the Local ment Board, urging the early introduction of legislation to give effect to the recommendations. legal proceedings. 65 LEGAL PROCEEDINGS. Summaries of the results of cases heard during the year will be found in the fo11owing tabular statements:—The total amount awarded in fines and costs was £208 5s. 6d., £32 19s. being awarded in cases under the Health Acts, and £175 6s. 6d. under the Food and Drugs Acts. In 1901, a total of £179 9s. was awarded, viz., £40 16s. under the Health Acts, and £138 13s. under the Food and Drugs Acts. Under the latter Acts the average fine increased from £2 His., in 1901, to £3 3s. 8d., in 1902; costs also increased by one shilling. The most important case, under the Health Acts, was that relating to the combined drain at Nos. 1 to 12, Windsor Gardens, which was dismissed with costs against the Council (10s. 6d. on each of twelve summonses). Proceedings were taken under Sec. 85 of the Metropolis Management Act, 1855, as amended by Section 64 of the Amending Act of 1862. The facts were briefly as follows:—Nos. 1 to 12 (inclusive), Windsor Gardens, are drained by a combined system of drainage discharging into the public sewer in Harrow Road. The combined drain was found, on examination, to be defective and much in need of repair. Sufficient records had been found among the documents of the late Commissioners of Sewers, to enable the Solicitor to form an opinion that the system was a private drain repairable by the owners of the houses, and notices requiring such repair were served. Nothing was done, and the Council had to take further action in the matter. Under the Section mentioned above, the Council has the alternative of either re-constructing the combined drain and recovering the cost (Section 85, Metropolis Management Act, 1855), or of proceeding for penalties for non-compliance with the notice issued. The latter course was selected. At the hearing, the Defendants were represented by a Solicitor who raised the point that there had been no non-compliance for which penalties could be sued under Section 64, of the Act of 1862. Section 8 5, of the Act of 1855, enacts that a "notice" may be served requiring repairs, &c., but Section (64, of the Act of 1862, provides penalties for failing to comply with the " order" of the Vestry (now Council). Mr. Curtis Bennett held that the " order " in Section 64 could not be the same as the " notice " in Section 85, and dismissed the summonses. A case was asked for, but before any definite action had been taken in connection therewith, the Council ordered the combined drain to be relaid. This was done and the expense of the work fell on the rates as the unsuccessful summonses barred proceedings to recover the cost of re-construction. fifi summary of legal proceedings. SUMMARY OF LEGAL PROCEEDINGS DURING 1902. Under Public Health (London) Act, 1891. Summonses for Non-compliance with Notices under Sec. 4. Fine. Costs. £ s. d. £ s. d. 46, Amberley Road Nuisance abated before the hearing of summons ... 0 2 0 99, Ashmore Road ,, ,, ,, ... 0 5 0 78, Bravington Road ,, ,, ,, ... 0 12 6 98, Clarendon Street ,, ,, ,, ... 0 5 0 2, Portsdown Place ,, ,, ,, ... 0 2 0 41, Shirland Road ,, ,, ,, ... 0 2 0 47, Amberley Road Order made for necessary works to be carried out ... 0 2 0 59, Portsdown Road ,, ,, ,, ... 2 4 6 113, Walterton Road ,, ,, ,, ... ... 163, Westbourne Terrace ,, ,, ,, ... 1 3 0 15, Shelden Street Closing order made ... ... Summons for Non-com bliance with Notice under Sec. 24. Usher's Brewery, Queen's Road Order made prohibiting smoke nuisance ... 5 5 0 Summonses under Section 47. C. Hughes, late of 12, Mozart St. Unsound fruit exposed for sale 2 0 0 0 5 0 T. Maiden, 137, Southam Street ,, „ 1 0 0 0 5 0 R. Marsh, 24, Carlton Terrace ,, ,, 2 0 0 0 5 0 Mrs. Solomon, 344, Kilburn Lane „ mushrooms exposed for sale 2 0 0 0 5 0 Summonses under Bye-laws. 81 and 83, Lancefield Street Failing to give notice before commencing alterations to sanitary arrangements 1 0 0 0 2 0 27, St. Stephen's Square ,, ,, ,, 0 10 0 0 2 0 12, Woodchester Street ,, ,, ,, 0 2 0 46, Amberley Road Failing to make return, as required under Bye laws pursuant to Sec. 94 ... 0 2 0 47, Amberley Road ,, ,, ,, ... 0 2 0 47, Amberley Road Order made for necessary work to be carried out ... 0 2 0 5, Cirencester Street Neglecting to carry out necessary works 1 0 0 0 2 0 7, Elcom Street ,, ,, ,, ... 0 2 0 11, Elcom Street ,, ,, ,, ... 0 2 0 32, Kensal Road ,, ,, ,, ... 0 0 10, Modena Street ,, ,, ,, ... 0 2 0 57, Walterton Road ,, ,, ,, ... 0 2 0 49, Waverley Road ,, ,, ,, ... 0 2 0 3, Cirencester Street Work done before the hearing of summons ... 0 2 0 30 & 72, Cirencester Street ,, ,, ,, ... 0 4 0 (2 summonses) ... 0 10 0 48, 50, 71, 76 & 81, Cirencester St. ,, ,, ,, ... (5 summonses) ... 0 0 2, Partington Terrace ,, ,, ,, ... 2 3, Partington Terrace ,, ,, ,, ... 0 2 0 1, Desborough Street ,, ,, ,, ... 0 2 0 10, Modena Street ... 0 2 0 22 & 23, Woodchester Street (2 summonses) ... 0 4 0 23, Woodchester Street ,, ,, ,, ... 0 2 0 35 & 54„ „ (2 summonses ,, ,, ,, ... 0 4 0 38 & 80, ,, ,, ,, ... 0 4 0 40,42 & 86, „ (3 summonses ,, ,, ,, ... 0 6 0 62, „ ,, ,, ,, ... 0 2 0 65, „ ,, ,, ,, ... 0 2 0 71, 79,85 & 87, „ (4 summonses ,, ,, ,, ... 0 8 0 Other Summonses. 34, Clarendon Street Non-compliance with Order of Court 5 0 0 0 o 0 30, Clarendon Street ,, ,, ,, 3 0 0 0 2 0 Under Metropolis Management Act, 1855. 1 to 12, Windsor Gardens Neglecting to reconstruct combined drainage Dismissed with 10s. 6d. costs in each case. n summary of legal proceedings. 67 SUMMARY OF LEGAL PROCEEDINGS. Under Sale of Food and Drugs Acts, 1875-1899. [####] Fines. Costs. [####] £ s. d. £ s. d. Milk 22% added water 2 0 0 0 12 6 „ 7% „ 3 0 0 1 8 0 „ 7% „ 2 0 0 1 5 0 ,, 12% „ 5 0 0 2 2 0 ,, 25% „ 5 0 0 1 1 0 22% „ 5 0 0 1 1 0 ,, 18% „ 7 10 0 1 1 0 ,, 16% „ 7 10 0 1 1 0 ,, 15% ,, 10 0 0 2 2 0 ,, 6% „ 1 0 0 0 12 6 9% ,, 1 0 0 0 5 0 ,, 9% ,, 1 0 0 0 12 6 Butter (1) 92% foreign fat 5 0 0 0 12 6 ,, 84% „ 2 0 0 0 12 6 Milk (2) 19% added water 3 0 0 0 12 6 (3) 47% fat abstracted No proceedings : sample sold as skim milk. Butter 86% foreign fat 3 0 0 0 12 6 Milk (4) 16% fat abstracted 10 0 0 0 12 6 ,, 17% added water 2 0 0 0 12 6 ,, 8% „ 2 0 0 0 12 6 ,, 12% „ 1 0 0 0 12 6 ,, 10%,, 1 0 0 0 12 6 ,, 5% 1 0 0 0 12 6 ,, 17% fat abstracted 5% added water 1 0 0 0 12 6 ,, 5% ,, 1 0 0 0 12 6 Skim milk 25% ,, 5 0 0 0 12 6 Milk 24% fat abstracted 3 0 0 0 12 6 ,, 57% „ 1 0 0 0 12 6 Butter 55% foreign fat 0 2 6 0 12 6 Milk 5% added water 1 0 0 0 12 6 Butter 86% foreign fat 1 0 0 0 12 6 ,, 92% ,, 1 0 0 0 12 6 ,, 11 % of water beyond standard limit of 10 % of water natural to butter. Proceedings abandoned ,, 12% do. do. Milk (5) 38% added water 3 0 0 0 12 6 „ (6) 11 % fat abstracted 2 0 0 0 12 6 „ (7) 22% ,, Wrong address on summons, no time to amend. Butter 80% foreign fat 3 0 0 0 12 6 „ 118% of water beyond standard limit of 1 0 0 0 12 6 16 % of water natural to butter. „ 80% foreign fat 2 0 0 0 12 6 Milk 16% added water 2 0 0 0 14 6 ,, 15% „ 2 0 0 0 14 6 ,, 6% fat abstracted 1 0 0 0 15 6 „ (8) 12% added water 10 0 0 0 12 6 ,, 10% ,, 2 0 0 0 12 6 „ (9) 10% fat abstracted 10 0 0 1 5 0 Refusing to serve Inspector with sample. 5 0 0 1 3 0 ,, ,, ,, ,, 3 0 0 1 O 0 68 notes. NOTES. (1) Defendant fined £5 with 12/6 costs, on September 4th, 1900, for selling milk containing 13% of added water. (2) „ 10/- 12/6 „ December 22nd, 1899, for selling butter containing 95% of foreign fat. (3) „ £2 12/6 „ December Cth, 1901, for selling milk 17% deficient in butter fat. (4) „ £2 12/6 „ December 6th, 1901, for selling milk 17%. deficient in butter fat. (5) „ £1 12/6 „ November 1st, 1901, for selling butter containing 77% of foreign fat. (6) „ £1 2/- „ August 31st, 1893, for selling milk containing 10% of added water. (7) „ £5 23/- „ October 12th, 1900, for selling milk 14% deficient in butter fat. (8) „ £2 2/- „ May 29th, 1894, for selling milk containing 17% of added water. „ £3 12/6 „ February 16th, 1899, for selling milk containing 17% of added water. „ £3 12/6 „ March 8th, 1901, for selling milk containing 12% of added water. (9) „ £3 12/6 „ January 17th, 1897, for selling milk containing 5% of added water. „ £2 12/6 „ 3rd June, 1897, „ „ 7% „ £1 12/6 „ „ „ „ 6 % „ „ summoned April 25th, 1902, for selling milk 12% deficient in butter fat. Case dismissed on warranty. 1902. 1901. 1900. 1899. 1898. . Fine £3 3 8 £2 16 0 £3 4 0 £3 4 9 £113 9 Average per conviction Costs 0 16 0 0 15 0 1 2 3 0 14 3 0 13 11 APPENDIX. TABLE I. Vital Statistics of Whole District during 1902 and Previous Years. [####]Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions, beyond the District. Nett Deaths at all Ages belonging to the District. Year. Population estimated to Middle of each Year. Number. Rate* Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1. 2 3. 4. 5. 6 7 8 9 10 11 12 13 1892 130,797 3,543 25.89 527 148 2,54G 18.61 610 305 171 2,412 17.63 1893 137,002 3,022 20.31 544 150 2,548 18.51 606 369 219 2.398 17.42 1894 138,438 3,399 24.55 457 134 2,106 15.21 615 293 242 2,055 14.84 1895 139,225 3,563 25.59 590 100 2,470 17.78 554 306 209 2,379 17.09 1890 140,022 3,612 25.37 585 102 2,349 16.49 672 316 225 2,258 15.85 1897 140,829 3,554 25.23 559 157 2,168 15.39 519 294 224 2,098 14.89 1898 141,048 3,444 24.31 591 171 2,433 17.17 600 330 235 2,338 1650 1899 142,477 3,452 24.22 549 159 2,445 17.16 606 298 223 2,370 16.63 1901 143,318 3,370 23.51 524 155 2,519 17.57 708 401 218 2,336 16.29 1902 144,188 3,359 23.29 484 144 2,163 15.00 652 324 218 2,057 14.26 Averages for years 1892-1901. 140,492 3,492 24.82 541 155 2,375 16.89 614 323 218 2,270 16.14 1902. 145,052 3,305 22.41 474 144 2,311 15.67 735 366 207 2,152 14.58 vital statistics. * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.—By the term " Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term " Residents " is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. 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 69 o TABLE II. Vital Statistics of Separate Localities in 1902 and Previous Years. [####]Names of Localities. 1.—BOROUGH. 2.—Registration Sub-District St. Mary. 3.—Registration Sub-District St. John. 5. Registration North-West Sub-District Paddington. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. A B C D a b. c. d. a. b. c. d. a. b. c. d. 1892 136,797 3,543 2,412 515 84,816 2,456 1,632 348 33,763 478 477 70 18,218 609 303 97 1893 137,662 3,622 2,398 538 85,820 2,567 1,685 407 33,746 444 445 43 18,096 611 268 88 1894 138,438 3 399 2,155 452 86 734 2 423 1 149 344 33,729 411 369 70 17975 565 237 68 1895 139,225 2 379 587 87 658 2 526 1 671 426 33,712 453 428 64 17855 584 280 97 1896 140,022 3,616 2,258 564 88,591 2,613 1,583 415 33 695 455 359 02 17,736 548 316 87 1897 140,829 3,554 2,098 535 89,534 2,586 1,455 403 33,678 424 45 17,617 544 288 87 1898 141,648 3,444 2,338 567 90,488 2,558 1,663 419 33,660 407 367 57 17,500 479 308 91 1899 142,477 3,452 2,370 530 91,451 2,555 1,709 407 33,643 385 353 36 17,383 512 308 87 1900 143,318 3,370 2,336 545 92,425 2 ,479 1,675 125 33 626 411 386 52 17267 480 275 68 1901 144,188 3,359 2,057 455 93,424 2,536 1,452 353 33,612 389 348 40 17,152 434 257 02 Averages of Years 1892 to 1901. 140,492 3,492 2,270 528 89,120 2,530 1,597 394 33,687 426 389 51 17,685 536 284 83 1902 145,052 3,305 2,152 433 94,419 2,443 1,556 325 33,595 386 326 32 17,038 476 270 76 vital statistics. TABLE III. Deaths in Local Institutions. 1902. Year. Paddington Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. 1892 236 355 12 7 1893 204 399 - 3 1894 165 347 - 3 1895 204 332 17** 1 1896 188 334 48 2 1897 192 262* 63 2 1898 194 324 80 2 1899 255 280* 69 2 1900 255 386 63 4 1901 238 317 92 5 Averages 1892-1901 213 334 69 3 1902 298 359 (Eight years.) 76 deaths in local institutions. 71 TABLE IIIa. Causes of Deaths in Institutions. 1902. Local Institutions. Deaths of Residents recorded beyond the Borough. Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Other Institutions, Homes, &c. Hospitals of Metropolitan Asylums Board. Special and General Hospitals. Lunatic Asylums. Poor Law Institutions. Elsewhere. Small-pox ... 20 Measles 2 2 1 Scarlet Fever ... ... 7 Influenza 2 1 Whooping Cough 1 Diphtheria 1 8 16 Enteric Fever 11 1 4 Diarrhœa 1 4 9 1 Epidemic Enteritis 5 4 ... Erysipelas 1 1 •• Puerperal Fever 2 1 Other Septic Diseases 3 5 2 2 Tuberculosis of Lungs 33 12 2 1 10 13 Other forms of Tuberculosis 5 9 10 3 2 2 Cancer 20 30 2 5 18 2 Premature Birth 2 2 1 2 Developmental Diseases 5 1 11 1 2 1 Old Age 17 5 Bronchitis 43 6 2 2 1 Pneumonia 19 32 13 4 1 2 Cirrhosis of Liver 4 10 Accidents of Childbirth 2 1 Accidents and Violence 4 57 2 8 2 Suicides 1 2 0 1 4 All other Causes 128 162 18 13 1 32 29 3 7 All Causes 298 359 70 32 52 79 55 7 14 Non-Residents 13 268 52 29 72 causes of death at various ages in each sex. TABLE IV. Causes of Death at Various Ages in Each Sex. 1902. Corrected for Non-Residents dying within the Borough, and (as far as possible) for Residents dying without the Borough. [####]Causes of Death Under 1 1—5 5—15 15—25 25-05 05 and Upw'rds. All Ages.[####] M. F. M. F. M. F. M. F. M. F. M. F. M. F. p. Small-pox 1 ... 1 ... 2 ... 2 9 0 6 ... ... 12 8 20 Measles 9 11 30 28 I 3 ... ... ... ... ... ... 40 42 82 Scarlet Fever 1 6 1 ... ... ... ... ... ... ... ... 7 1 8 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza ... ... 1 1 1 ... 1 2 14 15 8 19 25 37 62 Whooping-cough 7 6 4 5 ... ... ... ... ... ... ... ... 11 11 22 Diphtheria, Membranous Croup 1 2 8 9 5 5 ... ... 2 ... ... ... 16 16 32 Croup ... ... I ... 1 ... ... ... ... ... ... ... 2 ••• 2 Enteric Fever ... ... ... ... ... 1 3 ... 4 4 ... 1 7 6 13 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Diarrhœa, Dysentery 29 15 2 3 ... ... 1 ... 1 ... 1 3 34 21 55 Epidemic or Zymotic Enteritis 10 8 3 3 ... ... ... ... ... ... ... ... 13 11 24 Enteritis 5 3 2 ... ... ... ... ... ... 2 1 7 8 12 20 Other Continued Fevers—Chicken-pox 1 ... ... 1 ... ... ... ... ... ... ... ... I 1 2 Erysipelas 1 ... ... ... ... ... ... ... 1 ... 1 ... 3 ... 3 Puerperal Fever ... ... ... ... ... ... ... 2 ... 3 ... ... ... 5 5 Other septic diseases:- Pyaemia ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 2 Stomatitis 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Cellulitis ... ... ... ... ... ... ... ... 2 1 ... 1 2 2 4 Infective Endocarditis ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 Intermittent Fever and Malarial Cachexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Meninges 3 5 4 8 2 1 1 1 ... ... ... ... 10 15 25 Tuberculosis of I.ungs 1 ... ... ... 1 1 12 8 70 51 5 4 89 64 153 Other Forms of Tuberculosis 8 1 3 5 4 l ... 1 9 2 ... 1 24 11 35 Alcoholism ... ... ... ... ... ... ... ... 10 11 1 1 11 12 23 Cancer ... ... ... ... ... ... 1 2 27 58 18 28 46 88 134 Premature Birth 47 26 ... ... ... ... ... ... ... ... ... ... 47 26 73 Developmental Diseases 52 34 5 3 ... ... 2 ... ... ... ... ... 59 37 96 Old Age ... ... ... ... ... ... ... ... ... 2 30 60 30 o 62 92 17 Meningitis 3 3 3 1 l 2 1 1 8 9 17 Inflammation and Softening of Brain ... ... ... ... 1 ... ... ... 3 4 14 7 18 11 29 Organic Diseases of Heart ... 1 ... ... ... ... ... ... 11 13 7 18 18 32 50 Acute Bronchitis 30 6 6 6 ... ... ... ... 4 5 10 19 50 36 86 Chronic Bronchitis ... ... ... ... ... ... ... 2 21 17 32 52 53 71 124 Lobar (Croupous) Pneumonia ... ... ... ... ... ... ... ... 8 5 9 3 ID 8 18 Lobular (Broncho-) Pneumonia 18 8 15 5 1 3 ... ... 4 7 4 9 42 32 74 Diseases of Stomach 2 ... ... ... ... ... ... 3 2 6 4 5 8 14 22 Obstruction of Intestines 1 2 ... ... ... 1 1 ... 2 5 ... 3 4 11 15 Cirrhosis of Liver ... ... ... ... ... ... ... ... 9 10 4 2 13 12 25 Nephritis and Bright's Disease ... ... ... ... 1 ... ... 1 20 12 5 9 20 22 48 Tumours and Other Affections of Female Genital Organs ... ... ... ... ... ... ... ... ... 5 ... ... ... 5 5 Accidents and Diseases of Parturition ... ... ... ... ... ... ... ... ... 8 ... ... ... 8 8 Deaths by Accident or Negligence 6 5 1 2 5 1 6 2 19 7 1 4 38 21 59 Deaths by Suicide ... ... ... ... ... ... ... ... 11 4 3 1 14 5 19 Deaths from Ill-defined Causes ... 1 ... ... ... ... ... 1 ... 1 1 ... 1 3 4 Syphilis 4 1 ... ... ... ... ... ... ... ... ... ... 6 1 7 Rheumatic Fever ... ... ... ... 2 ... 1 ... - 2 ... ... 5 2 7 Convulsions 10 13 3 2 i 1 ... ... ... ... ... ... 14 16 30 Apoplexy ... ... ... ... ... ... ... ... 1 5 6 14 i 19 26 Cerebral Hæmorrhage ... i ... ... ... ... ... 16 10 10 9 26 20 46 "Heart Disease " 1 ... ... ... ... 1 3 4 21 21 8 22 23 48 81 Pneumonia 12 5 4 9 2 5 o 2 16 20 4 12 40 53 93 All other Causes 8 7 5 4 6 3 11 8 67 57 35 57 132 137 209 All Causes 269 164 107 98 37 28 49 43 389 381 215 372 1066 1086 2152 deaths at all ages. 73 TABLE V. Deaths at All Ages, Allocated to Wards and Registration Sub-Districts. 1902. Corrected for Non-Residents dying within the Borough, and (as far as possible) for Residents dying without the Borough. [####]Causes of Death. Wards. Registration Sub-Districts. Queen's Park.* Harrow Road. nj . Westbourne. Church. 1 Lancaster Gate West. Lan caster Gate East. Hvde Park I St. Mary. t St. John. 1[/####] Small-pox 2 2 5 1 10 ... ... ... 18 ... Measles 9 5 6 7 48 1 ... 6 64 9 Scarlet Fever ... 2 2 2 ... ... ... ... 6 ... Epidemic Influenza 7 20 6 10 11 2 3 3 47 8 Whooping-cough 4 8 1 6 3 ... ... ... 18 ... Diphtheria, Membranous Croup 8 9 4 1 6 1 2 1 19 5 Croup ... ... ... 2 ... ... ... ... 9 ... Enteric Fever 4 3 ... 2 4 ... ... ... 8 1 Diarrhœa, Dysentery 5 13 4 9 19 ... 1 4 42 8 Epidemic or Zymotic Enteritis 2 6 1 8 7 ... ... ... 22 ... Enteritis 3 4 ... 3 8 ... 1 1 15 2 Other Continued fevers—Chickenpox 1 ... 1 ... ... ... ... ... 1 ... Erysipelas 1 ... ... ... 1 ... ... l 1 1 Puerperal Fever 1 1 1 2 ... ... ... ... 4 ... Other Septic diseases ... 1 1 2 5 ... ... ... 9 ... Tuberculosis of Meninges 7 7 ... 1 8 1 ... 1 16 2 Tuberculosis of Lungs 16 34 18 22 41 6 6 10 111 26 Other Forms of Tuberculosis 9 5 1 10 9 ... ... l 25 1 Alcoholism 2 3 5 3 7 ... ... ... 17 4 Cancer 9 23 14 25 34 7 9 13 93 32 Premature Birth 16 24 8 11 11 1 1 1 54 3 Developmental Diseases 16 23 16 10 21 1 3 6 67 13 Old Age 11 18 8 21 14 5 9 6 61 20 Meningitis 3 3 2 3 4 ... ... 2 12 2 Inflammation and Softening of Brain 4 3 3 5 13 ... ... 1 22 3 Organic Diseases of Heart 5 6 8 13 12 1 1 4 36 9 Acute Bronchitis 11 19 6 16 29 1 ... 4 69 6 Chronic Bronchitis 7 21 24 33 24 2 3 10 97 20 Lobar (Croupous) Pneumonia 3 5 .2 1 7 ... ... ... 14 1 Lobular (Broncho-) Pneumonia 15 18 11 13 15 ... 1 1 56 3 Diseases of Stomach 1 2 6 2 3 1 1 6 13 8 Obstruction of Intestines 2 ... 4 4 4 1 ... ... 11 2 Cirrhosis of Liver 1 3 3 6 9 ... ... 3 20 4 Nephritis and Blight's Disease 9 9 8 7 8 ... 4 3 31 8 Tumours and Other Affections of Female Genital Organs ... 1 2 1 1 ... ... ... 5 ... Accidents and Diseases of Parturition 1 3 1 1 ... ... ... 2 5 2 Deaths by Accident or Negligence 6 9 7 10 16 4 4 3 39 14 Deaths by Suicide 3 3 1 3 3 1 3 2 10 6 Deaths from III-defined Causes 1 ... 1 ... 1 ... ... 1 2 1 Syphilis 2 ... 1 1 2 ... ... 1 3 2 Rheumatic Fever ... ... 1 1 3 ... ... 2 5 2 Convulsions 5 6 3 4 10 ... 1 1 23 2 Apoplexy 3 8 2 2 5 2 1 3 17 6 Cerebral Haemorrhage 4 10 6 12 10 2 ... 2 38 4 " Heart Disease " 15 18 10 11 16 3 3 5 53 13 Pneumonia 14 26 9 12 21 3 1 7 67 12 All other Causes 20 49 41 54 56 13 12 24 188 61 All Causes 270 433 204 373 539 59 70 144 1556 326 Death-rates, 1902 1901 15.58 14.98 15.17 14.45 13.68 13.59 15.21 14.80 18-37 6-80 9-08 8.67 7.67 10.17 12.04 16.20 15.54 9.54 10.35 * This Ward is coterminous with the North-West Paddington Registration Sub-District. 74 level bakehouses. " LEVEL " BAKEHOUSES. 53 to 57, Connaught Street. 549, Harrow Road. 24, Mozart Street. 377, Edgware Road. 690, Harrow Road. 75, Queen's Road. 143, Harrow Road. 226, Kilburn Lane. 80, Queen's Road. 339, Harrow Road. 336, Kilburn Lane. 3, Richmond Road. 618, Harrow Road. 2, Mozart Street. UNDERGROUND BAKEHOUSES. Queen's -Park Wakd. 02, Herries Street. | 83, Herries Street. Harrow Road Ward. 1, Chippenham Road. 75, Fernhead Road. 534, Harrow Road. 41, Chippenham Road. 360, Harrow Road. 560, Harrow Road. 99, Chippenham Road. 436, Harrow Road. 117, Walterton Road. 55, Elgin Avenue. Maida Vale Ward. 27, Amberley Road. 14, Formosa Street. 125, Shirland Road. 60, Carlton Vale. 37, Kilburn Park Road. 195, Shirland Road. 17, Clifton Road. 227, Maida Vale. 5, Warwick Place. 237, Elgin Avenue. 57, Shirland Road. Westbourne Ward. 67, Cornwall Road. 27, Kensal Road. 76, Richmond Road. 241, Harrow Road. 68, Ledbury Road. 43, Waverley Road. 265, Harrow Road. 3, Norfolk Road. 56, Westbourne Grove. 365, Harrow Road. 24, Porchester Road. 135, Westbourne Park Road. Ia, Kensal Road. 10, Richmond Road. Church Ward. 23, Chichester Street. 319, Edgware Road. 90, Harrow Road. 17 and 19, Chilworth Street. 347a to 351, Edgware Road. 292, Harrow Road. 113, Cirencester Street. 401, Edgware Road. 23, Westbourne Terrace North. 52, Clarendon Street. 72, Hall Place. 37, Westbourne Terrace North. 307, Edgware Road. 29, Harrow Road. 20, Woodchester Street. Lancaster Gate West Ward. 8, Coburg Place. 70, Queen's Road. 159, Queen's Road. 72, Prince's Square. 157, Queen's Road. Lancaster Gate East Ward. 32, Chilworth Place. 46, Craven Road. 16, Craven Terrace. Hyde Park Ward. 47, Cambridge Street. 9, London Street. 3, Spring Street. 57, Cambridge Street. 53, Praed Street. 91, Star Street. 189, Edgware Road. UNDERGROUND BAKEHOUSES NOT IN USE. 62, Alfred Road. 20, Craven Road. ' 67, Moscow Road. 35, Alexander Street. 59a, Fernhead Road. 7, Praed Street. 92 and 94, Bishop's Road. 77, Harrow Road. 43, Ranelagh Road. 102, Church Street. 303, Harrow Road. 41, Tavistock Crescent. 16, Cirencester Street. 500, Harrow Road. 4, Upper Porchester Street. 24, Cleveland Gardens. 14, Lancaster Street. 99, Westbourne Park Villas. 46, Connaught Street.