PAD 8 Metropolitan Borough of Paddington. ANNUAL REPORT OF the COUNCIL FOR THE YEAR 1903. APPENDIX. REPORT OF Medical Officer of Health. London. MORTON & BURT, Printers. 187, EDGWARE ROAD, PADDINCTON,W. Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND Sanitary Work For the Year 1903. BY REGINALD DUDFIELD, M.A , M.B., D.P.H., Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. CONTENTS. Page Alcoholism, Deaths from 00 Bacteriological Examinations, Results of 52 Bakehouses, Inspection of 59 Do. List of 83 Births and Birth-Rates for 1903 3 Births in Outlying Hospitals 4 Canals 54 Canal Boats Acts 54 Cancer, Mortality from 34 Childbirth, Mortality in 26 Chicken-pox, Cases reported 31 " Clarendon Street Area" 65 Combined Drainage 52 Common Lodging Houses, Deaths in 67 Cowhouses 69 Dairies and Milkshops Registered 69 Do. do. Defects found at 72 Deaths and Death-Rates for 1903 10 Deaths in Institutions 43 Death-rate, Correction Factor 14 Diarrhoea, Mortality from 38 Diphtheria, Cases of 16 Do. Mortality from 18 Disinfection and Disinfectants 46 Drains, Private, Re-laid 52 Enteric Fever, Cases of 22 Do. Mortality from 24 Erysipelas 27 Factory and Workshop Act, 1901, Work Under 54 Family Shelter 46 "Fever" 22 Food Analysis, Summary of Samples taken 74 do. Summary of proceedings 78 Food Supervision 69 Food Adulteration 74 Food Purveyors 72 Fried Fish Shops, Inspection of 72 Hospitals, Accemmodation provided 45 H ouses let in Lodgings, Annual Cleansing of 63 Do. do. Sickness, etc., in 64 Do. do. Registration of in 1903 61 Do. .do. Overcrowding in 63 Do. do. Sanitary defects in 64 " Housing of the Working Classes " 67 Ice Cream, Inspection of places where made 72 Illegitimates, Births of 5 Do. Deaths of 41 Infantile Mortality, 1903 36 Influenza, Mortality from 35 Inhabited House Duty, Exemption from 68 Inquests held 42 Institutions, Deaths in 43 Page Kitchens, Inspection of, at Restaurants 72 Laundries Legal Proceedings, 1903, Summary of 77 Manure, Removal of 52 Measles, Mortality from 29 Meat Supply Meteorology, 1903 Milkshops, Trades carried on at 71 Milk Supply, Sources of 70 Morbidity Rates, 1903 7 Mortuaries 48 Notifications 6 Offensive Refuse, Removal of 52 "Overcrowding" in Houses let in Lodgings 60 Office Work 74 Outworkers 55 Phthisis, Mortality from 31 Do. and "Overcrowding" 33 Do. and age constitution of population 33 Population, Estimates, 1903 1 Do. Census returns, 1891-1901 1 Prevention of Infectious Diseases 45 Puerperal Fever, Cases of 25 Do. do. Mortality from 26 Refreshment Houses, Inspection of 72 Respiratory Diseases, Mortality from 35 Scarlet Fever, Cases of 18 Do. do. Mortality from 20 Schools and Infectious Diseases 48 Septic Diseases, Mortality from 25 Slaughterhouses, Inspection of 69 Small-pox 15 Smoke Prevention 54 Tubercular Diseases, Mortality from 31 Unsound Food seized 73 Vaccination 16 Water Supply, Cutting off of 46 Wharves, Inspection of 54 Whooping Cough, Cases reported ; Mortality from 30 Workshops, Inspection of 54, 57 Do. Overcrowding in 58 Do. Sanitary Conveniences 59 Do. Ventilation of 58 Do. Warming 59 Do. Sickness on Premises 59 Do. Registration of 55 Do. Complaints relating to 58 APPENDIX. Tables required by the Local Government Board 79-83 List of Bakehouses 84 TO HIS WORSHIP THE MAYOR, THE ALDERMEN, AND COUNCILLORS OF THE BOROUGH OF PADDINGTON. Gentlemen, I have the honour to present my (tenth) Annual Report on the Health of the Borough and the work of the Public Health Department during the past year. As the Public Health Committee will submit a report of their proceedings during the year, I have omitted certain matters which I should otherwise have dealt with. Once more I have to report the lowest death-rate on record—the nett mortality falling from 14'58 per 1,000 persons in 1(102 to 13*14 last year—the difference 1*44 per 1,000 representing a saving of 210 lives, no inconsiderable gain when the persistent decline in the birthrate is borne in mind. The very low rate of mortality recorded last year was in part due to the peculiar climatic conditions of the year, which were favourable to a very low infantile mortality, nevertheless the reduction in the death-rate which has been going on almost continuously for some years past must be ascribed to the efforts of the late Vestry and the Council to improve the sanitary condition of the Borough. There was a satisfactory diminution in the prevalence of the notified infectious diseases, especially of enteric and puerperal fevers, that of scarlet fever being the only exception. The Department has been able, for the first time, to make really systematic efforts to check the spread of the other infectious diseases. Statistical proof of the utility of such efforts cannot be expected for some few years. In one direction a serious disappointment has been experienced. Attention has been called in previous reports to the continued high mortality among infants. In July of last year the Public Health Committee made inquiries as to the results of municipal depots for the supply of milk suitably prepared for infants, and it was hoped that it would be possible to establish such a depot in the Borough. The scheme had, however, to be abandoned, owing to the decision of the Local Government Board (communicated to another Authority) that there was no legal authority for any expenditure from the rates on such a depot. The attempt to deal with infantile mortality by such means cannot be justified except as a temporary measure to tide over the period required for the training of future mothers in domestic hygiene and management. I venture to hope that the County Council, as the Education Authority, will not be content with the provision of " special centres " and evening lectures for teaching these subjects, but will include them in the ordinary curriculum of every girls' school under the Council's administration. As customary, I desire to call your attention to certain matters which appear to me to require special consideration. I would first refer to the need of more frequent removal of house refuse, especially from houses (including blocks of flats) occupied by more than one family. In many such houses the amount of refuse produced in the course of a week is considerable, more than the average dustbin can hold, and consequently the refuse gets stored in cellars, or litters the area. Any accumulation of decomposable refuse in the immediate neighbourhood of the dwelling is prejudicial to health, owing to the pollution of the air (a factor which receives too little attention), and to the conveyance of noxious particles from the refuse to foodstuffs (or to wounds) by the flies bred in the refuse. The ideal, a daily removal of all refuse, is, perhaps, too much to expect at present, but it does not appear to be unreasonable to ask for a bi-weekly removal in the hot weather at least, if not all through the year. There is a most pressing need of relief sewers to prevent the flooding which periodically occurs in the Borough. This necessity is well known to you, hut unfortunately the provision of main sewers is not under your jurisdiction. The County Council has on occasions put forward the provision of additional pumping stations as a serious attempt to prevent flooding. Such an argument appears to lose sight of the fact that conduits of fixed dimensions and gradients cannot deliver more than certain quantities of fluid in given times, and that the quantities cannot be increased by pumps at the outlets. If the discharge is to be increased, either the dimensions or the number of the conduits must be increased. The provision of additional accommodation for housing the poorer classes has had the attention of the Housing Committee for some time, but the difficulties, financial and other, attendant upon the acquisition of a suitable site have been found almost insuperable. Much attention is given by the Staff of the Department to houses let in lodgings, but the want of additional housing accommodation and the consequent increase in rentals for the accommodation available have not only rendered the work of the Staff very difficult, but have done much to make it barren of result. I desire in conclusion to express my satisfaction with the manner in which all the members of the Staff of the Department have discharged their duties; to thank my colleagues in the profession for their continued and 'hearty co-operation; and to tender to the Chairman and Members of the Public Health Committee my sincere appreciation of the consideration and sympathy which I have received from them at all times. I have the honour to be, Gentlemen, a Your obedient Servant. m.a., m.b., d.p.h., Medical Officer of Health. Public Health Department, Howley Lodge, 112, Harrow Road, Paddington, W. 18th May, 1904. 1 REPORT. The Borough.—The Borough has an area of 1,350 acres, including 20 acres of water (canals) and 175 acres (approximately) of open spaces. At the census of 1901 there were 17,081 inhabited houses. The total number of families at that date was 33,061, 21,815 families residing in homes containing less than five rooms. Of the persons residing in such homes 27'0 per cent, were "overcrowded," that is, lived in homes where the inhabitants averaged more than two persons per room. In 1891 the corresponding proportion (Old Parish) was 41.5 per cent. Of the total inhabitants of the Borough 13.5) per cent, were "overcrowded" at the last Census, as compared with 16.7 per cent. (Old Parish) in 1891. The Borough comprises three Registration Sub-Districts and is also divided into eight Wards. The two schemes of division overlap to some extent, as may be gathered from the appended statement. Registration Sub-Districts. Wards. Harrow Road. St. Many Maida Vale. Westbourne. Church (part of). ( Church (part of). Lancaster Gate, West. St. John „ „ East. Hyde Park. North-West Paddington Queen's Park. Population in 1903.—The estimate of the population of the Borough at the middle of the year was 145,927 persons, of whom 02,483 were males and 83,114 females. At the census of 1901 the enumerated population was 143,976 persons, showing an increase of 1,951 persons, during 2¼ years. The estimates of the inhabitants of the various sub-divisions of the Borough are given in Table 1. TABLE 1. Estimated Population. 1903. Borough Males 62,483 Persons 145,927 Females 83,144 Registration Sub-Districts Persons. Wards. Persons. St. Mary 95,425 Queen's Park 16,924 St. John 33,578 Harrow Road 28,370 North-West Paddington 16.924 Maida Vale 19,171 Westbourne 24,352 Church 26,826 Lancaster Gate (West) 8,445 „ „ (East) 7,931 Hyde Park 13,908 During the vear the population of and the number of inhabited houses in the Old Parish of Paddington at each census from the earliest (1801) has been ascertained. The information is given here as it may be useful for future reference. Old Parish. Persons. Houses. Persons. Houses. 1801 1,881 324 1851 46,305 6,103 1811 4,609 879 1861 75,784 9,687 1821 6,476 1,139 1871 96,813 11,847 1831 14,510 1,933 1881 107,058 13,221 1841 25,173 3,479 1891 117,846 14,473 1901 127,328 14,910 (?) New Borough. Persons. Houses. 1891 135,955 17,143 1901 143,976 17,684 2 meteorology. METEOROLOGY. The appended table (Table 2) gives the results of observations taken at the Royal Botanical Gardens, which represent the local meteorological conditions better than do those taken at the Greenwich Observatory. The characteristic features of the year were the excessive rainfall and the low temperatures, peculiarities which, while not appreciated by the general public, undoubtedly tended to an improvement in public health. TABLE 2. Meteorological Elements. Month. Means at 9 a.m. Extreme Temperatures. Rain. Sunshine. Barometer reduced to sea level Thermometer. Shade. Max in Sun. Min. on Grass. Depth of Inches. No. of Days. Number of Hours. Number of Days Dry Bulb. Wet Bulb. Maximum. Minimum. 1903* 1903. Inches. Deg. Deg. Deg. Dates. Deg. Dates. Deg. Deg. h. m. Jan. 29.99 40.7 38.9 53.2 2nd 26.0 15th 70.5 19.0 2.14 16 24 56 13 Feb. 30.13 44.5 42.2 58.0 20th 28.0 17th 83.0 17.0 0.92 11 54 23 16 March 29.84 46.0 43.0 67.0 26th 30.5 10th 98.0 25.0 2.70 17 89 14 26 April 29.89 44.7 40.9 59.2 29th 29.0 16th & 17 th } 105.0 20.0 2.28 13 115 09 25 May 29.87 54.8 50.0 78.2 31st 37.5 12th 121.0 31.0 2.36 15 164 15 29 June 30.02 57.9 53.1 83.0 27 th 37.5 21st 128.0 36.5 620 11 175 36 23 July 29.94 63.0 57.3 86.0 10th 45.0 7 th 125.5 35.0 5.40 11 185 58 29 August 29.87 60.8 56.2 77.0 8th 46.2 25th 121.5 42.0 4.27 16 186 12 31 Sept. 30.03 58.5 55.3 82.0 2nd 40.0 11th 119.0 34.5 2.98 13 133 42 26 Oct. 29.60 53.0 50.5 65.2 1st 37.5 23rd 105.0 31.0 6.16 25 68 03 23 Nov. 30.06 44.7 42.6 55.0 1st & 1 10th | 30.5 19 th & 30th 83.0 27.0 1.90 12 35 53 18 Dec. 29.79 39.3 37.6 51.0 9th 27.0 31st 65.0 20.0 1.38 11 7 39 6 Totals — — — — — — — — — 38.67 171 1,241 00 265 1902. Means 29.92 50.6 47.3 — — — — — — — — — — Highest — — — 86.0 July — — 128.0 — — — — — Lowest — — — — — 26-0 Jan. — 19.0 — — — — Totals — — — — — — — — — 19.75 159 1,017 05 251 Means 29.98 49.4 461 — — — — — — — — — — Highest — — — 84.5 July — — 124.0 — — — — — Lowest — — — — — 20.0 Feb. — 9.0 — — _ — * This part of the table appeared in The Times of 2nd January last. According to Mr. H. R. Mill (Times, Jan. 11th, 1904), 38T0 in. of rain fell at Camden Square, being 12.04 in. (51 per cent.) in excess of the annual average for 30 years. Mr. Mill estimates that the fall for the whole of London amounted to 37 in., or 50 per cent, more than the average. In February (usually a wet month) the fall was only one-half the average for 3 births. the month; in November, three-quarters, and in December, two-thirds the average. In July and October the fall was more than twice the average, while in June the fall in ten days was three times the average for the whole month. The total rainfall for the year was three inches more than that recorded in the wettest year known. Of the whole country, one of the wettest areas lay in the south, triangular in shape, reaching from Swanage to Brighton on the coast, and extending northwards to include the whole of the Thames basin. The relatively driest area was on the north-east coast, covering the county of Norfolk, and extending up to Hull. BIRTHS. The births registered within the Borough during last year (52 weeks) numbered 3,302 (viz., 1,658 of boys and 1,644 of girls), as compared with a total of 3,305 for the previous year (53 weeks). Last vear's birth-rate was 22.62 per 1,000 persons, and that of 1902 (duly corrected for the extra week), 22.41—thus showing a slight increase of 0.21 per 1,000. In 1901 the rate was 23.29 per 1,000 (Table 3). TABLE 3. Births and Birth-Rates. 1903. Paddington. Births registered. Borough. Registration Sub-Districts. St. Mary. St. John. North-West Paddington Males 1,658 1,248 194 216 Females 1,614 1,235 188 221 Totals 3,302 2,483 382 437 Birth-Rates. Per 1,000 persons 1903 22.62 26.02 11.37 25.82 1902 22.41 25.45 11.29 27.48 1901 23.29 27.14 11.57 25.30 Per 1,000 females aged 15-45 years. 1903 70.1 87.6 25.7 110.6 f 1902 71.6 87.0 26.0 119.7 In Table 1 in the Appendix will be found particulars of the births and birth-rates for the eleven vears 1893-1903, and in Table 2, similar information as regards numbers of births for each Registration Sub-District. Last year's rate was 1.84 per 1,000 below the decennial mean rate (24.48). In St. Mary's Sub-District 2,483 births where registered, equal to a rate of 26.02, being nearly 2 per thousand less than the mean (28.01). In St. John's Sub-District the births numbered 382, the birth-rate being 11.37, or one less than the mean (12.37), and in NorthWest Paddington the 437 births were equal to a rate of 25.82, or 3.83 below the mean (29.65). In the last case the numbers of births in the years prior to 1901 have been estimated, the actual numbers registered not being available. The rates for those years (and con- 4 births. sequently the mean rates) are probably too high. The mean rates for the Borough and the Sub-Districts are given below. Birth-Rates.* Mean Rates. 1903. Borough 22.62 St. Mary 26.02 St. John 11.37 North-West Paddington 25.82 Five years, Five years, Ten years, 1893-97. 1898-1902. 1893-1902. 25.41 23.55 24.47 28.91 27.12 28.01 12.93 11.72 12.32 31.83 27.48 29.65 In comparison with 1002 all rates except that for North-West Paddington showed slight increases, the rates for that year (except in the District named) being the lowest recorded since 1892. In North-West Paddington the minimum rate was that of 11)01 (25.30). The foregoing returns represent the births registered in the Borough and include the births of children born in the Borough (e.g. at the Workhouse Lying-in-Ward) whose parents' homes are outside the Borough. There is reason to believe that a fair number of children are born at the Workhouse, whose births ought to be allocated to other Districts, but the data for such correction are not at present available. Inquiries have been made at the three principal Lying-in-Hospitals in the Metropolis and it has been found that during the two years 1901-02, 299 births took place (98 being births of illegitimates) which should have been allocated to the Borough. Last year similiar inquiries were made at two of the hospitals, the third being left out as onlv one Paddington birth occurred there during the previous two vears. The total Paddington births at the two hospitals numbered 103,46 being illegitimate. For particulars see below:— Paddington Births In Outlying Hospitals. 1901. 1902. 1903. Legitimate. Illegitimate. Legitimate. Illegitimate. Legitimate. Illegitimate. m f m f m f m f m f m f Oueen Charlotte 43 49 28 18 53 51 25 27 61 49 21 25 British 1 1 — — 1 1 — — 3 4 — — General — — — — —• 1 — — (books not examined). 44 50 28 18 54 53 25 27 64 53 21 25 If these figures be added to the numbers registered in the Borough the totals and rates for the past three years will be as below instead of those given in Table 3. "Corrected" Births and Birth-Rates, BOROUGH. Total. Rates. 1901 3,499 24.26 1902 3,461 23.49 1903 3,465 23.67 The rates thus obtained show increases of (approximately) 1 per 1,000 in each case over the uncorrected rates. In comparison with the adjacent boroughs and the Metropolis (Table 4), the local rate last year (22.01) was above those of Kensington (19.79), Westminster (10.85), and Hampstead (17.07); but below those of the Metropolis (28.30), and Willesden (31.93). The Marylebone rate obtained from the Reports of the Registrar-General is not comparable with the other rates, as no correction is made in those Reports for the births in the Queen Charlotte * All rates, unless otherwise stated, are calculated per 1,000 persons estimated living at the middle of 1903. 5 births. Hospital not belonging to the District. Of the rates mentioned, those cf the Metropolis Westminster and Hampstead were lower last year than in 1902. TABLE 4. Births and Birth-Rates. 1003. Birth-rates. Births Registered. Per 1,000 persons at all ages. Per 1,000 females aged 15-45 years. Borough 3,303* 22.61* 70.14 London 130,906 28.36 103.70 Kensington 3,567 19.79 55.50 Westminster 3,018 16.85 51.21 Marvlebone† 3,984 30.35 88.09 Hampstead l,456 17.07 45.11 Willesden 4,059 31.93 114.97 * Registrar-General's total and rate, f These figures require to be corrected for the births in Oueen Charlotte Lying-in Hospital. According to the Annual Report of the Medical Officer of Health, the corrected number f births was 2,818—which makes the rates in the second and third columns 21' 17 and 02 09 respectively. The foregoing rates have been calculated on the total population of both sexes. Rates calculated on the estimated numbers of females of child-bearing ages (15.45 years) are included in Table 4. The proportion of such women in each district who are unmarried varies greatly, and depends to some extent on the character of the district. Where a large number of domestic servants are kept—e.g. Kensington, Hampstead, and (South) Paddington —or where a large number of resident shop assistants are employed, the rate will be proportionated lower. This explains the low rate in Hampstead (45.11) and converselv the high rate in Willesden (114.07). Illegitimate Births.—Among the 3,302 births registered in the Borough last year, were 130 of illegitimate children, being 4.2 per cent, of the whole, as compared with 4.5 and 3.0 per cent, in 1002 and 1001. From the figures given in Table 5, it will be seen that there was a considerable increase in the proportion of illegitimate children registered in St. John's Sub-District 4.1 per cent., compared with 3.1 and 0.5 in the preceding years. As already recorded there were 40 illegitimate births belonging to Paddington at the Queen Charlotte Lying-in-Hospital, of which 34 belonged to St. Mary's, 10 to St. John's, and 2 to the NorthWest Paddington Registration Sub-District. TABLE 5. Illegitimate Births. Registration Sub-Districts. Borough St. Mary St. John North-West Paddington. Males 74 64 6 4 Females 65 49 10 6 Total 139 113 16 10 Per cent, of all births. 1903 4.2 4.5 4.1 2.2 1902 4.5 5.2 3.1 1.6 1901 3.9 4.8 0.5 2.0 6 notifications. NOTIFICATIONS. Last year 732 cases of infectious diseases were certified by medical practitioners in accordance with Sec. 55 (1) of the Public Health (London) Act, 189L In 1902 (53 weeks) 921 cases were so certified, excluding cases of chickenpox, which disease was temporarily added to the Schedule. 1 he decline in the number of cases reported in each of the two years was equal to 21 per cent, of the total for 1902. As will be seen from Table 6, the cases of all diseases except scarlet and continued fevers were fewer last year than in the previous year. In the Metropolis the cases reported last year (27,732) were 18,439 fewer than in 1902 (46,171), all diseases except typhus fever being less prevalent. The notification-rate for the Borough was 5.01 per 1,000 persons of all ages, or 1.22 less than the rate for 1902 (0.23), while that for the Metropolis (6.00) was 3.91 lower. TABLE 6. Notifications and Notification-Rates, 1903 and 1902. Paddington. London* Notification Ratesf 1903 1902 Differences. Increase ( + ) Decrease (—) 1903 1902 Differences. Increase (+) Decrease (—) Borough. London. 1903 1902 1903 1902 Smallpox 5 110 —105 417 7,814 —7,397 0-03 0.73 0.09 1.67 Cholera __ 1 —1 ... ... ... 0.00 Diphtheria 143 205 —62 7,593 10,551 —2,958 0.97 1.38 1.64 2.26 Membranous Croup 2 6 — 4 156 192 —36 0.01 0.03 0.03 0.04 Erysipelas 118 143 —25 4,382 5,554 —1,172 0.88 0.96 0.91 1.19 Scarlet 414 359 + 55 12,545 18,269 —5,724 2.83 2.42 2.71 3.91 Fevers. Typhus 1‡ ... + 1 22 4 + 18 0.00 ... 0.00 0.00 Enteric 43 83 —40 2,344 3,421 —1,077 0.29 0.56 0.50 0.73 Relapsing ... ... ... 1 2 —1 ... ... 0.00 0.00 Continued 3 1 + 2 41 49 —8 0-02 0.00 0.00 0.01 Puerperal 3 14 —11 231 314 —83 0.02 0.28 0.05 0.06 Totals 732 921 —189 27,732 46,171 —18,439 5.01 6.23 6.00 9.91 * From Weekly Returns issued by the Metropolitan Asylums Board. | Per 1,000 persons (estimated) of all ages. J An error of diagnosis. In Table 7 are given the numbers of cases of the more common diseases recorded in the adjacent districts, and in Table 8 the rates for those diseases in 1902 and 1903 are compared. The following are the most noticeable facts recorded in those tables— 1. The great diminution in prevalence of smallpox, enteric fever, and puerperal fever. 2. The special prevalence of scarlet fever in Paddington, Marylebone and Willesden. 7 notifications. TABLE 7. Notifications, 1903 From Registrar-General's Quarterly Reports. Pad- dinc.ton.* London, f Kensington. Westminster. Marylebone. Hamp- stead. Willesden Smallpox 5 416 5 45 4 1 7 Diphtheria and Membranous Croup 151 7,743 180 186 228 86 223 Erysipelas 119 4,371 177 111 177 41 74 Fevers. ( Scarlet 417 12,534 335 352 414 174 504 Enteric 43 2,340 66 71 67 29 45 Continued 3 40 2 9 4 — — Puerperal 4 233 4 5 7 1 10 * Also 1 case of typhus fever, erroneously diagnosed. †Also 22 cases of typhus fever. TABLE 8. Morbidity Rates, 1903. Per 1,000 persons of all ages. Based on figures given in Table 7. Paddington. London. Kensington. Westminster. Marylebone. stead. Willesden. 1903 1902 1903 1902 1903 1902 1903 1902 1903 1902 1903 1902 1903 1902 Smallpox 0.03 0.76 0.09 1.67 0.02 0.54 0.25 1.26 0.03 1.14 0.01 0.23 0.05 0.72 Diphtheria* 1.03 1.49 1.67 2.30 1.00 1.02 1.03 1.54 1.73 1.76 1.00 1.15 1.75 3.58 Erysipelas 0.81 0.99 0.94 1.18 0.99 1.04 0.61 0.78 1.34 1.62 0.48 0.67 0.58 0.86 Fevers. Scarlet 2.85 2.16 2.71 3.91 1.87 2.08 1.96 2.57 3.15 3.08 2.04 2.99 3.96 3.82 Enteric 0.29 0.56 0.50 0.73 0.36 0.45 0.39 0.72 0.51 0.71 0.34 0.53 0.35 0.59 Continued 0.02 0.00 0.00 0.01 0.01 0.02 0.01 0.00 0.03 ... ... 0.01 ... ... Puerperal 0.02 0.08 0.05 0.06 0.02 0.08 0.02 0.03 0.05 0.10 0.01 0.08 0.07 0.06 * Including membranous croup. As regards the local returns, it is seen from Table 9 that the numbers of cases recorded last year in the various Wards were, with the following exceptions, lower than those for 1902— Cases reported. Disease. Ward. 1903. 1902. Diphtheria Hyde Park 16 8 Erysipelas Maida Vale 19 10 „ Hyde Park 11 6 Scarlet Fever Queen's Park 63 51 „ Maida Vale 57 31 „ Church 92 65 8 NOTIFICATIONS. TABLE 9. Notifications distributed according to Wards, 1903. Figures for 1902 in ( ). Queen's Park.* Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde. Park. West. East. Smallpox 1 (17) 1 (11) - (12) 1 (14) 1 (50) - (7) -(7) 1 (7) Diphtheria 19 (52) 43 (61) 14 (23) 20 (24) 24 (24) 3 (~) 4 (6) 10 (S) MenibranousCroup - (3) — (1) - (—) 1 (--) 1 (1) - (-) — (—) — (/) Erysipelas 10 (16) 25 (35) 19 (10) 12 (28) 37 (42) 2 (3) 2(3) 11 (0) Fevers. Scarlet 63 (51) 97 (00) 57 (31) 73 (73) 92 (65) 14(14) 6(9) 12(17) Enteric 8(10) 3 (13) 6(71) 6(77) 15 (20) 3(7) 1 (4) 1 (') Continued ... -(-) -(l) - ( -) 2 (—) -(-) -(-) -(-) 1 (-) Puerperal 1 (4) 1 (!) - (2) ~ (•') 1 (2) -(-) -(2) — (—) Typhus l(-) - (-) -(-) -(-) - V—) -(-) -(-) _(_) Totals 103 (153) ' 170 (222) 9G (S9) 115 (150) 171 (204) 22 (26) 13 (25) 42 (43) Rates,* 1903 6.08 5.99 5.00 4.72 6.37 2.60 1.63 3.02 „ 1902 8.82 7.77 4.01 6.57 7.46 3.01 3.09 3.03 „ 1901 9.00 9.36 7.46 7.13 9.11 3.54 4.65 4.52 * Per 1,000 persons of all ages. TABLE 10. Notifications. St. Mary. St. John. North-West Paddington. Borough. London. 1903. Dep. from Average. 1903. Dep. from Average. 1903 Dep. from Average. 1903. Dep. from Average. 1903. Dep. from Average. Smallpox 3 —19 (86) 1 —2 (67) 1 —2 (67) 5 —23 (82) 417 —1,134(75) Cholera ... ... ... ... —0 (0) ... ... ... -0 (0) ... —24 (100) Diphtheria 97 —121 (56) 27 -9 (25) 19 —38 (67) 143 —168 (54) 7,593 —4,830 (39) Membranous Croup 9 —4 (67) -0 (0) -0 (0) 2 -5(71) 156 —231 (60) Erysipelas 90 —33 (27) 18 -3 (14) 10 —8 (46) 118 —44 (27) 4,382 —1,772(2.9) Fevers. Scarlet 314 —86 (22) 37 —37 (50) 63 -13 (17) 414 —13G (25) 12,545 —9,129(42) Typhus -0 (0) ... -0 (0) 1 + 1 (100) 1 + 1 (100) oo + 9 (60) Enteric 30 —28 (48) 5 —9 (72) 8 -1 (11) 43 —38 (47) 2,344 — 1,305 (36) Relapsing -0 (0) —0 (0) 1 -1 (50) Continued o +0 ... 1 + 1 (100) 3 + 1 (50) 41 —56 (5S) Puerperal 2 -6 (75) —1 (100) 1 -o (0) 3 -7 (70) 231 —60 (21) All Diseases 540 —297 (35) 89 —60 (40) 103 —62 (38) 732 —419 (33) 27,732 -18,533 (40) The figures in parentheses indicate the increase (decrease) in 1903 per cent. of the average. signifies no case recorded. 0 average less than unity. NOTIFICATIONS 1903. 1903 AVERAGE DURING 10 YEARS 1893 -1902. 9 notifications. In Table 10, last year's figures for the three Registration Sub-Districts are given, with the departures from the decennial averages (corrected for changes of population, and adjusted to nearest whole numbers) and the percentage changes from the averages. With the exception of typhus fever (the case reported last year was erroneously diagnosed) and continued fever—all diseases show satisfactory reductions in prevalence —including scarlet fever. The most noteworthy reductions are those of smallpox (82 per cent. for the Borough), diphtheria and membranous croup (jointly 44 per cent.), enteric fever (47 per cent.) and puerperal fever (70 per cent.). Contrasting the figures for the Borough with those for the Metropolis it is seen that while the total notifications for the year in the Borough were 33 per cent. below the average, those in the Metropolis were 40 per cent. below. The returns for the several diseases, except scarlet fever, showed greater reductions below the respective averages in the Borough than in the Metropolis. In the case of scarlet fever, last year's cases in the Borough (414) were 25 per cent. below the average, those in the Metropolis (12,545) 42 per cent. below. In Table 11 the cases have been tabulated according to the sex and age of the patient. The numbers of cases of the more important diseases reported each week are shown on the Chart facing this page. TABLE 11. Notifications distributed according to sexes and ages of patients. Borough. 1903. 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 2 1 2 ... ... ... ... ... 1— ... ... 3 6 1 ... ... 3 8 5 ... ... ... ... ... 2— ... ... 8 6 ... ... ... ... 22 18 ... 1 ... ... ... 3— ... ... 8 9 ... ... 1 ... 20 17 ... ... ... ... ... 4— ... ... 11 8 1 ... ... 1 15 32 1 ... ... ... ... 5— ... ... 24 18 ... ... 2 2 91 116 2 5 ... ... ... 13— ... ... 2 4 ... ... 2 ... 6 5 ... 1 1 ... ... 15— 1 ... 6 10 ... ... 4 10 15 23 7 9 ... 2 ... 25— 3 1 8 11 ... ... 29 48 3 15 10 7 ... ... 3 65 and over ... ... ... ... ... ... 4 8 ... ... ... ... ... ... ... All ages 4 1 71 72 2 ... 44 74 181 233 20 23 1 2 3 Rates*— 1903 0.06 0.01 1.13 0.86 0.03 ... 0.70 0.88 2.89 2.79 0.32 0.27 0.01 0.02 0.03 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 0.48 ... ... 0.12 * Per 1,000 individuals of each sex. 10 DEATHS. DEATHS. There were registered within the Borough, during 1903, 2,103 deaths (viz., 1,069 of males, and 1,031 of females) giving a gross death-rate of 14.41 per 1,000 persons of all ages. In 1902 (53 weeks) 2,311 deaths were registered, and the gross death-rate* was 15*07. Last year's rate was 1.26 below the rate for 1902 and 0.59 below that for 1901 (15.00). The decennial mean (gross) rate was 16.59. (Sec Table I., Appendix). Of infants under 1 year of age, 425 (474)† deaths were registered, the gross infantile mortality being at the rate of 128 per 1,000 births registered, compared with a rate of 144 per 1,000 births in each of the years 1902 and 1901, and a mean rate of 154. The deaths at other ages registered in the Borough are given below:— Age No. of deaths. Years. Persons. 1—5 220 (243) 5—15 77 (72) 15—25 79 (114) 25—65 794 (S36) 65 and over. 508 (572) The principal causes of death within the Borough, during the year, were— Infectious Diseases. Measles 41 (79) Scarlet Fever 1 (1) Whooping Cough 55 (21) Diphtheria and Membranous Croup 6 (23) Enteric Fever 7 (18) Continued Fever 2 (0) Influenza 26 (61) Diarrhœa 43 (61) Epidemic Enteritis 36 (28) Puerperal Fever 3 (5) Other Septic Diseases 26 (19) Phthisis 159 (141) Other Tubercular Diseases 74 (74) Other Diseases or Causes. Croup 0 (2) Cancer 179 (149) Bronchitis 160 (208) Pneumonia 161 (208) Other Respiratory Diseases 25 (25) Alcoholism 28 (23) Cirrhosis of Liver 23 (32) Premature Birth 54 (75) Accidents 94 (108) Suicides 21 (17) Included among the 2,103 deaths registered in the Borough were 366 deaths of nonresidents, while 181 deaths of residents of the Borough were registered in other parts of the Metropolis. By deducting the former and adding the latter, a corrected total of 1,918 deaths of residents during the year is obtained. In all subsequent paragraphs the deaths of such residents only will be considered, unless the contrary be definitely stated. The 1,918 deaths of residents comprised 945 of males, and 973 of females, and were equal to a rate of 13.14 per 1,000 persons, as compared with rates of 14.26 and 14.58 in 1901 and 1902 respectively. The death-rates of males and females were 15.12 and 11.66 per 1,000 of each sex. (Table 12). Last year's rate was 2.69 per 1,000 below the decennial mean rate (15.83) and the lowest on record. The highest rate for the eleven years 1893-1903 was that of 1893 (17.42) which was 4.28 per 1,000 higher than last year's rate, the difference between the two rates representing a saving of 624 lives during the one year. * All rates for 1902 have been adjusted to a year of 52 weeks. † The italic figures in parentheses are the corresponding returns for 1902, and are totals for 53 weeks. 11 deaths. TABLE 12. Deaths and Death-rates, from all causes at all ages. 1903. Deaths at all ages. Death-rates,* 190$. Death-rates,* Persons. Males. Females. Persons. Males. Females. Persons. 1902. 1901. Borough. 945 973 1,918 15.12 11.66 13.14 14.58 14.26 Registration Sub-Districts. St. Mary 679 697 1,376 16.00 13.15 14.41 16.20 15.54 St. John 144 161 305 12.44 7.31 9.08 9.54 10.35 North-West Paddington† 122 115 237 14.38 13.62 14.00 15.58 14.98 Wards. Harrow Road 170 183 353 12.64 12.25 12.44 15.17 14.45 Maida Vale 130 114 244 16.92 9.91 12.72 13.68 13.59 Westbourne 156 193 349 15.58 13.45 14.33 15.21 14.86 Church 240 230 470 18.82 16.33 17.52 19.95 18.37 Lancaster Gate (West) 19 32 51 6.68 5.71 6.03 6.86 9.08 Lancaster Gate (East) 32 28 60 13.98 4.96 7.56 8.67 7.67 Hyde Park 76 78 154 15.24 8.74 11.07 10.17 12.04 * Rates per 1,000 living in each area. † Queen's Park Ward is co-terminous with the Registration Sub-District "North-West Paddington." TABLE 13. Deaths at various ages from all causes, 1903. Age Groups. Deaths in Institutions. 0— 1— 5- 15— 25— 05 and over. Borough m. f. m. f. m. f. m. f. m. f. m. f. m. f. 208 180 106 84 24 23 32 27 382 342 193 317 305 267 Registration Sub-Districts. St. Mary 169 136 89 61 18 13 26 17 256 233 121 237 213 193 St. John 16 24 7 5 4 4 3 4 66 68 48 56 41 43 North-West Paddington * 23 20 10 18 2 6 3 6 60 41 24 24 51 31 Wards. Harrow Road 45 39 30 18 9 3 5 3 55 63 26 57 40 45 Maida Vale 26 18 9 5 1 2 5 1 58 41 31 47 37 29 Westbourne 32 31 15 18 4 2 7 5 65 63 33 74 51 53 Church 68 55 36 20 5 6 9 8 88 76 34 65 91 74 Lancaster Gate (West] — 3 2 1 — — 2 12 15 5 11 6 7 Lancaster Gate (East) o 3 2 — - — 1 — 14 14 12 11 4 5 Hyde Park 11 11 2 4 3 4 2 2 30 29 28 28 25 23 * Queen's Park Ward is coterminous with the Registration Sub-District "North-West Paddington." 12 deaths. TABLE 14. Mortalities at different ages per 1,000 estimated living in each age-group. Paddington, 1901-1903. Year. Males. Females. 0— 1— 5— 15— 25— 05 and over. 0— 1— 5- 15- 25— 05 and over. 1903 138.29 21.28 2.18 2.52 12.75 81.40 125.26 16.64 1.99 1.50 7.95 71.10 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 In St. Mary's Sub-District last year's rate was 14.41, as compared with rates of 15.54 and 10.20 for 1901 and 1902 respectively, and a decennial mean rate of 17.61 (showing a reduction of 3.20, or a saving of 305 lives).* In St. John's Sub-District the rate for 1903 was 9.08, against rates of 10.35 (for 1901), 9.54 (for 1902) and 11.05 (for the preceding decennium). The reduction of 1.97 per 1,000 under the decennial mean is equivalent to 66 lives. In North-West Paddington last year's rate of 14 per 1,000 was 0.98 below the rate of 1901 (14.98), 1.58 below that of 1902 (15.58) and 1.93 below the decennial mean (15.93), the last figure representing 33 lives. The total number of lives saved in the Borough during the vear by the smaller rates in the three Sub-Districts amounted to 404. Appended are the quinquennial and decennial mean rates— Death-Rates. Mean Rates. I Five years. Five years. Ten years. 1903 1893-97 1898-1902 1893-1902 Borough 13.14 16.01 15.65 15.83 St. Mary 14.41 17.84 17.38 17.61 St. John 9.08 11.56 10.38 11.05 North-West Paddington 14.00 15.51 16.36 15.93 The rates for the different wards (Table 12) were lower last year than in 1901 and 1902, except in Hyde Park Ward, where last year'srate (11.07) was higher than that of 1902 (10.17), but lower than that of 1901 (12.04). The numbers of deaths and mortality rates for each quarter of the last two years are contrasted below, the rates being in italics— 1903. 1902. ' First Quarter 522 14.35 736 20.35 Second „ 455 12.51 476 13.16 1903. 1902. Third Quarter 442 12.15 418 11.56 Fourth „ 499 13.72 522 13.40 In Table 15 the local mortality rates for 1903, obtained from the Registrar-General's Quarterly Reports, are compared with those for the whole Metropolis and the districts immediately adjacent to the Borough, and in Table 16 the local rates (Departmental figures) are compared with rates for the different parts of the whole country. I he Borough death-rate from all causes (13.20) stands third on the list (Table 15), lower rates being recorded in Hampstead (9.94) and Willesden (12.07). The highest rate was that of St. Marylebone (16*36). As regards mortality from the diseases mentioned, the Borough is also third in each case. As regards Infantile Mortality, it is fourth, lower rates being recorded in St. Marylebone (95), Hampstead (87), and Willesden (117), but the Marylebone rate is lowered by the excessive number of births at the Oueen Charlotte Hospital.† * The numbers of deaths in each of the eleven years 1893-1903, are given in Table II. Appendix. † The Medical Officer of Health of Marylebone gives the mortality rate as 142 per 1,000 births, after correcting births and deaths for non-residents, &c., which places the local rate third in order. 13 DEATHS. As to the figures in Table 16, the local rate from "All Causes" (13.14) was the lowest of all, the rate for "100 Smaller Towns" (14.6) being next lowest. The other rates will be referred to under their respective headings. TABLE 15. Death-Rates—Selected Causes, 1903. From the Registrar-General's Quarterly Reports. All Causes Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. "Fever." Diarrhœal Dis. Phthisis. Infantile Mortality. Paddington 13.20 ... 0.27 0.66 0.10 0.36 0.04 0.44 l.06 118 London 15.11 0.00 0.44 0.07 0.16 0.35 0.07 0.63 1.54 129 Kensington 13.83 ... 0.19 0.07 0.13 0.50 0.05 0.59 1.24 145 Westminster ... 13.59 0.01 0.27 0.05 0.08 0.18 0.07 0.30 1.68 123 St. Marylebone 16.30 ... 0.28 0.12 0.19 0.42 0.10 0.44 1.82 95* Hampstead 9.94 ... 0.09 0.04 0.11 0.18 0.02 0.10 0.73 87 Willesden 12.07 0.00 0.66 0.10 0.07 0.54 0.06 0.50 0.88 117 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 Lying.in.Hospital. According to Annual Return of the Medical Officer of Health the corrected rate is 142 per 1,000 births of residents registered in the Borough. TABLE 16. Death.Rates—Selected Causes. All Causes Smallpox. Measles Scarlet Fever. Diphtheria. Whoop ing Cough "Fever' Diar. rhœal Dis. Infantile Mortality. England and Wales 1903 15.4 0.02 0.27 0.12 0.18 0.27 o.io 0.50 132 1893.02 17.6 0.20 0.39 0.15 0.27 0.34 0.18 0.76 158 76 Great Towns 1903 16.3 0.03 0.36 0.14 0.20 0.33 0.12 0.71 144 1902 17.4 0.12 0.49 0.19 0.26 0.37 0.15 0.54 145 100 Smaller Towns... 1903 14.6 0.02 0.29 0.12 0.16 0.28 0.11 0.43 135 1902 15*3 0.08 0.37 0.14 0.24 0.22 0.13 0.35 135 Rest of England and Wales 1903 14.8 0.02 0.17 0.10 0.17 0.22 0.09 0.31 118 1902 15.3 0.03 0.27 0.10 0.20 0.22 0.10 0.22 119 London 1903 15.1 o.oo 0.44 0.07 0.16 0.35 0.07 0.63 129 1893.02 18.7 0.42 0'55 0.17 0.47 0.44 0.14 0.80 157 Paddington* 1903 13.14 ... 0.26 0.06 o.io 0.36 0.04 0.57 108 1893.02 16.13 0.01 0.36 0.11 0.44 0.34 0.11 1.02 149 Rates, other than Infantile Mortality, per 1,000 persons of all ages ; Infantile Mortality per 1,000 births registered. * From Returns prepared by the Department. The rates given in Tables 15 and 16 are calculated on the total populations and require to be corrected for the variations in the proportions of males and females at the different ages. The necessary factors for the Metropolitan Boroughs have been published by the Medical Officer of Health of the County, and corresponding factors have been calculated for 14 DEATHS. the sub-divisions of the Borough. The changes in the rates due to the use of such factors are indicated below:— 1903. Standard Rate. Recorded Rate.* Corrected Rate. Difference from Standard Rate. England and Wales 18.19 15.4 15.4 —2.79 Borough 17.10 13.14 13.98 —3.12 St. Mary 17.81 14.41 14.71 —3.10 St. John 15.44 9.08 10.69 —4.76 North-West Paddington 16.43 14.00 15.49 —0.94 Harrow Road 19.02 12.44 11.89 —7.13 Maida Vale 16.62 12.72 13.81 —2.81 Westbourne 18.96 14.33 13.74 —5.22 Church 17.03 17.52 18.71 + 1.68 Lancaster Gate—West 15.01 6.03 7.30 —7.71 „ East 14.76 7.56 9.31 —5.45 Hvde Park 16.18 11.07 12.44 —3.74 Kensington 17.05 13.83 14.75 —2.30 Westminster 15.46 13.59 15.91 +0.45 Marylebone 16.93 16.36 17.58 +0.65 Hampstead 16.19 9.94 11.17 —5.02 Willesden. 16.98 12.07 12.94 —4.04 * Except the local rates, compiled from Registrar-General's Quarterly Reports. † Standard rate and factor calculated by Registrar-General. As regards local rates, the "corrected rate" is in every instance, except Church Ward, below the "standard rate," which is the rate which would be recorded if the mortality in each sex-age group were at the rate which prevailed in England and Wales during 1891-1900. This reduction may be said to represent the nett results of the Council's efforts to improve the sanitary condition of the Borough. The greatest reduction in any Ward was that of Lancaster Gate West Ward (—7.71), that of Harrow Road Ward (—7.13) being almost as great. The latter appears to be a particularly satisfactory result, having regard to the conditions of housing, etc., which prevail in the Ward. The increase in Church Ward ( + 1.68), is undoubtedly due to the "Clarendon St. Area." In Tables IV. and V. in the Appendix will be found classifications of the causes of death of residents during the year, according to sex and age for the whole Borough ( Table IV.), and according to persons of all ages for each Ward and the Registration Sub-Districts (Table V.). small-pox. 15 SMALL-POX. Borough. London. 1903. 1902. 1903. 1902 Cases 5 110 417 7,798 Deaths — 20 13 1,314 *Morbidity 0.03 0.73 0.09 1.70 †Fatalitv — 18.1 3.1 16.8 ‡Mortality — 0.12 0.00 0.28 * Case-rate per 1,000 persons of all ages. † Deaths per 100 cases. ‡ Death-rate per 1,000 persons of all ages. As appears from the above figures, there was a great diminution in the prevalence of this disease both in the Borough and the Metropolis. The very great drop in the fatality in the Metropolis (from ltV8 per cent. in 1902 to 3T per cent. in 1903) suggests either that the proportion of wrongly diagnosed cases was higher last year than in 1902, when some 13 per cent. of the cases notified were found to be so diagnosed, or that the attacks were of a much milder tvpe. The former supposition is on the whole the more probable. There is still need of great watchfulness on the part of Metropolitan Authorities to prevent a recurrence of last year's epidemic, the disease continuing to prevail in the provinces, forming here and there small epidemics. ing here and there small epidemics. The totals reported in the Metropolis and the provinces* during the last two years are given below:— Quarter 1 2 3 4 Whole year. Year 1903 1902 1903 1902 1903 1902 1903' 1902 1903 1902 Metropolis ... 38 4,481 162 2,934 121 359 96 43 417 7,817† Provinces ... 2,112 1,843 3,210 2,171 1,424 622 691 1,529 7,437 6,165 As regards local returns, the 5 cases reported last year were 23 (82 per cent.) below the decennial average, and 22 below the averages (27 in each case) for the two quinquennial periods. Further comparisons are instituted below:— Small-pox. Averages. Corrected and adjusted. A. 1903 1893-97 1898-1902 1893-1902 Borough 5 27 27 28 St. Mary 3 22 21 22 St. John 1 3 3 3 North-West Paddington 1 2 3 3 Last year's cases in the Metropolis were 1,134 less than the average, a reduction of 73 per cent. Of the five cases reported, one (f. æt. 30) was erroneously diagnosed, proving to be a case of chicken-pox. This case did not go to hospital. Of the remaining four (all removed to hospital) two were clearly due to infection acquired outside the Borough, the patients arriving here within the period of incubation. One patient was a tramp (m. æt. 57) who was removed from a common lodging house in Kilburn Lane, where he arrived on April 3rd, on which day he sickened. His movements during the preceding fortnight were traced, and the medical officers of health of the various districts duly advised thereon. The other case was a groom out of work (m. æt. 37) who arrived in London on April 30th, and sickened on May 10th. During the interval he visited Haslemere in Surrev. * The figures are based on returns made weekly to the Local Government Board from certain boroughs and urban districts in the provinces representing a total population of 14,504,425 at the Census of 1901. † The total (19 in excess of that given higher up) is not fully corrected for duplicate notifications, &c. 16 diphtheria. The other two patients were residents of the Borough, one a printer (m. æt. 35) working in the City and the other a cook (m. net. 23) employed in the Borough. The former patient had been journeying to and from Dorking and might have come into contact with cases in South-East London where small-pox was then prevalent. No information could be obtained of the source of infection in the other case. All four patients had been vaccinated in infancy only. The measures adopted with regard to each case were the same as described in previous reports. No spread of infection occurred from anv of the cases. Vaccination.—The appended table is based on information kindly supplied by the Vaccination Officer. The proportion of children escaping vaccination from various causes is satisfactorily low. The returns for the first half of 1903 cannot be regarded as complete. Vaccination Returns. Births. Successfully Vaccinated. Insusceptible of Vaccination. Died Unvaccinated. Per cent. of Births. Cols. 2, 3, & 4. Vaccination Postponed. Certificates under Act granted for. Remaining (not traced, &c.* Per cent, of Births. Cols. 6, 7, & 8. Cols. 1 2 3 4 5 6 7 8 9 1901 3,364 2,676 5 313 89.0 23 34 313 11.0 1902 3,262 2,629 12 291 89.1 35 19 276 10.1 1903† Jan -June 1,651 1,268 8 132 85.3 74 18 151 14.7 * Including "gone away," "false addresses," apprisals to other districts, &c. † Provisional return only. DIPHTHERIA. (Including Membranous Croup.) Borough. London. 1903. 1902. 1903. 1902. Cases 145 211 7,749 10,743 Deaths 15 32 740 1,159 Morbidity 0.98 1.41 1.67 2.30 Fatality 10.3 15.1 9.9 10.70 Mortality 0.10 0.21 0.16 0.25 The reported cases of diphtheria, which numbered 343 in 1901, declined to 211 in 1902, and to 145 last year, giving a morbidity rate of 0'98 per 1,000 persons of all ages as compared with rates of 1.41 and 2.37 in the two preceding years. The Metropolitan rate last year (1.67, as compared with 2.30 in 1902, and 2.08 in 1901) was 0.69 above the local rate. The decennial average was 318 cases and last year's total was 55 per cent. below that number, while the recorded cases in the Metropolis (7,749) were only 40 per cent. below the average (12,810). The records for last year are contrasted with the various averages below— Diphtheria. (Including Membranous Croup.) Averages. Five years. Five years. Ten years. 1903. 1893-97. 18S8-1902. 1893-1902. London 7,749 13,292 12,312 12,423 Borough ... 145 358 284 318 St. Mary 99 273 179 224 St. John 27 44 28 36 North-West Paddington 19 41 77 58 . 17 diphtheria. The numbers reported last year from each Ward will be found in Table 9. Hyde Park Ward alone had more cases last year (16) than in 1902 (9). The numbers of cases recorded in the adjacent districts are given in Table 7, and the morbidity rates for the two last vears in Table 8. All the rates for 1903 were below those for 1902. The 145 cases reported in the Borough occurred in 130 houses, distributed as below— 1903. 1902. Houses with one case each 119 161 „ „ two cases 8 20 „ „ three „ 2 2 ,, „ four „ 1 1 Three or more cases occurred in 13 streets, compared with 23 in 1902. A tabular list of such streets is appended— 1903. 1902. 1903. 1902. c. h. c. h. c. h. c. h. Ashmore Road (II)* 10 6 7 6 Kilburn Park Road (III) 4 4 2 2 Avenue, Third (I) 3 3 3 9 Market Street (VIII) 3 3 — — Bravington Road (IT) 3 3 6 6 Portnall Road (II) 5 4 11 7 Clarendon Street (V) 5 9 8 6 Shirland Road (II) 3 3 9 7 Fernhead Road (II) 4 3 2 2 Star Street (VIII) 5 5 — — Goldney Road (II) 5 2 2 9 Westbourne Park Road (IV) 3 2 2 2 Kensal Road (IV) 3 3 1 1 The cases in Market and Star Streets represent part of an outbreak in connection with St. Michael's School, which had to be closed on account of the prevalence of the disease. The matter will be dealt with under School Attendance. Of the 145 reported cases, 22 were subsequentlv found to have been erroneously diagnosed, 12 were due to infection contracted outside the Borough, 2 followed the return home of previous patients, and in one other case the patient developed diphtheria in hospital, after admission as a case of scarlet fever. One hundred and twenty-three cases, including 15 "errors" were removed to hospital, equal to 85 per cent. of the notified cases, 9 per cent. more than in 1902. The highest proportion removed from any Ward was 96 (Church Ward) and the lowest, 0 (Lancaster Gate, East, Ward). Further details are given in Table 17. The 15 deaths recorded during the year represent a fatality of 10.3 per cent. of notified cases (including "errors"), as compared with a fatality of 15T per cent in 1902. In the Metropolis as a whole the fatalities for the two years were 9.9 and 10.70 respectively. Among patients treated at home the fatalitv (after correction for "errors") was 13.3 per cent., that among the patients removed to hospital, 12.1 per cent. The home fatality was lower than the rates of 1902 and 1901, while that of hospital cases was equal to rate for 1902, and higher than that for 1901. (See Table 17). The deaths (15) were less than one-fourth the decennial average (66) and compare well with the average for the first quinquennium (86) and with that for the second quinquennium (47). Nine of the deceased persons were residents of St. Marv's Registration Sub-District, 4 of St. John's, and 2 of North-West Paddington. The mortalitv rate for the Borough (0.10) was less than a fourth of the mean (0.44), while as regards the Sub-Districts, the rate for St. John's (0.11) is the only one not showing a large reduction. Full particulars are appended— * The Roman figures in parentheses indicate the Ward in which the street, or part of street is situated. The Wards are numbered thus— I. Queen's Park. V. Church. II. Harrow Road. VI. Lancaster Gate, West. III. Maida Vale. VII. „ „ East. IV. Westbourne. VIII. Hyde Park. 18 scarlf.t fever. Diphtheria. Death-rates all ages. 1903. Mean Rates. Five years. 1893-1897. Five years. 1895-1902. Ten years. 1893-1902. Borough 0.10 0.58 0.31 0.44 St. Mary 0.09 0.69 0.34 0.51 St. John 0.11 0.28 0.07 0.17 North-West Paddington 0.11 0.59 0.64 0.61 Of the adjacent districts Westminster (0.08) and Willesden (0.07) had lower rates than that of the Borough (Table 15) while in comparison with the whole country and its main divisions (Table 16) the local rate is the lowest of all. TABLE 17. Diphtheria 1903. District. Cases Notified.* To Hospital. Per cent. Cases Notified to Hospital Deaths. Fatalities. per cent, cases treated At Home. In Hospital At Home. In Hospital Wards— Queen's Park 19 (4) 16 (3) 84 — 3 (1) — 15.4 Harrow Road 43 (4) 39 (4) 90 1 5 (1) 25.0 11.4 Maida Vale 14 (4) 8(2) 57 — 1 - 16.6 YVestbourne 21 (1) 18 (0) 86 1 0 50.0 11.1 Church 25 (7) 24 (6) 96 — — — — Lancaster Gate, West 3 (0) 2 (0) 67 — — — — „ East 4(2) — — — — — — Hyde Park 16 (0) 16 (0) 100 — 4(0) — 25.0 Borough 1903 145 (22) 123 (15) 84.8 9 15 (2) 13.3 12.1 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. These cases (deaths) have been allowed for in calculating the fatalities. | One other death from diphtheria was registered during the year (in Maida Vale Ward) but the case not having been notified the death has been excluded from this table. SCARLET FEVER. Borough. London. 1903. 1902. 1903. 1902. Cases 414 359 12,545 18,269 Deaths 9 8 361 560 Morbidity 2.83 2.42 2.71 3.91 Fatality 2.5 2.2 2.8 3.0 Mortality 0.06 0.04 0.07 0.12 Although the cases of this disease increased from 359 in 1902 to 414 last year, yet the latter total was well below the corrected decennial average (550). The morbidity rate last vear (2*83) was a little higher than the Metropolitan rate (2.71). SCARLET FEVER 1 9 0 3 . SCARLET FEVER. 10 In addition to the comparisons instituted in Table 10—where the numbers all show considerable falls below the decennial averages—the appended statement will be of interest, as it compares last year's figures with the quinquennial means, and shows that the increase in prevalence last year was not general in the Metropolis, and was of a very slight character. Scarlet Fever. London. Borough. St. Mary. St. John. North-W est Paddington. Total, 1903 12,545 414 314 37 63 Mean, 1893-97 26,029 700 502 91 107 „ 1898-1902 17,418 406 305 57 44 The increase was limited to the late spring and early summer, and more particularly to the third quarter of the year—the cases reported, in the whole Borough, having been 56 in the first quarter (decennial average 79); 86 in the second (decennial average 38); 160 in the third (decennial average 74), and 112 in the fourth (decennial average 159). In the adjoining districts increased prevalence of this disease occurred in St. Marylebone (414 cases were reported in each year, but 1902 contained 53 weeks) and Willesden (474 cases in 1902, 501 in 1903). There is reason to believe that the increase in the Borough was to some extent due to the prevalence in Willesden. This view is supported by the Chart facing this which shows that the rise in the Willesden weekly returns* preceded that in the Borough, where the earliest increase took place in the neighbourhoods of "Oueen's Park" and "St. Peter's Park" Estates. The cases in Oueen's Park Ward (63) and in Church Ward (92) showed the greatest increases in comparison with 1902. (See Table 9). The appended statement of street distribution contains all streets in which three or more cases occurred during the year. scarlet fever. Ward I.—Queen's Park. 1903. 1902. C. H. C. H. Avenue—3rd 4 3 10 7 „ —5th 3 3 4 3 Droop Street 8 7 2 2 Farrant Street 3 3 1 1 Herries Street 5 3 4 4 Kensal Road 4 2 — — Lancefield Street 9 7 1 1 Oliphant Street 7 4 — — 43 32 22 18 Warcl II.—Harrow Road. 1903. 1902. C. H. C. H. Ashmore Road 21 12 16 10 Barnsdale Road 3 3 1 1 Bravington Road 9 6 26 16 Chippenham Road 6 5 6 5 Elgin Avenue 3 3 1 1 Fernhead Road 5 5 7 7 Portnall Road 21 17 14 8 Saltram Crescent 4 3 4 4 Shirland Road 5 4 2 2 Warlock Road 3 2 1 1 80 60 78 55 Ward III.—Maida Vide. 1903. 1902. C. H. C. H. Amberlev Road 11 8 5 4 Essendine Road 3 2 — — Kilburn Park Road 6 5 2 1 Leith Mansions 4 2 — — Maida Vale 4 3 — — Portsdown Road 3 9 1 1 Shirland Road 3 Q o 2 2 Wymering Road 3 1 — — 37 26 10 8 Ward IV.—Westbuurne. 1903. 1902. C. H. C. H. Brindley Street 4 3 3 3 BurlingtonMewsWest 7 4 2 2 Hampden Street 7 5 4 3 Tavistock Road 5 3 1 1 Waverley Road 3 3 5 4 Woodfield Place 4 3 — — Woodfield Road 9 1 3 2 39 22 18 15 * The carve in each case has been constructed by plotting the average of the rates for three consecutive weeks as the rate for the central week. 20 SCARLET FEVER. Ward V.—Church. 1903. 1902. Hall Park C. H. C. H. Adpar Street 12 4 4 2 Hall Place 3 2 2 2 Hethpool Street 5 3 1 1 Clarendon Street Area. Cirencester Street 11 7 3 2 Clarendon Street 4 2 9 8 Desboro' Street 4 2 — — Westbourne Terrace North 3 1 — — Woodchester Street 6 4 3 3 Harrow Road 6 5 7 3 Hermitage Street 4 3 1 1 North Wharf Road 12 7 1 1 70 41 31 23 Ward VI.—Lancaster Gate, West. 1903. 1902. C. H. C. H. Queen's Road 3 2 1 1 Ward VII.—Lancaster Gate, East. Ward VIII.—Hyde Park. 1903. 1902. C. H. C. H. Star Street 3 1 — — The streets named in Harrow Road Ward always furnish a large proportion of the cases of this disease. Special reference will be made later to the cases in Leith Mansions, Burlington Mews West, and Woodfield Road. The 411 cases notified occurred in 312 houses, distributed thus—(the 1902 returns are added for comparison.) 1903. 1902. Houses with 1 case each 239 223 „ 2 cases each 58 42 „ 3 „ 11 11 „ 4 „ — 1 „ 5 „ 9 3 „ 7 (a) „ 1 — „ 9 (b) „ 1 — (a) This "house" represents a group of 15 tenements, the cases occurring in 3 families. (b) This "house" is the Workhouse Nursery, occupied by infants. Of the cases reported, 9 were found to have been erroneously diagnosed, 27 were apparently due to infection contracted outside the Borough, and 14 were "return cases." The cases treated in hospitals numbered 378 (including the 0 "errors"), the removals constituting 01*3 per cent, of the notified cases, as compared with 82*4 in 1002' and 87'2 in 1901. The largest proportion of cases removed was from Westbourne Ward (90 per cent, of the notified cases) and the lowest from Lancaster Gate East Ward (50 per cent). (Table 18). The nine deaths from scarlet fever represent a fatality of 2.5 per cent, of the cases notified during the year, a slight increase over that for 1902 (2.2). The local fatality was lower than that for the Metropolis as a whole (2.8). Of the 309 cases treated in hospital 8 died (fatality 2"1 per cent.) and of the 30 cases kept at home 1 died (fatality 2.7 per cent). (Particulars for each Ward will be found in Table 18). The deaths were 8 below the decennial average (17), a little more than one-third the average (20), for the five vears 1893-97, and 1 in excess of that for the five years 1898-1902 (8). All the deceased persons were residents of St. Mary's Sub-District. The mean rates for the Sub-Districts are appended:— scarlet t ever. Death-rates all ages. 1903 Mean Rates. Five Years. 1893-97 Five Years. 1898-1902 Ten Years. 1893-1902 Borough 0.06 0.17 0.05 0.11 St. Mary 0.09 0.18 0.06 0.12 St. John — 0.10 1.01 0.05 North-West Paddington — 0.26 0.07 0.17 SCARLKT FEVER. 21 Lower death-rates than that for the Borough (0*06) were recorded in Westminster (0*05) and Hampstead (0-01), the other rates given in Table 15 being all above the local rate, which is the lowest of all those included in Table 10. TABLE 18. Scarlet Fever. 1903. District. Cases Notified.* To Hospital. Per cent. Cases Notified to Hospital Deaths. Fatalities per cent, cases treated At Home. In Hospital At Home. In Hospital Wards- Queen's Park 63 60 95 — — — — Harrow Road 97 (2) 86 (2) 89 — — — — Maida Vale 57 (3) 49 (3) 86 — 1 — 2.1 Westbourne 73 70 96 — 4 — 5.7 Church 92 (4) 87 (4) 94 1 4 (1) 20.0 3.6 Lancaster Gate, West 14 12 86 — — — — „ East 6 3 50 — — — — Hyde Park 12 11 92 — — — — Borough 1903 414 (9) 378 (9) 91.3 1 9(1) 2.7 2.1 1902 359 (4) 296 82.4 1 7 1.7 2.3 1901 503 (?) 439 (?) 87.2 2 9 2.7 2.1 * See foot-note to Table 17. The following three groups of cases are worthy of special mention. Leith Mansions.—4 cases in 2 families. The L. family, in which 3 cases occurred, were the first occupants of a new flat, taking possession on 12th Aug. On June 12th one of the children had been removed to hospital from the previous home outside the Borough ill with scarlet fever. After 7 weeks' detention the child was discharged on 1st Aug. On Aug. 13th her brother (C. fet. 4) sickened. He was removed to the Western Fever Hospital on Aug. 17th, and returned home on Oct. 20th. His brother (L. Eet. 12j sickened on Oct. 29th. and his sister F. ret. 18) on Nov. 1:5th. Special and full inquiries were made, but no source of infection could be traced apart from the patients home from hospital. The sanitary condition of the fiat was satisfactorv. Burlington Mews West. -7 cases in 4 families, 3 families having 2 cases each. This group of cases occurred between June 28th and Aug. 7th. On July 7th a case was reported at No. 22, and the certifving practitioner in a covering letter directed attention to three children he had been attending for a week for "sore throats." They had had no rash,,but he suspected that they were suffering from scarlet fever. The two families at Nos. 21 and 22 were in close association. The children at No. 21 were seen by the Medical Officer of Health, on Julv 7th, but no child presented sufficient symptoms to enable a diagnosis of scarlet fever to be made. The children were kept under observation. Subsequently a boy and a girl, aged 10 and 2 respectively, were certified as having the disease, and were removed to hospital on July 11th and 13th. The occurrence of three other cases in the Mews confirms the suspicion that an elder boy at No. 21 had an anomalous attack of the same disease. He was ill when seen by the Medical Officer of Health on the 7th. Woodfield Road.—9 cases in one house. This house was the "Nursery" belonging to the Workhouse. It was inhabited by 4 adults (staff) and 10 children, all under 3 years of age. The first case occurred on February 10th, and was removed to hospital on the same day. The source of infection was not discovered, although the lists of admissions were closely examined, and such visitors as could be identified traced to their homes. The second child sickened on the 12th, but the case was not diagnosed until the 21st, on which day the patient was removed to hospital. In the meantime other cases occurred on the 13th, 14th, 16th, 17th, and 20th. The outbreak concluded with 2 cases on the 23rd. Every case except the second was removed to hospital within twentyfour hours of the onset of the symptoms* 22 FEVER. "FEVER." (Including Enteric, Typhus and Continued Fevers). Borough. London. 1903 1902 1903 1902 Cases 47 84 2,408 3,463 Deaths 8 13 370 541 Morbidity 0.31 0.56 0.50 0.74 Fatality 17.0 15.4 15.0 15.6 Mortality 0.05 0.07 0.07 0.11 The 47 notifications of "fever" in the Borough comprised 43 of enteric fever, 3 of continued (2 being subsequently diagnosed as enteric) fever, and one of typhus fever (erroneously so diagnosed). The 2,408 notifications in the Metropolis comprised 2,344 of enteric, 41 of continued, 22 of typhus, and 1 of relapsing fever. Enteric Fever.—The 40 cases of enteric (and continued fever) in the Borough represented a further fall, the cases having numbered !)2 in 1901, and 84 in 1902. In the Metropolis the cases of these diseases (if thev represent distinct diseases) were 3,251 in 1901, 3,470 in 1902, and 2,385 in 1903. In comparison with the decennial averages the cases of enteric fever reported last vear represent declines equal to 47 and 30 per cent, of the respective averages in the Borough and the Metropolis. The various averages are set out below:— Enteric Fever. Including Continued Fever. 1903. Averages. Five years. 1893—97. Five years. 1898—1902. Ten years. 1893—1902. London 2,835 3,678 3,803 3,746 Borough 46 76 91 83 St. Mary 32 53 67 60 St. John 6 16 13 14 North-West Paddington 8 7 11 9 The only Wards in which any considerable number of cases occurred last year were Church, where 10 cases were reported (compared with 20 in 1902) and Queen's Park 8 (compared with 10 in 1902). In all the other Wards the cases were considerably fewer than in 1902. (See Table 9.) In comparison with the adjacent districts the reported cases (40) were fewer in the Borough than in any district except Hampstead (29 cases) while the morbidity rate for the Borough was the lowest of all. (See Tables 7 and 8). In 0 streets only did more than 1 case occur during the year, viz.:— 1903. 1902. C. H. C. H. Alfred Road (IV.)* 2 2 — — Cirencester Street (V.) 6 3 1 1 Droop Street (I.) 2 2 2 2 Dudley Street (V.) 2 2 — — Kilburn Lane (I.) 2 2 — — Marlboro' Street (IV.) 3 1 — — * For explanation of roman numerals see page 17 (foot note). In 1902, 13 streets had two or more cases. Multiple cases occurred at 5 houses, viz., 2 cases in each of 4 houses (2 cases in 2 houses, 1902) and 3 cases in one house (the same in 1902). In respect of 10 cases there was reason (more or less substantial) for regarding the diagnosis as erroneous, and in 11 cases the infection was contracted outside the Borough. FEVER. 23 It is always difficult to get any satisfactory evidence of the vehicle of infection in sporadic cases of this disease, but the inquiries made elicited the following information— Source of Infection, probably oysters 4 cases. „ ,, cockles 6 „ „ ,, mussels 2 ,, „ „ winkles 1 case „ possibly watercress 1 ,, In 2 cases there was a history of ice-cream being eaten during the incubation period; 4 patients habitually had meals away from home; and one other had been on "drain" work just before onset of illness. Of the 40 cases reported 33 (including 6 "errors") were removed to hospital, equal to 72 per cent, of the notified cases, as compared with 65 and P>3 per cent, in 1902 and 1901. (Sec Table 19). The 7 deaths of persons reported as ill with this disease, included one fatal "error." The fatality (taking all notified cases) was at the rate of 17 per cent., compared with 15.4 per cent, in 1902. Among patients treated at home the fatality was equal to 55 per cent., but in two cases the diagnosis of the disease was not made until death supervened, the patients being ill but a very few days in both cases. Among the patients removed to hospital the fatality (after correction for "errors") was 7.4 per cent, slightly higher than in 1902 (6. per cent, fatality) but much lower than in 1901 (fatalitv 17.6 per cent). (See Table 19). TABLE 19. Enteric Fever. 1903. District. Cases Notified* To Hospital. Per cent, of cases Notified to Hospital Deaths. Fatalities Der cent, cases treated At Home. In Hospital At Home. In Hospital. Wards— Queen's Park 8(3) 4(1) 50 2 — 100 — Harrow Road 3 2 67 1 — 100 — Maida Vale 6 3 50 — — — — Westbourne 8(1) 8(1) 100 — — — Church 15 (3) 14 (2) 93 1(1) 1 — 8.7 Lancaster Gate (West) 3(1) 1 (1) 33 1 1 (1) — — „ „ (East) 1 (1) 1(1) 100 — — — — Hyde Park 2(1) — — — — — — Borough .1903 46 (10) 33 (6) 17.7 5 2(1) 55.5 7.4 1902 84 (10) 54 (6) 65.0 5 8 19.2 6.2 1901 92 (?) 58 (?) 63.0 5 10 14.7 17.6 * See foot-note to Table 17. The 6 deaths certified as due to enteric fever were a trifle more than one-third the decennial average (17) and compare favourablv with the quinquennial averages (19 for 1893-97 and 15 for 1898-1902). Three (3) of the deceased persons were residents of St. Mary's Sub-District, 2 of North-West Paddington, and 1 of St. John's Sub-District. The mortality 24 FEVEK. rate for the Borough was 0.04, less than half the decennial mean rate (0.11). In NorthWest Paddington alone did the mortality anything like approach the averages. (See below). Enteric Fever. Death-rates at all ages. Mean Rates. 1903. Five years. 1893-97. Five years. 1898-1902. Ten years. 1893-1902. Borough 0.04 0.12 0.10 0.11 St. Mary 0.03 0.12 0.10 0.11 St. John 0.02 0.12 0.05 0.08 North-West Paddington 0.11 0.12 0.17 0.14 In Hampstead only (rate 0.02) was the mortality lower than in the Borough (see Table 15), while the local rate was lower than any of the other rates given in Table 10. The following brief notes touching certain cases will be of interest— Queen's Park Warp.- Two cases were reported on the fatal issue, but without post mortem examinations. Both occurred in March, the first being an engine driver on the G.W.R. working between London and Wales. He sickened on March 4th, and died on the 9th. The second was a married woman, with no occupation other than house duties. .She sickened on March 25th and died on April 4th. Harrow Road Ward.—A man, E. F., aged 28, came up on Nov. 8th, to see the Lord Mayor's Show. He sickened that day, and was removed to hospital on the 24th. The Medical Officer of Health of the district where E. F. lived communicated the following information:—"The well of the house is a bricked-in one, situated in the living room, with the pump in an outhouse; outside the house is a rainwater tub; rainwater from the roof can get into the well; the closet is an earth closet in good condition ; there are no other cases of zymotic diseases in the town." An analysis of the water from the well gave fairly high proportions of both ammonias and chlorine. Nothing was said of the soil, so that the value of the chlorine is doubtful. Westbourne Ward. —Three cases in one house in M—Street. Two sisters sickened on Sept. 6th (to hospital on 30th) and a third on (?) 24th (to hospital on 8th Oct.) The family had been to Leigh-on-Sea from the 5th to 10th Sept. While there they ate cockles. It was ascertained that a brother of these patients was ill at his home in Islington, and in consequence of a communication to the Medical Officer of Health of that Borough, the case was promptly certified to be one of enteric fever. A nephew also had the same disease at Leigh-on-Sea. The Medical Officer of the District expressed his opinion that all the cases were "undoubtedly due to polluted cockles." Two cases occurred in one house in A—Road, the first, a man aged 21, sickened on 28th Sept., and the second, his son, aged 4, on the 10th Oct. The father did not go to hospital until 10th Oct. No trace of the source of infection of the first case could be discovered. The son's case was probably due to personal infection from the father. Church Ward.—Of the 15 cases reported from this Ward, 12 occurred in the last quarter of the year. In the first quarter two cases were reported, one undoubtedly erroneously diagnosed, and the second probably so. In the second quarter, no case occurred, and in the third, one case (f. act. 29) who sickened on Sept. 9th. She had partaken of mussels bought raw on the 7th, and cooked (? at home It was ascertained that the mussels came from layings in Hadleigh Ray--a creek well known to be polluted with sewage. Of the 12 cases in the fourth quarter, 6 were reported from A (lease and Ci—(5 cases) Streets. A further case occurred in Willesden in an infected family which moved from the latter street shortly after infection. Five of the cases were from 3 houses situated close together (Ci—Street). The first case (sickened (?) 2nd—to hospital l(!th —died 25th Oct.) was a clerk employed in the City where he had some of his meals. The other four cases were all suspected to be due to the consumption of shell fish—mussels and (or cockles. A hawker from West Ham, well-known in the street, admitted that he obtained his cockles (and probably mussels) from Leigh-on-Sea. The short intervals between the cases precludes direct transmission of infection—see below— House A. f. 32 sickened Nov. 13 to hospital Nov. 20 f. 7 „ „ 19 „ Dec. 4 House B. m. 32 „ „ 18 „ Nov. 16 (to Infirmary) f. 15. „ „ 22 „ „ 24 After the second case in House A the family moved to Willesden, and a third case was admitted to the Infirmary there on Dec. 24. This case was probably due to direct infection from one or other of the earlier cases. Two interesting reports have been recently issued, one by the Medical Officer of Health of Hackney dealing with an outbreak of 110 cases of enteric fever traceable to the consumption of sewage polluted watercress; and the other, issued by the Fishmongers' Company, SEPTIC DISEASES. 25 describing experiments made to determine the efficiency (qua sterilisation) of cooking of mussels, cockles, &c. The results of the experiments may be briefly summed up by stating that the mere boiling of such shellfish is insufficient to destroy dangerous micro-organisms. For trade purposes the Company recommend steaming. In the spring of last vear an outbreak of enteric fever on the Training Ship "Cornwall" led to the discovery that a large number of condemned army blankets had been sold to the public contrarv to rules of the War Office. Many of the blankets were dirty and stained, some being probably "specificallv infected." Several cases of enteric fever were attributed to the use of such blankets. A very large number were traced in various parts of the country, and disinfected bv the local authorities. Some of the blankets were found in Paddington, but no case of illness could be attributed to them. SEPTIC DISEASES* Puerperal Fever. Borough. London. 1903. 1902. 1903. 1902. Cases notified 3 14 231 312 Deaths 4 8 169 201 Morbidity† 0.06 0.36 0.18 0.24 Fatality‡ 133.3 (66.66) 35.71 72.29 64.32 Mortality† 0.08 0.17 0.13 0.16 The notifications of puerperal fever rose from 10 in 1901 to 14 in 1002 and fell to 3 in 1903, the smallest number on record for any vear, and 7 below the decennial average (equal to a reduction of 70 per cent). In the Metropolis there was a decline from 312 cases in 1902 to 231 cases in 1903, the latter figure being 00 (or 21 per cent.) below the decennial average. Of the three cases reported 1 occurred in St. Mary's Sub-District in the first quarter, and 2 (one each in St. Marv's and North-West Paddington Sub-Districts) in the third quarter. The 2 cases in St. Mary's Sub-District were 6 (or 75 per cent.) below the average, the single case in North-West Paddington being the same as the average. The disease was generally less prevalent in the adjacent districts, all the rates given in Table 8 for last year being lower than those for 1902, except in the case of Willesden, where the rate (per 1,000 persons) rose from 0.00 in 1902 to 0.07 in 1903. The prevalence of puerperal fever is, however, more correctlv measured by the proportions to women of childbearing ages, and to births registered. These rates are given in Table 20. TABLE 20. Puerperal Fever. Rates per 1,000. Females aged 15-45 years. Births registered. London 0.18 1.77 Paddington 0.08 1.21 Kensington 0.06 1.12 Westminster 0.08 1.05 Marylebone 0.15 1.78 (2.48) Hampstead 0.03 0.68 Willesden 0.28 2.40 * Under this head fall "puerperal fever," "erysipelas" and "other septic diseases," the two first being scheduled for notification. † Rates per 1,000 females of childbearing age (15 to 45 years.) ‡ Per 100 cases notified. 26 SEPTIC DISEASES. Having regard to the relatively larger proportion of female servants employed in parts of Paddington, Kensington and Hampstead, it is natural that the rates per 1,000 females of marriageable ages should he low. A similarlv low rate might have been expected in Marylebone, where there are a considerable number of servants, and it is difficult to explain the comparatively high rate recorded (0*15). The rate per 1,000 births was highest in Marylebone (1'78 gross, 2*48 corrected) being, however, very cioselv followed bv that of Willesden (2*40). The fatality last year (4 deaths to 3 cases) works out at 133.3 per cent., but two deaths scheduled under "puerperal fever" were not notified as such. Allowing for them the fatality is 66.6 per cent., compared with 35.71 percent, in 1002, the corresponding figures for the Metropolis being 72.29 and 04*32 per cent, respectively. The fatality rates for the adjacent districts are not known. The four (4) deaths were equal to a rate of 0.2 per 1,000 persons of all ages, as compared with mean rates of 0*03 for the decennium and two quinquennia. There was no death from this cause in St. John's Sub-District, the four deaths comprising 3 from St. Mary's Sub-District (rate 0.03, mean-rates (all) 0004) and 1 from that of NorthWest Paddington (rate 0.05, mean rates, decennium 0*04, first quinquennium 0.05, second quinquennium 0.03). To fully measure the fatality of childbearing, deaths from "accidents and diseases of parturition" should be added to those from "puerperal fever." The deaths from these latter causes numbered 9 last vear—7 of the deceased residing in St. Mary's Sub-District, and 1 each in the other two. Appended are the figures for the Metropolis, the Borough, and the three Sub-Districts arranged in same way as in Table 20. Mortality in Childued. 1903. Rates per 1,000 Females aged 15-45 years. Births. London 0.29 2.86 Borough 0.27 3.93* St. Mary 0.35 4.02 St. John 0.06 2.01 North-West Paddington 0.50 4.57 * If the births in outlying institutions be added, the rate becomes 3'75. The rates per 1,000 births in the Borough and its Sub-Districts were higher than that for the Metropolis, except in the case of the Sub-District St. John. The low rate (per 1,000 females of childbearing ages) is undoubtedly due, in part, to the large number of female domestic servants residing there. The corresponding rates for the adjacent districts are not available. The following are the more important facts relating to the three notified cases— I. A. L., aet 33„ married; confined loth Dec. 1002; fever commenced 24th Dec.; to Infirmary 7th Jan., * 1903 ; died 18th Jan. Third child ; instruments used ; nurse untrained. II. M. P., .net. 25, married; confined 20th Aug.; fever commenced 30th Aug.; to hospital 27th Sept. First child; instruments used. III. E. B., at. 25; unmarried; confined 22nd Sept.; fever commenced 20th Sept.; to Infirmary 30th Sept., . died same day. Second child ; attended in labour by midwife, who, it is alleged, used a borrowed enema syringe without any preliminary cleansing ; four previous confinements and two subsequent attended by same midwife recovered without fever. Midwife unqualified. A woman living in the house who had been recently confined was reported to have abcesses in both breasts at the date of E. B's confinement. The two fatal cases which were not notified were recorded as— f. 39, died St. Mary's Hospital, on May 22 ; cause of death "incomplete abortion; septicaemia following miscarriage." f. 28, died at home on 10th March; cause of death "septic meningitis, 10 days; confinement, 9 weeks." SEPTIC DISEASES. 27 Erysipelas. Borough. London. 1903 1902 1903 1902 Cases reported 118 113 4,382 5,554 Deaths 8 3 183 183 Morbidity 0.88 0.96 0.91 1.19 Fatality 6.78 2.09 4.08 3.29 Mortality 0.05 0.02 0.03 0.03 The reported cases decreased from 143 in 1902 to 118 in 1903, and were 44 below the decennial average (102), equal to reduction of 27 per cent., whereas the cases reported in the whole Metropolis (1,382) represent a decline of 29 per cent, below the decennial average (Table 10). Locally the greatest decrease took place in North-West Paddington, and amounted to 46 per cent, of the average. The morbidity rates of all the districts given in Table 8 were lower last year than in 1902. Only nine cases were treated at hospital (or in the Infirmary). The 8 deaths included two fatal cases which were not notified—making the case mortality (fatality) 5.08 per 100 notifications, instead of 0.78 as given above. The local mortality was higher than that for the whole Metropolis. Other Si ptic Diseases.—Under this head there were 1(5 (9)* deaths last year, including "pyaemia and septicaemia" 7 (2) deaths; "infective endocarditis," 3 ((9); "ulcerative stomatitis," 2 (Z); "cellutitis," 2 ( ?); " cancrum oris," 2 (0); and " phlegmon, carbuncle," 1 (2). The sex-distribution was males 10 (5) and females 6 (-/). The ages, &c., will be found in Tables IV. and V. Appendix. Nine of the deaths occurred in hospitals. The mortalitv last vear was at the rate of 0.10 per 1,000 persons, compared with a rate of 0*03 for the Metropolis. In 1902 the respective rates were 0.00 and 0.07. For comparison with the preceding years, deaths from "ervsipelas" have been included among deaths from "other septic diseases." The comparison is given in full below— " Other Septic Diseases." Death-rates at all ages. 1903. Mean Rates. Five years. 1893-97. Five years. 1898-1902. Ten years. 1893-1902. Borough 0.16 0.11 0.10 0.11 St. Mary 0.15 0.12 0.13 0.12 St. John 0.23 0.07 0.06 0.06 North-West Paddington 0.05 0.12 0.06 0.09 MEASLES. Last year was a "non-epidemic" vear, the usual biennial epidemic (gauged by the mortalitv) being due during the current year. Nevertheless information relating to 929 cases was received during the year, 837 cases occurring in St. Mary's Sub-District, 42 in St. John's, and 50*in North-West Paddington. The first cases in households, reported by school teachers, have been tabulated week by week, and the appended statement shows the number of such cases occurring in each quarter in each Sub-District. Measles. Primary cases only. Ouarter 1 o 3 4 Year. St. Mary 38 139 169 330 676 St. John 1 4 2 19 26 North-West Paddington 3 4 14 13 44 42 147 185 362 736 * Figures in parentheses refer to 1902. 28 measles. The remaining 193 cases represent secondary attacks in households, cases reported by persons other than school teachers, and those discovered on registration of death. There is reason to believe that the sudden rise in the last quarter was attributable to the epidemic of the disease which had prevailed in Willesden since the summer. The 921) cases known to the Department were distributed among the Wards as below:— Queen's Park 50 Maida Vale 113 Church 321 Lancaster Gate (East) 11 Harrow Road 185 Westbourne 221 Lancaster Gate (West) 10 Hyde Park 18 The cases occurred in 491 houses, viz.:— 242 houses with 1 case each. 141 „ 2 cases „ 60 „ 3 „ „ 30 ,, 4 ,, ,, 10 houses with 5 cases each. 3 „ 6 3 ,, 7 ,, 2 ,, 8 ,, The sex and age distribution of cases and deaths is indicated in Table 21. TABLE 21. Measles, 1903. Registration Sub-Districts. 0— 1— 2— 3— 4— 5— 13— 15— m. f. m. f. m. f. m. f. m. f. m. f. m. F. m. f. St. Mary Cases 24 27 62 00 55 45 66 77 96 78 106 131 1 1 5 o o Deaths 2 2 12 4 9 4 — — — 1 — — — — — — St. John Cases — 2 2 1 3 5 1 3 3 o o 7 10 — — 1 1 Dentils — 1 — — — — — — — — — — — — — — North-West Paddington Cases 4 2 4 4 3 2 5 9 3 2 7 2 1 1 1 — Deaths — 1 1 1 — 1 — — — — — — — — — — It is difficult to frame any idea as to the proportion of total cases which comes to the knowledge of the department. It is, however, believed that nearly all the cases occurring in families sending children to the public elementary schools are reported, when such cases occur during term time or shortly before, but, of course, some remain unknown owing to the holidays. Moreover, compulsory closure of a school or any part of it involves the loss of information of cases among the children normally attending the school. Under School Attendance will be found a new table showing the number of attacks in families sending children to the various schools. With the present information it is profitless to calculate the fatality rates, but attention ma}' be directed to the special incidence of death at ages of one and two years. It is a well-known fact that the fatality of the disease decreases rapidly with the age of the patient. Hence it is desirable to make every effort to prevent voung children becoming infected. Although it is not inevitable that every child should have measles, yet with the (almost) contemptuous disregard which is paid at present to the disease, it is rare for a child to escape. Until last year there was no legal restriction to the spread of infection. Now the Order of the County Council, which came into effect on April 1st, 1903, makes the exposure of infected persons or articles in public places a penal offence, and places the question of disinfection of rooms and articles in the same position as that of notified diseases, such as scarlet fever. Difficulties have already been experienced in carrying out the Order from MEASLES. 29 (a) the fact that there is no provision for informing the local authority of the ocurrence of a case of the disease ; and (b) the habit which so many parents have of treating cases of measles without calling in medical advice. It is hoped, however, that two useful results will accrue—(i) that parents will come to regard measles as a serious disease, which it is if not properly treated, and will take more care to prevent the spread of infection; and (ii)— consequentially in part from (/)—that the children will have a better chance of escaping infection at the younger ages, If the Order is to be of real effect it will be mainly through the co-operation of the school teachers. The following extract from Miss O'Kell's report is of interest in this connection :— " It has been interesting to watch the effects of the Order made by the London County Council (April 1903/ applying to Measles, the sections of the Public Health (London) Act of 1891 relating to disinfection and the spread of infection. Undoubtedly one of the chief effects has been to raise (in the opinion of the public) the importance of the disease. Immediately before the Order came into operation the teachers of all elementary schools in the District were visited, and their co-operation asked for in making the Order as effectual as possible by regular and prompt notification of cases; and though I cannot say that all Schools have responded equally to this request, it must be recorded that many have aided us to the best of their ability, and, as they frequently admit, to their own advantage. There are many practical difficulties which the teachers have to contend with and which some teachers make notable efforts to overcome. The chief is their difficulty in quickly learning of the existence of cases. The School Board Visitor reports too late to be of use, and many teachers decline—and are surely justified in so doing—to send a message by a scholar to a house where infection is suspected. Continued absence of a child suffering from measles is not infrequently reported by a brother or sister as a "cold " or " bronchitis." This is known to be done in order to avoid the temporary exclusion from school of the whole family, which is often keenly resented by both parents and children, because of the custom of the Board in awarding medals for regular attendance. It would seem only fair to credit children with these enforced absences, but the Board take a different view of the matter, and will only reward for actual attendances made ; hence a certain amount of deception is practised." As regards prevention of spread of infection, it may be explained that owing to the specially insidious onset of the disease, the patient being then highly infectious, it is regarded by the Department as almost impossible to prevent secondary cases in households containing a number of susceptible children. The efforts of the Department are therefore directed to prevent the spread of infection to other households—in other words, the family rather than the patient is dealt with for isolation. Given early information of the first cases occurring after a lull in the prevalence of the disease, it is believed that the disease can with the co-operation of the public be prevented from becoming epidemic. The mortality last year was at the rate of 0'26 per 1,000 persons of all ages, being O'lO below the mean rates. The mortalitv in 1902 was 0'55. The mortalities in the SubDistricts are compared with the various mean rates below :— Borough St. Mary St. John North-West Paddington 1903 0.20 0.35 0.02 0.23 Measles. Death.rates. Five years. 1893.97 0.36 0.45 011 0.39 Mean Rates. Five years. 1898.1902 0.36 0.45 0.10 0.39 Ten years. 1893.1902 0.36 0.45 0.10 0.39 Of the rates included in Table 15, that of Paddington (0.27) was exceeded by those of Marylebone (0.28) and Willesden (0.66), while of those for last year, included in Table 16, all were higher than the local rate except that (0.17) for " Rest of England and Wales' (Rural Districts). 30 WHOOPING COUGH. WHOOPING COUGH. Information of 533 cases of this disease reached the Department, last year being the first occasion of the disease being systematically reported by the school teachers. The numbers reported in connection with the schools were:— Whooping Cough. Quarter 1 9 3 4 Year St. Mary . 189 26 11 2 228 St. John 3 9 — — 12 North-West Paddington 89 — — — 89 281 35 11 2 329 The Ward distribution of the known cases was— Queen's Park 134 Maida Vale 57 Church 56 Lancaster Gate (East) 7 Harrow Road 147 Westbourne 121 Lancaster Gate (West) 1 Hyde Park 10 The cases occurred in 290 houses— 152 houses having 1 case each. 8 houses having 5 cases each. 71 „ 2 cases „ 6 „ 44 „ 3 „ „ and 12 „ 4 „ ,, 1 house having 7 cases. The distribution of cases and deaths, distinguishing sex and age of the patients in the Registration Sub-District is given in Table 22. TABLE 22. Whooping Cough. 1903. 0- 1— 2- 3- 4— 5— 13— 15— M. F M. F. M. F. M. F M. F. M. F M. F. M. F. St. Mary Cases 12 25 23 25 19 16 26 36 21 39 62 74 - 1 — 2 Deaths 8 9 6 10 I 2 - 1 - - - - - - - 1 St. John Cases 1 1 1 - 1 — — — 1 4 2 7 - - - - Deaths 1 Z 1 — 1 - - - - - - - - - - - North-West Paddington Cases 7 8 9 8 9 4 6 8 19 12 21 23 — — — — Deaths 3 2 1 3 1 1 - — - - - - - - — The mortality was at the rate of 0.36 per 1,000 persons, as compared with 0T4 in 1902. Higher rates were recorded in Kensington (0.50), Marylebone (0.42), and Willesden (0.54). (See Table 15.) Last year's rates for the Sub-Districts are compared with the mean rates below:— Whooping Cough. Death-rates. Mean Rates. 1903. Five years. 1893-97 Five years. 1898-1902 Ten years. 1893-1902 Borough 0.36 0.40 0.29 0.34 St. Mary 0.39 0.43 0.35 0.39 St. John 0.11 0.12 0.09 0.10 North-West Paddington 0.61 0.74 0.35 0.54 31 chicken-pox. CHICKEN-POX. The Order requiring the notification of this disease expired at the middle of January of last year. In addition to 17 cases notified under the Order, 170 cases were reported to the Department. Of the 193 cases, 122 were from St. Mary's Sub-District, 21 from St. John's, and 47 from North-West Paddington. There was only one death from this disease. The sex-age distribution of the cases was— Ages 0— 1— 2— 3— 4— ;>— 13— 15— Males 4 11 5 8 18 48 10 4 Females 3 2 4 12 12 38 10 4 Distributing the cases according to Wards— Queen's Park Ward 47 Maida Vale 6 Church 20 Lancaster Gate (East) 6 Harrow Road 62 Westbourne 35 Lancaster Gate (West) 4 Hyde Park 13 The cases were reported from 139 houses, viz.— From 107 houses 1 case. From 5 houses 4 cases. „ 20 „ 2 cases. „ 1 house . 5 „ ,, 5 ,, 3 „ „ 1 ,, 6 ,. TUBERCULAR DISEASES. Phthisis (Consumption).—There were 152 deaths from this disease last year, one less than 1902 (53 weeks). The deaths comprised 87 of males and 05 of females. Particulars as to deaths at various ages and of deaths in the Wards, &c., will be found in Tables IV. and V. (Appendix.) The deaths last year were 22 below the decennial average (174), 28 below the average for the five years, 1893-97 (180), and 17 below the average for the five years, 1898-1902 (109). The mortality last year was at the rate of 1.04 per 1,000 persons of all ages, 0T4 below the decennial mean rate. A full comparison of rates is appended— Phthisis. Death-rates. Mean Rates. / Five years. Five years. Ten years. 1903 1893-97 1898-1902 1893-1902 Borough 1.04 1.22 1.15 1.18 St. Mary 1.21 1.37 1.32 1.34 St. John 0.31 0.82 0.66 0.74 North-West Paddington 1.47 1.28 1.21 1.24 Corresponding comparisons for the Wards are not available at present, as the rates have only been taken out for three years. These rates will be found in Table 25, and show that in the Northern Wards last year's rates were generally higher than those for 1902. The variations are, however, too irregular to warrant any conclusions being drawn from them. The death rates from phthisis in the adjacent districts, obtained from data given in the Registrar-General's Quarterly Reports, are set out in Table 15. The local rate there given (0.06) is third in order of magnitude, lower rates having been recorded in Hampstead (0.73) and Willesden (0.88). These rates are "crude" rates, and take no count of the sex-age constitutions of the populations. Factors for such correction were given in the last Annual Report of the Medical Officer of Health of the County, and Table 23 has been prepared by means of those factors. The local rate for last year (1.00) was 41.2 per cent, below the standard rate (1.80), the greatest decrease being in the rate for Hampstead (58.3 per cent, below the standard rate), and the least, that for Marylebone (decrease equal to 1.7 per cent, of the standard rate). * The factor for Willesden has been calculated by the Department. 32 phthisis. TABLE 23. Phthisis. Mortality Rates. Standard Rate. 1901. Recorded. Corrected. 1902. Recorded. Corrected. 1903. Recorded. Corrected. London 1-74 1-06 1-66 1-00 1-60 1-54 1-54 Paddington 1-80 ' 1-09 1-00 1-05 1-01 1-06 1-02 Kensington. 1-78 1-36 1-33 1-29 1-26 1-24 1-20 Westminster 1-95 1-89 1-68 1-78 1-59 1-68 1-49 Marylebone. 1-85 1-12 1-05 1-92 1-80 1-82 1-70 Hampstead 1*75 0-92 0-90 0-85 0-84 0-73 0-7 2 Willesden 1-65 0-82 0-85 0-89 0-93 0-88 0-92 In the Report for 1902, an attempt was made to show the connection between the "housing" conditions of the people and the phthisis mortality. The Tables then given are here reproduced in a somewhat modified form. (Sec Tables 21 and 25.) TABLE 24. Phthisis and Housing. Adjacent Districts. Percentage of total population "Overcrowded." Living in homes of less than 5 rooms. Mean mortality (all ages.) 1901-3. " c." " r." Hampstead 6-4 Hampstead 29-6 Hampstead ... 0*82 0-83 Willesden 11-6 Kensington 41-7 Willesden ... 0-90 0-86 Westminster 13-0 Westminster 45-7 Paddington 1-03 1-07 Paddington 13-6 Willesden 50-7 Kensington ... 1-26 1-30 Kensington 14-8 Paddington 50-9 Marylebone... 1-52 1-62 Marylebone 21-1 Marylebone 55-6 Westminster 1-59 1-78 C.—Mean of corrected rates. R.— „ recorded „ Considering whole districts first (Table 24), it is seen that in Hampstead, where there was least " overcrowding" at the Census, and where the smallest proportion of the inhabitants resided in homes of less than 5 rooms, the mean mortality rates (both recorded and corrected) were the lowest. On the other hand, Marylebone, where the proportions were highest in both cases, had a somewhat smaller mortality than Westminster, which stands about midway in the scale of overcrowding, etc. As regards the Wards (Table 25), in Lancaster Gate East and West Wards, where the housing conditions mav be taken as practically identical, and where the proportions of "overcrowding" of residents in the smaller houses are the lowest in the Borough, the 33 phthisis. phthisis mortality has been lowest during the three years (1901-03)—the mortality in Hyde Park Ward being, however, but slightly higher. The highest mortality has been recorded each year in Church Ward, where the housing conditions are least satisfactory. TABLE 25. Phthisis and Housing. Wards of the Borough. Percentage of Total Population " Overcrowded " Living in homes of Mortalities. (All ages.) less than 5 rooms. 1901. 1902. 1903. Queen's Park 9.1 51.7 1.04 0.91 1.47 Harrow Road 11.5 75.5 0.82 1.18 0.88 Maida Vale 12.6 43.4 1.11 0.92 1.14 Westbourne. 13.4 46.3 1.13 0.89 1.35 Church 32.8 61.3 1.93 1.51 1.49 Lancaster Gate— West 2.6 15.2 0.35 0.69 0.11 East 2.1 10.2 0.12 0.73 0.25 Hyde Park 5.2 25.3 0.50 0.69 0.28 The mortality of phthisis is especially disadvantageous to the community, as it falls heaviest on the productive vears of life, as appears from the following statement:— 0— 15— 25— 35— 45— 5£ — 05— M F. M. F. M. F. M. F. M. F. M. F. M. F. 1903 ... 3 4 15 11 10 18 27 10 18 7 6 5 2 4 1902 ... 2 1 12 8 19 15 20 13 10 10 9 13 5 4 1901 ... 2 4 9 12 10 21 22 10 21 9 10 4 5 0 The progress of the disease being usually slow, the foregoing figures indicate that infection was probably, in the majority of cases, acquired in the early vears of life. Children are always the first to show the ill effects of defective housing, and to that factor, conjoined to neglect of the illnesses of childhood—especially measles and whooping cough—must be attributed a large proportion of the phthisis now prevailing. Infective the disease undoubtedly is, but infection, apart from the causes already mentioned, is probably a minor factor in the spread of the disease. I here appears to be a danger, at the present time, of concentrating too much attention on phthisis as an infectious disease, and of neglecting the more effective factors connected with " housing " and child rearing. Other Tubercular Diseases.—The deaths from the various forms of tubercular diseases included under this head, numbered 54, as compared with 60 in 1902. The deaths in St. Mary's Sub-district, numbered 37 ; in St. John's, 8; and in North-West Paddington, 9. The decennial average number of deaths for the whole Borough was 80. The majority of deaths occurred in early years of life. (See Table IV. Appendix, also Table V. for numbers of deaths in the Wards). 34 CANCER. The mortality last year was at the rate of 0.37, or 0.03 less than in 1902. The mean rates, etc., are given below :— Other Tubercular Diseases. Death-rates. Mean Rates. Five years. Five years. Ten years. 1903 1893-97 1898-1902 1893-1902 Borough. 0.37 0.58 0.50 0.54 St. Mary 0.38 0.70 0.56 0.63 St. John 0.23 0.27 0.26 0.26 North-West Paddington 0.53 0.56 0.68 0.62 "CANCER." The deaths from the various forms of malignant disease numbered 159, being 25 more than in 1902 (134), 11 more than 1901, 7 more than in 1900, but 6 less than in 1899. The deaths last year were 19 in excess of the decennial average, and 25 in excess of the average for the five years 1893-97. Of the 159 deceased persons, 04 were males and 95 females—101 persons (both sexes) being residents of St. Mary's Sub-district, 27 of St. John's, and 31 of North-W est Paddington. (The numbers for the Wards will be found in Table V. Appendix, and the ages at death in Table IV.) The mortality last year was 1.08 per 1,000 persons, being 0.18 in excess of the rate for 1902. The rates for the Sub-Districts are compared with the mean in the appended statement :— Cancer. Death-rates. Mean Rates. Five years. Five years. Ten years. 1903 1893-97 1898-1902 1893-1902 Borough 1.08 0.91 1.00 0.95 St. Mary 1.16 0.93 1.04 ... 0.98 St. John 0.80 0.94 0.98 ... 0.96 North-West Paddington 1.83 0.73 0.84 ... 0.78 Thus, there was an increased mortality as compared with the mean rates, and a very marked increase (probably temporary only) in North-West Paddington, where last year's rate (1.83) was more than three times as large as the rate in 1902 (0.51). TABLE 26. Cancer. Mortality Rates. Standard Rates. 1901. Recorded. Corrected. 1902. Recorded. Corrected. 1903. Recorded. Corrected. London 0.87 0.88 0.88 0.93 0.93 1.01 1.01 Paddington 0.98 1.03 0.92 0.96 0.8G 1.08 0.96 Kensington 1.02 1.12 0.9G 0.89 0.76 1.04 0.89 Westminster 0.96 0.83 0.76 1.07 0.98 0.99 0.90 Marylebone. 0.99 1.04 0.92 1.10 0.97 1.24 1.09 Hampstead 0.92 0.96 0.91 1.11 1.05 1.23 1.6 Willesden. 0.71 0.74 0.91 0.79 0.97 0.91 1.2 * Calculations for this District made by the Department. other diseases. 35 The Medical Officer of Health of the County has calculated the factors necessary to correct recorded death-rates from " cancer " for the sex-age-constitution of the population of the Metropolitan Boroughs. In Table 26 will be found the recorded and corrected rates for the Borough and the adjacent districts for the last three years. The recorded and corrected rates for last year, with one or two exceptions, are in excess of the standard rates. The usual Table of the parts affected, distinguishing the principal forms of "Cancer," is appended (Table 27). TABLE 27. " Cancer." 1903. 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 ... ... ... ... ... ... ... ... ... ... ... ... 2. Organs of Special-Sense, Ear. ... ... ... ... ... ... ... ... ... ... ... 3. Respiratory System, Larynx ... ... ... ... 1 .... ... ... ... ... ... ... Lung 1 1 ... ... ... ... 1 ... ... ... ... ... 4. Circulatory System ... ... ... ... ... ... ... ... ... ... ... ... 5. Digestive System, Tongue 3 ... ... ... 2 ... 1 ... 1 ... ... ... Glamls of Mouth ... ... 1 ... ... ... ... ... ... ... ... ... [?phagus 4 1 ... 1 ... ... ... ... 2 ... ... ... Stomach . 8 1 ... 1 4 ... ... 5 2 ... ... Intestine . 3 6 ... ... ... ... ... 1 ... 1 ... Rectum 3 4 ... 1 1 ... ... 1 2 .... ... Liver 5 5 ... ... ... 4 ... ... 2 ... ... ... Pancreas 2 ... ... ... 1 ... ... ... . . . ... ... Peritoneum 1 1 ... ... ... 1 ... ... ... . . . ... ... Omentum . 1 ... ... ... ... ... ... ... 1 1 ... ... 6. Lymphatic System. 2 1 2 ... ... ... ... ... ... 1 ... ... 7. Urinary System ... ... ... ... ... ... ... ... ... 1 8. Generative System, Ovaries ... ... ... 1 ... 1 ... ... ... ... ... ... Uterus ... 12 ... 1 ... 3 ... ... 4 ... ... External Organs ... ... ... 1 ... ... ... ... ... ... ... ... Breast ... 10 ... 4 ... 3 ... 2 ... ... 9. Osseous & Muscular Systems 1 ... 1 ... ... ... 1 ... 1 ... ..! ... 10. Cutaneous System ... ... ... ... ... ... ... ... ... ... ... ... 11. Insufficiently described 1 1 ... 1 ... ... ... ... 1 ... ... ... Totals. 35 53 4 9 5 18 3 1 14 13 3 1 " C." includes Cancer (31 deaths), Carcinoma (83 deaths), Malignant Disease (24 deaths). " O." includes Sarcoma (8 deaths), Scirrhus (5 deaths), Epithelioma (6 deaths), Rodent Ulcer and Cancerous Cystic Fibroma (1 death each). " M."—Males. " F."—Females. OTHER DISEASES* Influenza.—The 26 (62) deaths from this disease were equal to a rate of 0.17 (0.41) per 1,000 persons, 0.30 less than the decennial mean. In St. Mary's Sub-District the deaths numbered 21 (47) (rate 0.22 (0.48), or 0.26 less than the mean), in St. John, 3 (rate 0.08 (0.22), or 0.40 less than the mean), and in North-West Paddington, 2 (rate 0.11 (0.40), or 0.26 less than the mean). Respiratory Diseases.—The deaths from bronchitis (160) and pneumonia (141) numbered 301 (395) and were equal to a rate of 2.05 (2.35) per 1,000 persons, being 0.75 less than the * " 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. | The italic figures in parentheses indicate the numbers or rates for 1902. 30 infantile mortality. decennial mean (2.82). In St. Mary's Sub-District the rate last year was 2.33 (3.14) mean 3.24, in St. John's 1.15 (1.21), mean 1.78, and in North-West Paddington 2.23 (2.86)t mean 2.70. Alcoholism.—Deaths are scheduled under two forms of " alcoholism," acute (delirium tremens) and chronic. It is usual to add the deaths from " cirrhosis of the liver" to these causes when dealing with the mortality from alcoholic excess, although a (probably) small proportion of the deaths from cirrhosis of the liver have no connection with alcohol. From " acute alcoholism" the deaths during the past three years have numbered 8, viz., 7 of males and 1 of females. From "chronic alcoholism," 50, 25 of males and 31 of females, and from " cirrhosis of the liver," 05, 32 of males and 33 of females. 1901. 1902. 1903. m. f. m. f. m. f. Acute alcoholism 1 — 3 — 3 1 Chronic alcoholism . 8 7 8 12 9 12 Cirrhosis of the liver 8 13 13 12 11 8 The combined mortality last year was 0.29 per 1,000 persons, being 0.07 in excess of the decennial mean. The other rates and means are given below :— Alcoholic Excess. Death-rates. Mean Rates. Five years. Five years. Ten years. 1903 1893-97 1898-1902 1893-1902 BOROUGH 0.29 0.20 0.26 0.22 St. Mary 0.33 0.21 0.28 0.25 St. John 0.22 0.24 0.22 0.23 North-West Paddington 0.16 0.05 0.20 0.12 The tendency to increased mortality from alcoholic excess, adverted to in previous reports, still persists. INFANTILE MORTALITY. The deaths of infants under one year of age registered within the Borough numbered 425 less than last year, 49 fewer than in 1902. (See Table I, Appendix.) The gross mortality at this age was 128 per 1,000 births registered in the Borough, compared with a rate of 144 in 1902. Last year's rate was 26 below the mean rate (154). The corrected total of dealhs at this age was 388, compared with 433 in 1902, the mortality rates for the two years being respectively 108 and 131 per 1,000 births registered in the Borough—a very satisfactory decrease, but due more to the character of the weather than to any other factor. The decennial mean rate was 149, 41 above last year's rate. The mean rates (quinquennial and decennial) for the Borough and the three Registration SubDistricts are given below :— Infantile Mortalities Per 1,000 Births registered. Mean Rates. Five years. Five years. Ten years. 1903 1893-97 1898-1902 1893-1902 "Borough 108 150 149 149 St. Mary 122 157 153 155 St. John 104 115 109 112 North-West Paddington 98 144 161 154 infantile mortality. 37 The mortality among males in the Borough was at the rate of 125 per 1,000 births, that for females 109. In Table 28 particulars are given of the numbers of deaths and mortalities at various ages under one year in the three Sub-Districts, and in Table 13 the number of deaths under one year in each Ward. The mortalities in the Wards cannot be calculated as the births are not known. The death-rates per 1,000 estimated living under one year of age in the Borough will be found in Table 14. Although not a reliable guide, the rates may be considered satisfactory. TABLE 28. Deaths and Mortalities at ages under One Year. 1903. 1903. Under One Year. Registration Sub-Districts Weeks. Months 0— 1— 0— 1— 3— 6— 9— 1903. 1902. 1901. Deaths : — M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. *'• M. F. M. F. St. Mary 29 21 29 22 58 43 33 25 37 36 26 22 15 10 169 j 136 204 121 186 168 St. John 3 6 2 2 5 8 3 7 2 3 4 4 2 2 16 24 22 10 20 19 North-West Paddington 4 2 2 2 G 4 5 4 6 4 1 1 5 7 23 20 43 33 35 27 Mortality* :— St. Mary 22 17 22 17 16 34 25 20 28 29 20 17 11 8 135 110 161 102 141 138 St. John 15 31 10 10 25 42 15 37 10 15 20 21 10 10 82 127 120 50 98 102 North-West Paddington 18 9 9 9 27 18 23 18 27 18 4 4 23 31 106 90 178 140 152 121 * Par 1,000 births of each sex registered in each district. Comparing the local rate with those of the adjoining Districts (Table 15), or with those for the whole County and its three main divisions (Table 10), the local rate stands well, being even on the higher rate obtained from the Registrar-General's returns (118) third on the list of the Districts in Table 15 and the lowest of all given in Table 16. The causes of death are indicated in Table 29. It will be seen that the number of deaths from each cause was below the average, except in the case of " measles " (26 cases last year, compared with an average of 11), "whooping cough" (24 against 22), "injury at birth" (3 deaths, average 2), and "rickets," (2 deaths, average 1). There was a very notable reduction in the number of deaths from " diarrhæeal diseases" (62 deaths recorded, the average being 113). 38 infantile mortality. TABLE 29. Causes of Death at Ages under One Year. Small-pox 1903. Borough. St. Mary. St. John. North-West Persons. Paddington. m. f. m. F m. f. 1903. Average. 1893-1902. ... ... ... ... ... ... 0 Measles 2 2 ... 1 ... 1 6 11 Scarlet Fever ... 1 ... ... ... ... 1 1 Whooping Cough 8 9 1 1 3 2 24 22 Diphtheria ... ... ... ... ... 4 Diarrhoeal Diseases 31 21 1 1 3 5 62 114 Syphilis 4 1 ... 1 ... 1 7 7 Tubercular Diseases 8 8 2 ... ... 2 20 29 Premature Birth 24 17 1 6 3 2 53 70 Congenital Malformation 7 5 1 3 ... ... 16 22 Injury at Birth 1 ... 1 ... ... 1 3 2 Dentition 2 ... ... 1 1 ... 4 9 Rickets ... ... 1 ... ... 1 2 1 Atrophy and Debility 21 20 2 2 6 ... 51 58 Convulsions 10 5 1 2 1 ... 19 27 Respiratory Diseases 32 23 4 2 3 5 69 87 Accident and Violence 4 6 ... 1 1 ... 12 17 Other Causes 15 18 1 3 2 ... 39 40 All Causes 160 136 16 24 23 20 388 521 Births Registered 1,248 1,235 194 188 216 221 3,302 3,468 Diarrheal Diseases. The total number of deaths from these diseases was 87 (46 of the deceased being males and 41 females), viz., : " Diarrhoea and dysentery," 41 deaths; " epidemic or zymotic enteritis," 33; and "enteritis," 13. Appended are the complete figures for the last three years. The deaths previous to 1901 were scheduled in a different form, and corresponding figures are not available. Diarrhoea and Dysentery Epidemic Enteritis Enteritis Totals Totals (Persons) All ages Under 1 year All ages Under 1 year All ages Under 1 year All ages Under 1 year All ages Under 1 year 1901. m. f. 41 49 37 40 23 22 21 21 3 4 3 2 67 75 61 63 142 124 1902. m. f. 34 21 29 15 13 11 10 8 8 12 5 3 55 44 44 26 99 70 1903. m. f. 23 18 20 14 17 16 15 13 6 7 6 5 46 41 41 32 87 73 infantile mortality. 39 The two first disorders represent the " summer diarrhoea" of infants. From them there were 62 deaths (at ages under 1 year) last year, as compared with 119 in 1901 and 62 in 1902. The "summer diarrhoea" of infants is mainly prevalent during the third quarter of the year and peculiarly dependent on temperature and rainfall. The deaths recorded during that quarter of the last three years are tabulated below together with the records of temperature andjjrainfall (Greenwich Observatory). Summer Diarrhcea. Infants under 1 year of age. Temperatures Weeks. Deaths recorded. Of Air. Earth at 3ft. Rainfall in. Max. Mean. 1-4 1903 5 87.5 63.3 61.17 5.27 1902 5 86.1 61.5 60.25 1.15 1901 19 87.9 64.6 62.50 2.35 5-9 1903 13 82.0 60.0 60.51 5.66 1902 18 79.0 59.3 59.80 2.57 1901 69 84.2 62.6 63.19 2.32 10-13 1903 13 70.7 56.0 57.02 1.39 1902 35 75.1 56.5 57.22 2.19 1901 16 76.9 57.8 60.21 1.35 Whole Quarter. 1903 31 87.5 59.8 60.17 12.32 1902 58 86.1 59.1 59.68 5.91 1901 94 87.9 61.8 62.06 6.02 Comparing 1901 with 1903, the two years of greatest contrast, it will be seen that, although there was no great difference between the maximal temperatures recorded in each year, yet the mean air temperature and the mean temperature of the earth, at a depth of 3ft., were in each case higher in 1901 than in 1903. On the other hand, the rainfall in 1903 was for the whole quarter, and for two out of the three sub-divisions thereof, more than twice the amount recorded in 1901. This last factor was probably the efficient cause of the lowered mortality from diarrhoea. The necessary data are not available for comparing the mortality from this cause among infants in other districts. The rates given in Tables 15 and 16 are calculated on the populations of all ages. In Table 15, it will be seen that Westminster (0.30) and Hampstead (0.10) had lower rates than the Borough (0.44). According to Table 16, the local rate was (0.57), and was exceeded only by that of the Metropolis (0.63), and that of the " 76 Great Towns" (0.71), but it is probable that the local rate, being that calculated by the Department, is based on a figure not strictly comparable with those used for the other rates. Comparing the rates for last year (per 1,000 persons of all ages) with the various mean rates, it is found that all were markedly below the means, as may be seen from below:— Diarrhœal Diseases. Rates per 1,000 Persons of all Ages. Mean Rates. 1903 Borough 0.57 St. Mary 0.63 St. John 0.08 North-West Paddington 0.59 ———— F ive years. 1893.97 0.96 1.10 0.43 1.30 Five years. 1898.1902 1.08 1.27 0.44 1.25 Ten years. 1893.1902 1.02 1.18 0.43 1.27 40 INFANTILE MORTALITY. The further comparison of deaths from these causes, at ages under one year, may prove of interest:— Diarrhœal Diseases.* Deaths at ages under One Year. Average annual number. Five years. Five years. Ten years. 1903 1893-97 1898-1902 1893-1902 Borough 73 101 125 113 St. Mary 61 75 97 86 St. John 3 8 10 9 North-West Paddington 9 18 18 18 * Including "Enteritis" and "Epidemic Enteritis." During the year 59 cases of fatal diarrhoea in infants were investigated bv the Inspectors.* This being the first occasion of such investigation the results are not so complete as might be desired, such as they are, they afford food for reflection. Of the 59 deceased infants, 13 only were breast fed, the remainder (46) having various substitutes :— 27 being fed on diluted cows' milk, 10 „ condensed milk. 7 „ a mixture of milks, &c. 2 „ patent foods. The type of bottle in use was noted in 10 out of the 46 cases—in 19, the long tube bottle was used (in some instances, in spite of medical advice to use tubeless bottles), and in 21, the boat-shaped tubeless bottle. As the inquiries were not instituted until some days after death, no useful information was obtained of the state of the bottles, or of the causes of the diarrhœa. In 3 cases, however, there was evidence pointing to direct infection of the patient from earlier cases of the disease occurring in the house. The provision for storing the infant's food, whatever be its nature (other than breast milk), is of vital importance. It is a significant fact that the Inspectors report that, "of the 59 homes inspected only 9 could be said to possess proper accommodation for the storage of food." Milk is best kept exposed to the air, but protected bv a fold of muslin, and where suitably placed as regard sun, the window-ledge is admirably suited for standing milk. Wherever kept, milk should be protected from dust and flics. On this, the Inspectors report, "We frequentlv find a family's whole stock of perishable food fully exposed to the attacks of flies, which always seem to patronise chiefly the babv's milk, especially if it be of the condensed and sweetened order. A more sickening sight can scarcely be imagined." The danger attaching to flies will be apparent, when it is remembered that dust-holes and refuse heaps are their breeding grounds and natural habitations. It is well known to scientists that the legs of flies are especially adapted for carrying micro-organisms from place to place. There can be no doubt that the provision of a suitable larder to eacli tenement should be insisted on. In 16 cases the mothers had to go out to work and leave the child to the care of other persons. Three of the deceased infants were "nurse children" and 6 in all were stated to be illegitimate. As regards "housing," 11 deaths occurred in homes of one room, the number of occupants of a home ranging from 2 to 1 persons (adults and children in about equal proportions); 21 in homes of two rooms (inhabited by 3 to 8 persons); 15 in homes of three rooms (occupants from 4 to 8 persons); and 1 in a home of four rooms (1 persons occupying the same). In other words, 50 out of the 59 deaths investigated occurred in homes of less * Miss Nicolas and Miss O'Kell. INFANTILE 'MORTALITY. than four rooms. Six deaths occurred in homes of 5 rooms and 2 in homes of 6 rooms. Defects were found in 22 houses (out of 59), of which the following statement gives the particulars:— Houses requiring cleansing 13 Defective dustbins 4 Defective drainage, gullies, &c. 9 Stagnant water 2 Dirty cisterns 3 Deficient ventilation 2 In four houses two cases of diarrha were known to have occurred under circumstances pointing to infection of the second child from the first. It is impossible to include all the notes of the cases of diarrhœa collected by the Inspectors, although of great interest. The following cases were selected as typical of the series. I. An infant aged 9 months: Family in comfortable circumstances; house scrupulously clean; feeding on sound principles; child ill only three days, sickening after the mother had rendered assistance to another family in the same house, the members of which had been ill with diarrhœa and sickness. II. An infant aged 3 months : Occupied back basement room, which, " at the time of inspection, smelt most objectionably " ; smells due to storm flooding. III. An infant aged 24 days: Healthy at birth; for about 14 days fed on barley water only; medical advice not obtained until too late. IV. An infant aged 9 months : Stated to have been fed "every two hours, and oftener if he cried"; food— condensed milk and water (1 teaspoonful to j cup of hot water) and Ridge's food '2 teaspoonfuls to small cup of hot water). V. Two infants aged 3 and C months died within 5 days: First child occupied back basement room, into which soaked foul liquids from defective dustbin of the next house. VI. R. H., f., 7 months, died October 1st of diarrhœa, after a week's illness. Fed on condensed milk by means of a long-tube bottle. Basement of house not inhabited, found to be dirty and foul smelling, as also the backyard. A second child (— C.), found ill in ground-floor back room, which was dark and "unsuitable for the rearing of children." This child, delicate from birth, was fed on cow's milk and "biscuit pap." The milk was bought in "½d.-worths," as there was no accommodation for keeping it in the home. The family was in very poor circumstances, but with assistance a move into a healthier home was effected, where, with the better feeding recommended by the Inspector, the child rapidly improved and ultimately recovered. The last report was that the child was getting on well. Mortality among Illegitimate Children.—Forty-five (45) deaths of illegitimate children were registered in the Borough, 8 of the deceased infants not belonging to the Parish. From other parts of the Metropolis 4 other deaths were returned. Of the corrected total (41 deaths), 30 were infants under one vear, 9 aged one to five years, and 2 aged over five years. The infantile mortality* among illegitimates was at the rate of 295 per 1,000 such births, as compared with rates of 208 in 1902, and 413 in 1901. An analysis, sex and age sub-division, of last vear's deaths is appended :— Deaths of Illegitimate Children. 1903. Age at Death years. St. Marv. St. John. North-West Paddington m f. m. f. m f. 0— 14 7 1 5 3 1 — 1 6 — — 1 1 5— 1 1 — — — — 1903 16 14 1 5 4 1 1902 19 16 2 1 3 2 * These rates are based on the number of illegitimate births registered in the Borough. If the births in outlying hospitals be taken into account the rates for the three years will be : 1903, 221; 1902, 213 ; and 1901, 352. 41 42 inquests. The more important causes of death, and the occupations of the mothers are indicated below:— Causes of Death. Ages. 0—1 1—5 5— m. f. M. F. m. f. Measles — 1 — 1 — — Whooping Cough — — — 2 — — Diarrhoeal Diseases 5 3 1 1 — — Chickenpox — — — 1 — — Erysipelas — 1 — — — — Tubercular Diseases 1 1 — — — 1 Premature Birth 1 4 — — — — Developmental Diseases 5 — — 1 — — Convulsions — 1 — — — — Heart Disease — — — — 1 — Respiratory Diseases 3 — 1 1 — — Enteritis — 1 — — — — Overlaid 1 — — — — — Cause not ascertained—"found dead" 2 — — — — — 18 12 2 7 1 1 Inquests were held touching four deaths. Occupations of Mothers. Domestic Service 25 Commercial Employments 13 " Servant " 6 Barmaid 3 Cook 5 Dressmaker 2 General Servant 7 Laundress 6 Housemaid 4 Tailor 2 Kitchenmaid 1 Charwoman 2 Occupation not known 3 INQUESTS. During the year 231 inquests were held in the Borough, 58 of them relating to deaths of non-residents. In other parts of the Metropolis, 23 inquests were held with reference to the deaths of residents of the Borough. In all, 196 deaths of residents were registered on the certificates of Coroners, as compared with 181 in 1902. The deaths thus registered formed 10·1 per cent, of the deaths in 1903, and 8·4 per cent, in 1902. An analysis of the "findings of the juries" will be found in Table 30. The following is a brief summary of the circumstances attending death in cases other than those found due to " natural causes":— Deaths by Misadventure—(5)— Narcotics, self-administered 2 Chloroform, f. 55 Opium, m. 51 Ptomaine poisoning, 2 Shellfish, f. 5 Fish, f. 35 Choked by food when in an epileptic fit, 1. Deaths by Accident (including neglect)—(56)— Vehicular traffic 14 " Falls" 15 Overlaid in bed 11 On railways 4 Building operations 3 Burns and scalds 3 Various causes, 6. 43 DEATHS IN INSTITUTIONS. Deaths by Suicide—(20)—all "of unsound mind" or "temporarily insane."— Poison, 4 (hydrochloric acid, m. 41; opium, m. 38; oxalic acid, m. 65; f. 37). Suffocation, 2 (chloroform, m. 29; coal gas, m. 31) Hanging, 4—all males Cut throat, 3—all males Drowning, 2—both males Jumped out of window—one each sex Shooting, 3—all males Jumped in front of train—both males Open Verdicts—(4)— Found dead and decomposed—2 (new-born infants) Found drowned—2 (males) TABLE 30. Inquests touching deaths of Residents. 1903. Finding of Jury. St. Mary. St. John. North-West Paddington. M. F. M. F. M. F. Natural Causes 45 39 9 6 7 5 By Misadventure 2 2 ... 1 ... ... By Accident 26 12 6 4 4 ... By Suicide 6 ... 7 1 6 ... Murder ... ... ... ... ... ... Neglect 2 ... ... 1 1 ... Open—" No evidence " 4 ... ... ... ... ... Totals 85 53 22 13 18 5 DEATHS IN INSTITUTIONS. From the public institutions within the Borough 743 deaths were registered, being 8 in excess of the number for 1902 (53 weeks). In addition, there were 13 deaths in nursing homes. Among the 756 deaths were 349 deaths of non-residents. (Sec Table III. Appendix). Of the 181 deaths of residents returned from Outlying Districts, were 161 deaths in public institutions. The corrected number of deaths of residents in public institutions was 564, as compared with 593 in 1902, the respective proportions per 100 deaths being 29·4 and 27·5. The causes of death will be found in Table IIIA., Appendix. The-deaths in public institutions occurred in:— Poor Law Institutions 311 (292) equal to 16·2 (13·5) per cent. of all deaths. Metropolitan Asylums Board Hospitals 26 (52) „ „ 1·3 (2·4) „ „ Lunatic Asylums 45 (55) „ „ 2·3 (2·5) „ „ Voluntary Hospitals 182 (194) „ „ 9·4 (9·0) „ „ The proportion of deaths of residents of the different Wards (in institutions of all descriptions) ranged from 35·0 per cent. in Church Ward to 15·0 per cent. in Lancaster Gate, East, Ward. In 1902 the highest proportion was in Church Ward (36 per cent.) and the lowest in Lancaster Gate, East, Ward (14 per cent.). 44 work of the department. TABLE 31. Report of the Work of the District Inspectors during the year 1903. 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's., 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. I Cellar Dwellings Closed. 1 Yards and Areas Paved and Drained, j Manure Receptacles Reconstructed, &c.j 1 Accumulations Removed. Improperly-kept Removed. Quarters. No. 1 133 130 751 4,844 112 78 43 48 149 53 4 18 1 23 — 11 4 14 52 2 — 31 6 5 — No. 2 147 42 671 — 4,556 127 50 19 39 132 28 11 7 1 22 — 12 1 15 34 7 — 18 5 31 — No. 3 190 — 696 — 3,903 150 78 21 101 224 36 5 5 5 8 10 9 32 5 — 18 — 35 2 .No. 4 91 16 507 — 4,335 84 57 27 28 102 25 6 4 3 15 — 18 1 12 32 3 — 19 3 46 3 Year 561 188 2625 — 17,638 473 263 110 216 607 142 26 34 10 68 — 51 6 50 150 17 — 86 14 117 5 45 WORK OF THE DEPARTMENT. WORK OF THE DEPARTMENT. General. Staff.—No changes took place in the Staff. The usual summary of work performed by the District Inspectors will be found in Table 31. Separate tables will be given later on with reference to the work of the Special Inspectors. Prevention of Infectious Diseases.—During the year 4,145 visits were paid by the Inspectors (District and Special) in connection with cases of infectious disease reported during the year.* This number shows a considerable increase in comparison with the totals for 1902 (3,341) and 1901 (1,855), the increase being mainly due to the fact that greater vigilance has been given to cases of measles. The totals for the various quarters of last year were:—1st quarter, 1,012 visits; 2nd, 1,004; 3rd (School and Staff Holidays), 988; 4th, 1,081. When patients are treated at home "letters of advice"—covering extracts from Acts of Parliament relating to the infectious diseases and memorandum of precautions necessary to prevent the spread of infection—are issued. Last year 60 such letters were sent out compared with 114 in 1902. To nurses and women attending cases of puerperal fever special cautionary letters are issued. Of these 4 only were required last year, compared with 19 in the previous. The Staff of the Department disinfected 1,970 rooms during the year, compared with 1,620 in 1902, and 1,227 in 1901. Hospital Work.—The number of patients removed to the various hospitals receiving cases of infectious illness decreased from 632 in 1902 to 549 in 1903. The greater number of such patients were removed to the hospitals of the Metropolitan Asylums Board, which were able to receive cases of every description without any delay throughout the year. The accommodation provided by the Board at the close of the year comprised 7,031 beds (4,991 for "fever" cases and 2,040 for small-pox). In addition thereto the construction of hospitals to provide 1,288 other beds for "fever" cases has been authorised, and the works are now in hand. The following is a summary statement of the beds provided or projected (in hand):— For "fever" (diphtheria and scarlet, typhus and enteric (typhoid) fevers)— Permanent accommodation provided—acute cases 4,243 beds in 9 hospitals. convalescent 748 „ 1 hospital. Accommodation to be provided acute cases† 488 „ 1 „ convalescent‡ 800 „ 1 „ For small-pox— Permanent accommodation provided, acute and convalescent cases 2,040 „ 3 hospitals. There are also 1,850 beds at the Gore Farm (Upper and Lower) Hospitals at present not allocated to any disease. These hospitals were erected to receive small-pox cases, but in view of, the large provision available in the other three hospitals these two hospitals have been set apart for other purposes. It has been suggested that they should be devoted to the treatment of tuberculous patients, but the Managers have declined to undertake this new work until the Local Government Board has given an opinion on the point. * The visits touching deaths and cases of consumption, infantile diarrhœa, and the so-called ' minor ' infectious diseases (measles, whooping cough, &c.,) numbered 3,159, the cases (deaths) of each disease being (approximately):— Measles 560 Consumption 163 Whooping Cough 335 Infantile Diarrhoea 67 Chicken-pox 131 Puerperal Fever 3 | South-Eastern Hospital in course of re-construction. The accommodation here will be increased from 408 beds to 488. ‡ Southern Hospital in course of construction. 46 WORK OF THE DEPARTMENT. There will shortly be 10,169 beds available for "fever" and small-pox, a provision which should suffice to meet all requirements for many years to come. The usual proportion recommended to be provided is one bed to every 1,000 inhabitants. It is doubtful whether the population of the Metropolis will ever increase to the extent requisite to reduce the accommodation already provided to that ratio. Disinfection.—As stated in previous reports, the disinfection of walls, &c., of rooms is carried out with the formaldehyde spray (2½-5 per cent. solution). The process appears to belsatisfactory in every way. Unless the premises are dirty, the wall papers torn, or other special reason evident, the stripping of walls, the whitewashing of ceilings, and renewal of paint are not required. Thus only 7 notices to " cleanse and whitewash " were issued during the year after the occurrence of notified cases of illness. Such work was required or recommended in connection with certain other forms of illness, more especially after phthisis. The disinfection of bedding, articles of clothing, &c., has been carried out by contract, as has been the custom for over 20 years. Orders for disinfection were issued after 1,879 cases of illness, viz. Smallpox 6 Erysipelas 4 Scarlet fever 389 Chicken-pox 91 Diphtheria (membranous croup) 147 Measles 530 Enteric fever 49 "Consumption " 90 Puerperal fever 9 Whooping cough 50 Other diseases (e.g., Cancer, &c.) 14 The articles removed weighed 64 tons 3 qrs., or 17 tons more than in 1902, when the goods weighed 47 tons 7 cwts. 3 qrs. The cost amounted to £1,355, the heaviest account under the new contract, and the largest amount for the past seven years. From information which was obtained from the other Metropolitan Cities and Boroughs disinfection under contract is more costly than that done at a "station." A Sub-Committee of the Public Health Committee has had the question of making other arrangements with regard to the disinfection of goods under consideration since June last. It is hoped that a report will be before the Council in the early part of the current year. The expenditure on disinfectants amounted to £24 last year, £9 less than in 1902 and less than one-third of that of 1900 (£76). Family Shelter.—No use was made during the year of the Shelter provided under Sec. 60(4) of the Public Health (London) Act, 1891. Water Supply,—The water supplied to the Borough did not maintain its usual standard of purity, being several times of bad colour and containing an excessive amount of organic matter chiefly of vegetable origin. The deterioration was due to the excessive rainfall and represents in part the surface washings of the gathering grounds and in part the disturbance of the river's banks and bed bv the scouring which takes place at floods. Of the two supplies that of the Grand Junction more frequently varied from its usual character, owing to the small storage available. The metropolitan supply is peculiarly dependent on storage, as when in flood the river water is too heavily charged with suspended matters to be fit for use, while, on the other hand, the deficiency in quantity which is associated with a low river can be successfully met by reserves drawn off into storage reservoirs when the river is in flood. With so small a reserve as one of 3·2 days (compared with storage for 18·0 days provided bv the West Middlesex Company) the Grand Junction Company is unable to avoid sending into its mains water which has undergone incomplete sedimentation. Hence in times of much rain that supply frequently has a decided yellowish (deepening to shades of brown) tinge. Although not presenting an attractive appearance, such water appears to exercise no prejudicial influence on health. As already shown, the cases of enteric fever were considerably below the average. That disease might have been anticipated to exceed the average with 47 WORK OF THE DEPARTMENT. the river in the condition of last year had there been any serious pollution of the gathering grounds. It is hoped that, with the transfer of the Water Companies' undertakings to the Water Board, arrangements will be made not only to equalise the available storage so as to give all parts of the Metropolis a supply of equal quality, but also to increase the accommodation for storing unfiltered water, so as to avoid the use of flood water without full sedimentation. The notices of discontinuance of water supply to inhabited houses, which the Water Companies are required under the provisions of Sec. 49 (1) of the Public Health (London) Act, 1891, to send to the Sanitary Authority, numbered 70 as compared with 121 in 1902. The reasons for discontinuing the supply were alleged to be :— Grand Junction. West Middlesex. Repair of fittings 28 10 Empty houses 10 17 Unpaid rates — 6 Premises in course of demolition — 5 The periods which elapsed between discontinuance and restoration of supply are sufficiently indicated below:— Grand Junction. West Middlesex. Supply restored on same day 16 — next day 4 2 after 2 days 4 4 3 3 3 5 „ — 1 7 or more 1 8 Notices to restore supply were required in 10 cases, but only one summons was required for not restoring supply (non-payment of rates). The house was vacated by the tenant. Sec. 48 of the Public Health (London) Act, 1891, provides that an occupied house without a proper and sufficient water supply is a nuisance to be dealt with summarily under the Act, and if a dwelling-house, is to be deemed unfit for human habitation. Nothing has, however, been done to prevent a water company from cutting off a supply from an inhabited house—not even to require civil process to be adopted to recover unpaid rates—but notice has to be given to the sanitary authority within twenty-four hours of cutting off the supply, a penalty, not exceeding £10, being provided for failure to give such notice.* In many cases, the notice is not only unnecessary, but almost farcical. A company cuts off a supply in the morning to allow of a repair being effected, the supply being restored later during the day, yet a notice is despatched to the sanitary authority, thus involving a waste of time in an unnecessary inspection. On the other hand, cases occur which show what little protection the provision affords to the public. Such a case occurred during the past vear. On February 12th, 1903, information was received that certain premises in "A" mews were flooded with sewage, and that an empty house—lately licensed premises—was without water supply. From inquiries made, it was found that the "empty" house had been inhabited by caretakers—man and wife—for several months, and that the house had been without a water supply during the whole period. The drain was choked, and the sewage overflowing into the adjacent" premises. The Water Company stated that the water had been cut off" at the request of the owners" on 28th May, 1902, and that, the house being then uninhabited, it was not necessary to forward a notice. The caretakers were put in during the following month, and they were compelled to beg water from the adjoining occupiers. * Under Sec. 4 of the "Water Companies (Regulation of Powers) Act, 1877," a supply cannot be cut off for non-payment of water-rate when the owner and not the occupier of the house is liable to pay the rate. There is no definition of "owner " or "occupier " in the Act. 48 WORK OF THE DEPARTMENT. It does appear desirable that, when a supply has been once provided to a house, such supply should not be cut off for any purpose, except temporarily for repairs, until the house is abandoned and demolished. That which happened in this case—that is, water cut off from a house which at the time is uninhabited, but caretakers put in subsequently without restoration of supply—may (and probably does) happen elsewhere, and grave nuisance be caused thereby. The present law appears to be unequal to dealing with such cases. Mortuaries.—The new buildings at Manor Place, Paddington Green, were taken into use at the beginning of last year. The mortuary at Kensal Road is still in use, the proposed alteration in the boundaries of the Coroners' districts, consequential on the formation of the Borough, not having been effected. During the year 304 bodies were received at the two Mortuaries, viz., 283 at Paddington Green Mortuary, and 21 at Kensal Road. The inquests held numbered 240, 98 being after post-mortem examination—See below. Paddington Green. Kensal Road. Bodies Deposited 283 21 Inquest Cases 221 19 Post-mortem Examinations 89 9 Schools and School Attendance.—During the year all the Public Elementary Schools in the Borough were inspected, and repairs carried out where found necessary. Under Sec. 55 (4) of the Public Health (London) Act, 1891, notices are sent to the head teachers of all schools with reference to notified cases of infectious diseases. Similar notices are sent of cases of non-notified diseases coming to the knowledge of the Department. Further notices are sent at the conclusion of the case, i.e., after disinfection. The notices despatched during the year numbered 2,660 in all*, viz.:— Notices. Exclusion. Re-admission. For notified diseases 686 686 For other diseases 911 377 In Tables 32 and 33 will be found the numbers of children attending the different schools ("P.A.") who were reported to be suffering from certain infectious diseases, also the numbers of cases occurring in houses (or homes) whence children, other than the patients, attended school ("P.N.A."). From inquiries made in 1902 it was ascertained that the places provided at the Board Schools numbered 8,438 in all, and those at Voluntary Schools, 14,560. The average numbers of scholars in attendance are (approximately) 7,500 and 10,800 respectively. The comparative incidence of disease in the two classes of school are set out below:— Scarlet Fever. Diphtheria. P.A. P.N.A. P.A. P.N.A. Board Schools 15·4 (10·0)| 5·3 (5·6) 2·2 (7·6) 2·9 (5·2) Voluntary Schools 8·1 (6·7) 3·7 (2·8) 3·0 (3·3) 1·4 (3·0) The foregoing figures show that, as in former years, there is more infectious illness among children attending Board Schools than among those attending Voluntary (or Denominational) Schools. Scarlet Fever.—In the Board Schools the cases of scarlet fever ("P.A." column) last vear showed marked increases over the 1902 figures at Amberley Road 8 cases in 1902; 27 in 1903. Kilburn Lane 2 „ „ 15 „ * One hundred and eightv-six notices were also sent to the Librarian of the Queen's Park Public Library. Formerly these notices were limited to cases of notified diseases, now all classes of infectious disease are included. Lists of all known cases cf infectious illness are also sent daily to the Superintendents of the Public Baths and Wash-houses. † The italic figures in parentheses are those for 1902. 49 WORK OF THE DEPARTMENT. TABLE 32. Borough Schools, 1903. Notified Diseases. Name of School. Residents in Borough. Residing beyond Borough. Scarlet Fever. Diphtheria. Scarlet Fever. Diphtheria. Board Schooi.s — Amberley Road p.a. 27 p.N.a. 6 p.a. 4 p.N.a. 2 ... ... Beethoven Street 17 3 3 3 1 ... Campbell Street 11 9 3 2 ... ... Droop Street 15 9 1 1 2 ... F.ssendine Road 8 3 3 2 1 ... Harrow Road 23 5 2 9 3 5 Kilburn Lane 15 5 1 3 ... ... Totals 116 40 17 22 7 5 Voluntary Schools— Bayswater Jewish 2 1 1 ... 5 3 Cirencester Street R.C. 1 ... ... ... ... ... Holy Trinity 5 ... 1 2 ... ... St. Augustine 7 2 1 2 30 4 St. James 1 1 ... ... ... ... St. John, Kilburn Lane ... ... ... ... 7 3 St. John, Titchborne Street 2 ... 1 ... ... ... St. Luke, Kilburn 3 2 1 ... 14 1 St. Mary 14 5 ... 3 ... ... St. Mary of the Angels, R.C. 2 ... 1 ... 4 1 St. Mary Magdalene 12 8 6 ... ... 1 St. Matthew 1 ... 1 ... 1 ... St. Michael 2 3 10 ... ... ... St. Paul 7 6 ... ... ... ... St. Peter 3 2 3 2 5 ... St. Saviour 5 ... 2 1 1 ... St. Stephen 9 6 2 2 16 7 Westbourne ... ... ... ... 2 ... Wilberforce 8 3 3 3 10 2 Woodfield 2 1 2 1 ... ... Wordsworth 2 ... 1 ... 1 ... Totals 88 40 36 16 96 22 P.A.— Patients attending school. P.N.A.—Patients not attending school. Among the Voluntary Schools two also showed considerable increase in cases of this disease, viz.:— St. Mary 0 cases in 1902; 14 in 1903. St. Mary Magdalene 5 ,, „ 12 „ It was not thought necessary to close any of the schools, but at the schools mentioned close scrutiny was kept over the attendance and dates of attack of the reported cases, and frequent Visits of inquiry were paid to the schools. As regards St. Mary's School 4 cases (out of the 14 reported in the year) were from one family. Diphtheria.—At only one school (St. Michael's) was there any special prevalence of this disease, 10 cases occurring during the year, compared with none in 1902. The outbreak began during the week ended 21st February, and the school was closed under Art. 88 of the Code on March 21st. The cases did not exceed 2 in any week, but that the school was infected is evidenced by the following facts:— (а) All the cases of diphtheria (10) reported in South Paddington, between the middle of February and the middle of March, were children attending this school; and (б) After closure of the school, no further cases occurred in that part of the Borough during the next six weeks. 50 WORK OF THE DEPARTMENT. There were no further cases in the school after the re-opening. During the closure the drains were examined and tested. It was found that the drains were defective and that there was an escape of "sewer air" from an unsealed gulley just outside an air-brick ventilating the space under the floor of the infants' school where the cases occurred. TABLE 33. Borough Schools, 1903. Other Diseases. Name of School. Measles. Chicken-pox. Whooping Cough. Quarters. Yr. Quarters. Yr. Quarters. Yr. 1 2 3 4 1 2 3 4 1 2 3 4 Board Shools— Amberley Road ... 35 9 6 50 2 ... 1 1 4 13 15 1 ... 29 Beethoven Street ... 3 2 1 6 7 5 1 ... 13 53 2 ... ... 55 Campbell Street ... 29 10 ... 39 ... ... 1 ... 1 12 7 ... ... 19 Droop Street ... ... ... 2 2 2 6 ... ... 8 31 3 ... ... 34 Essendine Road 1 1 1 55 58 1 3 1 ... 5 30 ... ... ... 30 Harrow Road 1 2 37 22 62 19 7 1 1 28 4 3 ... 1 8 Kilburn Lane ... ... ... ... ... ... 2 ... ... 2 1 ... ... ... 1 Totals... 2 70 59 86 217 31 23 5 2 61 144 30 1 1 176 Voluntary Schools— Bayswater Jewish ... ... 10 ... 10 2 ... ... ... 2 ... ... ... ... ... Cirencester Street, R.C. ... ... ... 3 5 8 ... ... ... ... ... ... ... ... ... ... Holy Trinity 27 ... ... 19 46 ... ... ... 1 1 ... ... 2 ... 2 St. Augustine ... ... ... 6 6 1 ... ... ... 1 2 ... 1 ... 3 St. James ... 1 2 ... 3 ... 3 ... 2 5 3 1 ... ... 4 St. John, Kilburn Lane ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. John, Titchborne Street ... ... ... ... ... ... ... ... ... ... ... 11 ... ... 11 St. Luke, Kilburn ... ... ... 5 5 1 ... ... ... 1 ... ... ... ... ... St. Mary ... 2 4 ... 6 ... ... ... ... ... 8 7 ... ... 15 St. Mary of the Angels, R.C. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mary Magdalene ... 3 8 45 56 ... ... ... ... ... 14 ... ... ... 14 St. Matthew ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... St. Michael ... ... ... 5 5 ... ... 1 ... 1 ... ... ... ... ... St. Paul 2 37 3 ... 42 ... ... 4 2 6 15 1 ... ... 16 St. Peter ... 3 2 ... 5 ... ... ... 1 1 19 ... ... ... 19 St. Saviour 1 4 2 ... 7 ... 2 ... ... 2 ... 1 ... ... 1 St. Stephen ... 7 22 ... 29 7 2 ... ... 9 14 ... ... ... 14 Westbourne ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wilberforce 3 ... ... 5 8 ... ... 1 ... 1 31 ... ... ... 31 Woodfield ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wordsworth 3 1 ... ... 4 ... ... ... ... ... 2 ... ... ... 2 Totals... 36 58 56 91 241 11 7 6 6 30 108 21 3 ... 132 Table 33 is new to these reports. It contains summaries of the returns of infectious diseases to which notification does not apply. Information relating to these diseases is supplied by the school teachers and others. The returns are undoubtedly incomplete but will be useful for comparison in future years. They indicate the prevalence of the diseases mentioned in each quarter of the year, as well as the incidence on the various schools. Here again the Board Schools show greater prevalence of infectious illness than do the Voluntary Schools. No schools were closed by the Council for any of the diseases mentioned in the Table, but the following partial closures of Board Schools were enforced, on the advice of the Board's Medical Officer :— Campbell Street : Class-rooms 1) and F, Infants' Department, trom July 1st to holidays. Essendine Road : Infants' Department, from 17th December, 1903, to January 11th, 1904. 51 WORK OF THE DEPARTMENT. Several consultations took place during the year between the Board's Medical Officer and the Medical Officer of Health with regard to certain other schools, but it was finally decided in those cases that closure was not necessary. Disinfection of class-rooms and cloakrooms was carried out after the closure specified, and fit other schools which were not closed. In reporting on results of visits to the public elementary schools, Miss O'Kell draws attention to the (onlv too common) vitiation of the atmosphere of the school-rooms and to the common use of "modelling clay." The former has been frequently noted by the Medical Officer of Health and is not due to want of means of ventilation—which are always amply provided—but either to neglect to use such means intelligently or to their failure. To plan means of ventilation of, and to secure success in ventilating a room are two very different things, the latter being bv no means a direct consequence of a well designed system based on theoretical principles. It need scarcely be said that a school-room in which the ventilation fails is a fruitful source of illness. Children whose resistance to infection is impaired through breathing foul air, are more prone to contract infectious diseases, and thus the chance of an epidemic outburst is increased. Moreover, the children cannot do their work so well and what they do perform involves a greater strain on their nervous svstems. They are also more prone to headaches and to chills on leaving the school-room. Clay modelling has onlv recently been introduced into the public elementary schools. The mass of clay is broken up for class purposes and handed round to the children. At the end of class the small lumps are mixed together and again served out to the children, usually (if not always) without any preliminary cleansing. As this goes on for an indefinite time, the clay must become impregnated with dirt crowded with organisms some of which may be those of the infectious diseases. The use of slates has been universally condemned on the ground that they afford a channel for the transmission of infectious diseases. The promiscuous use of modelling clay appears to be even more dangerous. By the Provisional (1003) Code of Regulations for Public Elementary Schools, Art. 101* (Epidemic Grant), became inoperative after March .31st of the year. The grounds for repeal of the Article were that, the amounts awarded were so small as to be disproportionate to the clerical and accountancy work involved in the awards. The Article was distinctly useful, in that it encouraged teachers to report cases of infectious illness to the Sanitary Authority, with a view to recoupment for reduced attendances. If cannot be said that there has been any slackness on the part of the teachers in so reporting cases since the grant has been withdrawn, but it is desirable that some other measure should be introduced to keep teachers in close (or closer) touch with the medical officer of health. Outside London, this has been largely effected by the Sanitary Authority becoming the Education Authority. In London the London County Council will be the Education Authority, and no scheme has as yet been foreshadowed to give metropolitan medical officers of health any share in the medical supervision of schools. The junior classes (and especially the baby classes) in the Public "Elementary Schools are such fruitful centres of infectious disease, that the local sanitary officers should be kept constantly posted as to all cases of such diseases as they occur. In New York, medical officers are appointed bv the Board of Health to visit all public schools daily. Teachers set apart for examination all suspected children, and if found to be ill, such children are sent home and not re-admitted until medicallv certified fit. Such a system reduces the risks of epidemic outbreaks in schools from the presence of undetected cases, to a minimum, and is well worthy of adoption in this country. In accordance with old-standing arrangements with the Medical Officers of Health of the adjacent districts, duplicates of notices sent to schools outside the respective districts are exchanged. Last year 202 duplicate notices were despatched bv the Department, 116) 52 work of the department. relating to exclusion (72 for notified illnesses, and 44 for other diseases), and 86 to re-admission. The returns received numbered 126, 77 from Willesden and 49 from Kensington. Eightv-seven (87) of the returns related to scarlet fever, 34 to diphtheria and 5 to enteric fever. (See below.) Disease. Kensington. Willesden. Scarlet fever 28 59 Diphtheria 19 15 Enteric fever 3 Bacteriological Examinations.—Sixty-seven specimens were received from medical practitioners, 2 more than in 1902. In 1901 when diphtheria was greatly prevalent, 129 specimens were received. Of the specimens received last year, 42 were for the diagnosis of diphtheria ; 24 of enteric (typhoid) fever and one of consumption. The results of examination are tabulated below— Diphtheria. Enteric Fever. Phthisis. Suspicion confirmed 5 7 1 „ negatived 37 17 — Offensive Refuse.—This includes (a) trade refuse ; (b) manure ; and (c) house refuse. Trade refuse.—There were eight prosecutions during the year for the removal of offensive (trade) refuse during prohibited hours. (See Legal Proceedings.) Manure.—The Order requiring the removal of manure every forty-eight hours was duly placarded throughout the Borough at the commencement of the summer. Owing to the unseasonable weather there were very few complaints arising from the non-removal of manure, or from the removal of peat moss litter. Hon se Refuse.—Few complaints were received of offensive effluvia from dustbins. The majority of the complaints received related to dustbins belonging to boarding houses. In some instances the dustbins were found to be defective, and in others refuse liable to undergo decomposition had been placed. These matters were duly dealt with, but the proper remedy, viz. more frequent removal from such premises, has not yet been introduced. Drainage Work.—Last year 665 new drains were put in at existing houses, under the supervision of the Inspectors, each being water-tested before and after "filling in." In 1902, 573 new drains were similarly constructed, and in 1901, 572. During the year 70 old drains were tested and found sound at the first inspection. The majority of such drains had been reconstructed at earlier dates under the supervision of the Staff of the Department. The By-laws pursuant to the Metropolis Management Acts Amendment (By-laws) Act, 1899 were issued in August last. The By-laws as issued are practically identical with the draft issued in January, 1900—more than three years prior to the adoption of the By-laws. The By-laws require notice to be given and duplicate plans, See., to be deposited with Sanitary Authority, fifteen days previous to commencing work of constructing, reconstructing, altering, &c., any drain, &c. The Council had not, at the end of the year decided whether the supervision of the reconstruction, &c., of existing drains should remain with the Public Health Department or be transferred to the Works Department. Combined Drainage.—The following systems have been reported as defective during the vear :— (1) No. 35, Albion Street and Nos. 21 and 22, Albion Mews East. (2) 5 and 6, Alexander Street. (3) 20-24 (even), Artesian Road. (4) 24-38 (even), Beethoven Street. (5) 1-5 (odd) Chippenham Road. (6) 9, Green Street and 1, North Wharf Road. (7) 36-40 (consec.), Porchester Square and 1, Porchester Square Mews. (8) 74-86 (even), Porchester Terrace and 41-45 (consec.), Porchester Square. (9) 32 and 34, Richmond Road. (10) 12 and 13, Shelden Street. (11) 1, 2, and 3, Warwick Place. (12) 107, Westbourne Park Road and 108 and 108A, Richmond Road. (13) 20-26 (even), Westbury Road. 53 work of the department. System No. 1 was in part reconstructed by the Council, and in part broken up by diversion of the top drain at the expense of the Council ; System No. 6 was reconstructed by the owner of the premises, the Council paying a portion of the expense ; Systems Nos. 7 and 8 were held to be private drains, and have not yet been reconstructed*; and System No. 11 was broken up, and each house now has a new and independent drain, the Council putting in the necessary sewer-eyes without charge. The remaining systems have been reconstructed by the Council, being in each case deemed to be a sewer and not a drain. In the case of System No. 10, the combination was at the time of reconstruction broken up, each house now having independent drains. Orders under Sec. 74 of the Metropolis Local Management Act, 1855, were issued with respect to new systems of combined drains at:— Nos. 17 and 19, Chilworth Street. Nos. 55 and 57, Elgin Avenue. Nos. 560 and 562, Harrow Road. Nos. 1-4, Junction Place and No. 22a, Market Street. Nos. 129 and 131, Westbourne Grove and No. 1A, Chepstow Place. The new combined drains have been constructed under the supervision of the Department, except that for Junction Place and Market Street, where the work had not been commenced at the end of the year. The reconstruction of the combined drainage systems on the Queen's Park Estate is being carried on. In 1902 small sections were dealt with here and there, while last year certain blocks were dealt with as a whole, a system which will be continued in the future. The Inspector of the District reports that the main and branch drains of the undermentioned blocks or groups of houses were reconstructed during the year, the new drains following the old lines in each case. Kilburn Lane, Nos. 2-26 (even). Peach Street, Nos. 1-47 (odd). Harrow Road, Nos. 716-740 (even). Sixth Avenue, Nos. 1A, 3A, 5A. Droop Street, Nos. 115-187 (odd). Fifth Avenue, Nos. 132-154 (even). Third Avenue, Nos. 111-145 (odd). Nutbourne Street, Nos. 2-22 (even). Peach Street, Nos. 2-12 (even). Ilbert Street, Nos. 137-153 (odd). Droop Street, Nos. 189-199 (odd). Fifth Avenue, Nos. 147-167 (odd). Oliphant Street, Nos. 113-165 (odd). Kilburn Lane, Nos. 162-222A (even). Ilbert Street, Nos. 121-135 (odd). Droop Street, Nos. 86-148 (even). Sixth Avenue, Nos. 1 to 49 (odd). J Proper gullies were put in, rain-water pipes disconnected, and new soil pipes constructed as required. The whole of the underground work was water-tested before and after filling in, and the above-ground soil pipes &c. (where constructed) smoke-tested. In most cases the work was preceded by chemical tests of the old drains, the Inspector reporting that defects were revealed by such tests in "a large percentage" of cases. Forty-four (44) special tests other than those alreadv referred to were made during the year after the occurrence of infectious illness. Twenty-four (24) of those tests gave positive results, i.e. proved the drains defective. Complaints of " drain smells " were received from 36 other houses, and on the chemical test being used, 32 positive results were obtained. The total number of houses on the Estate re-drained during the year numbered 352. * Orders for reconstruction, as settled by Counsel, were issued in December last. 54 WORKSHOP SUPERVISION. Smoke Prevention.—Observations were taken of the smoke emitted from the shafts and chimneys connected with the following premises :— St. Mary's Hospital. 90, Harrow Road. 189, Edgware Road. 24 & 26, Queen's Road. 257, „ 195, Shirland Road. 259, „ 27, South Wharf Road. 265, The observations numbered 73, extending over 38½ hours in all, smoke being visible for 19. No legal proceedings were required, but one notice under Sec. 24 of the Public Health (London) Act, 1891, was issued. Canal Boats Acts.—The Annual Report for 1903 of the Examining Officer was submitted to the Council on 2nd February last, and subsequently forwarded to the Local Government Board. The year was quite uneventful. Only one case of infectious illness (diphtheria) occurred on board the boats, while 3 deaths were registered of persons connected with the boats. All the deaths occurred on land. The causes of death were "heart disease" (f. aet. 51), "chronic bronchitis" (m. let. 84), and "malignant disease" (m. aet. 64.). Canals.—The " Cut " (Paddington Basin) was emptied at Easter, and about 500 tons of mud were removed. There was an ample supply of water throughout the year, and no complaint was received of effluvia from the canals or Basin. Wharves.—These have been systematically visited by the Inspector, and periodically by the Medical Officer of Health. No complaints were received during the year, but large numbers of flies have been observed in one part of Harrow Road from a manure wharf abutting on the roadway. That wharf is really too near inhabited premises. The Willesden Urban District Council has acquired " Fermoy Wharf," which is to be used for loading refuse, chiefly household, direct into barges. The wharf is situated between the canal and the Harrow Road (Moberley) Board School. A Local Government Board Inquiry was held in February of last year with reference to the Council's application for sanction to raise a loan to purchase the Wharf. The Town Clerk and the Medical Officer of Health of the Borough appeared in opposition and urged (inter alia) that the Wharf was situated so close to the School that danger to the health of the scholars might be reasonably feared. The Board, however, sanctioned the loan. 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 workplaces in his district. Domestic workshops and factories are here referred to as "workshops," while the term "workplace" 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. 55 WORKSHOP SUPERVISION. The supervision of bakehouses and homeworkers are specially provided for under the Factory and Workshop Act, 1901. The supervision of workshops and workplaces where women are employed is in the charge of Miss O'Kell and Miss Nicolas. The former has the northern part of the Borough and the latter the southern. The distribution of workshops in the Borough is so unequal, that an arbitrary division not coinciding with any recognised sub-division of the Borough has been found necessary. Mr. Wansbrough looks after workshops where males are employed and assists in the inspection of workshops where both sexes are employed. He also inspects bakehouses, to which duty he has been obliged to devote a large part of his time during the past year. 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, which involve a considerable amount of clerical work, are performed by the Inspectors, not by the clerical staff. The registers are kept in the form of books, inspection cards and manilla cases. The cards serve as memoranda for reference at subsequent inspections, the Register required by the Act being in book form. The manilla cases form " dossiers " in which reports, &c., relating to each workshop are filed. Outworkers and workplaces 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. The homeworkers' (outworkers') lists received from employers and contractors are filed in manilla cases, the names and addresses of workers residing in other districts being first abstracted and forwarded to the medical officers of health of the respective districts. The particulars forwarded are recorded in a special press-copied register. Registration.—At the end of 1902, 901 "work premises"* were on the Register. During the past year, 320 premises were added to the Register, and 150 removed therefrom, leaving 1,131 effective entries at the close of the year. The 1,131 premises comprised 1,704 workrooms, the estimated number of workers therein being 6,444 persons, viz., 4,757 women, 700 "young persons," and 921 men. These figures are liable to such frequent changes that they can be accepted as estimates only, probably much below the actual numbers. In Table 34 will be found a summary of the principal businesses carried on in the Borough, and the numbers of persons employed therein. The Home Office forwarded 24 notices relating to new workshops, but in every case the premises had already been placed on the Departmental Register prior to the information being received. Outworkers (Homeworkers).—Circular letters were issued in February and August directing the attention of those thought likelv to have outworkers, to the provision of Sec. 107 of the factory and Workshop Act, 1901. In February, 53 lists were received, and in August 49. Naturally, the names of some of the outworkers appear in both returns, and it will therefore suffice to say that at the end of the year 261 premises were on the local Register as * Including " factories," " workshops," " domestic factories," and " domestic workshops " (as defined by the Factory and Workshop Act, 1901), " workplaces," and "single worker's work-rooms" but not bakehouses and places where food is prepared for sale. 56 workshop supervision. occupied by outworkers. Two hundred and twelve (212) addresses were forwarded to, and 135 received from other districts. The 135 addresses were given in 55 lists, received from :— Kensington 15 lists. Hampstead 7 lists. One list from each. Westminster 8 „ Marylebone 3 „ St. Pancras Finsbury 8 „ Chelsea 2 ,, Shoreditch City of London 7 ,, Islington 2 ,, Willesden The following business were carried on at the 261 premises:— Tailoring, 103. Bootmaking, 20. Dressmaking, 67. Other Costume Work, 30. Laundry Work, 17. Upholstering, 14. Other businesses, 10. The total number of persons working at such premises was 573. Ninety-three (93) of the premises came within the definition of workshops; 1, of factories ; 2, of workplaces ; and at 165, single workers were found, that is, the work was done by the occupiers and no hands were employed. TABLE 34. Factories, Workshops, and Work-places.0 No. of Premises. No. of Rooms. Women. Employees. Young Persons. Men. Total. Clothing— Boot-making 39 (20) 42 (23) 8 (2) 1 87 (25) 96 (27) Clothing, repairs 5 6 10 — — 10 Corset-making 9 (1) 10 (1) 20 (1) 1 — 21 (1) Dressmaking 458 (67) 621 (76) 1,753 (147) 354 (19) 19 (1) 2,126 (167) Fur-sewing and Furriers 5 (1) 7 (1) 15 (1) 1 7 23 (1) Mantle-making 10 (7) 13 (8) 19 (7) — — 19 (7) Millinery 38 (3) 60 (3) 223 (4) 50 7 280 (4) Millinery and Dressmaking 16 55 253 63 3 319 Outfitting and Plain Needlework 31 (19) 35 (21) 46 (22) 2 (1) 48 (23) Tadoring 144 (103) 172 (111) 234 (124) 22 (19) 228 (116) 484 (259) „ Ladies' 9 21 66 — 50 116 Various 4 (4) 4 (4) 5 (5) 1 (1) 1 (1) 7 (7) Fancy Work— Embroidery and Art Needlework 4 (1) 6 (1) 17 3 (2) 6 26 (2) Cleansing— Dyers and Cleaners 6 (2) 7 (2) 15 (8) 2 1 18 (8) „ „ —Receiving Offices 16 16 34 5 2 41 Laundries 147 (16) 418 (26) 1,199 (34) 46 (2) 132 (3) 1,377 (39) „ —Receiving Offices 30 31 30 7 — 37 Mangling 23 (1) 23 23 (1) — — 23 (1) Other Businesses— Bookbinding and Printing 8 8 20 — 31 51 Cvcle-making 9 13 — — 30 30 Trunk-making 6 10 — — 29 29 Umbrella-making 5 (1) 5 (1) 7 (1) 1 5 13 (1) Upholstery 24 (14) 42 (19) 56 (20) 15 (4) 18 (1) 89 (25) Various 35 (1) 46 (1) 139 (1) 79 101 319 (1) .Mixed Occupations 50 93 565 113 164 842 1,131 (261) 1,764 (298) 4,757 (378) 766 (48) 921 (147) 6,444 (573) The figures in parentheses indicate the number of " outworkers " in each group. 57 workshop supervision. Inspections.—The total number of inspections and re-inspections was 2,468 (See Table 35) and of rooms measured 392. The latter involves the calculation of the cubic contents of each room, and the filling up of a special card (to be hung in the workroom) stating the number of workers such room will accommodate. Admission was refused on two occasions. In one case the refusal occurred after service of notice to cleanse a workroom, and proceedings were instituted, the summons being, however, withdrawn at the adjourned hearing, the defendant in the interval affording the necessary facilities for inspection. In the other case the occupier stated that no hands were employed, and the matter was carried no further. The address was, however, noted with a view to the occurrence of any illness in the house, or of any occasion to inspect the premises for other reason. TABLE 35. Miss O'Kell. Miss Nicolas. Mr. Wansbrough. Workshops— On register end of 1902 478* 387* 961† added during 1903 188 109 23 removed „ ,, 84 66 — On register end of 1903 582 430 119 Inspections 223 104 89 Re-inspections and miscellaneous calls.. 1,059 889 104 Rooms measured 142 164 86 Workrooms used as bedrooms 46 31 3 Workrooms without Abstracts 65 53 — Nuisances discovered 208 185 4 Nuisances abated 195 160 4 Notices served, totals Written intimations 48 16 4 Under Sec. 4 1 Public Health 8 3 — 37 (London) 2 1 — 38 Act, 1891. 4 3 — By-laws, under same Act 34 10 — Nuisances dealt with— Discovered. Abated. Discovered. Abated. Discovered. Abated. Overcrowding 9 9 21 21 1 1 Dirty Conditions 51 42 61 58 1 1 Deficient Ventilation 9 9 10 10 — — Temperature too high 2 2 2 2 — — Temperature too low — — 15 9‡ — — Sanitary conveniences— Insufficient 5 5 — — — — Not separately provided 9 7 8 8 — — Badly placed 4 3 4 3 2 2 Unventilated 4 4 1 1 — — Defective 15 15 13 13 — — Vapour, effluvia not removed Steam in washhouses 2 9 — — — — Gas fumes 2 2 17 16 — — Drains 7 7 3 3 —. — Wet floors, laundries 6 6 — — Accumulations of refuse — — — — — — Other nuisances 40 40 1 1 — — Totals 165 153 156 145 4 4 * Including premises where both sexes are employed. † Workshops where men only are employed. ‡Six cases referred to Home Office. 58 WORKSHOP SUPERVISION. At 80 places the workroom was found to be used as a bedroom, a fact which entails an increased allowance of airspace. "Abstracts" were not displayed at 118 workrooms, the omission in each case being reported to the Home Office. Three hundred and ninety-seven (397) nuisances of various descriptions were discovered, 359 of which were reported to have been abated (See Table 35.). One hundred and thirty-three (133) notices were served, in addition to many verbal intimations as to the defects or nuisances discovered. A great deal of work—probablv more than that after notice—is done at the request of the Inspectors. At one workshop, attached to a factory but occupied by a sub-contractor, a number of young persons (women) were found at work in a stable where horses stood continuously. The work wood-bundling was carried on in certain of the stalls not actually required for the horses and in an adjacent, dilapidated shed. Men were employed in the yard, and there was no provision of closet accommodation for the females. The occupier of the factory was informed that the stables (and the shed, which was inadequately lighted and ventilated) were not proper places for the work-people to be in, and that separate closet accommodation was necessary for the women. He, thereupon, terminated the contract, and the women were discharged—a regrettable result, but one which could not be prevented. Complaints.—The Home Office forwarded 10 complaints, 18 fewer than in 1902. It is satisfactory to record this smaller number, as it shows that the supervision exercised by the Department is efficient. The complaints related to— Defective Drainage, &c. 3 Sanitary Accommodation (mixed) 1 Dirty Premises 3 Insufficient means of ventilation 1 Overcrowding 2 These matters were duly attended to, in some cases the cause of the complaint being remedied before the Department Inspector visited the premises. Various complaints relating to work premises, to the number of 12* were received from other sources, which are roughly classified below— Dirty premises 4 Dampness 1 Sanitary accommodation 3 Gas fumes 1 Overtime 2 Ill-lighted workroom 1 The overtime complaints were passed on to the proper authorities; that relating to insufficient (artificial) light would not be dealt with officially; while the others were duly attended to by the Inspectors. Many of these complaints were received from the workers concerned or their relatives. More complaints from these sources are likely to be received as the Inspectors become better known, especially if it be recognised that the names of the complainants are not disclosed. Overcrowding.—Overcrowding was discovered on 31 occasions, as compared with 44 in 1902. Many of the cases were found on first inspections, that is, before the workrooms had been measured^ and their capacity determined. Only one workshop presented any difficulty in respect of overcrowding, and there the excuse put forward was, that the alterations in progress made it difficult to keep the workers in their proper rooms. In no case was the amount of overcrowding very great. Ventilation.—It is not yet appreciated by all employers that not only must means of ventilation be provided, but that such means must be kept in efficient operation. The prevention of draughts constitutes a most difficult problem in ventilation, but efforts are continuously being made to obviate the difficulty, and, on the whole, the workrooms have been better as regards ventilation than in 1902. * Thirty-three (33) complaints, not relating to workshops, were made to the Workshop Inspectors, including 18 in connection with visits paid in connection with infectious diseases. 59 WORKSHOP SUPERVISION. Warming.—Although this is under the: jurisdiction of the Home Office qua temperature of room, yet the Inspectors have to deal with the matter on account of the frequent use of gas stoves without proper means of conveying the products of combustion into the outer air. The weather was cold in January, and several cases of want of means of warming were reported to the Home Office. One prosecution resulted, the defendant being fined £10, wi th £3 9s. costs. Means of warming were provided before the summons was heard. During November and December there were few really cold days, and therefore the Inspectors found but few cases to complain of. ! Sanitary Conveniences.—No special case has to be reported under this head. The accommodation, is, however, being gradually improved. The Order under Sec. 9 of the Act, which does not apply to the Metrcpolis, prescribes certain provisions to exclude from workroom emanations arising from closets and urinals, which might be usefully enforced. They could not, however, be universally applied, as they would entail the reconstruction of many premises. Sickness.—Sixty-two cases of infectious sickness occurred on "workshop premises," 20 of which were occupied by outworkers. The cases of the various diseases were— Diphtheria 4 (2) Scarlet fever 6 (2) Erysipelas 1 (1) Puerperal fever 1 (—) Measles 24 (9) Whooping Cough 20 (11) Chicken-pox 6 (1) Consumption (deaths) 10 (5) Measles is now a " dangerous infectious disease " for all purposes save notification, but, owing to the wording of Sec. 110 of the Act,* there is no legal power to take precautions to prevent work being carried on in infected homes. There is need of an extension of that Section to include measles, as the Inspectors have found dressmaking and mangling being done in rooms where children ill with measles have been in bed. At present the only remedy is to proceed under Sec. 08 of the Public Health (London) Act, 1891—" exposing infected articles." Laundries.—The majority of the laundries are in the northern district. So much work was accomplished during 1902 that there is but little to record on this occasion. The Inspector (Miss O'Kell) reports that " a verv fair standard of cleanliness and order" has been maintained during the year, only one laundry having been found in a chronic state of dirt. Even here some improvement was noted at the end of the year. The yards used as drying grounds, the majority of which were formerly unpaved and undrained, are gradually being put into proper condition. The drainage of the floors of washhouses has received attention, and the provision of hoods over the coppers has been found to be a great improvement. At three (3) laundries excessive temperatures were noted, and the attention of the Home Office called to the premises. After consultation between the Medical Officer of Health and the Inspector from the Home Office, suggestions were made to the occupiers which have successfully removed the cause of complaint without involving a large expenditure on the part of the occupiers. Bakehouses.—The number of bakehouses on the Register remained unchanged during the year, but there were two transferences from the " underground " to the " level" class—the Register now containing 62 premises in the former category, and 17 in the latter. As regards the "underground" class, the Inspector (Mr. Wansbrough) reports that he made 1,328 * The provisions of the Section apply to " the infectious diseases required to be notified under the law for the time being in force in relation to the notification of infectious diseases "—Sec. 110 (5). 60 housing. inspections of such premises in connection with the alterations required for the certificate under Sec. 101 of the Factory and Workshops Act, 1901, and prepared 64 plans and reports for office use. The inspections of " level" bakehouses numbered only 26, mainly on account of the time demanded for the supervision of works at the underground bakehouses. Only 4 of the bakehouses were reported as dirty during the year, cleansing being carried out on the serving of intimation notices. In the 15 "level " bakehouses, 31 men are reported to be employed, in the 62 " underground," 315 men. In December an Order was made by the Home Secretary under Sec. 3 of the Factory and Workshop Act, 1901, increasing the amount of cubic space to be allowed to workers in bakehouses to:— 400 cubic feet in " level " bakehouses where work is carried on at night and electric light not used ; and 500 cubic feet in " underground." It is proposed to submit a complete separate report on the work carried out in underground bakehouses. In the meantime, the appended brief statement of the principal improvements effected will be of interest. Certificates were refused for 3 underground bakehouses, one refusal being subsequently cancelled. The other two bakehouses went out of use at the beginning of the current year. Summary of Work Carried Out at the Underground Bakehouses. Bakehouses entirely reconstructed 4 Dimensions—height increased 6 „ cubic space increased by other alterations 3 „ cubic space reduced to provide areas 2 Walls, floors and ceilings made to comply with Schedule 62 Drains—reconstructed 13 „ ditto partly 13 „ old, tested and found sound 12 „ new, combined constructed 3 „ old, „ tested and found sound 1 „ penstock valve fixed (to prevent flooding) 1 Water supply—supply off the main provided 25 Light—electric 9 „ —incandescent gas 44 Ventilation—mechanical means provided 3 „ —air pump ventilators fixed 6 ,, —disused chimneys converted into upcasts 50 Flour Stores provided 12 „ „ shut off from baking rooms 6 Lavatories and Dressing-rooms provided 37 Dampness of sites remedied ------ 3 Housing. This subject will be dealt with under the sub-heads :— (i) Houses let in lodgings ; (ii) Common Lodging Houses ; and (iii) Housing of the Working Classes Acts. Houses let in Lodgings.—This description is undoubtedly an unfortunate one, as the public confuse the registration of houses occupied by members of more than one family with the licensing of common lodging houses. The term is given in Sec. 94 of the Public Health (London) Act, 1891, so that its use can hardly be avoided. The Scotch equivalent, "apartment houses," would be much preferable, as it would clearly differentiate such houses from common lodging houses. 61 HOUSING. Registration.—At the close of 1902, 580 houses were on the Register. During the past year 205 houses were added, making the number of houses on the Register at the close of 1903, 851. Registration involves the obtaining of particulars as to sex and age of each inhabitant, of rooms inhabited by each family, and rent paid for same. This information the landlord has to supply, and frequently several communications (or calls) are required to obtain the requisite return (324 " notices" and 137 " reminders" were issued). The Inspectors then have to measure each room and determine its cubic capacity, inspect the house to ascertain if it comes up to the requirements of the By-laws, and secure the amendment of defects and (or) removal of nuisances. Originally the supervision of such work was entrusted to the District Inspectors, but it has been found necessary to transfer this duty to the Special Inspectors. As a consequence, the number of houses added to the Register is somewhat smaller than was anticipated. The two Special Inspectors made 2,007 inspections during the year (apart from inspections required for the "annual cleansing") in connection with registration and general supervision of registered houses. On registration each landlord receives a communication stating that the house has been registered, and with that are sent copies of all By-laws imposing duties or liabilities on landlords, and a table giving the cubic capacities of the rooms registered. Three (3) summonses were required for failure to supply the information demanded. In the following table the conditions as to housing in the 205 houses placed on the register are set out :— Summary of Particulars obtained at Registration, 1903. Housing. Inspector Wingfield Group A. Inspector Lawrence. Group B. No. of Houses in selected streets 134 240 Houses Registered 112 153 „ Exempt 12 85 Empty — 2 No. of Rooms, registered 626 548 For living only 126 92 For sleeping only 220 211 For living and sleeping 280 245 Other Rooms 286 559 Occupied by landlords 126 256 Exempt by rent — 266 Occupied but not inhabited 130 9 Empty 30 27 Grand Totals, Rooms 912 1,107 Inhabitants. Group A. Group B. In Registered Rooms, Persons 1,134 1,028 Persons under 10 years 288 284 Persons 10 years and upwards 846 744 In other Rooms, Persons 243 884 Persons under 10 years 53 272 Persons 10 years and upwards 190 612 Grand Totals, Persons 1,377 1,912 Overcrowding. In Registered Rooms— Group A. Group B. Families 26 47 Persons, all ages 116 181 „ under 10 years 42 79 „ 10 years and upwards 74 102 Abated by re-adjustment of occupants ... 25 29 Requiring removal 9 18 62 housing. Streets comprised in Group A. Group B. Alfred Road (20 houses) Barnsdale Road ( 1 house) Hethpool Street ( 1 house ) Brindley Street (52 „ ) Braden Street (16 houses) Kensal Road ( 8 houses) Emily Street (12 „ ) Braithwaite Place (8 „ ) Lancefield Street (2 „ ) Philip Terrace (12 „ ) Cuthbert Street (20 „ ) Paddington Green ( 1 house) Ranelagh Road( 7 „ ) Goldney Road ( 1 house) Sale Street (1 „ ) Westbourne (9 ,,) Hall Place West ( 4 houses) Southam Street ( 3 houses) Terrace North ,, Hall Place (67 „ ) woodfield Place (20 „ ) In Table 36 will be found the numbers of the inhabitants in each class of home placed on the Register, following the form used by the Registrar-General in his Census Reports, 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 By-la ws differs from the overcrowding estimated by the Registrar-General. In the course of registration only 63 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 188 families would be held to be overcrowded. TABLE 36. Particulars as to Numbers of Tenements and Inhabitants therein, registered during 1003. Rooms to Tenement. Group of Streets. 1 2 3 4 5 6 7 8 9 10 T P 10 T P 10 T p 10 T P 10 T P 10 T p 10 T P 10 T P 10 T P 10 T P 10 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 — P 10 p 10 p 1 A 53 53 ... 73 142 4 22 50 16 9 17 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... B 75 75 ... 67 129 5 37 84 27 20 39 41 3 7 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 A 6 6 41 81 1 47 120 21 39 103 53 25 73 52 16555 41 8 30 20 1 4 4 2 9 9 ... ... ... B 6 6 ... 36 71 1 47 117 24 37 93 55 22 59 51 13 37 41 6 17 ... ... ... ... ... ... ... ... ... ... 3 A ... ... ... 5 10 ... 1 3 ... 6 17 7 8 31 9 6 24 12 3 18 13 ... ... ... ... ... ... ... ... ... B ... ... ... 1 2 1 3 ... 1 2 .2 ... ... ... ... ... ... 1 3 4 ... ... ... ... ... ... ... ... ... 4 A ... ... ... ... ... ... 2 5 1 ... ... ... 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... B ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... T- -number of Tenements containing I he particulars given in the preceding table may be summarised in the following form:— Tenements registered— Group A. Group B. - One-room tenements 157 202 Two-room „ 185 167 Three-room ,, 29 4 Four-room „ 3 — Inhabitants therein— Tenements of one room 301 415 „ two rooms 688 597 ,, three rooms 134 16 ,, four rooms 11 — Persons over 10 years of age, and Persons under 10 years of age. * See above for lists of Streets included in each Group. 63 HOUSING. Annual Cleansing.—At the beginning of April 648 houses were on the Register, all of which required more or less cleansing. To secure this, the Inspectors made 2,826 visits, besides serving a very large number of notices,* reminders, and other forms of communication. Nine (9) summonses were taken out, one-third the number issued in 1902, when 392 houses were dealt with. The results of the summonses will be found under Legal. Proceedings. In the course of this work inquiries were made as to numbers comprising each family and the numbers of rooms occupied. In Table 37 will be found the complete particulars as to housing of the occupants of all registered tenements in the 851 houses on the Register at the end of the year. TABLE 37. Particulars as to Numbers of Tenements and Inhabitants in Registered Houses, 1903. Rooms to | Tenement. 1 2 3 4 5 6 7 8 9 10 T P 10 10 P T P 10 10 P T P 10 10 P T P 10 10 P T P 10 P T P 10 10 P T P 10 10 P T P 10 10 p T P 10 10 T P 10 10 P 1 371 371 ... 459 890 22 235 520 185 124 261 235 43 94 121 13 30 48 1 3 5 ... ... ... ... ... 2 30 30 235 466 4 291 740 133 310 876 364 249 770 475 189 609 525 93 311 340 31 114 134 7 26 37 2 10 10 3 1 1 ... 22 44 ... 23 64 5 44 141 35 58 207 83 52 206 106 34 135 103 23 107 77 12 60 48 2 11 9 4 1 1 ... 1 2 ... 2 5 1 3 12 ... 6 28 2 6 34 2 2 10 4 2 9 7 ... ... ... 2 14 6 5 ... ... 2 4 ... ... ... ... 1 4 1 5 ... 2 8 4 ... ... ... 1 6 2 ... ... ... 1 5 5 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... The Table may be summarised brieflv as follows :— Totals. " Overcrowded."† Average number of persons per room.‡ One-room tenements - 1,246 416 2.2 Two-room '' 1,437 571 2.0 Three-room '' 271 71 2.1 Four-room '' 25 2 1.3 Five-room '' 8 0 1.0 Six-room '' 1 0 0.8 Overcrowding.—Attention has been directed in this and previous reports to the great difference between the " overcrowding" measured by the Registrar-General's standard, and that based on the cubic space allowances provided for by the By-laws relating to houses let in lodgings. According to Table 37, 1,060 tenements (out of a total of 2,988) were "over- * Intimation letters, 641 ; By-law notices, 353 : Reminder notices, 180. Total, 1,174. † Registrar-General's standard, inhabitants averaging more than 2 persons per room, irrespective of ages of occupants. ‡ Irrespective of ages. 64 housing. crowded," whereas the Inspectors found during the year only 293 families actually overcrowded, as regards cubic space. The returns for 1902, when 61 cases of overcrowding were reported, are not comparable, as no record was made of the overcrowding discovered by the visits for annual cleansing, as was done in 1903. The 293 families occupied 332 rooms, and comprised 1,281 persons (754 aged 10 years and upwards, and 527 aged under 10 years). In 161 cases the overcrowding was abated by a re-arrangement of the sleeping accommodation, 37 families voluntarily moved to other rooms on being informed of the overcrowding, and 17 did so on service of notice. The remaining 78 families were " under observation " at the close of the year. Sanitary Defects.—In Table 38 are set out the infringements of By-laws and nuisances dealt with by the Inspectors during the year. The numbers show considerable increase in consequence of the transfer of this work from the District to the Special Inspectors. TABLE 38. Sanitary Defects Remedied in Registered Houses. Drain defective 1902. * 1903. 65 „ unventilated * 46 „ choked 11 12 Manhole cover defective * 1 Surface inlet improperly trapped * 11 Gully in living room * 1 „ choked * 3 Rain-water pipe not disconnected from drain or soilpipe * 12 „ defective 15 15 Sink waste pipe not disconnected from drain — 5 „ defective 5 3 Soilpipe not ventilated * 1 Water-closet flushed direct from drinking water cistern * 4 ,, defective 17 21 „ choked 22 14 „ improperly constructed * 20 „ foul * 21 ,, without water supply 8 7 „ insufficiently flushed 23 22 „ without external light or ventilation * 2 ,, accommodation insufficient 23 17 Cistern dirty ,, cover defective 5 11 8 „ improperly placed * 2 Rooms dirtv Premises damp 14 9 9 Roof defective 41 33 Wash-house floor defective 14 25 Yard or area paving defective 13 35 Area dirty 5 Dustbin defective 38 33 Accumulation of refuse 18 11 * These were dealt with by the District Inspectors in 1902. Sickness, &c.—In the 586 houses which have been on the Register since the beginning of the Year, 396 cases of infectious diseases occurred, viz. :— Small-pox 1 case Diphtheria 15 cases Measles • 223 cases Erysipelas 12 „ Whooping Cough 81 „ Probably partial returns only. Scarlet Fever 41 „ Chicken-pox 14 „ ) Enteric „ 9 „ 05 housing. The occupants of these 580 houses numbered 9,295 persons, 0,512 under 10 years, and 2,783 aged 10 years and upwards. The morbidity rate (notified diseases) was 8.39 per 1,000 persons, compared with a rate of 1.78 for the rest of the Borough. The deaths of occupants (including those dying in institutions) numbered 247—111 at ages under 10 years, and 130 at ages of 10 years and upwards. The causes of death are indicated below— Age Under 10 yrs. 10 yrs. and over. Under 10 yrs. 10 yrs. and over. Measles 11 — "Cancer" — 10 Scarlet Fever 4 — Developmental Diseases 20 — Whooping Cough 5 — Old age — 8 Diphtheria 2 — Respiratory Diseases 26 24 Enteric Fever — 1 Alcoholism — 4 Diarrhoeal Diseases 19 — Cirrhosis of Liver — 2 Erysipelas — 1 Overlaid in Bed 3 — Other Septic Diseases — 1 Accidents 3 5 Syphilis 2 1 Suicides — 2 Tubercular Diseases 9 22 Other causes 7 55 Owing to the additions to the Register during the year, last year's returns cannot be compared with those of previous years. The death-rates last year were 39.88 per 1,000 persons under 10 years of age, and 20.88 per 1,000 persons aged 10 years and upwards. The rates for the rest of the Borough were 28.10 and 11.38 respectively. Clarendon Street Area.—This Area was the subject of a full report in 1901. Since that date the Area has been under constant supervision. In Table 39 will be found the more important particulars as to morbidity and mortality for 1903 compared with the mean- TABLE 39. 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. 1903. 1890-00. 1901. 1902. 1903. Small-pox — 0.13 5.12 0.37 0.00 0.15 0.51 0.02 Diphtheria 1.85 2.19 2.02 0.96 2.17 2.38 1.39 0.99 Notifications. Erysipelas 2.07 2.33 1.75 1.37 1.07 0.90 0.92 0.77 Scarlet Fever 5.21 5.76 2.69 3.43 3.99 3.36 2.42 2.80 Enteric Fever 0.95 1.78 0.40 0.96 0.54 0.57 0.57 0.28 Puerperal Fever 0.05 0.12 — 0.07 0.07 0.09 0.02 At all ages 28.75 22.66 23.23 26.08 16.17 13.81 14.14 12.46 Deaths. 0—10 years Rates per I ,ooo persons at 10— these ages. 46.87 20.41 32.99 17.78 32.45 18.89 36.84 21.01 27.79 11.17 26.87 11.72 23.64 10.34 Infants under 1 yr.* 308 290 250 263 288 215 197 195 In Institutions † 30.0 42.4 40.7 43.1 22.6 20.5 27.2 28.3 Infants under 1 yr. ‡ 59.0 62.3 55.8 58.1 ? 67.1 65.0 64.6 * Per 1,000 deaths at all ages. † Per 100 deaths at all ages. ‡ Per 100 deaths, 0—10 years. 66 HOUSING. rates for the years covered by the Special Report, and with those for the two subsequent years. The figures indicate that some improvement has been effected in the sanitary condition of the Area, but all rates are still much too high, some being double the rates for the Rest of the Borough, e.g., mortality at all ages, 26.08 per 1,000 in the Area, 12.46 in the Rest of the Borough ; mortality at 10 years and upwards, 21.01 in the Area, 10.34 in the Rest of the Borough. To some extent the deaths in institutions* indicate the poverty of the district. It is regrettable that the percentage of total deaths in this category has increased so much, from a mean of 30 per cent. in 1896-1900 to 43.1 in 1903. At the same time there has been an increase in the Rest of the Borough. Indications are not wanting of an early need to reconsider the rent limits for houses let in lodgings, both in this Area and elsewhere. One house in the Area which produced 26s. 6d. a week in 1901,was found this year (1904) to be producing 37s. 6d.† On the other hand, there is no evidence that the rents of the houses (as single houses) or the rateable values have increased to a like extent. Sec. 94 of the Public Health (London) Act, 1901, which deals with the registration, etc., of houses of this class, does not provide for any rent limit, and Counsel's opinion has been given to the effect that such limits are illegal. They are, however, convenient. The verminous condition of some of the tenements has proved difficult to deal with. There is a provision in the London County Council (General Powers) Bill, 1904, which should be useful, but it is feared that the habits of some of the tenants are such that it would scarcely suffice to clear out the vermin once a month. In the Special Report of 1901, attention was called to the inadequate means provided in these houses for washing. In many houses the single copper is dilapidated, and the scullery or wash-house too small to suffice for several families. There is no remedy for this provided by the existing By-laws, but it is thought that the matter is not outside the provisions of Sec. 94. The local By-laws do not deal with the separation of the sexes, and in that respect differ from (probably) the majority of such By-laws. The Act gives power to secure proper separation of the sexes, and occasionally very gross instances of promiscuous habitation of tenements come to the knowledge of the Department. They are dealt with as far as possible by appeals to the landlords and the occupants of the tenements. The houses in "Clarendon Street Area" were erected for smaller numbers of inhabitants than now occupy them—the families numbering 4, 5, and even 6 in some cases. The dustbins provided, while in accordance with the By-laws, are inadequate to hold the household refuse produced by so many families, when the refuse is collected, as at present, once a week only. The refuse from this class of property requires to be collected more frequently, and there should be strict supervision of the scavengers to see that each house is regularly visited and all refuse removed. The most unsatisfactory houses in the Area are the furnished houses, where the rents are from 5s. and upwards for a single room, and 11s. and upwards for two rooms. The tenants of such rooms are found to be more migratory than are those of unfurnished tenements. The furniture is usually of the poorest character and rarely kept clean. * These include deaths in the Asylum Board's Hospitals, but such deaths were fewer last year than they have been for many years. † It is probably not too much to say that rents for tenements in all parts of the Borough have increased from 1s. 6d. to 2s. a week during the last three or four years. 67 HOUSING. Common Lodging Houses.—Under the provisions of the London County Council (General Powers) Act 1902, these houses are now licensed annually by the County Council. The change from simple registration, which was practically perpetual, to annual licensing, should be productive of much good, both by securing that the houses are maintained in good sanitary condition, and by enabling persons who conduct their houses improperly to be deprived of the right to keep such places. There are 9 houses in the Borough, 7 accommodating 225 men, 1 accommodating 34 women, and 1 for women and married couples (45 lodgers). One case of small-pox occurred in these houses during the year, the patient being a tramp just arrived from the country, and one case of enteric fever, this patient also being a recent arrival. Thirteen (13) deaths of the occupants of the houses were registered, all in institutions, as compared with 12 in 1902, and 10 in 1901. The causes of death are indicated below— 1901. 1902. 1903. Tubercular Diseases 3 3 6 Cancer, malignant disease — 1 3 Respiratory Diseases 4 1 3 Other causes 4* 9† l‡ * Including " Diarrhoea " 1 death. † Including 3 from " heart disease." ‡ Whooping-cough. Housing of the Working Classes Acts.—The negotiations with regard to a site for the erection of houses under these Acts, alluded to in the Report for 1902, have been continued during the year, and plans for erection of such dwellings have been prepared but not yet approved. The " Housing of the Working Classes Act, 1903," gives effect to the recommendations contained in the Report of the Select Committee of the House of Commons, so far as concerns the period of repayment of loans, which is now any term not exceeding 80 years (instead of 60) for any purposes under the Acts, and to the Report of the Joint Committee (Lords and Commons) dealing with the re-housing of persons displaced under any scheme involving the compulsory acquisition of lands occupied by such persons. The duty of providing substituted accommodation is imposed on local authorities as well as private undertakings. (Secs. 3 and 16, and Schedule of the Act.) Among the various provisions of the Act, those of Sec. 8 will probably prove the most useful. Under the Act of 1890 (Sec. 32), when a house was condemned as unfit for habitation, it was necessary to serve notice on the owner requiring him to put the place into habitable state, and, on his failure to do so, proceedings could be taken to close the premises. Not only was much time lost by this procedure, but certain owners made it a habit to patch up houses to an extent which made it difficult to secure condemnation by the Court, although the houses were not (even after the patching) really fit for habitation. By Sec. 8 of last year's Act the notice is no longer required, and the authority is empowered to institute process to close the house as soon as it is, in their opinion, "not reasonably capable of being made fit for habitation." Moreover, if the cost of demolition of such house exceeds the sum obtained by the sale of the old materials, the balance can be recovered from the owner as a civil debt (Sec. 9). A simpler procedure is also provided for getting the tenants out of a house which has been condemned (Sec. 10). By Sec. 12 of the Act a local authority is empowered to build business premises in connection with houses erected under the Acts.* Under Sec. 75 of the Act of 1890, the letting of a house, or part of a house, of a rateable value not exceeding £20, imnlied a condition that the premises were " in all respects reasonably fit for human habitation. ' This * The Housing of the Working Classes Acts, 1890-1903. 68 HOUSING. implied condition has been set aside in some cases by the terms of the agreement between landlord and tenant, but under Sec. 12 of the Act of 1903, the condition is to remain effective notwithstanding any agreement to the contrary, and any future agreement to waive the implied condition is to be void. The Council has the power under Section 57 (2) of the Act of 1890 to acquire houses and adapt them for the purposes of housing people of the working classes*—in other words to become landlords of houses let in lodgings. Under Sections 59 and 60 of the same Act, land can be acquired for this purpose, and bv Section 74 it is provided that if any such houses are found—after a period of at least seven vears—to be too expensive or unnecessary, they may, with the consent of the Local Government Board, be sold. The Boroughs of Kensington and Camberwell have exercised their powers under these provisions, the former during the past year, the latter at an earlier date. In Paddington nothing has been actually undertaken, but proposals have been under the consideration of the Housing Committee. A private company has within the last two years commenced similar operations within the Borough. It cannot be too often stated that the main difficulty in connection with "housing" is the question of profit—that it to sav to decide to what extent it is justifiable to draw on the rates to make good deficiencies. It is a comparatively easy matter to provide for those who can pay market value rents, but the accommodation which is wanted is for those who are unable to pay such rents. The housing of such people must involve more or less deficiency, which must be made up either by philanthropists or from the rates. With the former it is not necessary to deal, as regards the latter, it is a question which sooner or later must be faced and settled. The danger which appears to be likely to arise is the creation of a special class of persons who might under certain circumstances exercise an undesirable influence in local politics. A suggestion which offers the simplest solution to that danger is the disfranchisement so far as concerns local government of all persons living in municipal houses. That the letting of lodgings to the working classes, as usually managed, is profitable, can hardly be doubted. The statement is supported by the fact that houses for this purpose command a ready sale, and by the fact that certain people practically live—and live comfortably— bv the business. Information has been obtained, by one of the Staff of the Department, which suggests that, after making due allowance for bad debts, dilapidations, etc., the net profits do not fall short of 8 per cent. per annum, a very fair return for an investment at the present time. Inhabited House Duty.—Sec. 11 of the Revenue Act, 1903, consolidates, and partly repeals the corresponding provisions of Sec. 26 of the Customs and Inland Revenue Act, 1890, and Sec. 4 (2) of the Act of 1891. Houses of an annual value—i.e., gross rateable value—not exceeding .£20 are exempted from the Inhabited House Duty; the Duty for houses of values between £20 and £40 is reduced to 3d., and that for houses between £40 and £60, to 6d. As regards houses in the two first categories, a certificate to the effect that the houses are constructed so as to afford suitable accommodation for each of the families or persons inhabiting them must be obtained. Such certificate is to be issued by the medical officer of health, unless some person qualified to hold that office be specially appointed by the Local Authority to issue such certificate. Very few applications have been received for the certificate for some years. Last year one application was received, relating to four blocks of flats in Wvmering Road, each block containing 10 flats. It has been ascertained that before flats can come under the provisions of the Section, they must be rated separately. It is not certain whether the same rule does not apply to tenement houses. * The first definition of the expression " working class " is given in the Schedule to the Act of 1903. 69 FOOD SUPERVISION. Food Supervision. This subject will be considered under the following heads :— (i.) Meat Supply—Slaughterhouses, Butchers' Shops ; (ii.) Milk Supply—Cowsheds, Dairies, Milkshops ; (iii.) Food Purveying—Restaurants, Eating-houses, Fried Fish shops, and " Ice-cream " purveyors and makers ; (iv.) Unsound Food ; (v.) Food Adulteration. Meat Supply : Slaughterhouses.—There are eight slaughterhouses in the Borough, one less than in 1902, the slaughterhouse in Jonson Mews having been abandoned. The premises licensed in October last are as below :— Bishop's Mews, No. 1. Portsdown Mews (in rear of No. 249 Maida Vale). Southwick Mews, No. 15, Harrow Road, No. 125. Edgware Road, No. 275, Upper Brooks Mews, No. 6. Hero Place, Chippenham Mews, No. 18. These premises have been under the constant supervision of the Inspector (Mr. Grivell)> who made in all 770 inspections to examine the animals on slaughter. He reports that he examined the carcasses of 6,725 sheep, 232 bullocks, and 38 calves, all killed at the beforementioned premises. The following organs, &c., were condemned and destroyed. Livers, 178 affected with Spleen—" Angioma.'' Lungs, 25 parasites. Head—" Actinomycosis." Plucks, 10 One sheep was found to have pleurisy, and one bullock to be tuberculous. No legal proceedings were taken in connection with this work during the year. Butchers' Shops.—The Inspector has on his list 86 butchers' and 28 pork butchers' shops. He visited these premises 406 times to examine the meat, &c.* Milk Supply: Cowhouses.—There are two licensed cowhouses in the Borough, viz.:— Chichester Mews, Nos. 7 and 8 licensed for 8 cows, 4 kept. Star Street, No. 39 „ 10 „ 4 kept. The Inspector reports that he has visited these premises 8 times during the year. Dairies and Milkshops — At the close of 1902, there were 173 milk vendors on the Register. During the past year there were 4 new registrations, 10 changes of name, and 3 removals from the Register, which at the close of 1903 contained 174 effective entries. The classes of shops at which milk is sold are indicated below :- Dairies: milk, eggs and butter only sold 86 „ milk depots (wholesale) 4 Grocers' shops 8 General shops, not selling lamp oil 24 ,, „ selling lamp oil 28 Sweet-stuff and confectionery 8 Provision dealers 5 Bakers 3 Off-licensed premises 2 Fish and grocery 2 Butcher 1 Coal, wood and oil (combined) 3 The Inspector reports that he made 210 inspections of the above premises. A list of the defects found thereat is given in Table 40. * The subject of meat inspection will be dealt with under " Unsound Food." 70 FOOD SUPERVISION. Two cases of scarlet fever occurred on premises where milk was sold; 3 milk carriers were reported ill with infectious diseases (viz., one each of diphtheria, erysipelas, and enteric fever) and 3 cases occurred in the families of milk carriers (1 of diphtheria and 2 of scarlet fever). Every precaution was taken to obviate the milk supplies becoming contaminated, and no spread of infection occurred through that channel. The supervision of the sale of milk in the Metropolis is in a somewhat confused state owing to the partial transfer of responsibility effected by the London Government Act, 1899. Prior to that Act coming into force the County Council was the sole authority dealing with the milk supply of the Metropolis. By Sec. 28 of the Public Health (London) Act, 1891, the Local Government Board is empowered to issue an Order to regulate the sale, &c., of milk, and the London County Council to make By-laws under such Order. The Board has never issued any Order, and the supervision has been carried out under the Dairies, Cowsheds, and Milkshops Orders of 1885-99. No regulations or by-laws specially applying to the Metropolis have been made. The circumstances of the Metropolitan trade are such* as require special regulations, while those now in use, have been framed to deal with the whole country. In the sub-division of the jurisdiction between the County and the Borough Councils, to the former is left the administration of "Orders," and to the latter that of "regulations and by-laws (non-existing)." Sources of Milk Supply— From inquiries made by the Inspector it appears that the milk sold in the Borough is obtained from:— (a) The two cowsheds in the Borough ; and (b) 1,051 farms, situated in the (16) counties of Bedford Cornwall Hertford Somerset Berks Derby Northampton Stafford Buckingham Dorset Middlesex Warwick Cheshire Gloucester Oxford Wilts At the time of the inquiry (1901) there were 157 vendors on the Register, 17 less than at the end of 1903. The 82 milkshops obtained their supplies from:— Shops. Wholesale firms in the Borough (entirely) 35 Wholesale firms in the Borough and from farms direct 10 Wholesale firms outside the Borough 13 From (206) farms direct 17 From (9) farms direct, and the (2) cowsheds in the Borough 7 At these milkshops, the Inspector reports that the provision made for the cleansing of cans and receptacles is adequate, and that the premises are well kept and in good sanitary condition. The counter-pans at 80 shops are of chinaware in 77 shops, iron in 3 shops, while at the remaining (2) shops, no counter-pan is used, the milk for sale over the counter being kept in a " churn." At 57 (out of 82) of the shops, he found the counter-pan covered with muslin at the time of his visit, but he states that in the summer "practically the whole of the utensils " are covered, to exclude flies and dirt. Milk is also sold at 75 " miscellaneous " shops, the supplies being obtained from :— Shops. Milk vendors (13), supplied by local wholesale firms 29 „ (8), supplied by farmers direct 19 „ (10), outside the Borough 16 Wholesale firms (2) in the Borough 9 „ „ (1) outside the Borough 1 * The total consumption of milk in the Metropolis is approximately 63 million gallons per ann., of which only 1¾—2 million gallons are " produced " within the Metropolis. 71 FOOD SUPERVISION. The amount of milk sold at the "miscellaneous" shops varied from one pint to two gallons dailv, except at the " provision " dealer's, where the amount was ten gallons a day. The " miscellaneous " shops fall into two groups. (a) 17 shops, viz.:— Grocers - - 8 Bakers - - 2 " Provision" dealer 1 Sweetshops - - 5 Butcher 1 These premises are " kept fairly clean." The counter-pans—the whole trade is done over the counter—were iron cans, usually belonging to the firm supplying the milk, at 8 shops, china pans at 9 shops. Four (4) of the counter-pans were found covered with muslin. In 6 cases the (iron) pans were cleansed by the firms supplying the milk. (c) 58 shops, in 33 of which lamp oil is also sold. At 7 only of the 33 shops was the oil kept out of the shop. The commodities sold in various combinations at such shops included— Tea and Sugar - 50 Oil - - 33 Sweets - - 49 Vinegar - - 30 Wood - - 44 Coal - 5 Loose Pickles - 40 Pickled Fish - 2 Jams - 39 Beer - 2 The majority of the above are in themselves harmless to milk, but their association is undesirable, as it makes it difficult to secure that cleanliness which is so essential for a pure milk supplv. Others, such as coal, vinegar and oil, can undoubtedly contaminate the milk, either by the dust arising from their handling, or from the fumes given off, which would be readily absorbed by the milk. The milk was found to be kept in iron cans at 49 shops, and in basins, jugs or counterpans at the remaining 9. It is perhaps fortunate that in 46 cases the milk vessels were found to be cleansed bv the firm supplying the milk. The Inspector states he did not notice " a single utensil properly covered," as either the handle of the measure was generally on the edge of the milk can, preventing the lid from closing, or the muslin cover was by the side of the pan, not spread over the top. The foregoing facts bring out strongly the importance of the work which ought to be carried out in the provinces under the Dairies, Cowsheds and Milkshops Orders* but which unfortunately receives but scant attention from rural authorities. Put simply and plainlv the state of the case is this—the farmers, whose places and manner of producing milk should come under the supervision of the sanitarv officials, have the appointment and practically untrammelled dismissal of such officers in their own hands. Effective supervision is not to be expected under such circumstances, and the only remedies available, appear to be the transference of the administration of the Orders from the defaulting rural district councils to the countv councils, or to give the authority of the district where the milk is sold powers to obtain the names of farmers sending such milk into the district, to inspect the farms whence the milk comes, and to prohibit the sale of milk within the district from farms not conforming to prescribed standards. Having regard to the difficulties which would inevitably be associated with the latter alternative, it can only be suggested to be set aside at once. The intervention by the county council when default is made by the district council is the proper remedy. The inquiries made, also indicate that new regulations, or by-laws, are required to deal with the sale of milk. It should be a penal offence to sell milk in a shop with other goods likely to cause milk to be contaminated, or to keep the counter-pan uncovered. The sale of milk in the " miscellaneous" shops (second group more particularly) is a matter of trade competition. One shopkeeper cannot afford to give up the sale, but if such sale were absolutely prohibited, no hardship would be inflicted. * It should be stated that most of the large wholesale firms have very stringent clauses in their contracts dealing with the water supply and sanitation of the farms, keeping of cows, &c. 72 FOOD SUPERVISION. There is one other point to which attention should be directed. In the course of the inquiries it was ascertained that one firm, and one firm only, made use of the tuberculin test to exclude the introduction of milk from tuberculous cows from a part of their supply. The test may be used by the farmers and others, but if so, the fact has not been elicited by the inquiries made. On the other hand, the notorious neglect to enforce the Dairies, Cowsheds, and Milkshops Orders in the provinces, raises a presumption that the use of such test is very exceptional. Food Purveyors.—The Register of premises where cooked foods (meals) are provided contains 182 entries, 25 of the premises being shops of fish-fryers. A special Register of makers and vendors of " ice-creams " is also kept. This contained 114 entries at the close of the year (74 more than at the end of 1902). All the above premises have been frequently inspected both to detect nuisances and to see that the commodities dealt in were sound and free from contamination. Table 40 gives the details of defects found, &c. TABLE 40. Numbers of places where Food is sold:— Butchers 86 Milkshops and Dairies 174 „ Pork 28 Refreshment Houses 157 Fishmongers 29 Fried Fish and Sausages 25 Game and Poultry 12 Ice Cream Makers & Vendors 114 Fruit and Greengrocery 91 Sausage Factories 9 Food Purveyors. Defects found and remedied :— Milkshops and Dairies.* Restaurants and Eating Houses. Premises occupied by Ice Cream Makers. Drains Defective ... 12 1 ,, unventilated ... 6 ... Surface inlets improperly trapped ... 4 ... Open drains inside premises ... 3 ... Soilpipes defective ... 6 1 „ unventilated ... 5 ... Water-closets defective ... 10 . . . „ dirty ... 5 ... Flushing apparatus defective ... 3 ... Rain-water pipes connected to drain or soilpipe ... 4 2 Waste pipes, do. do. ... 6 ... Rain-water pipes defective ... 2 ... Dirty conditions 6 4 5 Cisterns dirty ... 1 1 „ uncovered ... 1 ... Water for flushing W.C.'s drawn direct from drinking water cisterns ... 1 ... Paving defective ... 2 1 No dustbin ... 1 ... Dustbins defective "2 9 ... * These were systematically dealt with in 1902, leaving no structural defects unremedied. Inspections during the year :— Slaughterhouses 770 Cowhouses 8 Butchers' Shops Greengrocers' Shops Costers' Barrows 406 Milkshops, &c. 210 116 Restaurants, &c. ... 321 20 Ice Cream Shops and Barrows 172 Fish Curing Premises 8 Fried Fish Shops ... 51 Fishmongers' Shops 12 73 FOOD SUPERVISION. As regards the makers and vendors of " ice-cream," the Inspector (Mr. Grivell) reports in the following terms. Ice cream is made at 80 shops, viz.:— Sweet Vendors 46 Confectioners 4 Restaurants 6 " Cook" shops 2 Milkshops 4 Bakers 10 " General" shops 4 Newsvendors Tobacconists Of the proprietors GO were English, 11 German, and 3 Italian. Ice-cream was also found to be made at 2 disused stables, one scullery, and one " wooden structure." These premises have been brought into conformity with the provisions of the London County Council (General Powers) Act 1902. There are 22 Italians regularly selling ice-cream in the Borough streets from barrows— 9 of these reside in Marylebone; 7 in Kensington ; 3 in Clerkenwell; 2 in Islington ; and 1 in Chelsea. The Inspector remarks that he has noted " a great improvement in the cleanliness of the premises, utensils; towels and washing water used " in connection with the sale of ice-cream, and "especially in the personal cleanliness of the street vendors." Two cases of infectious disease occurred at premises where ice-cream is made, viz., 1 case each of scarlet fever and diphtheria. Unsound Food.—All places where food for human consumption is prepared or sold, have been frequently visited to see that such food was in good condition. The inspections have included the coster stalls which stand in the various roadways on Saturdays. Facilities are afforded to butchers wherebv thev can have the meat coming from the wholesale markets inspected before exposing the same for sale. The amount of meat destroyed at the slaughterhouses, the unsoundness being discovered during the slaughtering, has already been mentioned. The appended statement gives the other commodities surrendered or seized— Meat:— Total weight (lbs.). 15 Pigs - 1,325 tuberculous 4 Pigs' heads 20 tuberculous 19 Rabbits 60 mouldy—foreign importation 2 Pieces of beef - 217 decomposition owing to imperfect chilling. Fish :— Total weight (lbs.). 1 Barrel of Herrings 112 putrid 3 Trunks of Plaice 150 putrid Vegetables and Fruits :— Tomatoes 420 lbs. Apples 161 lbs. Horse-radish 1,512 „ Melons 50 „ Oranges 20 „ Lemons 20 „ Plums 14 „ Grapes 14 „ Mixed parcel 24 lbs. The fishmongers voluntarily submitted and surrendered the fish, receiving a certificate of condemnation from the Medical Officer of Health. Much of the fruit and vegetables was also voluntarily submitted and surrendered. As regards the meat, the whole quantity was dealt with at the request of the local tradesmen. The results of such cases as were taken into Court during the year, will be found under Legal Proceedings. Food Analysis.—The samples taken under the Acts during 1903, numbered 517, of which 36 (or 6.9 per cent.) proved to be adulterated. In 1902, 529 samples were taken, and 8.8 per cent. were found adulterated. In 1901, the proportion was 10.9 per cent. A list of the samples taken will be found in Table 41, and the results of proceedings in respect thereof, under Legal Proceedings. 74 office work. TABLE 41. Summary of Articles submitted to the Public Analyst during the year 1903. Total. Found Adulterated. Percentage Adulterated. Milk 244* 15 0.1 Butter 96 5 5.2 Coffee 40 3 7.5 Butter on Bread 15 6 40.0 Mustard 15 1 6.6 Whisky 14 — Pepper 13 — — Jam 9 — — Beer 8 — Lard 8 — — Honey 7 — — Arrowroot 6 — — Blaud's Pills 6 — — Bread 6 — — Cream 6 6† 100.0 Margarine 5 - — Olive Oil 4 — — Vinegar 4 — — Gin 2 — — Sweets 2 — — Bloater Paste 1 — — Green Peas 1 — — Golden Syrup 1 — — Ham and Chicken 1 — — Skim Milk 1 — — Sago 1 — — Tapioca 1 " 517 36 6.9 * Including 61 taken at Paddington Terminus in course of delivery ; 5 adulterated. f Boric acid, or other boron preparation present. Of the 244 milk samples taken during the year, 15 (or 6.1 per cent.) proved to be adulterated. In 1902, the percentage was 11.5. Among the 61 samples taken at the Milk Platform G.W.R., 5 (8.1 per cent.) were found adulterated, and the remaining 183 samples (obtained in the street or at shops), 10 were adulterated, equal to 5.4 per cent. The station samples being obtained at the request of the consignees, who usually have good reason to suspect adulteration, naturally contain a large proportion of adulterated samples. Office Work. The work of the Clerical Staff is not of a nature to be reduced to a statistical record, but the following figures will indicate a small part of the work accomplished during the year:— Letters received 3,566 Complaints received and entered - 690 „ despatched 1,949 Plans received and entered 522 Entries in postage book 8,730 New entries in Journals 1,570 Cases of infectious disease, notified and entered in Register 753 Orders of disinfection (duplicate) - 1,879 Ditto forwarded to Metropolitan Asylums Board and Guardians 753 Notices for abatement of nuisances, &c., issued 444 Notices of Infectious sickness to schools, library, &c. 2,846 75 LEGAL PROCEEDINGS. LEGAL PROCEEDINGS. Summaries of the results of cases heard during the year are given in the appended tabular statements. The total amount of fines and costs was £163 12s. fid., as compared with £208 5s. fid. in 1902, and £179 9s. in 1901. Dividing the cases into two groups, (a) under Health Legislation, and (b) Adulteration Legislation, the amounts for the three years were:— Health Cases. Adulteration Cases. £ s. d. £ s. d. 1903 63 6 0 100 6 6 1902 32 19 0 175 6 6 1901 40 16 0 138 13 0 The average fine and costs in the adulteration cases were £3 1s. fid. and 15s. 7d. respectively, being a trifle lower than in 1902. The appeal case of Nokes & Nokes v. Mayor, &c., of Islington, decided during the autumn of last year, will have a far reaching effect on by-law legislation. The original summons for failing to provide sufficient closet accommodation in a house let in lodgings, was taken out against the "landlord" under By-law pursuant to Sec. 39 (1) of the Public Health (London) Act, 1891. The decision of the Court was that the By-law was invalid on the ground that it made no provision for service of notice on the party liable, as a precedent to proceedings for penalties. The Court appears to have been guided by the fact that under Sec. 37 of the Act, dealing with the provision of closet accommodation, the local authority is directed to serve a notice requiring accommodation (additional or otherwise) to be provided. That Section sets up no standard accommodation, but leaves each case to be considered and decided upon by the local authority. Consequently the person liable to provide the accommodation cannot tell what the requirements of the local authority are until he receives the notice. On the other hand, the By-law fixes a standard for houses let in lodgings, so that one would have thought that ignorance of the need of the house could not (in accordance with the rule of English Law) be successfully pleaded. Moreover, Sec. 136 of the Public Health Act, 1875, which governs the framing of By-laws under the Public Health (London) Act, 1891, provides a penalty for an offence against a By-law, and a daily penaltv for a continued offence—in the latter case a notice in writing being requisite before the penaltv becomes operative. From the construction of Sec. 136 there does not appear to be any need for a notice to render the offender liable to the first fine. As no attempt has been made to reverse the decision of the Court of Appeal, the decision will govern all proceedings under the various by-laws, and involves a re-casting of several by-laws. The decision will considerably impair the usefulness of by-law legislation, as it has been found that the liability to summary proceedings which has been supposed to exist, encouraged many to undertake sanitary work promptly who would otherwise avail themselves to the utmost of the delay involved in serving notices. In the proceedings under the Sale of Food and Drugs Acts, it will be seen that 5 summonses were dismissed on the plea of "warranty." This defence is becoming each year more common, and the difficulties arising therefrom almost insuperable. A case such as is here sketched is no fancy case, but based on actual experience:— A sample of milk was purchased of vendor A (an old offender). On service of the summons, A gives notice of purchase under warranty from R and proves his defence to the satisfaction of the Court. On proceedings being taken against B for giving a false warranty, A is called as a witness for the prosecution, and as a result of the cross-examination of A, the case against B is dismissed. 76 LEGAL PROCEEDINGS. Such a decision implies that A has been guilty of the adulteration in respect of which he successfully pleaded his warranty at the hearing of the first summons. It appears, however, to be impossible to reach A, who not only gets off this time, but successfully engineers the next case on the same lines.* Two vendors at least have recently discovered the virtues of a warranty defence, after being convicted several times. Another difficulty arises from the multiplication of warranties relating to a single sample:— A, the vendor of the sample, buys under warranty, from a wholesale firm B, which firm buys with a like condition from a farmer C, who, perhaps, to make up a deficiency, buys (also with a warranty) from D. Under such circumstances, proceedings would be necessarv in succession against A, B, C, and D, and might involve going to at least three Courts in various parts of the country, as the provisions of Sec. 20 of the Act of 1899 would not apply to proceedings against C and D. This was decided in the case of Manners v. Tyler (1902). Even if the case be carried to the last (first) warranty giver, failure is almost inevitable, as it is usually found impossible to prove the act of adulteration. Moreover, the six months' limit imposed on such proceedings (Whittaker v. Pomfret Bros, 1902), involves further hampering of efforts to check adulteration. In this last respect it has still to be decided whether the six months' limit dates from the contract to supply the milk, or from the date of delivery or purchase of the milk—each day's supplv being covered by an invoice or label to the effect that the milk supplied is according to contract. The Board of Agriculture favours the view that the limit runs from the day of delivery of the milk. * These statements are based on actual facts within the knowledge of the officials of the Department. 77 SUMMARY OF LEGAL PROCEEDINGS. SUMMARY OF LEGAL PROCEEDINGS DURING 1903. Under Public Health (London) Act, 1891. Fine. Costs. Summonses under Section 4. £ s. d. £ s. d. 68, Chippenham Road* Premises dirty and dilapidated ... 0 2 0 3, Fordingley Road Defective drainage. Order made ... ... 88, Kensal Road* ,, ... 0 10 6 90, Kensal Road* ,, ... 0 10 6 284, Kilburn Lane „ Order made ... 0 2 0 52, Lancefield Street* Overcrowding ... 0 2 0 221, Shirland Road* Workshop in a dirty condition Summons withdrawn 11, Stalham Street Defective drainage (case pending). Order made ... ... 25, Waverley Road Premises without water supply 5 0 0 1 1 0 22, Woodfield Place* Overcrowding ... 0 3 0 Summons under Section 38. 115, Herries Street* Insufficient water-closet accommodation ... 1 3 0 Summonses under Section 47. Buckingham, W., 9, Porchester Rd. Unsound cherries exposed for sale 1 0 0 0 5 0 Goddard & Rawle, Willesden Sending tuberculous pig to 396, Harrow Road Summons without dismissed costs. Mansi, P., 18, Praed Street Unsound fruit deposited for sale 5 0 0 0 12 6 Marsh, R., 24, Carlton Terrace „ tomatoes exposed „ 3 0 0 0 5 0 Swift, R., 261, Harrow Road ,, apples ,, ,, 5 0 0 0 5 0 Swift, R., 328, ,, „ „ deposited „ 2 0 0 0 5 0 Wootton, A., 123, ,, „ tomatoes exposed „ 2 0 0 0 5 0 Young, H., 71, Praed Street apples „ „ 2 0 0 1 8 0 Summonses under By-laws relating to Houses let in Lodgings. 20, Amberlev Road* Water-closet choked ... 0 12 6 46, ,, Annual cleansing not carried out ... 1 3 0 47, „ ,, ,, ,, ... 1 3 0 28, Kensal Road ,, ,, ,, 1 0 0 0 2 0 9, „ Failure to send return of inhabitants 0 12 6 174, „ ,, ,, ,, These fines were subsequently remitted. 2 0 0 0 12 6 176, „ ,, ,, ,, 2 0 0 0 12 6 10, Netley Street Annual cleansing not carried out ... 1 3 0 41, Shirland Road ,, ,, ,, ... 0 2 0 57, Walterton Road ,, ,, ,, ... 3 3 0 49, Waverley Road ,, ,, ,, ... 1 3 0 29, Woodchester Street* ,, ,, ,, ... 0 13 6 100, „ ,, ,, ,, 1 0 0 0 2 0 Summonses under other By-laws. 15, Amberley Road* Insufficient water-closet accommodation ... 0 12 6 20, „ * Yard not properly paved ... 0 12 6 12, Beethoven Street ,, ,, ... 0 3 0 37, Clarendon Street* Water-closets defective ... 0 12 6 65, Herries Street* Yard not properly paved ... 1 3 0 Hill's Yard, Kilburn Lane Soilpipe improperly constructed 1 0 0 0 2 0 42, Marylands Road Failing to give notice before constructing new watercloset and altering soilpipe. (Summons withdrawn on payment of costs) ... 1 2 0 3, Pressland Street Cistern in a dirty condition 0 5 0 0 12 6 62, Woodchester Street* Insufficient water-closet accommodation ... 0 2 0 81, „ * ,, ,, ,, ... 1 3 0 4, Woodfield Crescent Failure to give notice before constructing new soilpipe and water-closets 0 5 0 0 2 0 Cook, E., & Co., Ltd., Bow Removing offensive refuse during prohibited hours 1 0 0 0 2 0 Davison, H., Merton ,, ,, ,, Summons dismissed Eddington, W, Stratford ,, ,, ,, 2 0 0 0 2 0 Hornett, W. H„ „ ,, ,, ,, 0 10 0 0 2 0 Page, J., Blackfriars ,, ,, ,, 0 10 0 0 2 0 Wickens, Pease & Co., Bermondsey ,, ,, ,, 0 10 0 0 2 0 Do. ,, ,, ,, 0 10 0 0 2 0 Waddington, R., Stratford „ „ in uncovered cart 0 5 0 0 2 0 Under London County Council (General Powers) Act, 1902. De Lucca, 4, Southwick Mews Failure to take precautions to protect Ice Cream from contamination Dismissed. De Lucca, „ Failure to have name and address on barrows do. Rollo, A., Fulham „ ,, ,, 0 1 0 0 2 0 * Nuisance abated or necessary works carried out before the hearing of summons 78 SUMMARY OF LEGAL PROCEEDINGS. SUMMARY OF LEGAL PROCEEDINGS DURING 1903. Under Sale of Food and Drugs Acts, 1875-1899. Fine. Costs. £ s. d. £ s. d. Milk 31% fat abstracted 3 0 0 0 15 6 ,, 29% ,, 2 0 0 0 12 6 ,, 23% „ 1 0 0 0 12 6 ,, 20% ,, Dismissed: warranty proved. ,, 18% ,, do. ,, 10% ,, 2 0 0 0 12 6 ,, 10% ,, 1 0 0 0 12 6 ,, 10% ,, 1 0 0 0 12 6 ,, (1) 15% added water 3 0 0 0 12 6 ,, (2) 12% ,, 10 0 0 2 2 0 ,, 8% ,, ... 1 8 0 ,, 7% ,, Dismissed: warranty proved. ,, 7% ,, do. further warranty proved. ,, 7% ,, 10 0 0 0 12 6 ,, 7% ,, 1 0 0 1 15 6 ,, 5½% ,, Dismissed : warranty proved. Butter (4) 50% foreign fat 20 0 0 0 12 6 ,, 82% „ 2 0 0 0 12 6 ,, (5) 82% ,, 5 0 0 1 3 0 ,, 82% „ 1 10 0 0 12 6 ,, 80% ,, 2 0 0 0 12 6 Butter on Bread 91% ,, 2 0 0 0 12 6 ,, 88% ,, 2 0 0 0 12 6 ,, 82% „ 1 0 0 0 12 6 ,, 81% ,, 1 0 0 0 12 6 ,, 80% ,, 1 0 0 0 12 6 ,, 50% ,, 1 0 0 0 12 6 Coffee 35% chicory 0 10 0 0 12 6 ,, 26% „ 2 0 0 0 12 6 ,, 10% „ 4 0 0 0 12 6 Mustard 25% wheaten flour 1 0 0 0 12 6 NOTES. (1) Defendant fined £1 with 2/- costs, on August 31st, 1893, for selling milk containing 10% of added water. „ £2 12/6 „ July 18th, 1902, for selling milk containing 11% of added water. (2) „ £1 33/6 „ January 27th, 1898, for selling milk containing 11% of added water. (3) „ £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. „ £10 12/6 „ January 23rd, 1903, for selling milk containing 12% of added water. (4) „ — 12/6 „ December 22nd, 1899, for selling butter containing 80% of foreign fat. „ £3 12/6 „ November 25th, 1901, for selling butter containing 80% of foreign fat. (5) M £3 23/- „ December 28th, 1900, for selling butter containing 81% of foreign fat. 1903. 1902. 1901. 1900. 1899. 1898. Average per conviction Fine £3 1 6 £3 3 8 £2 16 0 £3 4 0 £3 4 9 £1 13 9 Costs 0 15 7 0 16 0 0 15 0 1 2 3 0 14 3 0 13 11 79 VITAL STATISTICS. APPENDIX. TABLE I. Vital Statistics of Whole District during 1903 and Previous Years. Year. Population estimated to Middle of each Year. 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. 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 1893 137,662 3,622 26.31 544 150 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 25.59 590 166 2,476 17.78 554 306 209 2,379 17.09 1896 140,022 3,612 25.37 585 162 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 141,648 3,444 24.31 591 171 2,433 17.17 600 330 235 2,338 16.50 1899 142,477 3,452 24.22 549 159 2,445 17.16 606 298 223 2,370 16.63 1900 143,318 3,370 23.51 524 155 2,519 17.57 708 401 218 2,336 16.29 1901 144,188 3,359 23.29 484 144 2,163 15.00 652 324 218 2,057 14.26 1902 145,052 3,305 22.41 474 144 2,311 15.67 735 366 207 2,152 14.58 Averages for years 1893-1902. 141,357 3,468 24.48 536 154 2,352 16.59 627 330 222 2,244 15.83 1903 145,927 3,302 22.63 425 128 2,103 14.41 743 366 181 1,918 13.14 * 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. Area of District in acres (exclusive of area covered by water), 1,336, Total population at all ages, 143,976 Number of inhabited houses, 13,221 Average number of persons per house, 8.9 At Census of 1901. 80 vital statistics. TABLE II. Vital Statistics of Separate Localities in 1903 and Previous Years. Names of Localities. 1.—BOROUGH. 2.—Registration Sub-District St. Mary. 3.—Registration Sub-District St. John. 5.—Registration Sub-District North-West 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. Birtns 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. 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 2,055 452 86,734 2,423 1,449 344 33,729 411 369 40 17,975 565 237 68 1895 139,225 3,063 2,379 587 87,658 2,526 1,671 426 33,712 453 428 64 17,855 584 280 97 1896 140,022 3,616 2,258 564 88,591 2,613 1,583 415 33,695 455 359 62 17,736 548 316 87 1897 140,829 3,554 2,098 535 89,534 2,586 1,455 403 33,678 424 355 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 1,675 425 33,626 411 386 52 17,267 480 275 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 62 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 Averages of Years 1893 to 1902. 141,357 3,468 2,244 521 90,120 2,529 1,589 393 33,670 416 374 47 17,567 523 281 81 1903 145,927 3,302 1,918 388 95,425 2,483 1,376 305 33,578 382 305 40 16,924 437 237 43 * The births recorded in North-West Paddington prior to 1001, 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. 81 deaths in local institutions. TABLE III. Deaths in Local Institutions. 1903. Year. Paddington Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. 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 1902 298 359 76 2 Averages 1893-1902 219 334 70 Seven years. 3 1903 317 342 82 2 * Closed part of year for repairs and alterations. ** Hospital open for part of year only. † Hospital being re-built. TABLE IIIA. Causes of Deaths in Institutions. 1903. Causes of Death. Local Institutions. Deaths of Residents recorded beyond the Borough. Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital, and Nursing Homes. Hospitals of Metropolitan Asylums Board. Special and General Hospitals. Lunatic Asylums. Poor Law Institutions. Elsewhere. Small-pox ... ... ... ... ... ... ... ... ... Measles 8 2 ... ... ... ... ... ... 1 Scarlet Fever ... ... ... ... 8 ... ... ... ... Influenza 1 2 ... ... ... ... ... ... 2 Whooping-cough 1 1 ... ... ... ... ... ... ... Diphtheria ... 4 ... ... 11 1 ... ... ... Enteric Fever ... 2 ... ... 1 ... ... ... ... Diarrhœa ... 1 5 ... ... 1 ... 1 1 Epidemic Enteritis 10 1 1 ... ... ... ... ... ... Erysipelas 2 ... ... ... ... ... 1 ... ... Puerperal Fever 2 2 ... ... ... ... ... ... ... Other Septic Diseases 2 6 3 ... ... 2 ... ... ... Tuberculosis of Lungs. 50 16 5 ... ... 9 2 2 1 Other forms of Tuberculosis 6 11 14 1 ... ... 2 1 ... Cancer 36 42 3 4 ... 20 2 ... 1 Premature Birth 5 ... 1 ... ... 2 ... ... ... Developmental-Diseases 3 4 8 ... ... 4 ... ... ... Old Age 29 ... ... ... ... 1 3 1 ... Bronchitis 23 4 1 ... ... 3 1 ... ... Pneumonia 23 24 13 ... 1 ... ... ... ... Cirrhosis of Liver 1 9 1 ... ... 1 ... ... ... Accidents of Childbirth ... 3 ... ... ... 2 ... ... ... Accidents and Violence 8 43 2 ... ... 6 2 1 6 Suicides 1 7 ... ... ... 1 ... ... 2 All other Causes 106 158 25 10 5 26 32 5 6 All Causes 317 342 82 15 26 79 45 11 20 Non-Residents* 17 260 61 11 ... ... ... ... ... * The deaths of 17 other non-residents took place either in the streets or houses in the Borough. 82 CAUSES OF DEATH AT VARIOUS AGES IN EACH SEX. TABLE IV. Causes of Death at Various Ages in Each Sex. 1903. 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—65 65 and Upw'rds. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. P. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 4 22 11 ... ... ... ... ... ... ... ... 24 15 39 Scarlet Fever ... 1 4 3 ... ... 1 ... ... ... ... ... 5 4 9 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza ... 1 1 ... ... ... 1 1 1 7 2 12 5 21 26 Whooping-cough 12 12 11 17 ... ... ... ... ... ... ... 1 23 30 53 Diphtheria, Membranous Croup ... ... 1 9 3 2 ... ... ... ... ... ... 4 11 15 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... 1 1 1 2 1 ... ... 3 3 6 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 20 14 1 1 ... ... ... ... 1 ... 1 3 23 18 41 Epidemic or Zymotic Enteritis 15 13 1 3 ... ... ... ... ... ... 1 ... 17 16 33 Enteritis 6 5 ... ... ... 1 ... ... ... 1 ... ... 6 7 13 Other Continued Fevers ... ... ... 2 ... ... ... ... ... ... ... ... ••• 2 2 Erysipelas 1 2 ... ... ... ... ... ... 2 1 1 1 4 4 8 Puerperal Fever ... ... ... ... ... ... ... ... ... 4 ... ... ... 4 4 Other Septic Diseases:- Pyæia 2 ... ... ... ... ... ... ... 2 2 1 ... 5 2 7 Stomatitis 1 1 ... 1 ... ... ... ... ... ... ... ... 1 2 3 Cellulitis 1 ... ... ... ... ... ... ... ... 2 ... ... 1 2 3 Infective Endocarditis ... ... ... ... 1 ... ... ... 2 ... ... ... 3 ... 3 Intermittent Fever and Malarial Cachexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Meninges 3 6 8 4 ... 1 ... ... ... ... ... ... 11 11 22 Tuberculosis of Lungs ... ... ... 1 3 3 15 11 67 46 2 4 87 65 152 Other Forms of Tuberculosis 7 4 3 5 ... 2 ... 2 3 6 ... ... 13 19 32 Alcoholism ... ... ... ... ... ... ... ... 12 13 ••• ... 12 13 25 Cancer ... ... ... ... 1 ... ... 1 39 61 24 33 64 95 159 Premature Birth 28 25 ... ... ... ... ... ... ... ... ... ... 28 25 53 Developmental Diseases 44 34 12 2 ... ... ... ... 1 ... ... ... 57 36 93 Old Age ... ... ... ... ... ... ... ... 1 ... 29 50 30 50 80 Meningitis 2 3 4 3 2 ... ... 1 3 ... ... ... 11 7 18 Inflammation and Softening of Brain ... 1 1 ... ... ... 1 ... 5 3 1 6 8 10 18 Organic Diseases of Heart ... ... ... ... 1 2 ... ... 18 12 12 10 31 24 55 Acute Bronchitis 19 13 9 2 1 1 ... 1 3 7 7 12 39 36 75 Chronic Bronchitis ... ... ... ... ... ... ... ... 10 9 19 47 29 56 85 Lobar (Croupous) Pneumonia 2 ... ... ... ... ... 1 1 9 6 2 1 14 8 22 Lobular (Broncho-) Pneumonia 9 8 6 4 ... 1 ... 1 3 2 4 2 22 18 40 Diseases of Stomach ... 2 1 ... ... ... ... 2 6 3 ... 3 7 10 17 Obstruction of Intestines 1 ... ... ... 1 ... ... ... 2 5 2 5 6 10 16 Cirrhosis of Liver ... ... ... ... ... ... ... ... 10 8 1 ... 11 8 19 Nephritis and Bright's Disease ... 1 ... ... ... 1 ... ... 8 19 8 10 16 31 47 Tumours and Other Affections of Female Genital Organs ... ... ... ... ... ... ... ... ... 4 ... 3 ... 7 7 Accidents and Diseases of Parturition ... ... ... ... ... ... ... 1 ... 8 ... ... ... 9 9 Deaths by Accident or Negligence 5 7 5 ... 4 ... 4 ... 21 6 6 5 43 18 61 Deaths by Suicide ... ... ... ... ... ... ... ... 16 1 3 ... 19 1 20 Deaths from Ill-defined Causes 2 ... ... ... ... ... ... ... ... 2 ... 1 2 3 5 Syphilis 4 3 ... ... 1 ... ... ... 2 1 ... ... 7 4 11 Rheumatic Fever ... ... ... ... ... ... 2 ... 1 ... ... ... 3 ... 3 Convulsions 12 7 5 2 ... ... ... ... ... ... ... ... 17 9 26 Apoplexy ... ... ... ... ... ... ... ... 5 4 2 5 7 9 16 Cerebral Hæmorrhage ... ... ... ... ... ... ... ... 8 13 4 18 12 31 43 "Heart Disease" ... ... ... ... 2 ... ... ... 29 21 12 24 43 45 88 Pneumonia 9 9 6 11 1 1 1 2 13 7 7 12 37 42 79 All other Causes 1 4 5 3 5 7 5 2 77 57 42 49 l35 122 257 All Causes 208 180 106 84 24 23 32 27 382 342 193 317 945 973 1,918 83 deaths at all ages. TABLE V. Deaths at All Ages, Allocated to Wards and Registration Sub-Districts. 1903. 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. Maida Vale. Westbourne. Church. Lancaster Gate West. Lancaster Gate East. Hyde Park St. Mary. St. John. Small-pox ... ... ... ... ... ... ... ... ... ... Measles 4 8 2 9 15 ... ... 1 34 1 Scarlet Fever ... ... 1 4 4 ... ... ... 9 ... Epidemic Influenza 2 3 6 6 7 ... ... 2 21 3 Whooping-cough 11 14 5 10 9 1 2 1 38 4 Diphtheria, Membranous Croup 2 5 1 3 ... ... ... 4 9 4 Croup ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 1 ... ... 2 1 ... ... 3 1 Diarrhoea, Dysentery 4 6 7 8 15 ... ... 1 35 2 Epidemic or Zymotic Enteritis 6 4 6 5 11 ... ... 1 26 1 Enteritis 2 2 6 ... 2 ... ... 1 10 1 Other Continued fevers ... 2 ... ... ... ... ... ... 2 ... Erysipelas 1 2 ... 1 2 ... 1 1 5 2 Puerperal Fever l 2 1 ... ... ... ... ... 3 ... Other Septic diseases ... ... 2 3 7 ... 2 2 10 6 Tuberculosis of Meninges 4 2 3 3 6 ... ... 4 14 4 Tuberculosis of Lungs 25 25 22 33 40 1 2 4 116 11 Other Forms of Tuberculosis 5 4 4 2 13 1 ... 3 23 4 Alcoholism 2 2 5 5 8 ... ... 3 19 4 Cancer 31 29 23 31 23 9 4 9 101 27 Premature Birth 5 14 7 12 10 1 2 2 41 7 Developmental Diseases 10 22 7 16 27 ... 4 7 70 13 Old Age 6 20 8 15 15 1 3 12 56 18 Meningitis 2 7 ... 4 4 ... ... 1 15 1 Inflammation and Softening of Brain ... 3 4 3 6 l ... 1 16 2 Organic Diseases of Heart 6 9 12 7 7 2 2 10 35 14 Acute Bronchitis 6 16 9 14 18 1 2 9 57 12 Chronic Bronchitis 10 15 11 19 21 2 2 5 64 11 Lobar (Croupous) Pneumonia 4 5 1 2 8 2 ... ... 16 2 Lobular (Broncho-) Pneumonia 7 9 1 6 14 ... ... 3 30 3 Diseases of Stomach 1 5 1 4 2 2 ... 2 12 4 Obstruction of Intestines 1 3 ... 4 2 1 4 1 9 6 Cirrhosis of Liver 1 5 3 1 5 1 2 1 14 4 Nephritis and Bright's Disease 3 4 5 14 9 3 2 7 31 13 Tumours and Other Affections of Female Genital Organs ... 1 2 1 1 ... ... 2 5 2 Accidents and Diseases of Parturition 1 3 2 1 1 ... 1 ... 7 1 Deaths by Accident or Negligence 5 11 6 10 20 2 2 5 44 12 Deaths by Suicide 6 2 ... 2 5 1 1 3 6 8 Deaths from Ill-defined Causes ... ... 1 ... 2 1 1 ... 3 2 Syphilis 1 1 1 2 6 ... ... ... 8 2 Rheumatic Fever ... ... 2 ... 1 ... ... ... 3 ... Convulsions 2 8 2 1 10 2 ... 1 19 5 Apoplexy 1 6 2 2 3 1 ... 1 13 2 Cerebral Hæmorrhage ... 6 4 15 11 1 2 4 35 8 "Heart Disease" 15 15 14 12 22 1 3 6 63 10 Pneumonia 11 15 3 17 19 3 ... 8 57 11 All other Causes 31 34 42 42 57 9 16 26 169 57 All Causes 237 353 244 349 470 51 60 154 1,376 305 * This Ward is co-terminous with the North-West Paddington Registration Sub-District. 84 bakehouses. "LEVEL" BAKEHOUSES. 8, Bristol Gardens. 53, 55, 57, Connaught Street. 319, Edgware Road (d). 377, Edgware Road. 143, Harrow Road. 339, Harrow Road. 549, Harrow Road. 618, Harrow Road. 690, Harrow Road. 226, Kilburn Lane. 336, Kilburn Lane. 2, Mozart Street. 24, Mozart Street. 75, Queen's Road. 80, Queen's Road. 3, Richmond Road. 56, Westbourne Grove. UNDERGROUND BAKEHOUSES. Queen's Park Ward. 62, Herries Street (b). 83, Herries Street (b). Harrow Road Ward. 1, Chippenham Road (b). 41, Chippenham Road (a). 99, Chippenham Road (a). 55, Elgin Avenue (a). 27, Amberley Road (b). 60, Carlton Vale (a). 17, Clifton Road (b). 237, Elgin Avenue (b). 67, Cornwall Road (b). 241, Harrow Road (a). 265, Harrow Road (b). 365, Harrow Road (a). 23, Chichester Street (b). 17, 19, Chilworth Street (b). 113, Cirencester Street (a). 52, Clarendon Street (b). 307, Edgware Road (b). 72, Prince's Square (b). 37, Douglas Place (b). 75, Fernhead Road (b). 360, Harrow Road (a). 436, Harrow Road (a). Maida Vale Ward. 1*4, Formosa Street (a). 37, Kilburn Park Road (a). 227, Maida Vale (a). 57, Shirland Road (b). Westbourne Ward. 27, Kensal Road (b). 68, Ledbury Road (b). 3, Norfolk Road (a). 24, Porchester Road (a). Church Ward. 347a, 349, 351, Edgware Rd. (b). 401, Edgware Road (b). 72, Hall Place (c). 90, Harrow Road (a). Lancaster Gate West Ward. 70, 72, Queen's Road (b). 534, Harrow Road (a). 560, 562, Harrow Road (a). 117, Walterton Road (b). 125, Shirland Road (a). 195, Shirland Road (b). 5, Warwick Place (b). 10, Richmond Road (b). 76, Richmond Road (b). 43, Waverley Road (b). 135, Westbourne Park Road (b). 292, Harrow Road (b). 23, Westbourne Terrace North (6). 37, Westbourne Terrace North (a). 20, Woodchester Street (a). 153, 155, 157, Queen's Road (b). Lancaster Gate East Ward. 32, Chilworth Street (b). 16, Craven Terrace (b). 46, Craven Road («). Hyde Park Ward. 47, Cambridge Street (a). 57, Cambridge Street (a). 189, Edgware Road (b). 9, London Street (c). 53, Praed Street (b). 3, Spring Street (a). 91, Star Street (b). UNDERGROUND BAKEHOUSES NOT IN USE. 62, Alfred Road. 35, Alexander Street. 92, 94, Bishop's Road. 102, Church Street. 16, Cirencester Street. 24, Cleveland Gardens. 46, Connaught Street. 20, Craven Road. 307, Edgware Road. 59a, Eernhead Road. 29, Harrow Road (d). 77, Harrow Road. 303, Harrow Road. 500, Harrow Road. 1A, Kensal Road. 14, Lancaster Street. 67, Moscow Road. 7, Praed Street. 43, Ranelagh Road. 41, Tavistock Crescent. 4, Upper Porchester Street. 99, Westbourne Park Villas. (a) All works required for the Certificate completed before December 31st, 1903. (b) Works approaching completion at end of year : Certificates now issued. (c) Works only put in hand just before the end of the year: Certificates not yet issued. (d) Underground bakehouses given up owing to refusal of Certificate.