CONTENTS. Page Alcoholism, Deaths from 43 Bacteriological Examinations, Results of 55 Bakehouses, Inspection of 61 Births and Birth-Rates 3 Births in Outlying Hospitals 3 Brandy, Adulteration of 76 Canals 57 Canal Boats Acts 57 Cancer, Mortality from 40 Childbed, Mortality in 28 Chicken-pox, Cases reported 34 *"Clarendon Street Area" 67 Combined Drainage 55 Common Lodging Houses 69 Cowhouses 70 Dairies and Milkshops 71 Deaths and Death-Rates 10 Deaths in Institutions 49 Death-rates, Factor Corrected 15 Diarrhoea, Deaths from 46 Diphtheria, Cases of 17 ,, Mortality from 19 Disinfection and Disinfectants 52 Drains, Private, Re-laid 55 Enteric Fever, Cases of 24 „ Mortality from 25 Erysipelas 29 Factory and Workshop Act, 1901, Work Under 58 Family Shelter 52 "Fever" 24 Food Analysis, Summary of Samples taken 75 ,, Summary of Proceedings 80 Food Supervision 70 Food Adulteration 74 Food Purveyors 72 Frost v. Aylesbury Dairy Co., Ltd. 78 Heavor's Exors. v. Mayor, &c., of Fulham 78 Hospitals, Accommodation provided 51 Houses let in Lodgings, Annual Cleansing of 64 „ „ Exemption by rent 68 „ „ "Sickness, etc., in 66 „ Registration of 62 „ „ Overcrowding in 64 „ „ Sanitary defects in 66 „ „ Verminous rooms 69 „ ,, ' Water supply 69 "Housing of the Working Classes" 69 Ice Cream, Inspection of places where made 73 Illegitimates, Births of 4 „ Deaths of 47 Infantile Mortality 43 Influenza, Mortality from 42 Page Inhabited House Duty, Exemption from 69 Inquests held 48 Institutions, Deaths in 49 Laundries 61 Legal Proceedings, Summary of 78 Manure, Removal of 55 Measles, Cases reported 30 ,, Mortality from 31 Meat Supply 70 Meteorology 2 Milkshops, Trades carried on at 71 Mortuaries 52 Notifications 7 Offensive Businesses 58 Offensive Refuse, Removal of 55 Office Work 77 Outworkers 58 Phthisis, Mortality from 35 ,, and "Overcrowding" 38 „ and age constitution of population 35 Population, Estimate 1 Prevention of Infectious Diseases 51 Puerperal Fever, Cases of 27 „ „ Mortality from 27 Respiratory Diseases, Mortality from 42 Scarlet Fever, Cases of 20 ,, „ Mortality from 23 Schools and Infectious Diseases 52 Septic Diseases, Mortality from 29 Sewers, Complaints of 56 Slaughterhouses, Inspection of 70 Small-pox 16 Smoke Prevention 57 Tubercular Diseases, Mortality from 35 Unsound Food seized 73 Vaccination 16 Washing Soda, Adulteration of 75 Water Supply, Cutting off of 52 Wharves, Inspection of 58 Whooping Cough, Cases reported 33 „ „ Mortality from 34 Workshops, Inspection of 58 APPENDIX. Tables required by the Local Government Board and Home Office 82-87 TO HIS WORSHIP THE MAYOR, THE ALDERMEN, AND COUNCILLORS OF THE BOROUGH OF PADDINGTON. Gentlemen, I beg to submit my Report on the health of the Borough and the work of the Public Health Department during the past year, this being the eleventh annual report which I have had the honour to lay before you. Speaking generally, I think the statistics will be found satisfactory, the sickness and death rates being low, the latter the lowest on record save that of 1903. On the other hand, the birth-rate is lower, and the infantile mortality higher, than the respective rates of the previous year. The birth-rate for last vear is, with the exception of that of 1902, the lowest on record. The mean rates for the last five years (1900-04) all show decreases from the means for the five years immediately preceding the date when I took office (1894), as may be seen from the appended statement:— Mean Rates for Births. Sickness. Deaths. Infantile Mortality. 1889—93 24.7 7.5 17.0 146 1900-04 22.8 5.7 14.4 136 The Council are to be congratulated on the satisfactory results of their labours to improve the health of the Borough. The continued decline in the birth-rate is so serious a matter from a national point of view that I venture to submit a few observations on the question. Taking the Census year as the central period in each case, the birth-rates for England and Wales for the four 3-year periods of 1870-72, 1880-82, 1890-92 and 1900-02 have been 35.3, 34.0, 30.7 and 28.6—the difference between the first and last being 6.7 per 1,000 persons, which implies a deficit of over 650,000 new lives, during the three years 1900-02. If the death-rate had decreased by an equal amount such deficiency would be of small importance. For the four 3-year periods already mentioned the death-rates were 21.1, 18.8, 19'4 and 47.1, the difference between the first and last rate being 4.0 per 1,000 (as compared with 0.7 for the births) which means a saving of over 400,000 lives during the three years 1900-02. Balancing the deficit on births against the saving on deaths, there remains a nett deficit of more than 250,000 lives which would have been added to the nation had the birth-rate ii. which prevailed during 1870-72 persisted during 1900-02. The rates are set out in tabular form below:— Mean Rates : England and Wales. Periods. Births. Deaths. Infantile Mortality. 1870—72 35.3 21.1 156 1880—82 34.0 18.8 141 1890—92 30.7 19.4 149 1900—02 28.6 17.1 146 1903 28.4 15.4 132 1904 27.2 16.2 146 It is true that the actual number of births in each year is in excess of the number of deaths, as is shown by the differences between the birth and death rates. It is also true that the population enumerated at each Census has shown considerable increases, but the percentage increase has fallen from 13.1 during the ten years 1801-71 to 12.2 during 1801-1901 Against this must be set the loss by emigration (the amount of which cannot be given here' and the increased proportion of foreign-born immigrants. The numbers of the latter have increased at each Census since 1871, and the rate of increase has been higher on each occasion except in 1881. Thus the number enumerated at the Census of 1871 was 30.9 per cent. higher than the number enumerated in 1801. Similarly the return for 1901 was 45.7 per cent. higher than that of 1891. (See Table below.) Increases per cent. in each previous Decennium. Date of Census. Total Population of England and Wales. Of Persons born in Foreign Countries enumerated in England and Wales. As determined by Census enumeration. As calculated from natural increment. Total. Classified as Foreign Subjects. 1871 13.19 13.58 36.9 19.7 1881 14.36 15.09 25.0 17.3 1891 11.66 13.97 33.6 67.9* 1901 12.16 12.39 45.7 25.1 * Overstated owing to imperfect filling up of Schedules. The changes in the birth and death rates may be stated in a different manner Comparing the rates for 1900-02 with those for 1870-72, the decrease in each rate for 1900-05 is equal to 19 per cent, of the rate for 1870-72. In 1870-72 the mean infantile mortality was 156 per 1,000 births, in 1900-02, 146—showing a decrease equal to 6.4 per cent, of the rats for the earlier period, or very little more than one-third the decline in the general rate. Such a trifling reduction can scarcely be claimed as a credit to sanitary administration. Having regard to the decreased birth-rate, the high infantile mortality is a problem ranking second only to that of the housing of the working classes—with which it is indeed very closely associated. iii. As to remedies to check the loss of infant lives, it is not easy to lay down any definite suggestions within the space allotted to this introduction. Many advocate municipal milk supplies, creches, etc. Useful as they have been found to be, I regard them only as makeshifts. Permanent results can only be hoped for from radical changes in the system of education of girls—the future mothers. The work of the Department during the year was uneventful. The two most notable incidents were the legal proceedings for the sale of tuberculous pigs and the preparation of new By-laws for houses let in lodgings. As to the future—the disposal of refuse of all kinds will demand early consideration. The ultimate adoption of destruction of house refuse by incineration appears to be inevitable. Municipal disposal of manure and offensive refuse of all descriptions will also be necessary. The housing question still awaits solution, although at present there seems to be a fair amount of accommodation available in the Borough. In conclusion, I must express my satisfaction with the manner in which all members of the Staff have worked during the year. I desire also to acknowledge the cordial co-operation of the medical profession practising in the Borough, and to thank the Chairman and Members of the Public Health Committee for the sympathetic consideration always afforded to me. I have the honour to be, Gentlemen, Your obedient Servant, m.a., m.b., d.p.h., f s.s., Medical Officer of Health. Public Health Department, Paddington, W. May, 1905. 1 REPORT. The Borough.—The Borough has an area of 1,356 acres, including 20 acres of water (canals) and 175 acres (approximately) of open spaces. At the census of 1901 there were 17,684 inhabited houses. The total number of families at that date was 33,661, including 21,815 residing in homes containing less than five rooms. Of the persons residing in such homes 27.6 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. St. Mary Harrow Road. Maida Vale. Westbourne. Church (part of). St. John Church (part of). Lancaster Gate, West. „ „ East. Hyde Park. North-West Paddington Queen's Park. Population in 1904.—The estimate of the population of the Borough at the middle of the year was 146,815 persons, of whom 62,873 were males and 83,942 females. At the census of 1901 the enumerated population was 143,976 persons, showing an increase of 2,839 persons during 3¼ years. The estimates of the inhabitants of the various sub-divisions of the Borough are given in Table 1. TABLE 1. Estimated Population. 1904. Borough Males 62,873 Persons 146,815. Females 83,942 Registration Sub-Districts Persons. Wards. Persons. St. Mary 96,441 Queen's Park 16,813 St. John 33,561 Harrow Road 28,672 North-West Paddington 16,813 MaidaVale 19,375 Westbourne 24,612 Church 27,076 Lancaster Gate (West) 8,441 „ „ (East) 7,926 Hyde Park 13,900 9 meteorology. METEOROLOGY. In Table 2 will be found the meteorological data for the past three years, based on observations taken at the Royal Botanic Gardens, Regent's Park. The mean air temperature was a little below that of the previous year; but the maximum was 3 deg. higher. The amount of rain measured (21.06 in.) was 17.61 in. below the total for 1903, but 1.31 in. above that for 1902, while the number of days on which measurable amounts fell was the lowest for the three years. Although the number of days on which bright sunshine was recorded (245) was the smallest for the three years, the total number of hours recorded (1,282½) was the highest. TABLE 2. Meteorological Elements. 1904.* Months. 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. 1904. Inches. Deg. Deg. Deg. Dates. Deg. Dates. Deg. Deg. h. m. Jan. 29.96 39.7 37.9 54.5 13th 28.0 16th 72.5 20.0 2.41 23 22 07 9 Feb. 29.66 39.2 37.0 53.0 21st 27.5 28th 79.0 22.0 2.70 18 37 31 19 March 29.98 40.2 37.9 58.9 9th 26.5 17th 91.0 22.5 1.27 15 47 19 18 April 29.94 50.2 46.2 66.0 20th 36.5 25th 109.0 28.0 1.18 11 138 24 25 May 29.95 54.5 50.1 74.0 26th 35.5 8th 118.0 27.0 2.14 16 123 28 26 June 30.04 59.9 54.2 75.0 30th 43.0 3rd 120.5 36.5 0.66 6 200 43 29 July 30.02 68.3 61.5 89.0 17th 54.0 28th 128.0 45.0 2.11 9 265 14 29 August 30.01 63.8 57.6 89.2 4th 44.5 24th 130.5 36.0 1.59 10 231 52 30 Sept. 30.07 56.0 53.2 73.5 5th 40.5 25th 115.5 27.5 1.33 11 129 27 24 Oct. 30.09 50.2 48.9 65.0 18th 35.0 14th 97.0 18.0 1.59 13 45 00 16 Nov. 30.07 40.9 39.7 58.0 9th 25.0 26th 84.5 12.0 1.66 10 29 13 12 Dec. 29.93 41.7 40.5 55.0 16 th & 17th 29.0 23rd 73.0 20.0 1.82 15 12 34 8 Totals — — — — — — — — — 21.06 157 1,282 52 245 Means 29.97 50.3 46.2 — . — — — — — — — — — — Highest — — – 89.2 Aug. — — 130.5 — — — — — — Lowest — — — — — 25.0 Nov. — 12.0 — — — — — 1903. Totals — — – — — — — — — 38.67 171 1,241 00 265 Means 29.92 50.6 47.3 — — — — — — — — — — — Highest — — — 86.0 July — 128.0 — — — — — — Lowest – — — — — 26.0 Jan. — 190 — — — — — 1902. Totals – – – — — — — — — 19.75 159 1,017 05 251 Means 29.98 49.4 46.1 — — — — — — — — — — — 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. 3 births. BIRTHS. During the 52 weeks taken as the year, 3,295 births were registered in the Borough, 7 less than the total for the previous year. The births comprised 1,642 (1,658*) of boys, and 1,653 (1,644) of girls. The birth-rate was 22.44 per 1,000 persons, 0.18 less than the rate for 1903. The numbers registered last year in each of the three Registration Sub-Districts, and the rates for the years 1901—4, are given in I able 3. TABLE 3. Births and Birth-Rates. 1901. Births. Borough. Registration Sub-Districts. St. Mary. St. John. North-West Paddington Males 1,642 1,262 172 208 Females 1,653 1,262 206 185 Totals 3,295 2,524 378 393 Birth-Rates. Per 1,000 persons 1901 22.44 26.17 11.26 23.37 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. 1901 69.6 88.0 25.5 100.5 1903 70.1 87.6 25.7 110.6 1902 71.6 87.0 26.0 119.7 1901 72.1 91.4 26.2 108.3 Last vear's rate for the Borough was 1.67 below the decennial mean rate (24.11). The quinquennial and decennial mean rates are compared in full below:— Birth-Rates, Per 1,000 persons of all ages. Mean Rates. Five years, Five years, Ten years, 1904. 1894-1898. 1899-1903. 1894-1903. Borough 22.44 25.02 23.21 24.11 St. Mary 26.17 28.58 26.67 27.62 St. John 11.26 12.71 11.58 12.14 North-West Paddington 23.37 30.55 27.17 28.86 The greatest diminution has taken place in North-West Paddington (Queen's Park Ward). The numbers for each year will be found in Tables I. and II. in the Appendix. Outlying Institutions.—From an examination of the records of the three principal Lying-in-Hospitals, viz., Queen Charlotte (158), British (4), and General (1) it appears that 163 children were born in those Institutions whose maternal homes were in the * Figures for 1903 shown in parentheses. 4 births. Borough. The corresponding numbers for the three previous years were: 1901, 40; 1902, 159; and 1903, 163. Of the 163 children born during last year 37 were illegitimate, as against 46 in 1903, 52 in 1902, and 46 in 1901. Allocating the births according to the parents' homes, 21 belonged to North-West Paddington, 124 to St. Mary, and 28 to St. John. The "corrected" numbers of births in the three Sub-Districts were 414, 2,648, and 406 respectively, giving the following "corrected " birth-rates:— St. Mary 27.45, St. John 12.09, North-West Paddington 24.62; and for the Borough 23*55. (Compare these rates with those in Table 3). Illegitimate Births.—Included in the 3,295 births registered within the Borough were 167 of illegitimate children, viz., 79 of boys and 88 of girls. In the Lying-in Hospitals there occurred 37 other births. Births of Illegitimates. (Including those in Outlying Hospitals). Borough. St. Mary. St. John. North-West Paddington. Males 100 89 9 2 Females 104 91 6 7 Total 204 180 15 9 Per cent. of all Births Registered- 1904 5.9 6.8 3.7 2.2 1903 5.3 5.6 6.3 2.7 1902 5.5 6.9 3.9 1.8 1901 5.1 6.0 1.4 3.1 In the whole County the births registered during the year numbered 129,335, or 571 fewer than the total for the previous year, the numbers recorded in all the Adjacent Districts (Willesden excepted) being also below the returns for 1903. In Willesden last year's total was 4,319, or 260 above that for the preceding year. The local birth-rate (calculated per 1,000 persons of all ages) was third in order of magnitude, higher rates having been recorded in Willesden (32.57) and the County (27.81). (See Table 4). TABLE 4. Births and Birth-Rates.* 1904. Births Registered. Birth-rates. Per 1,000 persons at all ages. Per 1,000 females aged 15-45 years. Borough 3,295 22.41 69.58 London 129,335 27.81 101.68 Kensington 3,450 19.24 53.43 Westminster 2,898 16.67 49.66 Marylebone† 3,948 30.28 87.90 Hampstead 1,431 16.49 43.58 Willesden 4,319 32.57 117.27 * From figures published in the Quarterly Reports of the Registrar-General † According to the Medical Officer of Health of the Borough the corrected figures for Marylebone are:— Births 2,791. Birth-rates 2141 per 1,000 persons; 62.ll per 1,000 females 15—45. 5 births. Owing to the varying proportions of females of child-hearing ages (15-45 years) in the different populations, the rates per 1,000 persons of all ages convey but an imperfect idea of the fruitfulness of marriage. In Tables 3 and 4 the rates per 1,000 females, aged 15-45 years, are given. These rates are generally accepted as a satisfactorv indication of re-productivity, but even they give only an imperfect idea of the true state of affairs. The widely varying proportions of single, married, and widowed women and of females engaged in earning their livelihood in the different localities materially affect rates of reproduction based on the total numbers of women—whether of all ages or of the child-bearing ages. The figures relating to these points have been taken out from the last Census' Report, and the proportions calculated therefrom will be found in Table 5. It appears that in Hampstead 708 out of every 1,000 females, aged from 15-45 years, were enumerated as unmarried, while in Willesden the ratio was as low as 465, Of females of child-bearing ages the highest proportion returned as occupied was that of Westminster (629), and the lowest that of Willesden (377), while of married and widowed women at those ages the proportions were 267 in Westminster (the highest), and 115 in Willesden (the lowest). TABLE 5. (Census, 1901.) Of 1,000 Females aged 15-45 Proportion occupied per 1,000. Unmarried. Married. Females 15-45. Married and Widowed, 15 years and upwards. Borough 621 354 534 165 London 524 448 466 172 Kensington 688 284 602 234 Westminster 648 320 629 267 Marylebone 634 334 601 250 Hampstead 708 561 128 Willesden 465 513 377 115 Note.—The Condensed Tables of Occupations do not distinguish the ages of "married and widowed" engaged in occupations. No female under 15 years of age was returned as married at the last Census. The birth-rate ought to be calculated on the married women of child-bearing ages, due correction being made for the births of illegitimate children. Unfortunatelv the whole of the data necessary for such correction are not available. In Table 6 rates are given based on all births, and also on legitimate and illegitimate, as far as can be done. The table at present gives but little information ; but continued for a series of years, will afford a clear indication of the changes in the fruitfulness of marriage and the improvement (or deterioration) in the morality of the various districts. The only point to which attention need be called is the fact that the "married women" rate in Hampstead is higher than that of Westminster, whereas the birth-rate as usually given is lower. (See Table 4). 6 births. TABLE 6. Birth-rates. Per 1,000 females (15-45) of each class. All Births. Married Females. Legitimate Births. Married Females. Illegitimate Births. Unmarried Females. Paddington 1901 203.77 195.70 4.56 1902 199.38 190.39 5.12 1903 198.08 189.74 4.75 London 1901 236.66 217.99 7.41 1902 232.40 224.09 7.16 1903 232.11 223.72 7.18 Kensington 1901 199.17 190.10 3.74 1902 191.98 183.12 3.65 1903 195.33 187.05 3.41 Westminster 1901 168.63 ? ? 1902 172.47 159.55 4.82 1903 160.00 150.13 4.87 Marylebone 1901 257.39 ? ? 1902 194.72 ? ? 1903 186.56 ? ? Hampstead 1901 177.63 ? ? 1902 175.70 171.18 1.73 1903 165.52 160.74 1.83 Willesden 1901 226.34 223.45 3.18 1902 225.95 223.18 3.05 1903 224.73 219.93 5.30 The numbers of births used in this table are those given in the local annual reports as registered in the respective districts—except that the totals for Marylebone have been corrected for non-resident births in Queen Charlotte's Hospital. [Since the last paragraph was written the Registrar-General's Annual Summary for 1904 has been published. In it is included a review of the birth-rates of the Metropolis calculated in the way set out above. The appended table is an abbreviation of the table given in the Summary. Birth-rates, London. Per 1,000 individuals of each class. Total Births. Legitimate Births. Illegitimate Births. Unmarried and Widowed females 15—45 years. Total Population. All females Aged 15-45 years. Married females 15-45 years. Mean-rates. 1870-72 35.2 134.0 269.9 10.3 1880-82 34.8 133.3 272.6 9.8 1890-92 31.1 118.5 250.4 8.1 1900-02 28.9 105.8 227.6 6.9 1903 28.5 103.9 223.7 6.8 1904 27.9 101.9 218.9 7.0 If the mean rates for 1870-72 be taken as 100 in each case, the rates for last year would be 79, 76, 81, and 68 respectively—thus showing that the legitimate birth-rate has decreased by 19 per cent., and the illegitimate by 32 per cent. Having regard to the increase in the number of women of child-bearing ages now living, the fall in the birth-rate recorded last year from the standard of 1870-72, represents a loss of nearly 37,000 new lives in the Metropolis alone.] 7 NOTIFICATIONS. NOTIFICATIONS. The cases certified* under Sec. 55 (1) of the Public Health (London) Act, 1891. numbered 684, being 48 fewer than the total cases reported in 1903 (732), and 237 less than the corresponding total (921) for 1902 (53 weeks). In comparison with the previous year, the numbers of cases of all the diseases scheduled showed reductions (sec Table 7), except those of enteric fever (increase of 5 cases) and puerperal fever (increase of 7 cases). The greatest decrease was that of scarlet fever (49 cases, equal to 12 per cent. of the total for 1903). TABLE 7. Notifications. Borough. London. Notification Rates. 1904 1903 Differences. Increase ( + ) Decrease (—) 1904 1903 Differences. Increase ( + ) Decrease (—) Borough. London. 1904 1903 1904 1903 Smallpox 4 5 — 1 495 417 + 78 0.02 0.03 0.10 0.09 Cholera ... . . . ... ... ... ... ... ... ... ... Diphtheria 140 143 — 3 7,082 7,593 —511 0.95 0.97 1.52 1.64 Membranous Croup ... 2 2 145 156 — 11 ... 0.01 0.03 0.03 Erysipelas 117 118 — 1 4,954 4,382 + 572 0.79 0.88 1.06 0.91 Fevers. Scarlet 365 414 —49 13,451 12,545 + 996 2.48 2.83 2.89 2.71 Typhus ... 1 — 1 3 22 — 19 ... 0.00 0.00 0.00 Enteric 48 43 + 5 1,903 2,344 —441 0.32 0.29 0.40 0.50 Relapsing . . . ... 2 1 + 1 ... ... 0.00 0.00 Continued ... 3 — 3 28 41 — 13 ... 0.02 0.01 0.00 Puerperal 10 3 + 7 274 231 + 43 0.06 0.02 0.04 0.05 Totals 684 732 —48 28,337 27,732 + 605 4.65 5.01 6.09 6.00 TABLE 8. Notifications, 1904 (Compiled from Registrar-General's Quarterly Reports). dington. London.* Kensington. Westminster.† Marylebone. Hampstead. Willesden Smallpox 4 491 3 6 8 1 12 Diphtheria and Membranous Croup 143 7,220 187 145 118 58 351 Erysipelas 117 4,947 141 126 187 56 74 Fevers. Scarlet 363 13,438 267 313 295 169 327 Enteric 48 1,896 47 51 50 27 37 Continued — 27 3 2 – 1 — Puerperal 10 273 11 5 3 6 5 * Also 3 cases typhus fever † Also 1 case typhus fever. * Chicken-pox was added to the list of notified diseases for part of the year; but the cases of this disease certified in accordance with the Order of the London County Council have been reserved for separate consideration. 8 NOTIFICATIONS. TABLE 9. Notification Rates. (Based or) figures given in preceding Table.) Paddington. London. Kensington. Westminster. Marylebone. Hampstead. Willesden. 1904 * Mean 1904 Mean 1904 Mean 1904 Mean 1904 Mean 1904 Mean 1904 Mean Smallpox 0.02 0.31 0.10 0.71 0.01 0.21 0.03 0.68 0.06 1.92 0.01 0.10 0.09 0.27 Diphtheria 0.97 1.62 1.55 2.21 1.01 1.14 0.83 1.32 0.90 1.81 0.66 1.33 2.64 2.91 Erysipelas 0.79 0.92 1.06 1.04 0.78 0.99 0.72 0.67 1.43 1.44 0.64 0.59 0.55 0.70 Fevers. Scarlet ... 2.46 2.93 2.89 3.55 1.48 2.21 1.80 2.38 2.26 3.07 1.94 2.56 2.46 4.15 Enteric ... 0.32 0.49 0.40 0.64 0.26 0.45 0.23 0.56 0.38 0.61 0.31 0.49 0.27 0.47 Continued — 0.00 0.00 0.00 0.01 0.02 0.01 0.00 — 0.01 0.01 0.00 — — Puerperal 0.06 0.06 0.05 0.05 0.06 0.05 0.02 0.02 0.02 0.06 0.06 0.05 0.03 0.04 * Mean rates for the three years 1901-03. In the County as a whole the total number of cases certified last year (28,337) exceeds the total for 1903 bv 605—an increase equal to 2 per cent, of the total for the latter year, The decrease in the total number of cases in the Borough was equal to 7 per cent. The greatest increase in prevalence in the County was that of scarlet fes'er (900 cases) (see Table 7), equal to 7 per cent, of the total for 1903. Other increases were erysipelas (572 cases in excess), smallpox (78), and puerperal fever (43). The numbers of cases of the principal diseases reported in the Adjacent Districts are given in Table 8, and the corresponding rates in Table 9. The local figures and rates compare not unfavourably with those for the other districts mentioned in the tables. TABLE 10. Notifications, 1904. Distributed according to Wards. Numbers for 1903 shown {italics). 1. Queen's Park. II. Harrow Road. III. Maida Vale. IV. Westbourne. V. Church. VI. Lancaster Gate West. VII. Lancaster Gate. East. VIII. Hyde. Park. Smallpox 1 (1) 2 (/) 1 (-) -(?) –(1) - (-) -(-) — (1) Diphtheria 17 (19) 32 (43) 28 (14) 16 (20) 28 (24) 4 (3) 4(4) 11 (16) Membranous Croup -(-) -(-) -(-) -(1) - (1) -(-) -(-) - (-) Erysipelas 11 (10) 27 (25) 20 (19) 13 (12) 35 (37) 3(2) 4 (2) 4 (11) Fevers. Scarlet 76 (63) 95 (97) 29 (57) 46 (73) 73 (92) 15 (14) 4 (6) 27 (12) Enteric 1 (8) 3 (5) 8 (6) 14 (6) 11 (15) 3(5) 3(1) 5 (1) Continued -(-) -(-) - (—) -(1) -(-) -(-) -(-) — (1) Puerperal 1 (1) 1 (1) 2 (—) 2(—) 3 (1) -(-) -(-) 1 (-) Typhus -(1) - (-) — (—) -(-) – (–) – (–) — (-) -(-) Totals 107 (103) 100 (170) 88 (96) 91 (115) 150 (171) 25 (22) 15 (13) 48 (42) Rates, 1904 6.36 5.58 4.54 3.69 5.53 2.96 1.89 3.45 „ 1903 6.08 5.99 5.00 4.72 6.37 2.60 1.63 3.02 „ 1902 8.82 7.77 4.61 6.57 7.46 3.01 3.09 3.03 „ 1901 9.96 9.36 7.46 7.13 9.11 3.54 4.65 4.52 notifications. 9 Tabulating the cases according to Wards (see Table 10), it appears that numbers for 1904 were generally below those for 1903, the more important exceptions being— Ward. 1904. 1903. Diphtheria—Maida Vale 28 14 „ Church 28 24 „ Lancaster Gate (West) 5 3 Scarlet Fever—Queen's Park 76 63 „ Hyde Park 27 12 Enteric Fever—Maida Vale 8 6 „ Westbourne 14 6 Puerperal Fever—Maida Vale 2 — „ Westbourne 2 — „ Church 3 1 The rates calculated on the total numbers of cases were slightly higher in 4 out of the 8 Wards, viz.:— 1904. 1903. 1904. 1903. Queen's Park 6.36 6.08 Lancaster Gate (East) 1.89 1.63 Lancaster Gate (West). 3.08 2.60 Hyde Park 3.38 3.02 TABLE 11. Notifications, 1904. Distributed according to sexes and ages of patients. 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— ... ... 4 ... ... ... 1 9 5 2 1 ... ... ... ... 1— ... ... 2 2 ... ... 1 ... 5 10 ... ... ... ... ... 2- ... ... 3 6 ... ... 1 1 24 4 ... ... ... ... ... 3— 9 ... 9 11 ... ... I 1 18 17 ... ... ... ... ... 4— ... ... 8 11 ... ... ... ... 27 22 1. 2 ... ... ... 5— ... ... 23 28 ... ... 3 3 74 98 5 1 ... ... ... 13— ... ... 1 3 ... ... 3 1 7 5 ... 1 ... ... ... 15— ... ... 2 8 ... ... 3 14 8 20 6 9 ... ... 3 25— 2 ... 7 12 ... ... 34 39 4 15 7 15 ... ... 7 65— ... ... ... ... ... ... 7 2 ... ... ... ... ... ... ... All ages ' 4 ... 59 81 ... ... 54 63 172 193 20 28 ... ... 10 Rates— 1904 0.06 ... 0.93 0.96 ... ... 0.85 0.75 2.73 0.029 0.31 0.33 ... ... 0.11 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 2.76 217 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 10 notifitations. The cases have been distributed in Table 11, according to sex and age of patients, to which are appended the sex rates (all ages) for each disease during the past 4 years. Last year's rates were generally the lowest of the series, the exceptions being— 1904. Lowest Rate. Diphtheria, Females 0.96 0.86 (1903) Erysipelas, Males 0.85 0.70 (1903) Scarlet Fever, Females 2.29 2.17 (1902) Enteric Fever 0.33 0.27 (1903) Puerperal Fever O.11 0.03 (1903) The Chart facing this shows the numbers of cases of diphtheria (including membranous croup), scarlet and enteric (including continued fever) fevers, reported in each week during the year, the broken line giving the uncorrected decennial number for each week. DEATHS. The deaths registered within the Borough during the year numbered 2,228 (viz., 1,120 of males and 1,108 of females), giving a gross death-rate of 15.17 per 1,000 of the estimated population (persons of all ages). In 1903 the total number of deaths was 2,103, and the death-rate 14.41. The numbers and rates for the other years since 1894 will be found in Table L, Appendix. Last year's gross rate was l.01 below the decennial mean rate. The ages at death are sufficiently indicated in the appended statement, in which the numbers for 1903 are given in parentheses:— Ages, Years. No. of deaths. Persons. Ages, Y ears. No. of deaths. Persons. 0— 490 (425) 15— 86 ( 79) 1— 189 (220) 25— 839 (794) 5— 78 ( 77) 65— 546 (508) The principal causes of death were— Infectious Diseases. Other Diseases and Causes. Measles 38 (41) Croup 1 (0) Scarlet Fever - (1) Cancer 176 (179) Whooping Cough 15 (55) Bronchitis 192 (160) Diphtheria and Membranous "Pneumonia" 133 (161) Croup 9 (6) Other Respiratory Diseases 17 (25) "Fever" 13 (9) Alcoholism 19 (28) Epidemic Influenza 46 (26) Cirrhosis of Liver 27 (23) Diarrhoeal Diseases 153 (79) Premature Birth ... 60 (54) Puerperal Fever 8 (3) Accidents and Diseases of Other Septic Diseases 12 (26) Parturition 9 9) Phthisis 159 (159) Accidents 105 (94) Other Tubercular Diseases 81 (74) Suicide 21 (21) Of the deaths, 780 (35.0 per cent.) occurred in the local Public Institutions, viz.:— Workhouse 66 (57), Infirmary 261 (260), Lock Hospital 1 (2), Children's Hospital 92 (82)r and St. Mary's Hospital 360 (342). (See also Tables III. and IIIa. in the Appendix). Among the deaths registered within the Borough were 387 of non-residents which have been allocated to the respective districts whence the deceased persons came. On the other hand 173 deaths of residents have been reported from outlying districts, of which 154 (89.0 per cent.) occurred in Public Institutions. (See Table III.A Appendix). By deducting the former and adding the latter, the "corrected" total (2,014) * is obtained, giving a "nett ' * Unless otherwise stated, all numbers given hereafter have been similarly "corrected." 10 notifitations. The cases have been distributed in Table 11, according to sex and age of patients, to which are appended the sex rates (all ages) for each disease during the past 4 years. Last year's rates were generally the lowest of the series, the exceptions being— 1904. Lowest Rate. Diphtheria, Females 0.96 0.86 (1903) Erysipelas, Males 0.85 0.70 (1903) Scarlet Fever, Females 2.29 2.17 (1902) Enteric Fever „ 0.33 0.27 (1903) Puerperal Fever 0.11 0.03 (1903) The Chart facing this shows the numbers of cases of diphtheria (including membranous croup), scarlet and enteric (including continued fever) fevers, reported in each week during the year, the broken line giving the uncorrected decennial number for each week. DEATHS. The deaths registered within the Borough during the year numbered 2,228 (viz., 1,120 of males and 1,108 of females), giving a gross death-rate of 15.17 per 1,000 of the estimated population (persons of all ages). In 1903 the total number of deaths was 2,103, and the death-rate 14.41. The numbers and rates for the other years since 1894 will be found in Table I., Appendix. Last year's gross rate was 1.01 below the decennial mean rate. The ages at death are sufficiently indicated in the appended statement, in which the numbers for 1903 are given in parentheses:— Ages, Years. No. of deaths. Persons. Ages, Years. No. of deaths. Persons. 0— 190 (425) 15— 86 ( 79) 1— 189 (220) 25— 839 (794) 5— 78 ( 77) 65— 546 (508) The principal cxiuses of death were— Inffxtious Diseases. Other Diseases and Causes. Measles 38 (41) Croup 1 (0) Scarlet Fever -(1) Cancer 176 (179) Whooping Cough 15 (55) Bronchitis 192 (160) Diphtheria and Membranous "Pneumonia" 133 (161) Croup 9 (6) Other Respiratory Diseases 17 (25) " Fever " 13 (9) Alcoholism 19 (28) Epidemic Influenza 46 (26) Cirrhosis of Liver 27 (23) Diarrhoeal Diseases 153 (79) Premature Birth 60 (54) Puerperal Fever 8 (3) Accidents and Diseases of Other Septic Diseases 12 (26) Parturition 9 9) Phthisis 159 (159) Accidents 105 (94) Other Tubercular Diseases 81 (74) Suicide 21 (21) Of the deaths, 780 (35.0 per cent.) occurred in the local Public Institutions, viz.:— Workhouse 60 (07), Infirmary 261 (260), Lock Hospital 1 (2), Children's Hospital 92 (82) and St. Mary's Hospital 360 (342). (See also Tables III. and IIIa. in the Appendix). Among the deaths registered within the Borough were 387 of non-residents which have been allocated to the respective districts whence the deceased persons came. On the other hand 173 deaths of residents have been reported from outlying districts, of which 154 (89.0 per cent.) occurred in Public Institutions. (See Table III.a Appendix). By deducting the former and adding the latter, the "corrected" total (2,014)* is obtained, giving a "nett " *Unless otherwise stated, all numbers given hereafter have been similarly "corrected." NOTIFICATION CHART 1904. DEATHS. 11 death-rate of 13.71 per 1,000 persons of all ages, being 0.57 higher than the rate of 1903 (13.14). The corrected total of deaths comprised 959 of males and 1,055 of females, the corresponding rates being 15.25 (15. 12)* and 12.56 (11.66). The rate for females was slightly higher than the mean rate (12.46) for the previous three years; but the other rates were lower. (See Table 12). The highest rate recorded in the Registration Sub-Districts was that of NortliWest Paddington, 14.81 (14.OO), and the lowest that in St. John, 10.28 (9.08). Of the Ward rates that of Queen's Park, 14.81 (14.OO) was the highest, and that of Lancaster Gate (West) the lowest, 8.06 (6.03). TABLE 12. Deaths and Death-rates, 1904. All causes, all ages. Deaths, 1904. Death-rates. 1904. Mean-rates, 1901-03. Males. Females. Persons. Males. Females. Persons. Males. Females. Persons. Borough 959 1,055 2,014 15.25 12.56 13.71 16.04 12.46 13.99 St. Mary 668 752 1,420 15.57 14.03 14.72 16.94 14.12 15.39 St. John 162 183 345 14.00 8.32 10.28 12.80 7.99 9.66 North-West Paddington. 129 120 249 15.30 14.30 14.81 16.01 13.68 14.86 Harrow Road 194 208 402 14.27 .13.78 14.02 14.88 13.29 14.02 Maida Vale 129 131 260 16.62 11.27 13.42 15.29 12.04 13.33 Westbourne 142 168 310 14.03 11.59 12.59 15.29 14.01 14.80 Church 220 262 482 17.09 18.44 17.80 20.72 16.70 18.62 Lancaster Gate (West) 26 42 68 9.14 7.50 8.06 8.72 6.63 7.34 Lancaster Gate (Last) 30 36 66 13.12 6.38 8.33 13.04 5.91 7.97 Hyde Park 89 88 177 16.05 9.86 12.73 14.35 9.28 11.11 . Identical with Queen's Park Ward. Table 13 is new, and gives the rates (per 1,000 of each age and sex) in the Borough, the Registration Sub-Districts and the Wards for each sex in six age groups, the mean rates for 1901—3 being added for comparison. The majority of the rates for last year were below the respective mean rates. No deaths occurred at four ages among males (in the three Wards of South Paddington), and the like number among females. On the other hand the rate for females aged 5-15 years in Lancaster Gate (East) Ward was 2.89 last year, there having been no death at these ages during the preceding three years. The rates for females at ages 15-25 and 25-65 in South Paddington Wards are strikingly lower than those for the northern Wards. *Rate for 1903 indicated thus. 12 deaths. The number of deaths in each quarter of the last four years is given below, together with the death.rate. The rates for the 1st and 2nd quarters of the year, especially the latter, compare very favourably with the rates of the preceding years; but the rates for the 3rd and 4th quarters are each the highest of the series. Deaths. Rates. 1904. 1903. 1902. 1901. 1904. 1903. 19.02. 1901. First 599 522 736 631 16.41 14.35 20.35 17.56 Second 393 455 476 445 10.76 12.51 13.16 12.38 Third 486 442 418 469 13.31 12.15 11.56 13.05 Fourth 536 499 522 512 14.68 13.72 13.40 14.24 Quarters. TABLE 13. Death.rates, 1904. All causes. Sex. Ages. Borough. Registration Sub.Districts. Wards. St Mary. St. John. North.West Paddington.. Harrow Rd. Maida Vale. Westbourne. Church. Lancaster Gate (West). Lancaster Gate (East). Hyde Park. Males. 0— 1904 ... 165.67 160.24 143.67 216.08 134.93 163.74 168.88 180.05 111.11 111.11 166.66 Mean † 159.38 165.79 110.42 165.99 147.77 152.67 159.81 191.69 98.16 109.91 114.27 1— 1904 ... 17.34 17.56 8.14 24.25 13.75 20.10 15.42 20.94 15.87 27.52 Mean ... 22.39 23.24 15.69 23.75 19.96 15.49 20.88 32.14 13.14 18.29 14.43 5— 1904 ... 2.35 2.45 0.66 3.35 1.97 2.26 3.17 2.17 - - - Mean ... 2.51 2.74 1.75 2.19 3'45 1.78 2.34 2.66 1.01 2'19 2.01 15— 1904 ... 2.81 3.32 1.95 1.67 4.47 3.76 2.34 2.33 1.34 2.07 2.99 Mean ... 0.7 0 2.96 1.67 3.09 2.60 2.74 3.33 2.88 2.20 0.69 1.97 25— 1904 ... 11.61 11.81 11.22 11.16 11.62 14.47 9.28 12.39 7.44 5.70 15.63 Mean ... 12.82 13.30 10.88 13.47 10.54 12.29 13.13 17.42 7.61 11.61 10.96 65— 1904 ... 87.59 82.41 99.30 96.77 70.38 80.49 66.18 117.80 65.69 111.88 118.85 Mean ... 86.67 83.62 79.15 135.29 76.40 93.76 62.20 114.83 53.13 67.25 92.66 Females. 0— 1904 ... 136.83 142.05 94.73 149.73 104.98 149.06 106.66 203.70 88.88 88.88 101.26 Mean ... 129.68 134.30 94.45 139.53 96.94 136.32 143.36 174.46 51.85 66.42 109.22 1— 1904 ... 14.55 15.32 9.16 15.53 12.90 11.72 19.94 16.65 - 22.22 7.01 Mean.... 16.70 17.17 10.60 19.88 13.35 14.74 17.48 22.50 11.22 2.49 12.74 5— 1904 ... 1.80 1.36 1.15 4.42 1.16 2.74 0.57 1.18 — 2.89 1.27 Mean ... 2.57 2.43 1.92 3.79 1.83 2.10 2.95 2.82 3.30 — 2.13 15— 1904 ... 2.26 2.89 0.51 4.43 4.47 1.78 2.50 2.94 - - 0.91 Mean ... 1.99 2.37 1.02 2.77 2.75 1.20 2.54 2.85 0.62 0.42 1.65 25— 1904 ... 9.04 10.33 6.44 8.50 9.41 8.01 8.81 14.23 7.35 5.08 7.06 Mean ... 8.41 9.66 5.42 9.66 9.57 8.51 9.17 11.66 4.24 4.15 6.04 65— 1904 ... 73.52 72.54 68.03 99.70 81.28 69.80 49.22 110.38 52.08 46.41 81.08 Mean ... 76.85 79.89 68.86 77.76 7 8.68 83.25 68.99 97.41 61.00 65'60 71.67 *Identical with Queen's Park Ward. †Mean rates for the three years 1901-03. DEATHS. 13 TABLE 14. Death-rates, 1904. All and selected causes. All Causes Smallpox. Measles Scarlet Fever. Diphtheria. Whooping Cough. "Fever' Diarrhœal Dis. Phthisis. Infantile Mortality. Paddington 1904 ... 13.72 0.01 0.27 0.06 0.12 0.10 0.06 0.89 1.19 135 Mean... 14.03 0.04 0.29 0.06 0.26 0.29 0.07 0.58 1.00 129 London 1904 ... 16.03 0.00 0.48 0.07 0.15 0.32 0.06 1.02 1.61 143 Mean... 10.40 0.11 0.46 0.10 0.23 0.37 0.09 0.67 1.59 138 Kensington 1904 ... 14.27 0.00 0.37 0.02 0.09 0.10 0.03 0.77 1.43 150 Mean... 14.75 0.02 0.37 0.09 0.17 0.32 0.07 0.56 1.29 152 Westminster . 1904 ... 13.78 ... 0.13 0.05 0.04 0.10 0.06 0.48 1.54 124 Mean... 15.18 0.10 0.27 0.06 0.12 0.21 0.09 0.32 1.78 131 Marylebone* 1904 ... 16.18 ... 0.38 0.06 0.10 0.09 0.02 0.82 1.67 94 Mean... 17.07 0.08 0.35 0.12 0.21 0.30 0.09 0.57 1.02 103 Hampstead 1904 ... 10.19 ... 0.19 0.02 0.04 0.09 0.05 0.24 0.83 112 Mean... 10.40 0.02 0.09 0.05 0.16 0.20 0.08 0.18 0.83 93 Willesden 1904 ... 11.15 ... 0.29 0.01 0.14 0.08 0.05 1.02 1.06 113 Mean... 12.30 0.03 0.42 0.09 0.32 0.42 0.07 0.70 0.80 120 * The Infantile Mortality, after correction for non-resident births in Queen Charlotte's Lying-in-Hospital, is 140 for 1904, and 134 for the mean. TABLE 15. Death-rates, 1904. All and selected causes. All Causes Smallpox. Measles Scarlet Fever. Diphtheria. ing Cough “Fever” Diarrhœal Dis. Infantile Mortality. England and Wales 1904 16.2 0.01 0.36 0.11 0.17 0.34 0.09 0.86 146 1894-03 17.1 0.01 0.38 0.13 0.26 0.34 0.16 0.74 149 76 Great Towns 1904 17.2 0.01 0.47 0.12 0.19 0.40 0.10 1.20 160 1903 16.3 0.03 0.36 0.14 0.20 0.33 0.12 0.71 144 100 Smaller Towns 1904 15.6 0.03 0.36 0.13 0.16 0.35 0.10 0.89 154 1903 14.6 0.02 0.29 0.12 0.16 0.28 0.11 0.43 135 Rest of England and Wales 1904 15.3 0.01 0.23 0.09 0.14 0.27 0.08 0.46 125 1903 14.8 0.02 0.17 0.10 0.17 0.22 0.09 0.3l 118 London 1904 16.03 0.00 0.48 0.07 0.15 0.32 0.06 1.02 143 1894-03 18.13 0.03 0.56 0.14 0.42 0.43 0.15 0.78 154 Paddington 1904 13.71 0.01 0.26 0.05 0.13 0.11 0.07 0.96 136 1894-03 15.41 0.01 0.36 0.09 0.40 0.33 0.10 1.00 145 14 deaths. The corrected totals of deaths for the years 1894—1903 will be found in Table II. Appendix. The rates for each year are not included in this Report; but the following statement compares last year's rates with the mean rates for the preceding decennium:— Death-Rates—All Causes. Per 1,000 persons. Mean Rates. i r Five years. Five years. Ten years. 1904. 1894-98. 1899-03. 1894-03. Borough 13.71 15.83 14.98 15.41 St. Mary 14.72 17.59 16.59 17.09 St. John 10.28 11.11 10.19 10.65 North-West Paddington 14.81 10.06 15.96 16.01 The reduction of the Borough Rate from 15.41 (decennial mean) to 13.71 implies a saving of 250 lives; but if each Registration Sub-District be taken separately, the total number of lives saved during the year in the whole Borough will be found to be 200.* In Table 14 will be found the death-rates for 1904 in the Metropolis, and the five districts immediately adjacent to the Borough, with the mean rates for 1901—3 for comparison. Table 15 sets the local rates in comparison with those for the whole country, and those for the groups of towns used by the Registrar-General in his Reports. In all cases the comparison is one favourable to the Borough. The comparison of rates based on the populations at all ages is defective, in that it takes no count of the influences due to variable mortality peculiar to each age of life and to each sex. This defect can be remedied by the use of "factors" obtained from the experience of mortality at each age of life in the whole country. Certain of these factors are available in the Reports of the Registrar-General and the Medical Officer of Health of the County; but the factors for the sub-divisions of the Borough have been calculated by the Department. The "corrected" rates (as distinguished from the "nett") will be found in Table 16. The first column of that table gives the "standard rate," i.e., the rate which would be recorded were the mortality of the residents of the district at each age of life exactly equal to the corresponding mortality recorded in the whole country (England and Wales) during 1891—1900. The salubrity of a district is more or less indicated by the (negative) difference between the "standard" and "corrected" rates. The exceptional appearance of the sign "+" in the table is, therefore, a very satisfactory feature. *It is interesting to note that the decline in the birth-rate represents an almost equal deficiency in added lives. Applying the reduction in the rate to the population of the Borough as a whole, the loss last year works out at 245 lives; but the sum of the deficiencies in the three Registration Sub-Districts amounted to 262 lives. DEATHS. 15 TABLE 16. Corrected Death-rates. Standard Rate. Corrected Rate, 1904. Difference from Standard. Mean Corrected Rate, 1901-03. Difference (1904) from Mean. Borough 17.10 14.59 —2.51 14.89 —0.30 Registration Sub-Districts— St. Mary 17.81 15.04 —2.77 15.72 —0.68 St. John 15.44 12.11 —3.44 11.38 +0.73 North-West Paddington † 16.43 16.39 —0.04 16.44 —0.05 Wards— Harrow Road 19.02 13.41 —5.61 13.40 +0.01 Maida Vale 16.62 14.69 —1.93 14.59 +0.10 Westbourne 18.96 12.08 —4.88 14.20 —2.12 Church 17.03 19.01 + 1.98 19.88 —0.87 Lancaster Gate—West 15.01 9.76 —5.25 8.89 +0.87 „ East 14.76 10.26 —4.50 9.83 +0.43 Hyde Park 16.18 14.31 —1.87 12.48 + 1.83 London 17.31 16.85* —0.46 17.30 —0.45 Kensington Westminster 17.05 15.46 15.23* 16.22* —1.82 +0.76 15.74 17.86 —0.51 —1.64 Marylebone 16.93 17.39* +0.93 18.41 —1.02 Hampstead 16.19 11.45* —4.74 11.75 —0.30 Willesden 16.98 11.96* —5.02 13.25 —1.29 *Based on Registrar-General's Quarterly Returns. †Identical with Queen's Park Ward. 16 small-pox. SMALL-POX. Bokough. London. 1904. 1903. 1904. 1903. Cases notified 4 5 495 417 Deaths 2 — 25 13 *Morbidity 0.02 0.03 0.10 0.09 †Fatality 50.0 — 5.0 3.1 ‡Mortality 0.01 — 0.00 0.00 * Notification-rate per 1,000 persons, all ages. †Deaths per 100 notifications. ‡ Death-rate per 1,000 persons of all ages. Of the four cases reported in the Borough during the year one was erroneously diagnosed, being in fact a case of severe chicken-pox. Of the three genuine cases—one was reported in March, and the other two in April. Although no cases were reported in the Borough after the latter month, the disease continued to prevail in the Metropolis—495 cases being reported during the year as compared with 417 in 1903, and 7,798 in 1902. The cases reported in the provinces were much more numerous than they need be, were vaccination only efficiently practised. The appended figures represent the cases reported to the Local Government Board from 255 boroughs and urban districts, having a total population at the last census of 14,861,491 persons—excluding the Metropolis. Quarters Year Metropolis Provinces 1 1904. 1903. 181 38 1,345 2,112 2 1904. 1903. 251 162 1,519 3,210 3 1904. 1903. 42 121 1,098 1,424 4 1904. 1903. 23 96 1,283 691 Whole year. 1904. 1903. 497 117 5,245 7,437 The histories obtained with reference to the three cases reported in the Borough were as follow:— M. 31, butcher, employed locally; vaccinated infancy only; everyday at Smithfield Market, where he probably came into contact with an infected person; sickened 23rd March; to hospital 28th March. M. 63. builder; vaccinated infancy; resided next door to previous case; sickened 7th April; to hospital 10th April; died loth Mav. No source of infection other than the previous case could be ascertained, but patient and his family denied any contact with the other family. M. 3, son bandmaster (retired); reported to have been vaccinated four times, but without success; arrived home quite recently from India; sickened 15th April (?); to hospital 22nd: died 28th. Special enquiries were made as to association with last family, one member of which is in the musical profession. but no history if any contact could be obtained. The usual procedure as to vaccination, disinfection, observation of contacts, &c., was adopted. No spread of infection is known to have occurred. Vaccination—The appended table, based on information supplied by Mr. House (the Vaccination Officer), shows that there is a tendency, slight at present, towards an increase in the proportion of children escaping vaccination. Neglect is likely to become more prevalent until the next general outbreak of small-pox rouses the public from its apathy, lor many the rousing will certainly be too late. Nothing is known of the number of persons undergoing adult vaccination or of those re-vaccinated. 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 3 3 4 5 6 7 8 9. 1901 3,364 2,676 5 313 89.0 23 34 313 11.0 1902 3,262 2,629 12 291 89.8 35 19 276 10.1 1903 3,315 2,621 10 296 88.2 48 32 308 11.7 1904† 1,741 1,306 5 149 83.8 88 7 186 16.1 Jan -June * Including "gone awav," "false addresses," apprisals to other districts, &c. † Provisional return only. DIPHTHERIA. 17 DIPHTHERIA. (Including Membranous Croup.) Borough. London. 1904. 1903. 1904. 1903. Cases notified ... 140 145 7,227 7,749 Deaths ... 19 15 723 740 Morbidity ... 0.95 0.98 1.55 1.67 Fatality ... 13.7 10.3 10.0 9.9 Mortality ... 0.13 0.10 0.15 0.16 The notifications of this disease numbered 343 in 1001, fell to 211 in 1902, to 145 in 1903, and to 140 last year, the lowest number since 1890, the first year of complete notification. The reduction from 145 in 1903 to 140 in 1904 was equal to 3.5 per cent. of the cases in the former year, the corresponding figure for the Metropolis being 6.8 per cent. On the other hand the morbidity in the Borough last year was at the rate of 0.95 per 1,000 persons, as against a rate of 1.55 for the Metropolis. The cases reported last year in the Borough were less than half the corrected decennial average (299), the greatest proportional diminution having taken place in North-West Paddington Sub-District (17 cases in 1904, decennial average 57). The complete comparison is given below. Diphtheria : Notifications. (Including Membranous Croup.) Averages (corrected and adjusted). Five years. Five years. ears. 1904. 1894-98. 18S9-1903. 1894-1903. London 7,227 12,905 11,475 12,194 Borough 140 365 239 299 St. Mary 103 271 153 209 St. John 20 39 28 33 North-West Paddington 17 55 58 57 In the Borough as a whole and in the Registration Sub-Districts the cases in each quarter of the year were with one exception below the corresponding averages (uncorrected), the reduction in numbers being striking in most cases. In St. John Sub-District (fourth quarter of year) the cases were one above the average. (See below.) Quarters. 1 2 3 4 Borough 26 (62) 26 (72) 40 (69) 48 (88) St. Mary 15 (42) 24 (48) 31 (48) 33 (61) St. John 7 (8) 1 (10) 3 (7) 9 (8) North-West Paddington 4 (12) 1 (14) 6 (14) 6 (19) Uncorrected decennial averages thus:- (62). The numbers of cases reported from each Ward during the last two years will be found in Table 10. Church and Lancaster Gate (West) Wards were the only two in which the notifications received last year were in excess of the returns for 1903. The numbers and rates recorded in the Adjacent Districts will be found in Tables 8 and 9. Lower rates were recorded in Westminister (0.83), Marylebone (0.90) and Hampstead (0.66). The rate recorded in Willesden (2.64) was comparatively high and showed the smallest reduction from the mean rate for the three years 1901-3 (2.91). The notifications received related to cases in 121 houses, distributed thus:— 1904. 1903 Houses with one case each 109 119 „ „ two cases 6 8 „ „ three „ 5 9 „ ” four „ 1 1 18 diphthkkia. From 7 out of the 12 houses where multiple cases occurred, two or more notifications were received on the same day, viz., in six instances, two cases, and in one, three. As regards the house whence four notifications were received the nature of the malady was not recognised, and isolation (removal to hospital) not effected until three children had been taken ill. One house whence 3 cases were reported, and the patients removed to hospital, may be disregarded, the second and third cases being subsequently reported as errors of diagnosis. Of the 140 reported cases 15 were afterwards certified as erroneously diagnosed, 11 of the patients going to hospital. There were other cases, kept at home, the duration of which was so short as to suggest erroneous diagnosis. In 2 cases the infection was apparently contracted outside the Borough, and in 2 others the attacks followed the discharge of a patient from a provincial hospital. In 5 instances the death of the patient took place on or before the day on which the certificate was received. Cats are strongly suspected as channels of infection, and it is interesting to note that in four families, the house cat was reported to be ill. In only one instance was the cat secured for examination, the result of which was negative. One hundred and one of the 140 patients were removed to hospital, equal to 72.1 per cent. of the cases, a smaller proportion than that of any of the vears 1901-03. (See Table 17). The percentage of cases removed to hospital varied from zero in Lancaster Gate (East) Ward to 82 in Queen's Park Ward. TABLE 17. DiphthEria. 1904. District. Cases Notified.* To Hospital. Per cent. Cases Notified to Hospital Deaths. At Home. In Hospital Fatalities. per cent. cases treated At Home. In Hospital Wards— Oueen's Park 17 14 82 — 3 — 21.4 Harrow Road 32 (5) 22 (4) 69 9 1 22.9 5.5 Maida Vale 28 (4) 20 (2) 71 1 2(1) 16.6 11.1 Westbourne 16 (1) 11 69 — — — 16.6 Church 28 (4) 22 (4) 78 2 5 33.3 27.7 Lancaster Gate, West 4 3 7.1 — — — — „ East 4 — — — — — Hyde Park 11 (1) 9 (1) 81 — 1 — 12.5 Borough 1904† 140 (15) 101 (11) 72.1 5 12 14.2 13.3 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. †Two further deaths from diphtheria were recorded, one each Queen's Park and Harrow Road Wards, but as the cases were not notified, the deaths have been excluded from this table. ‡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. DIPHTHERIA. 19 The deaths scheduled as due to diphtheria numbered 10, and included 2 not reported during life. Of the latter one was certified as dying of “ulcerated throat” (there had been a case of diphtheria in the family at the time the deceased was ill) and the other of heart failure following diphtheritic paralysis, the nature of the illness apparently not having been recognised during life. Of the remaining 17 deaths, 12 occurred in hospital (equal to 13.3 per cent. of the cases removed) and 5 at home (14.2 per cent. of the cases kept at home). The fatality last year, calculated on the uncorrected total notifications, was 13.7 per cent. rather higher than that of 1903 (10.3). The local fatality was higher than that for the whole Metropolis (10.0 per cent.) The mortality last year was 0.13, 0.03 above the rate for 1003, but below the rate for the Metropolis (0.15). The local rate was higher than any recorded in the adjacent districts, that of Willesden (0.11) excepted. (Table 14). On the other hand the local rate was the lowest of those given in Table 15. Last year's mortality rates were all markedly below the various mean rates, as will be seen from the appended statement:— Diphtheria: Death-rates Per 1,000 persons. Mean Rates. Five years. Five years. Ten years. 1904. 1894-1898. 1897-1903. 1894-1903. Borough 0.13 0.57 0.22 0.40 St. Mary 0.13 0-69 0.23 0.46 St. John 0.06 0.21 0.07 0.14 North-West Paddington... 0.24 0.08 0.46 0.57 Definite records of multiple attacks of diphtheria in the same patient are sufficiently rare to render the following particulars generally interesting:— W.B., f. æt. 5; sickened 14th September, 1904; to hospital 15th September. The girl had a previous attack on October 4th, 1903, for which she was removed to hospital. F.D., f. æt. 3; sickened March 31st, 1904; to hospital April 6th. The girl had a previous attack on December 13th, 1903, went to hospital on December 14th, and returned home at the end of January, 1904. L.N., f. æt. 8; sickened May 29th, 1904; to hospital May 30th. Previous attack May 13th, 1903, treated in hospital. A.J., f. æt. 14; sickened February 27th, 1904; to hospital February 28th. Previous attacks—September 1st, 1903, treated in hospital; August 13th, 1902, treated in hospital. All the patients were removed to the Asylums Board's Hospitals, and inquiries made elicited confirmation of the diagnosis on each and every occasion. No explanation can be offered of the recurrence of susceptibility manifested in these cases, which is quite contrary to the usual experience. 20 scarlet fever. SCARLET FEVER. Borough. London. 1904. 1903. 1904. 1903. Cases notified 365 414 13,451 12,545 Deaths 8 9 365 361 Morbidity 2.48 2.83 2.89 2.71 Fatality 2.1 2.5 2.7 2.8 Mortality 0.05 0.06 0.07 0.07 The notifications during the past year (365) showed a decline equal to 12 per cent. of the total for 1903, while in the Metropolis as a whole the cases increased by 7 per cent. It will, however, be seen from Table 10 that cases reported last year in the following Wards were more numerous than in 1903, viz.:—Oueen's Park, 70 ((13); Lancaster Gate (West), 15 (14); and Hyde Park, 27 (12).* The local morbidity (calculated on data furnished by the Registrar-General's Reports) was higher than that of any of the Adjacent Districts, Willesden excepted. (See Table 9.) The cases reported during each quarter of the year were below the (uncorrected) averages for the quarters, except in the first quarter (St. Mary) and third quarter (NorthWest Paddington)—See below. Scarlet Fever: Notifications, 1904. Averages shown in parentheses. Quarters 1 2 3 4 Borough 92 (90) 72 (103) 92 (146) 109 (145) St. Mary 68 (65) 40 (71) 55 (104) 74 (106) St. John 12 (12) 19 (16) 7 (18) 14 (17) North-West Paddington 12 (13) 13 (16) 30 (24) 21 (21) The year's total (365) was considerably below the decennial average (501), duly corrected for changes in population and adjusted to nearest whole number. A complete comparison with the averages is set out below:— Scarlet Fever: Notifications. Averages. Corrected and adjusted. Five years. Five years. Ten years. 1904. 1894-98. 1899-03. 1894-1903. London 13,45.1 21,815 16,521 19,148 Borough 365 587 418 501 St. Mary 237 420 317 367 St. John 52 71 55 63 North-West Paddington 76 96 46 71 The 365 cases notified included 9 subsequently ascertained to have been erroneously diagnosed, 7 of the patients having been removed to hospital; 11 due to infection contracted outside the Borough ; 13 due to patients recently discharged from hospital; and 4 contracted in hospitals—not counting a small group of cases in connection with the Workhouse Infirmary- * Figures in parentheses numbers for 1903. 21 scarlet fever. The cases were reported from 279 houses, as here set out:— 1904. 1903. Houses with 1 case each 225 239 „ 2 cases each 35 58 „ 3 „ 10 11 „ 4 „ 7 — „ 5 „ — 2 „ 6 „ 2 — „ 7 „ — 1 „ 9 „ — 1 In 19 instances 2 or more cases were reported in the same household on the same day» viz., 2 cases from 17 families (out of 35) and 3 cases from 2 families. In 7 houses the infection spread to a second family occupying the same house, and in 6 other instances the secondary cases were due to discharged patients. As to the 2 houses with 6 cases each:— One was an institution in which the three first patients sickened on 18th Nov., the fourth on 19th Nov., the fifth on 23rd, and the sixth on the 20th. The fourth case was the first diagnosed as scarlet fever. In the other household two families (Bu. and Ba.) were infected. The sequence of the cases is indicated below:— m. 4 (Bu.); sickened 9 ix.; to hospital 16 ix. m. 6 (Bu.); sickened 15 ix.; to hospital 16 ix. f. 4 (Ba.); „ 14 ix.; „ 16 ix. m. 29 (Ba.); „ 10 ix.; „ 17 ix. f. 1 (Bu.); „ 15 ix.; „ 17 ix. f. 1 (Ba.); „ 25 ix.; „ 26 ix. The delay in isolating the first case was undoubtedly the cause of all the others. In the following instances second attacks of the disease were reported, with the usual symptoms of rash, &c.:— W.H., m. æt. 20; sickened October 17th, 1904; to hospital October 20th. This patient was said to have had an attack "17 years ago,"but the complete history of that attack could not be obtained. R.N., m. act. 9; sickened May 4th, 1904; to hospital May 5th. Previous attack March 14th, 1903 (when a sister and brother had the disease); to hospital March 17th; discharged May 8th. M.S., m. set. 11/12; sickened October 22nd, 1904; to hospital the same day. Previous attack January 29th, 1904 (a sister also attacked then) at age of 6 weeks; to hospital January 30th; discharged March 7th. A.W., f. æt. 7; sickened March 11th, 1904; to hospital March 14th. Previous attack January 17th, 1902; treated at home. As regards the first and last cases the accuracy of diagnosis in the earlier attacks could not be verified. The diagnosis of the second attack was confirmed in each case after removal to the Asylum Board's Hospital. In the other two cases the diagnosis was confirmed in both the first and second attacks. The case of M. S., who had two attacks of the disease in the first year of his life, is very remarkable. One attack of the disease is generally held to confer complete immunity for many years, if not for life. During January and February outbreaks of the disease occurred among the inmates of the Workhouse Infirmary, 9 cases being reported. The particulars are given below;— C.D., m. æt. 3; admitted to Infirmary Jan. 11, 1904 ; removed to hospital Jan. 14. C.O., f. æt. 25 ; on Staff; „ Jan. 14. R.W., m. æt. 8/12; admitted to Infirmary Sept. 5, 1903; „ Jan. 21. R.K., f. æt. 10; „ Sept. 14,1903; „ Jan. 21. L.M., f. æt. 5; „ May 20, 1903; „ Jan. 21. C.P., m. æt. 4; „ Jan. 14, 1904; „ Feb. 1. A.B., f. æt. 3; „ Dec. 7, 1903; „ Feb. 8. H.P., f. æt. 1; „ Aug. 27,1903; „ Feb. 8. B.K , f. æt. 4; „ Sept. 19, 1903; „ Feb. 8. 22 scarlet fever. The outbreak was due to the case of C. D., who was admitted for "atrophy and catarrh" on Jan. 11 to the general ward, whence he was removed to a small ward for isolation an hour later. Characteristic desquamation was observed on the 14th, on which date he was transferred to the Asylums Board's Hospital. C. D. was bathed on admission by C.O., one of the nurses of the ward. No new patients were admitted to the ward after the diagnosis of C. D.'s illness, but the ward could not be disinfected as the remaining patients could not be accommodated in other parts of the building. The intervals which elapsed between what may be called the first, second, third and fourth outbreaks were longer than might have been expected. Thus no case occurred between Jan. 13 and 20, between Jan. 21 and Feb. 1, or between Feb. 1 and Feb. 8. There were some cases of measles under treatment in the ward, a fact which made the diagnosis of some of the cases somewhat difficult. There was an exceptional prevalence of the disease during August and September, 51 cases being reported in 5 weeks (32nd-37th weeks). The following notes were put together at the time:— 32nd-37th weeks. 32nd-34th weeks. 35th-37th weeks. Notified: 1904 51 cases 9 cases 42 cases 1903 62 „ 26 „ 36 „ 1902 26 „ 11 „ 15 „ 1901 51 „ 16 „ 35 „ The 51 cases comprised 30 primary (p) and 15 secondary (s), distributed thus:— Week ending— By notification. By date of attack. p. s. p. s. Aug. 6 — — 3 1 „ 13 3 0 — 1 „ 20 3 — 4 — „ 27 1 — 8 — Sept. 3 11 3 7 3 „ 10 10 1 12 2 „ 17 8 9 0 8 The cases, with the exception of four, occurred within a comparatively small area lying to the north of the line Fernhead Road, Carlton Terrace and Kensal Road. A complete tabulation of the facts relating to each case was prepared, but is too lengthy for publication. There was nothing to suggest any connection with the milk supply or with school attendance. The most striking feature was the delay in notification (and consequent isolation) which took place in connection with 8 of the primary cases. Intervals of 5, G, 7, 9 (2 cases), 14 (2 cases) and 17 days were noted between the onset of the sickness and the notification of the case. One case with a delay of 7 days gave rise to 5 others, and one with 17 days' delay to 4 others. In the latter instance the other children from the house continued to attend school for over a week after the onset of the primary illness. Reviewing all the facts noted, the conclusion arrived at was that the exceptional prevalence was due to the delay in isolating the earlier cases. Of the 305 cases notified, 324 (including 7 erroneously diagnosed) were sent to hospital for isolation—equal to 88.7 per cent. of the total, or 2.0 less than the percentage for 1903. From Oueen's Park Ward 99 per cent. of the cases went to hospital, and from Westbourne Ward, 98. The smallest proportion removed to hospital (25 per cent.) was from Lancaster Gate (East) Ward. (Sec Table 18.) 23 scarlet fever. TABLE 18. Scarlet Fever. 1904. 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— Oueen's Park 76 75 99 — 2 — 2.6 Harrow Road 95 (2) 87 (2) 91 — 4 — 4.7 Maida Vale 29 18 62 — 1 — 5.5 Westbourne 46 (2) 45 (2) 98 — 1 — 2.3 Church 73 (3) 69 (3) 94 — — — — Lancaster Gate, West 15 (1) 7 46 — — — — „ East 4 1 25 — — — — Hyde Park 27 (1) 22 81 — — — — Borough 1904 365 (9) 324 (7) 88.7 — 8 — 2.4 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 8 deaths all occurred in hospital. The fatalities prevailing among the cases from the different Wards ranged from 2.3 per cent. (Westbourne) to 4.7 per cent. (Harrow Road). The mortality calculated by the Department as 0.05 per 1,000 persons, by the Registrar General as 0.06, was little more than half the decennial mean rate (0.09) but equal to the mean for the five years 1899-1903. (See below.) Scarlet Fever: Death-rates Per 1,000 persons. Mean Rates. Five Years. Five Years. Ten Years. 1904 1894-98 1899-1903 1894-1903 Borough 0.05 0.14 0.05 0.09 St. Mary 0.06 0.14 0.07 0.10 St. John — 0.08 0.00 0.04 North-West Paddington 0.12 0.24 0.04 0.12 The rate based on the figures published in Quarterly Reports of the Registrar-General (0.06) was above the rates for the Adjacent Districts except that of Marvlebone (0.06). Sec Table 14. On the other hand, the local rate (either 0.05 or 0.06) is the lowest of all the rates given in Table 15. 24 fever. "FEVER." (Including Typhus, Enteric, Relapsing and Continued Fevers). Borough. London. 1904. *1903. 1904. 1903. Cases notified 48 47 1,936 2,408 Deaths 10 8 292 376 Morbidity 0.32 0.31 0.41 0.50 Fatality 20.8 17.0 15.0 15.6 Mortality 0.07 0.05 0.06 0.07 The 47 cases of "fever" reported in 1003 comprised 43 of enteric, 3 of continued* and 1 of typhus fever†—which last may be entirely neglected as the case was erroneously diagnosed. The 46 cases of enteric and continued fevers were the lowest number on record. Last year 48 cases of enteric fever were reported, showing an increase of two cases—approximately 5 per cent. In the Metropolis the cases decreased from 2,408 in 1903 to 1,936 last year, a fall of nearly 20 per cent. Last year's total for the Metropolis is the smallest on record. Both in the Borough and the Metropolis last year's records were markedly below the corrected averages. The cases recorded in St. John Sub-District (12) showed the smallest reduction below the average (14). See below. "Fever": Notifications. Averages. Corrected and adjusted. 1904. Five years. 1894—98. Five years. 1899—1903. Ten years. 1894—1903 London 1,936 3,527 3,676 3,607 Borough 48 78 81 80 St. Mary St. John 35 12 54 16 60 11 57 14 North-West Paddington 1 8 10 9 In St. John Sub-District only were the quarterly records up to the decennial (uncorrected) averages. North-West Paddington was particularly free from the disease. Quarters 1 2 3 4 Borough 7 (16) 11 (11) 12 (20) 18 (29) St. Mary 4 (11) 10 (8) 10 (14) 11 (20) St. John 3 (3) 1 (2) 2 (3) 6 (6) North-West Paddington — (2) — (1) — (3) 1 (3) Decennial averages in parentheses. Distributing the cases according to Wards (Table 10), more than half the cases (25 out of 48) were located in Westbourne and Church Wards. Five cases occurred in Hyde Park Ward, as against one in 1903. Multiple infection of households and imported cases accounted for this special prevalence. The rates in the Adjacent Districts were all lower than the local. (Table 9). Multiple cases occurred in 5 houses, viz.:— 1904. 1903. Houses with 2 cases each 2 4 „ 3 „ 1 1 „ 4 „ 1 — „ 5 „ 1 — * Almost all cases of "continued" fever are cases of enteric fever with some of the usual symptoms in abeyance. Hence the two forms of notifications are dealt with as relating to one disease. † Some half dozen cases of typhus fever have been reported in the Borough since notification was instituted, hut in no instance has the diagnosis been correct. 25 fever. Direct infection from person to person has been referred to in preceding reports. Some further notes of such cases will be given at the end of this part of the report. From one family 2 cases were reported on the same day, and from another, 3. Of the 48 cases reported, 5 were subsequently certified to have been erroneously diagnosed. All the patients had been removed to hospital. In 1903, 10 out of 46 cases (enteric and continued fevers) were erroneously diagnosed. In 2 cases death occurred on the day of, or before, notification. Infection contracted outside the Borough (imported cases) was traced in 13 instances (2 apparently by personal infection) while 4 other patients regularly had meals outside the Borough, and might therefore be fairly described as imported cases. Inquiries elicited information of the consumption within the incubation period of the disease of Watercress 3 cases. Watercress and Winkles 1 case. Oysters 2 cases. Of the 48 cases reported, 38, including 5 erroneously diagnosed, were removed either to the Workhouse Infirmary or to hospitals for isolation and treatment. The percentage of notified cases thus dealt with was 79.1, nearly 8 per cent. more than in 1903. The proportions removed from the different wards varied from 33 to 100 per cent. (See Table 19.) TABLE 19. Enteric Fever. 1901. District. Cases Notified* To Hospital. Per cent. of cases Notified to Hospital Deaths. Fatalities per cent, cases treated At Home. In Hospital. At Home. in Hospital Wards— Oueen's Park 1 1 100 — — — — Harrow Roail 3(2) 3(2) 100 — — (1) — — Maida Vale 8 5 62 1 — 33.3 — Westbourne 14 (2) 12 (2) 85 — 3 — 30.0 Church 11 10 99 — 3 — 30.0 Lancaster Gate West 3 1 33 — — — — „ „ East 3 3 100 — 1 — 33.3 Hyde Park 5 (1) 3 (1) 60 — — — — Borough 1904† 48 (5) 38 (5) 79.1 1 8(1) 10.0 24.2 1903 46 (10) 33 (6) 71.7 5 2(1) 55.5 7.4 1902 84 (10) 54 (0) 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. † One death (Church Ward) not notified (diagnosis arrived at after death only) has been excluded from this table. Of the nine deaths occurring among notified cases, 8 took place in hospital—one death, however, not being due to enteric fever. Correcting the figures for errors of diagnosis, the fatality was 24.2, the highest for the four years. (Table 19.) The fatality calculated on the total notifications was 20.8 per cent., 3.8 above the rate for 1903, and 5 per cent. above the fatality for the Metropolis (15.0). 26 fever. The mortality (rate per 1,000 persons) was 0.07, as compared with 0.01 in 1903. Last year's rates, except in St. Mary's Sub-District, were notably below the mean rates. {See below.) "Fever": Death-rates (Enteric and Continued Fevers.) Per 1,000 persons. Mean Rates. 1904. Five years. 1894-98. Five years. 1899-1903. Ten years. 1894-1903. Borough 0.07 0.12 0.08 0.10 St. Mary 0.09 0.12 0.09 0.10 • St. John 0.02 0.12 0.03 0.07 North-West Paddington — 0.12 0.16 0.14 In comparison with the rates for the Adjacent Districts (Table 14), the local rate was highest of the series—that of Westminster, however, being equally high. On the other hand, the local rate is the lowest of those given in Table 15, except that for the Metropolis. The following notes on the multiple cases will be of interest:— A. F Mews—f. æt. 24; sickened 11th Aug.; to hospital 20th Aug. f. æt. 20; „ 15th „; „ 20th „ m. æt. 23; „ 20th „; „ 30th „ All three patients were in the habit of eating watercress frequently. B. W Road.—f. æt. 13; sickened 10th May; to hospital 24th May. m. æt. 12; „ 1st June; „ 5th June. No source of infection could be traced in the first case. The second was probably due to direct infection. C. B Street.—f. æt 21; sickened 14th May: to hospital 19th May. f. æt. 29; „ 8th June; „ 10th June. m. æt. 11/12; „ 15th „; „ 16th „ f. æt. 58; „ 2nd July; „ 27th July. f. æt. 4; „ 20th „; „ 6th August. No history could be obtained of the source of infection of the first case. The others were apparently infected directly each from the preceding case. The fifth case was in a second family in the same house. There was only one w.c. D. C Street.—Four Members of a family (f. æt. 38, f. 0t. 13, m. æt. 10, m. æt. 4) were admitted to the Workhouse on 27th September, and subsequently transferred to the Infirmary between that day and 10th October, ill with enteric fever. The family had returned from "hopping" in Kent one week before going into the Workhouse. Enquiries were made of the local Medical Officer of Health, but the source of infection, certainly acquired while the patients were out of London, could not be ' traced. A fifth member of the family went to stay with relatives in Willesden, and was subsequentlv admitted into the Willesden Hospital ill with the same disease. E. I Terrace.—f. æt. 60; sickened 5th November; took to her bed on 12th; case notified on 19th. f. æt. 19; sickened about 12th November; to hospital 19th. The second patient was maid-servant to the first. The interval between the two attacks is so short that personal infection seems excluded. No source of infection could be traced, but no other cases occurred in the household. 27 SEPTIC DISEASES. SEPTIC DISEASES.* Puerperal Fever. Borough. London. 1004. 1903. 1904. 1903. Cases notified 10 3 274 231 Deaths 6 (8) 2 (4) 218 169 Morbidity† 0.15 0.06 0.21 0.18 Fatality‡ 60.0 66.6 79.5 72.29 Mortality† 0.12 0.08 0.17 0.13 I here was last year an increased prevalence of the febrile conditions included under the term "puerperal fever," both in the Borough and the whole Metropolis. The 10 cases recorded in the Borough were equal to the number recorded in 1001, but four less than the total for 1002 (14). The corrected decennial annual average was 10. Seven of the cases were reported from St. Mary Sub-District, two from St. John, and one from North-West Paddington. The morbidity (per 1,000 persons of all ages) was 0.06, or the same as the mean rate for the three years 1901-03. Equal rates were recorded in Kensington and Hampstead, all the others being lower. (See Table 0.) Better standards of morbidity are the rates based on the numbers of women of child-bearing ages, and on the numbers of births registered. Both these rates are given below:— Puerperal Fever, 1004. Morbidity rates per 1,000 Females aged 15-45. births registers d Paddington 0.15 3.03 London 0.21 1.90 Kensington 0.17 3.18 Westminster 0.08 1.72 Marylebone 0.06 1.07 Hampstead 0.18 4.19 Willesden 0.13 1.15 The deaths of residents scheduled as due to "puerperal fever" numbered 8; 2, however, were deaths following abortion or miscarriage which were not notified during life. The fatalitv of the notified cases was 60.0 per cent., a little lower than that of 1003 (66.6), and lower than the fatality (calculated on all deaths registered) of the Metropolis (79.5). The mortality (per 1,000 persons of all ages) was 0.05, 0.02 above the decennial mean. The mortality per 1,000 females aged 15-45 years was 0.12, and that per 1,000 births registered 2.42. The corresponding figures for the Adjacent Districts are given below:— Puerperal Fever : Death-rates, 1901. Mortality per 1,000 Females aged 15-45 years. Births registered. Fatality per 100 cases notified. Paddington 0.12 2.42 80.0 (60.0) London 0.17 1.68 79.5 Kensington 0.07 1.44 45.4 Westminster 0.01 0.34 20.0 Marylebone — — — Hampstead 0.12 2.79 66.6 Willesden ... 0.13 1.15 100 * Under this head fall "puerperal fever," "erysipelas" and "other septic diseases," the two first being scheduled for notification. † Per 1,000 females of child-bearing ages (15-45 years). † Per 100 cases notified. 28 SEPTIC DISEASES. Of the 8 deaths recorded, 0 belonged to St. Mary Sub-District and 2 St. John, the pecennial averages being 4 and 0 respectively. The mortalities, calculated as in the statement above, were:— St. Mary. St. John. Per 1,000 females aged 15-45 years 0.27 0.13 Per 1,000 births 3.16 5.29 The total mortality in childbed is measured by the sum of the deaths from "puerperal fever," and from "diseases and accidents of parturition." Last year the total number of deaths from these causes was 15, 2 more than in 1903 (13). One death was recorded from North-West Paddington, 12 from St. Mary, and 2 from St. John. The mortalities were:— St. Mary. St. John. North-West Paddington. Per 1,000 females aged 15-45 years 0.41 0.13 0.25 Per 1,000 births 4.75 5.29 2.54 The corresponding rates for last year for the Adjoining Districts are not at present available. The data for the years 1901-03 have been extracted from the various Annual Reports, and the rates based thereon are here submitted:— Mortality ix Childbed. Per 1,000 births registered. Paddington. London. Kensington. Westminster. Marylebone. Hampstead. Willesden. 1901 2.07 3.05 3.05 3.39 3.55 3.98 2.39 1902 3.93 3.17 2.58 2.43 3.71 5.27 1.78 1903 3.93 2.85 2.24 2.98 2.12 3.44 4.42 The inquiries made after notification again emphasise the dangers of unskilled nursing at confinements. It is noticeable also that a considerable proportion of the attacks followed first confinements, and others were associated with abortions and miscarriages. I he following are summaries of the principal facts elicited:— F. B., æt 23; married; first child; confinement attended by midwife; patient cared for by woman residing in same house, untrained, and reported to be dirty in person and in her home. Fever set in on 3rd day, but the case was not notified (through inadvertence) for a fortnight. Midwife attended other women during the fortnight and had one other known case of puerperal fever in her practice. The trained nurse subsequently called in informed the inspector that she found patient and her room neglected, and accumulations of foul linen in the bedroom, and of refuse outside the bedroom door. Animals were found kept in dirty conditions on the premises and in the yards of the adjacent houses. F. S., æt. 28; married; first child; premature confinement; twins; laceration; attended by medical practitioner and untrained nurse. L. G., æt. 28; married; first child; dead child (6 months) removed under anaesthetic; trained nurse. J. McV., æt. 40; married; 15th child; medical practitioner and untrained nurse; instruments used. 29 septic diseases. H. W., æt. 32; married; 4(+)th child; medical student and untrained nurse of doubtful cleanliness; labour protracted; high temperature from beginning; streptococci found in blood; general peritonitis and pleurisy found at P. M. examination but no lesion in the uterus. History of severe attack gonorrhoea some 18 months previous to confinement, but a normal confinement had taken place during that period. — N., æt. 32; married; medical practitioner and untrained nurse; protracted labour; no instruments; animals kept in dirty condition in adjacent garden. E. P., æt. 28; married; 5th child; midwife and untrained nurse in attendance: labour normal; premises dirty. J. H., æt. 21; married; 1st child ; premature confinement at 8th month ; history incomplete. M. A., æt. 22; married; neglected miscarriage; lived in basement of partly inhabited house; premises dirty. B., æt. 36; married; history incomplete; lived on stable premises, of very bad construction, the window of bedroom opening on to a covered well in direct communication with stalls in basement. Erysipelas. Borough. London. 1904. 1903. 1904. 1903. Cases notified 117 118 4,954 4,382 Deaths 6 8 232 183 Morbidity* 0.79 0.88 1.06 0.91 Fatalityf 5.1 6.7 4.6 4.0 Mortality* 0.01 0.05 0.04 0.03 * Per 1,000 persons of all ages. Per 100 cases notified. The cases notified in the Borough decreased from 118 in 1903 to 117 last year, while the number for the Metropolis rose from 4,382 to 4,954. Last year's total (117) was 29 less than the decennial average. The cases reported from St. Mary Sub-District numbered 93 (decennial average 110), those from St. John 13 (average 19), and those from North-West Paddington (average 17). In three Wards, viz., Church, Lancaster Gate East, and Hyde Park, the cases reported last year were fewer than in the previous year. (Table 10.) The morbidity rates in the Adjoining Districts are given in Table 9. Three of the cases occurred in hospitals, and nine other patients were removed to the Infirmary*. Other Septic Diseases.—Nine deaths were recorded last year under this heading—a little more than half the number recorded in 1903 (16). The deaths were due to "pyæmia" 2 (7),* "infective endocarditis" 3 (3), "stomatitis" 2 (3), and "cellulitis" 2 (3). (See Tables IV. and V., Appendix.) The mortality rates, calculated on the total deaths from erysipelas and other septic diseases, are set out below:— "Other Septic Diseases": Death-rates (Including Ervsipelas.) Per 1,000 persons. 1901. Mean Rates. A. Five years. 1894-98. Five years. 1899-1903. Ten years. 1894-1903. Borough 0.10 0.09 0.11 0.10 St. Mary 0.14 0.10 0.13 0.12 St. John 0.02 0.06 0.07 0.07 North-West Paddington — 0.08 0.06 0.07 * Figures for 1903 shown thus. 30 measles. MEASLES. Although not one of the diseases scheduled for notification, 896 cases of measles came to the knowledge of the Department, mainly through the schools, that number being 39 less than the total for 1904 (929). The disease was epidemic to a slight extent during the last half of 1903 and the first half of 1904, as is seen from the appended summary of the cases reported:— Measi.es. Primary cases only. 1904. Quarters 1 2 3 4 St. Mary 383 70 13 17 St. John 77 17 3 1 North-West Paddington 2G3 7 9 5 Totals, 1904 723 94 18 23 ,, 1903 42 147 185 362 In addition to the above, 48 cases were discovered by other means. During 1903 there were 460 known cases among males with 24 deaths, and 469 known cases among females with 15 deaths—fatality (persons) 4.1 per cent. During 1904 there were 442 known cases among males with 23 deaths, and 454 cases among females with 10 deaths—fatality (persons) 4.3 per cent. The foregoing figures suggest that a fairly large and constant proportion of the attacks are brought to the knowledge of the Department. The fatality according to sex was:— Males, 5.2 per cent. in both years; females, 3.1 in 1903 and 3.5 in 1904. The ward distribution of cases and deaths during 1901 and 1903 is indicated below:— c. D. c. D. Queen's Park 1904 288 15 Church 1904 129 5 1903 50 4 1903 321 15 Harrow Road 1904 231 10 Lancaster Gate (West) 1904 54 1 1903 185 8 1903 10 — Maida Vale 1901 09 6 Lancaster Gate (East) 1904 27 1 1903 113 2 1903 11 Westbourne 1904 79 1 Hyde Park 1904 19 — 1903 221 9 1903 18 1 c.—cases. d—deaths. In 1903 the largest numbers of cases were recorded in Westbourne and Church WardsLast year Queen's Park and Harrow Road Wards were most affected. In 1903 the 929 known cases occurred in 491 houses, while last year 896 cases occurred in 490 houses;—showing a slight tendency to a reduction in the frequency of multiple cases. 1904. 1903. Houses with 1 case each 237 242 „ 2 cases „ 10G 141 „ 3 „ „ 59 GO „ 4 „ „ 25 30 „ 5 „ „ 5 10 „ 6 „ „ 3 3 „ 7 „ „ 1 3 „ 8 „ „ — o 31 measles. The ages of the patients attacked, distinguishing the sexes, and the numbers of deaths, are given in full below:— TABLE 20. Measles, 1901. Registration Sub-Districts. Ages—Years. 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 17 15 43 20 40 32 37 37 41 10 75 88 2 4 3 7 Deaths 4 4 5 2 — 1 1 1 — 1 2 1 — — — — St. John Cases 1 3 7 6 3 4 6 8 8 8 15 17 1 1 3 10 Deaths — — 1 — — — — — — — — — — — — — North-West Paddington Cases 8 6 16 20 15 16 23 18 32 29 45 58 — — 1 1 Deaths 3 1 3 — 1 1 I 1 1 — 1 1 — — — 1 Borough. Fatality 1904 26.9 20.9 13.0 3.8 1.7 3.8 3.1 4.7 1.2 1.2 2.2 1.2 — — — 5.5 1903 7.1 12.9 19.1 7.0 14.7 9.6 — — — 1.2 — — — — — — It may be noticed that the fatality decreases greatly after the second year of life, also that the fatality is generally greater among males than among females. The mortality last year was at the rate of 0.26 per 1,000 persons of all ages, 0.10 below the decennial average. According to the figures of the Registrar-General, the rate was 0.27 (see Table 14, 0.02 below the mean for the three preceding years. The rates for Westminster (0.13) and Hampstead (0.19) were lower than that for the Borough, the other higher. In comparison with the country, the local rate was lower than any of the prevailing rates, that for "Rest of England and Wales" (Rural Districts) alone excepted. (See Table 15.) Last year's rate for North-West Paddington was the only one in excess of the means. (See below.) Measles: Death-rates Per 4,000 persons. Mean Rates. r Five years. Five years. Ten years. 1901. 1894-98. 1899-1903. 1894-4903. Borough 0.20 0.47 0.26 0.30 St. Mary 0.23 0.56 0.33 0.45 St. John 0.00 0.14 0.08 0.11 North-West Paddington 0.89 0.00 0.18 0.39 On April 1st, 1903, the Order made by the London County Council extending to measles the Sections of the Public Health (London) Act, 1891, relating to disinfection and other means of limiting the spread of infection, came into operation. After a year's experience of 32 MEASLES. the working of the Order it can be said that one effect has been to impress on the minds of a large section of the community, the fact that measles is not a disease to be trifled with, and there is little room for doubt that greater care is now exercised in dealing with the disease. The Order, however, is inoperative to some extent for the following reasons. The disease not being scheduled for notification, few families except those sending children to the Public Elementary Schools receive anv visits from the Staff of the Department. Even among that section of the communitv verv little is done during the school holidays, as the registration of fatal cases is then practically the only source of information of cases. In homes which are not visited by the Staff the old regime prevails, and disinfection is rarely practised. A decision given at the Marvlebone Police Court has shown that the penal clauses of the Public Health (London) Act relating to infectious diseases cannot be enforced in the absence of anv medical evidence as to the nature of the illness. An admission on the part of the parent or guardian that he (she) knew the patient had measles, was held to be insufficient evidence for a conviction. Although the compulsory powers implied by the Order are to a large extent noneffective, much useful work has been accomplished and refusals to comply with the requirements of the Department as regards isolation, disinfection, See., have been rare. It is anticipated that greater familiarity with the Order will result in convincing the public that the benefits accruing from its provisions are worth seeking, and that an increasing proportion of the cases of the disease will be brought to the knowledge of the Department by voluntary notification. A few examples of carelessness in dealing with cases, discovered during the past year, will show the need of supervision by the Sanitary Authority. D. N. sickened with measles in the first week of January. She attended school on the first day of term (Jan. 11th), but was sent home by the teacher, who suspected that the child was ill with measles. She was sent to school again on Jan. 12th and loth, but not afterwards. The case was reported to the Department by the school on the 18th, and the house was visited on the 19th. The mother admitted that D. N. had the eruption out on Jan. 12th and 13th, on which days the child was sent to school. D. N.'s brother was found in bed ill with measles in a tireless room. To keep him warm various garments belonging to other members of the family were on the bed. The mother was attending the patients and also making a dress for a customer, which dress was to have been delivered on the day the Inspector called. She was urged (unsuccessfully) to obtain medical advice for the two patients, and for her other two children who were later on found to be ailing. 1). X. and her brother were sent to school on Feb. 1st, but refused admission as the quarantine period (one month) prescribed by the Code of the School Board had not expired. D. G. was sent home from school on Jan. 25th by the teacher, who thought the child was sickening for measles. The child did not return to school but the brother continued his attendance. It was not until Feb. 5th that a confession was obtained that D. G. had passed through an attack of the disease the brother continuing his attendance the meanwhile. In one instance in the southern part of the Borough a patient was found in the kitchen cared for by the mother and sister, who were doing mangling in the same, room, for customers. The Inspector was able to secure better accommodation for the patient in another part of the house, and the washing was disinfected before leaving the premises. In another case the patient fa boy) was found playing with other children in the street, he having the eruption well out. His parents professed themselves unable to control the lad. R. D. sickened Dec. 25th, 1903; brother A., minded by Mrs. M. from Dec. 28th to Jan. 1st; another brother, W., sickened Jan. 1st; A. sickened Jan. 4th, but still sent to Mrs. M., who had one child, N., of her own, and from Jan. 20th to 22nd had charge of another child, F. J.: N. M. sickened Jan. 22nd, and died Jan. 31st: F. J. sickened Jan. 23rd. Mrs. D. continued her work as laundry washer continuously 33 whooping cough. WHOOPING COUGH. The known cases decreased from 533 in 1903 to 19(1 last year, while the deaths recorded shrank from 53 to 16. The numbers reported in each quarter are set below Whooping Cough. 1904. Quarters 1 2 3 4 St. Mary 16 26 33 93 St. John 1 1 10 2 North-West Paddington 6 — 0 3 Totals, 1904 23 27 45 98 „ 1903 281 35 11 2 In addition to the above, 3 other cases were dealt with. Summarising the returns there were:— In 1903:— 240 known cases among males, with 23 deaths ; 293 known cases among females, with 30 deaths. In 1904.:— 100 known cases „ „ „ 8 „ ; 96 „ „ „ „ „ 8 „ The foregoing numbers give fatalities equal to— 9.6 for males; 10.2 for females; and 9.9 for persons in 1903 ; and 8.0 „ ; 8.3 „ ; „ 8.1 „ 1904. There is, however, good reason to believe that the cases are not reported so regularly during life as in the case of measles. The distribution of cases and deaths according to Wards is set out below:— c. d. c. d. Queen's Park 1904 8 9 Church ... 1904 65 3 1903 134 11 1903 56 9 Harrow Road 1904 58 3 Lancaster Gate (West) 1904 7 1903 147 14 1903 1 1 Maida Vale 1904 4 1 Lancaster Gate (East) 1904 4 1 1903 57 5 1903 7 2 Westbourne 1904 45 6 Hyde Park 1904 5 1903 121 10 1903 10 1 c—cases. d—deaths. In Church and Lancaster Gate (West) Wards only were the cases reported last year in excess of the numbers for 1903. Last year 94 houses were known to be infected, as compared with 290 in 1903. As was to be expected from the reduced number of cases there were fewer instances of multiple infections. 1904. 1903. Houses with 1 case each 40 152 „ 2 cases „ 29 71 3 „ „ 12 44 ,, 4 ,, ,, 5 12 „ 5 ,, ,, 0 8 „ 6 „ „ 2 2 „ 7 „ „ - 1 34 chickkn-pox. The incidence of attacks and deaths is fully given in the appended table:— TABLE 21. Whooping Cough. 1904. Registration Sub-Districts. Ages-—Years. 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 13 5 17 11 14 14 14 12 18 22 12 17 — — 1 2 Deaths 9 0 4 — 1 0 1 1 — — — — — — — — St. John Cases 11 — 1 1 1 2 — 2 1 2 2 3 — — — — Deaths — — — 1 — — — — — — — — — — —. — North-West . Paddington Cases — — 1 — 1 1 1 — 1 — 1 2 — — — — Deaths — — — — — — — — — — — — — — — — . There were 2 deaths in this Sub-District, one being a case included in the Report for 1903, and the other, a case not reported during life. The mortality was at the rate of 0.11 per 1,000 persons of all ages, just one-third of the decennial mean (0.33). All the rates for last year were well below the respective means. (Sec below.) Whooping Cough : Death-rates per 1,000 persons. Mean Rates. Five years. Five years. Ten years. 1904. 1894-98 1899-1903 1894-1903 Borough 0.11 0.36 0.30 0.33 St. Mary 0.13 0.40 0.34 0.37 St. John 0.02 1.1 0.09 0.10 North-West Paddington 0.12 0.04 0.43 0.53 Lower rates (Table 14) were recorded in Marylebone (0.09)), Hampstead (0.09) and Willesden (0.08), while higher rates prevailed in the County as a whole. (Table 15.) CHICKEN-POX. The notification of chicken-pox was re-introduced by an Order of the London County Council under Section 55 of the Public Health (London) Act, 1891, on April 4th, and remained effective until November 6th. The cases notified numbered 280, and 146 additional cases were reported to the Department. The total number of known cases was 432 as compared with 183 in 1903. There was no death from this disease during the year. The sex-age incidence is indicated below:— Ages 0— 1— o 3— 4— 5— 13— 15— Males 13 17 20 16 32 91 5 4 Females 11 18 20 23 35 112 4 8 35 phthisis. More than half the cases occurred in Harrow Road and Church Wards. The cases reported from different Wards. were:— Queen's Park 34 (47) Church 102 (20) Harrow Road 128 (OS) Lancaster Gate (West) 10 (4) Maida Vale 55 (6) Lancaster Gate (East) 29 (6) Westbourne 27 (35) Hyde Park 47 (13) The number of houses invaded was 286 as compared with 139 in 1903. 1904. 1903. Houses with 1 case each 194 107 „ 2 cases „ 57 20 „ 3 „ „ 22 5 „ 4 ,, „ 10 5 „ 5 „ „ 1 1 „ 6 „ „ 1 1 „ 7 „ „ 1 — TUBERCULAR DISEASES. Phthisis (Consumption),—The deaths numbered 104 last year, or 12 more than in 1903. Of the deceased persons 99 were males and 65 females. Reference to Tables IV. and V. in the Appendix will furnish particulars as to sex.age distribution and as to numbers in the Wards. Last year's total (1G4) was 11 below the decennial average, duly corrected for increase of population. In St. Mary's Sub.District alone was the total for last year (112) below the average (127). The nett mortality in the Borough was at the rate of 1T2, 0.08 above the rate for 1903. The decennial mean rate for the Borough (IT(i) was 0'04 higher than that of last year—the reduction being due entirely to diminished mortality in St. Mary, where the rate for last year was 1T6 as compared with a mean rate of 1.31. See below. Phthisis : Death.rates Per 1,000 persons. Mean Rates. Five years. Five years. Ten years. 1904 1894.98 1899.1903 1894.1903 Borough 1.12 1.23 1.09 1.16 St. Mary 1.16 1.39 1.24 1.31 St. John 0.83 0.80 0.58 0.69 North-West Paddington 1.43 1.27 1.27 1.27 The data furnished by the Registrar-General give a mortality equal to 1.19 instead of 1.12, 0.13 in excess of the mean rate for the three years 1901.03. (See Table 14.) The local rate was lower than the rates in the Adjoining Districts, with the exception of those of Hampstead (0.83) and Willesden (1.06). These rates based on the total population of all ages require to be adjusted for variations in proportions of sexes and ages. The necessarv factors for this correction have been calculated, some by the Medical Officer of Health of the County, others by the Department. The results obtained by the use of those factors will be found in Tables 22 and 23. The relationship between density of population, housing conditions, and mortality from phthisis is also indicated. With the exception of those of Westminster and Hampstead (Table 22) all the rates for last year were slightlv higher than the mean rates for 1901.03. . Numbers for 1903 indicated in parentheses. 30 phthisis. All the corrected rates were below the standard rates, indicating that the mortality in the districts selected is lower than that prevailing in the Metropolis as a whole. Such diminution is doubtless due to the operation of several causes, among which may be cited the efforts of the Borough Councils to improve sanitary conditions of the districts, and (possibly) the special work recently inaugurated to check the spread of infection. TABLE 22. Phthisis. District. CENSUS, 1901. Death-rates. Persons per Acre. Percentage of total Population. "Overcrowded." Living in homes of less than 5 rooms. Standard Rate. Corrected Rates. 1904. Mean 1901.03. London 61 16.0 54.0 1.74 1.61 1.60 Paddington 10C 13.6 50.9 1.80 1.15 1.03 Kensington 77 14.8 41.7 1.78 1.39 1.26 Westminster 73 13.0 45'7 1.95 1.37 1.59 Marylebone 90 21.1 55.6 1.85 1.56 1.52 Hampstead 36 6.4 29.6 1.75 0.82 0.82 Willesden 21 11.6 50.7 1.65 1.11 0.90 TABLE 23. Phthisis. Wards. Percentage of total Population, 1901. Death-rates. "Overcrowded." Living in homes of less than 5 rooms. 1904. Mean Corrected Rate 1901.03. Standard. Recorded. Corrected. Queen's Park 9.1 51.7 1.73 1.43 1.42 1.14 Harrow Road 11.5 75.5 1.77 1.01 0.99 0.95 Maida Vale 12.6 43.4 1.82 0.92 0.88 1.01 Westbourne 13.4 46.3 1.80 1.14 1.09 1.41 Church 32.8 61.3 1.68 1.48 1.52 1.70 Lancaster Gate— West 2.6 15.2 1.84 0.47 0.44 0.37 East 2.1 16.2 1.84 0.76 0.71 0.35 Hyde Park 5.2 25.3 1.88 1.08 0.99 0.46 37 phthisis. In Table 23 will be found the corrected rates for the different Wards of the Borough. In Church Ward only was last year's rate (1.48) below the mean rate for 1901-03 (1.52), but in every Ward the "corrected" rates were below the " standard," some notably so, e.g., Lancaster Gate (West) Ward, standard rate 1.84; rate for 1901, 0.47; mean rate, 0.44. The "standard" rate, it will be seen, is highest in the Lancaster Gate Wards (1.84 in each), both these wards having the lowest "corrected" rates (0.47 and 0.76). In these Wards the proportions of inhabitants, both those "overcrowded" and those occupying homes of less than five rooms, are the lowest of the series. "Overcrowding" and small homes are most common in Church Ward, where the "corrected " rates are also highest. Enquiries, with offers to disinfect the deceased's room and goods, are made after every death of residents from consumption. Information sufficient for tabulation was obtained with reference to 137 deaths. Enquiries were also made with reference to 32 cases reported to the Department during the patients' lifetime. Of these 32 patients, 16 died during the year. Of the 137 fatal cases investigated, in 55 histories of tubercular diseases in other members of the family were obtained, and in 64 the previous occurrence of the disease was denied. As regards the remaining 18 cases, no definite particulars could be given. In 88 instances the infectious nature of "Consumption" was not known, but in some of these families precautions against the spread of infection were carried out—in 36 cases only did it appear that nothing was done in this direction. Disinfection by the Department was carried out at 104 premises, only 10 definitely declining the offer. Twenty-three cases, however, came to the knowledge of the Department so long after the deceased had gone to the hospital where death occurred that disinfection appeared to be useless.. Domestic cleansing with re-decoration of the deceased's room is urged after disinfection. Where the paper and paint are good, the former is rubbed down with dough and the latter washed with strong soda. Of the 32 cases reported during life, the particulars relating to the 16 which terminated during the year are included in above paragraph. Fifteen of the surviving patients belonged to consumptive families. The infectious nature of the disease was known to six of the patients' families, but precautions were being taken in 8 families. The homes of 12 of the patients were disinfected and cleansed during the year. Housing.—The 137 deaths occurred in the same number of homes, comprising— 40 homes of one room, occupied by 58 inhabitants, 4 being under 10 years of age. 33 „ two rooms „ 137 „ 26 „ „ „ 34 „ three rooms „ 157 „ 27 „ „ „ 14 „ four rooms „ 62 „ „ „ 10 „ five or more rooms „ 76 „ 10 „ „ „ The average number of persons per room in each class of home and the average for the whole Borough (Census 1901) are given below:— Homes of one room, phthisis homes, 1.4—whole Borough, 1.8. „ two rooms „ „ 2.0 „ „ 1.7. „ three rooms „ „ 1.5 „ „ 1.3. „ four rooms „ „ 1.1 „ „ 1.2. All the above „ „ 1.5 „ „ 1.4. . The Medical Superintendent of the Workhouse Infirmary now reports each case on admission, so that it will be possible to offer disinfection promptly. 38 phthisis. Thus there was a slightly greater aggregation of inhabitants in the phthisis homes than in the Borough as a whole. At the last Census 50.86 per cent. of the inhabitants of the Borough lived in homes of less than five rooms. Supposing the incidence of mortality were the same in all classes of homes, the number of deaths in homes of less than five rooms would have been 70, whereas the actual number recorded was 121. Overcrowding.—Taking the Registrar-General's standard of an excess of two persons per room, the proportions of homes (H) and inhabitants (I) overcrowded were as set out below—the Census figures for the Borough have been added for comparison:— Per cent. Phthisis homes. Borough, 1901. overcrowded. H. I. H. I. Homes of one room 10.0 24.0 20.5 40.0 „ two rooms 36.3 52.5 23.7 44.6 „ three rooms 17.6 29.2 9.2 18.8 „ four rooms — — 4.9 10.5 The proportion of cases occurring in the different homes were:— One room 29. per cent. Three rooms 24.8 per cent. Two rooms 24T „ Four rooms 10.2 ,, The occupations of the deceased persons are set out below, arranged under three headings, viz., "indoor," "in and out door," and "outdoor." Consumption'. Occupations of Deceased Persons. Occupation. M F. Total. Occupation. M F. Total. Indoor:—- Brought forward 30 56 86 Pianoforte Maker 1 ... 1 Indoor (contd.):— Servants (domestic) ... 9 9 Licensed Victuallers 3 ... 3 Tailor 1 ... 1 Nurse (sick) 1 ... 1 Charwomen ... 3 3 P. O. Employees (indoor) 2 ... 2 Washerwomen,Laundresses ... 9 2 Professor of Elocution 1 ... 1 Domestic duties (wives) ... 29 29 Priest 1 ... 1 Dressmaking ... 5 5 Independent Means ... 3 3 Ladv's Maid ... 1 1 Forage Contractor's Employe 1 1 Clerks 6 ... 6 Shop Assistants 1 9 3 ,, Keepers 9 ... 2 M ixed:— Scholars 3 1 4 Painters 7 ... i Infant 1 ... 1 Dairyman 1 ... 1 Carver, Gilder 2 ... 2 Porter, Packer 4 ... 4 Florist ... 1 1 Policeman 1 ... 1 Waiter 1 ... 1 Glass Painter l ... 1 Outdoor:— Railway Employees,Ticket 4 ... 4 Professional Cricketer 1 ... 1 Collector, Clerk Soldiers 2 ... 2 Railway Carriage Cleaner 2 ... 2 Butchers 9 ... 2 and Repairer Labourers 9 ... 9 Basket Maker 1 ... 1 Stonemasons 2 ... 2 Bookbinder ... 1 1 Commercial Traveller 1 ... 1 Compositor 1 ... 1 Handy Men (outdoor) 3 ... 3 Carpenter 1 ... 1 Carmen 3 ... 3 School Teachers ... 2 0 Cabman, Coachman 2 ... 2 Lavatory Attendant 1 ... 1 Farrier 1 ... 1 Upholsterer I ... 1 Carried forward 30 56 86 Total 78 59 137 39 phthisis. In one-room homes separate sleeping accommodation, except where the home is occupied bv one person only (there were 28 such homes), is impossible. In other homes of all classes 50 of the deceased had separate bedrooms, and 24 others separate beds but not separate bedrooms. In 33 houses previous cases of fatal consumption were known to have occurred:— 21 had one previous case each; 9 „ two „ „ ; and 3 „ three „ „ ; Insanitary conditions were noted at 21 houses, including 12 cases of dirty and 0 of damp premises. Many interesting facts relating to the cases have been reported bv the Inspectors for which space cannot be found here. The following brief notes are submitted as tvpical:— V. A., female, at. 17; died Feb. 7th W. A., male, set. 14; died Aug. 8th brother and sister. Mother's lungs reported affected, also a third child's; five relatives on the mother's side are known to have died of "consumption." W. A. in close association with V. A. during last months of latter's life. Family reside on ground floor of house, very clean but damp. P. N., male, ret. 6 mos.; died after 3 months' illness. Mother belongs to consumptive family, and was in advanced stage of disease at time of her marriage. At age of 3 months child was affected, and was then taken from mother, whose death occurred shortly after that of the child. S. R., male, aet. 50. Died after illness of some 7 months. Subject to bronchitis; deceased had a bad attack of that disease while in " straitened circumstances," from which he never really recovered. He left his wife and two younger children in failing health, the widow having no prospects of earning a livelihood except by charing, for which she is physically unfit. L. L., female, aet. 53, died in February. The home was found to be damp and dirty. Cleansing was promised after disinfection, but, owing to the deceased's husband being always at work, the Inspector was not able to get admission to the home to ascertain whether the work had been carried out. In November the husband died of consumption, and it was then found that no cleansing had been done. W. I., male, aet. 58, of intemperate habits. The father of 10 children, of whom 13 died in childhood, all, it is said, having had "delicate lungs," a euphemism for consumption. C. M., male, aet. 34. Was consumptive as a child, but had been discharged from hospital at age of 15 as cured. Two of his children died from this disease. There was no history of earlier cases of consumption in the deceased's family. The case of S. R. given above illustrates one of the great difficulties associated with the treatment of this disease. When the breadwinner of the family is affected, the poverty which almost inevitably results not only prejudices his chances of recoverv, but leads to such a lowering of the vitality of the other members of the family as to render them specially liable to contract the disease. The patient is unable to lie up for the many weeks or months necessary for his cure. If removed to a sanatorium, his mental anxiety for those left at home impedes-his recovery, and often leads him to take his discharge too earlv. Organisation is required to provide, either by gift or loan, the money necessarv for the wants of the families of persons who are admitted to sanatoria. Until this be done, sanatorium treatment will not be available for those of the poorer classes having families dependent on them. Other Tubercular Diseases.—To these 54 deaths were due, the same number as in 1903, but 27 less than the corrected annual average (81). In St. Marv Sub-District there were 45 deaths (average 60), in St. John 4 (average 10), and in North-West Paddington 5 (average 11). (Sec also Tables IV. and V., Appendix.) The mortality was at the rate of 40 cancer. 0.37 per 1,000 persons of all ages, 0.17 less than the mean. A complete comparison is given below:— Other Tubercular Diseases : Death-rates Per 1,000 persons. Mean Rates. Five years. Five years. Ten years. 1904 1894-9S 1899-1903 1894-1903 Borough 0.37 0.59 0.49 0.54 St. Mary 0.47 0.71 0.54 0.62 St. John 0.12 0.27 0.27 0.27 North-West Paddington 0.30 0.62 0.66 0.04 " CANCER." Under this term are included several varieties of malignant new growths. The deaths attributed to them numbered 150, 3 less than in 1003, but 22 more than in 1902. The deceased persons comprised 54 males and 102 females. Last year's total was 8 in excess of the corrected annual average (148k Of the 150 deaths 96 were recorded from St. Mary Sub-District, the decennial average being 07; 48 from St. John (average 35); and 12 from North-West Paddington (average 10). The mortality was at the rate of 1.06 per 1,000 persons of all ages, 0.09 above the mean rates—'the whole of the increase falling in St. John. (See below.) Cancer : Death-rates Per 1,000 persons. Mean Rates. Five years. Five years. Ten years. 1904 1894-98 1899-1903 1894-1903 Borough 1.06 0.89 1.04 0.97 St. Mary 0.99 0.92 1.07 1.00 St. John 1.43 0.90 0.94 0.92 North-West Paddington 0.71 0.72 1.10 0.91 The sex-age distribution of the deaths in the Borough will be found in Table IV Appendix. The numbers for the Wards in 194 and 193 (in parentheses) are compared below, and show some striking differences. Thus in the four Northern Wards there were 35 fewer deaths last year than in 1003, and in the four Southern Wards, 32 more:— Queen's Park 2 (31) Church 32 (23) Harrcvv Road 7 (29) Lancaster Gate (West) 13 (9) Maida Vale 5 (23) Lancaster Gate (East) 5 (4) Westbourne 25 (31) Hyde Park 27 (9) The greatest proportional increase occurred in Hyde Park Ward, and the greatest decrease in-Queen's Park Ward. The Medical Officers of Health of the Adjacent Districts have kindly forwarded particulars of the numbers of deaths from "cancer" in their respective areas, and the figures for the years 1001-03 have been extracted from their annual reports. From the data thus collected, and by the use of "correction factors," Table 24 has been compiled. The local "recorded" rate (1.00) is the highest of the series, and the "corrected" rate (0.94) is the third highest, being exceeded by the rates for the Metropolis (0.00) and Willesden (l.04). 41 cancer. TABLE 24. Canckr : Death-rates. District. Standard. 1904. Mean Corrected. 1901.03. Recorded. Corrected. London 0.87 0.99 0.99 0.97 Paddington 0.98 1.06 0.94 0.90 Kensington 1.02 0.97 0.83 0.84 Westminster 0.96 1.01 0.92 0.87 Marylebone 0.99 1.01 0.89 0.99 Hampstead 0.92 0.99 0.93 1.02 Willesden 0.71 0.84 1.04 1.00 With the exceptions of those for Kensington and Marvlebone, all the rates for last year were above the mean rates for 1901.03. The mean rates for London, Hampstead and Willesden are higher than the respective "standard" rates. Correction factors for the Wards of the Borough have been calculated by the Department during the past year. The use of these factors make the rates given in Table 25 strictly comparable with those in the preceding table. TABLE 25. Cancer : Death-rates. Wards of Borough. Standard. 1904. Mean Corrected. 1901.03. Recorded. Corrected. Queen's Park 0.83 0.71 0.74 1.23 Harrow Road 0.88 0.59 0.58 0.94 Maida Vale 1.01 1.29 1.11 0.83 Westbourne 1.17 1.01 0.75 0.82 Church 0.87 1.18 1.18 0.99 Lancaster Gate West 1.02 1.54 1.32 0.94 Lancaster Gate East 1.02 0.63 0.53 0.67 Hyde Park 1.07 1.94 1.57 0.76 The highest "recorded" rate was that of Hyde Park Ward (1.94), and the lowest that of Harrow Road (0.59). After correction the rate of the former Ward still remains the highest (1.57), but the rate of Lancaster Gate East (0.53) becomes the lowest. The "corrected" rate was higher than the "standard" in Maida Vale, Church, Lancaster Gate West, and Hyde Park Wards. 42 other diseases. Particulars as to sites and nature of the "cancer" will be found in the annexed Table. TABLE 26. "Cancer." 1904. [###1Organ, &c., affected. St. Mary. St. John. North-West Paddington. C. O. C. O. C. O. M. F. \1. F. M. F. M. F. M. F. M. F.[/###1 1. Nervous System, Brain ... ... ... ... ... ... ... 1 . . . ... ... ... 2. Organs of Special Sense, Ear ... ... ... ... ... ... ... 1 ... ... ... ... 3. Respiratory System, Larynx ... ... 1 ... "i ... 1 ... ... ... 1 ... Lung 1 ... ... ... ... ... ... 1 ... ... ... ... 4. Circulatory System ... ... ... ... ... ... ... ... ... ... ... 5. Digestive System, Tongue 2 ... ... ... 2 ... ... ... ... ... ... Glands of Moutlui 1 ... 1 ... ... ... ... . . . ... ...... 1 ... (Esophagus 6 ... ... ... 1 1 ... ... ... ... ... ... Stomach 3 2 ... 3 6 5 ... ... ... ... ... Intestine 4 6 ... ... 1 ... ... 1 ... l 1 ... Rectum 4 7 ... ... 1 ... ... ... ... l ... ... Liver 1 3 1 ... 2 2 ... ... ... ... ... ... Pancreas ... 3 ... ... ... ... ... ... ... ... ... ... Peritoneum ... 1 ... ... . . . 1 ... ... ... ... ... ... 6. Lymphatic SysteM 1 3 1 ... ... ... ... ... ... 7. Urinary System ... ... ... ... ... 1 1 1 ... ... 8. Generative System, Testes Ova ries 1 1 ... ... ... ... l ... ... ... ... ... Uterus ... 11 ... ... ... 4 ... 1 ... 2 ... Breast ... 15 ... 4 7 ... 2 ... 1 ... 1 9. Osseous & Muscular Systems ... ... ... 1 ... ... ... ... ... ... ... 10. Cutaneous System ... ... 3 1 . . . ... ... . . . ... ... ... ... 11. Insufficiently described ... 1 1 2 ... ... l ... ... ... ... ... Totals 24 53 8 11 14 22 4 8 1 7 3 l "C." includes Cancer (31 deaths), Carcinoma (71 deaths), and Malignant Disease (19 deaths'). "O." includes Sarcoma 17 deaths), Scirrhus (8 deaths), Epithelioma (9 deaths), and Glioma (1 death). " M."—Males. "F."—Females. OTHER DISEASES. Influenza.-—There were 44 (26). deaths from this cause, equal to a rate of 0.30 (0.17) per 1,000 persons of all ages, and 0.13 below the mean (0.43). The deaths in St. Mary numbered 27 (21), equal to a rate of 0.28 (mean 0.45), those in St. John 8 (3), rate 0.24 (mean 0.42), and those in North-West Paddington 9 (2), rate 0.53 (mean 0.37). Respiratory Diseases.—From bronchitis (acute and chronic) there were 194 (160) deaths, 54 less than the decennial average, and from the various forms of pneumonia 120 (141), 24 less than the average. The mortalities were 1.32 and 0.82 respectivelv, the mean rates being 1.71 and 0.90, thus showing fair reductions. In St. Mary there were 144 (121) deaths from bronchitis, and 79 (99) from pneumonia. The corresponding mortalities were 1.51 and 0.80, compared with decennial mean rates of 1.99 and 1.08. In St. John the deaths numbered 19 from each cause, while the deaths from these causes in 1903 numbered 23 and 16 respectively. The mortality (0.57 from each cause) was 0.47 below the mean rate for bronchitis and 0.01 above that from pneumonia. In North-West Paddington 31 (10) deaths were registered from bronchitis, rate 1.84 (mean 1.55) and 22 (22) from pneumonia, rate 1.31 (mean 1.08). The decennial averages were: bronchitis 27 deaths, pneumonia 19. * Figures for 1903 shown thus. 4,". infantile mortality. Alcoholism,—Under this head fall deaths from "acute alcoholism" (delirium tremens), "chronic alcoholism," and "cirrhosis of the liver." The deaths scheduled under these causes during the past year numbered 2 (4), 14 (21), 22 (10), or 38 in all, or G less than in 1903 (44), 10 less than in 1902 (48), but one more than in 1901 (37). Although the figures quoted show a decline, vet they were in excess of the decennial annual average (36). The proportion of males to females dying from this cause last year was 17 (23) to 21 (21). In 1901 the deaths of males numbered 17 and those of females 20, the corresponding numbers for 1902 being 22 and 24. Reference has been made in previous Reports to the increasing mortality under this head, the apparent increase in mortality among females being particularly regrettable. It is satisfactory to note some indication of a check in the increase. The mortality last year was 0.26 (0.29) per 1,000 persons, 0.01 above the mean rate. The full comparison is given below:— Alcoholism : Death.rates Per 1,000 persons. Mean Rates. Five years. Five years. Ten years, 1904 1894.98 1899.1903 1894.1903 Borough 0.20 0.21 0.28 0.25 St. Mary 0.32 0.22 0.30 0.26 St. John 0.18 0.23 0.24 0.23 North-West Paddington 0.05 0.10 0.18 0.15 INFANTILE MORTALITY. The deaths at ages under one year registered within the Borough during the past year numbered 490, and were 65 in excess of the number registered in 1903, and 16 in excess of that of 1902. (See Table I., Appendix.) The gross mortality was 148 per 1,000 births registered, 4 less than the mean rate for the ten years 1894.1903, but 20 in excess of the rate for 1903. The nett total of deaths at these ages was 449, 57 less than the decennial average (506), but 61 in excess of the number for 1903. (Sec Table II., Appendix.) The mortalitv calculated on the births registered within the Borough was 136 per 1,000, 9 less than the mean rate. Lower rates prevailed in 1903 (108), 1902 (131), 1894 (133), and 1901 (135). From the appended statement it will be seen that the rate for last year for St. Mary was below the mean, that for St. John below the quinquennial mean for 1894.98 (124) but in excess of that for 1899.03 (103). Last year's rate in North.West Paddington (180) was above all the means. Only once since 1892 has that rate been exceeded, viz., in 1898, when the rate was 190. In 1903 the rate was only 98. Infantile Mortality Per 1,000 Births registered in each district. Mean Rates. Five years. Five years. Ten years. 1904 1894.98 1899.1903 1894.1903 Borough 130 153 138 145 St. Mary 132 158 145 151 St. John 113 124 102 113 North.West Paddington 180 158 142 150 44 infantile mortality. Separate rates for the two sexes have been calculated for St. Mary and St. John Sub-Districts, beginning from 1891, the necessary figures for North-West Paddington not being, however, available prior to 1901. From the annexed statement it will be seen that there has been a diminution in the infantile mortality, all the rates in the second quinquennium (1899-03) being lower than those in the first. Infantile Mortality Per 1,000 Births of each sex. Males. Females. Decreases.. 1894-98 1899-03 1894-98 1899-03 Males. Females. St. Mary 175 157 140 131 11.3 6.5 St. John 138 112 106 91 18.9 14.2 In each case the decrease has been greater among males than among females. On comparing the rates for the combined sexes it appears that the decreases in the rates for the second quinquennium were— St. Mary8.3 per cent. St. John 17.8 North-West Paddington 10.3 Last year's rates with one exception were higher than the mean rates for 1901-03. St. Mary. St. John. North-West Paddington. m. k. p. m. f. p. m. f. p. 1904 145 120 132 145 87 113 206 151 180 1901-03 143 117 130 100 93 95 145 120 133 Comparing last year's rate for the Borough (135) with those of the Adjacent Districts (Table 14 ante), it will be seen that higher rates were recorded in Kensington (150) and Marylebone (140). The lowest rate was that of Hampstead (112). In the whole country the rate was 146, those of the "70 Great Towns" and "100 Smaller Towns" being 160 and 154 respectively. (Table 15.) The employment of married women has considerable influence on infantile mortality by depriving the children of their mothers' care, and the consequent practice of hand feeding. The condensed tables of occupations for females do not give any separate information of the numbers of married women of child-bearing ages, the only numbers furnished being those of " married and widowed women aged 15 years and upwards employed." In the appended statement the proportions of " occupied " women to all married and widowed women are set out in comparison with the infantile mortality rates. Infantile Mortality. Proportion " occupied " per 1,000 females, Married and Widowed. Infantile Mortality. 1904. Mean. 1901-03. Westminster 267 Kensington 150 Kensington 152 Marylebone 250 Marylebone 140 Marylebone 134 Kensington 234 Paddington 135 Westminster 131 Paddington 165 Westminster 124 Paddington 129 Hampstead 128 Willesden 113 Willesden 126 Willesden 115 Hampstead 112 Hampstead 93 Table 27 contains an analysis of the 449 deaths at ages under one year according to cause and sex, and compares the numbers from each cause (persons) with the uncorrected decennial averages. The averages should be slightly reduced (5 per cent.) to make them strictly comparable with the figures for last year. . Per cent. of rate for 1894-98. 45 INFANTILE MORTALITY. TABLE 27. Causes of Death at Ages under One Year. 1904. Borough. St. Mary. St. John. North-West Paddington. 1904. Average. 1894-1903. Small-pox m. k. >1. f. m. f. p. p- ... ... ... 0 Measles 4 4 ... 3 1 12 ii Scarlet Fever 1 ... ... ... ... 1 9 i Whooping Cough 9 2 9 6 22 Diphtheria 1 1 3 Enteric Fever 1 ... ... ... 1 Diarrhoeal Diseases 59 47 3 3 16 4 132 112 Syphilis 1 1 ... 2 7 Tubercular Diseases 9 5 ... 1 1 1 17 28 Premature Birth 25 21 9 3 o 2 62 69 Congenital Malformations 5 13 ... 1 1 2 22 21 Injury at Birth 3 ... ... ... o O 2 Dentition q o 1 1 1 1 7 8 Rickets 1 ... i 1 Atrophy and Debility 25 15 9 2 4 2 50 56 Convulsions 10 7 1 3 1 1 23 26 Respiratory Diseases 18 18 4 9 o 11 6 60 84 Accident and Violence 5 7 2 1 1 1 17 17 Other Causes 13 11 .1 1 1 4 31 37 All Causes 183 152 25 18 43 28 449 505 Births Registered 1,262 1,262 172 206 208 185 3,295 3,436 The only causes showing increases were— Measles, scarlet and enteric fevers, and congenital malformations Diarrhœal diseases Increase, 1 death each, and „ 20 deaths. Of the deaths from "diarrhœal diseases" (132), 47 were returned as due to "diarrhœa," 77 to "zymotic enteritis" or one of the synonyms thereof, or 18 to "enteritis." Of male infants 78 died from these causes (decennial average 02) of female 64 (average, 50). The increase was slightly larger in the case of females than of males (28 per cent. as compared with 25 per cent.). Last year's returns were considerably higher than those of 1903, when 87 deaths were recorded, viz., "diarrhœa" 41 deaths, "zymotic enteritis" 33, and "enteritis 13. It will be noted that the bulk of the increase was in the deaths from "zymotic enteritis." 46 infantilis mortality. Many interesting facts have been reported by the Inspectors* with reference to the deaths of infants from diarrhoea, of which a few only can be recorded here. Inquiries were made by them touching 147 deaths at ages under 2 years; 124 of the deceased children being under twelve months' old, 20 of whom were first-borns. The first point to record is the fact that no fewer than 62 out of the 147 infants are reported to have had "bad medical histories," many being more or less premature. Whether it is desirable to take measures to preserve such offspring is a debatable question. On the other hand it has to be remembered that there are notable histories of puny infants developing into robust and very valuable citizens. Up to the age of ten months, the breast is the natural source of food supply. Of 108 infants dying at ages under'ten months, 8 were suckled, 53 were fed exclusively on artificial foods, and the remainder had a mixed diet. Stated as proportions:— 7.4 per cent. of these infants had natural food, and 92.6 „ „ „ artificial feeding. After the tenth month of life the child requires other foods, but there is evidence that a breast-fed child stands a better chance during the rest of the period of infancy than does a child fed artificially from its earliest days. Thus of the 39 children who died between the ages of 10 months and 2 years:— 6 (15.4 per cent.) had been suckled for at least 6 months. 20 (51.3 „ ) „ artificially fed from birth, and 13 (33.3 „ ) had had mixed feeding ,, „ Artificial feeding implies many forms of food, chiefly cow's milk. Many children are fed on condensed milk, and it is satisfactorv to note that the Inspectors state that they did not find any family using separated condensed milk. The " starvation " brands appear to be out of use in the Borough. On the other hand starchv foods are too commonly use. Such foods cannot be digested until after the sixth month of life. The long tube bottle is still used largely, but probably not to the extent noticed in other vears. The screw-top boat bottles are almost as objectionable as the long tube pattern, as the screw thread is difficult to keep clean, and is frequentlv found sour. Attention has been called in previous reports to the want of larder accommodation. Of 135 premises visited during the year, only 13 had proper accommodation. In other cases the food is left about the rooms—exposed to dirt and flies— or kept in a cupboard where the most miscellaneous assortment of household effects may be found. In one case dirty clothes were found in the cupboard where the infant's milk was stored. The enquiries made enabled the housing conditions of 107 families to be analysed:— 19 occupied one room. 7 occupied four rooms. 36 „ two rooms. 8 „ five or more rooms. 39 ,, three rooms. The infectious nature of "summer diarrhœa" is not recognised as it should be. The infective agent is to be found in the stools, and hence great care is required in disposing of soiled napkins. In the homes visited last year 26 cases were discovered in addition to those recorded in the death returns. It has been felt from the commencement of these inquiries that the Inpector's visits are made too late to secure any immediate results. Information of the births has not been obtainable in the past, but during last autumn the Registrar-General sanctioned the issue * Miss Nicolas and Miss O'Kell. 47 INFANTILE MORTALITY. of weekly returns of births registered. Useful as this information will prove to be, it is feared that it will in many cases be too late. Six weeks may elapse between the child's birth and registration, the latter not coming before the Department for another week. In certain cases therefore upwards of two months will elapse before any advice can be offered. Of the deaths from diarrhœa at ages under one year, 13 per cent, took place within the first two months of life. Mortality among Illegitimate Children.—Seventv-one (71) deaths of illegitimate children were registered in the Borough, 7 of the deceased infants not belonging to the Parish. From other parts of the Metropolis 5 other deaths were returned. Of the corrected total (69 deaths), 58 were infants under one year, 10 aged one to five years, and 1 aged over five years The infantile mortality* among illegitimates was at the rate of 425 per 1,000 such births,† as compared with rates of 295 in 1903, 208 in 1902, and 413 in 1901. An analysis, sex and age sub-division, of last year's deaths is appended:— Deaths of Illegitimate Children. Age at Death St. Mary. 1904. North-West Paddington. St. John. years. M. F. M. F. M. F. 0— 16 24 4 3 7 4 1— 4 4 1 — 1 5— — 1 — — — — 1904 20 29 5 3 8 4 1903 10 14 i 5 4 1 1902 19 16 2 1 3 2 The more important causes of death, and the occupations of the mothers are indicated below:— Causes of Death. 0— 1— 5— M. F. M. F. M. F. Measles 1 — 1 — Whooping Cough — — — 1 — — Diarrhoeal Diseases 6 12 3 3 — Syphilis 2 — Tubercular Diseases 1 1 Premature Birth 7 2 Developmental Diseases 5 5 — — — — Convulsions 1 1 — — Heart Disease 1 Respiratory Diseases 4 5 1 — — — Overlaid in Bed — — Accident and Violence 1 1 Other Causes 1 2 — — — l All Causes 27 31 6 4 0 l Inquests were held touching 6 deaths. Occupations of Mothers. Domestic Service 48 Commercial Employments 17 "Servant" 10 Dressmaker 6 Cook 10 Laundress 8 General Servant 14 Waitress 1 Housemaid 5 Book-keeper 1 Kitchenmaid 1 Paper-sorter 1 Charwoman 5 Housekeeper 2 Occupation not known 4 Parlourmaid 1 *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 four years will be: 1904, 338; 1903, 221; 1902 213; and 1901, 352. The mortalities among legitimate and illegitimate children, calculated on the numbers of each class whose births were registered during the year, were—Males, 138 and 417; females, 103 and 409 ; and persons, 119 and 425. 48 INQUESTS. INQUESTS. During the year 230 inquests were held in the Borough, 77 of which related to deaths of non-residents. Inquests were held outside the Borough with reference to deaths of 18 residents. The nett total of inquests (171) is analysed below:— TABLE 28. Inquests, 1901. Finding of Jury. St. Mary. St. John. North-West Paddington. m. f. m. f. m. f. Natural Causes 33 31 10 3 6 9 By Misadventure 4 1 ... 1 ... 1 Accidental Causes 21 20 6 4 4 2 Murder ... 2 ... ... ... ... Suicide 5 5 ... ... 1 ... "Open" ... ... 1 1 ... ... Totals 63 59 17 9 11 12 As regards deaths by suicide, there was a decline, 11 deaths being recorded compared with a corrected decennial average of 15. An analysis (condensed) of the causes and circumstances of the deaths, other than those by natural causes, is appended. Misadventure—(7 deaths)— Carbonic oxide poisoning (coal gas) 2 Chloroform narcosis 1 Ptomaine poisoning (stale shrimps) 1 Belladonna poisoning 1 Choked by food (m. æt. 1) 1 Born under bedclothes 1 Accident—(57 deaths)— Vehicular traffic 11 Conflagrations (suffocation) 2 Overlaid in bed 12 Clothes taking fire 3 Falls (various) 19 Other accidents 8 Weather agencies (heat) 2 Murder—(2 deaths)— Females, aged 20 and 3 years, by cutting throats. Suicide—(11 deaths)— By poison, 3, hydrochloric acid (spirits of salt), morphia and hydrocyanic acid (prussic acid), 1 each—all females. By hanging, 3—males 2, female 1. By drowning, 2—male and female, 1 each. By shooting, 1—male. By throwing self from window—1 male. By cut throat—1 male. In 8 instances, the deceased were found to be of "unsound mind," and „ 3 „ „ „ „ "temporarily insane." Often—(2 deaths)— A new-born male child found dead. A female killed by fall from window, no evidence as to reason for fall. 49 DEATHS IN INSTITUTIONS. DEATHS IN INSTITUTIONS. From the local public institutions 780 deaths were recorded, 37 deaths more than in 1903. The numbers of deaths in all the institutions, except the Lock Hospital, were in excess of the averages. (Sec Table III., Appendix.) In addition to these deaths, 21 deaths occurred in nursing homes in the Borough, 8 more than in the preceding year. The 801 deaths included 365 of non-residents, while of the 173 deaths of residents recorded outside the Borough 154 occurred in public institutions. The nett total of deaths of residents in such institutions was 582, compared with 564 in 1903, and 593 in 1902. The deaths in institutions constituted 28.8 per cent. of all deaths, the proportions in 1903 and 1902 having been 29.4 and 27.5 respectively. The principal causes of death are tabulated in Table IIIa , Appendix. The proportions in the different Wards were (figures for 1903 in parentheses):— Queen's Park 20.0 (34.5) Church 35.4 (35.1) Harrow Road 28.8 (24.0) Lancaster Gate, West 22.0 (25.4) Maida Vale 27.3 (27.0) Lancaster Gate, East 19.6 (15.0) Westbourne 27.0 (20.7) Hyde Park 25.9 (31.1) The highest proportion has hitherto always been in Church Ward, and the lowest in Lancaster Gate West Ward. * Proportions for 1903 thus. The 582 deaths have been distributed according to the following classification of institutions Rate-supported— Metropolitan Asylums Board's Hospitals 27 (26)* equal to 1.2 (1.3) per cent. of all deaths. Workhouses and Infirmaries 321 (311) „ „ 15.9 (10.2) Lunatic Asylums 46 (45) „ „ 2.2 (2.3) Voluntary— Hospitals and Homes (but not private nursing homes) 188 (182) „ „ 9.3 (9.4) Ol o ADMINISTRATIVE WORK. » TABLE 29. Report of the Work of the District Inspectors during the year 1904. 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. Cistern Overflows Disconnected. New, Provided. Repaired, &c. Drains Cleared, Flushed, &c. Houses or Rooms Cleansed, Whitewashed, &c. Cases of Overcrowding Abated. Cellar Dwellings Closed. Yards and Areas Paved and Drained. Manure Receptacles Reconstructed, &c. Accumulations Removed. Improperly-kept Removed. Quarters. No. 1 132 40 479 – 4,363 83 51 8 29 96 23 1 11 – 14 – 17 3 8 25 – – 23 2 64 – No. 2 168 98 601 – 4,536 67 46 16 20 69 14 1 5 – 10 – 9 2 9 42 1 – 19 1 106 1 No. 3 207 36 613 – 3,914 100 233 11 60 121 19 4 7 2 8 – 16 2 13 20 2 – 11 5 100 – No. 4 125 90 470 – 4,093 78 170 84 40 244 28 11 4 2 18 – 19 1 14 34 3 – 14 – 24 3 Year 632 264 2163 – 16,906 328 500 119 149 530 84 17 27 4 50 – 61 8 44 121 6 – 67 8 294 4 51 ADMINISTRATIVE WORK. ADMINISTRATIVE WORK. Staff.—The Staff of the Department remained unchanged. The usual summary of work performed by the District Inspectors is given in Table 29. Separate tables will be found under the subjects of "Housing," "Workshops," &c., summarising the work of the other Inspectors. Prevention of Infectious Diseases.—The visits made by the Staff of the Department with reference to cases of infectious illnesses (notified and other diseases) amounted to 4,652, 3,704 of which were made by the two Women Inspectors, with reference to cases (or deaths) of the following diseases:— Measles 543 visits. Chicken-pox 100 visits. "Consumption" 175 visits. Whooping Cough 104„ Infantile Diarrhœa 152„ Puerperal Fever 10„ In 1903, 4,145 such visits were made, and, in 1902, 3,341. The increase in the number of visits recorded during the past year, took place in the first and fourth quarters of the year (see below). 1st Quarter, 1,732 (1,012); 3rd Quarter (Holidays), 801 (988); 2nd Quarter, 872 (1,064); 4th Quarter, 1,247 (1,081). Figures for 1003 in parentheses. "Letters of advice" are sent when patients suffering from notified illnesses are kept at home, with which are enclosed a memorandum of the precautions necessary to prevent the spread of infection, and extracts from the Public Health (London) Act, 1891, and Factory and Workshop Act, 1901, relating to the " dangerous infectious diseases." During the past year 72 such letters were issued, as compared with 00 in 1903 and 114 in 1902. Special communications are sent to midwives and others having charge of cases of puerperal fever, of which 8 were issued last year, as against 4 in 1903 and 19 in 1902. The rooms disinfected numbered 1,795 last year, as compared with 1,970 in the previous year. Hospital Work.—The total number of cases of infectious illnesses removed to hospital was 478 last year, 549 in 1903, and 632 in 1902. The accommodation provided by the Metropolitan Asylums Board at the close of the year comprised 7,058 beds (5,018 for "fever" cases and 2,040 for small-pox). The construction of hospitals to provide 1,288 further beds for "fever" cases has been authorised, and the works are well 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 4,266 beds in 9 hospitals. convalescent 752 „ 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. This statement leaves out of consideration the 1,850 beds at Gore Farm Hospital, in regard to which no decision has as yet been arrived at as to their future use. †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. 52 ADMINISTRATIVE WORK. Disinfection.—No change has to be recorded in the practice of the Department either as regards rooms or goods. It has not been necessary to issue any notice for the delivery of articles exposed to infection for the purposes of disinfection, and only one notice to "cleanse and whitewash" premises after infectious illness was required. The articles dealt with by the contractor weighed just under 57 tons, 7 tons less than in 1903. The cost amounted to £1,181, nearly £200 below the total for 1903 (£1,355). On disinfectants (formaldehyde, soap and chloride of lime) the expenditure last year was £24, the same as in 1903. The expenditure under this head has declined for some years, and a further reduction is anticipated during the current year. The provision of a Disinfection Station has been under consideration of the Public Health Committee and Council during the past year. It has been decided to provide such a station, the work to be done thereat to include disinfection and rough drying of washable articles. No decision has been arrived at on the question of re-making beds, as has been done by the Contractor. In June of last year the Public Health Committee submitted a scheme for the erection of a station outside the Metropolitan Area, on land belonging to the Council. The scheme was not adopted bv the Council, and the whole question was referred to a Special Committee. On the recommendation of that Committee it was decided to utilise a site in Kensal Road, and provisional plans were forwarded to the Local Government Board in December last. Family Shelter.—No one has made use of the shelter for two years. The substitution of the formaldehyde sprav for sulphur, as the means of room disinfection, has made such shelter almost unnecessary. Water Supply.—The notices of discontinuance of water supply which are sent to the Council under the provisions of Sec. 19 (1) of the Public Health (London) Act, 1891, numbered 59 as compared with 70 in 1903 and 121 in 1902. The reasons for discontinuing the supply were reported bv the Inspectors to be— District. Grand Junction. West Middlesex. Repairs of fittings 21 4 Empty houses 4 23 Unpaid rates 2 1 Premises in course of demolition — 4 In 19 instances the supply was restored within 24 hours, and in 4 others after 2 days' interval. Notices to restore supply were required in 8 instances, and two prosecutions were necessary. (See Legal Proceedings). Mortuaries.—During the year 209 bodies were received at the Paddington Green Mortuary and 24 at that in Kensal Road. Inquests were held on 229 of the bodies received at the former Mortuary and 24 at the latter. One hundred and fourteen post-mortem examinations were made, viz., 103 at Paddington Green and 11 at Kensal Road. Schools and School Attendance.—The London County Council became the Education Authority for the Metropolis during the year. One important result of the change in administration is the extension of the Authority's control, qua medical supervision, to the Voluntary (Non-Provided) Schools. These are now on the same basis as the Provided (late Board) Schools. 53 ADMINISTRATIVE WORK. TABLE 30. Borough Schools, 1904. Notified Diseases. Name of School. Residents in Borough. Residing beyond Borough. Scarlet Fever. Diphtheria. Scarlet Fever. Diphtheria. Provided Schools — p.a. p.n.a. p.a. p.n.a. Amberley Road 6 5 7 5 ... 1 Beethoven Street 17 6 4 ... ... 2 Campbell Street 9 1 3 2 ... ... Droop Street 17 5 5 3 ... ... Essendine Road 7 3 6 1 1 ... Harrow Road 13 6 ... ... 1 ... Kilburn Lane 12 6 1 1 4 1 Totals 81 32 26 12 6 4 Non-Provided Schools— ... ... ... ... ... ... Bayswater Jewish 4 3 ... ... ... 2 Cirencester Street R.C. ... ... ... 1 ... ... Holy Trinity 3 1 4 4 ... ... St. Augustine 0 1 9 1 5 8 St. James 2 ... ... ... ... ... St. John, Kilburn Lane 2 ... ... ... 9 ... St. John, Titchborne Street 4 1 1 1 ... ... St. Luke, Kilburn 1 1 ... ... 10 4 St. Mary 3 1 ... 1 ... ... St. Mary of the Angels, R.C. ... ... ... ... ... ... St. Mary Magdalene 11 9 1 2 ... ... St. Matthew 6 1 ... ... ... ... St. Michael 8 3 3 1 ... ... St. Paul 8 1 ... 2 ... ... St. Peter 6 ... 4 ... 1 1 St. Saviour 9 1 3 1 1 ... St. Stephen 5 2 3 1 6 4 Westbourne ... ... 1 ... 1 ... Wilberforce 18 6 0 ... 7 1 Woodfield 1 1 2 1 ... ... Wordsworth ... ... 2 ... ... ... Totals 93 25 28 16 33 20 P.A. - Patients attending school. P.N.A.—Patients not attending school. Notices to exclude children from infected houses are sent to all schools, not only in connection with notification, hut also for all cases of infectious illness coming to the knowledge of the Department. Re-admission notices are sent later on in the majority of cases. In all 2,804 such notices were sent, viz.:— Exclusion. Re-admission. For notified diseases 810 726 For other diseases 729 546 The numbers of cases occurring in connection with the different schools are given in Tables 30 and 31. Scarlet fever and diphtheria were unduly prevalent during the autumn among the children attending the Droop Street School, but closure of the school die not appear to be necessary at any time. The following class-rooms were closed at the dates and for the times set out below:— School. Class-room. Date of Closure. Duration. Disease. Droop Street (Inf.) E Jan. 29th 3 weeks. Measles. ,, D Feb. 2nd 3 „ „ Moberley (Inf.) D „ 12th 2 „ „ Amberley Road (Inf.) C „ 23rd 3 „ „ Campbell Street (Inf.) C Nov. 16th 2 ,, „ 54 ADMINISTRATIVE WORK. The closure was in each case on the advice of the Medical Officer of the School Board (Countv Council), and not by Order of the Borough Council, that Officer's attention being directed to the prevalence of the disease by letter from the Department. The Teaching Staffs of the Public Elementary Schools have rendered valuable assistance to the Department by reporting cases of suspected disease. Unfortunately, in a large proportion of the cases of so-called minor diseases (e.g., measles, whooping cough) no medical opinion is taken by the parents, and when the occurrence of the illnesses is denied by them, the Department can take no further steps in the matter. A system of medical examination in the schools of suspected cases would not only be of great value to the children and their families, but would also help to check the spread of disease. Returns are regularly made to the medical officers of health of the Adjacent Districts of Paddington children attending schools in those districts, and similar returns are received with reference to children from those districts attending Paddington schools. Last vear 69 such returns were received, 52 from Willesden and 17 from Kensington. (See below.) Disease. Willesden. Kensington. Scarlet fever 23 11 Diphtheria 16 6 Enteric fever 2 — Other diseases 11 — TABLE 31. Borough Schools, 1904. Other Diseases. Name of School. Measles. Chicken-pox.* Whooping Cough. Quarters. Yr. Quarters. Yr. Quarters. Yr. 1 0 3 4 1 2 3 4 1 2 3 4 Provided Schools— Amberlev Road 25 2 ... 1 28 3 1 ... 2 6 ... 3 1 ... 4 Beethoven Street 73 1 ... ... 74 4 5 10 6 25 ... 1 1 ... 2 Campbell Street 1 10 ... ... 11 9 12 9 ... 23 ... ... ... 26 26 Droop Street 78 1 ... ... 79 1 8 2 2 13 ... ... 2 1 3 Essendine Road 7 1 ... 2 10 2 1 4 30 37 ... ... ... ... ... Harrow Road 25 1 2 2 30 ... 2 2 10 14 ... 7 6 17 30 Kilburn Lane 40 ... ... ... 40 ... ... 2 2 4 ... ... ... 2 2 Totals 249 16 2 5 272 19 29 22 52 122 11 10 46 67 Non-Provided Schools— Bayswater Jewish ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirencester Street, R.C. 1 1 ... 2 4 ... 2 1 ... 3 1 ... ... ... 1 Holy Trinity 1 1 2 1 5 ... 1 ... ... 1 ... ... 2 1 3 St. Augustine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. James 1 ... ... ... 1 11 2 ... ... 13 ... ... ... ... ... St. John, Kilburn Lane ... ... 1 ... l ... ... ... ... ... ... ... ... ... ... St. John, Titchborne Street ... 2 ... ... 2 ... 14 ... ... 14 ... ... ... ... ... St. Luke, Kilburn 5 2 ... 1 8 ... ... 1 6 7 ... ... ... ... ... St. Luke, Westbourne Park ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... St. Mary 2 ... 2 ... 4 ... 5 3 ... 8 ... ... ... ... ... St. Mary of the Angels, R.C. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mary Magdalene 2 1 ... 3 6 8 2 ... ... 10 1 ... ... ... 1 St. Matthew 27 ... ... ... 27 2 ... ... ... 2 ... ... 5 ... 5 St. Michael ... ... 1 ... 1 2 15 ... ... 17 ... ... ... ... ... St. Paul 16 ... ... 2 18 ... ... 1 1 2 1 ... ... ... 1 St. Peter 1 ... ... ... 1 1 2 2 4 9 ... ... ... ... ... St. Saviour 29 1 ... ... 30 2 ... ... ... 2 ... ... ... ... ... St. Stephen 2 ... ... ... 2 9 ... ... 2 4 4 2 ... ... 6 Westbourne 11 ... ... ... 11 ... 1 ... 4 5 ... ... ... ... ... Wilberforce 27 ... ... ... 27 ... 3 1 ... 4 ... ... ... 3 3 Woodfield 1 ... ... ... 7 ... ... ... 3 3 ... 1 1 ... 2 Wordsworth ... 2 ... ... 2 ... ... ... 2 2 ... ... ... ... ... Totals 132 11 6 9 158 28 47 9 22 106 7 3 8 4 22 * Chicken-pox notifiable from April 6th to November 6th. 55 ADMINISTRATIVE WORK. Bacteriological Examinations.-Eighty specimens were submitted for bacteriological examination, 13 more than in 1903, but 49 less than the total for 1901. Of the specimens received last year, 52 gave negative results. The diseases suspected and the results are given below— Specimens received. Results. Positive. Negative. Diphtheria 58 16 42 Enteric fever 19 10 9 "Consumption" 9 2 — Glanders ... 1 — 1 Offensive Refuse.—Trade Refuse.—In February of last year a communication was received from the London County Council containing proposals to give effect to resolutions adopted at the Conference of London Authorities, held in 1900, relating to the removal by the Councils of this class of refuse. The resolution was to the effect that the Local Authorities should have compulsory power to collect such refuse, and charge the producer thereof for the cost of such collection and subsequent disposal. At present this can only be done with the consent of the producers. The Council agreed to the proposal of the London County Council, subject to the amendment, that the Council should be left to put the powers in force should it be deemed necessary to do so. Manure.—At the Conference already referred to a similar resolution was adopted with regard to manure. Nothing has however been done towards giving effect to the resolution. Each year greater difficulty is experienced bv horse owners in getttng rid of the manure, the difficulty being more acute at the time when the nuisance is greater. Municipal collection at the cost of the horse owners appears to be the only practical solution to the question. The usual 48-hours' notice was posted throughout the Borough at the commencement of the hot weather, and the Inspectors were directed to see that the notice was duly attended to. A large number of visits were requisite for this purpose, but no legal proceedings were necessary. Drainage Work.—Existing Buildings.—During the past vear 858 new drains have been provided to existing premises, the drain being in each case water-tested before and after filling in. In 1903, 665 new drains were reported; in 1902, 573; and in 1901, 572. Of the 858 new drains constructed last year, 352 were on the Queen's Park Estate. Thirtv-nine old drains were tested during the year and found sound. The majority had been reconstructed under the Department. Combined Drainage.—The following systems of combined drains were found to be defective, and as no record of approval could be found for any of them, they were deemed to be sewers and referred to the Surveyor for amendment:— Nos. 1, 2, and 3, Craven Terrace. Nos. 30 and 31, Maida Hill West. Nos. 5 and 6, Polygon Mews. Nos. 6, 8, and 10, Portsdown Road. Nos. 1-23 (odd) Upper Westbourne Terrace. Nos. 16 and 17, Victoria Place, Nos. 25 and 27, Warwick Road. Nos. 14, Shrewsbury Road, and 19, Richmond Mews West, Nos. 1-9 (odd) Kilburn Park Road, 1-7 (consec.), Andover Place, and 1-5 (consec.) Portsdown Mews. All have been re-constructed or otherwise dealt with except that of Nos. 5 and 6 Polygon Mews. 56 ADMINISTRATIVE WORK. Orders have been made by the Council—under Sec. 74 of the Metropolis Management Act, 1855—for new systems of combined drainage at:— Nos. 6, 7, and 8, Hall Place. Nos. 9 and 11, Harrow Road. Nos. 38, 40, and 42, Herries Street. Nos. 10 and 17, North Wharf Road Nos. 3, Portsdown Road and 3, Kilburn Park Road. No. 128, Hall Place, and workshop in rear. Nos. 413 and 415, Harrow Road. Nos. 3, 4, and 5, North Wharf Road. Pickford's Yard, Harrow Road. On the Oueen's Park Estate the combined drains of the following blocks of houses were reconstructed during the year:— Droop Street, Nos. 68-84 (even). Huxley Street, Nos. 1-47 (odd). Ilbert Street, Nos. 103-119 (odd). Sixth Avenue, Nos. 2-48 (even). Nutbourne Street, Nos. 24-58 (even). Fifth Avenue, Nos. 131-145 (odd). Oliphant Street, Nos. 90-128 (even). Sixth Avenue, Nos. 104-118 (even). Lothrop Street, Nos. 82-118 (even). Marne Street, Nos. 87-99 (odd). Fifth Avenue, Nos. 99-113 (odd). Kilburn Lane, Nos. 28-160 (even). Ilbert Street, Nos. 158-170 (even). Oliphant Street, Nos. 1-109 (odd). Sixth Avenue, Nos. 88-102 (even). Marne Street, Nos. 82-112 (even). Fifth Avenue, Nos. 115-129 (odd). Nutbourne Street, Nos. 69-101 (odd). In each case the main and all branches were re-laid with the maximum fall obtainable, gullies substituted for lip-traps, and rain-water pipes disconnected. The new drains were carefully tested with water. The branch drains had been tested with chemicals before the work was commenced, and a large percentage of them found to be defective. At 48 other houses where cases of infectious illness occurred during the year, the drains were similarly tested, and 20 proved to be defective. At 18 other houses where rats were complained of 15 were similarly proved to be defective. The new drains have been plotted on the Ward Map with the dates of reconstruction, thus affording a permanent record for future reference. Sewers.—Complaint was made in June of offensive smells in the neighbourhood of Kensington Gardens Terrace. The smells were traced to the ventilating grids at the junction of the Terrace and Bayswater Road. At this point the Ranelagh Sewer joins the Mid Level Sewer. Complaints of effluvia from this point have been frequently made in past years, but have been less frequent during 1902-04—probably owing to the cooler summers and greater rainfall. The County Council has been urged to provide an upcast shaft and to close the grids, but nothing has resulted. The inadequacy of the Ranelagh Sewer to take the growing volume of sewage which is associated with the extension of residential property in North Paddington and (part of) Willesden, is generally admitted. On July 25th there was a recurrence of the flooding on the occasion of a rainfall somewhat in excess of the average. The flooded area included parts of Ranelagh Road, Senior Street, and Westbourne Terrace North, with the smaller cross streets. In this neighbourhood the maximum height of the flood was 3 ft. above the surface of the ground. The flood lasted about an hour and a half. Much filth was left behind, especially under the floors of basement rooms. The inadequacy of the Ranelagh Sewer caused some of the subsidiary sewers to overflow, and floodings occurred in parts of Formosa Street, Shirland Road, and Warrington Crescent. administaative work. 57 Smoke Prevention.— Table 32 contains a list of the premises which were watched during the year. The observations made numbered 133, as compared with 73 in the previous year, extending over 56⅓ hours (38½ hours in 1903). Smoke was observed for hours, the total duration of black smoke being 3 hours. No summonses were taken out, but 5 notices under Sec. 24 of the Public Health (London) Act, 1891, were issued. The distinction between dark and black smoke is a matter of some difficulty in the absence of any recognised standard. TABLE 32. Smoke Observations. Address. Business. Chimney Shaft of 12, Adpar Street Solder Smelting Smelting Furnace Bishop's Road Bridge Refreshment Rooms Steam Boiler „ „ New Buildings Steam Crane 8, Bishop's Road Refreshment Rooms Kitchen Stove 8, Bristol Gardens Baking Baker's Ovens 75.77, Edgware Road Restaurant Kitchen Stove 189, „ „ Baking Baker's Ovens 213, „ „ Restaurant Kitchen Stove 149.151, Harrow Road Saw Mills Steam Boiler Goods Yard „ Hydraulic Works „ „ Lock Hospital „ Hospital Heating Boiler 156.158, Kensal Road Saw Mills, &c. Steam „ Moscow Court, Moscow Road New Buildings Steam Cranes 14.18, North Wharf Road Refuse Destructor Destructor 15.19, ,, ,, Iron Works Furnaces 47, Praed Street Laundry Iron Heater Hotel, „ Hotel Kitchen Stove 25, Oueen's Road Restaurant „ „ 182, „ „ „ „ 114.118, Shirland Road Dairy Steam Boilers 195, Baking Baker's Ovens 33, Westbourne Grove General Stores Steam Boilers Westbourne Terrace Bridge Electric Light Works „ „ Canal Boats Acts.— The usual report of the Examiner of Canal Boats was submitted to the Council on February 7th last. The contraventions of the Acts reported were few and trifling in character. No case of sickness was reported during the year, and only two deaths one each from bronchitis and pneumonia. Canals.— There was no shortage of water in the canals during the year. No complaints of effluvia were received. The "cut" or basin was emptied at Easter, when 600 tons (approximately) of mud, &c., were removed from the bottom. That amount was 100 tons in excess of the estimated amount cleared away in 1903. The "cut" has a concrete bottom throughout its whole length, and much less mud has to be cleared away than was necessary (say) 8 years ago. Each time the water is run off any defective concrete is made good. The London County Council in July last called attention to the conveyance of house refuse in uncovered barges. Notices were issued to all barge.owners and wharfingers calling attention to the provisions of By.law No.1, pursuant to Sec. 10 (2) of the Public Health (London) Act, 1891, under which conveyances carrying fæcal or offensive or noxious matters in or through the Metropolis, must be covered to prevent the escape of effluvia and the dispersal of such matters—by wind or other agency. 58 workshop supervision. Wharves.— These have been regularly inspected during the year. No complaint has been received of any nuisance from those on the "cut," but complaint was made in July last by the Education Department of the County Council of "unpleasant smells arising from refuse collected and carted . . . from the district of the Willesden Council, and shot into barges alongside a landing wharf at the rear" of the Moberley School, Harrow Road. The complaint apparently referred to the wharf acquired by the Willesden District Council in 1903. At an inquiry held by the Local Government Board in February of that year the Borough Council opposed the proposal of the Willesden Council on the ground that nuisance and danger to health of the scholars might be anticipated, owing to the proximity of the wharf to the school. The Council's objection was not upheld by the Board. Offensive Businesses.— By an Order dated 29th March, 1903, the London County Council declared the business of dressing of fish skins to be an offensive business within the meaning of Sec. 19 of the Public Health (London) Act, 1891. That Council has also drafted new by.laws relating to the conduct of the various offensive businesses, but the by.laws have not yet been promulgated. There are no offensive businesses carried on in the Borough. 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 within his district. In the autumn of last year the Home Office issued directions and tables indicating the information required. The system of work adopted bv the Department, sufficientlv described in previous Reports, remains unchanged. Registration.—At the close of 1903, 281 premises were on the Registers of the Department. During 1901, 96 premises were added to and 23 removed from the Registers, leaving 354 effective entries at the close of the year. The premises comprised 98 factories, 750 workshops, 15 domestic workshops, 343 premises occupied by single workers, and 54 "workplaces." In addition there are 24 contractors' premises which are not included in the total of 1,260. The classes of businesses carried on and the number of workers are indicated in Table 33. The latter can be regarded as an approximate estimate only, owing to frequent changes which take place from various causes. Notices of 31 new workshops were received during the year from the Home Office, most of which were already known to the Department. Outworkers (Homeworkers).—Under the provisions of Sec. 107 of the Act lists of outworkers have to be sent to the Local Authority of the District in February and August of each year, and such lists are to be examined and particulars forwarded to any district in which any of the outworkers reside. During the year, 83 lists were received from employers in the Borough, containing 414 addresses of outworkers, viz., 26 in Februarv and 37 in August. The addresses forwarded to other Boroughs numbered 253, and those received from, 165. The 165 addresses were received from the following districts :— Kensington Hampstead Willesden Finsbury Marylebone Shoreditch Westminster 20 lists 11 „ 2 lists each 5 lists 3 lists each Chelsea Fulham St. Pancras Battersea Camberwell Islington City of London 2 lists each. 1 list each. workshop supervision. 59 TABLE 33. Factories, Workshops, and Work-pi.aces. No. of Premises. No. of Rooms. Employees. Women. Young Persons. Men. Total. 85 85 126 128 Clothing-— (32) (32) 2 (32) (32) Boot-making Clothingr,repairs — — 6 Corset making 2 — 23 (1) Dressmaking 128(32) 9 2,251(207) fur-sewing and Furriers 4 6 9 Mantle making 11 (5) 14 (5) 37 Millinery 44 (6) 63 (6) 288 Millinery and Dressmaking 19 52 292 Out fitting and plain Nedle work 37 (23) 8438 (23) 93 Tailoring 80 78 „ Ladies' 19 44 31 44 112 Various 10 (4) 10 (4) 11 Fancy Work— Embroidery and Art Needlework 6 (3) 8 (3) 18 Other 7 (3) 7 (3) 16 Cleansing— Dyers and Cleaners' Receiving Offices 16 16 22 Laundries 143 (14) 433 (18) 1,140 „ —Receiving Offices 29 29 30 Mangling 25 (1) 25 (1) 26 Various 5 (2) 5 (2) 14 Other Businesses— Bookbinding 24 33 85 Coach Building 30 55 — Cycle and Motor Making 17 22 — Jewellery and Clock-making 7 11 16 Metal-working 12 13 — Saddlery 8 10 — Sign and Ticket Writing 6 6 — Trunk-making 6 9 Umbrella-making 5 6 13 Upholstery 36 (17) 60 (23) 114 Various 56 84 171 *1,260(249) †1,907 (285) 4,520 * Including 190 Single Workers †„ 220 rooms in The figures in parentheses refer to outwo At the close of the year the Department's Registe occupied by outworkers, comprising— Factory, 1 ; workshops, 95 ; workplaces, 2 ; : The last alone are really within the definition of persons working in the 249 premises was 591. (For on, &c., see Table 33, where the figures are shown in parentheses.) Inspections.— The inspections and re-inspections made during the year numbered 3,414 (see Table 34) as compared with 2,468 in 1903, and 220 rooms were measured, or 172 less 6O workshop supervision. than in 1903. On two occasions admission was refused at the time of the Inspector's first visit. One occupier readily admitted the Inspector a few days subsequently, and the other subsequently sought the Inspector's advice and assistance. Eighty.seven (87) workrooms were found to be used as bedrooms. The number of workshops without the "Abstract" prescribed by the Act was 65, against 118 in the previous year. Each case was duly reported to the Home Office. In 1903, 133 notices were required to deal with nuisances and infringements of the Factorv and Workshop Act. Last year the number fell to 90. Much necessary work was, however, done without notice, on verbal requests of the Inspectors. Miss O'Kell. Miss Nicolas. Mr. Wansbrough. 573* 83 120 536 433* 77 67., 443 281 113 31 363 83 1,025 18 81 949 103 236 1,223 23 57 19 25 43 6 6 37 18 2 17 27 15 2 1 9 32 2 Discovered. Abated. 1 34 2 2 1 1 11 0 1 1 21 81 % 1 38 1 1 2 10 5 1 13 72 Discovered. 15 75 8 1 3 11 13 11 2 27 166§ Abated. 15 67 6 1 3 11 12 2 16 133 Discovered. 56 3 1 66 Abated. 50 3 1 12 60 * Including workshops where both sexes are employed. † Workshops where men only are employed (Bakehouses not included.) † Nine cases referred to Male Inspectors, five to Home Office, and one to District Surveyor. § Twelve cases referred to Male Inspectors, and four to Home Office. workshop supervision. 61 Complaints.— In 1902 the Home Office forwarded 28 complaints, in 1903 10, and last year 6—one of which being, however, apparently sent in error, as no evidence of any cause for complaint could be discovered. The 5 other complaints referred to— Dirty conditions, 3 ; insufficient ventilation and overcrowding, 1 each. From other sources 18 complaints were received last year, relating to— "Bad smells," 4 ; insufficient means of warming, 3 ; dirty conditions, 2 ; overtime, 2 ; and " other matters," 5. The complaints as to temperature and overtime were referred to the Home Office. Overcrowding.—In 1902, 44 cases of overcrowding were reported, in 1903, 31, and last year 16—a very satisfactory reduction. Deficient Ventilation.—In 1903, 19 workshops were noted as insufficiently ventilated, which number decreased to 10 last year. Warming.— A steady improvement is taking place in the provision of means of warming, but the reduction in the number of complaints has been in part due to the milder winter. Unventilated gas.stoves are gradually being banished from workshops of all classes. Sanitary Conveniences.— These are being gradually improved, as may be seen by comparing the complaints recorded by the Inspectors during the past three years :— 1902. 1903. 1904. Insufficient 9 5 2 Not separately provided 33 17 4 Badly placed 18 10 13 Unventilated 8 5 — Defective 29 28 23 All the closets reported last year as "badly placed" were in men's workshops inspected for the first time. The defects were chiefly those of waste preventers out of order. Sickness.—Fifty.three cases of infectious illnesses were reported at " workshop premises, 14 of the cases occurring in houses occupied by home workers. The cases reported are as follow :— Scarlet fever 10 Chickenpox 10 (5) Enteric fever 3 (2) Measles 28 (7) Erysipelas 1 Whooping Cough 1 There were 11 deaths from consumption during the year at premises where workshops exist, 4 being outworkers' premises. The precautions taken were in every case found to be sufficient, and no action was requisite under the special sections of the Factory and Workshop Act. Laundries.— The conditions prevailing in these premises continue satisfactory. The defects found during the year were of very small importance, and were promptly remedied on attention being called to them. Bakehouses.— At the close of 1903, 33 underground bakehouses were without the certificate required by Sec. 101 of the Act, the necessary alterations being unfinished. During 1904, 32 certificates were issued, one bakehouse being left over as incomplete. The total number of bakehouses in Borough at the end of 1904 was 79, viz., 17 " level " and 62 underground. Of the 79 bakehouses 8 are factory bakehouses, and 71 workshop. Of. the former 91 inspections were made during the past year ; of the latter, 465. Four bakehouses only were reported to be dirty. Four cases of sickness—viz., one each of scarlet and enteric fevers, erysipelas and chickenpox—occurred on the premises. 62 HOUSING. There is no doubt that the work of the Department during the past three years has resulted in a general raising of the standard of sanitation in all the premises coming within the scope of the Factory Act. Nearly all the defects reported during the year in workshops were discovered in places which had not previously been known to the Department. The Inspectors report that they have been cordially received by the occupiers when making their inspections, and that their suggestions have been largely acted on. Housing. This subject will be dealt with under the following sub.heads:— (i.) Houses let in lodgings ; (ii.) Common Lodging Houses (iii.) Housing of the Working Classes Acts ; and (iv.) Remission of Inhabited House Duty. Houses let in Lodgings.—The supervision of these houses was considerably hampered by the doubtful validity of the (then) existing by.laws. The decisions given in November and December of 1903* rendered a re.modelling of the by.laws necessary, all hough the practice of the Department had always been on the lines indicated by the Lord Chief Justice, that is to say, proceedings were never instituted for an infringement of the by.laws without notice being first given. As, however, the decisions referred to declared in effect that the old model by.laws of the Local Government Board (the basis of the local series) were invalid, the latter could not be relied upon for legal work. It was therefore thought advisable to take only urgent cases into Court, and a number of tenements which under ordinary procedure would have been cleansed in April remained dirty (more or less) pending the confirmation of the new by.laws. The draft of the new series was submitted to the Local Government Board in December last.} Registration.—At the end of 1903, 851 houses were on the Register. During 1904 217 houses were visited for the purpose of registration, of which 185 were placed on the Register, and C houses on the Register at the end of the previous year, were struck off owing to the operation of the exemption clauses of the by.laws. To secure the information prescribed by the by.laws, 148 notices and 60 " reminders " were issued, but no summonses were required. The total number of inspections for purposes other than the annual cleansing was 3,511. Appended is a general summary of the housing conditions in tht houses visited. The large proportion of exempt houses in group B is worthy of notice. Summary of Particulars obtained at Registration, 1904. Housing. Inspector Wingfield. Group A. Inspector Lawrence. Group B. No. of Houses visited with a view to Registration 111 106 Houses Registered 102 83 „ Exempt 9 23 „ Empty — — No. of Rooms, registered 570 275 For living only 132 36 For sleeping only 217 101 For living and sleeping 221 138 Other Rooms 399 275 Occupied by landlords 248 115 Exempt by rent . . — 120 Occupied but not inhabited 119 16 Empty 32 18 Grand Totals, Rooms 969 550 * Stiles v. Gali'isky, and Nokes and Nokes v. Mayor, &c., of Islington. †The by.laws were confirmed in February, 1905. housing,. 63 Inhabitants. Group A. Group B. In Registered Rooms, Persons 1,024 542 Persons under 10 years 280 171 Persons 10 years and upwards 738 371 In other Rooms, Persons 241 381 Persons under 10 years 58 90 Persons 10 years and upwards 183 285 Grand Totals, Persons 1,265 923 Overcrowding. In Registered Rooms— Group A. Group B. Families 42 17 Persons, all ages 154 69 „ under 10 years 64 ... 37 „ 10 years and upwards 90 32 Abated by re.adjustment of occupants ... 30 8 Requiring removal 12 9 Streets comprised in Group A. Group B. Alfred Road (35 houses) Amberley Road ( 2 houses) Hall Place ( 2 houses) Waverley Road (67 „ ) Artesian Road (3 „ ) Hethpool Street (33 „ ) Campbell Street (23 „ ) Kennet Road ( 1 house ) Chippenham Road( 1 house ) Rents Place ( 5 houses) Church PI., P. Gn.( 1 „ ) Southam Street ( 1 house ) Cuthbert Street ( 2 houses) Walterton Road ( 1 ") Delamere Crest. ( 1 house ) Westbourne Pk. Villas ( 1 ) Green Street (1 „ ) Woodfield Place ( 5 houses) In Table 35 the occupants are shown in the form used bv the Registrar.General. TABLE 35. Particulars as to Numbers of Tenements and Inhabitants therein, registered during 1904 Rooms to Tenement. Group of Streets. 1 2 3 4 5 6 7 8 9 10 P 10 P 10 P 10 P 10 p 10 P 10 P 10 P 10 P 10 P 10 1 — — T — — T — — T — — T — — T — — T — — T — — T — — T — — 10 P 10 p 10 P 10 p 10 P 10 P 10 P 10 P 10 P 10 P 1 A 30 30 ... 34 05 3 15 31 14 9 19 17 ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... ... ... ... B 36 36 ... 27 52 2 24 48 24 9 19 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 A 7 7 41 80 2 46 118 20 46 125 59 21 59 40 18 58 50 5 17 18 3 ,3 11 ... ... ... 1 5 5 B ... ... ... 16 32 ... 17 39 12 21 54 30 17 41 44 6 20 16 5 15 20 ... ... ... ... ... ... ... ... ... 3 A ... ... ... 4 8 ... 5 13 2 6 10 8 3 11 4 ... ... ... 2 7 7 ... ... ... 2 9 9 ... ... ... B ... ... ... 1 2 ... ... ... ... 2 5 3 1 3 2 1 5 1 ... ... ... ... ... ... ... ... ... ... ... ... 4 A ... ... ... ... ... ... 1 3 ... 1 3 1 1 5 ... 4 19 5 2 12 2 1 5 3 ... ... ... ... ... ... B ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... P 10 T—number of Tenements containing — Persons over 10 years of age, and — Persons under 10 years of age 10 P The foregoing table may be summarised thus : — Tenements containing— Number enumerated. Total inhabitants therein. Average number of persons per room. One room 184 377 2.0 Two rooms 270 1,016 1.8 Three rooms 27 115 1.4 Four rooms 10 58 1.4 64 HOUSING. At the Census of 1901 the average number of persons per room in each class of tenement in the whole Borough was— One room, 1.8 Two rooms, 1.7 Three rooms, 1.3 Four rooms, 1.1 Annual Cleansing.— At the beginning of April of last year 901 houses were on the Register, all of which were inspected with a view to the cleansing requisite. This work involved 3,225 visits, and the service of 1,717 notices of various descriptions, viz., 901 " intimation letters," 49.1 " by.law notices," and 322 " reminders." Overcrowding.— Of the 3,590 tenements on the Register, 1,185 were "overcrowded" according to the theoretical standard of the Registrar.General, that is, their inhabitants averaged more than two persons (irrespective of age) per room. The total number of each class of tenement and the number " overcrowded " were— Tenements of— Total. " Overcrowded." Average number of persons per room. One room Two rooms Three „ Four „ Five „ 1,423 1,756 345 60 6 417 677 88 3 . 2.1 2.0 1.7 1.4 1.1 The percentages found " overcrowded" (the first three classes) during 1903 and were— Tenements of— Percentage found "overcrowded." 1903. 1904. One room 33.3 29.1 Two rooms 39.7 38.5 Three „ 26.2 25.5 The reductions, although small, afford some reason for thinking that the registration is not without good result. The cases of real overcrowding discovered during the year numbered 298, viz., 59 on registration, 233 at the annual cleansing, and 6 on other inspections. The 298 tenements contained 1,244 persons, occupying 339 rooms, an average of 3.6 persons per room. In 206 of the tenements, occupied by 787 persons, the excess of inhabitants amounted to 259. Further particulars are given in the appended summary :— Registration. Annual Cleansing. Other Visits. Tenements overcrowded Rooms Occupants, total Under 10 Ten and upwards Overcrowding abated— By re.arrangement By voluntary removal Under notice Cases held over 59 98 223 101 122 38 9 . 233 412 983 441 542 151 19 4 59 6 8 38 10 28 . . 6 Of the cases reported last year, 12 were so slight that action was not thought necessary; in 189 the overcrowding was obviated by a re.arrangement of the sleeping accommodation, in 28 the families voluntarily sought other homes, and 10 did so after service of notice. Fifty.nine families remained under observation at the close of the year. Want of accommodation could hardly be pleaded as a sufficient excuse for overcrowding, as there were many empty tenements in the streets where registration was in force. At the close of last year a special enquiry was made as to the amount of accommodation HOUSING. 05 available for habitation but standing empty. From the reports of the Inspectors the following summary has been prepared :— No. of empty rooms. Furnished. Unfurnished. Alfred Road 21 95 Amberley Road — 15 Kensal Road — 23 Clarendon Street Area 24 175 Hall Park — 20 North Wharf Road „ — 18 45 316 TABLE 3G. Sanitary Defects Remedied in Registered Houses. 1903. 1904. Drain defective 65 85 „ choked 12 5 „ untrapped — 17 „ unventilated 46 89 Manhole cover defective 1 1 Inadequate means of access to drain — 3 Surface inlet improperly trapped 11 23 Gully in living room 1 „ choked 3 4 . Ventilating pipe improperly constructed... — 2 Soilpipe defective — 3 „ improperly constructed 1 „ unventilated 1 Water.closet choked 14 32 „ defective 21 25 „ flushed from drinking water cistern 4 9 „ insufficiently flushed 22 26 „ flushing apparatus defective — 2 „ without water supply 7 6 „ foul 21 32 „ improperly constructed 20 22 „ accommodation insufficient 17 5 „ without door — 2 „ without external light or ventilation 2 Rain.water pipe not disconnected from drain or soilpipe 12 28 „ defective 15 13 „ choked — 3 Sink waste pipe not disconnected from drain 5 18 „ defective 3 9 „ choked — 1 „ not provided — 1 •Cistern connected to drain — 1 „ defective — 7 „ 'dirty 11 12 „ improperly placed 2 5 „ without cover — 15 „ cover defective 8 Dustbin defective 33 29 „ not provided — 1 Paving defective in area or yard 35 37 „ „ washouse 25 31 Guttering defective — 18 Copper „ — 3 Premises damp 9 4 „ dirty 14 9 Roof defective 33 73 Service pipe defective — 1 Sink defective 1 Staircase unventilated — 1 Window defective — 1 Accumulation of refuse 11 5 66 HOUSING. Sanitary Defects.— A summary of the defects and nuisances discovered at the houses on the Register during the past two years is given in Table 36. The larger numbers recorded last year are in part due to the increase in number of houses on the Register. Sickness.— In previous reports the data as to morbidity and mortality have been limited to cases and deaths occurring in registered houses only. On this occasion the data have been extracted for 30 streets in which practically all the houses are registered—including therefore the houses in such streets which are not on the Register. For brevity's sake these streets will be referred to as " Registered Streets."* At the annual cleansing the inhabitants of the Registered Streets were found to number 15,978 persons, of whom 4,330 were under 10 years of age. The cases of sickness notified numbered 119, viz.:— Diphtheria and membranous croup 20 cases Scarlet fever 61 cases Erysipelas 24 „ Enteric and continued fevers 12 „ Puerperal fever 2 cases. The notification rate was 7.44 per 1,000 persons, compared with one of 4.31 for the Remainder of the Borough. In addition, 267 cases of non.notifiable infectious diseases were brought to the knowledge of the Department, viz.:— Measles, 139 Chickenpox, 65 Whooping Cough, 63 The deaths numbered 365, equal to a rate of 22.84 per 1,000 persons of all ages, compared with one of 12.60 for the Rest of the Borough. The rates from the selected causes of death are given in Table 37. The following are specially worthv of note:—Diarrhceal diseases, 2.56 (3 times the rate for the Rest of the Borough); Phthisis, 2.19 (more than twice the rate for the rest of the Borough) ; Developmental Diseases (all young children) 1*00, nearly five times the rate for the Rest of the Borough; Respiratory diseases (bronchitis and pneumonia) 3.74, nearly double the rate for the Rest of the Borough. * The following are " Registered Streets." Alfred Road. Amberley Road. Braden Street. Draithwaite Place. Brindley Street. Campbell Street. Cirencester Street. Clarendon Street. Cuthbert Street. Dartington Terrace. Desborough Street. Elcom Street. Emily Street. Hall Place. Hall Place West. Hasborough Street. Hethpool Street. Kensal Road. Modena Street. Netley Street. Philip Terrace. Pressland Street. Ranelagh Road. Senior Street. Stalham Street. Southam Street. Waverley Road. Westbourne Terrace North. Woodchester Street. Woodfield Place. housing. 67 The sex.age mortality rates cannot be given in full, but the rates for the two age.groups (persons), 0.10 and 10 upwards, together with the ratios of infantile deaths to deaths at all aces, and under 10 years, are appended:— Registered Streets. Rest of Borough. Death.rate per 1,000 persons 0.10 of each age 10— Infantile mortality (under 1 year) Per 1,000 deaths, all ages Per 100 deaths, 0.10 36.48 17.77 295 68.3 23.90 10.52 206 70.3 TABLE 37. Rates per 1,000 persons. Registered Streets. Rest of Borough. Clarendon Street Area. Rest of Borough. Notifications— Small.pox — 0.03 — 0.02 Diphtheria and Membranous Croup ... 1.25 0.91 0.95 0.95 Erysipelas 1.50 0.71 1.59 0.76 Scarlet Fever 3.81 2.32 5.26 2.36 Enteric and Continued Fevers 0'75 0.27 0.63 0.31 Puerperal Fever... 0.12 0.06 0.15 0.06 All Diseases 7.14 4.31 8.45 4.48 Deaths— Small.pox 0.01 — 0.01 Measles 0.31 0.25 0.15 0.27 Scarlet Fever 0.01 0.05 — 0.05 Whooping Cough 0.31 0.08 0.31 0.09 Diphtheria 0.31 0.01 0.15 0.12 Enteric Fever 0.31 0.03 0.15 0.06 Diarrhœal Diseases 2.56 0.76 3.83 0.83 Erysipelas — 0.01 — 0.04 Puerperal Fever 0.18 0.03 — 0.05 Phthisis 2.19 0.98 4.30 1.17 Other Tubercular Diseases 0.87 0.01 Alcoholism 0.18 0.09 0.15 0.01 Cancer 1.18 1.04 * * Premature Birth 0.59 0.40 0.79 0.40 Developmental Diseases 1.00 0.21 2.07 0.22 Bronchitis Pneumonia 2.56 1.18 1.16 0.76 1 4.94 2.00 Cirrhosis of Liver 0.18 0.14 * * Accidents and Diseases of Childbirth 0.12 0.03 * * Suicides 0.06 0.07 — 0.07 Other Causes 8.63 6.14 12.45 7.45 All Causes 22.84 12.60 29.36 13.02 * Included with " Other Causes." Exemption by rent.— The model by.laws of the Local Government Board include a clause exempting tenements above a given rent (left to be determined by the local authority) from the operation of the provisions of the Public Health (London) Act relating to houses let in lodgings. Practically all by.laws adopted by local authorities include one founded on the model clause. It must be observed that there is nothing in the Act sanctioning any exemption, the provisions being applicable to all houses occupied by members of more than one family. Counsel's opinion on the legality of an exemption clause was taken some three years ago by the London County Council, the opinion being against the practice of the Local Government Board. 68 HOUSING. A more extended experience of the work leads to the view that the present limits act prejudicially both towards the occupiers of the tenements and towards the efficient supervision of this class of property. Landlords desirous of keeping their houses beyond the scope of the by.laws raise the rents sufficiently to exceed the limit, with or without a rebate. In either case a general rise in the rents is almost certain to follow, with a consequent tendency to congestion, if not actual overcrowding. Some lodgers sublet part of their tenements to meet the rise in rent. Houses in the same street, offering practically identical accommodation* may or may not be registered owing to the landlord leaving the rents at their normal level or artificially raising them. The selection which is inevitable creates friction and suspicions of unfair dealing. Moreover, the artificial raising of the rents is usually the action of nonresident landlords. In such houses there is an insufficiency of supervision, and the need of official intervention is so much the greater. The limits prescribed by the by.laws are fixed, and can only be altered by a somewhat cumbersome process. It is therefore difficult to meet the emergency created by a natural rise in rents from any cause, especially if of a temporary character. Such rise is almost invariably associated with an increased congestion, demanding closer supervision on the part of the local authority. Continued work has proved that the by.laws are very beneficial, and it appears to be desirable that their scope should be made as wide as possible. Water Supply.—It has long been thought that a single water tap (usually) in the basement of the house is not a sufficient and adequate supply for the needs of a tenement house occupied possibly by four or five families. A case on this point was tested in December last at Woolwich. The summons was under Sec. 48 of the Public Health (London) Act, 1891, and the Magistrate decided that a single tap in the yard was not a sufficient supply (as required by that Section) for a house containing 5 families living on 3 floors. The decision is not binding on any other Police.court, and it will be interesting to note what line will be taken by other Magistrates. Verminous Rooms.—Attention has been called in previous reports to the need of special powers to deal with rooms and articles infested with vermin. The London Countv Council (General Powers) Act, 1904, enables this matter to be dealt with, Sec. 20 giving power to require a verminous house or room to be treated in such a way as to destroy the vermin, and Sec. 19 power to cleanse and purify articles in a filthy, dangerous, or unwholesome condition. The procedure as to the latter Section appears, however, to be somewhat defective. Clarendon Street Area.—This Area has been under special supervision since 1901. At the time of the Special Inquiry held in that year the population of the Area was found to be 7,281 ; at the last annual cleansing 6,265 persons were enumerated. In the appended statement (Table 38) comparisons are made between the rates for last vear for the Area and the Rest of the Borough. Rates for the selected causes of death during the past year are given in Table 37. The returns for the Area are not so satisfactory as those for 1902 and 1903. It is singular that the change from decreased to increased rates should coincide with the difficulty in securing the usual amount of " cleansing." housing. 69 TABLE 38. Rates of Morbidity and Mortality per 1,000 persons of all ages, except where otherwise indicated. Clarendon Street Area. Rest of Borough. 1890.00. 1901. 1902. 1903. 1904. 1890.00. 1901. 1902. 1903. 1904. Notifications. Small.pox — 0.13 5.12 0.37 ... 0.00 0.15 0.51 0.02 0.02 Diphtheria. 1.85 2.19 2.02 0.96 0.95 2.17 2.38 1.39 0.99 0.95 Erysipelas 2.07 2.33 1.75 1.37 1.59 1.07 0.90 0.92 0.77 0.76 Scarlet Fever 5.21 5.76 2.69 3.43 5.26 3.99 3.36 2.42 2.80 2.36 Enteric Fever 0.95 1.78 0.40 0.96 0.63 0.54 0.57 0.57 0.28 0.31 Puerperal Fever 0.05 — 0.12 — 0.15 0.07 0.07 0.09 0.02 0.06 At all ages 28.75 22.66 23.23 26.08 29.36 16.17 13.81 14.14 12.46 13.02 Deaths. 0—10 years Rates per 1,ooo persons at these ages. 46.87 32.99 32.45 36.84 47.90 ? 27.79 26.87 23.64 24.33 10— 20.41 17.78 18.89 21.01 21.55 ? 11.17 11.72 10.34 10.83 Infants under 1 yr.* 308 290 250 263 353 288 215 197 195 209 In Institutions † 30.0 42.4 40.7 43.1 38.58 22.6 20.5 27.2 28.3 27.8 Infants under 1 yr.‡ 59.0 62.3 55.8 58.1 73.0 ? 67.1 65.0 64.6 69.3 * Per 1,000 deaths at all ages. I Per 100 deaths at all ages. \ Per 100 deaths, 0—10 years. Common Lodging Houses.— These houses are now registered annually under the London County Council (General Powers) Act, 1902. That Council exercises all the necessary supervision—the only matters coming under the jurisdiction of the Borough being the reconstruction of drains, &c. There are 8 houses in the Borough, 6 accommodating 195 men; 1,31 women; and 1, 19 married couples. No case of sickness was reported from any of the houses, but seven deaths of inmates were recorded, the smallest number since the returns were first extracted in 1901. The deceased were all males, whose ages ranged from 3 to 64 years. The causes of death during the four years are sufficiently indicated below :— 1901. 1902. 1903. 1904. Tubercular diseases Cancer, Malignant diseases Respiratory diseases Other causes 3 4 4 3 1 1 9 6 3 3 1 6 1 Housing of the Working Classes Acts.—The negotiations for a site referred to in the last Report ended unsuccessfully. A smaller scheme is now under consideration. Inhabited House Duty : Revenue Act, 1903.—A larger number of applications for certificates were received last vear than in any year since 1894. One application was refused on account of the very small dimensions of the living rooms and the absence of suitable and separate scullery accommodation. Certificates were granted for two houses let in separate tenements, 3 families in each, for 19 blocks of flats containing 10 flats each, and for 8 separate flats—making 198 flats in all. 70 FOOD SUPERVISION. Food Supervision. This subject falls under the following heads:— (i.) Meat Supply—Slaughterhouses, Butchers' Shops ; (ii.) Milk Supply—Cowsheds, Dairies, and Milkshops ; (iii.) Food Purveying—Restaurants, Eating-houses, Fried Fish shops ; (iv.) Ice-creams—Manufacture and Sale ; (v.) Unsound Food; and (vi.) Food Adulteration. Meat Supply.—There are 8 slaughterhouses and 112 butchers' shops on the Register. Slaughterhouses.—These are situated as under:— Bishop's Mews, No. 1. Southwick Mews, No. 15. Edgware Road, No. 275. „ Hero Place. Portsdown Mews (in rear of No. 249 Maida Vale) Harrow Road, No. 125. Upper Brooks Mews, No. 6. Chippenham Mews, No. 18. The ground lease of buildings in Hero Place will expire very shortly, when it is proposed to re-construct the slaughterhouse on more approved principles. No objections were raised to any applications for renewals made at the last annual licensing, all the premises having been maintained in good repair and well managed. The Inspector visited the slaughterhouses 659 times during the year, and examined the carcasses of 6,457 sheep, 204 bullocks, and 29 calves. He estimates that 1,740 lbs. of meat and offal were destroyed on account of pathological conditions discovered at the time of slaughter, which are summarised below:— Sheep. Livers, 153—parasitic, 135, cirrhotic, 5, and containing abscesses, 13. Lungs, 5— „ 2, pneumonia, 2, pleurisy, 1. Plucks, 3— „ 2, pleuro-pneumonia, 1. Caul fat, 1— „ Bullocks. Livers, 31— ,, 20, cavernous adenoma, 1, containing abscesses, 8, fatty degeneration, 2. Lungs, 3— „ 2, pleurisy, 1. One entire carcase (heifer) was destroyed on account of extensive tuberculosis. This was the worst specimen of the disease seen in the Borough, although the beast was well nourished. The sinkin^-in of the flanks should, however, have aroused suspicions. Butchers' Shops.—At 84 of these shops the trade is in beef and mutton, &c., and the remainder (28) exclusively pork. The inspections numbered 646, at least half being on the request of the proprietors of the shops to inspect pigs' carcasses on delivery from the Central Meat Markets. The following surrenders were made— 21½ pigs carcasses, 7 heads, and 1 "hand-and-spring," all tubercular, and 1 pig's head (mange) and 30 lbs. (approximate) of organs (parasitic). Milk Supply: Cowhouse.—The only cowhouse in the Borough is that at Star Street, No. 39 licensed for 10 cows, 4 kept. The cowhouse is frequently inspected by the officers of the County Council, and a quarterly visit by the Inspector of the Department is deemed to be sufficient. food supervision. 71 During the autumn of last year an incomplete return of the cowhouses and cows standing within the Metropolis in 1850-57 has been found. The paper is one of the earliest documents issued by the Metropolitan Association of Medical Officers of Health, founded in May, 1856. The return embodies replies received from 35 out of 49 sanitary districts, then constituting the Metropolis. In those 35 districts there were— 846 cowhouses, comprising 1,154 cowsheds, and accommodating 11,818 cows. The numbers of cows at the different establishments are summarised as— 277 having 1— 5 cows. 99 having 21— 50 cows. 256 „ 6—10 „ 18 „ 51—100 „ 173 „ 11—20 „ 9 „ Over 100. 14—no numbers stated. In 10 " cowhouses and sheds " the cubic space per cow was under 200 cubic feet. 56 „ „ „ „ „ 200—300 ,, 142 „ „ „ „ „ 300—400 ,, 164 „ „ ,, „ „ 400—500 ,, 150 „ „ „ „ „ 500—600 ranging thence up to 169 „ „ „ over 1,000 „ There were in Paddington at that date— 25 cowhouses, comprising 36 cowsheds, and accommodating 368 cows. The numbers of cows in the various establishments were— From 1— 5 cows 5 establishments. „ 6— 10 ,, 8 ,, „ 11— 20 „ 6 „ 21— 50 „ 5 „ 51—100 „ 1 There are no further details of the local establishments. The reduction in the number of cows which has taken place during the half-century—viz., from 308 to 4—is worthy of record. Whether the change has been altogether advantageous is a question on which different opinions may well be held, and cannot be discussed here. Dairies and Milkshops—At the close of 1904, 174 names of milk-vendors were on the Register. During the year 3 new entries were made, 11 names removed, and 23 changed— leaving 166 entries effective at the close of the year. There appears to be a tendency to a reduction in the number of milk-vendors, the numbers on the Register at the close of each year being lower. The character of the premises on which milk is sold is sufficiently indicated below :— Dairies: milk, eggs and butter only 86 „ wholesale depots 4 Grocers' shops 6 General shops, selling oil 31 „ not „ 23 Sweet-stuff and confectionery 5 Provisions and Bakers 2 (each) Fish and grocery 2 Off-licensed premises, Butcher's shop 1 (each) Coal, wood and oil (combined) 3 The above premises were visited on 231 occasions in all. One case each of erysipelas and scarlet fever and 3 cases of diphtheria were reported from premises on which milk was sold; 2 milk-carriers had scarlet fever; 2 cases of the same disease occurred in families of milk-carriers; and 1 case of small-pox in a house where a milk-carrier resided. All necessary precautions were taken. 72 FOOD SUPERVISION. Strict regulations are prescribed for dealing with infectious illness among those concerned with the milk trade, but no restriction is placed by law on the delivery of milk to houses where such illnesses are being treated. It is common practice to deliver the morning milk in cans which are collected later during the day. Some of the larger firms require their customers to report any illness of an infectious character, and special precautions are then taken. As a rule, however, the cans from infected houses are dealt with in the ordinary routine, and such practice appears to afford a chance of spread of infection. It is not, however, a simple matter to suggest a remedy. Food Purveying.—The premises on the Register of Food Purveyors numbered 177 at the close of last year, being 5 fewer than in 1003. Twenty-five of the premises were fried fish shops. The inspections of restaurants, &c., numbered 367, and of fried fish shops GO. The defects found are set out in Table 39. TABLE 39. Numbers of places where Food is sold:— Butchers 84 Milkshops and Dairies 166 Pork 28 Refreshment Houses 152 Fishmongers 29 Fried Fish and Sausages 25 Game and Poultry 12 Ice Cream Makers & Vendors 135 Fruit and Greengrocery 91 Sausage Factories 9 Food Purveyors. Inspections during the year:— Slaughterhouses 659 Cowhouses 4 Butchers' Shops 646 Milkshops, &c. 231 Greengrocers' Shops 65 Restaurants, &c. 367 Costers' Barrows 48 Ice Cream Shops and Barrows 91 Fish Curing Premises 11 Fried Fish Shops 60 Fishmongers' Shops 40 Defects found and remedied:— Milkshops and Dairies.* Restaurants and Eating Houses. Premises occupied by Ice Cream Makers. Drains defective 1 9 1 „ unventilated 3 1 Surface inlets improperly trapped 1 1 Soilpipes defective 1 7 1 „ unventilated ... 5 ... Water-closets defective ... 9 1 ,, dirty ... 2 ... Flushing apparatus defective ... 3 ... Rain-water pipes connected to drain or soilpipe ... 4 1 Waste pipes, do. do. ... 2 ... Rain-water pipes defective ... 1 1 Dirty conditions 4 ... Cisterns dirty 1 3 1 ,, uncovered ... 4 ... Paving defective 1 3 ... No dustbin ... 1 ... Dustbins defective ... 5 1 * These were systematically dealt with in 1902, leaving no structural defects unremedied. FOOD SUPERVISION. 73 Ice-cream Makers and Vendors.—A special Register is kept under the provisions of the London Count}' Council (General Powers) Act, 1902 (Part VIII.). Twenty-one entries were made during the past year, the total number on the Register at the end of the year being 135 Of these 122 are shopkeepers and 13 Italian barrow-men. The shops include— Sweet shops 58 Newspapers and Tobacco 7 Bakers 20 Confectioners and General 4 (each) Milk 14 Cooks' 2 Restaurants 13 In addition to the 13 local barrow-men, 26 from other districts have regular stands in the Borough, viz.:— From Marylebone 11 From Islington and Clerkenwell 2 each. „ Kensington 9 „ Chelsea and W'illesden 1 „ No case of illness was reported from any premises where ice-cream is made. Unsound Food.—The total weight of foodstuffs seized or surrendered during the year was •over 5 tons, viz.:— In Slaughter-houses 1,740 lbs. ,, Butchers' shops 2,348 ,, „ Fishmongers 218 „ „ Fruit and greengrocery 7,026 „ 11,332 „ = 5 tons, 1 cwt., 20 lbs. Fish :— 1 Trunk Cods' roes. 1 Trunk Plaice and Haddocks. 1 Barrel Skate. V-getables and Fruit:— Apples - - - 3,044 lbs. Lettuces- - 200 lbs. Tomatoes - - 2,854 ,, Plums - - 182 „ Potatoes - - 336 „ Cherries- - 84 ,, Sprouts- - - 270 ,, Oranges- - 56 ,, All the above were surrendered, being found putrid on examination at the shops. The apples and tomatoes formed parts of large consignments from abroad. The Inspector found it necessary to caution 14 greengrocers and 17 costermongers for exposing unsound fruit. There was one prosecution.—See Legal Proceedings. Meat:- 22½ Pigs 1,647 lbs. ... tubercular. 8 Pigs' heads 60 ,, ... ,, 1 Hand-and-spring 4 ,, ... ,, 1 Pig's head 10 ,, ... mange. 2 Legs of Pork 2 Shins of beef 34 ,, ... broken bones. Kidneys and pluck 15 ,, ... parasitic. Livers (bullocks and sheep's) 50 ,, ... "flukes." .Bullock's head 20 ,, ... actinomyiosis. Rabbits (18); sheep (1); fowls (90); hare (1); pigs' heads (16) 508 ,, ... putrid. 74 FOOD SUPERVISION. In May of last year summonses were heard at the Guildhall Court touching pigs which were purchased at the Central Meat Market and condemned on inspection by the Council's staff after delivery at the local shop. A summary of the cases will be found under Legal Proceedings. The "pork season" lasts from August to April, and it was anticipated that the number of pigs showing evidences of tuberculosis would be much the same during last winter's season as in the previous vear. A practice has, however, been adopted which renders it impossible, except on rare occasions, to say whether the "dressed" carcasses are or are not tubercular. The lymphatic glands, tonsils, &c., are usually so minced up—when not cut out—that it is impossible to form any opinion as to their freedom from disease. The practice is in effect identical with "stripping" of the pleura in cattle. In the latter case the direction of the Local Government Board is that the whole carcass is to be condemned as unfit for food, and logicallv the same course should be adopted in dealing with pigs' carcasses from which the glands have been removed. Carcasses for deliverv in Paddington are almost always held back for special inspection, but where the "stripping" takes place is not definitely known. It is not done in the Borough. The facts of the case have been laid before the Local Government Board, who have ordered a special inquiry to be held as to meat inspection in the Metropolis. Communications on the subject have also been addressed to the Consul-General of the Netherlands, whence a large proportion of the pigs are imported. In that country there is a complete system of inspection and labelling of carcasses. It is an unfortunate circumstance that butchers are in general so ignorant of the signs of a disease such as tuberculosis. In the only case taken at Marylebone Police Court during the past year, the defendant's manager stated in evidence that he had had many years' experience and saw nothing wrong with the carcass. The head had been cut off from the trunk before the Inspector saw the meat, and the knife had gone through the tonsil. This gland was much enlarged, contained masses of tubercle easily visible to the naked eye, and there was an abscess full of pus in the centre of the cut. The conditions were so patent as to attract the attention of the Inspector in passing the shop window. The lesions discovered on further examination were as here set out:— Both tonsils much enlarged, studded with tubercular deposit, some caseous, some purulent; pleural surfaces, tubercular nodules on ribs, and remains of tubercular pleurisy; all lymphatic glands enlarged, many of them caseous, others gritty. The carcass had been partially cut up for sale. Food Adulteration.—During the year 512 samples were submitted to the Public Analyst, of which 46 (or 8.9 per cent.) were found to be adulterated. The proportion adulterated was a little higher last year than in 1903 and 1902, but lower than in 1901. The percentages for those years were—1903, 6.9 ; 1902, 8.8; 1901, 10.9. The increase in the percentage last year was largely owing to the examination of samples of soda (33.3 per cent. adulterated) and of brandy (25 per cent, adulterated). 75 food supervision. TABLE 40. Summary of Articles submitted to the Public Analyst during the year 1904. Total. Found Adulterated. Percentage Adulterated. Milk 282* 27 9.5 Butter 71 6 8.4 Coffee 27 — — Soda 27 9 33.3 Mustard 14 — — Pepper 12 — — Whisky 10 — — Lard 9 — — Bread 8 — — Cocoa 7 — — Cheese 6 — — Jam 6 — — Brandy 4 1 25.0 Salt 4 - — Skim Milk 4 2 50.0 Tapioca 4 - - Stout 3 — Ale 2 — Bitter Ale 2 - — Gin 2 1 50.0 Honey 2 — — Sago 2 - - Chocolate 1 — — Meat Extract 1 - Porter 1 Sweets 1 - - 512 46 8.9 * Including 96 taken at Paddington (G.W.R.) Terminus in course of delivery ; 17 adulterated. Of the milk samples (282), 96 were taken at the Paddington (G.W.R.) Terminus. Of the 90 station samples 17 were reported as adulterated, or 18.7 percent., as compared with 8.1 per cent, in 1903. Of the remaining 186 samples purchased in the street and shops, 10 were adulterated, equal to 5.3 per cent. (5.4 per cent, in 1903). The samples at the railway are taken only at the request of the consignees who have found the consignments adulterated before communicating with the Department. Hence a larger proportion of adulterated samples is always obtained. It is, however, difficult to account for the great increase (over 100 per cent.) in the proportion found adulterated last year. Of the other samples enumerated in Table 40, those of soda and brandy are deserving of comment. The former is what is generally known as washing soda, and should consist of bicarbonate of soda and water of crystallisation. The commercial article is never quite pure, generally containing a little (about 5 per cent.) sulphate of soda formed in the process of manufacture. Within recent years adulteration with the sulphate has become very general. From information obtained it appears that the increased proportion of sulphate is not due to the omission of any process of purification, but to the actual addition of crystals of the sulphate to the carbonate. There is a great difference in the cost of the two articles, sulphate of soda being worth about 24s. a ton, and "washing soda" over £3 a ton. The commercially pure soda can be purchased at the price the adulterated article is 76 FOOD SUPERVISION. usually retailed, so that the sale of the latter affords a substantial profit over and above the legitimate. Although used mainly for cleansing purposes,* washing soda is also used in certain culinar processes. It was thought that such use would bring the adulteration within the scope of the Sale of Food and Drugs Acts, reliance being placed on the extended definition of "food" contained in Section 26 of the Act of 1899. The Magistrate, however, held that the article did not come within that definition, and dismissed the summonses. In December last prosecutions were initiated by the Board of Trade against vendors of the adulterated soda, under the Merchandise Marks Act, 1887, and a conviction obtained. An appeal against the conviction is now pending. As to the sample of brandy, adulterated with 25% of foreign alcohol, the circumstances are as follow:— In November, 1902, The Lancet published a Report of an Analytical Commission on Brandy, in which it was shown that it was possible to determine whether a "brandy" was derived from grape spirit, the proper origin, or from "silent" spirit (i.e. spirit made from grain, potatoes, etc., bv distillation in a patent still), or was a combination of the two, by a determination of the "secondary products"—ethers and higher alcohols—the normal proportions of which were ascertained by analyses of brandies, which were known to be made from grape spirit and nothing else. Acting on the Report, the Countv Council of Lanark in the following December caused samples to be purchased, and a test case (brandy containing 65 per cent, foreign spirit) to be heard. A conviction was obtained which was appealed against:— Wilson and McPhee v. Wilson (S.L.R. lxi. p. 195). The conviction was upheld. Although the decision is not binding on English Courts, it has undoubtedly exercised considerable influence therein. The sample purchased in the Borough was sold without any verbal declaration of mixture of spirits, and was wrapped in a plain paper. A small printed label was, however, found on the bottle stating that the purity of the brandy was not guaranteed (or words to that effect), and the Solicitor held that no proceedings could be successfully taken. Silent spirit is not of a character which commends itself to the medical profession as a harmless drink. Indeed, it usually contains a considerable portion of furfural, which is distinctly poisonous in its action. The intoxication resulting from excessive consumption of spirits adulterated with "silent" spirit is marked with greater nervous disturbance, and is more injurious to the system than that due to alcohol derived from (what may be described as) natural sources. For medicinal purposes there is no comparison between the two spirits. The stimulating effects so valuable in shock and exhaustion depend on the ethers and aldehydes. It is therefore very desirable that brandies should be plainly distinguished—the name " brandy " being reserved for the spirit derived from grapes, and some other trade term assigned to blends of "silent" and other spirits, flavoured to resemble brandy. Nearly all that has been written relating to brandy applies mutatis mutandis to whisky, and to some extent to rum. The preceding paragraphs illustrate the difficulty in securing a pure food supplv, which is experienced, owing to the loop-hole afforded by the "declaration" provisions of the ActsIn the case mentioned, it was not until the wrapper was removed that any intimation of admixture was found. The provisions require to be amended to compel a verbal declaration to be given in everv case. * The sulphate is quite useless for any such purposes, possessing only purgative properties. legal proceedings. 77 Of the difficulties in the admistration of the Acts arising from the warranty provisions, it is unnecessary to say much, as the question has been dealt with elsewhere on many occasions. It is a common occurrencc to be met with a notice of warranty with reference to an adulterated sample when the vendor has already been successfully prosecuted. It would seem as if certain vendors rely on the protection of the warranty as a cover to adulteration, and not as a security against it. It is exceedingly difficult to prove practices which are more than suspected, as all the witnesses are interested in upholding the defence of the vendor of the sample. Occasionally the case is "given away" by a discharged employee, and not uncommonly information is forthcoming, after the case is over, which would have entirely upset the warranty defence. As regards the milk trade (and it is in that trade that the warranty defence is most used) the warranty provisions practically stultify the rest of the Acts. The honest traders—happily in the majority—suffer from the mischievous practices of the other class, who are able to undersell them almost with impunity, while the children and sick who get their supply from this class of dealer, are robbed of their nourishment, and pay a really exorbitant price for the impoverished milk sold. The recommendations of the Departmental Committee on Preservatives are still in the pigeon-hole. An interesting Appeal case (Hull v. Horsncll) was heard in November of last year, bearing on this question. The appeal was against a conviction, under Section 3, of the Act of 1875, for selling preserved peas containing 1.87 grs. of sulphate of copper per pound. Shortly put, the result of the appeal was to uphold the decision of the Magistrates, that peas containing that amount of copper sulphate were injurious to health. 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 3,234 Complaints received and entered - 800 „ despatched - - - 1,632 Plans received and entered - 408 Entries in postage book - - 6,908 New entries in Journals - - 1,263 Cases of infectious disease, notified and entered in Registe 974 Orders of disinfection (duplicate) - 1,429 Ditto forwarded to Metropolitan 974 Notices for abatement of nuisances, Asylums Board and Guardians &c., issued Notices of Infectious sickness to schools, library, &c. 28,04 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 9s. 0d., as compared with £1(53 12s. fid. in 1903, £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 four years were:— Health Cases. Adulteration Cases. £ s. d. £ s. d. 1904 *62 6 6 101 2 6 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 £2 15s. 2d. and £1 5s. Sd. respectively. * £7 18s. could not be collected owing to death of defendant, and in another case the fine (£2) was remitted, he work having been carried out within the time specified by the Magistrate. 78 LEGAL PROCEEDINGS. Two important cases were heard in the Higher Courts during the past year, which should be noticed here. Heaver's Exors. v. Mayor, &c.., of Fulham.—This was a combined drainage case. The plaintiffs alleged inter alia that, as no Order had been made by the late Vestry of Fulham for drainage of certain houses by a combined system, the existing defective system was a sewer vested in and repairable by the Council. It is not necessary to give the full details of the case, which was reported in The Times of March 21st, 1904, and it will suffice to say that the case was given against the plaintiffs on the main point at issue. The basis of the decision was that misfeasance in constructing a combined drain without the consent of the authorities, is an estoppel to a subsequent claim that the system is a sewer, if made by the person guilty of the act of misfeasance. This is almost the first, if not the first, relief given to local authorities in respect of illicit construction of combined drainage. So long as the property drained by such system remains vested in the person of the constructor of the system, or has only passed by devolution to his heirs and executors, no claim that such system is a sewer vested in the local authority, can be successfully maintained. A transference by sale would, however, apparently make such system a sewer. Had such a decision been given some eleven years ago, the case of Florence v. Paddington Vestry would have been decided differently. Frost v. Aylesbury Dairy Co. (Ltd..).—This case, upheld on appeal, raises important questions of liability for supply of pure food. The issue was raised under Sec. 14 (1) of the Sale of Goods Act, 1893, which enacts that "there is no implied warranty or condition as to the quality or fitness for any particular purpose of goods supplied under a contract of sale, except as follows:— (1) Where the buyer expressly or by implication makes known to the seller the particular purpose for which the goods are required, so as to show that the buyer relies on the seller's skill or judgment, and the goods are of a description which it is in the course of the seller's business to supply (whether he be the manufacturer or not) there is an implied condition that the goods shall be reasonably fit for such purpose . . . ." The interest of the case lies in the application of the judgment on appeal rather than in the facts brought out in the trial. It should be remarked that in an earlier case, Randall v. Newson (2 Q.B.D. 102, 40 LJ. Q.B. 259) it was decided that "on the sale of an article for a specific purpose there was a warranty by the vendor that it was reasonably fit for the purpose and that there was no exception as to latent undiscoverable defects." This decision is of importance in connection with food-stuffs which are not reasonably fit for the purposes for which they are purchased by reason of the presence of deleterious micro-organisms. As regards chemical impurities, the ordinary methods of analysis are sufficient for their discovery and proceedings will lie under Sec. 3 of the Sale of Food and Drugs Act, 1875. There are two commodities which come within the scope of the decision of Frost v. Aylesbury Dairy Co.—water and meat. As regards the former, however, special liabilities have long existed under the Waterworks Clauses Acts and (in the case of municipal supplies in the provinces) under the Public Health Act, 1875. In the case of meat the liability of the vendor has apparently not yet been tested, but taking the two decisions quoted above it would be reasonable to assume that the vendor of unsound meat—say tuberculous—would be liable to action for damages for breach of warranty. It is difficult to suggest a food supply in which greater reliance has to be placed on the "skill or judgment" of the vendor than is the case in the purchase of meat. It might however be necessary in every case to state the intended use of meat purchased, but it "is doubtful whether a butcher doing a retail family trade could successfully plead that he had no knowledge of "the particular purpose for which the goods were required." As already intimated, it would be no defence to say that he could not detect the presence of the specific micro-organism. Another commodity to which the decisions will apply with special effect is shell-fish—oysters, mussels, &c. SUMMARY OF LEGAL PROCEEDINGS DURING 1904. Under Public Health (London) Act, 1891. Fine. Costs. Summonses under Section 4. £ s. d. £ s. d. 9, Beethoven Street Defective roof ... 2 2 0 11, .. ... 2 2 0 13, „ ,, drainage Order made. No costs. 15, ,, ,,eutterine Summons withdrawn 22, Burlington Mews West* ,, stable-paving ... 0 12 6 21, Edgware Road Premises without water supply 1 0 0 1 3 0 35, Harrow Road Defective drainage, &c. Order made. 1 3 0 ,, Non-compliance with Magistrate's Order 5 0 0 1 15 0 94, Kensal Road Order made. NO costs. 17, Oxford Terrace ,, 5 5 0 32, Randolph Gardens Defective soil-pipe, &c. ,, No costs. 2, Rundell Road† Defective drainage, &c. ... ,, 11, Stalham Street Non-compliance with Magistrate's Order 3 0 0 1 3 0 81, Sutherland Avenue Defective drainage, &c. Order made. No costs. 119, ,, * Premises without water supply 1 0 0 1 2 0 Summonses under Section 47. Bone, C., Central Meat Market Selling unsound pork Summons 10 guineas withdrawn, costs against Clayton, G., „ „ Do. Council. do. Covell, J. C., „ „ „ Dismissed without costs. Holmes, 52, Porchester Road Having unsound pork in possession 10 0 0 5 5 0 Lardner, Central Meat Market Selling „ Dismissed. 20 guineas costs against Council Marsh, R., 578, Harrow Road Exposing unsound tomatoes for sale 5 0 0 0 2 0 „ „ „ „ „ grapes „ 5 0 0 0 2 0 Wood, Central Meat Market Selling unsound pork Summons withdrawn. Summons under Section 68. 10 guineas costs against Council. Drury, Mrs., 7, Beethoven Street Exposing infected person Dismissed without costs. Summons under By-laws relating to Houses let in Lodgings. 11, Stalham Street Unventilated drain 9 0 0 1 3 0 Summonses under other By-laws. 9, Beethoven Street Yard unpaved ... 1 1 0 15, „ „ Summons withdrawn. 7, Emily Street Works executed without notice to Sanitary Authority 3 0 0 1 3 0 44, Westbourne Grove ... ... Do. do. 2 0 0 0 2 0 Metropolis Management Act, 1855. Summonses under Section 85. 74 to 86 (even) Porchester Terrace Defective combined drain and 41 to 45 (cons.) Porchester Square 18Summonses. Dismissed. Council ordered to pay 36. to 40 (cons.) Porchester Square „ „ „ and 1, Porchester Square Mews £6 6s. 0d. costs. * Nuisance abated or necessary works carried out before the hearing of summons † Council arranged to carry out works. 79 summary of legal proceedings. 80 summary of legal proceedings. SUMMARY OF LEGAL PROCEEDINGS DURING 1904. Under Sale of Food and Drugs Acts, 1875-1899. Fine. Costs. £ s. d. £ s. d. Milk 20% fat abstracted 2 0 0 ... 0 12 0 „ 20% „ 5 0 0 ... 3 3 0 „ 20% „ Withdrawn. Copy of Analyst's Certificate not served. „ 19% „ 1 0 0 ... 0 14 0 „ 18% „ 0 5 0 ... 0 12 6 „ 17% „ ... ... 0 10 6 „ 17% „ 10 0 0 ... 5 5 0 „ (1) 17% „ 5 0 0 ... 1 11 0 „ (1) 17% „ 1 0 0 ... 0 12 6 „ 15% „ 1 0 0 ... 1 3 0 „ (4) 14% „ 3 0 0 ... 1 3 0 (2) 13% „ 5 0 0 ... 1 3 0 „ (3) 12% „ Dismissed: warranty proved. „ (2) 12% „ 3 0 0 ... 1 3 0 „ (4) 11% „ 3 0 0 ... 1 5 0 „ (2) 10% „ 5 0 0 ... 1 3 0 „ (5) 10% „ 1 0 0 ... 0 12 6 „ (5) 8% „ 3 0 0 ... 1 9 6 „ 24% „ „ 6% added water — ... 0 12 6 „ (6) 8% „ „ (6) 6% „ Dismissed : warranty proved. „ (7) 8% „ do. 6% 2 0 0 1 3 0 6% „ 2 0 0 1 1 0 Butter (8) 84% foreign fat 5 0 0 0 12 0 „ 84% „ 2 0 0 1 3 0 „ 82% „ 2 0 0 0 12 0 „ (9) 82% „ 5 5 0 3 3 0 „ (10) 78% „ 1 0 0 0 12 6 „(11) 28% „ 1 10 0 0 12 6 Soda 70% Glauber's Salts „ 68% „ „ 51% „ Summonses withdrawn. „ 50% „ „ 43% „ „ 42%' „ Dismissed: .£5 5s. costs against Council. Gin 10% below legal standard Dismissed.. Dilution notice displayed. 23s. costs against Council. NOTES. (1) The same defendant (two summonses). (2) Do. (three summonses). (3) Defendant fined £3 with 12/6 costs, on 17th January, 1897, for selling milk containing of added water. „ £2 12/6 „ 3rd June, 1897, for selling milk containing 7% of added water. „ £1 21/- „ 3rd June, 1897, for selling milk containing 6% of added water. „ £10 25/- „ 5th December, 1902, for selling milk lO% deficient in fat A summons heard on the 25th April, 1902, was dismissed, the defendant proving a warranty. summary of legal proceedings. 81 (4) The same defendant (two summonses). (5) Do. do. (6) Do. do. On the 1st December, 1898, this defendant was fined £2 with 12/6 costs, for selling butter containing 94% of foreign fat. {7) Defendant fined £2 with 12/6 costs, on 29th May, 1894, for selling milk containing 177% of added water. „ £3 12/6 „ 16th February, 1899, for selling milk containing 17% of added water. „ £3 12/6 „ 8th March, 1901, for selling milk containing 12% of added water. „ £10 12/6 „ 23rd January, 1903, for selling milk containing 12% of added water. „ £10 12/6 „ 7th August, 1903, for selling milk containing 7% of added water. On 1st January, 1904, a summons with respect to a sample containing added water was dismissed, the defendant proving a warranty. (8) Defendant fined £5 with 12/6 costs, on 16th February, 1899, for selling butter containing 75% foreign fat. (9) „ £2 12/6 „ 23rd March, 1900, for selling milk 23% deficient in fat. „ £3 25/- „ 29th November, 1901, for selling butter containing 80% foreign fat. {10) „ £2 12/6 „ 13th November, 1901, for selling butter containing 80% foreign fat. (11) ,, 10/- 12/6 „ 1st November, 1901, for selling butter containing 55% foreign fat. 1904. 1903. 1902. 1901. 1900. 1899. 1898. Average per Fine £2 15 2 £3 16 £3 3 8 £2 16 0 £3 4 0 £3 4 £1 13 9 conviction Costs 1 5 8 0 15 7 0 16 0 0 15 0 1 2 3 0 14 3 0 13 11 82 vital statistics. APPENDIX. TABLE I. Vital Statistics of Whole District during 1904 and Ten 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 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 3,616 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 1903 145,927 3,302 22.62 425 128 2,103 14.41 743 366 181 1,918 13.14 Averages for years 1894-1903. 142,182 3,436 24.11 524 152 2,307 16.18 640 329 218 2,196 15.41 1904 146,815 3,295 22.44 490 148 2,228 15.17 780 387 173 2,014 13.71 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.- -By the term " Non-residents " is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term Residents is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. Total population at all ages, 143,976 ) Area of District in acres (exclusive of area covered by water), 1,336. Number of inhabited houses, 13,221 At Census of 1901. Average number of persons per house, 8.9 ) 83 vital statistics. » TABLE II. Vital Statistics of Separate Localities during 1904 and Ten 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. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered.* Deaths at all Ages. Deaths under 1 year. A B C D a b. c. d. a. b. c. d. a. b. c. d. 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 3,563 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 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 Averages of Years 1894 to 1903. 142,182 3,436 2,196 506 91,080 2,520 1,559 382 33,653 410 360 47 17,449 506 277 77 1904 146,815 3,295 2,014 449 96,441 2,524 1,420 335 33,561 378 345 43 16,813 393 249 71 * The births recorded in North-West Paddington prior to 1901, have been calculated from the births registered in the (old) Kensal Town Registration Sub-District of Chelsea on the basis of the proportion of the population transferred to Paddington. The figures are consequently somewhat theoretical, but the best available. 84 deaths in local institutions. TABLE III. Deaths in Local Institutions. Year. Paddington Workhouse and Infirmary. St. Mary s Hospital. Children's Hospital. Lock Hospital. 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 1903 317 342 82 2 Averages 1894-1903 231 328 74 Eight years. 2 1904 327 360 92 1 * 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. 1904. 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 ... ... ... ... 2 ... ... ... ... Measles 3 1 ... ... 3 ... ... ... ... Scarlet Fever ... ... ... ... 8 ... ... ... ... Influenza ... 3 ... ... ... ... ... ... ... Whooping-cough ... ... ... ... 2 1 ... ... ... Diphtheria ... 2 1 ... 9 ... ... ... ... Enteric Fever 3 5 ... ... 1 ... ... ... ... Diarrhœa ... 5 1 ... ... 1 1 ... ... Epidemic Enteritis 16 3 4 ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... ... ... Puerperal Fever 3 2 ... ... ... ... ... ... ... Other Septic Diseases ... 8 2 ... ... 3 ... ... ... Tuberculosis of Lungs 55 13 l 2 1 10 8 ... ... Other forms of Tuberculosis 13 16 20 ... ... 2 2 ... ... Cancer 29 46 2 5 ... 16 4 1 2 Premature Birth 6 ... ... 1 ... 2 ... ... ... Developmental Diseases 1 7 23 ... ... 6 ... 1 ... Old Age 37 ... ... ... ... ... ... ... 2 Bronchitis 25 4 ... ... ... 2 1 ... 1 Pneumonia 8 16 9 ... ... ... 2 1 1 Cirrhosis of Liver 4 5 ... 2 ... ... ... ... ... Accidents of Childbirth ... 3 ... ... ... ... ... ... ... Accidents and Violence 7 53 8 ... ... 3 ... 2 4 Suicides 1 8 ... 1 ... 1 ... ... 1 All other Causes 116 170 21 11 1 27 28 2 8 All Causes 327 360 92 22 27 74 46 7 19 Non-Residents* 13 277 61 14 ... ... ... .. ... * The deaths of 22 other non-residents took place either in the streets or houses in the Borough. 85 causes of death at various ages in each sex. TABLE IV. Causes of Death : Borough—Sex and Age Distribution. 1904. 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 ... ... 1 ... ... ... ... ... 1 ... ... ... 2 ... 2 Measles 7 5 13 8 3 2 ... 1 ... ... ... ... 23 16 39 Scarlet Fever 1 1 2 2 1 ... ... ... ... 1 ... ... 4 4 8 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 1 3 1 1 ... ... ... ... 10 10 6 12 18 26 44 Whooping-cough 2 4 6 4 ... ... ... ... ... ... ... ... 8 8 16 Diphtheria, Membranous Croup 1 ... 3 7 3 5 ... ... ... ... ... ... 7 12 19 Croup ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Enteric Fever 1 ... 1 ... ... ... 2 ... 1 5 ... ... 5 5 10 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 30 17 6 5 ... ... ... ... 2 ... 1 1 39 23 62 Epidemic or Zymotic Enteritis 37 30 7 5 ... ... ... ... ... ... ... ... 44 35 79 Enteritis 11 7 2 ... ... 1 ... ... 1 2 2 ... 16 10 26 Other Continued Fevers ... ... 1 ... 1 ... ... ... ... ... ... ... 2 ... 2 Erysipelas 1 ... ... ... ... 1 ... ... 1 2 1 ... 3 3 6 Puerperal Fever ... ... ... ... ... ... ... 3 ... 5 ... ... ... 8 8 Other Septic Diseases:— Pyæmia ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 2 Stomatitis 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 Cellulitis ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 2 Infective Endocarditis ... ... ... ... ... 1 1 1 ... ... ... ... 1 2 3 Intermittent Fever and Malarial Cachexia ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Tuberculosis of Meninges 2 4 3 7 2 2 ... ... 2 1 ... ... 9 14 23 Tuberculosis of Lungs 1 ... 1 ... 1 1 15 13 75 47 6 4 99 65 164 Other Forms of Tuberculosis 7 3 4 1 1 1 1 2 2 4 3 2 18 13 31 Alcoholism ... ... ... ... ... ... ... ... 6 8 1 1 7 9 16 Cancer ... ... 1 2 ... ... ... ... 37 64 16 36 54 102 156 Premature Birth 36 26 ... ... ... ... ... ... ... ... ... ... 36 26 62 Developmental Diseases 46 39 3 2 1 ... ... ... ... ... ... ... 50 41 91 Old Age ... ... ... ... ... ... ... ... ... 1 29 70 29 71 100 Meningitis 5 2 2 4 1 1 ... 1 1 1 1 ... 10 9 19 Inflammation and Softening of Brain ... ... ... ... ... ... ... ... ... 1 1 3 1 4 5 Organic Diseases of Heart ... ... ... ... ... ... 2 2 11 14 7 16 20 32 52 Acute Bronchitis 10 10 4 7 1 ... ... 1 11 12 9 13 35 43 78 Chronic Bronchitis ... ... ... ... ... ... ... ... 20 14 30 52 50 66 116 Lobar (Croupous) Pneumonia ... 1 ... 2 ... ... ... ... 5 2 ... 2 5 7 12 Lobular (Broncho-) Pneumonia 13 9 8 1 1 ... ... ... 2 5 4 2 28 17 45 Diseases of Stomach 1 1 ... ... ... ... 1 1 5 9 1 2 8 13 21 Obstruction of Intestines 1 3 ... ... 1 ... ... ... ... 4 3 2 5 9 14 Cirrhosis of Liver ... ... ... ... ... ... ... ... 9 12 1 ... 10 12 22 Nephritis and Bright's Disease ... ... 1 ... ... 1 1 ... 24 25 12 10 38 36 74 Tumours and Other Affections of Female Genital Organs ... ... ... ... ... ... ... ... ... 4 ... 2 ... 6 6 Accidents and Diseases of Parturition ... ... ... ... ... ... ... ... ... 7 ... ... ... 7 7 Deaths by Accident or Negligence 8 9 4 3 3 ... 2 ... 14 10 4 8 35 30 65 Deaths by Suicide ... ... ... ... ... ... 1 1 5 4 ... ... 6 5 11 Deaths fqpm III-defined Causes ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Syphilis 1 3 ... 1 ... ... ... 1 2 2 ... ... 3 7 10 Rheumatic Fever ... ... ... ... ... ... ... ... ... 1 1 1 1 2 3 Convulsions 12 11 2 1 ... ... ... ... ... ... ... ... 14 12 26 Apoplexy ... ... ... ... ... ... ... ... 5 9 4 7 9 16 25 Cerebral H æmorrhage ... ... 1 ... ... ... ... ... 11 9 11 14 23 23 46 " Heart Disease " ... ... ... ... ... ... 3 2 14 32 10 19 27 53 80 Pneumonia 10 7 5 8 2 ... 1 2 6 12 1 8 25 37 62 All other Causes 4 2 4 3 4 5 6 8 65 51 44 42 127 111 238 All Causes 251 198 87 74 26 21 36 41 350 391 209 330 959 1055 2014 86 deaths at all ages. TABLE V. Deaths Allocated to Wards and Registration Sub-Districts. Persons—All Ages. 1904. Correctedfor 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 1 1 ... ... ... ... ... ... 1 ... Measles 15 10 6 1 5 1 1 ... 22 2 Scarlet Fever 2 4 1 1 ... ... ... ... 6 ... Epidemic Influenza 9 8 8 7 6 1 1 4 27 8 Whooping-cough 2 3 1 6 3 ... 1 ... 13 1 Diphtheria, Membranous Croup 4 4 3 ... 7 ... ... 1 13 2 Croup ... 1 ... ... ... ... ... ... 1 ... Enteric Fever ... 1 1 3 4 ... 1 ... 9 1 Diarrhœa, Dysentery 10 12 7 11 21 ... ... 1 51 1 Epidemic or Zymotic Enteritis 12 22 5 8 26 ... 1 5 60 7 Enteritis 4 3 5 4 9 ... 1 ... 21 1 Other Continued fevers ... 2 ... ... ... ... ... ... 2 ... Erysipelas ... 3 1 2 ... ... ... ... 6 ... Puerperal Fever ... 1 2 2 2 ... ... 1 6 2 Other Septic diseases ... 3 3 1 1 ... ... 1 8 1 Tuberculosis of Meninges 4 8 2 2 7 ... ... ... 18 1 Tuberculosis of Lungs 24 29 18 28 40 4 6 15 112 28 Other Forms of Tuberculosis 1 8 4 6 9 ... ... 3 27 3 Alcoholism 1 1 4 1 6 1 ... 2 12 3 Cancer 12 17 25 25 32 13 5 27 96 48 Premature Birth 4 14 9 12 12 2 2 7 46 12 Developmental Diseases 13 19 13 12 27 2 3 2 69 9 Old Age 8 18 19 20 19 4 2 10 75 17 Meningitis 1 5 1 4 6 ... ... 2 15 3 Inflammation andSofteningof Brain 1 1 ... 1 2 ... ... ... 4 ... Organic Diseases of Heart 5 11 7 9 10 3 2 5 35 12 Acute Bronchitis 13 13 4 12 26 4 3 3 55 10 Chronic Bronchitis 18 26 13 17 33 2 2 5 89 9 Lobar (Croupous) Pneumonia 2 3 ... 1 5 ... ... 1 9 1 Lobular (Broncho-) Pneumonia 11 7 3 7 10 1 3 3 27 7 Diseases of Stomach 2 1 3 3 6 1 2 3 12 7 Obstruction of Intestines 5 3 2 1 2 ... ... 1 8 1 Cirrhosis of Liver ... 5 8 2 4 1 2 ... 19 3 Nephritis and Bright's Disease 8 7 9 13 19 5 4 9 46 20 Tumours and Other Affections of Female Genital Organs ... 1 1 ... 2 1 ... 1 3 3 Accidents and Diseases of Parturition 1 1 ... 2 3 ... ... ... 6 ... Deaths by Accident or Negligence 6 17 3 9 19 2 2 7 46 13 Deaths by Suicide 1 4 1 3 2 ... ... ... 10 ... Deaths from Ill-defined Causes ... ... ... 1 ... ... ... 1 1 1 Syphilis ... 1 ... 3 4 ... 1 1 8 2 Rheumatic Fever ... 1 ... ... 2 ... ... ... 3 ... Convulsions 3 4 3 3 9 1 ... 3 19 4 Apoplexy 5 7 4 4 3 1 ... 1 17 3 Cerebral Hæmorrhage 4 7 6 8 10 2 4 5 29 13 " Heart Disease " 4 15 7 11 21 4 4 14 54 22 Pneumonia 9 14 8 13 9 2 2 5 43 10 All other Causes 24 56 40 31 39 10 11 28 161 54 All Causes 249 402 260 310 482 68 66 177 1,420 345 * This Ward is co-tenninous with the North-West Paddington Registration Sub-District. 87 factories, workshops, laundries, workplaces and homework. 1.—Inspection. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 309 3 ... Bakehouses 37 ... ... Workshops (including Workshop Laundries) 2704 76 ... Bakehouses 519 4 1 Workplaces 53 2 ... Homeworkers' Premises 269 11 ... Total 3891 96 1 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of Cleanliness 118 104 ... ... Want of Ventilation 10 8 ... ... Overcrowding 16 16 ... ... Want of drainage of floors 1 1 ... ... Other nuisances and offences 78 69 5 ... Sanitary accommodations insufficent 2 2 ... ... unsuitable or defective 36 32 ... ... not separate for sexes 4 4 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 1 ... ... 1 Failure as regard lists of outworkers (S. 107) ... ... ... ... Giving out work to be done in premises which are unwholesome (S. 108) ... ... ... ... infected (S. 110) ... ... ... ... Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (S. 109) ... ... ... ... Other offences 5 1 4 ... Total 271 237† 9 1 * Including those specified in Sections 2,3,7, and 8, of the Factory Act as remediable under the Public Health Acts. † It is impossible to balance this column with that showing the number of defects found, as all the latter had not been remedied at the end of the year. 3.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories : Failure to affix Abstract of the Factory and Workshop Act (S. 133) 65 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5) Notified bv H.M. Inspector 6 Reports (of action taken) sent H.M. Inspectors 7 Other 3 Underground Bakehouses (S. 101):— In use durine 1903 65 Certificates granted in 1903 29 in 1904 32 In use at the end of 1904 62 Homework:— Number of Lists of Outworkers (S. 107) Lists. Outworkers. Lists received 83 414 Addresses of Outworkers forwarded to other Authorities 253 received from other Authorities 156 Homework in unwholesome or infected premises: Wearing Apparel. Other. Notices prohibiting homework in unwholesome premises (S. 108) ... ... Cases of infectious disease notified in homeworkers premises 4 ... Orders prohibiting homework in infected premises (S. 110) ... ... Workshops on the Register (S. 131) at the end of 1904 (see Table 33).