PAD 10 Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND Sanitary Work For the Year 1905. BY REGINALD DUDFIELD, M.A., M.B., D.P.H., F.S.S.,. Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. CONTENTS. Page Alcoholism, Deaths from 43 Bacteriological Examinations, Results of 58, 81 Bakehouses, Inspection of 66 Births and Birth-Rates 2 „ Corrected returns 3 „ in Institutions 3 Canals 62 Canal Boats Acts 62 Cancer, Mortality from 40 Childbed, Mortality in 27 Chicken-pox, Cases reported 36 " Clarendon Street Area" 71 „ „ Proof of benefits accruing from supervision of 71 Combined Drainage 60 Common Lodging Houses 75 Cowhouses 76 Dairies and Milkshops 77 Deaths and Death-Rates 9 Deaths in Institutions 10, 52 Death-rates, Factor Corrected 13 Diarrhoea, Deaths from 49 Diphtheria, Cases of 15 „ Mortality from 17 „ „ „ Factor Corrected 18 Disinfection and Disinfectants 55 Drains, Private, Re-laid 59 Enteric Fever, Cases of 22 „ Mortality from 23 „ „ Factor Corrected 24 „ Personal infection of 24 Erysipelas 28 Factory and Workshop Act, 1901, Work Under 63 Family Shelter 55 "Fever" 22 F'ood Analysis, Summary of Samples taken 82 „ Summary of Proceedings 86 Food Supervision 76 Food Adulteration 81 Food Purveyors 77, 80 Hospitals, Accommodation provided 54 House Refuse 59 H ouses let in Lodgings, Annual Cleansing of 68 „ „ Exemption by rent 72 ,, „ Sickness, etc., in 70 ,, „ Registration of 67 „ „ Overcrowding of 69 ,, „ Rents paid in 74 „ „ Sanitary defects in 69 ,, „ Verminous rooms 74 ,, ,, Vital Statistics 70 „ „ Water supply 75, 83 " Housing of the Working Classes " 75 Ice Cream, Inspection of places where made 77 Illegitimates, Births of 5 „ Deaths of 50 Page Infants, Feeding of 6, 49 „ Mortality among 44 Influenza, Mortality from 43 Inhabited House Duty, Exemption from 75 Inquests held 51 Institutions, Deaths in 10, 52 I Laundries 66 Legal Proceedings, Summary of 83 Manure, Removal of 59 Measles, Cases reported „ Mortality from 30 „ „ Factor Corrected 31 „ Disinfection after 32 „ Hospital accommodation for 33 Meat Supply 76 „ Stripped Carcases 78 Meteorology Milkshops, Trades carried on at 77 Mortuaries 56 Notifications 6 Offensive Businesses 63 Offensive Refuse, Removal of 58 Office Work 82 " Other Septic Diseases" 28 Outworkers 63 Phthisis, Mortality from 37 Population, Estimate 1 Prevention of Infectious Diseases 54 Puerperal Fever, Cases of 26 „ „ Mortality from 27 Respiratory Diseases, Mortality from 43 Scarlet Fever, Cases of 19 ,, „ Mortality from 20 „ „ „ ,, Factor Corrected 21 Schools and Infectious Diseases 56 Septic Diseases, Mortality from 27 Sewers, Complaints of 60 Slaughterhouses, Inspection of 76 Small-pox 14 Smoke Prevention 61 Smyrna Figs .81 Tubercular Diseases, Mortality from 37 Unsound Food seized 77 Vaccination 15 Water Supply, Cutting off of 55 Wharves, Inspection of 62 Whooping Cough, Cases reported 34 „ „ Mortality from 35 Corrected 36 Workshops, Inspection of 63 APPENDIX. Tables required by the Local Government Board, Home Office, and London County Council 88-95 TO HIS WORSHIP THE MAYOR, THE ALDERMEN,, AND COUNCILLORS OF THE BOROUGH OF PADDINGTON Gentalmen, I have the honour to submit herewith my Report on the health of the Borough and the work of the Public Health Department during the past year, the twelth report submited by me. It affords me much pleasure to be able to record, a continued decrease in the prevalence Health (London) Act, .1891, and a very low death rate. The. only matters for regret in connection with the vital statistics are the low, and still decreasing birth rate and the high prevalence Of measles and whooping cough. As regards the first, some consolation may be derived from a diminished infantile mortality. The rate as given in this Report is lower than any on record in the Borough, except that for 1903, and but for a change in the manner of recording the births, probably lower than that. I anticipate that much good will accrue from the efforts to assist and instruct mothers which were initiated during the year. In this work the services of the Student Women Inspectors have been of great use. In comparing death rates in different districts the proportions of the two sexes at different ages require to be taken into consideration. Factors to correct for these differences have been available for deaths from all.causes, phthisis and cancer. During the past autumn Licalculated corresponding factors for the principal zymotic diseases—viz., smallpox, scarlet fever, diphtheria, enteric fever, measles and whooping cough. The corrected rates for this Borough and the Adjacent Districts will be found under each disease. A very striking demonstration has been given of the need of promptly removing cases of enteric fever to hospital when the home surroundings are such as to make it impossible to take the. precautions necessary to prevent the direct transference of infection from the patient to those living in the house or tenement. It is very generally thought that this disease can be kept at home with safety—an opinion in which I shared until a few years ago. The differences in the rates of infantile mortality observed in the Wards and smaller Selected Areas point to the need for energetic action. Success in this direction depends on prompt information of the births of the children. It is therefore a matter of satisfaction that some of the midwives practising in the District have agreed to report the cases attended by them to the County Council, and that that Authority forwards the particulars to each district. The information is, however, very partial, and can only be made complete by making it a statutory obligation for every.birth to be reported (say) within forty.eight hours to the medical officer of health of the district in which it occurs. Civil registration would remain as at present, and with the introduction of a preliminary notification would probably I would direct your especial attention to the proof of the benefits accruing from a systematic supervision of houses let to more than one family, which is afforded by the comparisons of the vital statistics for the "Clarendon Street Area." for the past 10 years. II As regards matters of administration, the supply of water in tenement houses and meat inspection (more particularly that relating to tuberculous pork) are the more important subjects dealt with. The decision of the Magistrate on the former point seems a little illogical, even if good law. In effect that decision means that if there be an ample supply in the street mains, it is immaterial how little water can be got in the house. I he inspection of meat is in a somewhat unsatisfactory position, as it is in many cases quite impossible to fix the responsibility for introducing diseased meat into the retail markets. The only satisfactory remedy is the prohibition of slaughtering for food for man in any place except the municipal slaughterhouse, to which an adequate number of skilled inspectors are attached. The task of ensuring a pure food supply which shall be what it professes to be (e.g., that "milk" shall be "whole milk," not a fancy product) is much hampered by the warranty provisions of the Sale of Food and Drugs Acts and decisions under them. The result is again that responsibility for tampering with the natural article cannot be brought home to any of the parties through whose hands the commodity passes. In addition to the changes in the present administration foreshadowed in the last paragraph, I feel convinced of the need of more frequent removal of house refuse and of change in systems of collection of other forms of refuse. In conclusion, I desire to record the fact that work of the Staff of the Department has been carried on during the year in a manner which gives me great satisfaction. I ought also to acknowledge the co-operation afforded to me by the medical profession, although, infectious disease being at a low ebb, there has been less need to seek their help. Lastly, I must express my sincere thanks to the Chairman and Members of the Public Health Committee for their unfailing and sympathetic consideration and for the encouragement they extend to the Department in the discharge of duties which are onerous and not always popular. 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, Paduington, W. June, 1906. I 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. Harrow Road. Maida Vale. St. Mary Westbourne. Church (part of). Church (part of). Lancaster Gate (West). St John „ „ (East). Hyde Park. North.West Paddington Queen's Park. Population in 1905.—The population of the Borough was estimated at the middle of the year to be 147,713 persons, of whom 63,266 were males and 84,447 females. At the census of 1901 the enumerated population was 143,976 persons, showing an estimated increase of 3,737 persons during 4¼ years. The natural increment (i.e., excess of births over deaths) during that period amounted to 5,743 persons. The estimates of the inhabitants of the various sub.divisions of the Borough are given in Table 1. TABLE 1. Estimated Population. 1905. Borough Males 63,2661 Persons 147,713. Females 84,447 Registration Sub.Districts Persons. Wards. Persons. St. Mary 97,468 Queen's Park 16,701 St. John 33,544 Harrow Road 28,978 North.West Paddington 16,701 Maida Vale 19,581 Westbourne 24,874 Church 27,326 Lancaster Gate (West) 8,436 „ ,, (East) 7,923 Hyde Park 13,894 2 METEROLOGY 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. The maximum temperature (86.3°) was nearly 3° below that of 1904. The amount of rain measured (23.35 in.) was 2.29 in. above the total for 1904, but no less than 15.32 in. below that for 1903, while the number of days on which measurable amounts fell was the lowest for the three years. The number of days on which bright sunshine was recorded (270) was the largest for the three years, the total number of hours recorded (1,314½) showing a considerable increase over the totals for the two preceding years. TABLE 2. Meteorological Elements. 1905.. 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. 1905. Inches. Deg. Deg. Deg. Dates. Deg. Dates. Deg. Deg. H. M. Jan. 30.29 38.0 36.7 54.5 6th 22.0 15th 69.0 16.0 1.26 6 39 16 19 Feb. 30.18 41.5 39.5 59.5 18th 31.0 19th 80.0 23.0 0.83 13 61 02 19 March 29.73 44.7 42.3 59.0 22nd 29.0 3rd 101.5 19.0 3.10 20 84 10 24 April 29.85 47.4 43.8 63.0 13th 31.8 7th 105.0 24.0 1.86 17 83 39 24 May 30.11 55.7 49.5 81.2 29th 35.5 22nd 126.0 27.0 1.04 7 243 47 30 June 29.94 610 56.8 79.0 27 th 46.5 7th 126.5 42.0 4.59 17 162 44 23 July 30.05 66.5 61.5 86.3 25th 50.0 6 th 135.0 40.5 1.15 9 245 20 31 August 29.89 62.0 57.6 73.7 14th 46.0 23rd 121.5 37.0 2.68 15 174 32 29 Sept. 29.96 57.2 54.1 74.0 3rd 41.5 10th 114.0 35.0 1.77 11 104 05 25 Oct. 29.69 45.4 42. 9 59.0 9th 29.0 16th 93.0 17.0 1.24 13 95 25 23 Nov. 29.68 41.4 40.0 54.5 26th 25.0 20th 79.0 15.0 3.19 17 36 41 15 1904. Dec. 30.19 39.9 38.6 56.5 7th 29.'0 11th 73.0 20.0 0.64 6 14 18 8 Totals . . . . . . . . . 23.35 151 1,344 59 270 Means 29.96 50.0 16.9 . . . . . . . . . . — Highest . . . 86.3 July . . 135.0 . — . . . . Lowest . . . . . 22.0 Jan. . 15.0 . — . . . 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. . 19.0 . . . . . . This part of the table appeared in The Times of 2nd January last. BIRTHS. During the 52 weeks taken as the year, 3,184 births. were registered within the Borough, 111 less than the total for 1904. That total comprised 1,628 (1,642†) of boys, and 1,556 (1,653) of girls. The birth.rate was 21.55 per 1,000 persons, 0.89 less than the rate for the previous year. The numbers registered in the Borough during each year since 1895 are given in Table I., and in the three Registration Sub.Districts in Table II. in the Appendix. . Including 38 " twins," 23 being of the same sex (11 males and 12 females) and 15 mixed sexes. Ninety. seven infants (3 per cent, of all born) died prior to the registration of their births. † Figures for 1904 shown in italics and parentheses. births. 3 The births registered last year were 242 below the mean annual number for the ten years. An analysis of last year's registrations, with the rates for 1901.05, is to be found in Table 3. TABLE 3. Births and Birth.Rates. 1905. Births. Borough. Registration Sub.Districts. St. Mary. St. John. North.West Paddington Males 1,628 1,209 205 214 Females 1,556 1,177 183 196 Totals 3,184 2,386 388 410 Birth.Rates. Per 1,000 persons 1905 21.55 24.48 11.56 24.54 1904 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. 1905 66.8 82.4 26.2 105.2 1904 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 The rate for 1904 was 1.67 below the mean (24.11) for 1894.03, while that for last year was 2.35 below the mean for 1895.04. (Sec below.) In the Registration Sub.Districts the greatest decrease (3.51) occurred in North.West Paddington, the district with the highest rate. Birth.Rates, Per 1,000 persons of all ages. Mean Rates. 1905. 1895.1899. 1900.1904. 1895.1904. Borough 21.55 24.95 22.85 23.90 St. Mary 24.48 28.58 26.32 27.64 St. John 11.56 12.56 11.54 12.05 North.West Paddington 24.54 30.16 25.95 28.05 Institutions.—Of the 3,184 births registered, 121 (3.8 per cent.) took place in the Workhouse, and 161 other births of children whose parents were reputed to belong to Paddington occurred in Lying.in Hospitals outside the Borough, viz., Queen Charlotte's, 156 (158); British, 3 (4); and General, 2(7). For the first time complete returns of particulars of births have been received during the year, whereby it is possible to allocate the births to the Wards, &c., in which the children's parents resided, and to exclude from the final returns the births of children whose parents do not belong to the Borough. Of the births registered in the Borough, 29 (16 of males and 13 of females) must be thus excluded, 18 of the births occurring in the Workhouse, and of the 161 births in the Lying.in Hospitals already referred to, 17 (10 of males and 7 of females) have to be similarly dealt with. 4 births. The corrected total for the Borough thus becomes 3,299 (1,681 of males and 1,618 of females) equal to a rate of 22.33 per 1,000 persons of all ages. The numbers belonging to the various sub.divisions of the Borough and the corresponding rates are given in Table 4. TABLE 4. Births. 1905. All Births. Rates. Illegitimate Births. Per cent, of All Births. Per 1,000 persons. Per 1,000 females, 15.45. St. Mary 2,449 25.12 84.63 140 5.7 St. John 422 12.58 28.53 26 6.1 North.West Paddington 428 25.62 109.79 8 1.8 Harrow Road 818 28.22 105.83 26 3.1 Maida Vale 423 21.60 61.09 28 6.6 Westbourne 510 20.50 62.95 43 8.5 Church 760 27.81 103.91 46 6.0 Lancaster Gate (West) 72 8.53 18.82 5 6.9 „ (East) 91 11.48 22.52 3 3.2 Hyde Park 197 14.17 34.00 15 7.6 The exceedingly low rates for South Paddington (lowest Lancaster Gate (West) Ward, 8.53) are mainly due to the preponderance of unmarried persons (male and female domestic servants, shop assistants, &c.). The proper rates based on the numbers of married women cannot be given, as the necessary data are not available. The birth.rate for the Metropolis last year was 27.02, and that for the whole country {England and Wales) 27.2. The rates for the Borough (uncorrected 21.55, corrected 22.33) were considerably below those figures. Of the rates given in Table 4, only those of Harrow Road (28.22) and Church (27.81) Wards were in excess. In the Adjacent Districts (Table 5) the rate (uncorrected) was in each lower than that recorded in the Borough, except in Willesden, where the rate last year was 29.90 per 1,000 living, 2.67 lower than in 1904. TABLE 5. Births and Birth.Rates.. 1905. Births Registered. Birth.rates. Per 1,000 persons at all ages. Per 1,000 females aged 15.45 years. Borough 3,185 21.52 66.87 London 126,620 27.02 98.78 Kensington 3,458 19.19 53.31 . Westminster 2,940 16.74 50.87 Marylebone† 3,879 29.96 86.95 Hampstead 1,421 16.12 42.26 Willesden 4,134 29.90 107.77 * 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,(518. Birth.rates 20.22 per 1,000 persons; 58.68 per 1,000 females 15—45. births. 5 The rates spoken of so far have been based on the estimated population (both sexes) at all ages. Such populations contain very varying proportions of females of the reproductive ages (15.45 years) in the three civil states—single, married and widowed. The reproductive powers of the various districts would be more accurately measured by rates for legitimate births based on the numbers of married women, and for illegitimate on the numbers of the unmarried and widows. As, however, the data for such comparison are not available in every case, rates based on the total numbers of females at ages 15.45 years are given in each of the three last tables. Illegitimate Births.—The number of these registered in the Borough was 152 (167), and 53 (37) were returned from the Lying.in Hospitals outside the Borough. Of the former, 14, and of the latter, 17, have to be excluded as not belonging to the Parish, so that the corrected number of such births is 174. In previous years this correction has not been made, and for the purpose of comparison with those years the gross total of these births (205) must be used. In 1904 the total was 204. An analysis on the same lines as previous years is given below:— Births of Illegitimates. (Including those in Outlving Hospitals). Borough. St. Mary. St. John. North.West Paddington. Males 103 91 10 2 Females 102 90 8 4 Totals 205 181 18 6 Per cent, of all Births Registered—1905 6.1 7.2 4.3 1.4 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 A better idea of the proportions of illegitimate to legitimate births can be obtained from Table 4 (two last columns). The percentages for Westbourne (8.5) and Hyde Park (7.6) Wards can hardly be considered as satisfactory. Below will be found a complete statement of the birth.rates for the whole Borough during the past five years :— Birth.rates : Borough. Per 1,000 females (15.45) of each class. All Births. Married Females. Legitimate Births. Married Females. Illegitimate Births. Unmarried Females. 1901 203.77 195.70 4.56 1902 199.38 190.39 5.12 1903 198.08 189.74 4.75 1904 200.28 194.11 6.66 1905 195.69 185.25 5.72 Doubtless some part of the reductions in the rates for last year is due to more complete Correction for births not belonging to the Borough. On the other hand, indications are not wanting that the birth.rate is still decreasing. During second half of the year the Women Inspectors and Students visited houses in the poorer streets where births were recorded as having taken place. Inspections were made for 6 notifications. detection of grosser nuisances, and some attention given to the circumstances of the infant. The houses thus visited numbered 968. In 23 instances the name of the family was unknown. False addresses are deliberately given when registering births for various reasons, one being with a view to evading vaccination. In 58 other instances the family had removed since the birth of the child. Thus 8 per cent, of the children born, whose surroundings the experience of the department indicated were in need of supervision, could not be reported on. The Inspectors found it necessary to exclude 22 other children from their reports on this work for various reasons. Of the 865 children reported on 177 were first.borns. The total number of children born to the remaining 688 families (excluding those dealt with here) was, according to the parents' statements, 3,268, an average of nearly 5 to a family, of whom 605 were dead at the time'of the inquiries—equal to a mortality of 185 per 1,000. The deaths, however, were not equally averaged as they occurred in 314 families out of a total of 688. From the general survey of the children, admittedly a very rough criterion, the Inspectors classed 676 children as in " good " health ; 140 in " fair " ; and 49 in " bad "—or in percentages 78, 16, and 6. These figures, even with every reservation, appear to afford grounds for hoping that good results will accrue from systematic endeavours to check infantile mortality. The Inspectors report that they found 670 children (77 per cent.) were being fed from the breast; 102 (12 per cent.) by hand; and 93 (11 per cent.) by breast supplemented by hand feeding. Of 862 homes, 653 were reported as clean, 174 as " fairly clean," and 35 as dirty. Larder accommodation was provided at 124 only. The nuisances discovered numbered 131, viz., 43. defective dustbins, 59 dirty cisterns, and 29 " various." NOTIFICATIONS. The cases of infectious disease certified in accordance with the Public Health (London)' Act, 1891, numbered 564 in 1905, as compared with 684 in 1904 and 732 in 1903. The figures show a decline of 23 and 17.5 per cent, of the totals of 1903 and 1904 respectively. In the whole Metropolis the total cases in each of the three years 1903, 1904 and 1905 have been 27,732, 28,337 and 32,874 respectively—the figures for the last two years represent increases of 2T and 18.5 per cent, respectively. Comparing 1905 with 1904 (Table 6) the only increases in the numbers of cases recorded in the Borough during the past year were those of membranous croup (4) and erysipelas (18). In the Metropolis, increases were recorded in the cases of scarlet fever (6,018), erysipelas (21), puerperal fever (17) and typhus fever (6). The total sickness rate for the Borough for last year (3.81) was a little more than half that for the Metropolis (7.01). All the local rates for individual diseases were below those for the Metropolis, the contrast in the rates for diphtheria and scarlet fever being particularly' satisfactory. notifications. 7 TABLE 6. Notifications. Borough. London. Notification Rates. 1905 1904 Differences. * 1905 1904 Differences. * Borough. London.[/###} 1905 1904 1905 1904 Smallpox 2 4 — 0 74 495 — 421 0.01 0.02 0.02 0.10 Cholera ... ... ... ... ... ... ... ... ... ... Diphtheria 92 140 — 48 6,365 7,082 — 717 0.62 0.95 1.36 1.52 Membranous Croup 4 ... + 4 124 145 — 21 0.02 ... 0.03 0.03 Erysipelas 136 117 + 19 4,975 4,954 + 21 0.92 0.79 1.06 1.06 Fevers. Scarlet 277 365 — 88 19,469 13,451 + 6018 1.87 2.48 4.15 2.89 Typhus ... ... ... 9 3 + 6 ... ... 0.00 o.oo Enteric 46 48 — 2 1,552 1,903 — 351 0.31 0.32 0.33 0.40 Relapsing ... ... ... 1 2 — 1 ... ... 0.00 o.oo. Continued ... ... ... 14 28 — 14 ... ... o.oo 0.01 Puerperal 7 10 — 3 291 274 + 17 0.05 0.06 0.06 0.04 Totals 564 684 —120 32,874 28,337 +4537 3.81 4.65 7.01 6.09 * + indicates increase in 1905. „ decrease „ In Table 7 the numbers of cases of the principal diseases, as obtained from the Registrar. General's Quarterly Reports, in the Borough and the Adjacent Districts, are set out, and in Table 9 the rates for last year are compared with the mean rates for the four years 1901.04. The local rate for diphtheria (including membranous croup) was 0.65—the lowest of all the rates from this disease, that from scarlet fever 1.87 also the lowest, but in this case the Kensington rate was the same. The Westminster rate for enteric fever (0.23) was the only one below that for the Borough (0.30), while the rates for Kensington and Hampstead (0.02 in each case) for puerperal fever were the only two below that for Paddington (0.04). The differences from the mean rates are, generally speaking, much in favour of the Borough. TABLE 7. Notifications, 1905. (Compiled from Registrar.General's Quarterly Reports). Pad. dington. London.* Kensington. Westminster. Marylebone. Hampstead. Willesden Smallpox' 0 74 . '2 . — . Diphtheria, Memb. Croup 97 6,489 130 120 131 66 275 Erysipelas 136 4,966 158 124 161 44 56 Fevers. Scarlet 279 19,467 337 368 278 180 397 Enteric 45 1,550 53 41 46 18 41 Continued — 14 0 . . 1 — Puerperal 7 293 4 12 6 2 13 * Also 9 cases of typhus fever and 1 of relapsing fever. 8 NOTIFICATIONS. TABLE 8. Sickness Rates. Per 1,000 persons of all ages. (Based on the figures (for 1905) given in Table 8.) Paddington. London. Kensington. Westminster. Marylebone. Hampstead. Willesden. Smallpox 1905 Mean 1905 Mean 1905 Mean 1905 Mean 1905 Mean 1905 Mean 1905 Mean 0.01 0.24 0.01 0.56 . 0.16 0.01 0.52 . 0.45 . 0.08 — 0.23 Diphtheria* 0.65 .46 1.46 2.05 0.72 1.12 0.68 1.20 1.01 1.58 0.74 l.66 1.99 2.85 Erysipelas 0.91 0.89 1.05 1.05 0.87 0.94 0.70 0.08 1.24 1.44 0.49 0.59 0.02 0.66 Fevers Scarlet 1.87 2.81 4.15 3.39 1.87 2.03 2.09 2.23 2.14 2.87 2.04 2.41 2.87 3.73 Enteric† 0.30 0.45 0.33 0.59 0.30 0.42 0.23 0.48 0.35 0.56 0.21 0.45 0.29 0.42 Puerperal 0.04 0.05 0.05 0.05 0.02 0.05 0.05 0.02 0.04 0.05 0.02 0.05 0.09 0.04 * Including membranous croup. .†Including continued fever. Distributing the cases according to the Wards in which the patients resided (Table 9) a general reduction in the cases of the various diseases is to be noted. The principal exceptions are:— Cases. .»• Disease. Ward. 1904. 1905. Diphtheria Harrow Road 32 36 Scarlet Fever Lancaster Gate—West 15 26 ” „ —East 4 10 Enteric Fever Queen's Park 1 4 ” Harrow Road 3 8 Maida Vale 8 17 TABLE 9. Notifications, 1905. Distributed according to Wards. Numbers for 1904 shown (italics). I. Queen's Park. II. Harrow Road. III. Maida Vale. IV. West. bourne. V. Church. VI. Lancaster West. VII. Gate. East. VIII. Hyde. Park. Smallpox .(1) .(2) .(1) 1 (.) .(.) 1 (.) .(.) .(.) Diphtheria T (17) 34 (32) 10 (28) 10 (16) 18 (28) 2(4) 3 (4) 2(11) MembranousCroup .(.) 2 (—) — (—) 1 (.) — (—) — (—) 1 (.) — (.) Erysipelas 18 (11) 34 (27) 19 (20) 23 (13) 28 (35) 2(3) 1 (4) 11(4) Fevers 'Scarlet 24 (76) 77 (95) 33 (29) 38 (46) 51 (73) 26 (15) 10 (4) 18 (27) Enteric 4 (/) 8(3) 17 (8) 6 (14) 5 (11) 2(3) 1 (5) 3(5) Puerperal 1 (1) 1 (1) .(2) 1 (2) 3(5) .(.) .(.) 1 (1) Totals 54 (107) 156 (160) 79 (88) 86 (91) 105 (150) 33 (25) 16 (15) 35 (48) Rates, 1905 3.24 5.38 4.03 3.46 3.84 3.91 2.02 2.52 „ 1901 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 In Table 10 the sex.age distribution of the cases reported is given. The weekly numbers of cases of the principal diseases are shown in Fig. I. (page 9), the decennial average number for each week being indicated by the broken line. 17 diphtheria. Of the 96 cases reported, 16 were certainly erroneously diagnosed, and 7 others probably so. Fourteen cases of erroneous diagnosis were removed to hospital. Imported infection appeared to have occurred in 5 cases. Two cases were reported in patients in hospital for other diseases. One case was a relapse. This patient returned from hospital on May 18th, and was found to be infectious on June 12th. In the meantime the patient's brother was taken ill (on June 7th) and removed to hospital (June 8th). Three cases were the same patients' second attacks of the disease. In one case only did death precede notification. Of the 96 cases, 86 were removed to hospital, equal to 89.5 per cent. of all cases, the highest proportion since 1901. (See Table 15.) The deaths recorded during the year numbered 3, as compared with 19 and 15 in the two preceding years. The fatality for the year was equal to 3.1 per cent. of all notifications, and 3.7 per cent. after deducting the known cases (16) of erroneous diagnosis. No death occurred among the 10 cases treated at home. The fatalitv among patients removed to hospital was only 4T per cent., one-third the rate for 1904 (12.2 per cent.). The mortality per 1,000 persons of all ages was 0.02, compared with a decennial mean rate of 0.33, a very striking difference. A complete comparison of last year's rates for the Borough and the Registration Sub-Districts, with the corresponding mean rates, is given below:— 9 DEATHS. TABLE 10. Notifications, 1905. Distributed according to sexes and ages of patients. Ages. Smallpox. Diphtheria. Membranous Croup. Erysipelas. Fevers. Scarlet. Enteric. Continued. Puerperal m. f. m. f. m. f. m. f. m. f. m. f. m. f. F. 0— ... 1 1 ... ... ... 3 2 2 4 ... ... ... ... ... 1— ... ... 3 3 ... ... ... ... 8 6 1 ... ... ... ... 2— ... ... 5 3 ... 1 2 ... 12 10 ... ... ... ... ... 3— ... ... 4 6 2 ... 1 ... 13 11 ... ... ... ... ... 4— ... ... 4 6 ... ... ... 2 17 17 ... ... ... ... ... 5— ... ... 13 22 1 ... ... 3 56 69 6 3 ... ... ... 13— ... ... ... 1 ... ... 1 1 5 3 ... 1 ... ... ... 15— ... ... 5 4 ... ... 7 9 11 16 4 9 ... ... 4 25— ... 1 5 7 ... ... 48 41 8 9 8 14 ... ... 3 05— ... ... ... ... ... ... 5 11 ... ... ... ... ... ... ... All ages ... 2 40 52 3 1 67 69 132 145 19 27 ... ... 7 Rates— 1905 ... 0.02 0.63 0.61 0.04 0.01 1.06 0.82 2.07 1.72 0.30 0.32 ... ... 0.08 1904 0.06 ... 0.93 0.96 ... ... 0.85 0.75 2.73 2.29 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 2.17 0.68 0.46 ... 0.00 0.15 1901 0.19 0.12 2.52 2.20 0.03 0.03 0.87 1.05 3.67 3.34 0.84 0.48 ... ... 0.12 Fig. I. Notification Chart. 1905. DEATHS. In 1903 the deaths registered within the Borough numbered 2,103, rose to 2,228 in 1904, and fell to 2,210 last year. The decennial average annual number is 2,319, 109 in excess of last year's total. The gross death-rates for the last three years—1903-05—have been 14.41, 15.17 and 14.96 respectively. Last year's rate is 1.22 below the decennial mean. (See Table I., Appendix.) 10 deaths. Last year's total (2,210) comprised 1,038 (1,120)* deaths of males, and 1,172 (1,108) of females. The ages at death and the principal causes thereof are sufficiently indicated below:— Ages, No. of deaths. Ages, No. of deaths. Years. Persons. Years. Persons. 0— 441 (490) 15— 96 (86) 1— 227 (189) 25— 797 (839) 5— 84 (78) 65— 565 (546) Infantile mortality, 139 (148). Infectious Diseases. No. of deaths. Persons. Measles 63 (38) Scarlet Fever — (—) Whooping Cough 51 (15) Diphtheria and Membranous Croup 1 (9) "Fever" 6 (13) Epidemic Influenza 40 (46) Diarrhœal Diseases 94 (153) Puerperal Fever 1 (8) Other Septic Diseases 26 (12) Phthisis 128 (1.59) Other Tubercular Diseases 82 (81) Other Diseases and Causes. No. of deaths. Persons. Croup 2 (1) Cancer 163 (176) Bronchitis 196 (192) "Pneumonia" 188 (133) Other Respiratory Diseases 26 (17) Alcoholism 15 (19) Cirrhosis of Liver 36 (27) Premature Birth 58 (60) Accidents and Diseases of Parturition 9 (9) Accidents 97 (105) Suicides 19 (21) Institutions.—Of the 2,210 deaths, 806 (780)—equivalent to 36.4 (35.0) per cent.— occurred in the local Public Institutions, viz.:—Workhouse 91 (66), Infirmary 233 (261), Lock Hospital 4 (1), Children's Hospital 91 (92), and St. Mary's Hospital 387 (360). The causes of death and other particulars are given in Tables III. and IIIa., Appendix. The deaths registered within the Borough included 410 (387) of non-residents, and 161 (173) deaths of residents were reported from other parts of the Metropolis and the provinces. By excluding the former deaths and including the latter, a nett total of 1,961 is obtained, being 53 fewer than the total for 1904 and 43 more than that for 1903. The annual average for 1895-04 is 2,192, 231 in excess of last year's total. If the average be corrected for increase in the population, it becomes 2,262—301 in excess. The nett totals for each of the past ten years for the Borough and the three Registration Sub-Districts will be found in Table II., Appendix. The corrected numbers of the deaths recorded in each quarter of the last five years, with the corresponding mortality rates, are given below. The rate for the second quarter of last year is the highest of the series for the quarter, due to the prevalence of measles and whooping-cough, and that for the third quarter the lowest. The rates for the first and fourth quarters of the year compare favourably with the others:— Quarters. Deaths. Rates. 1905. 1904. 1903.1902.1901. 1905. 1904. 1903. 1902. 1901. 'First 533 599 522 736 631 14.47 16.41 14.35 20.35 17.56 Second 496 393 455 476 445 13.46 10.76 12.51 13.16 12.38 Third 394 486 442 418 469 10.69 13.31 12.15 11.56 13.05 Fourth 538 536 499 522 512 14.61 14.68 13.72 13.40 14.24 Last year's nett death-rate was 13.27 per 1,000 persons, as compared with rates of 13.71 in 1904 and 13.14 in 1903. The decennial mean rate (15.29) is 2.02 in excess of last year's rate. (See also below.) Death-Rates—All Causes. Per 1,000 persons. Mean Rates. 1905. 1895-99. 1900-04. 1895-04. Borough 13.27 16.19 14.39 15.29 St. Mary 14.33 17.98 15.79 16.89 St. John 10.27 11.01 10.14 10.58 North-West Paddington 13.23 16.97 15.37 16.17 * Figures for 1904 indicated thus:—(1120). 11 deaths. The corrected numbers of deaths of males and females at all ages in the Borough and its Sub-Divisions are given in Table 11., with the "nett" rates based thereon, and the corresponding mean rates for the four years 1901-04. The corrected numbers of deaths in each Registration Sub-District during the past ten years are given in Table II., Appendix. TABLE 11. Deaths and Death-rates. All causes, all ages. Deaths. All causes, all ages. 1905. Death-rates. Per 1,000 of all ages. 1905. Mean-rates, 1901-04. Males. Females. Persons. Males. Females. Persons. Males. Females. Persons. Borough 910 1,051 1,961 14.38 12.44 13.27 15.84 12.49 14.49 Registrat'n Sub-Dis'cts St. Mary 651 746 1,397 15.02 13.78 14.33 16.60 14.10 15.14 St. John 147 196 343 12.71 8.91 10.27 13.10 8.07 9.81 North-West Paddington 112 109 221 13.37 13.08 13.23 15.83 13.84 14.84 Wards. Harrow Road 175 221 396 12.74 14.49 13.66 14.72 13.41 14.01 Maida Vale 112 145 257 14.28 12.35 13.12 15.62 11.84 13.59 Westbourne 164 174 338 16.03 11.87 13.58 15.44 13.40 14.24 Church 219 229 448 16.86 15.97 16.39 19.81 17.13 17.90 Lancaster Gate (West) 33 44 77 11.61 7.86 9.12 8.83 6.84 7.51 Lancaster Gate (East) 29 47 76 12.69 8.33 9.59 13.06 6.03 8.06 Hyde Park 66 82 148 13.25 9.20 10.65 14.78 9.42 11.51 In general the rates for last year were below the corresponding mean rates, the exceptions being— Males. 1905. Mean. Females. 1905. Mean. Wards— Registration Sub-District. Westbourne 16.03 15.44 St. John 8.91 8.07 Wards— Lancaster Gate (West) 11.61 8.83 Harrow Road 14.49 13.41 Maida Vale 12.35 11.84 Lancaster Gate (West) 7.86 6.84 Lancaster Gate (East) 8.33 6.03 There were very satisfactory decreases from the mean in the rates for Church Ward, where the highest rates were recorded last year. Last year's rates for this Ward were, also, considerably below those for 1904—Males 16.86 (17.09), Females 15.97 (18.44), Persons 16.39 (17.80). In comparison with the Metropolis and the Adjacent Districts (Table 12), the local "nett" rate was below all rates except those for Hampstead (9.31) and Willesden (11.55). The reduction from the four year mean was highest in Marylebone (1.40) and lowest in Paddington (0.43). 12 deaths. TABLE 12. Death-rates. At all ages, persons. Compiled from the Quarterly Reports of the Registrar-General. All Causes Smallpox. Measles Scarlet Fever. Diphtheria. Whooping Cough. "Fever" Diarrhœal Dis. Phthisis. Other Tub. Dis. Cancer. Infantile Mortality. Paddington 1905 13.27 ... 0.41 0.04 0.02 0.33 0.03 0.51 0.95 0.37 1.00 123 Mean† 13.70 0.03 0.29 0.06 0.22 0.24 0.07 0.66 1.09 ? 1.02 130 London 1905 15.03 0.00 0.36 0.11 0.11 0.31 0.04 0.71 1.41 0.54 0.99 128 Mean 16.35 0.08 0.46 0.09 0.21 0.35 0.08 0.76 1.60 ? 0.98 139 Kensington 1905 13.96 ... 0.31 0.11 0.04 0.33 0.07 0.50 1.13 0.41 0.95 144 Mean 14.63 0.01 0.37 0.07 0.15 0.26 0.06 0.61 1.33 ? 0.98 151 Westminster 1905 13.44 ... 0.21 0.08 0.02 0.15 0.02 0.29 1.50 0.42 1.02 114 Mean 14.83 0.07 0.23 0.06 0.10 0.18 0.08 0.36 1.72 ? 0.97 129 Marylebone 1905 15.44 ... 0.29 0.11 0.03 0.18 0.04 0.41 1.43 0.41 1.20 88§ Mean 16.84 0.05 0.36 0.10 0.18 0.24 0.07 0.63 1.63 ? 1.09 100 Hampstead 1905 9.31 ... 0.09 0.06 0.03 0.19 0.02 0.12 0.82 0.24 0.82 94 Mean 10.39 0.01 0.11 0.04 0.13 0.17 0.07 0.20 0.83 ? 1.05 97 Willesden 1905 11.55 ... 0.36 0.03 0.10 0.48 0.07 1.63 1.05 0.34 0.83 112 Mean 12.05 0.02 0.39 0.07 0.27 0.34 0.06 0.78 0.91 ? 0.82 123 * Rates, except Infantile Mortality, per 1,000 persons of estimated population. Infantile Mortality per 1,000 births registered. j Mean rates for four years 1901-04. § Rate after correction for births of non-parishioners in Queen Charlotte's Lying-in Hospital—1905, 131; Mean, 135. So far no account has been taken of the differences in the age-sex composition of the various populations, a fact which is material to trustworthy comparison. The necessary standard rates and correction factors have been calculated by the Registrar-General and the Department, and the comparisons made in Table 13 show how the different Districts and Sub-Divisions of the Borough really stand. It will be seen that in Church Ward only was the " corrected" rate for last year (17.51) in excess (+0.48) of the "standard" rate (17.03). The mean corrected rate (19.67) is 2.64 in excess of the standard. These figures suggest that the sanitary condition of the Ward is not all that might be desired, but evidences of the improvement which is apparently taking place are not lacking. In 1904 the corrected rate (19.01) was 1.98 in excess of the standard and 1.50 higher than last year's rate. Further, the decline in last year's rate (2.16) from the four years' mean is confirmatory evidence which conveys a sense of satisfaction. On the other hand, the rates for the two Lancaster Gate Wards point either to some deterioration in the sanitary condition of those Wards, or to changes in either the sex—age composition of the population which have taken place since the last Census, or in social condition. Judging by the results of inspection of the Wards, the sanitary condition is about the same as before the Census. Proof of the alternative suggestions will not be forthcoming until the next Census has been taken. 13 DEATHS. TABLE 13. Corrected Death-rates. Standard Rate. Corrected Rate, 1905. Difference from Standard. Mean Corrected Rate, 1901-04. Difference (1905) from Mean. Borough 17.10 14.12 —2.98 14.81 —0.69 Registration Sub-Districts— St. Mary 17.81 14.63 —3.18 15.55 —0.92 St. John 15.44 12.10 —3.34 11.56 +0.54 North-West Paddington† 16.43 14.65 —1.78 16.43 —1.78 Wards— Harrow Road 19.02 13.06 —5.96 13.40 —0.34 Maida Vale 16.62 14.36 —2.26 14.61 —0.25 Westbourne 18.96 13.03 —5.93 13.67 —0.64 Church 17.03 17.51 +0.48 19.67 —2.16 Lancaster Gate (West) 15.01 11.05 —3.96 9.11 + 1.94 „ (East) 14.76 11.82 —2.94 9.94 + 1.88 Hyde Park 16.18 11.97 —4.21 12.94 —0.97 London 17.31 15.80* -1.51 17.18 —1.38 Kensington 17.05 14.90* —2.15 15.61 —0.71 Westminster 15.46 15.82* +0.36 17.45 —1.63 Marylebone 16.93 16.59* —0.34 18.15 —1.56 Hampstead 16.19 10.46* —5.73 11.68 —1.22 Willesden 16.98 12.39* —4.59 12.92 —0.53 * Based on Registrar-General's Quarterly Returns. † Identical with Queen's Park Ward. In the Adjacent Districts greater departures (diminutions) from the standard rates are to be noted in Hampstead and Willesden, but in both these districts much of the land is yet unbuilt on. Of the fully covered districts, none show reductions equal to that of the Borough—indeed, in Westminster there is an increase—corrected rate 15.82, standard 15.46. In all the districts last year's rates were below the four years' mean rates, varying from 1.63. in Westminster to 0.53 in Willesden. In Table 14 the mortality rates for each sex in six age-groups are compared with the mean rates for the past four years. As the data are for such a limited period, a minute criticism would be futile. It will suffice to call attention to the fact of higher rates being recorded in the following Wards for the sex—age groups specified:— Age-Groups. Ward. Males. Females. Queen's Park 0-, 15- 15-, 25-, 65- Harrow Road 15-, 65- 0-, 1-, 15-, 25-, 65- Maida Vale 1-, 65- 0-, 1-, 15-, 65- Westbourne 5-, 25-, 65- - Church 15-, 65- 1-, 5-, 15- Lancaster Gate (West) 0-, 5-, 15-, 25-, 65- 1-, 25-, 65- „ (East) 1-, 25- 25-, 65- Hyde Park 0-, 1-, 25- 1-, 5-, 25- Full particulars as to causes of death will be found in Tables V. (Sex and AgeDistribution, Borough) and Va (Wards, Persons, all ages) in the Appendix. 14 small-pox. TABLE 14. Death-rates. All causes. Sex. Age. Period. 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— 1905 140.98 131.71 155.17 182.74 114.55 138.72 127.75 164.38 111.11 74.74 144.44 Mean 160.96 164.40 118.73 178.51 144.56 155.43 162.07 188.78 101.40 110.21 127.37 1— 1905 16.83 17.65 16.28 12.93 12.09 19.92 17.81 22.47 - 27.50 20.06 Mean 21.13 21.82 13.80 23.87 18.40 16.64 19.51 29.34 13.82 20.60 10.82 5— 1905 2.15 2.29 1.32 2.24 1.56 - 5.01 2.35 6.07 - — Mean 2.47 2.66 1.48 2.47 3.08 1.90 2.55 2.69 0.76 1.64 1.50 15— 1905 2.64 2.58 1.17 5.06 3.21 1.86 1.85 3.08 2.68 Mean 2.74 3.05 1.74 2.73 3.07 2.99 3.08 2.74 1.98 1.03 2.22 25— 1905 11.21 11.83 10.26 9.36 10.27 11.19 13.67 11.78 8.80 13.05 10.80 Mean 12.51 12.92 10.96 12.89 10.81 12.84 12.17 16.16 7.57 10.13 12.13 65— 1905 88.25 91.90 73.17 102.70 76.92 95.09 74.20 127.27 94.89 55.94 73.73 Mean 86.90 83.32 84.18 125.66 74.89 90.44 63.20 115.57 56.27 78.41 104.20 F emales. 0— 1905 120.79 136.91 63.15 86.02 119.48 165.64 123.34 155.96 22.22 66.66 50.63 Mean 131.46 136.23 94.52 142.08 98.95 139.51 134.18 181.77 61.10 72.03 107.23 1— 1905 19.33 20.20 16.79 17.04 15.77 18.21 13.14 30.38 20.27 — 24.56 Mean 16.16 16.71 10.24 18.79 13.24 13.98 18.09 21.03 8.41 7.42 11.31 5— 1905 1.88 1.71 3.47 1.11 1.53 - 1.14 3.92 2.48 — 3.83 Mean 2.37 2.16 1.73 3.94 1.66 2.26 2.35 2.41 2.47 0.72 1.91 15— 1905 2.31 2.67 1.03 4.45 3.62 1.76 1.85 4.37 - - 1.37 Mean 2.06 2.50 0.89 3.18 3.18 1.35 2.53 2.87 0.46 0.31 1.47 25— 1905 8.34 9.15 6.12 9.90 9.84 8.09 8.45 9.78 5.43 5.69 6.67 Mean 8.57 9.83 5.67 9.37 9.53 8.43 9.08 12.30 5.01 4.38 6.29 65— 1905 77.28 74.07 78.28 103.55 80.38 85.34 57.70 85.34 76.38 105.48 64.44 Mean 76.02 77.80 68.65 83.24 79.33 79.88 64.04 100.65 58.77 60.80 74.02 Rates per 1,000 each sex-age group. Means for four years 1901-04. * Co-terminous with Queen's Park Ward. SMALL-POX. Borough. London. 1905. 1901. 1903. 1905. 1904. 1903. Cases notified 2 4 5 74 495 417 Deaths — 2 — 10 25 13 *Morbidity 0.01 0.02 0.03 0.02 0.10 0.09 †Fatality — 50.0 — 13.5 5.0 3.1 ‡Mortality — 0.01 — 0.00§ 0.00 0.00 * Notification rate per 1,000 persons, all ages. ‡ Death-rate per 1,000 persons, all ages. † Deaths per 100 notifications. § Indicates a rate less than 0.01. 15 DIPHTHERIA. Of the two cases reported in the Borough, one was erroneously diagnosed—the patient was returned forthwith from the hospital—and the other was an adult female very recently landed from South America. There had been a fatal case of smallpox on the steamship. This case was treated at home. The disease was much less prevalent throughout the country during the past year, and, moreover, the numbers of cases reported* in each quarter were progressively less. The appended statement shows the numbers reported to the Local Government Board in each quarter of the last two years :— Quarters 1 2 3 4 Year. Year 1905. 190-1. 1905. 1904. 1905. 1904. 1905. 1904. 1905. 1904. Metropolis ... 34 181 36 251 6 42 1-23 77 497 Provinces ... 1,093 1,345 602 1,519 310 1,098 271 1,283 2,276 5,245 Appended are the usual Vaccination statistics kindly supplied by Mr. House, the Vaccination Officer:— 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. 0, 7, & 8. Cols. 1 2 3 4 5 6 7 8 9 1901 3,364 2,676 5 313 89.0 23 34 313 11.0 1902 3,262 2,629 12 291 89.8 35 19 276 10.1 1903 3,315 2,621 10 296 88.2 48 32 308 11.7 1904 3,311 2,578 8 307 87.4 52 22 344 12.6 1905† Jan -June ) 1,640 1,232 5 139 83.9 81 24 159 16.1 * Including "gone away," "false addresses," apprisals to other districts, &c.† Provisional return only. DIPHTHERIA. (Including Membranous Croup.) Borough. London. 1905. 1904 1903. 1905. 1904. 1903. Cases notified 96 140 145 6,489 7,227 7,749 Deaths 3 19 15 546 723 740 Morbidity * 0.64 0.95 0.98 1.39 1.55 1.67 Fatality 3.1 13.7 10.3 8.4 10.0 9.9 Mortality 0.02 0.13 0.10 0.11 0.15 0.16 * See notes to statement under " Smallpox." The decline in the number of notifications of this disease in the Borough, recorded in each of the last three Reports, continued during 1905, 90 cases being reported as compared with 343 in 1901, 211 in 1902, 145 in 1903, and 140 in 1904. Last year's cases represent a decrease of 59 per cent. of the total for 1901. Comparing the totals for 1905 and 1904, the former show diminutions equal to 31.5 per cent. and 10.5 per cent. in the Borough and Metropolis respectively. Last year's morbiditv rate (0.64) was less than half that of the Metropolis (1.39), and was (even with the slightly higher figure obtained from the Registrar- * The figures are from the weekly returns of cases reported from 255 Boroughs and Urban Districts having a total population at the last census of 14,801,491 persons—excluding the Metropolis. 16 diphtheria. General's number) lower than that of any of the Adjacent Districts. (See Table 9, ante.*) The rate immediately above that of the Borough was recorded in Kensington (0.72), and the highest that of Willesden (1.99). Last year's total for the Borough (96) was but little more than one-third the corrected decennial average (270), that for the Metropolis (6,489) rather more than one-half. A complete comparison is given below:— Diphtheria : Notifications. (Including Membranous Croup.) Annual Averages (corrected and adjusted). 1905. 1895-99. 1900-1904. 1895-1904. London 6,489 13,492 10,177 11,815 Borough 96 336 206 270 St. Mary 80 236 137 185 St. John 9 35 26 31 North-West Paddington 7 65 43 54 The diminution in prevalence of the disease was not due to any marked fall at any particular part of the year, but was uniform throughout the year. Below will be found the figures for last year (each quarter for each of the three Registration Sub-Districts) set out in comparison with the uncorrected averages for the two five-year periods, 1895-99 and 1900-04. Diphtheria. St. Mary. St. John. North-West Paddington. Quarters 1. 2. 3. 4. 1. 2. 3.4. 1. 2. 3. 4. 1895-99 43 55 53 67 7 9 10 9 18 21 15 16 1900-04 31 30 51 41 7 8 3 8 6 5 11 21 1905 16 21 28 15 3 4 1 1 3 3 —1 Table 10 gives the numbers of cases reported from each Ward during the past two years. In Harrow Road Ward only was the number for last year (36) in excess of that of 1904 (32). The Borough's morbidity (sickness) rate for the disease last year (0.65) was lower than that of any of the Adjacent Districts (Table 9). The highest rate was that of Willesden (1.99), but the latter rate shows a greater diminution (0.86) from the mean for the four years 1901-04 than does the Borough rate (0.81). The 96 cases notified were received from 89 houses, distributed thus:— 1905. 1904. 1903. Houses with one case each 83 109 119 „ „ two cases 5 6 8 „ „ three „ 1 5 2 „ „ four „ — 1 1 In the family with three cases, the secondary cases were apparently due to delay (8 days) in certifying the first cases. Of the 5 houses with two cases, one can be ignored, the second case being subsequently certified as erroneously diagnosed. In a second, the nature of the first patient's illness was not discovered until the second case had been certified. In a third, the first patient was kept at home, and the second sickened after that patient had been freed from quarantine (18 days' duration). * The discrepancies between the rate as shown above and in Table 9 are due to differences between the totals obtained from the weekly returns issued by the Metropolitan Asylums Board (used above) and the returns issued quarterly by the Registrar-General (used in Table 9). 17 diphtheria. Of the 96 cases reported, 16 were certainly erroneously diagnosed, and 7 others probably so. Fourteen cases of erroneous diagnosis were removed to hospital. Imported infection appeared to have occurred in 5 cases. Two cases were reported in patients in hospital for other diseases. One case was a relapse. This patient returned from hospital on May 18th, and was found to be infectious on June 12th. In the meantime the patient's brother was taken ill (on June 7th) and removed to hospital (June 8th). Three cases were the same patients' second attacks of the disease. In one case only did death precede notification. Of the 96 cases, 86 were removed to hospital, equal to 89.5 per cent. of all cases, the highest proportion since 1901. (See Table 15.) The deaths recorded during the year numbered 3, as compared with 19 and 15 in the two preceding years. The fatality for the year was equal to 3.1 per cent. of all notifications, and 3.7 per cent. after deducting the known cases (16) of erroneous diagnosis. No death occurred among the 10 cases treated at home. The fatalitv among patients removed to hospital was only 4T per cent., one-third the rate for 1904 (12.2 per cent.). The mortality per 1,000 persons of all ages was 0.02, compared with a decennial mean rate of 0.33, a very striking difference. A complete comparison of last year's rates for the Borough and the Registration Sub-Districts, with the corresponding mean rates, is given below:— Diphtheria. Mortality rates per 1,000 persons of all ages. Mean Rates. 1905. 1895-1899 1900-1904. 1895-1904. Paddington 0.02 0.48 0.19 0.33 St. Mary 0.02 0.56 0.19 0.38 St. John — 0.13 0.09 0.11 North-West Paddington 0.05 0.65 0.39 0.52 Comparing the rate for the Borough with those for the Metropolis and the Adjacent Districts (Table 12), it will be seen that so low a rate as that for the Borough (0.02) was recorded in Westminster only. The reduction from the four years' mean was greatest in the Borough (0.20), that for Westminster (0.08) being the smallest. It seemed desirable to ascertain what differences the variations in the sex—age constitutions of the populations would have on the comparison of mortality. For this purpose "correction factors" have been calculated in the usual manner, the mean annual mortality for age-groups of each sex in London during the ten years 1891-1900 being taken as a standard. The "standard rates" for such of the Districts included in Table 16 as form the Western Boroughs of the Metropolis are very nearly equal, that for Paddington (0.39) being the highest and that for Westminster (0.32) the lowest. The standard rate for Willesden (0.56) is above that for London (0.50). The changes in the rates by the use of the correction factors are not marked, but the Borough rate now stands alone at the bottom of the list. The Willesden rate for last year (0.08) shows the greatest difference (0.48) from the standard rate, that for Paddington coming next with a fall of 0.37. 18 SCARLET FEVER. TABLE 15. Diphtheria. ]District. Cases Notified.* Cases to Hospital. Hospital Cases Percent. of Notified Cases. Deaths. Fatalities. Per cent. Cases At Home. At Hospital. At Home. At Hospital. Wards— Queen's Park 7 (2) 7 (2) 100 - 1 - 20.0 Harrow Road 36 (3) 35 (2) 97 - 1 — 3.0 Maida Vale 10 (1) 9 (1) 90 - - — — Westbourne 17 15 88 — 1 — 6.6 Church 18 (9) 17 (8) 94 — 1 (1) — — Lancaster Gate(West) 2 (1) 2 (1) 100 — - — — „ (East) 4 — — — - — — Hyde Park 2 1 50 — - — — Borough Percentages 1905 96 (16) 86 (14) 89.5 - 4 (1) - 4.1 1904† 140 (15) 101 (11) 72.1 5 12 (1) 14.2 12.2 1903 145 (22) 123 (15) 84.8 2 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. TABLE 16. Corrected Mortality—Diphtheria. Standard Rate. Correction Factor. Corrected Rates. Differences, 1905, from 1905. Mean, 1901-04. Standard Rate. Mean Rate. London 0.50 - 0.11 0.21 — 0.39 — 0.10 Paddington 0.39 1.27891 0.02 0.28 — 0.37 — 0.26 Kensington 0.36 1.37657 0.04 0.20 — 0.32 — 0.16 Westminster 0.32 1.58515 0.03 0.15 — 0.29 — 0.12 Marylebone 0.37 1.36729 0.04 0.24 — 0.33 — 0.20 Hampstead 0.36 1.36920 0.04 0.17 — 0.32 — 0.13 Willesden 0.56 0.89729 0.08 0.24 — 0.48 — 0.16 SCARLET FEVER. Borough. London. 1905. 1904. 1903. 1905. 1904. 1903. Cases notified 277 365 414 19,469 13,451 12,545 Deaths 6 8 9 549 365 361 Morbidity* 1.87 2.48 2.83 4.15 2.89 2.71 Fatality 2.1 2.1 2.5 2.8 2.7 2.8 Mortality 0.04 0.05 0.06 0.11 0.07 0.07 * See notes under Smallpox 19 SCARLET FEVER. Although there has been an increased prevalence of this disease in the Metropolis as a whole during the last two years, the number of cases reported in the Borough during each year has decreased. The variations in prevalence in the Borough and the Metropolis since 1901 are set out below:— Borough. London. Increase ( + ) Decrease (—) Increase ( + ) Decrease (—) Cases reported. Cases reported. per cent. per cent. 1901 503 — 18,381 — 1902 359 —28.7 18,252 — 0.7 1903 414 +15.3 12,545 —31.3 1904 365 —11.9 13,439 + 7.1 1905 277 —24.2 19,469 +44.8 The only year in which the progressive decrease in the Borough was checked was 1903. During that year there was a high prevalence of the disease in Willesden, the morbidity rate for that year being 3.90 per 1,000 persons, and 0.14 above that for the preceding year (3.82).* The decennial average number (1895-1904) for the Borough is 503, last year's figure showing a reduction equal to 45 per cent. The complete figures for the Borough and the Registration Sub-Districts are given below:— Scarlet Fever : Notifications. Averages. Corrected and adjusted. 1905. r 1895-99. 1900-04. 1895-1904. London 19,469 21,844 15,604 18,684 Borough 277 603 405 503 St. Mary 194 437 302 367 St. John 59 75 52 64 North-West Paddington 24 91 51 72 In the St. John Sub-District only does last year's total (59) fail to compare favourably with all the averages. On comparing the numbers recorded in each quarter of last year with the averages for the two preceding quinquennia, it appears that the incidence of the disease was unequal. Thus, in St. Mary's Sub-District, the cases recorded in the first two quarters were but slightly below the averages, and the usual autumnal increase was not marked. In St. John's Sub-District the cases in the second quarter were in excess of the averages,† and the autumnal increase was almost absent. In North-West Paddington the cases in the first half of the year were markedly below the averages, while the autumnal increase was fairly marked. Scarlet fever. Averages—not corrected or adjusted. St. Mary. St. John. North-West Paddington. Quarters 1 2 3 4 1 2 3 4 1 2 3 4 1895-99 71 78 127 105 16 18 21 20 16 17 33 30 1900-04 58 57 83 95 10 13 14 13 9 11 18 15 1905 51 45 58 40 17 20 8 14 2 4 11 7 * See pages 7 and 19, Annual Report, 1905. † There was a slight outbreak in connection with one of the schools in this District. 20 SCARLET FEVER. Distributing the cases according to Wards (Table 10), it is seen that there were increases in three Wards, viz., Maida Vale, Lancaster Gate—West and East. The greatest decreases were in Oueen's Park and Harrow Road Wards. In comparison with the Adjacent Districts (Table 9), the Borough rate (1.87) was the lowest, and showed the greatest diminution (0.94) from the mean for the four years. The highest rate was that of Willesden (2.87). The Kensington rate was the same as that of the Borough, but the diminution from the mean rate was only 0.16. The 277 cases reported were from 225 houses, distributed thus:— 1905. 1904. 1903. Houses with 1 case each 185 225 239 „ 2 cases each 31 35 58 „ 3 „ 6 10 11 „ 4 ,, 3 7 — „ 5 or more cases each — 2 4 Of the 31 instances of two cases in a house, one can be dismissed, both cases being ultimately found to have been erroneously diagnosed; while in another case the second patient (an infant) was taken to hospital with the mother, and developed the disease there. Of the remaining 29 instances, 4 were due to return infection, and in 5 the second case occurred whilst the first was under treatment at home. In 9 instances the two cases were reported together. The instances in which 3 and 4 cases occurred in the same house were due to circumstances over which the Department had no control. The inquiries made after notification indicate that 15 patients were infected beyond the Borough, 7 being by discharged patients, and that 3 contracted the disease in hospitals. The number of cases known to have been erroneously diagnosed was 15, and the diagnosis was doubtful in 4 others. The cases removed to hospital for isolation numbered 247 out of 277, equal to 89.1 per cent., a proportion exceeded once only—viz., in 1903, when the percentage was 91.3— since 1901. All the cases in Lancaster Gate East Ward were removed to Hospital; the removals from Maida Vale Ward constituted the smallest proportion (67 per cent.). The deaths recorded during the year as due to scarlet fever numbered 6, two less than the total for 1904. The fatality during the year was at the rate of 2.1 per cent. of notified cases. Among the 232 cases of the disease removed to hospital, 4 deaths (equal to 1.7 per cent.) occurred. That proportion is the smallest recorded since 1901. (See Table 17.) The mortality was at the rate of 0.04 per 1000, half the decennial mean rate, and one-third the mean rate for the five years 1895-99. (See also below.) Scarlet Fever. Mortality per 1,000 persons of all ages. Mean Rates. 1905. 1895-99 1900-04 1895-1904. Paddington 0.04 0.12 0.05 0.08 St. Mary 0.03 0.12 0.07 0.09 St. John 0.05 0.07 o.oo 0.04 North-West Paddington 0.05 0.21 0.06 0.13 21 SCARLET FEVER. Comparing last year's rate for the Borough with those for the Districts given in Table 12, the local rate was lower than all the others, that for Willesden excepted, where the rate was 0.03. Last year's rates for the four adjacent Metropolitan Boroughs were in excess of the respective mean rates, those for Paddington and Willesden less. The rates, after correction for differences in sex and age proportions, are given in Table 18 In Kensington, Westminster and Marylebone the rates for last year were above the standard rates, in Paddington and Willesden below. In the two latter districts also last year's rates were less than the mean rates for the four years 1901-01, the rates for all the other districts being higher. TABLE 17. Scarlet Fever. Cases Notified.* Cases to Hospital. Hospital Cases Per cent. of Notified Cases. Deaths. Fatalities percent. cases. At Home. At Hospital. At Home. At Hospital. Wards— Queen's Park 24 (1) 20 (1) 83 — 1 — 5.2 Harrow Road 77 (3) 76 (2) 99 — — — — Maida Vale 33 (4) 22 (2) 67 — 1 — 5.0 Westbourne 38 (4) 34 (3) 89 — — — — Church 51 (3) 50 (3) 98 — 1 (1) — — Lancaster Gate( West) 26 (3) 21 (3) 81 — - — — „ (East) 10 (1) 10 (1) 100 — — — — Hyde Park 18 14 78 - 2 - 14.2 Borough Percentages 1905† 277 (19) 247 (15) 89.1 - 5 (1) - 1.7 1904 365 (9) 324 (7) 88.7 — 9 — 2.8 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 15. † Two other deaths from scarlet fever were registered during the year from Church Ward. One belonged to 1904, and has been added thereto, and the other was after a notification of diphtheria (error). TABLE 18. Corrected Mortality—Scarlet Fever. Standard Rate. Correction Factor. Corrected Rates. Differences, 1905, from 1905. Mean, 1901-04. Standard Rate. Mean Rate. London 0.17 - o.11 0.09 -0.06 + 0.02 Paddington 0.13 1.27045 0.05 0.07 -0.08 -0.02 Kensington 0.12 1.36601 0.15 0.09 + 0.03 + 0.06 Westminster 0.11 1.55555 0.12 0.09 + 0.01 + 0.03 Marylebone 0.12 1.35389 0.14 0.13 + 0.02 + 0.01 Hampstead 0.12 1.38885 0.08 0.06 -0.04 + 0.02 Willesden 0.19 0.89921 0.02 0.06 -0.17 -0.04 22 FeveR. "FEVER." (Including Typhus, Enteric and Continued Fevers). Borough. London. 1905. 1904. 1903. 1905. 1904. 1903. Cases notified 46 48 47 1,576 1,936 2,408 Deaths 6 10 8 237 292 376 Morbidity* 0.31 0.32 0.31 0.33 0.41 0.50 Fatality 13.0 20.8 17.0 15.0 15.0 15.6 Mortality 0.04 0.07 0.05 0.04 0.06 0.07 * See notes under Smallpox. The 46 cases of "fever" notified in the Borough were all cases of enteric (typhoid) fever,* and is the smallest recorded since 1901. In the Metropolis 1,576 cases of "fever" were recorded, including 1,552 of enteric (351 fewer than in 1904), 14 of continued (half the number for 1904), 9 of typhus (an excess of 6 over the number for 1904) and 1 of relapsing fever. Confining the attention to enteric and continued fevers—practically the two terms designate one disease, viz., enteric fever—the cases reported during the year in the Borough were 29 below the decennial average (75)—equal-to a reduction by 38.7 per cent. Last year's total for the Metropolis (1,566) was 1,907 below the decennial average (3,443)—equal to a reduction by 54.6 per cent. A complete comparison of the averages, &c., is given below:— Enteric Fever. (Including Continued Fever.) Cases Notified. Averages, corrected and adjusted. 1905. 1895- 99. 1900—1904. 1895—1904. London 1,566 3,740 3,139 3,447 Paddington 46 84 69 75 St. Mary 34 60 51 55 St. John 8 15 10 12 North-West Paddington 4 9 8 8 The greatest diminution occurred in the second quarter of the year, and the least in the fourth, as may be seen from below:- Quarters 1 2 3 4 Registration Sub-Districts St. Mary 6 (10) 1 (8) 10 (14) 17 (20) St. John 1 (3) 1 (2) 2 (3) 4 (5) North-West Paddington 1 (2) -(1) 1 (3) 2 (3) The figures in parentheses are the uncorrected decennial averages. The only Wards in which the numbers of cases reported in 1905 exceeded those of 1904 were Queen's Park and Maida Vale. (See Table 10.) The figures and rates for the Adjacent Districts will be found in Tables 7 and 8. In one instance only did more than one case occur in any house. This case will be dealt with specially later on. By inquiries made after notification it was ascertained that 4 cases were diagnosed erroneously, and two others possibly so. Of the remaining 40 cases, 22 (viz., 13 primary and * But for an outbreak of 9 cases attributable to an imported case treated at home, last year's total would have been much lower. In addition to the 46 cases reported within the Borough, a case was reported from Scarborough, and one fatal case occurred in a Lunatic Asylum. The former patient may have been infected in Paddington, the latter was certainly not. FEVER. 23 9 secondary) were due to infection received outside the Borough. In certain other cases— the patients having had food in other Districts—similar importation of infection was suspected. Shellfish was known to have been eaten by 7 patients within the limits of the incubation of the disease, but no evidence could be obtained of such fish being the vehicle of infection. In 4 cases the shellfish were oysters, in 2 periwinkles, and in 1 mussels. Of the 46 cases reported, 31 were removed to hospital (Infirmary, &c.) for isolation and treatment—the latter being for the patient the more important element. Among the cases kept at home, the fatality (deaths per cent. of notifications) was 33.3, while among those removed only 7.4. A reference to Table 19 (last two columns) will demonstrate the value of the skilled nursing and dieting available in hospitals. The corrected number of deaths from enteric fever was 6, 4 fewer than in 1904. Included in that total is the death of an inmate of a lunatic asylum chargeable to Paddington, who contracted the disease in the asylum. The mortality for the year was 0.04 per 1,000 persons, less than half the decennial mean rate (0.09). The rates for the year in the Registration Sub-Districts are compared with the respective means below:— Enteric Fever. Per 1,000 persons of all ages. Mean Rates. 1905 1895-99 1900-04 1899-1904 Paddington 0.04 0.11 0.08 0.09 St. Mary 0.05 0.10 0.08 0.09 St. John 0.02 0.10 0.03 0.06 North-West Paddington - 0.17 0.11 0.14 TABLE 19. Enteric Fever. District. Cases Notified* Cases to Hospital. Hospital Cases Per cent. Notified Cases. Deaths. Fatalities At Home. At Hospital. per cent, cases. At Home. At Hospital. Wards— Queen's Park 4 (1) 2 (1) 50 - - - - Harrow Road 8 5 62 2 1 66.6 20.0 Maida Vale 17 (1) 13 (1) 76 - 1 - 8.3 Westbourne† 6(1) 5 (1) 83 1 1 (1) 100 - Church 5 (1) 5 (1) 100 - - - - Lancaster Gate (West) 2 - - - - - - „ „ (East)‡ 1 - - 1 - 100 - Hyde Park 3 1 33 1 - 50 - Borough Percentages 1905 46 (4) 31 (4) 67.3 5 3 (1) 33.3 7.4 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 (6) 65.0 5 8 19.2 6.2 1901 92 (?) 58 (?) 63.0 5 10 14.7 17.6 * See foot-note * to Table 15. †One additional death belonging to this Ward recorded in a lunatic asylum. As the case was not certified during life, the death has been excluded from the Table. ‡ The case in this Ward was in the person of a non-resident. The case terminated fatally, and the death has been allocated to Kensington, whence the deceased came. § One death (from Church Ward) has been excluded from the Table as the case was not certified during life. 24 fevEr. The mortality rates for the Adjacent Districts will be found in Table 12. Rates below that for the Borough were recorded in Westminster and Hampstead (0.02 in each cases The highest rate (0.07) was recorded in Kensington and Willesden. After correction sex-age differences in populations, the local rate (Table 20) becomes 0.02, and is lower the that of any of the Adjacent Districts, Westminster excepted. The differences from the standard rates are fairly great. Last year the greatest difference was that in Westmins (0.14), Paddington coming next (0.12), and Kensington last (0.07). TABLE 20. Corrected Mortality—Enteric Fever. Standard Rate. Correction Factor. Corrected Rates. Differences, 1905, from 1905. Mean, 1901-04. Standard Rate. Mean Rate. London 0.14 - 0.04 0.08 -0.10 -0.04 Paddington 0.14 0.99635 0.02 0.06 -0.12 -0.04 Kensington 0.14 1.01853 0.07 0.06 -0.07 †0.01 Westminster 0.15 0.93441 0.01 0.07 - 0.14 - 0.06 Marylebone 0.14 0.98552 0.03 0.06 - 0.11 - 0.03 Hampstead 0.14 0.99677 0.04 0.06 - 0.10 - 0.02 Willesden 0.14 0.99887 0.06 0.05 - 0.08 † 0.01 In the majority of cases of enteric fever the infection gains access to the system through food or water. Of recent years more attention has been given to the danger of the disease being conveyed directly from person to person. Two channels for such conveyance are easily thought of—namely, neglect to properly cleanse the hands after attending to the patient (the usual means of infection in the case of nurses) and washing infected bed or body linen. Comment has been made in previous reports on the occurrence of multiple cases in households apparently due to direct infection from the primary patient. A more striking instance of the dangers attending the retention of patients in homes where every appliance and attention necessary for eradicating infection do not exist, has not hitherto come to the knowledge of the Department, and is here described. It will be useful, however, as a preliminary to recall the frequency of multiple infection of households recorded in previous Reports. In 1897 attention was first directed to this subject, 3 cases occurring during the year among the Nursing Staff at St. Mary's Hospital. (Page 26.) In 1898 six groups of multiple cases were specially dealt with, in 5 of which direct, personal infection was believed to be the main, if not the only, cause of the succession of cases. (Page 30.) In 1899 multiple cases were reported in 8 houses (7 with 2 cases and 1 with 3). In 2 houses the personal element was very clear. (Page 35.) In 1900 four such cases were reported, one being a nurse at St. Mary's Hospital. (Page 21.) In 1901 only one such case occurred. (Page 34.) In 1902 two houses had two cases during the year; and one, 3. No instance of direct personal infection was recorded. (Page 23.) . FEVER. 25 In 1903 multiple cases occurred in 5 houses (4 houses, 2 cases; 1 house, 3). In two instances direct personal infection was apparently the cause of the secondary cases. (Page 24.) In 1904 multiple cases occurred in 5 houses (2 houses 2 cases, and three houses with 3, 4 and 5 cases each). In 3 out of the five groups, all channels of infection except the direct personal appeared to he excluded bv the inquiries made. (Page 2(5.) In 1905 multiple cases occurred in one house only. The particulars were as follow:— K. Y., f., æt. 7, returned to her home from Teignmouth on September 1st. She was reported to have had shellfish (periwinkles, and possibly other varieties) whilst at the seaside. She was certified to be ill with enteric fever (after a positive result with the Widal test) on September 9th. The history given of her attack was that she had been ailing since August 26th, and had taken to her bed on September 3rd. The patient was kept at home.* A communication to the Medical Officer of Health of Teignmouth elicited the following information:—"With regard to shellfish. The estuary of the Teign is polluted with the crude sewage of some 30,000 (persons) and every year I hear of visitors apparently contracting enteric (fever) by this means. Local cases are comparatively rare, though some thirty per cent. of our few typhoids (sic) can be traced to the like cause." On September 25, S. F., m., æt. 9, residing in the same house as K. Y., was reported ill, and removed to hospital the same day. His case was erroneously diagnosed, although a Widal test made before notification gave a positive result. On October 18th, H. H., f., aet. 29—a district nurse—was removed to University College Hospital, ill with the disease. She had been attending K. Y., and sickened October 15th. An aunt of K. Y., in service in the country, whilst in Town for her holiday, assisted to nurse the patient. The aunt was taken to a nursing home, after her return to the country ill with the disease. She sickened about October 10th. Disinfection after K. Y.'s illness was carried out on October 24th. On October 14th, M. Y., f., æt. 42, K. Y.'s mother, sickened and was removed to hospital on the 28th. She died on November 7th. Cases continued to occur in the house at intervals until the end of December. The dates of the successive cases are set out below:— Patient. Sickened. Removed to Hospital. Disinfection carried out. Notes. K. Y., f. 6 26 viii. No 24 x. S. F., m. 9 18 ix. 25 ix. 25 ix. Error. Widal positive result. - Y., f. adult ? 18 x. ? Aunt of k.y.- ill in country. H. H., f. 29 15 x. 19 x. 20 x. Nursed K.Y.- resident elsewhere. M. Y., f. 42 14 x. 30 x. 30 x. Mother of K.Y. A. Y., f. 14 16 x. 30 x. Slept with A. Y. until 10 xii. C. F., m. 6 21 x. 30 x. C. F., m. 12 22 xi. 8 xii. 8 xii. A.Y., m. 9 3 xii. 7 xii. 7 xii. A. Y., f. 19 7 xii. 13 xii. 13 xii. F.Y., m. 1 19 xii. (?) 29 xii. 29 xii. * The Medical Officer of Health was away on leave at the time. 26 SEPTIC DISEASES. The Y. and F. families resided in the same house, the former (comprising father, mother, and 5 children) occupying the ground floor (3 rooms), the latter (comprising the same number of persons) the basement (2 rooms). There was no legal overcrowding. Of the Y. family all the members were reported ill with the disease except the father, who, however, had a slight illness of short duration and uncertain nature towards the end of November. Of the F. family two only were affected. Very special attention was given to the disinfection of the house after each case, staircases, closets (2), &c., being sprayed with formalin, and the closet apparatus, gulleys, &c., flushed with the same disinfectant. It is remarkable that there was no case among the four other families occupying the upper floors of the house. The intervals between each attack in the Y. family, especially if the periods which elapsed between the onsets of the cases and dates of removal to hospital be taken into consideration, point clearly to transference of infection from person to person. Beds were shared by the children, but no note was made of the persons sleeping with each patient, except in the last two cases. As regards the F. family, some suspicion was aroused that this family might have been infected by clothes brought down from the ground floor to be washed in the wash-house (common to the whole house) which is in the basement. Against that theory is the fact that the other families residing in the house escaped—although they used the wash-house. On the whole, it appears to be more probable that the two F. lads were infected directly from the Y. children. The experience here set out makes it clear that cases of enteric fever cannot be safely treated in tenement houses, and in future all cases will be removed to hospital. The facts given above should be sufficient to convince any Court of the urgency of such removal, should it be necessary to resort to legal measures. SEPTIC DISEASES* Puerperal Fever. Borough. London. 1905. 1904. 1903. 1905. 1901. 1903. Cases notified 7 10 3 291 274 231 Deaths 1 6(8) 2 (4) 185 218 169 Morbidity* 0.14 0.15 0.06 0.22 0.21 0.18 Fatality† 14.3 60.0 66.6 63.5 79.5 72.29 Mortality‡ 0.02 0.12 0.08 0.14 0.17 0.13 * Sickness rate per 1,000 females aged 15-45 years. † Deaths per 100 cases notified. ‡ Death-rate per 1,000 females aged 15-45 years. There was a decrease in the number of cases of this form of "fever" reported in the Borough during the past year, but the total number of cases (7) was more than double the total for 1903 (3) and only one below the corrected decennial average. In the whole Metropolis there was a rise from 274 cases in 1904 to 291 last year, the corrected decennial average being 276 cases. The numbers of cases reported in the Adjacent Districts and the morbidity rates will be found in Tables 7 and 8. In Church Ward only were the cases reported last year equal to the number for 1904. (See Table 9.) * Under this heading are included "erysipelas," "other septic diseases," and "puerperal fever," the first and last being included in the schedule for notification. septic diseases. 27 Rates based on the numbers of births registered and the numbers of females of childbearing ages, are set out below:— Puerperal Fever. Morbidity rates per 1,000 Females aged 15-45. Births registered. 1905. 1904. 1905. 1904. Paddington 0.14 0.15 2.19 3.03 London 0.23 0.21 2.31 1.90 Kensington 0.06 0.17 1.15 3.18 Westminster 0.20 0.08 4.08 1.72 Marylebone 0.13 0.06 2.29 1.07 Hampstead 0.06 0.18 1.40 4.19 Willesden 0.33 0.13 3.14 1.15 Only one death from this cause was registered in the Borough, the smallest total recorded since 1891. The mortality and fatality rates for the Borough and the Adjacent Districts are set out below:— Puerperal Fever: Death-rates. Mortality per 1,000 Females aged 15-45 years. Births registered. Fatality per 100 cases notified. 1905. 1904. 1905. 1904. 1905. 1904. Paddington 0.02 0.12 0.31 2.42 14.3 80.0 (60.0) London 0.14 0.17 1.45 1.68 63.1 79.5 Kensington 0.04 0.07 0.86 1.44 75.0 45.4 Westminster 0.10 0.01 2.04 0.34 50.0 20.0 Marylebone 0.02 - 0.38 - 16.6 - Hampstead - 0.12 - 2.79 - 66.6 Willesden 0.23 0.13 2.17 1.15 69.2 100 The figures given just above represent only a part of the mortality in childbed. Even when the deaths scheduled under " accidents and diseases of parturition" are added, it is not certain that the full total is obtained, as the occurrence of labour immediately before death is not always included in the certificate. The deaths from "puerperal fever" and "accidents, &c., of parturition" in the Borough numbered 10, equal to a rate of 0.06 per 1,000 persons, or 0.03 below the decennial mean (0.09). In St. Mary's Sub-District the rates were the same (O.OO last year, 0'09 mean); in St. John, 0.17, mean 0.05; and in North-West Paddington (where the death from puerperal fever occurred) 0.16, mean 0.15. Calculating the mortality on the corrected numbers of children whose births were registered during the year, the following rates are obtained:— Rates per 1,000 Births. (Corrected.) 1904. 1905. Borough 4.32 3.03 St. Mary 4.53 2.45 St. John 4.92 2.37 North-West Paddington 2.41 7.01 28 SEPTIC DISEASES. Similar rates, but not corrected as above, are given below for the Adjacent Districts, &c., during the past five years:— Mortality in Childbed. Per 1,000 births registered. Paddington. London. Kensington. Westminster. Marylebone. Hampstead. Willesden. 1901 2.67 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 1904 4.55 2.91 3.48 2.76 3.94 6.98 3.47 1905 3.13 2.85 2.02 4.42 3.43 3.51 4.11 Partly from Reports of Registrar-General, and partly from information kindly supplied by the Medical Officers of Health. Other Septic Diseases. Erysipelas.—This is the only variety scheduled for notification. The cases reported during the year numbered 136, 19 more than the total for 1904. In the Metropolis the cases numbered 4,975, 21 in excess of the previous year's total. The total for the Borough was 7 less than the decennial average (143), that for the Metropolis 526 less than the average (5,501). Last year's morbidity rates were 0.92 in the Borough and 1.06 in the Metropolis. In St. Mary's Sub-District 102 cases were reported, the decennial average being 110; in St. John's, 16, average 17 ; and in North-West Paddington 18, average 16. Multiple cases occurred in two houses, in one the husband being infected by his wife, and in the other the second case occurred (in a different family) nine months after the first. Eighteen of the cases were treated in hospital or workhouse infirmary. The deaths during the year from erysipelas numbered 7, giving a mortality equal to 0.04 per 1,000 persons, and a fatality of 5.1 per 100 cases notified. In the Metropolis the mortality was 0.05 and the fatality 4.5. The deaths in the Borough from the remaining forms of septic disease numbered 10, one more than in 1904, and included 2 each from "stomatitis," "pyaemia," and "infective endocarditis," and one each from "cellulitis," "carbuncle," "angina ludovici" and "septic laryngitis." The mortality from all diseases scheduled as "other septic diseases" was 0.11, the decennial mean rate being 0.10. Full comparison is made below:— Other Septic Diseases : Death-rates. (Including Erysipelas.) Per 1,000 persons. Mean Rates. 1905. 1895-99. 1900-04. 1895-1904. Borough 0.11 0.10 0.10 0.10 St. Mary 0.10 0.11 0.13 0.12 St. John 0.14 0.08 0.05 0.07 North-West Paddington 0.11 0.09 0.03 0.06 MEASLES. 29 MEASLES. During the past year 1,714 cases of measles came to the knowledge of the Department, chiefly from particulars supplied by the school-teachers. In 190-1, 890 cases were reported or discovered, and, in 1903, 929. Weekly records are kept of the cases newly investigated, and from those records the following statement has been compiled:— Quarters 1 2 3 4 Year. St. Mary 196 570 244 286 1,296 St. John 12 116 41 1 170 North-West Paddington 19 209 7 1 236 1905 227 895 292 288 1,702 1904 723 94 18 23 858 1903 ... 42 147 185 362 736 The total for each year is always in excess of the number recorded by the weekly analysis. Last year there were 63 deaths (23 of males and 40 of females), the fatality (per 100 known cases) being 3.6. In 1904 the fatality was at the rate of 4.3 per cent., and, in 1903, 4.1. It is not easy to say why the fatality decreased, but two suggestions may be put forward:— (a) Either a larger proportion of the cases came to the knowledge of the ment; or, (b) The time of year at which the greater number of attacks occurred was more favourable to a recovery. Thus, in 1903, 55 per cent. (approximately) occurred in the 1st and 4th quarters of the year; in 1904, 87 per cent.; and in 1905, only 30 per cent. The fatality for each sex—per 100 known cases—has been:— 1905 Male, 2.9 Female, 4.2 1904 „ 5.2 3.5 1903 „ 5.2 3.1 The Ward distribution of cases and the corresponding fatalities for the past three years are given below Queen's Park c. d. f. Church c. d. f. 1905 244 3 1.2 1905 434 25 5.7 1904 288 15 5.2 1904 129 5 3.8 1903 50 4 8.0 1903 321 15 4.6 Harrow Road 1905 461 20 4.3 Lancaster Gate (West) 1905 27 - - 1904 231 10 4.3 1904 54 1 1.8 1903 185 8 4.3 1903 10 - - Maida Vale 1905 185 5 2.7 Lancaster Gate (East) 1905 65 1 1.5 1904 69 6 8.7 1904 27 1 3.7 1903 113 2 1.7 1903 11 - - Westbourne 1905 187 7 3.7 Hyde Park 1905 111 2 1.8 1904 79 1 1.2 1904 19 - - 1903 221 9 4.0 1903 18 1 5.5 C.—Cases. D.—Deaths F.— Fatality per 100 Cases. In 1903, 896 cases of measles occurred in 496 houses (average 1.08 per house); in 1904 there were 929 cases in 491 houses (average 1*8); and, in 1905, 1,714 cases in 958 houses 30 measles. (average 1.7). The frequency of multiple infections is further shown by the following tabulation:— 1905. 1904. 1903. Houses with 1 case each 495 237 242 „ 2 cases „ 257 166 141 „ 3 „ „ 143 59 60 „ 4 „ „ 43 25 30 „ 5 ,, ,, 16 5 10 „ 6 „ „ 4 3 3 „ 7 ,, „ - 1 3 „ 8 „ „ - - 2 In 1903 the "single attacks" (that is, instances of only one attack in the house) constituted 26 per cent, of the whole; in 1904, 24 per cent.; and, in 1905, 29 per cent. With a more general infection of the District, it would be expected that the proportion of " single attacks " would have been lower, not higher. The numbers of cases and deaths in the three Registration Sub-Districts at various ages (distinguishing the sexes) are given below:— TABLE 21. Measles: 1905. Registration Sub-Districts. Ages. 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 29 54 74 92 70 83 86 94 121 107 176 230 3 6 5 19 Deaths 4 10 8 15 5 3 - 5 3 1 1 2 — — - - St. John Cases 3 7 7 12 8 15 15 12 15 22 49 50 1 - 3 2 Deaths - 1 - 2 — - - - - — - - - - - - North-West Paddington Cases 5 4 15 15 7 15 21 15 22 25 41 56 1 2 Deaths 1 - 1 1 - - - - - - - - - - - - Borough. Fatality per 100 known cases 1905 13.5 16.9 9.3 15.1 5.8 2.6 . 4.1 1.8 0.6 0.3 0.5 - - - - 1904 26.9 20.9 13.6 3.8 1.7 3.8 3.1 4.7 1.2 1.2 2.2 1.2 - - - 5.5 1903 7.1 12.9 19.1 7.6 14.7 9.6 - - - 1.2 - - - - - - The data contained in the foregoing table indicate that the age of three years is a crucial point in the fatality of measles. This is shown also if the fatalities be calculated on cases and deaths above and below that age. In 1904 there were 278 cases (150 males and 128 females) at ages under 3 years, and 26 deaths (17 males and 9 females). The fatalities per 100 known cases were— Males, 11.3 | Females, 7.0 | Persons, 9.3 At ages of 3 years and upwards there were 618 cases (292 males and 326 females) and 13 deaths (6 males and 7 females). The fatalities were— Males, 2.0 | Females, 21 | Persons, 2.1 MEASLES. 31 In 1005 there were 515 cases (218 males and 297 females) at ages under 3 years, and -51 deaths (19 males and 32 females). The fatalities were— Males, 8.7 | Females, 10.7 | Persons, 9.9 At ages of 3 years and upwards there were 1,199 cases (559 males and 640 females) and 12 deaths (4 males and 8 females). The fatalities were— Males, 0.7 | Females, 1.2 | Persons, l.0 It may also be noted that the proportions of cases under 3 years to the total known cases were 31.0 per cent. in 1904 and 29.7 in 1905—a fact which in part accounts for the lower fatality. The mortality (rate per 1,000 persons of all ages) was 0.42, or 0.16 above the rate for 1904. In St. Mary's Sub-District there was an increase of 0.35, in St. John's of 0.02, but a decrease of 0.72 in North-West Paddington. Last year's rates are compared with the various means below :— Measles: Death-rates Per 1,000 persons. Mean Rates. 1905. 1895-99. 1900-1904. 1895-1904. Borough 0.42 0.37 0.30 0.33 St. Mary 0.58 0.44 0.37 0.41 St. John 0.08 0.09 0.09 0.09 North-West Paddington 0.17 0.51 0.34 0.42 In the Adjacent Districts (Table 12) the highest rate was that of Willesden (0.36) and the lowest that of Hampstead (0.09). The local rate was 0.41, and is the only rate in excess of the mean for the four years. Having regard to the special incidence of fatality and mortality, proper correction for varying proportions of the different sexes, &c., appear to be eminently desirable. "Correction factors" for the Adjacent Districts, &c., have been calculated during the past year, and in Table 22 the completely corrected rates for those districts for last year will be found together with the means for the four years 1901-04. TABLE 22. Corrected Mortality—Measles. Standard Rate. Correction Factor. Corrected Rates. Differences, 1905, from 1905. Mean, 1901-04. Standard Rate. Mean Rate. London 0.58 - 0.36 0.46 - 0.22 - 0.10 Paddington 0.43 1.28504 0.52 0.36 † 0.09 † 0.16 Kensington 0.47 1.24697 0.38 0.46 -0.09 - 0.08 Westminster 0.36 1.62534 0.34 0.38 - 0.02 - 0.04 Marylebone 0.42 1.37716 0.39 0.49 - 0.03 -0.10 Hampstead 0.40 1.44384 0.12 0.16 - 0.28 -0.04 Willesden 0.66 0.87562 0.31 0.34 - 0.35 - 0.03 In Paddington only was last year's rate above the "standard" and the mean rate. 32 measles. Since 1903 systematic efforts have been made to check the spread of measles, and the statistics given above appear to justify the belief that those efforts have not been entirely unsuccessful. Three years constitute too short a period for definite conclusions, and, moreover, in 1903 and 190-1 the system was undoubtedly not working as efficiently as it is at present. Most of the cases are reported by the school teachers, and, although there has been a very great improvement in the promptitude of reporting, certain teachers are still slow in sending the information. It is not uncommon to hear of attacks, not through teachers of the schools attended bv the patients, but through teachers of other schools to which other families in the house send children. For this there is some excuse, as many parents report "cold" or other indefinite complaint to the school, while recognising, and confessing to the other residents in the house, the true nature of the illness. The efforts of the Department are very seriously handicapped if cases, and especially the first cases, are not reported at the very earliest possible date. It is better to report a suspicion than to wait for a certainty. One verv serious defect in the present system is the want of co-operation on the part of the Sunday Schools. A few of those schools seek for information from the Department and exclude children from infected houses, but none send any information. As the Department depends on the schools for information, cases occurring during the holidays largely escape supervision. How this defect is to be remedied, except by the introduction of compulsory notification, it is impossible at present to say. t Since the issue of the Order made by the County Council in 1903, disinfection has been regularly carried out after cases of measles. The total number of such disinfections last year was 1,078. Some scepticism exists as to the need or utility of disinfection. One objection— perhaps the most usual—is that several disinfections will be required in the same family. Last year disinfection after this disease was carried out twice for 36 families, and three times for one. It may be useful to give some particulars:— 36 families 2 disinfections. In 8, the second attack appears to have had an independent origin, as may be judged from the intervals April—October (a) | April—June | April—July | March—May | March—November (a) April—May—June (b) | February—April | January—April (a) (а) The second cases here were reported to be second attacks in the original patient. (b) The sequence of events in this family was as follows:— N.B., sickened 8 iv.; A. B., sickened 15 iv. Disinfection 22 iv. N.B., „ 23 v. ; A. B., „ 3 vi. „ 30 vi. In 11, there was a second child ill when the first disinfection was carried out, the nature of the illness not being disclosed until a later date. In 17,.secondary cases occurred at the following intervals :— 0 day, 1 3 days, 2 7 days, 1 1 „ 6 4 „ 2 14 „ 1 2 days, 1 5 „ 2 21 „ 1 At least 15 of these patients were infected before disinfection was performed, leaving 2 as possible failures, i.e., cases where the disinfection did not prevent the recurrence of secondary infection. MEASLES. 33 In one family disinfection was required three times. The sequence of events was— f. 6; sickened C v.; disinfection 20 v. | f. 7 ; sickened 31 v.; disinfection 13 vi. f. 9 ; sickened 14 vi.; disinfection 29 vi. The second and third patients were apparently infected at a late stage of the preceding attack, and were incubating the disease at the date of disinfection. Looking at the facts here set out, there does not appear to be reason for holding that disinfection is useless to stop the spread of the disease. The provision of hospital accommodation for measles has been urged, but, while admitting that such accommodation might be expected to save life and mitigate suffering, there are special points connected with the disease which appear to afford strong arguments in opposition to any proposal to provide accommodation on a large scale out of the rates. The first point is the fact that death occurs usually very early in the attack. The fatal cases for the past three years have been specially tabulated to show this. (See below.) Per cent. of all fatal attacks. Duration of Illness. 1903. 1904. 1905. 1903. 1904. 1905.[/### Less than 1 week 1 0 8 3 6 13 Between 1 and 2 weeks 14 12 26 48 34 41 „ 2 and 3 „ 8 9 22 28 26 25 „ 3 and 4 „ 2 9 3 7 26 5 „ 4 or more ,, 4 3 4 14 8 6 29 35 63 100 100 100 In other words, an average of 50 per cent. (taking the three years together) of the fatal cases ended fatally within a fortnight of the onset of the disease. The initial stages of the disease last four days, and usually diagnosis is not arrived at until the fifth day. It is feared that many of the cases terminating fatally within even the second week would be too ill to be removed to hospital when the diagnosis was made. It is very doubtful whether the removal of the remaining cases would have such an influence in limiting the spread of infection as to neutralise the opposite effect due to the patients kept at home. The second point is the special characteristic of the explosive character of the outbreaks of the disease. Epidemics recur, under present circumstances, every 18 or 20 months (approximately each alternate year), and the duration of each epidemic is but a few weeks During the past year the numbers of cases recorded in four weekly periods were— Qr. 1. Qr. 2. Qr. 3. Or. 4. Wks. 1-4... 29 cases. Wks. 14-17...151 cases. Wks. 27-30...200 cases. Wks. 40-43... 96 cases. „ 5-8... 32 „ „ 18-21...317 „ „ 31-34... 58 „ „ 44-47...136 „ „ 9-13... 166 „ „ 22-26...417 „ „ 35-39... 33 „ „ 48-52... 56 „ This may be stated in another and perhaps more striking way :— During the first 10 weeks of the year, the weekly totals ranged from 2 to 18 cases in a week. 10th-33rd „ „ 13 „ 114 34th-40th „ „ „ 2 „ 11 „ 41st-52nd „ „ „ 8 „ 50 ,, 34 WHOOPING COUGH. While the epidemics in the different parts of the Metropolis are not exactly synchronous, they are sufficiently so to result in fairly long periods of practical freedom from the disease, interspersed with comparatively short periods with large numbers of attacks. No definite information has ever been obtained of the total number of attacks in any community, but as a guide to the probable requirements of this Borough at least, the returns included in these Annual Reports are, from the character of their sources, sufficiently complete. It may safely be said that the cases reported by the elementary schools occur in homes which make hospital treatment desirable for the public good and the patients' welfare. Assuming that to be the case, the patients to be provided for may be said to have numbered not less than 900 in 1903 and 1904, and 1,700 in 1905. How long treatment would last cannot be stated, but a duration of one month may be hazarded as a guess. To meet the maximum demand it would seem that 300 beds (taking the second quarter of last year as a standard) would require to be kept in constant readiness, as the short duration of pressure would not permit of emergency provision. On the other hand, during the third quarter of 1904 only '18 cases were reported. It is believed that the action of the Department has to some extent imposed limits on the spread of infection, and consequently even larger numbers may be expected from districts where no official steps are taken. It will be seen that what is here stated means a provision of accommodation on a much greater scale than has hitherto been contemplated. A further consideration is the large proportion of young children among the patients, a fact which implies a specially large staff of nurses. The foregoing observations may be summed up thus:— That while it is admitted that a proportion of the deaths and of the subsequent ill-health of survivors would be prevented and obviated by hospital treatment, the provision of such treatment would be so expensive, both on capital and revenue accounts, and the result qua prevention so doubtful, that it does not appear to be advisable to impose such provision on the rates. It is believed that by continued official action it will ultimately be possible to produce a change in the age-incidence of attack, and, if that be accomplished, the results as regards saving of life and prevention of after ill-health obtainable by treatment in hospital may make the provision of such accommodation not only desirable but even absolute!}' necessary. WHOOPING COUGH. Last year 540 cases were reported to the Department, as compared with 19G in 1904 and 533 in 1903. The numbers of cases investigated in each quarter of last year are set out below :— Whooping Cough. Quarters 1905. 1 2 3 4 Year. Corrected Totals.[/### Registration Sub-Districts. St. Mary 126 194 36 17 373 341 St. John 32 19 1 14 66 73 North-West Paddington 83 42 1 5 131 126 Totals, 1905 241 255 38 36 570 540 „ 1904 23 27 45 98 193 196 „ 1903 281 35 11 2 339 533 whooping cough. 35 The deaths numbered 50 last year, having been 15 in 1904 and 53 in 1903. The foregoing figures may be stated thus:— In 1903 240 cases among males, with 23 deaths; 293 among females, 30 deaths. In 1904 100 „ „ 8 „; 96 „ „ 8 „ In 1905 254 „ „ 23 „; 286 „ „ 27 „ The respective fatalities, per 100 known cases, were— Males. Females. Persons. 1903 9.6 10.2 9.9 1904 8.0 8.3 8.1 1905 9.0 9.4 9.2 The Ward distribution of cases and deaths is appended:— C. d. f. C. d. f. Queen's Park 1905 126 10 7.1 Church 1905 99 8 8.0 1904 8 2 25.0 1904 65 3 4.6 .1903 134 11 8.2 1903 56 9 16.0 Harrow Road 1905 165 12 7.2 Lancaster Gate (West) 1905 — –* ? 1904 58 3 5.1 1904 7 — ? 1903 147 14 9.5 1903 1 1 ? Maida Vale 1905 48 8 16.6 Lancaster Gate (East) 1905 17 – ? 1904 4 1 25.0 1904 4 1 ? .1903 57 5 8.7 1903 7 2 ? Westbourne 1905 39 5 12.8 Hyde Park 1905 46 6 13.0 1904 45 6 13.3 1904 5 — — 1903 121 10 8.2 1903 10 C—cases, d—deaths, f—fatality per 100 known cases. * One death in this Ward, but case not known during life of deceased. The 540 cases occurred in 302 houses (average l.6 per house). In 1903 the average was 1.8, and, in 1904, 2.0. The numbers of multiple infections are given below:— 1905. 1904. 1903. Houses with 1 case each 148 40 152 „ 2 cases „ 93 29 71 „ 3 „ „ 44 12 44 „ 4 „ „ 13 5 12 „ 5 „ „ 3 6 8 „ 6 „ „ — 2 2 „ 7 „ „ 1 — 1 The sex-age incidence of attacks and deaths is sufficiently indicated in the following table:— TABLE 23. Whooping Cough: 1905. 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 18 18 21 13 19 25 21 21 36 30 51 66 — — — 2 Deaths 7 10 4 6 3 — 1 — — — — 1 — — — — St. John Cases 2 3 6 2 4 5 6 6 1 10 11 17 — — — — Deaths 1 1 — 2 1 1 1 — — — — 1 — — — — North-West Paddington Cases 7 5 6 6 7 9 5 12 13 17 20 19 — — — — Deaths 4 1 1 1 — 1 — — — 1 — 1 — — — — 36 CHICKEN-POX. The mortality—rate per 1,000 persons of all ages—was 0.33 last year, just three times the rate for 1904. In each of the three Sub-Districts the mortality for last year was much in excess of that of the previous year, the latter rates being St. Mary, 0.13; St. John, 0.02; and North-West Paddington, 0.12. The rates for last year are given below, and are there compared with the respective mean rates. Whooping Cough: Death-rates Per 1,000 persons. 1905. Mean Rates. 1895-99 1900-04 1895-1904 Borough 0.33 0.36 0.24 0.30 St. Mary 0.32 0.10 0.28 0.34 St. John 0.23 0.09 0.09 0.09 North-West Paddington 0.59 0.65 0.34 0.39 The mortality in the Adjacent Districts (Table 12) varied from 0.15 in Westminster to 0.48 in Willesden. In Westminster and Marylebone only was last year's mortality below the mean rates for 1901-04. The rates for last year, after correction for sex-age constitution of the populations, are given in Table 24. TABLE 24. Corrected Mortality—Whooping Cough. Standard Rate. Correction Factor. Corrected Rates. Differences, 1905. from 1905. Mean, 1901-04. Standard Rate. Mean Rate. London 0.50 0.31 0.35 -0.19 -0.04 Paddington 0.39 1.27591 0.42 0.30 +0.03 +0.12 Kensington 0.35 1.43405 0.47 0.37 +0.12 +0.10 Westminster 0.31 1.62357 0.24 0.29 -0.07 -0.05 Marylebone 0.36 1.37086 0.24 0.33 -0.12 -0.09 Hampstead 0.34 1.45226 0.27 0.24 -0.07 +0.03 Willesden 0.57 0.87550 0.42 0.28 -0.15 +0.14 CHICKEN-POX. This disease was not on the list for notification during last year. Information was, however, received of 304 cases, as compared with 432 in 1904 (when notification was in force for part of the year) and 183 in 1903. Last year's cases occurred in 181 houses (average 1.6 per house). In 1904 the average was 1.5 per house. The sex-age distribution of the cases last year was— Ages 0— 1— 2— 3— 4— 5— 13— 15— Males 7 11 15 15 22 55 2 2 Females 8 9 17 20 32 81 2 6 phthisis. 37 The Ward distribution was more equable, as may be seen below. The numbers for 1904 are shown in parentheses:— Queen's Park 43 (34) Harrow Road 83 (128) Maida Vale 20 (55) Westbourne 37 (27) Church 76 (102) Lancaster Gate (West) 10 (10) Lancaster Gate (East) 11 (29) Hyde Park 24 (47) There was one death from the disease, a male under one year of age. TUBERCULAR DISEASES. Phthisis (Consumption).—The deaths from consumption, which numbered 152 in 1903, 164 in 1904, decreased to 136 last year, 78 of the deceased persons being males and 58 females. In Tables IV. and V. (Appendix) will be found a sex-age distribution for the Borough and the total numbers of deaths in each Ward. The nett mortality for the Borough was 0.92, as compared with rates of 1.12 and 1.04 in 1904 and 1903. The decennial mean rate (1.15) is 0.23 in excess of the rate for last year. All rates for the past year (with one exception) were below the means, as may be seen from the appended tabulation:— Phthisis: Death-Rates Per 1,000 persons. 1905 Mean Rates. 1895-99 1900-04 1899-1904 Borough 0.92 1.23 1.08 1.15 St. Mary 1.02 1.37 1.21 1.29 St. John 0.68 0.78 0.61 0.69 North-West Paddington 0.77 1.37 1.25 1.31 In Queen's Park, Harrow Road, Maida Vale, and Westbourne Wards last year's rates (see Table 25) were below the mean rates for 1901-04, and in the others above. The greatest increase was in Lancaster Gate (East) Ward, from 0.46 to 0.03, and the least in Church Ward, from 1.60 to 1.64. In the Borough last year's rate (0.92) was 0.14 below the mean for the four years (1.06). TABLE 25. Phthisis Mortality. Wards. Percentage of total Population, 1901. Recorded Rates. Standard Rate. Corrected Rates. "Overcrowded." Living in homes of less than 5 rooms. 1905. Mean, 1901-04. 1905. Mean, 1901-04. Queen's Park 9.1 51.7 0.77 1.21 1.73 0.77 1.21 Harrow Road 11.5 75.5 0.82 0.97 1.77 0.80 0.96 Maida Vale 12.6 43.4 0.56 1.02 1.82 0.53 0.98 Westbourne 13.4 46.3 0.92 1.12 1.80 0.88 1.08 Church 32.8 61.3 1.64 1.60 1.68 1.69 1.65 Lancaster Gate— (West) 2.6 15.2 0.47 0.40 1.84 0.44 0.38 (East) 2.1 16.2 0.63 0.46 1.84 0.59 0.44 Hyde Park 5.2 25.3 0.79 0.64 1.88 0.72 0.59 38 phthisis. In Church Ward only was the "corrected" rate for last year (1.69) above the standard rate. The changes in the corrected rates in comparison with the mean rates are the same as those for the recorded rates. In the Adjacent Districts (Table 12) the recorded mortality was above that of the Borough, except in Hampstead (rate 0.82). In Willesden last year's rate (1.05) was higher than the mean for 1901-04 (0.91). The corrected rates are given in Table 26. TABLE 26. Phthisis Mortality. istrict. CENSUS, 1901. Death-rates. Persons per Acre. Percentage of total Population. "Overcrowded." Living in homes of less than 5 rooms. Standard Rate. Corrected Rates. 1905. Mean 1901-04. London 61 16.0 54.0 1.74 1.41 1.60 Paddington 106 13.6 50.9 1.80 0.92 1.05 Kensington 77 14.8 41.7 1.78 1.10 1.29 Westminster 73 13.0 45.7 1.95 1.34 1.53 Marylebone 90 21.1 55.6 1.85 1.34 1.52 Hampstead 36 6.4 29.6 1.75 0.81 0.82 Willesden 21 11.6 50.7 1.65 1.10 0.95 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 112 deaths. Enquiries were also made with reference to 21 cases reported to the Department during the patients' lifetime. Of these 21 patients, 9 died during the year. Histories of tubercular diseases in other members of the family were obtained in 35 instances; in 47 the previous occurrence of the disease was denied. As regards the remaining 30 cases, no definite particulars could be given. In 52 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 26 cases only did it appear that nothing was done in this direction. Disinfection by the Department was carried out at 97 premises, only 5 definitely declining the offer. Seven 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 21 cases reported during life, the particulars relating to the 9 which terminated during the year are included in above paragraph. Five of the surviving patients belonged to consumptive families. The infectious nature of the disease was known to 7 of the patients families, and precautions were being taken. The homes of the 12 patients still surviving were disinfected, six of them being cleansed and re-decorated during the year. PHTHISIS. 39 Housing.—The 112 deaths occurred in the same number of homes, comprising— 32 homes of one room, occupied by 54 inhabitants, 3 being under 10 years of age. 25 „ two rooms „ 107 „ 26 „ „ 27 „ three rooms „ 115 „ 26 „ „ 17 „ four rooms „ 78 „ 10 „ „ 11 „ five or more rooms „ 69 „ 8 „ „ 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, 1.6—whole Borough, 1.8 „ two rooms „ 1.8 „ 1.7 „ three rooms „ 1.5 „ 1.3 „ four rooms „ 1.0 „ 1.2 All the above „ 1.1 „ 1.4 In 1904 a slightly greater aggregation of inhabitants in the phthisis homes than in the Borough as a whole was noted; last year the aggregation in the former homes was greater in those of 2 and 3 rooms only. The proportion of cases occurring in the different homes were:— One room 29.2 per cent. Three rooms 24.8 per cent. Two rooms 24.l „ 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. 1905. Occupation. M F. Occupation. M. F. Indoor:— Mixed:— Army Pensioner 2 ... Engineering — Driver, Stoker, Fitter 5 ... Artist 1 Asylum Attendant ... 1 Goods Foreman 1 ... Blacksmith, Farrier 3 Painter 4 ... Bootmaker 1 ... Plumber 2 ... Carpenter 1 ... Porter, Packer 5 ... Charwoman ... i Potman 1 ... China Repairer 1 ... Railway Carriage Repairer 1 ... Clerk 7 l Traveller, Commercial 1 ... Coach-painter 1 ... 20 — Confectioner 1 ... Dressmaker, Sempstress ... 6 Outdoor:— French Polisher 1 Glove Maker 1 Cabman, Coachman 7 ... Lavatory Attendant 1 Carman 4 ... Manager—Commercial ... 1 Costermonger 1 ... Mechanical Engineer 1 Crossing Sweeper 1 ... Printer 3 ... Labourer 1 ... Tailor, Master 1 ... Omnibus Conductor 1 ... „ Journeyman 2 Postman 1 ... Telegraphist 1 Scavenger, Roadman 2 ... Upholsterer 1 Window Cleaner 1 ... Domestic Servants 2 9 19 ... Lodging House Keeper 1 Married Women—no work ... 45 Children, 7—no occupation— 6 boys and 1 girl. 33 57 40 cancer. In one-room homes separate sleeping accommodation, except where the home is occupied by one person only (there were 13 such homes), is impossible. In other homes of all classes 11 of the deceased had separate bedrooms, and 26 others separate beds but not separate bedrooms. In 25 houses previous cases of fatal consumption were known to have occurred:— 16 had one previous case each; 8 „ two „ ,,; and 1 „ three „ „ Insanitary conditions were noted at 24 houses, including 11 cases of dirty and 8 of damp premises. Other Tubercular Diseases.—From these causes there were 56 deaths last year, 2 more than the totals for 1904 and 1903 (54 each year). The deaths comprised 27 from tubercular meningitis and 29 from other forms. (See Table IV., Appendix.) The death-rate last year was 0.37 for the Borough, 0.45 for St. Mary's Sub-District, 0.14 for that of St. John, and 0.41 for that of North-West Paddington, all of the rates being below the respective decennial mean rates. (See below.) Other Tubercular Diseases: Death-rates Per 1,000 persons. 1905 Mean Rates. 1895-1900 1900-04 1895-1904 Borough 0.37 0.57 0.47 0.51 St. Mary 0.45 0.67 0.53 0.60 St. John 0.14 0.23 0.25 0.24 North-West Paddington 0.41 0.69 0.58 0.63 In Table 12 will be found the mortality rates for the Adjacent Boroughs. "CANCER." Under this term are included several varieties of malignant new growths. The deaths attributed to them numbered 149, 7 less than in 1904, 10 less than in 1903, but 15 more than in 1902. The deceased persons comprised 56 (1904, 54) males and 93 (1904, 102) females. Of the 149 deaths, 105 (1904, 96) were recorded from St. Mary Sub-District, 28 (1904, 48) from St. John, and 16 (1904, 12) from North-West Paddington. (The sex-age distribution of last year's deaths will be found in Table IV., Appendix.) The numbers of deaths returned from each Ward during the past five years (1901-05) show striking variations year by year for which no explanation can be offered. (See below.) Cancer: Deaths from. Ward. 1905 1904 1903 1902 1901 Ward. 1905 1904 1903 1902 1901 Queen's Park 16 12 31 9 20 Church 19 32 23 34 23 Harrow Road 33 17 29 23 29 Lancaster Gate (West) 7 13 9 7 10 Maida Vale 28 25 23 14 18 Lancaster Gate (East) 8 5 4 9 7 Westbourne 27 25 31 25 24 Hyde Park 11 27 9 13 17 The mortality in the Borough last year was at the rate of 1.01 per 1,000 persons of all ages, slightly less than that for 1904 (1.06). On the other hand, the rates for the Sub-Districts St. Mary (1.07) and North-West Paddington (0.95) were above those for 1904 cancer. 41 (0.99 and 0.71 respectively). The reduction was due to the lower rate in St. John's Sub-District (0.83, 1905; 1.43, 1904). Last year's mortality for the Borough was but slightly in excess of the decennial mean rate (0.97), but just below the mean for the five years 1900-04 (1.02). A full comparison is given below:— Cancer: Death-rates Per 1,000 persons. 1905 Mean Rates. 1895-99 1900-1904 1895-1904 Borough 1.01 0.93 1.02 0.97 St. Mary 1.07 0.97 1.02 0.99 St. John 0.83 0.95 0.99 0.97 North-West Paddington 0.95 0.71 1.11 0.91 The rates (per 1,000 persons of all ages) recorded last year in the different Wards of the Borough ranged from 0.69 in Church Ward to 1.42 in Maida Vale. The disease (or diseases) being so specially peculiar to old age, the foregoing rates are of but slight value. In Table 27 the rates have been corrected for sex-age composition of the populations. TABLE 27. Cancer: Death-rates Wards of Borough. Standard. 1905. Mean Corrected. 1901-04. Recorded. Corrected. Queen's Park 0.83 0.95 0.99 1.11 Harrow Road 0.88 1.13 1.11 0.85 Maida Vale 1.01 1.42 1.22 0.89 Westbourne 1.17 1.08 0.80 0.80 Church 0.87 0.69 0.69 1.04 Lancaster Gate (West) 1.02 0.82 0.70 1.03 Lancaster Gate (East) 1.02 1.00 0.85 0.64 Hyde Park 1.07 0.79 0.64 0.96 TABLE 28. Cancer: Death-rates. District. Standard. 1905. Mean Corrected. 1901-04. Recorded. Corrected. London 0.87 0.99 0.99 0.98 Paddington 0.98 1.00 0.89 0.91 Kensington 1.02 0.95 0.81 0.84 Westminster 0.96 1.02 0.93 0.88 Marylebone 0.99 1.20 1.06 0.96 Hampstead 0.92 0.82 0.78 1.00 Willesden 0.71 0.83 1.02 1.01 42 CANCER. It will be noted that last year's rates for three of the four northern Wards were in excess of the "standard" rates. The variations between the "corrected" rates for 1905 and the "mean corrected" for 1901-04 show considerable irregularities. In Table 12 the recorded rates for 1905 and the mean rates for 1901-04 for the Adjacent Districts will be found. The corrected rates are given in Table 28. The local rate for last year was lower than those for 3 of the 5 Districts, a somewhat unusual occurrence. The majority of the rates for 1905 were below the respective mean rates. The deaths of residents of the Borough have been tabulated according to site of disease in Table 29. TABLE 29. "Cancer." 1905. Organ, &c., Affected. Registration Sub-District. St. Mary. St. John. North-West Paddington. C. O. C. O. C. O. m. f. m. f. m. f. m. f. m. F. m. f. I. Nervous System, Brain ... ... 1 1 ... ... ... ... ... ... ... ... II. Organs of Special Sense, Eye ... ... 1 1 ... ... ... ... ... ... ... ... III. Respiratory System, Larynx 1 ... ... ... ... ... ... ... 1 ... ... ... Lung 1 1 1 ... ... ... ... ... ... ... ... ... IV. Circulatory System ... ... ... ... ... ... ... ... ... ... ... ... V. Digestive System, Tongue 4 ... 2 ... 1 ... ... ... ... ... ... ... Œsophagus 5 1 ... ... 2 ... ... ... 1 ... ... ... Stomach 8 6 ... ... 2 3 ... ... 3 ... ... ... Bowel 2 8 ... ... ... 1 ... ... ... ... ... 1 Rectum 3 2 ... ... ... 1 ... ... ... ... ... ... Liver 4 7 ... ... 1 ... ... ... ... 2 ... ... Pancreas 4 2 ... ... ... 1 ... ... ... ... ... ... Peritoneum ... ... ... ... ... 1 ... ... ... ... ... ... Omentum ... ... ... ... ... 1 ... ... ... ... ... ... VI. Lymphatic System, Thyroid Gland ... ... ... ... ... 1 ... ... ... ... ... ... Mediastinal Glands ... ... ... 1 ... ... ... ... ... 1 ... ... Bronchial Glands ... ... 1 ... ... ... ... ... ... ... ... ... Spleen ... 1 ... ... ... ... ... ... ... ... ... ... VII. Urinary System, Kidney ... ... ... ... ... 1 ... ... ... ... ... ... Bladder ... ... ... ... 1 ... ... ... ... ... ... ... VIII. Generative System, Ovary ... 1 ... 2 ... 1 ... ... ... ... ... ... Uterus ... 12 ... ... ... 1 ... ... ... 4 ... ... Breast ... 12 ... 2 ... 2 ... 2 ... 2 ... ... IX. Osseous System, Head and Neck ... ... 2 ... ... ... ... ... ... ... ... ... Pelvis ... ... 1 ... ... 2 ... ... ... ... ... ... Leg ... ... ... 1 ... ... ... ... ... ... 1 ... X. Cutaneous System, Head and Neck ... ... ... 1 ... 1 ... ... ... ... ... ... Groin ... ... ... 1 ... ... ... ... ... ... ... ... XI. Insufficiently described ... ... 1 ... ... ... ... ... ... ... ... ... Totals 32 53 10 10 7 17 1 3 5 9 1 1 "C." includes Cancer (23 deaths) Carcinoma (85 deaths), and Malignant Disease (15 deaths), "O." includes Sarcoma (15 deaths), Scirrhus (4 deaths), Epithelioma (5 deaths), and Rodent Ulcer and Glioma (1 death each). "M."—Males. "F."—Females. OTHER DISEASES. 43 OTHER DISEASES. Influenza.—There were 40 (44)* deaths from this cause, equal to a rate of 0.27 (0.30) per 1,000 persons of all ages, and 0.17 below the mean (0.44). The deaths in St. Mary numbered 23 (27), equal to a rate of 0.23 (mean 0.45), those in St. John 13 (8), rate 0.38 (mean 0.43), and those in North-West Paddington 4 (9), rate 0.23 (mean 0.40). Respiratory Diseases.—From bronchitis (acute and chronic) there were 189 (194) deaths, and from the various forms of pneumonia 162 (120). The mortalities were 1.27 and 1.09 respectively, the mean rates being 1.68 and 0.96. Some of the increased mortality from the pneumonias was doubtless consequential on the prevalence of measles. In St. Mary there were 137 (144) deaths from bronchitis, and 115 (79) from pneumonia. The corresponding mortalities were 1.40 and 1.17, compared with decennial mean rates of 1.95 and 1.07. In St. John the deaths numbered 31 from bronchitis and 30 from pneumonia, while the deaths from each of these causes in 1904 numbered 19 only. The mortality from bronchitis was 0.92, that from pneumonia 0.89, the respective mean rates being 0.97 and 0.55. In North-West Paddington 21 (31) deaths were registered from bronchitis, rate 1.25 (mean 1.59) and 17 (22) from pneumonia, rate 1.01 (mean 1.14). Alcoholism.—Under this heading are included all deaths from acute and chronic alcoholism, and from cirrhosis of the liver. The total number of deaths from these causes during the past year was 42, four in excess of the number in 1904. An analysis of the figures for the past five years points to a diminished mortality from these causes among males, but an increased among females. A special feature is the small proportion of deaths of females from acute alcoholism to all deaths from "alcoholism." In the five years 10 out of 94 deaths of males were due to the acute variety, as compared with 2 out of 115 deaths of females. (See below.) Deaths from "Alcoholism." Males. Females. 1901 1902 1903 1904 1905 1901 1902 1903 1904 1905 Alcoholism Acute 1 3 3 2 1 — — 1 — 1 Chronic 8 8 9 5 4 7 12 12 9 8 Cirrhosis of Liver 8 13 11 10 8 13 12 8 12 20 Totals 17 24 23 17 13 20 24 21 21 29 The mortality from "alcoholism" last year was 0.27 per 1,000 persons of all ages, or 0.02 above the decennial mean. A full comparison of rates is given below:— Alcoholism: Death-rates Per 1,000 persons. 1905 Mean Rates. 1895-99 1900-1904 1895-1904 Borough 0.27 0.22 0.29 0.25 St. Mary 0.25 0.24 0.31 0.27 St. John 0.19 0.24 0.23 0.23 North-West Paddington 0.28 0.12 0.19 0.15 In 1904 the mortality in North-West Paddington was only 0.05 per 1,000. * Figures for 1904 shown thus. 44 infantile mortality. INFANTILE MORTALITY. Among the deaths registered within the Borough during the past year were 441 of infants under one year of age, equivalent to a rate of 139 per 1,000 births registered. Last year's total was 86 below the annual average for the 10 years 1895-1904, and lower than the total for any of those years except that of 1903, when 425 deaths were registered. The mortality rate was 14 below the decennial mean (153), and is the lowest recorded in the eleven years 1895-1905, except that of 1903, when the rate was 128. (See Table I., Appendix.) After correction for non-resident and outlying deaths, a total of 391 is obtained for the past year, 114 less than the decennial average (505) and 58 less than the total for 1904. In 1903 only was the corrected total (388) less than that of last year. To St. Mary's Sub-District 300 deaths belonged, 81 less than the average (381), and the lowest figure for the eleven years 1895-1905; to St. John's Sub-District 39, 8 below the average (47); and to North-West Paddington 52, 25 less than the average (77). (See Table II., Appendix.) The nett mortality for the whole Borough, per 1,000 births registered within the Borough, was 122 last year, 14 less than the rate for 1904. In the three Sub-Districts the rates last year were—St. Mary, 125 (132 in 1904); St. John, 100 (113 in 1904); and North-West Paddington, 126 (180 in 1904). A full comparison with the mean rates (persons) is given below:— Infantile Mortality: Persons. Per 1,000 Births registered in each district. 1905 Mean Rates. 1895-99 1900-1904 1895-1904 Borough 122 157 134 146 St. Mary 125 161 139 150 St. John 100 123 106 114 North-West Paddington 126 168 144 156 In St. Mary's Sub-District the rate for 1903 (119) is the only one below that for last year. In St. John's, lower rates were recorded in 1893 and 1894 (97 each year), in 1899 (93) and in 1902 (82). In 1903 the rate was 104. In North-West Paddington lower rates were recorded in 1894 (120) and 1903 (98). In the two first Sub-Districts sex rates are on record back to 1892. The rate for males last year was 125 in St. Mary (the lowest on record) and 130 in St. John (lower rates have been recorded in this District on several occasions). The rate for females was 125 in St. Mary (lower rates have been recorded four times since 1892) and 65 in St. John (the lowest on record except that for 1902, 49). Sex rates in North-West Paddington have been recorded since 1901 only. Last year's rate for males was 168 (that for 1903, 106, being the only one below the figure for last year) and for females 81 (the lowest on record). In Table 12 will be found the infantile mortality rates for the Adjacent Boroughs for 1905 and the mean rates for 1901-04. The rates for Kensington (144 in 1905, mean 151) are the highest of the series, and those for Hampstead (94 in 1905. 97 mean) the lowest. All the rates for last year were below the means for the preceding 4 years. It is possible for the first time to give the infantile mortalities for the Wards of the Borough (Table 30). In calculating these a difference has been made from the rule followed INFANTILE MORTALITY. 45 in getting out the rates given above. Not only have the deaths been corrected for non-residents and outlying institutions, but similar corrections have also been applied to the births. This rule will be followed in all future calculations of Ward rates. TABLE 30. Infantile Mortalities. Deaths and Births fully corrected. Births Registered. Deaths under One Year. Mortality. Proportional Mortality. M. f. P. M. f. P. M. f. P. Queen's Park 219 209 428 36 16 52 164 76 122 221 Harrow Road 413 405 818 48 46 94 116 113 115 209 Maida Vale 206 207 423 24 27 51 116 124 120 218 Westbourne 260 250 510 29 28 57 111 120 112 203 Church 398 362 760 60 51 111 151 141 146 265 Lancaster Gate (West) 36 36 72 3 1 4 83 28 55 100 „ (East) 49 42 91 2 3 5 41 71 55 100 Hyde Park 100 97 197 13 4 17 130 41 86 156 Borough 1,681 1,618 3,299 215 176 391 128 109 118 214 Lancaster Gate (combd.) 85 78 163 5 4 9 59 51 55 100 From a return for one year only no deductions can be safely drawn. It must suffice to direct attention to the great disparity between the mortalities in the two Lancaster Gate Wards (55) and Church Ward (146). Taking the former as a standard (100), the latter rate is equivalent to 265 (see last column of Table 30). Such figures afford prima facie evidence of a lamentable waste of infant life, and call for active measures of prevention. Table 31 gives the sex-age distribution of the deaths in each Ward. Taking the two Lancaster Gate Wards together (last line), a striking contrast is apparent if they be compared with the numbers for the other Wards. Inasmuch as the number of children born TABLE 31. Deaths of Infants under One Year. 1905. Wards. Males. Females. Dys. Wks. Months. Dys. Wks. Months. 0-7 1-4 1-3 3-6 6-9 9-12 0-7 1-4 1-3 3-6 6-9 9-12 Queen's Park 4 4 6 5 9 8 2 3 3 2 4 2 Harrow Road 9 5 15 5 8 6 8 3 14 5 11 5 Maida Vale 6 3 5 6 3 1 5 5 3 4 4 6 Westbourne 5 3 6 5 4 6 3 6 2 6 5 6 Church 8 7 10 17 8 10 9 7 4 9 11 11 Lancaster Gate (West) 1 ... ... ... 2 ... 1 ... ... ... ... ... „ (East) ... 1 1 ... ... ... 1 1 ... 1 ... ... Hyde Park 3 1 7 1 1 ... 1 1 ... 1 ... 1 Borough 36 24 50 39 35 31 30 26 26 28 35 31 Lancaster Gate (combd.) 1 1 1 ... 2 ... 2 1 ... 1 ... ... ■ 46 INFANTILE MORTALITY. in each Ward varies considerably, the differences are better illustrated by taking the combined figures for the Lancaster Gate Wards and obtaining theoretical numbers for the other Wards, on the assumption that the mortality rates (for each sex and age) were the same as those for the Lancaster Gate Wards. The results are given in Table 32. In two instances only are the theoretical totals in excess of the recorded. The total wastage amounts to 209 lives (114 of boys and 95 of girls). The deaths of infants under 1 month old are to a large extent not preventable. Deducting such deaths, the wastage during the past year may be stated as amounting to 197 lives (98 of boys and 99 of girls). Much of this wastage is due to carelessness and ignorance and ought to be obviated. TABLE 32. Wards. Males. Females. Dys. Wks. Months. Dys. Wks. Months. 0-7 1-4 1-3 3-0 6-9 9-12 0-7 1-4 1-3 3-6 6-9 9-12 Lancaster Gate (2) 1 1 1 ... 2 ... 2 1 ... 1 ... ... Queen's Park 3 3 3 ... 5 ... 5 3 ... 3 ... ... Harrow Road 5 5 5 ... 10 ... 10 5 ... 5 ... ... Maida Vale 2 2 2 ... 5 ... 5 3 ... 3 ... ... Westbourne 3 3 3 ... 6 ... 6 2 ... 3 ... ... Church 5 5 5 ... 9 ... 9 5 ... 5 ... ... Hyde Park 1 1 1 ... 2 ... 2 1 ... 1 ... ... Theoretical Totals 19 19 19 ... 37 ... 37 20 ... 20 ... ... Recorded Numbers 35 23 49 37 33 31 28 25 26 27 35 31 Loss (—) or Gain (+) -16 -4 -30 -37 +4 —31 +9 —5 —26 —7 -35 —31 —114 —95 Causes of Death.—The Local Government Board has forwarded a new table on this subject. (Table VI., Appendix.) In Table 33 the numbers for last year are compared with the decennial averages. The only diseases showing increases above the respective averages are— Measles—increase of 8 deaths; whooping cough—increase of 4 deaths; and dentition—increase of 3 deaths. There was a notable decrease in the number of deaths from the diarrhœal diseases (68 in 1905, 116 annual average). In 1904 there were 106 deaths from these causes (59 of males and 47 of females) as compared with 51 last year. The 68 deaths under this head comprise 33 of "diarrhœa," 31 of "zymotic enteritis," and 4 of "enteritis." In 1903, the only year when the mortality rate was below that of last year, 87 deaths were recorded, viz., " diarrhœea" 41, " zymotic enteritis" 33, and "enteritis" 13. Attention has already been directed to the great disparity in infantile mortality in some of the Wards (Table 31) and to the differences in age incidence (Table 32). The subject will be so far completed by a reference to the causes of death in the two Wards specially selected for contrast (Table 34). INFANTILE MORTALITY. 47 TABLE 33. Registration Sub-Districts. 1905. Borough. St. Mary. St. John. North-West Paddington. 1905. Averages,* 1895-1904 m. f. m. F. m. F. p. P. Small-pox ... ... ... ... ... ... ... 0 Measles 4 10 ... 1 1 ... 16 10 Scarlet Fever ... ... ... ... ... ... ... 1 Whooping Cough 7 10 1 1 4 1 24 20 Diphtheria ... ... ... ... ... ... ... 3 Enteric Fever ... ... ... ... ... ... ... ... Diarrhœeal Diseases 27 24 4 ... 11 2 68 116 Syphilis 5 ... ... ... ... ... 5 6 Tubercular Diseases 9 4 ... 1 1 2 17 26 Premature Birth 27 19 4 3 4 1 58 66 Congenital Malformations 6 9 2 1 ... 3 21 22 Injury at Birth 1 ... 1 ... ... ... 2 2 Dentition 5 4 ... ... 1 1 11 8 Rickets 1 ... ... ... ... ... 1 1 Atrophy and Debility 15 8 3 2 3 1 32 56 Convulsions 7 10 ... 1 1 ... 19 25 Respiratory Diseases 24 31 5 2 7 1 70 81 Accident and Violence 5 4 ... ... 2 ... 11 17 Other Causes 9 15 7 ... 1 4 36 45 All Causes 152 148 27 12 36 16 391 505 Births Registered 1,209 1,177 205 183 214 196 3,184 3,426 "m"—males. "f"—females "P"—persons of both sexes. *Averages uncorrected: Factor for correction 3426 = 3184 0.929 TABLE 34. Deaths Recorded. 1005. Lancaster Gate (E. and W.) Church. Rest of Borough. m. f. P. m. f. P. m. F. P. Small-pox ... ... ... ... ... ... ... ... ... Measles ... 1 1 ... 3 3 5 7 12 Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough 1 ... 1 1 2 3 10 10 20 Diphtheria ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... Diarrhœal Diseases ... ... ... 15 7 22 27 19 46 Premature Birth ... 1 1 10 5 15 25 17 42 Congenital Malformations ... ... ... 4 3 7 4 10 14 Injury at Birth 1 ... 1 ... ... ... 1 ... 1 Dentition ... ... ... 2 3 5 4 2 6 Rickets ... ... ... 1 ... 1 ... ... ... Atrophy and Debility 1 1 2 4 5 9 16 5 21 Convulsions ... ... ... ... 6 6 8 5 13 Respiratory Diseases 1 1 2 9 11 20 26 22 48 Overlaid ... ... ... 2 ... 2 4 2 6 Other Accidents ... ... ... ... 2 2 1 2 3 Other Causes 1 ... 1 12 4 16 19 20 39 All Causes 5 4 9 60 51 111 150 121 271 Births Registered 85 78 163 398 362 760 1,198 1,178 2,376 48 INFANTILE MORTALITY. Owing to the small number of deaths in the Lancaster Gate Wards, comparison of rates for individual diseases would be not only useless but misleading. By grouping the diseases the contrast between those Wards and Church Ward and "Rest of Borough" is well brought out, but some reservations are necessary on account of the very small numbers in the Lancaster Gate Wards. From the "specific febrile diseases" the mortalities per 1,000 of all births, were— Lancaster Gate Wards, 12.2; Church Ward, 7.8; "Rest of Borough," 13.4 ; From the "diarrhœal diseases"— Lancaster Gate Wards, nil; Church Ward, 28.9 ; "Rest of Borough," 19.3 ; From the "developmental diseases"— Lancaster Gate Wards, 24.2 ; Church Ward, 48.5 ; "Rest of Borough," 35.1; From "convulsions"— Lancaster Gate Wards, nil; Church Ward, 7.8; "Rest of Borough," 5.4; From the "respiratorv diseases"— Lancaster Gate Wards, 12.2 ; Church Ward, 26.3 ; "Rest of Borough," 20.2; and From accident and violence— Lancaster Gate Wards, nil; Church Ward, 5.2; "Rest of Borough," 3.7. It should be stated that deaths from the " specific febrile diseases" are rare in the Lancaster Gate Wards, and that last year these Wards did not, therefore, afford so critical a standard as usual. The "respiratory diseases" vary fairly closely with the "specific febrile diseases." In addition to the work done in comparing Wards, statistics of the mortalities in certain smaller areas with well defined boundaries have been collated, including tabulation under causes, sex and age. On this occasion only the total mortalities for the combined sexes are given. (Table 35.) TABLE 35. Infantile Mortality Per 1,000 Births, after full correction. Name of Area. Births. Deaths. Infant Mortality. "Hall Park"* 107 21 196 " North W hi rf " 80 12 150 "Alfred Road" 157 23 146 "Amberley Road" 78 15 192 "Clarendon Street"* 296 49 165 "Queen's Park Estate" 253 34 134 The mortality for the year in these Areas ranged from 134 in the Oueer's Park Estate to 196 in "Hall Park." In a few of the streets included in the Areas the deaths under one year equalled the births, and in many were equal to one-third or one-quarter. A final tabulation will show the effect of the high mortalities in these Areas on the mortality for the whole Borough :— Infantile mortality WhileBorough 118 per 1,000 births; Areas, combined 118 Births and deaths Ret of Borough 101 fully corrected * If these Areas be excluded from Church Ward, the mortality for the Ward is reduced from 146 to 104. infantile mortality. 49 It has been recorded* that the homes of 8(55 children were visited shortly after birth, and. that the proportions of children fed naturally, artificially, and mixed were 77, 12, and 11 respectively. The deaths of 20 of those children were recorded during the year, the proportions of the deceased fed naturally, artificially, and mixed being 50, 20, and .50 per cent, respectively. The rates of mortality per 1,000 children of each class were— Naturally fed, 15 ; artificially fed, 39 ; and mixed,† 01; the total mortality being only 23 per 1,000. These figures require to be received with much reservation, but nevertheless it is impossible to refuse to regard them with some satisfaction. As the information necessary to enable the visits to be made is received after intervals ranging from 1 or 2 weeks to nearlv 2 months, it is not surprising to find that none of the deceased children were under one month. On distributing according to age at death, it is found that there were 3 aged 1 month, 7 aged 2 months, G aged 3 months, and 4 aged 4 months. The causes of death were as follow, distinguishing manner of feeding:— Natural. Artificial. Mixed. Diarrhœal disease 2 Diarrhœal disease 2 Diarrhœal disease 4 Marasmus 1 Whooping cough 1 each Marasmus 1 each Digestive disorders, not diarrhœal 2 Respiratory disease Respiratory disease Syphilis 1 each Whooping cough Respiratory disease Suffocation 2 Two-thirds of the deaths among those fed on a mixed diet were from diarrhœal diseases, one-half of those among children entirely artificially fed and one-fifth of those among children naturally fed. From enquiries made regarding 78 deaths of children under two years of age, from the diarrhœal diseases, (60 of the deceased being under 10 months old, it appears that— Among those under 10 months 6 were fed naturally ; 29 were fed artificially ; and 25 had a mixed diet. Stated as percentages, the figures are— 10 p. c. had natural food ; 49 p. c. artificial diets ; and 42 p. c. both varieties. Of those who died at ages between 10 months and 2 years (18 in all)— 11 (61 per cent.) had been fed naturally for at least 6 months ; 4 (22 „ ) „ „ artificially from birth; and 3 (17 „ ) had a mixed diet from birth. In 50 of the 78 families the long tube bottle was in use, and of the 78 houses, only 11 had proper accommodation for the storage of food. The families were found to occupy 1 room—23 families ; 2 rooms—28 families ; 3 rooms—19 families ; 4 rooms—4 families ; 5 or more rooms—4 families. The nuisances discovered and dealt with numbered 20, viz.:— Dirty premises 5 Defective dustbins 9 Dirty cisterns 5 Doubtful drainage 1 In the course of visiting these houses 10 other cases of diarrhoea not ending fatally were discovered. * See p. 6. † Here " mixed " includes early weaning. 50 infantile mortality. Mortality among Illegitimate Children.—The deaths of these registered in the Borough numbered 39 last year, 12 of them being non-residents. From outside districts 7 other deaths were returned, making the nett total 34. The number of deaths of children under one year was 30, as compared with 58 in 1903. The mortality per 1,000 births registered within the Borough was 197, the rate for 190-1 having been 347. The mean rate for the four years 1901-04 is 290, 99 in excess of that of last year. The corresponding rates for legitimate children are—1905, 113; mean, 120. The rates for last year, calculated on the births as fully corrected as possible, are given below, in contrast with similar rates for legitimate children. Infantile Mortalities. Deaths and Births fuilly corrected. Illegitimate. Legitimate. Males. Females. Persons. Males. Females. Persons. 1905 223 113 172 122 108 115 Mean, 1 1901-04 217 240 226 126 103 116 Particulars as to sex, ages, causes of death, &c., of illegitimate children are appended below :— Deaths of Illegitimate Children. Age at Death St. Mary. 1905. St. John. North-West Paddington. years. m. f. m. f. m. f. 0— 11 10 5 4 1— 3 l – – – – 5— – – – – – – 1005 14 11 5 – 4 – 1904 20 29 5 3 8 4 1003 16 14 1 5 4 1 1902 19 16 2 1 3 2 Causes of Death. 0— 1— 5— m. f. m. f. m. f. Measles 1 – – – — – Whooping Cough 2 – — – — – Diarrhœal Diseases 2 3 1 – – – Syphilis 2 – – – – – Tubercular Diseases 4 — 1 1 – – Premature Birth 3 1 – – – – Developmental Diseases 4 3 – – — – Convulsions 1 – – – – – Heart Disease — – – – – – Respiratory Diseases 1 2 1 — — Overlaid in Bed — 1 – – — – Accident and Violence — – – – — – Other Causes — — – – – – All Causes 20 10 3 1 — — Inquests were held touching 4 deaths. Occupations of Mothers. Domestic Service 20 Commercial Employments 13 " Servant" 4 Dressmaker 5 Cook 2 Laundress 3 General Servant 7 Actress, Barmaid, each 1 Housemaid 2 Artists' Model, Tailoress Charwoman 4 Machinist, Lady's Maid 1 No occupation ... 1 inquests. 51 INQUESTS. During the Year 208 inquests were held in the Borough, 72 of which related to deaths of non-residents. Inquests were held outside the Borough with reference to deaths of 12 residents. The nett total of inquests (148) is analysed below:— TABLE 30. Inquests, 1905. Finding of Jury. St. Mary. St. John. North-West Paddington. m. f. m. f. m. f. Natural Causes 30 26 5 4 3 6 By Misadventure 1 3 2 1 ... Accidental Causes 15 15 7 4 5 1 Murder ... ... ... ... ... ... Suicide 7 2 5 2 ... ... "Open" 2 1 ... ... ... ... " Neglect ... ... 1 ... ... ... Totals 55 47 20 11 8 7 As regards deaths by suicide, there was a slight increase, the deaths being equal to a rate of 0.10 per 1,000 as compared with a decennial mean rate of 0.09. The increase was limited, however, to the St. John's Sub-District, where the rate for last year (0.20) was double the mean (0.10). An analysis (condensed) of the causes and circumstances of the deaths, other than those by natural causes, is appended. Misadventure—-(7 deaths)— Mistaken medicine 2 Chloroform narcosis 1 Overdose of sulphonal 1 Drowned when intoxicated 1 Epileptic seizure (suffocation) 1 Fainted in bath 1 Accidcnt—(47 deaths)— Falls (various) 14 Overlaid in bed 8 Vehicular traffic 7 Drowning 2 Clothes taking fire 7 Other accidents 5 Suffocation 4 Neglect-—(1 death). Suicide—(16 deaths)— By poison, 6, oxalic acid (3), hydrochloric acid (2), and cyanide of potassium (1). By cut throat, 4—3 males and 1 female. By shooting, 3—males. By hanging, 1 male. BY throwing self from window—1 female. By jumping in front of train—1 male. Often—(3 deaths)— A man aged 50 years found drowned in Serpentine. A man aged 35 years and a woman aged 49 years found drowned in Canal. 52 Deaths In Institutions. DEATHS IN INSTITUTIONS. The 806 (780*) deaths registered in the local Public Institutions included 374 of persons not belonging to the Borough. In institutions outside the Borough, 146 (154) deaths of residents occurred. The total number of residents dying in public institutions was 578 (593). The principal causes of death are given in Table IIIa, Appendix. The deaths in institutions last vear constituted 29.4 per cent, of all deaths of residents compared with 28.8 in 1904, 29.4 in 1903 and 1902, and 22.2 in 1901—or an average of 26.8 per cent, for the four years. The proportions of deaths in institutions of residents of the different wards to all deaths varied from 22.5 per cent, in Maida Vale Ward to 35.2 per cent, in Church. The proportions for each Ward for the past three years are given below :— Wards. 1905 1904 1903 Wards. 1905 1904 1903 Queen's Park 31.1 26.0 34.5 Church 35.2 35.4 35.1 Harrow Road 26.5 28.8 24.0 Lancaster Gate (West) 27.2 22.0 25.4 Maida Vale 22.5 27.3 27.0 „ (East) 20.3 19.6 15.0 Westbourne . 31.3 27.0 29.7 Hyde Park 25.0 25.9 31.1 Grouping the institutions according to sources of revenue, it appears that 19.3 per cent, of the deaths recorded therein took place in those maintained out of the rates, and 10.1 per cent, in those depending on voluntary contributions. A further classification according to the special characteristics of the institutions is appended :— Rate-maintained— Metropolitan Asylums Board's Hospitals 13 (27) deaths, equal to 0.6 (1.2) percent, of all deaths. Poor Law Workhouses and Infirmaries 318 (321) „ „ 16.2 (15.9) „ „ Lunatic Asylums 49 (46) „ „ 2.5 (2.2) „ „ Supported by Voluntary Contributions— Hospitals and Homes (but not private nursing homes) 199 (188) „ „ 10.1 (9.3) „ „ * Figures for 1904 shown thus. 53 TABLE 37. Report of the Work of the District Inspectors during the year 1905. 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. ADMINISTRATIVE WORK. Quarters. No. 1 93 168 601 4,314 70 27 6 5 71 24 2 4 1 4 5 3 16 – – 10 1 No. 2 200 86 745 – 4,407 85 49 22 17 80 25 6 3 – 13 — 6 13 36 1 – 3 1 37 – No. 3 100 121 610 — 4,225 68 15 23 9 43 18 6 4 22 12 9 13 29 – – 6 4 49 – No. 4 124 105 534 – 4,666 80 40 35 17 88 28 6 14 1 24 29 3 12 30 3 1 17 -- 8 – Year 577 480 2490 17,612 303 131 86 48 282 95 20 25 2 63 – 52 12 41 111 4 1 36 5 95 54 ADMINISTRATIVE WORK. ADMINISTRATIVE WORK. Staff.—The Staff of the Department remains unchanged. The usual summary of work performed by the District Inspectors is given in Table 37. 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 5,107, 4,425 of which were made by the Women and Student Inspectors,* with reference to cases (or deaths) of the following diseases :— Measles 2,762 visits. Chicken-pox 274 visits. "Consumption" 393 visits. Whooping Cough 860 „ Infantile Diarrhoea 106 „ Puerperal Fever 21 „ In 1904 the visits in connection with infectious illnesses numbered 4,652; in 1903, 4.145 and 1902, 3,341. The numbers for each quarter of the three last years are given below :— Quarter 1 2 3 4 1905 1,092 2,096 964 955 1904 1,732 872 801 1,247 1903 1,012 1,064 988 1,081 "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 44 such letters were issued, as compared with 72 in 1904 and 60 in 1903. Special communications are sent to midwives and others having charge of cases of puerperal fever, of which 2 were issued last year, as against 8 in 1904 and 4 in 1903. The rooms disinfected numbered 2,662 last year, as compared with 1,795 in the previous year. Hospital Work.—The total number of cases of infectious illnesses removed to hospital was 387 last year, 478 in 1904, 549 in 1903, and 632 in 1902. The Asylums Board have accommodation available at the present time for 6,795 "fever patients and 2,040 small-pox. Two hospitals are in course of preparation, viz., South-Eastern (fever, acute cases; reconstruction; ready June, 1906; 486 beds) and Southern (fever, convalescent cases; new; 800 beds). Gore Farm (Upper and Lower) Hospitals, originally provided for small-pox, have been taken for the reception of convalescent fever cases.- I he appended summary shows the accommodation provided and in course of provision. For "fever" (diphtheria and scarlet, typhus and enteric (typhoid) fevers)— Permanent accommodation provided—acute cases 4,243 beds in 9 hospitals. convalescent 2,552 „ 3 „ Accommodation to be provided acute cases 488 „ 1 hospital. convalescent 800 „ 1 „ For small-pox— Permanent accommodation provided, acute and convalescent cases 2,040 „ 3 hospitals. * In addition, 516 visits were made to houses to which patients were discharged from hospital after infectious illness, 1,120 inspections of houses where children had been recently born, and 1,591 calls for other purposes. ADMINISTRATIVE WORK. 55 When the two hospitals now in progress are completed, the accommodation available will amount to 10,121 beds. The usual scale of provision is one bed to every 1,000 of the population, which would mean 4,700 beds for the Metropolis—less than half the number given above. Disinfection.—No change has to be recorded in the practice of the Department either as regards rooms or goods. No notices for the delivery of articles exposed to infection for the purposes of disinfection, or for the "cleansing and whitewashing" of premises after infectious illness were required. The articles disinfected and cleansed by the contractor weighed just over 67 tons, 10 tons more than in 1904. The cost amounted to £1,392, roughly £200 in excess of the total for 1904 (£1,181). On disinfectants (formaldehyde, soap and chloride of lime) the expenditure last year was £24, the same as in 1904 and 1903. The expenditure under this head has declined for some years. In the Report for 1904 it was stated that the Council had decided to erect a disinfection station on land in Kensal Road, in rear of the Public Baths. Legal difficulties arising from the conditions of purchase, &c., led to the abandonment of that scheme. The Special Committee have had before them other sites, but at the close of the year no definite decision had been reached.* Family Shelter.—No one has made use of the shelter for three years. The substitution of the formaldehyde spray 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. 49 (1) of the Public Health (London) Act, 1891, numbered 102 as compared with 59 in 1904, 76 in 1903 and 121 in 1902. The reasons for discontinuing the supply were reported by the Inspectors to be— District Grand Junction. West Middlesex. Repairs of fittings 13 12 Empty houses 40 18 Unpaid rates 2 6 Premises in course of demolition 9 2 The supply was restored at 22 houses within 24 hours of being cut off, at 3 houses in 2, 8, or 4 days (1 each), at 2 after 5 days', 4 after 6 days', 1 after 14 days' and 1 after 8 months' interval. Notices to restore the supply were issued in 9 instances, one case requiring the intervention of the Court and a closing Order. (See Legal Proceedings.) An attempt was made during the year to secure increased supply of water to tenement houses, an account of which will be found under Legal Proceedings. * While this Report has been in preparation a communication has been sent to the Kensington Borough Council enquiring whether arrangements could not be made for the work to be done at that Council's new station in Wood Lane. 56 ADMINISTRATIVE WORK. Mortuaries.—During the year 252 bodies were received at the Paddington Green Mortuary and 13 at that in kensal Road. Inquests were held on 210 of the bodies received at the former Mortuary and 13 at the latter. Eighty-three post-mortem examinations were made, viz., 76 at Paddington Green and 7 at Kensal Road. Schools and School Attendance.—All schools are now under one local authority, viz., the London County Council, a fact which makes the work in connection with exclusion of children for infectious diseases somewhat easier, and is gradually rendering the closing of schools by the Borough Council unnecessary. The Girls' and Infants' Departments of St. Mary's School, Paddington Green, were finally closed in May of last year, the buildings being condemned as unsuitable for use as public elementary schools. Other Non-Provided Schools are awaiting final decisions as to their future, while to the remainder alterations and repairs more or less extensive have been required, and in most cases carried out. There is no doubt the schools are in a much better "sanitary" condition than they were (say) two years ago, but that is not intended to imply that their condition was then "insanitary"—the demands which have been made notwithstanding. TABLE 38. Borough Schools, 1905. 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 1 1 ... ... ... Beethoven Street 9 4 2 ... 1 ... Campbell Street 3 3 ... 1 ... ... Droop Street 3 ... 2 1 1 ... Essendine Road 10 1 6 2 ... ... Harrow Road 11 3 2 3 3 ... Kilburn Lane 4 4 ... ... 2 2 Totals 46 16 13 7 7 9 Non-Provided Schools— Bayswater Jewish ... ... ... 1 ... ... Cirencester Street R.C. 3 l ... ... ... ... Holy Trinity 4 1 ... ... ... ... St. Augustine 2 2 ... ... 8 3 St. James 3 1 ... ... ... ... St. John, Kilburn Lane ... ... ... ... 1 ... St. John, Titchborne Street 2 ... ... ... ... ... St. Luke, Kilburn 6 4 2 ... 8 1 St. Mary ... 1 1 ... ... .. . St. Mary of the Angels, R.C. ... .... ... 1 ... ... St. Mary Magdalene 1 1 1 2 ... 1 St. Matthew 13 9 l ... ... ... St. Michael 2 1 l ... 1 ... St. Paul 6 2 2 1 ... ... St. Peter 3 ... 3 2 ... ... St. Saviour 3 1 1 4 ... ... St. Stephen 6 9 3 ... 5 1 Westbourne 4 1 1 1 2 ... Wilberforce 1 ... ... 1 1 1 Woodfield 7 1 ... ... ... ... Wordsworth 3 ... ... ... ... ... Totals 69 21 16 13 26 7 P.A. —Patients attending school. P.N.A.—Patients not attending school. Administrative work. 57 In Table 38 will be found returns of the cases of notified diseases which have occurred in families sending children to school, and in Table 39 a similar but differently compiled return for all the other diseases. In the latter no distinction has been made between cases of scholars from those of non-scholars. In considering the figures it is necessary to remember that the number of places in Non-Provided Schools is to the number in the Provided as 3:2 (approximately). Owing to the prevalence of measles there was a considerable increase in the number of notices forwarded to the teachers of the public elementary schools. In 1901, 2,804 notices (for exclusion and re-admission of scholars) were issued. Last year the number was 3,707, distributed thus— Exclusion. Re-admission. For notified diseases . 462 4-12 For other diseases 1,928 875 TABLE 39. Borough Schools, 1905. Other Diseases. Name of School. Measles. Chicken-pox. Yr. Whooping Cough. Quarters Yr. Quarters. Quarters. Yr. 1 2 3 4 1 2 3 4 1 2 3 4 Provided Schools— Amberley Road 1 9 16 33 59 9 1 ... 1 11 ... 2 2 2 6 Beethoven Street 13 17 3 1 34 1 1 ... ... 2 14 25 ... ... 39 Campbell Street 3 19 23 ... 45 3 11 2 1 17 10 6 ... 2 18 Droop Street 7 72 ... ... 79 9 9 ... 6 24 42 12 ... ... 54 Essendine Road 11 57 ... 49 117 3 4 1 1 9 20 29 ... 3 52 Harrow Road 24 63 ... 2 89 22 ... 1 ... 23 9 7 5 ... 21 Kilburn Lane 17 61 ... ... 78 ... 1 ... 3 4 3 1 ... ... 4 Totals 76 298 42 85 501 47 27 4 12 90 98 82 7 7 194 Non-Provided Schools— Bayswater Jewish ... 5 6 ... 11 ... ... ... 1 1 1 2 1 ... 4 Cirencester Street, R.C. ... 4 19 ... 23 ... ... ... ... 2 ... 6 2 ... 8 Holy Trinity ... 3 ... 28 31 2 ... ... ... 2 ... ... ... ... ... St. Augustine ... ... 3 ... 3 ... 1 ... ... 1 1 8 ... ... 9 St. James ... 33 20 2 55 3 ... ... 20 23 18 3 ... .. 21 St. John, Kilburn Lane 3 2 ... ... 5 ... ... ... ... ... ... ... ... ... ... St. John, Titchborne Street 8 34 ... 1 43 ... ... ... 8 8 2 7 1 ... 11 St. Luke, Kilburn 3 7 8 7 25 6 ... 1 ... 7 ... ... ... ... ... St. Luke, Westbourne Park ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 St. Mary 23 4 2 ... 29 6 ... ... ... 6 14 9 ... ... ... St. Mary of the Angels, R.C. 1 ... 1 ... 2 1 ... ... ... 1 ... ... ... ... 2 St. Mary Magdalene 3 16 17 1 37 ... 1 ... 8 9 ... ... 2 ... ... St. Matthew 2 13 ... ... 15 ... ... 1 11 12 ... 2 ... 6 8 St. Michael 2 21 4 ... 27 ... ... 2 2 4 ... 4 ... ... 5 St. Paul 5 ... ... 1 6 6 4 1 ... 11 ... 4 1 ... 1 St. Peter 8 15 1 ... 24 4 ..... ... 11 15 ... 1 ... ... ... St. Saviour 2 6 ... 23 31 1 2 ... 4 7 .. ... ... ... ... St. Stephen 7 42 ... ... 49 ... ... ... 2 2 2 5 ... ... 7 Saltram Crescent 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... West bourne ... 8 ... ... 8 ... ... ... 1 1 ... 1 ... ... 1 Wilberforce 3 2 4 ... 9 1 ... 1 ... 2 5 ... ... ... 5 Woodfield 1 ... ... ... 1 ... ... ... ... ... .... ... ... ... ... Wordsworth ... 1 .. ... 1 ... ... ... ... ... ... 2 ... ... 2 Totals 72 216 85 63 436 30 8 6 68 112 43 60 8 8 119 58 ADMINISTRATIVE WORK. Closure was enforced on ten occasions in nine schools, 5 Orders being issued by the Council. The other closures were directed by the Education Committee of the County Council. Particulars are given below. School. Class-room. Date of Closure. Duration. Disease. By Order of the Borough Council :— St. James (Inf.) 1 and 2 Mar. 17th 3 weeks. Whooping Cough. St. Mary (Inf.) 3 and 4 Mar. 21st 3 „ Measles and Whooping Cough. St. Stephen (Inf.) C May 17 th 3 „ Measles. St. James (Inf.) Whole Department June 23rd 3 „ „ St. Saviour (Inf.) „ Nov. 27th 6* „ „ By Education Committee :— St. Mary Magdalene (Inf.) D June 28th 2½ weeks. Measles. Campbell Street (Inf.) C and D July 15th† „ Essendine Road (Inf.) D Oct. 20th 2½ " „ Amberley Road (Inf.) C „ 2½ „ „ Essendine Road (Inf.) A, B and C Nov. 11th 2½ „ „ * Including Christmas holidays. † Until Summer holidays. Duplicate copies of notices to Extra-Borough Schools are sent to the Medical Officers of Health of the Adjacent Districts, from whom similar returns are received relating to Borough Schools. Pradically all non-resident scholars come from either Willesden or Kensington. From those Districts 44 returns were received last year compared with 69 in 1905. Willesden. Kensington. Scarlet fever 22 11 Diphtheria 6 4 Enteric fever – 1 28 16 Bacteriological Examinations.—There was a decrease in the number of specimens (61) received for examination during the past compared with preceding year, and the percentage of positive results (34*4) was also lower. The numbers submitted during the four preceding years and the percentage of positive results were—1904, 80 (35) ; 1903, 67 (19.4) ; 1902, 05 (43) ; and 1901, 129 (53.4). The specimens received last year related to the following diseases :— No. Specimens Results. received. Positive. Negative. Diphtheria 36 8 28 Enteric fever 23 11 12 "Consumption" 1 1 — Septicemia 1 1 — It is a matter for some regret that more use is not made of the offer to bacteriologically examine the sputum in cases of suspected "consumption." The early detection of the bacillus is advantageous both to the public (that proper precautions be promptly initiated) and to the patient (that suitable treatment be adopted at the earliest possible time). Of fensive Refuse.—Trade Refuse.—There has been no change in the systems of dealing with this class of refuse, and no complaints of nuisances arising therefrom have been received. 59 Bacteriological Laboratory. During the year 132 examinations have been made at the Lister Institute in 100 suspected cases of diphtheria, 22 of typhoid fever, and 8 of pulmonary tuberculosis, at a cost of £20 12s. 8d. At the general hospitals bacteriological examinations are made in the laboratories of the medical schools attached thereto. The result of the 132 examinations were as follows:— 24 positive 78 negative. (In 4 cases Hoffman's pseudo - diphtheria was recognised.) Typhoid fever 12 positive 10 negative. Tuberculosis 1 positive 7 negative. The report of the bacteriologist is of very considerable value in assisting medical men in forming a correct diagnosis in doubtful cases, and may thereby prevent persons not suffering from an infectious disease being sent to a fever hospital. Disinfection. During 1905, 1,177 rooms in 667 houses were disinfected by the Staff of the Department, 34,703 articles were subjected to steam disinfection in the City Disinfecting Stations. In addition, a number of rooms and their contents were disinfected to the satisfaction of medical men by private firms. 151 articles were destroyed by fire at the request of the owners. Disinfection was carried out after all cases of the notifiable diseases, except as regards erysipelas (in which disinfection was only performed when the circumstances of the case required it), and also after 36 cases of measles, 3 German measles, 7 chicken-pox, 1 whooping cough, 15 cancer, 3 influenza, 1 glanders, 1 Mediterranean fever, 1 cholera (suspicious), 1 mumps, and 49 phthisis. Fifty-two books were disinfected. Books belonging to the public libraries are, as a rule, treated by the librarians, a copy of each certificate of infectious disease being sent to the Chief Librarian. Shelters.—Six persons were admitted to the temporary shelters (Horseferry Road and Dufour's Place) during 1905. One nurse had her clothing disinfected and received a bath at one of the shelters after attendance on a case of puerperal fever. The following table gives a comparative statement of the above work during the past five years :— 60  1001. 1902. 1903. 1904.  Houses 834 1,097 709 581 667 Rooms 1,287 1,836 1,039 935 1,177 Articles disinfected 32,218 39,965 27,766 29,107 34,703 Articles destroyed 58 37 126 52 151 Boots 95 24 16 10 52 Number admitted to shelters 13 20 19 39 6 Cleansing of Persons.—Under the provisions of this Act seven persons received a free bath and had their verminous clothing disinfected. Since the closing of the Denzell Street premises there has been no accommodation for this work, but provision is to be made at the new central station, and as it will probably be in the vicinity of most of the common lodging-houses, it is likely that greater use will be made of it. The Guardians have dealt with frequenters of their Casual Wards at their own establishments. Verminous Houses.—Twenty-two rooms in nine houses were fumigated with burning sulphur, and 385 articles were passed through the disinfecting apparatus. Mortuaries. The number of bodies removed to the public mortuaries in the City during 1905 was 370; 344 were taken to Horseferry Eoad, 13 to Dufour's Place. 11 to Drury Lane, and 2 to Ebury Bridge. There were 313 inquests held, all being at Horseferry Eoad, where the Coroner's Court is situated; 15 adjourned inquests were held. The number of inquests was 12 per cent, of the deaths registered in the City. Post-mortem examinations were made at Horseferry Eoad in 204 instances, and at Dufour's Place in 12 instances. Sixty-one bodies were removed to mortuaries to await burial, 35 being taken to Horseferry Eoad Mortuary, the remainder to the other mortuaries specified above. A petition signed by over forty influential citizens of Westminster, alleging the urgent need for a public mortuary for the reception of bodies awaiting burial in the City, apart from the one already existing and attached to the Coroner's Court, Horseferry Eoad, was presented to the Mayor, and referred to the Public Health Committee, who reported to the Council as follows :— "Prom a report submitted to us by the Medical Officer of Health, we have ascertained that there are five public mortuaries in the City (viz., in Horseferry Eoad, Mount Street, Drury Lane, Dufour's Place and Ebury Bridge, and two private mortuaries, 61 one in connection with St. Matthew's Church, Great Peter Street, and the other with the Church of St. Barnabas, Pimlico. The mortuary in connection with St. Matthew's Church is free to all persons living within the ecclesiastical parish of St. Matthew who are entitled to Christian burial, and for those who have been regular communicants at the church, although they may not have been living within the borders of the ecclesiastical parish. Bodies are also admitted to this mortuary at any hour of the day on notice being given, restrictions being made in cases of persons having died from certain diseases. "The mortuary in connection with St. Barnabas Church is not available for public use, being primarily for the use of the poor in the ecclesiastical parish of St. Barnabas, other persons being granted leave to have their dead placed there, application to deposit a body in this mortuary having to be made co the Sister in Charge, The Mission House, 17, Pimlico Eoad. No fees are charged to parishioners, and not less than 2s. 6d. to a nonparishioner in respect of this mortuary. "We have also ascertained that there is a mortuary in connection with St. Mark's Church, North Audley Street, but that this is no longer available. "After very careful consideration, we are of opinion that the mortuary accommodation provided in the City is sufficient. "We consider, however, that certain decorative works and refurnishing are desirable at the premises at Ebury Bridge, Mount Street, Drury Lane, and Dufour's Place, with a view to adding a more comfortable and suitable appearance to the mortuaries, and thus encourage relatives of deceased persons to have bodies placed there whilst awaiting burial. "We are also of opinion that the existence of these mortuaries should be made more generally known throughout the City." .... ■ " o 62 PART II. C. House Inspection, &c. Below is a list of details of the work done in connection with insanitary conditions in dwelling-houses. In many cases some of the work specified was in premises part of which was occupied as workshops:— 1905. 1905. Complaints received and dealt Sanitary "Work completed :— with 692 Water-closets:— Houses and premises inspected 4,663 Constructed 834 „ „ re-inspected 20,633 Repaired 781 „ (registered), visits to 1,578 Ventilated 549 Notices issued (preliminary) 3,095 Separated from rooms 17 „ ,, (statutory) 159 Cleansed or limewashed 903 Sanitary Work completed:— New pans fixed 1,319 Houses:— Pans and traps cleansed 361 Closed under H.W. Classes Obstruction removed 146 Act — Traps ventilated 791 Closed under P.H. (London) Water supply provided 777 Act 1 Flushing apparatus fixed 1,166 Cleansed throughout 236 ,, repaired 622 „ partially 797 Waste Pipes:— Overcrowding abated 120 To sinks, baths, lavatory Light or ventilation improved 166 basins, &c. 68 Roofs repaired 271 Fixed 750 Floors and staircases repaired 275 Repaired or unstopped 336 Underground rooms vacated 54 Disconnected from drain 186 Yards, areas, paved or re- Trapped 913 paired 537 Ventilated 668 Damp walls remedied 28 Water Supply:— Offensive refuse removed 231 Provided 511 Keeping of animals discontinued16 Reinstated 81 Cisterns fixed 148 Drains:— „ cleansed 262 Constructed 302 „ covered 360 Amended and repaired 402 „ old, defective, Disconnecting traps fixed 358 abolished 73 Ventilated 368 Disconnected from w.c. Tested 1,324 supply 85 Unstopped or cleansed 274 Dust Bins:— Gully traps fixed 1,263 Provided 130 Inspection chambers built 819 Repaired 133 „ repaired Old, abolished 66 or cleansed 280 Stables: — Inspection chambers, cover Drained 39 fixed or sealed 730 Paved 27 Soil pipes fixed or repaired 549 Cleansed 31 Ventilating pipes fixed or Dung receptacles provided 24 repaired 470 ,, repaired 2 New sewer connections 109 Dung pits abolished 3 Rainwater Pipes :— Dung accumulations re moved 470 Fixed or repaired 561 Disconnected from drain 295 63 WORKSHOP SUPERVISION. The quantity of refuse dealt with on the Wharves was less last year than it has been for some time. Offensive Businesses.—In 1903 the County Council made an Order declaring the dressing of fish skins to be an offensive business within the meaning of Sec. 10 of the Public Health (London) Act, 1891. During 1905 by-laws for regulating the conduct of that business were issued. There is no offensive business 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. The Home Office issues special directions and tables (Table VII., Appendix) indicating the information required. The system of work adopted by the Department, sufficiently described in previous Reports, remains unchanged. Registration.—At the close of 1904, 1,200 premises were on the Registers of the Department. During 1905, 180 premises were added to and 93 removed from the Registers, leaving 1,353 effective entries at the close of the year. The premises comprised 104 factories, 790 workshops, 15 domestic workshops, 385 premises occupied by single workers, and 59 "workplaces." In addition there are 20 contractors' premises which are not included in the total of 1,353. The classes of businesses carried on and the number of workers are indicated in Table 41. The latter can be regarded as an approximate estimate only, owing to frequent changes which take place from various causes. Notices of 10 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, 84 lists were received from employers in the Borough, containing 424 addresses of outworkers, viz., 44 in February and 40 in August. The addresses forwarded to other Boroughs numbered 240, and those received from, 183. The 183 addresses were received from the following districts :— Finsbury 13 lists St. Pancras 3 lists City of London 12 „ Fulham 2 lists Kensington 11 ,, Shoreditch each Hampstead 9 „ Chelsea Marylebone 6 lists Hammersmith 1 list Westminster each Islington each Willesden At the close of the year the Department's Register contained 272 entries of premises occupied by outworkers, comprising— Factory, 1; workshops, 97 ; workplaces, 2; and 172 "single workers." The last alone are really within the definition of "outworkers." The total number of persons working in the 272 premises was 592. (For particulars as to businesses carried on, &c., see Table 41, where the figures relating to outworkers are shown in parentheses.) 64 WORKSHOP SUPERVISION. TABLE 41. Factories, Workshops, and Work-places. 1905. No. of Premises. No. of Rooms. Employees. Totals. Women. Young Persons. Men. Clothing— Boot-making 99 (40) 102 (40) 8 (3) 4 138 (44) 150 (47) Clothing, repairs 4 4 6 — — 6 Corset-making 9 (1) 11 (1) 22 (1) 1 — 23 (1) Dressmaking 467 (58) 634 (72) 1,856 (148) 409 (29) 5 (3) 2,270 (180) Fur-sewing and Furriers 4 6 12 1 5 18 Mantle-making 11 (5) 16 (7) 59 (14) — — 59 (14) Millinery 46 (4) 71 (4) 334 (7) 38 1 373 (7) Millinery and Dressmaking 21 60 320 28 4 352 Outfitting and Plain Needlework 35 (22) 36 (22) 89 (26) 5 (1) — 94 (25) Tailoring 150 (101) 176 (109) 179 (101) 19 (12) 256 (113) 451 (226) „ Ladies' 19 29 121 25 44 190 Various 11 (4) 11 (4) 14 (5) — 18 32 (5) Fancy Work— Embroidery and Art Needlework 8 (4) 11 (4) 41 (8) 7 8 (1) 56 (9) Other 9 (3) 9 (3) 21 (5) 5 — 26 (5) Cleansing— Dyers and Cleaners' Receiving Offices 15 15 33 7 2 42 Laundries 140 (9) 423 (16) 1,152 (22) 23 (4) 106 (3) 1,281 (29) „ —Receiving Offices 31 35 38 4 2 44 Mangling 25 (1) 25 (1) 25 (1) — — 25 (1) Various 6 (2) 6 (2) 14 (8) 2 1 17 (8) Other Businesses— Bookbinding and Printing 27 38 72 20 153 245 Coach Building 37 64 — 1 272 273 Cycle and Motor Making 17 21 — 9 83 92 Jewellery and Clock-making 7 11 3 26 22 51 Metal-working 19 20 — — 76 76 Saddlery 8 10 — — 24 24 Sign and Ticket Writing 7 8 — 8 14 22 Trunk-making 5 8 — — 26 26 Umbrella-making 5 6 14 3 6 23 Upholstery 39 (17) 65 (22) 107 (26) 12 (4) 61 (1) 180 (33) Various 72 (1) 107 (1) 162 138 593 (2) 893 (2) 1,353 (272) 2,038 (308) 4,702(375) 795 (50) 1,920 (167) 7,417 (592) The figures in parentheses refer to outworkers. Inspections.—The inspections and re-inspections made during the year numbered 2,025 (see Table 42) as compared with 3,414 in 1904, and 109 rooms were measured, or 111 less than in 1904. Single workers' premises are not measured. Eighty-six (86) workrooms were found to be used as bedrooms. The number of workshops without the "Abstract" prescribed by the Act was 15, against 65 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 Factory and Workshop Act; and in 1904, 96. Last year the number fell to 54. Much necessary work was, however, done without notice, on verbal requests of the Inspectors. 65 WORKSHOP SUPERVISION. TABLE 42. Workshops, &c., Inspections. 1905. Miss O'Kell. * Miss Nicolas. * Mr. Wansbrough. † Workshops— On register end of 1904 536* 443* 281 added during 1905 33 40 113 removed „ „ 34 28 31 On register end of 1905 535 455 363 Inspections 30 40 236 Re-inspections and miscellaneous calls 224 272 1,223 Rooms measured 16 70 23 Workrooms used as bedrooms 54 25 7 Workrooms without Abstracts 1 8 6 Notices served, totals 11 8 8 Written intimations 8 5 6 Under Sec. 4 Public Health (London) Act, 1891. 1 1 — 37 — — — 38 — — 2 By-laws, under same Act 2 2 — Nuisances dealt with— Discovered. Abated. Discovered. Abated. Discovered. Abated. Overcrowding — — 6 6 3 3 Dirty Conditions 13 12 13 8 56 50 Deficient Ventilation 2 1 — 1 — — Temperature too high — — 1 1 — — Temperature too low — — 2 2 — — Sanitary conveniences— Insufficient — — — — — — Not separately provided — — 1 1 3 3 Badly placed — — — — 4 4 Unventilated 1 — — — — — Defective 2 2 4 2 1 1 Vapour, effluvia not removed Steam in wash houses — — — — — — Gas fumes — — 11 11 7 7 Drains — — 1 — — — Wet floors, laundries 2 1 — — — — Accumulations of refuse — — — — — — Other nuisances or offences 7 2 1 — 3 3 Totals 27‡ 18 41§ 32 77 71 *Including workshops where both sexes are employed. †Workshops where men only are employed (Bakehouses not included.) ‡Nine cases referred to Male Inspectors. §Three cases referred to Male Inspectors. Complaints.—In 1902 the Home Office forwarded 28 complaints, in 1903 10, in 1904 6, and last year 22, referring to— Dirty conditions, 8; insufficient ventilation, 2; overcrowding, 5; other matters, 7. 66 workshop supervision. From other sources 7 complaints were received last year, relating to— Defective drainage, 1; insufficient means of warming, 1; dirty conditions, 1; overcrowding, 2; overtime, 1; and "other matters," 1. 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; in 1904, 16; and last year 9—a very satisfactory reduction. Deficient Ventilation.—In 1903, 19 workshops were noted as insufficiently ventilated; in 1904, 10; and last year, 3. 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. 1905. Insufficient 9 5 2 — Not separately provided 33 17 4 4 Badly placed 18 10 13 4 Unventilated 8 5 — 1 Defective 29 28 23 7 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.—Seventy cases of infectious illnesses were reported at "workshop premises," 29 of the cases occurring in houses occupied bv homeworkers. In 1904 the numbers were 53 and 14 respectively. The cases reported are as follow:— Scarlet fever 3 (1) Chickenpox 5 (2) Diphtheria 1 Measles 43 (19) Erysipelas 1 Whooping Cough 17 (7) There were 8 deaths from consumption during the year at premises where workshops exist, 3 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 1904, only one underground bakehouse was without the certificate required by Sec. 101 of the Factory and Workshop Act, 1901, the necessary alterations not having been completed to the satisfaction of the Public Health Committee.. A summons against the Council was issued by the occupier of the bakehouse, and the certificate granted by the Magistrate. The total number of bakehouses in the Borough at the end of 1905 was 79, viz., 18 "level" and 61 underground. Of the 79 bakehouses 8 are factorv bakehouses, and 71 workshop. Of the former 39 inspections were made during the past year; of the latter, 506. Sixteen bakehouses were reported to be dirty. Three cases of sickness—viz., one each of enteric fever, erysipelas and chickenpox—occurred on the premises. 67 HOUSING Housing. This subject is 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: Registration.—At the end of 1904, 1,031 houses were on the Register. During 1905, 194 houses were visited for the purpose of registration, of which 140 were placed on the Register, and 21 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 and other causes. The total number of houses on the Register at the end of the year was 1,150. To secure the information prescribed by the by-laws, 157 notices and 76 "reminders" were issued, but no summonses were required. Appended is a general summary of the housing conditions in the houses visited with a view to registration. The large proportion of exempt houses in group B is worthy of notice. Summary of Particulars obtained at Registration, 1905. Housing. Inspector Wingfield. Inspector Lawrence. Group A. Group B. No. of Houses visited with a view to Registration 58 136 Houses Registered 55 85 „ Exempt 3 51 „ Empty — — No. of Rooms, registered 316 302 For living only 75 30 For sleeping only 112 127 For living and sleeping 129 145 Other Rooms 134 551 Occupied by landlords 59 120 Exempt by rent 14 408 Occupied but not inhabited 56 6 Empty 5 17 Grand Totals, Rooms 450 853 Inhabitants. Group A. Group B. In Registered Rooms, Persons 538 601 Persons under 10 years 140 173 Persons 10 years and upwards 398 428 In other Rooms, Persons 88 762 Persons under 10 years 14 190 Persons 10 years and upwards 74 572 Grand Totals, Persons 626 1,363 Overcrowding. In Registered Rooms— Group A. Group B. Families 11 43 Persons, all ages 32 190 „ under 10 years 8 73 „ 10 years and upwards 24 117 Abated by re-adjustment of occupants 6 10 Requiring removal 1 26 Cases held over, etc. 4 7 68 housing. Streets comprised in Group A. Group B. Alfred Place ( 4 houses) Campbell Street ( 1 house ) Netley Street ( 1 house ) Hampden Street (40 „ ) Crompton Street (14 houses) North Wharf Road (24 houses) Orchard Street (7 „ ) Dudley Street (14 „ ) Shirland Road (17 „ ) Waverley Terrace (4 „ ) Howell Street (13 „ ) Westbourne Pk. Cres. ( 1 house) The housing arrangements are set out in Table 43. TABLE 43. Particulars as to Numbers of Tenements and Inhabitants therein, registered during 1905. Rooms to Tenement. Group of Streets. 1 2 3 4 5 6 7 8 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 1 A 29 29 ... 29 57 1 20 43 17 1 2 2 1 2 3 ... ... ... ... ... ... ... ... ... B 55 55 ... 37 71 3 19 40 17 9 18 18 2 4 6 1 2 4 ... ... ... ... ... ... 2 A 4 4 ... 14 28 ... 19 49 8 21 51 33 10 22 28 4 20 4 ... ... ... ... ... ... B 3 3 ... 11 22 ... 16 41 7 12 35 13 22 63 47 4 11 13 5 19 16 3 11 13 3 A 1 1 ... ... ... ... 4 11 1 9 25 11 4 11 9 2 8 4 2 6 8 ... ... ... B ... ... ... ... ... ... 2 1 2 1 3 l 1 5 ... 2 8 4 2 9 5 1 4 4 4 A ... ... ... ... ... ... 1 2 1 ... ... ... 1 5 ... ... ... ... ... ... ... ... ... ... 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 Number Total inhabitants Average number of persons containing— enumerated. therein. per room. One room 203 394 1.9 Two rooms 148 561 1.9 Three rooms 31 144 1.5 Four rooms 2 8 l.0 At the Census of 1001 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, l.3 Four rooms, 1.1 Inspections.—The total number of inspections of registered houses, apart from those in connection with the "annual cleansing," was 3,756 last year, as compared with 3,511 in 1904. A statement of the nuisances and sanitary defects discovered and dealt with will be found in Table 44. Annual Cleansing.—At the beginning of April of last year 1,073 houses were on the Register, all of which were inspected with a view to the cleansing requisite. This work involved 4,002 visits, and the service of 1,024 notices of various descriptions, viz., 1,045 "intimation letters," 551 "by-law notices," and 28 "reminders." It was necessary to take out summonses against 13 landlords of 28 houses. (See Legal Proceedings.) 69 housing. TABLE 44. Sanitary Defects Remedied in Registered Houses. 1904 1905. Drain defective 85 78 „ choked 5 6 „ untrapped 17 33 „ unventilated or improperly ventilated 89 74 Manhole cover defective 1 3 Inadequate means of access to drain 3 1 Surface inlet improperly trapped 23 6 Gully choked 4 4 Ventilating pipe improperly constructed 9 3 Soilpipe defective 3 1 „ improperly constructed 1 — „ unventilated or improperly ventilated — 3 Water-closet choked 32 12 „ defective 25 34 „ flushed from drinking water cistern 9 9 „ insufficiently flushed 26 13 „ flushing apparatus defective 2 29 „ without water supply 6 7 „ foul 32 25 „ improperly constructed 22 14 „ accommodation insufficient 5 10 „ without door 2 8 „ without external light or ventilation — 4 Rain-water pipe not disconnected from drain or soilpipe 28 39 „ defective 13 14 „ choked 3 — Sink waste pipe not disconnected from drain 18 5 „ defective 9 6 „ choked 1 2 „ not provided 1 1 Other drainage defects — 10 Cistern connected to drain 1 6 „ defective 7 6 „ dirty 12 20 „ improperly placed 5 2 „ without proper cover 15 11 „ cover defective — 18 Dustbin defective 29 50 „ not provided 1 7 Paving defective in area or yard 37 42 „ „ wash house 31 35 Guttering defective 18 14 Copper „ 3 — Premises damp 4 12 „ dirty 9 10 Rooms verminous — 144 Roof defective 73 134 Accumulation of refuse 5 34 Animals improperly kept — 2 Other defects or nuisances 8 19 As the number of houses on the Register increases, this work becomes heavier each year and takes up more time. From March until September the two Inspectors in charge of registration have to devote practically all their energies to this matter. A new scheme was formulated during the autumn, which it is hoped will save time and secure a more speedy completion of the work. Overcrowding.—The cases of "legal" overcrowding discovered in houses let in lodgings during the year numbered 69 (as against 298 in 1904), viz., 54 on registration, 8 at the annual 70 HOUSING. cleansing, and 7 on other inspections. The 69 tenements contained 312 persons, occupying 98 rooms, an average of 3.2 persons per room. Further particulars are given in the appended summary:— Registration. Annual Cleansing. Other Visits. Tenements overcrowded 54 8 7 Rooms 78 10 10 Occupants, total 222 47 43 Under 10 81 24 22 Ten and upwards 141 23 21 Overcrowding abated— By re-arrangement 16 — — By voluntary removal 6 — — Under notice 21 8 7 Cases held Over 4 — — No action taken 7 — — Of the cases reported last year, 7 were so slight that action was not thought necessary; in 16 the overcrowding was obviated by a re-arrangement of the sleeping accommodation, in 6 the families voluntarily sought other homes, and 36 did so after service of notice. Four families remained under observation at the close of the year. Vital Statistics.—The number of inhabitants residing last year in the "Registered Streets"* was estimated to be 16,045 persons, of whom 2,708 were under 10 years of age. The cases of notifiable infectious disease in these streets numbered 104, viz.:— Scarlet fever,. 40 Erysipelas, 29 Diphtheria, 21 Enteric fever, 10 Puerperal fever, 3 Smallpox, 1 (error). In addition, 588 cases of other infectious disease were reported to the Department, viz.:— Measles, 435 Whooping Cough, 83 Chickenpox, 70 The notified cases were equal to a rate of 7.44 per 1,000 persons, compared with 4.31 for the Remainder of the Borough. The total number of deaths among the inhabitants of these streets was 375, equal to a rate of 23.37 per 1,000 persons. In 1904 the rate was 22.84. In the Remainder of the Borough the rates are 12.04 for 1905 and 12.00 for 1904. The changes in the rates for the last two years are to be seen in Table 45. Last year's rates for measles (1.18), scarlet fever (0.18) and pneumonia (2.36) were the most notable increases. On the other hand, there were marked decreases in the rates for diphtheria, enteric fever, phthisis and cancer. * The following are "Registered Streets " :— Alfred Place. Crompton Street. Hasborough Street. Pressland Street. Alfred Road. Cuthbert Street. Hethpool Street. Senior Street. Amberley Road. Dartington Terrace Howell Street. Stalham Street. Braden Street. Desborough Street Kensal Road. Southam Street. Braithwaite Place. Dudley Street. Modena Street. Waverley Road. Brindley Street. Elcom Street Netley Street. Waverley Terrace. Campbell Street. Emily Street Orchard Street. Woodchester Street. Cirencester Street. Hall Place. Philip Terrace. Woodfield Place. Clarendon Street 71 HOUSING. Clarendon Street Area.—The usual table of vital statistics for this Area has been slightly altered on this occasion, with, it is believed, considerable advantage. To this Area much attention has been given for some five or six years. Registration was effected prior to 1901, and since that year cleansing has been carried out annually as required by the By-laws and at other times when necessary. The value of such work has been questioned, but the comparisons instituted in Table 46 afford good proof that the labour has not been wasted. The mean morbidity rates for the three commoner notified diseases (diphtheria, scarlet and enteric fevers) for 1901-04 are all below the means for 1896-1900, and last year's rates are below the mean rates for 1901-04. The only rate showing an increase is that of puerperal fever, which can be explained to some extent. Last year's rates for erysipelas and enteric fever were just below those for the Rest of the Borough. The death-rate at all ages shows an equally satisfactory decline, both on comparing the two mean rates and the rate for last year with either mean. The mean rates for 0-10 and 10— years for 1901-04 were below those for 1890-1900, but last year's rate for the former age TABLE 45. Rates per 1,000 persons. 1904. 1905. Registered Streets. Rest of Borough. Registered Streets. Rest of Borough. Notifications— Small-pox - 0.03 0.06 0.00 Diphtheria and Membranous Croup 1.25 0.91 1.30 0.56 Erysipelas 1.50 0.71 1.80 0.81 Scarlet Fever 3.81 2.32 2.49 1.80 Enteric and Continued Fevers 0.75 0.27 0.62 0.27 Puerperal Fever 0.12 0.06 0.18 0.03 All Diseases 7.44 4.31 6.48 3.48 Deaths— Small-pox — 0.01 — — Measles 0.31 0.25 1.18 0.33 Scarlet Fever 0.06 0.05 0.18 0.02 Whooping Cough 0.31 0.08 0.49 0.31 Diphtheria 0.31 0.10 0.06 0.01 Enteric Fever 0.31 0.03 0.06 0.03 Diarrhœal Diseases 2.56 0.76 1.93 0.45 Erysipelas — 0.04 0.06 0.04 Puerperal Fever 0.18 0.03 — 0.00 Phthisis 2.19 0.98 1.86 0.80 Other Tubercular Diseases 0.87 0.10 0.99 0.30 Alcoholism 0.18 0.09 0.12 0.09 Cancer 1.18 1.04 0.74 1.04 Premature Birth 0.59 0.40 0.74 0.34 Developmental Diseases 1.00 0.21 1.43 0.43 Bronchitis 2.56 1.16 2.24 1.16 Pneumonia 1.18 0.70 236 0.94 Cirrhosis of Liver 0.18 0.14 0.12 0.19 Accidents and Diseases of Childbirth 0.12 0.03 0.12 0.05 Suicides 0.06 0.07 0.00 0.12 Other Causes 8.63 6.14 8.60 5.30 All Causes 22.84 12.60 23.37 12.04 72 HOUSING. was slightly above the mean for the second period (1901-04). The increase was probably due to measles. As regards infants under 1 year, the proportion to deaths at all ages has decreased from 308 per 1,000 in 1800-1900 to 288 in 1905, but the proportion to deaths at ages 0-10 years has increased from 50.0 to 62.5 per cent. The explanation of these changes is probably to be found in the reduced prevalence of infectious diseases with consequent decrease in the mortality at ages from 1-10 years. The changes further suggest that the infantile mortality has not decreased, as that at higher ages has done. A very significant change is the increased proportion of deaths in institutions, from 30 per cent. of all deaths in 1890-1900 to 41.2 per cent. in 1901-01, and 35.9 per cent. in 1905. Having regard to the decrease in prevalence of infectious diseases, this increase in institutional deaths suggests an increase in the poverty of the inhabitants of the Area. Unemployment has been for some time excessive, a fact which implies an increase in women's work, and to that may be due in part the failure of the infantile mortality to decrease. Poverty implies also inability to secure proper attention at the lying-in, to which is attributed the increase in the morbidity rate for puerperal fever. Dirty conditions can hardly account for that increase, as the rates for the other infectious diseases, and especially for erysipelas—the dirt disease—have gone down. TABLE 46. Clarendon Street Area. Morbidity and Mortality Rates per 1,000 persons, except otherwise stated. Clarendon Street Area. Rest of Borough. Mean Rates. 1905. Mean Rates. 1905. 1896-1900. 1901-04. 1896-1900. 1901-04. Morbidity. Small-pox - 1.41 - 0.00 0.14 0.01 Diphtheria 1.85 1.53 1.37 2.17 1.43 0.61 Erysipelas 2.07 1.41 0.91 1.07 0.84 0.92 Scarlet Fever 5.21 4.28 2.89 3.99 2.73 1.82 Enteric Fever 0.95 0.94 0.30 0.54 0.43 0.31 Puerperal Fever 0.05 0.07 0.15 0.07 0.06 0.04 Mortality. At all ages 28.75 25.33 23.75 16.17 13.36 12.78 0—10 years Rates per 1,000 persons at these ages. 46.87 37.54 37.75 ? 25.66 24.24 10— 20.41 19.81 18.00 ? 11.01 11.05 Infants under 1 yr.* 308 289 288 288 204 206 In Institutions† 30.0 41.2 35.9 22.6 20.9 28.7 Infants under 1 yr. ‡ 59.0 62.3 62.5 ? 66.5 65.0 * Per 1,000 deaths at all ages. †Per 100 deaths. ‡Per 100 deaths, 0—10 years. Exemption by rents.—For some time a doubt has prevailed whether the rent exemptions from the operation of the By.laws for Houses Let in Lodgings has not impeded the work of improving the condition of tenement houses. With a view to testing that suspicion, the opportunity was taken during the inspection requisite for the annual cleansing to obtain information as to the rents paid for the various classes of tenements in the registered houses. 73 housing. Before proceeding to consider the information thus obtained, it will he well to recite the provisions of the By-laws as to exemptions. They are as follow :— Houses are exempt where— (a) The landlord resides himself and sublets to one family only. (b) The rents for each tenement are not less than Unfurnished Lodgings. (i.) Single room, 4s. 6d. a week—provided not more than two persons occupy such room, (ii.) Two or more rooms, 7s. 6d. a week. Furnished Rooms. (iii.) Single room, 6s. a week—provided not more than two persons occupy such room, (iv.) Two or more rooms, 10s. a week. The information (see Table 47) obtained relates to .1,949 separate lodgings, viz.:— 1,567 of one room each 361 of three rooms each 1,944 „ two rooms „ 71 „ four „ 3 of five or more rooms. Of the one room tenements 305 (23 per cent.) were let at rentals above the limit (4s. 6d.). The number of occupants in each of these tenements was not taken. In previous years 67 per cent. of all one-rooms were found to be occupied by one or two persons. It is unlikely that among the higher priced tenements the proportion would be so high. Further enquiries will be made on the subject. In the case of two-room tenements 199 (10 per cent.) were exempted bv rental, the numbers for the tenements of 3 and 4 rooms being 252 and 69, or 69 and 98 per cent. respectively. The amount of overcrowding prevailing in these tenements is verv small, and registration is consequently not so urgently needed as in the case of tenements of one and two rooms. When a house is let to a number of families it is rare to find all the tenements exempt bv rent, and the house therefore goes on the register subject to the exclusion from inspection of the exempt tenements. The results of the inquiry are not sufficiently definite in all particulars to justify the expression of a final opinion, but so far as they go they do not confirm the suspicion originally entertained. This is the first occasion that particulars of rentals have been obtained over an extensive area. The only information previously collected related to the Clarendon Street Area, where inquiries were made in 1901. The appended Table (48) shows the rents charged for each class of tenement in 1901 and 1905. The absolute accuracy of the figures cannot be guaranteed, but they are sufficiently correct for purposes of comparison. The changes are somewhat remarkable, the reductions in the numbers of the lower rented tenements being striking. The average increases per week work out (approximately) at 6d. for single room and 9d. for two and three room tenements. The increases represent a net increase in turnover for the whole area of about £115 per week, or nearly £6,000 per annum. 74 HOUSING. TABLE 47. Rents paid in Houses let in Lodgings. All Registered Houses. Homes comprising Weekly Rents. Totals. Landlords' Rooms. Empty Rooms. Shops and Stores. 1/6 2/- 2/6 3/- 3/6 4/- 4/6 5/- 5/6 6/- 6/6 7/- 7/6 & upw'ds. One room 5 37 194 366 170 189 241 222 63 49 8 12 11 1,567 908 327 74 Two rooms ... ... ... 2 1 12 12 95 246 451 584 342 199 1,944 Three rooms ... ... ... ... ... ... ... 2 ... 12 30 68 252 364 Four rooms ... ... ... ... ... ... ... ... 1 1 ... 1 69 71 Totals 5 37 194 368 171 201 253 319 309 513 622 423 531 3,946 Five or more rooms ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Grand Totals 5 37 194 368 171 201 253 319 309 513 622 423 534 3,949 908 327 74 TABLE 48. Showing Increases in Rentals in the Clarendon Street Area. Rooms per Tenement. Rent per Week. Total. Tenements. Up to 2/6 2/6 3/- 3/6 4/- 4/6 5/- 6/- 6/6 7/- 7/6 & upw'ds. 1 1901 104 154 61 115 103 55 37 2 1 ... ... 632 1905 18 100 185 83 93 123 99 26 6 2 4 739 2 1901 ... ... ... 6 16 96 432 159 109 27 15 860 1905 ... ... ... ... 6 3 192 242 348 125 64 980 3 1901 ... ... ... ... ... ... 25 27 41 40 30 163 1905 ... ... ... ... ... ... 1 1 8 27 97 134 4 1901 ... ... ... ... ... ... ... ... 2 ... 24 26 1905 ... ... ... ... ... ... ... ... ... ... 25 25 In 1901.—Information was refused by occupants of— 28 tenements of one room; 3 tenements of three rooms; 23 „ two rooms; 6 „ four „ There were in addition 50 tenements of five or more rooms, and 154 empty rooms. In 1905.—No tenements of five or more rooms were returned. Upwards of 200 rooms were vacant. Verminous Rooms.—The power conferred by Sec. 20 of the London County Council (General Powers) Act, 1904, has been extensively used during the past year, 99 notices in all being issued. Of these no fewer than 85 related to rooms in registered houses. The notices require all wall papers to be stripped off, defective plaster to be cut away, vermin to be destroyed, where accessible by blowpipe, and by sulphur fumigation (2 lbs. to each 1,000 cu. ft.;, after which plaster to be made good, walls re-papered, paint work washed,,&c. Only one summons was necessary to secure the work being properly carried out. 75 Housing. Water Supply:—In consequence of a communication on this subject from the County Council, forwarding particulars of the case heard in Woolwich, Dec. 1904, special enquiries were made as to the provision of water-taps in Cirencester, Clarendon and Woodchester Streets, all the houses in those streets having 4 storeys (including the basement) and with one or two exceptions only being occupied by two or more families. In each street two lots of 10 houses were examined—60 in all. The number of families in the houses varied from 2 to 7, and the occupants from 11 to 31. In 17 houses only was there any provision of water-tap above the basement. In a few cases the supply was in the sub-basement, a part of the house which has been uninhabited for some years. There were no real difficulties in providing additional taps, but as the Magistrate decided that the provisions of Sec. 48 of the Public Health (London) Act, 1801, did not confer a power to require a sufficient number of taps in a house but only a sufficient supply of water in the mains, no further steps were taken. Additional taps were, however, fixed at nearly half the houses before that decision was given. Common Lodging Houses:—These houses are 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, 0 accommodating 195 men; 1, 31 women; and 1, 19 married couples. No case of sickness was reported from any of the houses, but eight deaths occurred among the inmates. Seven of the deceased were males and one a female their ages ranging from 4 months to 75 years. The causes of death during the five years are indicated below:— 1901. 1902. 1903. 1904. 1905. Tubercular diseases 3 3, 6 6 1 Cancer, Malignant diseases — 1 3 — 1 Respiratory diseases 4 1 3 — — Other causes 4 9 1 1 6 Housing of the Working Classes Acts:—There is nothing to report under this head. Inhabited House Duty: Revenue Act, 1903.—Applications for certificates to secure reduction or remission of the duty were received with reference to 137 blocks of flats, comprising 1,185 separate flats. These applications involved a very great amount of work in the shape of surveying and supervision of work. All the flats were in one Ward (Maida Vale) and it was found necessary to tell off an Inspector for some months to do practically nothing else. Certificates were issued with respect to 1,049 of the flats, the granting of certificates to the remainder being suspended until the works necessary have been completed. In the course of the inspection a number of bedrooms were found to have no open fireplaces, warming being provided for by gas stoves. The flue-pipes from the stoves are connected to one vertical shaft of small dimensions, the chimney being thus common to all the floors. The top of the flue has a small iron grating—not a chimney pot. There is no provision for the ventilation of the rooms except the doors and windows. When a stove is lighted in one of the lower rooms, the fumes escape into the upper—usually the room on the top floor—and complaints of the nuisance have been received. The issue of the certificate has been suspeneded until satisfactory steps have been taken to provide for the escape of the fumes, and the attention of the County Council (Architect's Department) has been directed to the case. The present Building Acts do not provide the necessary powers to prohibit this defective construction. 76 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. In 1872 there were 24 slaughterhouses. Slaughterhouses.— These are situated as under:— Bishop's Mews, No. 1. Portsdown Mews (in rear of No. 249 Maida Vale). Southwick Mews, No. 15. Harrow Road, No. 125. Edgware Road, No. 275. Upper Brook Mews, No. 6. „ Hero Place. 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 620 times during the year, and examined the carcases of 5,860 sheep, 148 bullocks, and 15 calves. He estimates that about 800 lbs. (1,740 lbs. in 1904) of meat and offal were destroyed on account of pathological conditions discovered at the time of slaughter, which are summarised below:— Organ, &c. Cause of destruction. Sheep. Livers, 62—parasites 50, cirrhosis 3, and abscesses 9. Lungs, 14— „ 8, pneumonia 3, pleurisy 3. Pluck, 1—pleuro-pneumonia. Bullocks. Livers, 31—parasites 22, necrosis 1, containing abscesses 7. fatty degeneration 1. Lungs, 4— ,, 1, pleurisy, abscesses, and fibroma 1 each. Spleen, 2— „ and angioma 1 each. Skirt, 1—abscess. Sixty pounds of beef were destroyed on account of extensive bruising. Butchers' Shops.— At 83 of these shops the trade is in beef and mutton, &c., and the remainder (29) exclusively pork. The inspections numbered 606, at least half being on the request of the proprietors of the shops to inspect meat and pork on delivery from the Central Meat Markets. The following surrenders were made— 5 pigs' carcases, 2 heads, side head and belly, 4 mesenteries, and 12 plucks (all tubercular), And some beef, mutton and pork, weighing about 50 lbs. (wet and stinking). Milk Supply: Cowhouse.— The only cowhouse in the Borough is that at Star Street, No. 39 licensed for 10 cows, 5 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. In 1856 there were 25 cowhouses (368 cows); and in 1872, 14. 77 food supervision. Dairies and Milkshops.— At the close of 1901, 166 names of milk-vendors were on the Register. During the past year 9 have been added, 3 removed, and 18 changed—leaving 172 entries effective at the close of the year. The businesses combined with the sale of milk at the different premises are indicated below:— Dairies: milk, eggs and butter only 85 „ wholesale depots 4 Grocers' shops 6 General shops, selling oil 31 „ not „ 26 Sweet-stuff and confectionery 6 Provisions 5 Fish and grocery 2 Off-licensed premises, Butcher's shop, Poulterer's shop (each) 1 Coal, wood and oil (combined) 2 Private houses 2 The above premises were visited on 206 occasions in all. One case of scarlet fever was reported from premises on which milk was sold; 8 cases of scarlet fever and diphtheria occurred in families of milk-carriers; and 3 cases in houses where a milk-carrier resided. All necessary precautions were taken. Food Purveying.— The premises on the Register of Food Purveyors numbered 177 at the close of last year, the same as in 1904, but 5 fewer than in 1903. Twenty-six of the premises are fried fish shops. The inspections of restaurants, &c., numbered 257, and of fried fish shops 40. The defects found are set out in Table 49. Ice-cream Makers and Vendors.— A special Register is kept under the provisions of the London County Council (General Powers) Act, 1902 (Part VIII.). Eight entries were made during the past year, the total number on the Register at the end of the year being 137. Of these 124 are shopkeepers and 13 Italian barrow-men. The shops include— Sweet shops 57 Newspapers and Tobacco 8 Bakers 20 Confectioners and General 4 (each) Milk 14 Cooks' 2 Restaurants 14 Barber 1 In addition to the 13 local barrow-men, 25 from other districts have regular stands in the Borough, viz.:— From Marylebone 10 From Islington and Clerkenwell 2 each. „ Kensington 9 „ Chelsea and Willesden 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 800 lbs. „ Butchers' shops 1,947½ „ „ Fishmongers 150 „ „ Fruit and greengrocery 1,785 „ 4,682½ „=2 tons, 1 cwt., 3 qrs., 6½ lbs. 1904 11,332 „=5 „ 1 „ 0 „ 20 „ Fish:— 3 Trunks Plaice. 78 FOOD SUPERVISION. Vegetables and Fruit:— Apples 452 lbs. Cherries 690 lbs. Tomatoes 66 „ Plums 20 „ Swedes 336 ,, Chestnuts 25 „ Peas 140 „ Oranges 108 „ Peaches 48 „ 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 13 greengrocers and 17 costermongers for exposing unsound fruit. There was one prosecution.— See Legal Proceedings. Meat:— lbs. Disease. 7½ Pigs 869½ Tuberculosis. 14 Pigs' plucks 90 ,, 4 „ mesenteries 6 „ 2 „ heads 12 „ 10 „ „ 170 Putrid. 1 Pig's head 10 Lymphadenoma. 6 Pigs' lungs 9 Parasites. Pork 43 Pleurisy and bruises. „ sausages 6 Tuberculosis. Ham 4 Calcified Trichina. Mutton 6 Wet. Beef 40 Putrid. Ox tongue 4 Actinomycosis. 7 Livers 160 Parasites: abscesses. 3 Lungs 12 Parasites: pleurisy. Spleen 2 Beef fat 504 Putrid. Three summonses were taken out during the year, two in respect of tubercular meat and one for unsound food. One of the meat cases was not heard until January of the current year. (See Legal Proceedings.) Stripping Carcases.— Attention was directed in the last Report to the practice recently introduced of mincing and (or) removing glands from carcases of pigs, whereby it is rendered impossible to decide whether such carcases be or be not tubercular. Some further facts have been collected which it appears desirable should be placed on record. During 1903 and 1904, 5,700* carcases (3,700 foreign and 2,000 English) were examined in the Borough, and 103 were found to be "stripped," viz., 67 foreign and 36 English—1.8 per cent. of each class. Last year 2,400 carcases were examined and 121 found "stripped"— 5.0 per cent. of all. Last year's total included 1,100 Dutch pigs (57 stripped), 900 English (48 stripped) and 400 from other countries (16 stripped). None of these carcases were condemned. During the two first years 35½ carcases and 7 heads were condemned, equal approximately to 0.6 per cent. Last year 5½ carcases and 2 heads were similarly dealt with, equal to 0.3 per cent. * These are "round numbers" only. 79 food supervision. The two preceding paragraphs may he summed up by saying that, while the number of diagnosed cases of tuberculosis diminished by one-half during 1905, that of suspected cases rose last year to nearlv three times the number of 1903-04. That there is good reason to believe that the majority of, if not all, the "stripped" carcases were tubercular, is evidenced by the facts that the parts removed were frequently abnormal, and that morbid changes—the nature of which was not recognisable by the naked eye as tubercular—were found in other parts of the bodies. It is commonly found that the spaces left after removing the glands are considerably larger than they would be after removal of healthy glands. The tonsils are the glands most frequently removed. In many cases the other glands, such as the inguinal, iliac, parotid, &c., are also cut into, sometimes minced up so that the naked eye can hardly recognise the gland structure. Such glands have been found enlarged, discoloured and unhealthy in carcases from which the enlarged tonsils had previously been removed. It has also been found that, where the tonsils have been removed, leaving large, wet vacuities, and no other glands have been cut into, the latter, when examined, have proved to be tubercular. On one or two occasions fragments of tubercular disease have been left after removal of the tonsils. Of the 57 stripped Dutch pigs, 19 (33.3 per cent.) presented abnormalities; of the 48 English, 20 (41 per cent.); and of the other 16, 9 (56 per cent.). The fact that the vacuities are found moist indicates that the "stripping" has been but a short time before the examination. It is not done in the Borough, as the carcases have been frequently examined as delivered from the carrier's cart. That there is either great carelessness or ignorance in the dressing of carcases is proved bv the fact that plucks have been sent to retail shops with the lungs crowded with tubercular lumps, the bronchial glands much enlarged and full of tubercular pus, and the liver studded with tubercular nodules. To discover these signs of disease requires no special training. The eye and the fingers will suffice for any one who has had the point once explained to him, presuming he is anxious—or at least desirous—to detect disease. The carcases from Holland, Denmark and the Netherlands have "inspection labels" attached to them, certifying that they have been examined by the Inspector appointed by the respective Government. The Dutch Government compensate the owner of the carcase if it be condemned for tuberculosis subsequent to passing their Inspector. The label is not always fastened in a manner which will prevent its misuse, and labels have been found on carcases which are believed to have come from countries other than those of the labels. On this the Inspector reports in the following terms:— "It is usual for the labels on Dutch carcases to be fixed into the belly fat with a wire, close up to the groin. On several occasions (in every instance stripping had taken place) I have seen the labels fixed much lower. So loose was the wire in the lead seal that I could remove it with my fingers. The carcases were so fresh and bright that I have no doubt they were not Dutch. Moreover, where the glands had been removed, the vacuities were quite wet, and the peritoneal covering to the belly fat has been red with blood staining, where the plucks had been placed . inside. These conditions are not seen in Dutch pigs." In consequence of the systematic examination of pigs' carcases in this Borough, the wholesale traders at the Central Markets hold back carcases purchased for delivery here for special inspection. In some instances refusals to sell have been reported. The holding back leads to considerable delay in delivery, a matter of some importance. 80 food supervision. It is generally admitted that pigs are susceptible to tuberculosis of human origin, and it can be scarcely doubted that the transference of the disease from pigs to man is more than probable or possible. It is therefore the duty of the Health Department to do its utmost to prevent the sale of tubercular pigs' flesh-in all its forms—for food for man. This will never be accomplished until the law enables the responsibility for such sale, and for its preceding exposure for sale, to be brought home to the proper person. Who then is to be regarded as liable? In the London trade the flesh passes through three hands, or occasionally only two. The three are the slaughterer, the wholesale dealer (usually on commission) and the retailer. In Paddington the retailer alone has to be dealt with. In all but a few cases, he gets his pigs from the wholesale dealer, the exceptions from farmers or slaughterers in the country. The Department, as representing the Council, looks primarily to the retailer to see that no diseased pork is exposed for sale. Most of the retailers, with the consent of the Public Health Committee, have during the past few years sought the advice of the Inspector in examining meat purchased by them prior to exposure for sale. It would be unfair, on fueling diseased meat, to proceed against a trader who takes this precaution; but it should be observed that it is scarcely within the province of the Department to protect him by placing at his disposal knowledge and skill which lie ought himself to possess as qualifications for his business. In no other trade or occupation is a similar protection afforded or expected, nor would the lack of knowledge and skill be admitted as a defence, as is so often done in meat prosecutions. The retailer who does not take the precaution to secure examination before exposure for sale, and on whose premises diseased pork is found, has to bear all the liabilities, pains and penalties prescribed by law. TABLE 49. Numbers of places where Food is sold:— Butchers 83 Milkshops and Dairies 172 „ Pork 29 Refreshment Houses 151 Fishmongers 28 Fried Fish and Sausages 26 Game and Poultry 13 Ice Cream Makers & Vendors 126 Fruit and Greengrocery 85 Sausage Factories 9 Food Purveyors. Inspections during the year:— Slaughterhouses 620 Cowhouses 4 Butchers' Shops 606 Milkshops, &c. 206 Greengrocers' Shops 24 Restaurants, &c. 257 Costers' Barrows 21 Ice Cream Shops and Barrows 58 Fish Curing Premises 4 Fried Fish Shops 40 Fishmongers' Shops 16 Defects found and remedied:— Milkshops and Dairies.* Restaurants and Eating Houses. Premises occupied by Ice Cream Makers. Drains defective ... 2 ... Soilpipes defective 1 2 ... Water-closets defective 1 2 ... Flushing apparatus defective ... 1 ... * These were systematically dealt with in 1902, leaving no structural defects unremedied. 81 food supervision. In the case of diseased meat being purchased by the retailer and being discovered on examination before exposure for sale, the responsibility falls on the vendor to the retailer— that is, either the wholesale dealer or (occasionally) a farmer or slaughterer. Against either of these a prima facie case lies under Sub-sec. 3 of Section 17 of the Public Health (London) Act, 1891. That Section, however, provides a defence which in the case of the wholesale dealer renders the Section practically inoperative. He has only to prove that "he did not know and had no reason to believe" that the meat was diseased. He is not required to prove that he had taken any real precautions to satisfy himself that it was free from disease. In a case heard at the North London Police Court last autumn, the Magistrate, without hearing any defence, dismissed the summons. Although his decision was afterwards set aside, the fact of its occurrence shows the fatal ease with which summonses against wholesale dealers can be decided. Even if proceedings were always successfully maintained against them, it is doubted whether the responsibility would be altogether fairly placed. The person who ought to be held responsible in every case for the soundness of the meat is the slaughterer. It is only in the act of dressing the carcase that freedom from disease can be absolutely proved. With a mulititude of private slaughter-houses in which adequate supervision is impossible, where the men emploved have neither the skill nor (usually) the desire requisite for the rejection of unsound meat, it is impracticable in every case to bring the responsibility to the right man, and so long as the present system remains diseased meat will get on to the market. The remedy for the present unsatisfactory system is the abolition of all private slaughter-houses substituting municipal abattoirs where properly skilled inspectors can examine meat at all stages. The staff of inspectors must be adequate to prevent the examination developing into a perfunctory sham. Until that change is secured the wholesale trade must be pressed to take measures to stop diseased meat sent to them, getting into the retailers' hands. The packing of Smyrna figs.— In The Times of Sept. 19th there was a letter signed "Palinurus," drawing attention to the use of sea-water by certain packers. It was stated that the sea-water was taken from the bay into which the whole of the town's sewage is discharged, the smell from the bay being described as at times overpowering. It was thought probable that the bacilli of enteric fever and other diseases were to be found in the water. By direction of the Public Health Committee, samples of figs, selected to include the best and worst grades, were submitted to bacteriological examination. The maximum number of organisms found in any sample was six per milligramme. The bacillus coli and allied organisms were not found, so that there was no evidence of sewage pollution. The very small number of organisms found was surprising. The most probable explanation is that concentrated sugar solutions are very unfavourable to the growth of almost all organisms, and that the figs after packing gradually sterilise themselves. A familiar example of the difficulty with which organisms develope in strong sugar solutions is furnished by condensed milk (sweetened), which will remain good for a lengthened period after being opened. Food Adulteration.— During the year 505 samples were submitted to the Public Analyst, of which 33 (or 6.5 per cent.) were found to be adulterated, the lowest proportion since 1901. The percentages for the previous four years were—1901, 8.9; 1903, 6.9; 1902, 8.8; 1901, 10.9. Of the milk samples (316), 87 were taken at the Paddington (G.W.R.) Terminus. Of the 87 station samples 11 were reported as adulterated, or 12.6 per cent., as compared with 18.7 per cent. in 1904, 8.1 in 1903. Of the remaining 229 samples purchased in the street 82 OFFICE WORK. and shops, 13 were adulterated, equal to 5.6 per cent. (5.3 and 5.4 per Cent. in 1903 and 1904). 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. The "warranty" provisions of the Acts continue to be a grave impediment to fixing the responsibility for adulteration. In thirty (30) cases taken into Court, 8 dismissals took place on proof of warranty. A certain proportion of vendors, having been once caught, and convicted for lack of warranty, enjoy a practical immunity against conviction by providing themselves with that (to them) necessary defence. There were no "warranty" provisions in the earlier Adulteration Acts, and it does appear to be necessary with a view to securing a pure food supply that the law should go back to the earlier system. (See Legal Proceedings.) TABLE 50. Summary of Articles submitted to the Public Analyst during the year 1905. Total. Found Adulterated. Percentage Adulterated. Milk 316* 24 7.6 Butter 119 7 5.9 Coffee 33 2 6.1 Lard 9 — — Mustard 9 - — Pepper 9 - — Skim Milk 3 - — Baking Powder 1 - — Bloater Paste 1 - — Brandy 1 - — Cocoa 1 - — Jam 1 - — Shrimp Paste 1 - — Whisky 1 - — 505 33 6.5 * Including 87 taken at Paddington (G.W.R.) Terminus in course of delivery; 11 adulterated. Office Work. The work of the Clerical Staff does not lend itself to statistical tabulation, but some idea of the registerable, and more or less routine, duties during the past two years is given by the appended figures. The multifarious duties relating to the preparation of reports, entering up work done by the other officers of the Department, keeping records of statistics and getting up cases for the Courts cannot be recorded numerically. It must suffice to say that the work is steadily increasing year by year. Letters received 3,672 (3,234) Complaints received 729 (800) ,, despatched 2,342 (1,632) Plans dealt with 431 (408) Entries in postage book 7,932 (6,908) New openings in Journals 942 (1,263) Cases of infectious disease (a) Entered in Register (b) Reported to Asylums 564 (974) Disinfection Orders 2053(1429) Board, Guardians (duplicate) and other Notices of Infectious disease Notices to abate nuisances 376 (315) sent to Public Library, 3,707 (2,804) Schools, Baths, &c. Figures for 1904 in parentheses. 83 legal proceedings. LEGAL PROCEEDINGS. Summaries of the results of cases heard during the year are given in the appended tabular statements. The total amount of fines and costs was £152 3s. 0d., as compared with £163 9s. in 1904. Dividing the cases into two groups, (a) under Health Legislation, and (b) Adulteration Legislation, the amounts for the five years have been:— Health Cases. Adulteration Cases. £ s. d. £ s. d. 1905 25 6 0 126 17 0 1901 *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 *£7 18s. could not be collected owing to death of defendant, and in another case the fine (£2) was remitted, the work having been carried out within the time specified by the Magistrate. The fines and costs in Adulteration cases have averaged during the past seven years:— 1905. 1904. 1903. 1902. 1901. 1900. 1899. Average per Fine £3 8 7 £2 15 2 £3 16 £3 3 8 £2 16 0 £3 4 0 £3 4 9 conviction Costs 120 158 0 15 7 0 16 0 0 15 0 123 0 14 3 Water Supply to tenement houses.— In February of last year a letter was addressed by the County Council to all the Metropolitan Boroughs, directing attention to case heard at Woolwich in December, 1904, in which the Magistrate decided that a tap in the yard of a house of three floors, occupied by five families, was not a proper and sufficient supply of water as required bv Sec. 48 of the Public Health (London) Act, 1891. It was suggested in the letter that efforts should be made "to secure the provision of a proper and sufficient supply of water for the tenants of every floor of a tenement house." Instructions were given to the Medical Officer of Health to cause enquiries to be made in the Borough as to the supply provided in the Clarendon Street Area, and a report was submitted in June showing the provision at 30 houses, 10 each in Cirencester, Clarendon and Woodchester Streets. The Committee being of opinion that the supply was not a sufficient and proper one, directed a circular letter to be sent to the owners of the houses requesting them to provide a better supply. Certain did so, but others took no action. Subsequently notices under Sec. 4 of the Act were issued, followed later by proceedings at the Police Court against the owners of six houses. The owner of one house then gave the additional supply, but the others contested the cases. It was shown in evidence that the houses comprised 4 floors, were occupied by from 5 to 8 families, and the only supply was from a tap in the basement—in one case under basement. Mr. Plowden decided that Sec. 48 did not apply. "It was a fallacy to suppose that the question of whether a supply of water was sufficient turned on the number of taps from which it could be obtained. It depended, in fact, on the source from which the water came. Here there was plenty of water but there was inconvenience in getting it." He dismissed the summonses. The Council's Solicitor advised that the case was prima facie one of fact, and that, having regard to the wording of the Section, the opinion expressed by the Magistrate was right. No appeal was therefore taken. Diseased Meat.— The case against J. Malpas for selling a pig's pluck which was tubercular, heard at the North London Court in November, was dismissed (without costs) without the defendant being called on to give anv defence. The proceedings were under 84 LEGAL PROCEEDINGS. Sub-Section 3 of Sec. 47 of the Public Health (London) Act, 1891. A case was asked for and granted.* Food Adulteration Case. Parker v. Suckling.— It is so rare to be able to get behind a warranty defence that a note of this case will be of more than passing interest. On April 9th, 1905, a sample of milk was purchased from Suckling, which was found on analysis to contain 12 per cent. less than the proper proportion of fat or cream. On a summons being issued, notice of warranty with a farmer in the country was given. When the case came on for hearing, an adjournment was asked for by the Council's Solicitor and granted, in spite of opposition on the part of the defendant's Solicitor. Nothing was said about the third (or reserve) part of the sample. During the interval a complete chain of evidence was got together covering the milk from the cow to the platform at Willesden Junction Station, where the defendant took charge of it. At the adjourned hearing on June 9th the evidence was gone through, and not shaken in cross-examination. One of the witnesses, a porter at Willesden, gave evidence that the defendant received churns of skimmed (separated) milk by the same train as the milk in question, and that he saw the defendant "tampering with the milk" at the station. The production of the reserve portion was demanded, and when the wrapper containing the bottle was undone, it was found that the cork had been forced out by the fermentation of the milk, and that some of the milk and cream had escaped. The bottle was sent to Somerset House for an analysis to be made, although there had been up to this point no question as to the Public Analyst's certificate. The Analyst at Somerset House reported that no analysis could be made, and defendant's Solicitor asked for the case to be dismissed. The Magistrate decided that the refusal to analyse was not a point of law by which he was bound to dismiss the case, and several previous convictions having been proved against the defendant, fined him £40 with 10 guineas costs. A case was subsequently stated on the question of the refusal by Somerset House to analyse the sample.† * The case stated was argued on May 7th, 1906, before the Lord Chief Justice and Justices Darling and Channel. The Magistrate's decision was set aside and the case remitted to him to be heard again. † While this report has been in preparation, the point has been argued, and the case remitted to the Magistrate for re-hearing on one point—namely, as to any neglect in sealing the bottle. The Magistrate found that there had been no neglect. The case has since that been settled by the defendant paying the fine and all costs. 85 summary of legal proceedings. SUMMARY OF LEGAL PROCEEDINGS DURING 1905. Under Public Health (London) Act, 1891. Fine. Costs. Section 4. £ s. d. £ s. d. 13, Andover Place Defective drawing, &c. Work done. Summons withdrawn. 4 and 6, Chippenham Road ,, Order made. 2 6 0 ,, Non-compliance with Magistrate's Order - - - 2 2 0 58, 60 and 76, Cirencester Street insufficient water supply Summonses dismissed. Council ordered to pay 21s. costs. 31,33 and 39, Clarendon Street„ „ Summonses dismissed. No costs. 23, Woodchester Street „ „ Summons withdrawn. Supply given. 38, Edbrooke Road Defective drainage, &c. - - - 0 10 6 5, 7 and 11, Elcom Street „ roofs - - - 1 15 6 1, 3 and 7, „ „ soil-pipes - - - 1 11 6 162, Harrow Road No water supply Closing Order made. 0 6 0 26, Kensal Road Defective manhole cover Work done. 0 2 0 106 and 106a, Westbourne Grove „ drainage, &c. ,, 1 3 0 Section 47. May, G., 199, Harrow Road Exposing unsound peaches for sale 1 0 0 0 12 6 Malpas, J., Hungerford Road, N. Selling diseased pig's pluck and mesentery Summons dismissed. Section 68. Toomey, John, 37, Clarendon Street Exposing infected children 2 0 0 0 4 0 By-laws relating to Houses let in Lodgings. 15, Amberley Road Annual cleansing - - - 1 1 0 25, „ „ Work done. Summons withdrawn. 36,42 & 45 „ - - - 1 11 6 16, 17, 18, 20 & 41, Brindley Street „ - - - 2 12 6 30, Cirencester Street „ Work done. Summons withdrawn 36, 38 and 47, Clarendon Street „ ,, ,, 57, „ ,, ,, ,, 34, Delamere Crescent ,, ,, ,, 1, 5, 7 and 11, Elcom Street ,, ,, 2 2 0 23, Hall Place „ ,, 0 2 0 49, ,, ,, Summons withdrawn. 52, Kensal Road „ ,, ,, 32, „ ,, 0 10 6 2, Kents Place „ ,, Summons withdrawn 3, Senior Street „ ,, 0 10 6 9, Stalham Street „ ,, - - - 13, „ ,, ,, Summons withdrawn. 20, Amberley Road Choked water-closet ,, 0 10 0 45, Brindley Street Drain unventilated ,, 1 3 0 Other By-laws. 21, Campbell Street Defective water-closet ,, 0 12 6 3, Delamere Street Works commenced without notice to Sanitary Authority 0 5 0 0 2 0 London County Council (General Powers) Act, 1904. Section 20. 17, Brindley Street Verminous room Work done. 0 10 6 Metropolis Management Act, 1855. By-laws pursuant to Section 202. 33, Campbell Street Inadequate means of access to drain Summons Council ord £10 10s. 0d. dismissed, ered to pay costs. 86 SUMMARY OF LEGAL PROCEEDINGS. SUMMARY OF LEGAL PROCEEDINGS DURING 1905. Under Sale of Food and Drugs Acts, 1875-1899. Fine. Costs. £ s. d. £ s. d. Milk 15% added water and 20% fat abstracted ... ... ... 2 2 0 ,, 19% „ 22% ... ... ... 0 12 6 ,, 22% ,, ... ... ... 0 12 6 ,, 18% „ 1 0 0 1 3 0 (1) „ 13% ,, 3 0 0 0 12 6 „ 13% „ 2 0 0 0 12 6 .,, 17% „ ... ... ... 0 12 6 ,, 10% „ Dismissed; warranty proved. „ 21% fat abstracted 2 0 0 0 14 6 „ 10% „ ... ... ... 0 2 0 ,, 9% „ ... ... ... 0 2 0 ,, 36% Summons withdrawn. 2 2 0 ,,... ... ... 23% „ Dismissed: warranty proved. ,, 23% „ ... ... ... 1 4 0 ,, 20% „ 3 0 0 0 12 6 ,, 18% „ 2 0 0 0 12 6 (2) „ 17% „ Dismissed; warranty proved. ,, 14% „ Do. do. ,, 32% „ 40 0 0 10 10 0 ,, 12% „ Dismissed: warranty proved. ,, 11% „ 1 0 0 0 12 6 ,, 7% „ 2 0 0 0 15 6 ,, 10% „ 0 5 0 0 14 6 ,, 5% „ 0 10 0 0 12 6 (3) ,, 9% „ Dismissed; warranty proved. ,, 10% „ Do. do. (4) 23% „ Summons dismissed. ,, 15% „ Summons withdrawn. (5) ,, 9% „ Dismissed; warranty proved. Butter 85½% foreign fat 10 0 0 0 12 6 ,, 81½% „ 2 0 0 0 12 6 ,, 89% 2 0 0 0 12 6 ,, 19% „ 0 10 0 0 15 0 (6) ,, 81% „ 20 0 0 0 12 6 ,, 82% ,, 0 10 0 0 12 6 ,, 78% „ 2 0 0 0 12 6 Coffee 30% chicory 2 0 0 0 12 6 ,, 50% „ 0 5 0 0 12 6 Cases against the same Defendant are bracketed together. NOTES. (i) Defendant fined £1 with 12/6 costs, on 1st November, 1901, for selling butter containing 77% of foreign fat. ,, £3 12/6 „ 4th July, 1902, for selling milk containing 38% of added water. 2) „ £3 12/6 „ 17th January, 1897, for selling milk containing 5% 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 10% deficient in fat. A summons heard on the 25th April, 1902, was dismissed, the defendant proving a warranty. Summonses heard on 25th April, 1902, and 11th March, 1901, were dismissed, the defendant proving a warranty in each case. 87 summary of legal proceedings. (3) Defendant fined 5/- with 12/6 costs, on 22nd July, 1902, for selling milk from which 18% of fat had been abstracted. (4) Defendants' servant ordered to pay 1d. for damage done to milk and 40/- for wilfully damaging same, or in default one month. (5) Defendant fined £3 with 12/6 costs, on 9th May, 1902, for selling milk from which 24% of fat had been abstracted. A summons heard on 13th February, 1903, for selling milk containing 7% of added water was dismissed, the defendant proving a warranty. (6) Defendant fined £5 with 12/6 costs, on 28th July, 1899, for selling butter containing 67% of foreign fat. A summons heard on 18th August, 1903, for selling milk from which 20% of fat had been abstracted was dismissed, the defendant proving a warranty. 88 VITAL STATISTICS. APPENDIX. TABLE I. Vital Statistics of Whole District during 1905 and Ten Previous Years. L. G. B. 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 9 3 4 5 6 7 8 9 10 11 12 13 1895 139,225 3,503 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 10.49 672 316 225 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 15.07 735 366 207 2,152 14.58 1903 145,927 3,302 22.62 425 128 2,103 14.41 743 306 181 1,918 13.14 1904 140,815 3,295 22.44 490 148 2,228 15.17 780 387 173 2,014 13.71 Averages for years 1895-1904. 143,020 3,420 23.90 527 153 2,319 10.18 657 334 211 2,192 15.29 1905 147,713 3,184 21.55 441 139 2,210 14.96 806 410 161 1,901 13.27 * 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 89 vital statistics TABLE II. Vital Statistics of Separate Localities during 1905 and Ten Previous Years. L. G. B. 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. 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 1,370 305 33,578 382 305 40 16,924 437 237 43 1904 140,815 3,295 2,014 449 90,441 2,524 1,420 335 33,561 378 345 43 16,813 393 249 71 Averages of Years 1895 to 1904. 143,020 3,426 2,192 505 92,050 2,530 1,556 381 33,636 407 357 47 17,334 489 279 77 1905 147.713 3,184 1,901 391 97,408 2,380 1,397 300 33,544 388 343 39 16,701 410 221 52 * 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. 90 deaths in local institutions. TABLE III. Deaths in Local Institutions. Year. Paddington Workhouse and Infirmary. St. Mary s Hospital. Children's Hospital. Lock Hospital. 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 1904 327 300 92 1 Averages 1895-1904 247 330 66 (Nine (years. 2 1905 324 387 91 4 * Closed part of year for repairs and alterations. **Hospital open for part of year only. TABLE III a. Causes of Deaths in Institutions. 1905. Causes of Death. Local Institutions. Deaths of Residents recorded beyond the Borough. Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital, and Nursing Homes. Hospitals of Metropolitan Asylums Board. Special and General Hospitals. Lunatic Asylums. Poor Law Institutions. Elsewhere. Small-pox ... ... ... ... ... ... ... ... ... Measles 2 1 2 ... 1 ... ... ... ... Scarlet Fever ... ... ... ... 6 ... ... ... ... Influenza 1 1 ... ... ... ... ... 1 ... Whooping-cough 1 ... 2 ... ... ... ... ... 1 Diphtheria 1 ... ... ... 2 ... ... ... ... Enteric Fever ... ... ... ... 2 ... 1 ... ... Diarrhoea ... 2 3 ... ... 1 ... ... ... Epidemic Enteritis 3 7 8 ... ... ... ... ... ... Erysipelas 3 3 ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... Other Septic Diseases ... 9 ... ... ... 3 ... ... ... Tuberculosis of Lungs 35 6 3 3 ... 8 9 1 1 Other forms of Tuberculosis 9 19 12 1 ... 4 ... ... ... Cancer 38 43 ... 5 ... 18 3 1 2 Premature Birth 6 2 1 ... ... 3 ... ... ... Developmental Diseases ... 7 12 ... ... 3 ... 1 ... Old Age 39 ... ... ... ... 1 1 1 1 Bronchitis 30 8 1 1 ... 2 1 ... ... Pneumonia 17 31 16 2 1 2 4 ... ... Cirrhosis of Liver 6 7 1 ... ... ... ... ... ... Accidents of Childbirth 1 1 ... ... ... ... ... ... 1 Accidents and Violence 12 46 10 ... ... 3 1 ... 2 Suicides ... 7 ... ... ... 1 ... ... 2 All other Causes 120 187 20 13 l 20 29 1 5 All Causes 324 387 91 25 13 79 49 5 15 Non-Residents* 5 294 65 18 ... ... ... ... ... * The deaths of 21 other non-residents took place either in the streets or houses in the Borough. 91 causes of death at various ages in each sex. TABLE IV. Causes of Death : Borough—Sex and Age Distribution. 1905. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond the Borough. L. G. B. 0— 1- 0— 15— 25— 65 and upwards. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. p. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 11 17 27 1 2 ... ... ... ... ... ... 23 40 63 Scarlet Fever ... ... 4 1 1 ... ... ... ... ... ... ... 5 1 6 Epidemic Influenza 2 1 1 1 ... ... ... 1 4 7 8 15 15 25 40 Whooping-cough 12 12 11 12 ... 3 ... ... ... ... ... ... 23 27 50 Diphtheria, Membranous Croup ... ... 2 ... 1 ... ... ... ... ... ... ... 3 ... 3 Croup ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 2 Enteric Fever ... ... ... ... ... ... 1 1 ... 4 ... ... 1 5 6 Diarrhoea, Dysentery 19 14 6 4 ... ... ... ... ... ... 1 1 26 19 45 Epidemic, Zymotic Enteritis 19 12 2 3 ... ... ... ... ... ... ... ... 21 15 36 Enteritis 4 ... ... 1 1 ... ... ... 1 1 1 1 7 3 10 Other Continued Fevers 1 ... ... ... ... ... ... ... 1 ... ... ... 2 ... 2 Erysipelas 1 ... ... ... ... ... ... ... 4 1 1 ... 6 1 7 Puerperal Fever ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Other Septic Diseases:— Stomatitis 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 2 Pyaemia ... ... ... ... ... 1 ... ... 1 ... ... ... 1 1 2 Cellulitis 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Carbuncle ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Infective Endocarditis ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 Angina Ludovici ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Septic Laryngitis ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Tuberculosis of Meninges 3 5 5 9 2 ... ... 2 1 ... ... ... 11 16 27 Tuberculosis of Lungs 1 ... 1 ... 1 2 11 8 61 42 3 6 78 58 136 Other Forms of Tuberculosis 6 2 1 ... 2 4 1 1 7 3 ... 2 17 12 29 Alcoholism ... ... ... ... ... ... ... ... 5 9 ... ... 5 9 14 Cancer ... ... ... ... 1 ... 1 1 41 55 13 37 56 93 149 Premature Birth 35 23 ... ... ... ... ... ... ... ... ... ... 35 23 58 Developmental Diseases 41 31 1 6 ... ... ... 1 ... ... ... ... 42 38 80 Old Age ... ... ... ... ... ... ... ... ... 1 40 70 40 71 111 Meningitis 3 9 1 2 1 ... ... ... 3 1 ... ... 8 5 13 Inflammation and Softening of Brain ... ... ... ... ... ... ... ... 2 7 5 9 7 16 23 Convulsions 8 11 2 3 ... ... ... ... ... ... ... ... 10 14 24 Apoplexy ... ... ... ... ... ... ... ... 3 4 1 8 4 12 16 Cerebral Haemorrhage ... ... ... ... ... ... ... ... 8 6 5 8 13 14 27 Organic Diseases of Heart ... ... ... ... 2 ... 2 5 14 27 4 11 22 43 65 Heart Diseases ... ... ... ... 1 ... ... 2 8 23 6 12 15 37 52 Acute Bronchitis 12 13 5 4 ... 1 ... ... 10 5 7 25 34 48 82 Chronic Bronchitis ... ... ... ... ... ... ... ... 18 15 25 49 43 64 107 Lobar (Croupous) Pneumonia ... 2 ... 2 ... 1 ... ... ... 7 9 1 9 13 22 Lobular (Broncho-) Pneumonia 16 12 11 8 ... ... 1 ... 4 3 4 3 36 26 62 Pneumonia 8 7 8 8 1 1 1 ... 16 15 7 6 41 37 78 Diseases of Stomach ... 1 1 ... ... ... 1 1 2 10 1 ... 5 12 17 Obstruction of Intestines ... ... ... ... ... ... ... ... 3 2 2 4 5 6 11 Cirrhosis of Liver ... ... ... ... ... ... ... ... 6 13 9 7 8 20 28 Nephritis and Bright's Disease ... ... ... ... 1 ... ... 2 20 22 7 20 28 44 72 Tumours, &c , of Female Genital Organs ... ... ... ... ... ... ... ... ... 8 ... 2 ... 10 10 Accidents and Diseases of Parturition ... ... ... ... ... ... ... 3 ... 6 ... ... ... 9 9 Accidents and Negligence 7 4 1 4 1 1 3 1 13 7 6 7 31 24 55 Suicide ... ... ... ... ... ... 2 1 7 3 3 ... 12 4 16 Syphilis 6 6 ... ... ... ... ... ... 2 1 ... ... 8 7 15 Rheumatic Fever 1 ... ... ... ... 2 3 1 2 1 1 ... 7 4 11 Ill-defined Causes ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 9 All other Causes 3 6 4 3 7 4 7 10 63 50 57 45 141 118 259 All Causes 215 176 85 99 24 22 34 42 340 363 212 349 910 1051 1961 92 deaths at all ages. TABLE V. Causes of Death: All Ages, Persons.—In Wards and Registration Sub-Districts. 1905. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond, the Borough. L.G.B. Wards.* Registration Sub-Districts.† I. II. III. IV. V. VI. VII. VIII. B. C. Small-pox ... ... ... ... ... ... ... ... ... ... Measles 3 20 5 7 25 ... 1 2 57 3 Scarlet Fever 1 ... 1 ... 2 ... ... 2 3 2 Epidemic Influenza 4 10 5 5 4 4 5 3 23 13 Whooping-cough 10 12 8 5 8 1 ... 6 32 8 Diphtheria, Membranous Croup 1 1 ... 1 ... ... ... ... 2 ... Croup ... 1 ... 1 ... ... ... ... 2 ... Enteric Fever ... 2 1 2 ... ... ... 1 5 1 Diarrhoea, Dysentery 11 10 5 7 10 ... ... 2 32 2 Epidemic, Zymotic Enteritis 7 3 5 6 15 ... ... ... 26 3 Enteritis ... ... 3 3 ... 1 3 ... ... ... 7 ... Other Continued Fevers ... ... l ... 1 ... ... ... 1 1 Erysipelas ... ... ..; 2 1 1 1 1 ... ... 1 4 1 Puerperal Fever 1 ... ... ... ... ... ... ... ... ... Other Septic Diseases :— Stomatitis ... ... 1 1 ... ... ... ... ... 2 ... Pyaemia ... ... ... ... 1 ... ... 1 ... 2 Cellulitis ... ... ... ... ... 1 ... ... ... 1 ... Carbuncle ... ... ... ... ... 1 ... ... ... 1 Infective Endocarditis ... ... ... ... 1 ... l ... 1 11 Angina Ludovici ... ... 1 ... ... ... ... ... ... l ... Septic Laryngitis ... ... ... ... 1 ... ... ... ... l ... Tuberculosis of Meninges ... 2 9 4 6 4 1 ... 1 23 2 Tuberculosis of Lungs 13 24 11 23 45 4 5 11 100 23 Other Forms of Tuberculosis 5 7 4 2 8 ... 1 2 21 3 Alcoholism ... 2 2 1 2 1 1 2 3 6 6 Cancer 16 33 28 27 19 7 8 11 105 28 Premature Dirth 5 16 9 8 15 ... 1 4 46 7 Developmental Diseases 12 15 12 7 25 3 2 4 56 12 Old Age 15 13 20 23 20 4 5 11 73 23 Meningitis 2 3 1 3 3 ... ... 1 10 1 Inflammation andSofteningof Brain — 7 2 4 7 ... 1 2 20 3 Convulsions 2 4 5 3 9 1 ... ... 19 3 Apoplexy 4 5 3 3 1 ... ... ... 12 ... Celebral 2 3 7 4 6 ... 1 4 20 5 Organic Diseases of Heart 7 9 12 8 12 8 5 4 39 19 Heart Diseases 3 7 7 10 16 9 3 4 40 9 Acute Bronchitis 8 9 9 21 18 5 7 5 56 18 Chronic Bronchitis 13 26 13 17 27 3 4 4 81 13 Lobar (Croupous) Pneumonia 4 5 2 5 9 2 2 ... 13 5 Lobular (Broncho-) Pneumonia 7 12 4 6 23 1 2 7 44 11 Pneumonia 6 18 12 13 16 3 4 6 58 14 Diseases of Stomach 3 1 3 4 3 1 1 1 11 3 Obstruction of Intestines 1 3 2 2 2 ... ... 1 8 2 Cirrhosis of Liver 3 7 2 8 3 2 2 1 19 6 Nephritis and Bright's Disease 9 15 4 15 17 4 2 6 49 14 Tumours, &c., of Female Genital Organs 1 3 2 2 ... ... 1 1 7 2 Accidents and Diseases of Parturition 2 2 2 1 2 ... ... ... 6 1 Accidents and Negligence 7 10 5 7 17 2 2 5 35 13 Suicide ... 3 ... 5 2 3 ... 3 9 7 Syphilis 1 4 2 3 5 ... ... ... 14 ... Rheumatic Fever 1 3 1 2 1 2 ... l 7 3 Ill-defined Causes ... 1 ... ... ... ... ... 1 1 1 All other Causes 22 52 35 57 47 12 8 26 189 48 All Causes 221 396 257 338 448 77 76 148 1,397 343 * The Wards are— † The Registration Sub-Districts are— I.—Queen's Park. V.—Church. A.—North-West Paddington, co-terminous II.—Harrow Road. VI.—Lancaster Gate (West). with Queen's Park Ward. III.—Maida Vale. VII.—Lancaster Gate (East). B.—St. Mary. IV.—Westbourne VIII.—Hyde Park. C.—St. John. DEATHS OF INFANTS UNDER ONE YEAR. 93 TABLE VI. Deaths of Infants under One Year. Corrected for Non-Residents, &c., and distributed under Causes, Sex and Age. 1905. L. G. B. Weeks. Months. Totals. 0— 1— 2— 3— 0- 1— 2 3— 4— 5- 6— 7— 8— 9— 10— 11— m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. All Causes—Certified 36 30 8 12 11 6 5 8 60 56 25 15 25 11 14 12 15 11 10 5 15 17 13 11 7 7 12 14 10 10 9 7 215 176 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... Measles ... ... ... ... ... ... ... ... ... ... ...... ... 1 ... ... ... ... ... ... 1 1 ... 4 ... ... 2 1 1 1 ... 2 5 11 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... 1 1 1 1 ... 1 ... 1 ... ... 1 1 4 ... ... 2 1 2 3 1 1 2 12 12 Diarrhœa ... 1 2 ... ... 1 3 1 2 1 6 2 5 3 4 3 4 2 3 8 5 2 2 1 2 3 9 38 26 Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 4 ... Premature Birth 23 16 2 2 4 3 1 ... 30 21 3 1 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 35 23 Congenital Defects 2 4 1 3 ... 1 ... ... 3 8 1 1 1 4 10 Injury at Birth 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Want of breast Milk ... ... ... ... ... ... ... 1 ... 1 1 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 Atrophy, Debility ... ... ... ... 1 ... ... 1 2 1 1 1 4 ... ... ... 1 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 13 5 Atelectasis 4 3 4 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 Debility at Birth 2 4 ... 1 1 1 3 6 3 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 6 Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 2 ... ... ... 1 ... ... 2 ... ... ... ... 3 5 Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 Other Tubercular Diseases ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 3 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 5 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Syphilis ... 1 1 ... ... ... 2 1 3 ... 1 3 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 6 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Meningitis ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... 3 2 Convulsions ... 1 ... 1 ... ... ... 1 4 5 1 1 1 1 1 ... ... 1 ... 1 1 ... ... ... ... ... ... 1 ... ... ... 1 8 11 Bronchitis ... 1 ... ... ... ... ... 3 2 4 1 1 1 1 ... 9 1 1 1 1 1 1 1 1 1 12 13 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... 4 4 1 1 2 2 2 1 3 3 1 2 2 6 3 ... 2 3 1 24 21 Suffocation 3 1 i ... 4 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 6 2 Other Causes ... 1 1 l ... 1 2 4 2 2 2 1 3 ... ... 2 ... ... 1 ... 1 1 1 1 2 1 2 2 ... 15 16 M. F. Population-middle of 1905 147,713. Births—registered within the Borough legitimate 1,553 1,479 illegitimate 75 77. Deaths—all causes at all ages ,, 1,961. 94 factories, workshops, laundries, workplaces and homework. TABLE VII. 1.—Inspection. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. H.O. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries and Bakehouses) 345 2 ... Workshops (including Workshop Laundries and Bakehouses) 1323 20 ... Workplaces 13 ... ... Home workers' Premises 308 2 ... Total 1989 24 ... 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 82 67 ... ... Want of Ventilation 3 2 ... ... Overcrowding 9 9 ... ... Want of drainage of floors... 2 1 ... ... Other nuisances 23 22 ... ... Sanitary accommodations • insufficent ... ... ... ... unsuitable or defective ... 10 8 ... ... . not separate for sexes 4 4 ... ... Offences under the Factorv and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) ) Breach of special sanitary requirements for bakehouses (SS. 97 to 100) ) ... ... ... ... 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 bv scarlet fever or smallpox (S. 101) Other offences 19 10 9 ... Total 152 123 9 ... * Including those specified in Sections 2,3, 7, and 8, of the Factory Act as remediable under the Public Health Acts. 3.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories : Failure to affix Abstract of the Factorv and Workshop Act (S. 133) 15 Action taken in matters referred bv H.M. Inspectors , Notified bv H.M. Inspector 22 as remediable under the Public Health Acts, but Reports (of action taken) sent not under the Factor Act (S. 5) to H.M. Inspectors 22 Other 1 Underground Bakehouses (S. 101):— Certificates granted during year 1 In use at the end of 1905 61 Homework:— Number of Lists of Outworkers (S. 107) Lists. Outworkers. Lists received 84 421 Addresses of Outworkers forwarded to other Authorities 246 received from other Authorities 183 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 1 ... Non-notifiable infectious diseases 25 3 Orders prohibiting homework in infected premises (S. 110) ... ... "Workshops on the Register (S. 131) at the end of 1905:— As set out in Table 41 1353 Bakehouses 79 Total number of workshops on Register 1432 95 proceedings during 1905. TABLE VIII. PROCEEDINGS DURING 1905. L.C.C. Premises. Number of Places— Number of Inspections, 1905. Number of Notices, 1905. Number of Prosecutions, 1905. On Register at end of 1904. Added in 1905. Removed in 1905. On Register at end of 1905. Milk premises 106 9 3 172 206 2 ... Cowsheds 1 ... ... 1 4 ... ... Slaughter-houses 8 ... ... 8 620 1 ... Other offensive trade premises ... ... ... ... ... ... ... Ice cream premises 129 8 ... 137 58 ... ... Registered houses let in lodgings 1,031 140 21 1,150 7,758 ( (a)* 36 (a)*... (b)* 3,019 (b)* 37 * (a) For overcrowding. * (b) For other conditions. Total number of intimation notices served for all purposes 859 Overcrowding, 1905— Number of dwelling rooms overcrowded 102 Number remedied 91 Number of prosecutions — Underground, rooms—- Illegal occupation dealt with during year — Number of rooms closed — Insanitary houses— Number closed under the Public Health (London) Act, 1891 1 Number closed under the Housing of the Working Classes Act — Number of premises cleansed under Sec. 20 of the L.C.C. (General Powers) Act, 1904 99 Shelters provided tinder Sec. GO (4) of the Public Health (London) Act, 1891 — Number of persons accommodated during the year — Revenue Acts— Number of houses for which applications were received during year 124 Number of tenements comprised therein 1,074 (a) granted 1,027 Number of tenements for which certificates were (b) refused 37 (c) deferred 10 Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc (b) For prevention of nuisance arising from offensive matter running out of any manufactorv, etc — (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc. — (f) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (h) With respect to water closets, earth closets, etc 1 (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) 1 (h) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) — Mortuaries-— Total number of bodies removed 265 Total number of infectious bodies removed 1