PAD 11 Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND Sanitary Work For the Year 1906. BY REGINALD DUDFIELD, M.A., M.B., D.P.H., F.S.S., Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. 68636 CONTENTS. Page Alcoholism, Deaths from 29 Bacteriological Examinations, Results of 48 Bakehouses, Inspection of 58 Births and Birth-Rates 2 „ Corrected returns 3 By-laws for Mortuaries 45, 77 Canals 50 Canal Boats Acts 50 Cancer, Mortality from 27 „ „ Corrected 25 Canned Goods 68 Childbed, Mortality in 20 "Clarendon Street Area" 65 Combined Drainage 49 Common Lodging Houses 66 Cowhouses 70 Dairies and Milkshops 70 Deaths and Death-Rates 7 Deaths in Institutions 41 Death-rates, Factor Corrected 9 Diarrhoea, Deaths from 36 Diphtheria, Cases of 10 „ Mortality from 12 „ „ ,, Factor Corrected 13 Disinfection 44 Drains, Private, Re-laid 48 Enteric Fever, Cases of 16 „ Mortality from 12 „ „ Factor Corrected 13 „ Personal infection of 16 Erysipelas 19 Factory and Workshop Act, 1901, Work Under 51 Food Analysis, Summary of Samples taken 71 ,, Summary of Proceedings 75 Food Supervision 67 Food Adulteration 71 Food Purveyors 68 Home Work, H.C. Return re 52 Hospitals, Accommodation provided 42 House Refuse 48 Houses let in Lodgings, Annual Cleansing of 60 „ „ Sickness, etc., in 64 „ „ Registration of 58 „ „ Overcrowding of 61 „ „ Sanitary defects in 60 „ „ Verminous rooms 66 „ „ Vital Statistics 64 Ice Cream, Inspection of places where made 70 Illegitimates, Births of 3 „ Deaths of 39 Infants, Feeding of 38 „ Mortality among 30 „ „ in certain districts 32 Influenza, Mortality from 29 Page Inhabited House Duty, Exemption from 67 Inquests held 40 Institutions, Deaths in 41 Laundries 58 Legal Proceedings, Summary of 72 Manure, Removal of 48 Measles, Cases reported 20 „ Mortality from 21 „ „ Factor Corrected 23 Meat Supply 67 Meteorology 2 Milkshops, Trades carried on at 70 Morbidity Rates 7 Mortuaries 45 Notifications 4 Offensive Refuse, Removal of 48 Office Work 72 " Other Septic Diseases" 20 " Other Tubercular Disease" 26 Outworkers 52 Personal Infection in Enteric Fever 16 Phthisis, Mortality from 24 „ „ corrected 25 Population, Estimate 1 Preservatives in Foods 71 Prevention of Infectious Diseases 42 Puerperal Fever 19 Respiratory Diseases, Mortality from 29 Scarlet Fever, Cases of 14 ,, „ Mortality from 12 „ „ „ ,, Factor Corrected 13 Schools and Infectious Diseases 45 Septic Diseases, Mortality from 19 Sewers, Complaints of 50 Slaughterhouses, Inspection of 67 Small-pox 10 Smoke Prevention 50 Trade Refuse 48 Tubercular Diseases, Mortality from 24 Unsound Food seized 69 Vaccination 10 Water Supply, Cutting off of 44 Wharves, Inspection of 51 Whooping Cough, Cases reported 22 „ „ Mortality from 23 ,, ,, ,, ,, 1 actor Corrected 23 Workshops, Inspection of 55 „ Registration 51 APPENDIX. Tables required by the Local Government Board, Home Office, and London County Council. TO HIS WORSHIP THE MAYOR, THE ALDERMEN, AND COUNCILLORS OF THE BOROUGH OF PADDINGTON. Mr. Mayor and Gentlemen, I have the honour to submit to you my Report on the health of the Borough and the work of your Public Health Department during the past year, this being the thirteenth Report submitted by me. The interval which has elapsed since the last census (1901) makes the estimate of the population a very uncertain quantity, and I am of opinion that the figure given in the report is too low. I have come to that conclusion from a consideration of the difference (2,153) between the estimated and natural increments during the five and a quarter years which had been completed at the middle of last year, and from the changes which are taking place in the manner of housing of the general population. The erection of blocks of flats, and the conversion of dwellings, originally constructed for occupation by single families, into flats, is leading to an increase in the density of population. At the last census this Borough was one of the most densely inhabited districts in the Western Division of the Metropolis, a fact which should be borne in mind when considering the vital statistics. There are no signs of any slackening in the rate of decrease in the reproductivity of the nation. Last year's birth-rate for England and Wales was the lowest on record, and the same has to be said of the Metropolitan and Borough rates. The following points from the Registrar-General's Annual Summary for 1906 will help to explain some of the causes operative in the production of the fall in the rate. In 1870-72 the marriage-rate in the Metropolis, calculated on the unmarried and widowed population aged 15 years and upwards, was 60.9 per 1,000. In 1900-02 that rate was 50'3, and, in 1904-06, 48.0 The rates for the second and third periods were 17 and 21 per cent. respectively below that for the first. The age of women at marriage is an important factor in this connection, hut information on that point is not immediately available. Some idea of the altered age at marriage can be obtained from the census returns. The percentage of females aged 15-45 years returned as married was 47'6 in 1871, and had fallen to 44.8 in 1901-a decline of 6 per cent. The proportions of females at different ages per cent. of the married women aged 15-45, at the census of 1871 and 1901, were as follows:- Ages 15- 20- 25- 35-45. 1871 1.3 14.1 46.6 38.0 1901 0.7 12.4 47.4 39.5 Increase (+) Decrease (-)-46 -12 +1 +4 per cent. In 1870-72 the birth-rate per 1,000 persons was 35.2; in 1900-02, 28.9; and in 1904-06, 27.2equal to decreases of 18 and 23 per cent. respectively. The legitimate birth-rate, calculated per 1,000 married women aged 15-45 years, was 269.9 in 1870-72, 227.8 in 1900-02, and 213.4 in 1904-06-shrinkages amounting to 16 and 21 per cent. The illegitimate rate, calculated on the unmarried and widowed females of the same ages, fell from 10.3 in the first period to 6.9 in the second and third, or by 23 per cent. ii. Summarising the foregoing, it appears that with a decrease in the marriage rate of 21 per cent. there has been a decrease in the legitimate birth-rate, calculated on the married women, of. exactly the same amount. On the other hand, with a larger proportion of unmarried and widowed women of reproductive ages, there has been a decrease of 23 per cent. in the illegitimate rate. I must confess that the results obtained from a consideration of the data given above have been a complete surprise, but I am doubtful whether the equality be more than a coincidence. For the last two years full particulars of the births registered within the Borough have been obtained from the Registrars, and enquiries have been made for the past four years at certain out-lying institutions for information of births of children of parents belonging to the Borough. The corrected figures have been given in these reports. In the Summary already referred to, published while this Report was in the press, there is a table giving the fully corrected rates for all the Metropolitan Boroughs since 1901. For the purpose of comparison with the rates given in Table 3 of this report, the appended rates for this and the adjacent Boroughs are given:- Birth-rates After distribution of outlying Births. Per 1,000 living. Per 1,000 married women, 15-45 years. Average. 1901-5. 1906. Average. 1901-5. 1906. Paddington 23.6 22.7 194.9 187.6 Kensington 20.4 19.2 188.6 176.4 Westminster 18.3 17.2 164.1 152.1 Marylebone 22.1 21.2 183.7 176.6 Hampstead 17.6 16.5 164.4 153.4 From information which has been obtained during the past two years, I have reason tobelieve that more births remain unregistered than has been suspected hitherto. Moreover, births are registered at false addresses in considerable numbers, as is shown both by the experience of the Staff when making their visits after the births of children, and by the Returns of the Vaccination Officers. In certain instances it has been found that the births have been falsely registered in adjacent Boroughs, and consequently lost for the purpose of calculating the birth-rate. It is hoped that the "Notification of Births Bill" now before the House of Commons will make the civil registration of births more complete, an aim which had no place in the scheme of the framers of the Bill. As regards sickness, the past year was signalised by an undue prevalence of scarlet fever. No cause for the outbreak was discovered, and, as what may be termed the main epidemic began towards the close of summer holidays, the schools could not be held responsible. The fact that for the previous two years the prevalence of the disease had been considerably lower in the Borough than in the Metropolis undoubtedly favoured the extension of the disease when it had gained a footing. Towards the middle of the autumn, the schools had some share in spreading the disease, and certain classes were closed in consequence. It is satisfactory to be able to record a continued decrease in the prevalence of enteric fever, a disease which is in many respects the most delicate test of the " sanitary" condition of a district. I desire to draw attention to the history of a small outbreak of this disease iii. which occurred in connection with one of the local institutions, which illustrates very clearly the dangers of "missed" cases, and, to some extent, by parity of reasoning, helps to explain how scarlet fever became so rife in the Borough during the year. (See page 16.) The mortality, both at all ages, and under one year of age, was again lower. To a certain degree the continued shrinkage of the mortality affords some consolation for the decrease in the birth-rate, but two considerations must be taken into account. First, there must be of necessity a limit below which the death-rate cannot be reduced ; and secondly, the decrease in the birth-rate has progressed, and probably is still progressing, at a greater rate than that of the mortality. Thus, between 1876-80 and 1901-05 the birth-rate per 1,000 living fell in the Metropolis from 35.55 to 28.17, while mortality decreased from 22.17 to 16.64. There was, therefore, a decrease amounting to 7.35 per 1,000 persons in the former rate and one of 5.53 in the latter, involving a fall in the rate of natural increase of 1.82 per 1,000 persons. What the lowest limit in the mortality may be cannot be foreseen, but it is permissible to point out that much remains yet to be done in the direction of reducing the mortality among infants and that from such diseases as measles, whooping cough and phthisis, or, I may say, tuberculosis generally. With regard to the first of these, it is satisfactory to record so substantial a reduction last year. It is, however, feared that but a very small proportion of that reduction was due to the operations of the Department. Climatic conditions were really the principal, but not the only, causes. This is, I think, evident from the fact that, taking the meteorological conditions into consideration, the diarrhoeal mortality for the third quarter of the year should have placed the year second in the list since 1899, whereas it was fifth (see page 38). The Registrar-General in his last Annual Summary deals with this subject, his results confirming to some extent those given in this Report. In a group of nine years, between 1870 and 1905, when the Infantile mortality during the third quarters ranged between 139 and 174 (with a mean of 160), the mean temperature of the earth was 60.4°, and the mean rainfall 8.1 in. In a second group of eight years, the mortality ranged from 177 to 196 (mean 188), the earth temperature was 61.3°, and the rainfall 7.3 in. In a third group of nineteen years the mortality varied from 205 to 279 (mean 226), the earth temperature was 62.5° and the rainfall 5.9 in. The concordance between earth temperature and infantile mortality is closer, according to the Registrar-General's figures, than that noted for "diarrhœa." The inverse concordance with rainfall is the same in the two cases. The mean air temperatures are not given by the Registrar-General. As regards administration, the past year has been uneventful. In a short time all the houses at present within the purview of the By-laws relating to houses let in lodgings will be on the Register, and it will be necessary to consider some amendment in the By-laws to secure the registration of tenement houses which are at present exempt. Changes are going on in the classes of the inhabitants of certain streets which make it very desirable that the houses in such streets should be placed under the provisions of the By-laws which cannot be done owing to the operation of the rent exemptions. I should much like to see the legal designation of such houses changed. "Houses let in lodgings," the present designation, creates a confusion with "common lodging houses," a confusion which offends landlords and tenants equally. It is scarcely necessary to urge the need of more frequent removal of house refuse, at least during the warmer months. The resolutions on the subject which have been adopted demonstrate that the importance of the subject to the occupants of flats and iv. tenement houses is fully appreciated. I would, however, urge the desirability of making two collections per week (from, say, May to September) a definite rule, not one subject to annual consideration. Further experience of the provisions of the Factory Act with regard to "outworkers" confirms the opinion that amendment of the law is necessary, both in the direction of simplification of procedure and in limitation of definition. I have ventured to submit certain proposals which, I think, will achieve both objects. On the question of the food supply, I have to observe that the "warranty" provisions of the Sale of Food and Drugs Acts, as interpreted by the Courts, are rendering those Acts practically nugatory. Each year that defence becomes more common, and although the adulteration, especially of milk, is bevond dispute, it is impossible, owing to such defence, to allocate the responsibilitv, or secure a conviction. A similar difficulty is experienced in connection with diseased meat. This is made manifest from the want of success attending the prosecutions of vendors of such meat. The defence provided by sub-section 3 of Section 47 of the Act-"that he (the vendor) did not know and had no reason to believe " that the meat was unsound, &c.-has been so interpreted as to relieve the vendor of all need of proper precaution-that is, examination prior to sale. In conclusion, I have to report that the Officers of the Department have discharged the duties of their respective offices to my entire satisfaction. I desire to express my acknowledgments of the assistance rendered to me by my medical colleagues practising in the Borough, and to tender my thanks for the courtesy and kindly consideration which I have received at all times from the Chairman and Members of the Public Health Committee. I count it a pleasure as well as an honour to carry out the duties entrusted to me. I have the honour to be, Mr. Mayor and Gentlemen, Your most obedient servant, Pequious duwfill. M.A., M.B., D.P.H., F.S.S., Medical Officer of Health. Town Hall, Paddington, W. 26th May, 1907. 1 REPORT. The Borough.-The Borough has an area of 1,356 acres, including 20 of water (canals) and 175 (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. St. Mary St. John North-West Paddington Wards. Harrow Road. Maida Vale. Westboume. Church (part of). Church (part of). Lancaster Gate (West). ,, ,, (East). Hyde Park. Queen's Park. Population in 1906.-The population of the Borough was estimated at the middle of the year to be 148,621 persons, of whom 63,665 were males and 84,956 females. At the census of 1901 the enumerated population was 143,976 persons. The estimated increase during 5¼ years amounts to 4,645 persons, and the natural increment (i.e., excess of births over deaths) to 6,798 persons. The estimates of the inhabitants of the various sub-divisions of the Borough are given below. Estimated Population. 1906. Borough ... Males 63,665 Persons 148,621. Females 84,956 Registration Sub-Districts Persons. Wards. Persons. St. Mary 98,505 Queen's Park 16,589 St. John 33,527 Harrow Road 29,286 North-West Paddington 16,589 Maida Vale 19,790 Westbourne 25,138 Church 27,580 Lancaster Gate (West) 8,432 „ ,, (East) 7,919 Hyde Park 13,887 2 METEOROLOGY. METEOROLOGY. Meteorologically the year was characterised by a higher mean air temperature (51.1°) and greater extremes of heat and cold (maximum 94°, minimum 20°). There was much more bright sunshine recorded, 1,580 hours-as compared with 1,344 in 1905, and the number of days yielding records (292) was also considerably above the number (270) for the previous year. In spite of the higher maximum temperature and the increased amount of bright sunshine, the maximum temperature in the sun (128.0°) was lower. More rain fell (amounting to 24.42 in.) than in the preceding year, but the number of days on which measurable quantities fell (145) was fewer. Taking all the data into consideration, they may be regarded as having been favourable to a healthy year. TABLE 1. Meteorological Elements. 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. h. m. Number of Days. Dry Bulb. Wet Bulb. Maximum. Minimum. 1906. Totals - - - - - - - - - 24.42 145 1,580 12 292 Means 29.99 51.1 47.6 - - - - - - - - - - Highest - - - 940 Sept. - - 128.0 - - - Lowest - - - - - 20.0 Dec. - 150 - - - 1905. Totals - - - - - - - - - 23.35 151 1,344 59 270 Means 29.96 50.0 469 - - - - - - - - - - Highest - - - 86-3 July - - 1350 - - - - - Lowest - - - - - 22.0 Jan. - 15.0 - - - - 1904. 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 - - - 128.0 - - - - - Lowest - - - - 26.0 Jan. - 19.0 - - - - 3 births. The 3,152 births registered in the Borough included 134 of illegitimate children (80 of boys and .14 of girls), 24 of whom were born of non-resident parents. Outside the Borough 21 such births occurred, which have to be added to the number for the Borough, making a nett total of 131 children, equal to 3.98 (say, 4) per cent. of the total births. In 1905 the percentage was 6.1, and the mean proportion for the five years, 1901-05, 5.6. The highest proportion in any Ward was 6.5 in Hyde Park, and the lowest 1.4 in Harrow Road and Lancaster Gate (East) Wards. (See Table 2.) TABLE 2. Births and Birth-Rates. 1906. Corrected for Non-residents, &c. All Births. Illegitimate. Corrected Total. Rates. Corrected Total. Per cent. of All Births Per 1,000 persons. Per 1,000 females. Borough. 3,286 22.10 68.61 131 4.0 Wards. Queen's Park 458 27.60 119.36 13 2.8 844 28.81 108.05 12 1.4 Maida Vale ... 430 21.72 61.44 22 5.1 Westbourne 453 18.02 55.33 24 5.2 Church 769 27.88 104.22 46 6.0 Lancaster Gate, West 63 7.47 16.48 3 4.8 „ East 71 8.96 17.58 1 1.4 Hyde Park 198 14.25 34.20 10 65 The numbers of births and corresponding rates in the Metropolis, the Borough and the circumjacent districts are given in Table 3. In England and Wales the rate last year was 27.0 per 1,000 persons, 0.2 below that for 1905, 1.7 below the decennial mean rate and the lowest rate on record. Visits were made to 2,37(5 homes after the birth of children by the Women Inspectors and students, principally the latter. At 72 houses the name of the family sought was unknown, and 109 families had gone away when the first call was made.* The actual number of births in connection with which satisfactory data were collected was 2,101. From the information elicited, it appears that the total number of children born to the 2,101 families was 5,491, an average of 2.6 per family. Of the children whose births led to the visits during the year, 429, or nearly 22 per cent., were first-born-a fact which is of some interest, as any information assimilated by the parents on the occasion of the first child is likely to produce good results on future occasions. Of the 5,029 children whose births antedated last year, 947 were found to have died, equal to 18.8 per cent. Attempts were made to ascertain the causes of death, but the results appear to be too uncertain to justify inclusion here. * In 15 instances only were the visits declined. 4 sickness. TABLE 3. Births and Birth-Rates. Based on returns given in the Quarterly Reports of the Registrar-General. Rates. Births Registered, 1906. Per 1,000 persons. Per 1,000 females, 15-45. 1906. 1901-5. 1906. 1901-5. Borough 3,165 21.25 22.44 65.79 69.47 London 125,652 26.61 28.12 97.22 102.74 Kensington 3,323 18.36 19.57 50.97 54.34 Westminster 2,763 15.88 17.16 48.24 52.16 Marylebone* 4,029 31.33 30.06 95.05 91.20 Hampstead 1,433 15.98 17.16 42.18 45.53 Willesden 4,160 28.96 31.51 104.22 113.39 * The figures for Marylebone, after correction for births of non-residents in Queen Charlotte's Hospital, are:Births, 1906-2,648. per 1,000 persons. Birth-rates, 1906-20.59. 1901-5-2294. per 1,000 females (15-45 years.) 1906-62.46. 1901-5-69.16. The intervals which elapse between the birth of the child and the visit of the Inspector range from a few days to over two months, depending on the channel through which the information of the birth reaches the Department. A considerable number are reported within a few days of birth by the County Council, on information supplied by the midwives, while the remainder (the larger proportion) are not known until registration takes place in the ordinary manner. Information as to manner of feeding, personal care by the mother, &c., is therefore unreliable, or, rather, acquired under circumstances which are not comparable It is of interest, however, to note that of 280 infants fed by bottle, 180 had tubeless pattern, 87 the long tube, and 13 bottles with screw tops. Twenty other babies were being spoon fed. SICKNESS. The cases of infectious disease reported in accordance with the provisions of Sec. 55 of the Public Health (London) Act, 1891, rose from 564 in 1905 to 1,083 last year, the highest number since 1901 when 1,111 cases were reported. The greater part of the increase was due to scarlet fever, the cases of which increased from 277 to 715 (an increase of 257 per cent.). The increases in prevalence of diphtheria (197 per cent.) and puerperal fever (171 per cent.) were doubtless in part due to the prevalence of scarlet fever. Enteric fever decreased by nearly 26 per cent. The morbidity rate for scarlet fever (4.81) was the only one markedly in excess of the mean for the five years 1901-05. (See Table 4). The diagram facing this shows how the numbers of cases varied from week to week during the year. It is interesting to note that the first rise in scarlet fever followed the re-opening of the schools after the Easter holidays, the second occurred during the summer holidays, and the third towards the end of the autumn school term. Spread of the disease by milk supplies appeared to be excluded, although suggested by the curves. The last and greatest rise was almost certainly due to school infection. NOTIFICATION CHART. 1906 Average during 10 years 1896 - 1905 Duration of School Holidays. 5 SICKNESS. TABLE 4. Notification of Sickness. Paddington. Notifications. Morbidity Rates. 1906 1905 Increase ( + ) 1906 1905 Mean Decrease (-) 1901-05 Smallpox 1 2 - 1 0.00 0.01 0.18 Cholera ... ... ... ... ... ... Diphtheria 182 92 + 90 1.22 0.62 1.25 Membranous ... Croup ... 4 - 4 ... 0.02 0.01 Erysipelas 138 136 + 2 0.92 0.92 0.90 Fever Scarlet 715 277 + 438 4.81 1.87 2.61 Typhus ... ... ... ... ... Enteric 34 46 -12 0.22 0.31 0.42 Relapsing ... ... ... ... ... ... Continued 1 ... + 1 0.00 ... 0.00 Puerperal 12 7 + 5 0.08 0.05 0.09 Totals 1,083 564 + 519 7.28 3.81 5.48 TABLE 5. Notifications, 1906. Distributed according to Sex and Age. Ages. Smallpox. Diphtheria. Membranous Croup. Erysipelas. Scarlet. Fevers. Enteric. Continued. Puerperal. M. F. M. F. M. F. M. F. M. F. M. F. M. F. F. 0- ... ... ... ... ... ... 3 3 5 3 ... ... ... ... ... 1- ... ... 7 5 ... ... ... ... 22 13 ... ... ... ... ... 2- ... ... 8 3 ... ... 2 14 19 ... ... ... ... ... 3- ... ... 10 7 ... ... 2 1 21 24 ... ... ... ... 4- ... ... 8 8 ... ... 1 1 32 34 ... ... ... 5- ... ... 34 40 ... ... ... 2 184 215 . 5 3 ... ... ... 13- ... ... 1 4 ... ... 1 2 11 24 1 ... ... 15- ... ... 4 14 ... ... 3 11 26 34 5 6 ... 2 25- ... 1 12 15 ... ... 41 47 12 22 6 8 ... 1 10 65- ... ... ... 2 ... ... 7 11 ... ... ... ... ... ... ... All Ages. ... 1 84 98 ... ... 58 80 327 388 16 18 ... 1 12 Rates, 1906 ... 0.01 1.31 1.15 ... ... 0.91 0.94 5.13 4.56 0.25 0.21 ... 0.01 0.14 1905 ... 0.02 0.03 0.61 0.04 0.01 1.06 0.82 2.07 1.72 0.30 0.32 ... ... 0.08 Mean Rates 1901-05. 0.23 0.15 1.34 0.58 0.02 0.01 0.90 0.88 2.28 2.46 0.49 0.37 0.00 0.00 0.09 6 SICKNESS. The sex-age incidence of the different diseases during the past year is given in Table 5. The disproportionately large numbers of cases both of diphtheria and scarlet fever at schoolages (5-13 years) suggest that school attendance had a no inconsiderable share in the spread of these diseases. In Table 6 the cases are distributed according to the Wards. There was a very great excess of scarlet fever in both Queen's Park and Harrow Road Wards. The large increase in the number of cases from Church Ward is to some extent more apparent than real, owing to the fact that there was an unusually large proportion of mistakes in diagnosis. It will be noted that in Lancaster Gate, West, Ward, the cases of this disease were little more than half the number recorded in 1905. The cases of diphtheria were more numerous last year in all Wards than in 1905. TABLE 6. Notifications from each Ward. 1906. Numbers for 1905 shown (italics). Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancast West. er Gate. East. Hyde. Park. Smallpox - (-) 1 (-) - (-) -(1) -(-) -(1) -(-) -(-) Diphtheria 16 (7) 37 (34) 38 (10) 28 (16) 43 (18) 5(2) 6 (3) 9 (2) MembranousCroup - (-) - (2) - (-) - (1) - (-) - (-) - (1) - (-) ErvsiDelas 13 (IS) 34 (34) 19 (19) 15 (23) 42 (28) 3 (2) 5 (1) 7 (11) Fever Scarlet 140 (24) 161 (77) 87 (33) 82 (38) 177 (51) 15 (26) 18 (10) 35 (18) Enteric 3 (4) 10 (8) 4 (17) 2 (6) 10(5) 2(2) 2(1) 1 (5) Puerperal 3(2) *5 (1) 2(-) 1 (7) 1 (3) -(-) -(-) 1 (1) Totals 175 (54) 248 (156) 150 (79) 128 (86) 273 (105) 25 (33) 31 (16) 53 (35) Rates, †1906 10.54 8.46 7.57 5.09 9.90 2.96 3.91 3.81 „ 1905 3.24 5.38 4.03 3.46 3.84 3.91 2.02 2.52 Mean Rates 1901-5 6.89 6.81 5.12 5.11 6.46 3.20 2.65 3.30 * Includes one case notified as " continued fever," but found at autopsy to be " puerperal fever." | Per 1,000 persons of all ages. Comparing the local rates with those of the areas set out in Table 7, it will be seen that the scarlet fever rate was in excess of the mean in all the areas, and that the highest rate was that of the Borough. As regards diphtheria, last vear's rate was generally below the mean, the exceptions being those of Westminster and Hampstead. The rate for enteric fever was lowest in Kensington, the Borough rate being, however, not materially higher. The local rate for puerperal fever is the highest of the whole series. 7 DEATHS. TABLE 7. Morbidity Rates. § Compiled from Official Publications. Paddington. London. Kensington Westminster. Marylebone. Hampstead. Willesden. 1906 Mean 1901-5 1906 Mean 1901-5 1906 Mean 1901-5 1906 Mean 1901-5 1906 Mean 1901-5 1906 Mean 1901-5 1906 Mean 1901-5 Smallpox 0.00 9.19 0.00 0.44 - 0.13 - 0.41 - 0.36 - 0.06 - 0.18 Diphtheria* 1.22 1.29 1.70 1.93 0.97 1.03 1.20 1.09 1.10 1.46 1.09 1.08 1.98 2.76 Erysipelas 0.93 0.89 1.06 1.04 0.81 0.92 0.73 0.68 1.15 1.40 0.59 0.57 0.71 0.65 Fever Scarlet 4.80 2.62 4.30 3.54 2.61 1.99 3.08 2.20 3.07 2.72 4.31 2.33 4.40 3.56 Enteric 0.22 0.42 0.33 0.53 0.21 0.40 0.28 0.43 0.37 0.51 0.24 0.40 0.32 0.39 Puerperal 0.08 0.05 0.06 0.05 0.07 0.04 0.05 0.03 0.04 0.04 0.02 0.04 0.06 0.05 § Per 1,000 persons. * Including membranous croup. † Including continued fever. DEATHS. There were registered within the Borough during the past year 2,041 deaths, equal to a rate of 13.73 per 1,000 persons of all ages. The number of deaths was 252 below the average for the decennium 189(5-1905, and the rate 2.16 below the mean. (Sec Table I., Appendix.) After correcting for non-residents (395 deaths) and for outlying institutions, &c. (197 deaths), a nett total of 1,843 is obtained, equal to a rate of 12.40, or 2.51 less than the decennial mean. The corrected totals and rates for the three Registration Sub-Districts will be found in Table II. of the Appendix. The death-rates in the Wards ranged from 6.87 to 17.65, all being lower than their respective means for the five years 1901-05, except those of Church (17.65) and Hyde Park (12.16). (See Table 8.) With but few exceptions, the age-group rates were below the corresponding means. (Table 9.) TABLE 8. Nett Numbers of Deaths and Nett Rates. Deaths. All causes, all ages. . 1906. Mortality per 1,000 persons. 1906. Mean-rates, 1901-05. Males. Females. Persons. Males. Females. Persons. Males. Females. Persons. Borough 879 964 1,843 13.80 11.34 12.40 15.55 12.47 14.24 wards. Queen's Park 101 105 206 12.14 12.68 12.41 15.34 13.68 14.52 Harrow Road 158 161 319 11.38 10.44 10.89 14.32 13.62 13.93 Maida Vale 129 121 250 16.27 10.19 12.63 15.35 11.94 13.30 Westbourne 136 161 297 13.15 10.87 11.81 15.56 13.09 14.10 Church 235 252 487 17.92 17.41 17.65 19.22 16.90 17.60 Lancaster Gate, West 23 35 58 8.10 6.25 6.87 9.38 7.04 7.83 Lancaster Gate, East 24 33 57 10.50 5.85 7.19 12.98 6.49 8.36 Hyde Park 73 96 169 14.66 10.77 12.16 14.47 9.37 11.33 8 deaths. TABLE 9, Nett Death-rates. Sex. Age. Period. Borough. Wards. Queen's Park. Harrow Rd. Maida Vale. Westboume. Church. Lancaster Gate, West. Lancaster Gate, East. Hyde Park. Males. 0- 1906 128.33 117.34 91.98 178.16 126.63 160.32 74.07 111.11 122.22 Mean 156.96 179.35 138.56 152.09 155.21 183.98 103.34 103.11 130.78 1- 1906 13.57 8.68 11.21 14.33 13.85 21.38 9.17 10.03 Mean 20.26 21.68 17.14 17.29 19.17 27.96 11.05 21.98 12.67 5- 1906 1.87 2.83 1.15 0.73 1.86 1.94 3.03 3.34 3.03 Mean 2.40 2.42 2.77 1.52 3.04 2.62 1.82 1.31 1.20 15- 1906 2.39 2.26 2.38 1.84 2.75 3.05 2.68 1.99 Mean 2.72 3.20 3.09 2.66 2.83 2.81 2.12 0.82 1.77 25- 1906 11.66 13.73 8.19 13.39 11.10 16.18 4.74 8.16 11.18 Mean 12.25 12.18 10.70 12.50 12.46 15.28 7.81 10.71 11.86 65- 1906 84.71 65.21 97.15 103.34 55.94 105.39 80.29 62.93 102.45 Mean 87.17 121.06 75.30 91.37 65.39 117.91 63.99 73.91 98.11 Females. 0- 1906 106.33 103.26 61.69 90.90 113.53 163.14 22.22 66.66 177.21 Mean 129.33 130.86 103.05 144.73 132.01 176.61 53.32 70.95 95.91 1- 1906 11.44 15.73 12.62 6.55 5.19 16.33 6.75 - 10.52 Mean 16.79 18.44 13.74 14.83 17.10 22.90 10.78 5.93 13.96 5- 1906 3.22 1.68 3.03 1.34 3.96 4.27 2.48 5.78 5.11 Mean 2.27 3.37 1.63 1.81 2.11 2.71 2.47 0.57 2.29 15- 1906 1.75 3.84 2.78 0.35 1.52 2.16 0.63 1.30 1.82 Mean 2.11 3.43 3.27 1.43 2.39 3.17 0.37 0.25 1.48 25- 1906 8.22 8.61 7.27 8.49 8.36 13.26 4.16 3.89 7.26 Mean 8.52 9.47 9.59 8.36 8.95 11.79 5.09 4.64 6.36 65- 1906 70.15 101.49 59.10 76.43 49.06 108.28 62.50 54.85 70.68 Mean 76.27 87.30 79.54 80.97 62.77 97.59 62.29 69.73 72.10 Rates per 1,000 individuals each age-group. Means-for five years 1901-05. For the purpose of comparison with other districts, the numbers given in the Quarterly Reports of the Registrar-General have been used in Table 10. The rate for the Borough (12.49) is a trifle higher than that derived from the departmental total, but is, with the exception of the rates of Hampstead (9.41) and Willesden (10.61), the lowest in the table. The rates in the last-mentioned table take no account of the differences in the sex-age compositions of the populations. In Table 11 will be found the fully corrected rates for the Borough, its Wards and the other districts. In Church Ward only was last year's corrected rate (18.85) above the standard (17.03). Last year's rate for Hyde Park Ward (13.67) is the only one in excess of its quinquennial mean (12.74). Information as to the numbers of deaths in institutions, both local and outlying, will be found in Tables III. and IIIa. in the Appendix. In Tables IV. and V. (Appendix) the nett numbers of deaths from the different diseases have been set out. 9 DEATHS. TABLE 10. Nett Death-rates.* Based principally on figures published in 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 1906 12.49 ... 0.10 0.12 0.10 0.08 0.04 0.83 1.12 0.36 1.10 112 Mean § 13.81 0.02 0.31 0.05 0.18 0.26 0.06 0.62 1.06 0.43 1.01 129 London ... 1906 15.06 ... 0.40 0.11 0.14 0.25 0.05 0.93 1.43 0.55 1.04 129 Mean 16.09 0.06 0.44 0.09 0.19 0.34 0.07 0.74 1.56 0.58 0.98 137 Kensington 1906 13.79 ... 0.44 0.06 0.10 0.11 0.02 0.79 1.25 0.46 0.94 137 Mean 14.49 0.01 0.36 0.07 0.12 0.27 0.06 0.59 1.28 0.47 0.97 150 Westminster 1906 12.88 ... 0.09 0.08 0.09 0.13 0.02 0.39 1.38 0.42 0.96 118 Mean 14.55 0.06 0.23 0.06 0.08 0.17 0.07 0.34 1.67 0.38 0.97 126 Marylebone 1906 14.86 ... 0.34 0.10 0.09 0.08 0.02 0.59 1.55 0.36 1.07 78+ Mean 16.56 0.04 0.34 0.10 0.15 0.23 0.06 0.58 1.59 0.46 1.11 98+ Hampstead 1906 9.41 0.11 0.05 0.08 0.02 0.03 0.25 0.66 0.24 1.03 78 Mean 10.17 0.01 0.11 0.04 0.10 0.17 0.06 0.18 0.82 0.33 1.01 97 Willesden 1906 10.61 ... 0.18 0.08 0.09 0.18 0.03 0.84 0.96 0.34 0.96 114 Mean 11.95 0.02 0.38 0.06 0.24 0.36 0.06 0.75 0.94 0.37 0.82 121 * Per 1,000 persons of all ages. † Per 1,000 births registered. § Mean for 1901-05. † The Rates after correction for non-resident births in Queen Charlotte's Hospital, are-1906, 116; Mean, 134. TABLE 11. Corrected Death-rates. Standard Rate. . Corrected Rate, 1900. Increase ( + ) Decrease( -) from Standard. Mean Corrected Rate, 1901-05. Increase (+) Decreased -) in 1906 from Mean. Borough 17.10 13.19 -3.91 14.67 -1.48 Wards. Queen's Park 16.43 13.73 -2.70 16.07 -2.34 Harrow Road 19.02 10.41 -8.61 13.33 -2.91 Maida Vale 16.62 13.82 -2.80 14.56 -0.74 Westbourne 18.96 11.33 -7.63 13.54 -2.21 Church Lancaster Gate, West 17.03 15.01 18.85 8.32 + 1.82 -6.69 19.23 9.49 -0.38 -1.17 ,, East 14.76 8.86 -5.90 10.31 -1.45 Hyde Park 16.18 13.67 -2.51 12.74 +0.93 London 17.31 15.82 -1.49 16.91 -1.09 Kensington 17.05 14.71 -3.34 15.47 -0.76 Westminster 1546 15.15 -0.31 17.12 -1.97 Marylebone 16.93 15.96 -0.97 17.84 -1.88 Hampstead 16.19 10.57 -5.62 11.43 -0.86 Willesden 16.98 11.37 -5.61 12.81 -1.44 10 small-pox. SMALLPOX. Only one case of this disease was reported in the Borough during the year, in the person of an adult female recently arrived from Plymouth, where the disease was, at that date, somewhat prevalent. The case ended favourably. The Metropolis was almost free from the disease during the year, only 31 cases (an unknown proportion of which were probably erroneously diagnosed) being reported, with not a single death. In 1905 there were 74 cases and 10 deaths. The cases included in the Weekly Returns issued by the Local Government Board (based on returns received from 255 Extra-Metropolitan districts, having a population of nearly 15 millions at the census of 1901) numbered 990 last year, as compared with 2,276 and 5,245 in the two preceding years. The quarterly totals are given below:- Metropolis. Extra-Metropolitan Districts. 1. 2. 3. 4 1. 2. 3. 4. 1906 14 16 1 - 545 275 100 70 1905 34 36 6 1 1,093 602 310 271 1904 181 251 42 23 1,345 1,519 1,098 1,283 Appended are the usual Vaccination statistics kindly supplied by Mr. House, the Vaccination Officer:- Vaccination Returns. Cols. Births. Successfully Vaccinated. Insusceptible of Vaccination. Died Unvaccinated. Per cent. of Birth Cols. 2,3,&4. Vaccination Postponed. Certificates under Act granted for. Remaining (not traced, &c.)* Per cent, of Births. Cols. 6, 7, & 8. 1 2 3 4 5 6 7 8 9 1901 3,364 2,676 5 313 89.0 23 34 313 11.0 1902 3,262 2,629 12 291 89.8 35 19 276 10.1 1903 3,315 2,621 10 296 88.2 48 32 308 11.7 1904 3,311 2,578 8 307 87.4 52 22 344 12.6 1905 3,188 2,495 11 261 86.8 61 40 320 13.2 1906† 1,611 1,259 4 99 84.6 60 20 169 15.4 Jan -June| * Including " gone away," "false addresses," apprisals to other districts, &c. Provisional return only. 11 g x H X ffl 2 > TABLE 12. Notifications. Quarterly Numbers and Averages. Wards Queen's Park. Harrow Road. Maida Vale. West bourne. Church. Lancaster Gate, West. Lancaster Gate, East. Hyde Park. Borough. Quarters 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Diphtheria † 1906 8 3 5 6 4 10 17 8 4 17 9 7 5 10 6 10 5 18 10 1 4 2 2 2 1 2 3 3 43 22 61 56 * Average 6 5 10 20 11 10 13 20 3 5 6 6 4 6 7 6 8 7 7 5 1 1 1 1 1 5 0 2 4 2 1 3 40 40 45 64 Scarlet Fever 1906 7 35 25 73 10 27 33 91 10 24 27 26 7 21 28 26 4 36 85 52 6 4 3 2 1 7 4 6 3 10 8 14 48 164 213 290 Average 7 11 18 14 20 20 28 29 7 7 14 16 17 12 19 17 17 20 20 33 4 5 4 4 1 2 2 3 3 7 7 5 76 84 111 112 Enteric Fever 1906 1 2 — 3 3 — 5§ — 1 1 2 — 1 — 1 — — 2 8 1 — — 1 1 — 1 — — 1 — — 5 7 6 17 Average 2 1 2 1 1 2 3 2 2 1 4 5 3 2 4 3 3 2 3 7 1 — 1 1 1 0 1 0 1 0 2 1 13 10 19 21 Puerperal Fever 1906 1 — 1 1 1 1 2 1 1 - - - 1 - - - - - 1 - - - - - - - - 1 - - - 3 3 2 4 Average — 0 1 0 0 0 — 0 0 0 — 0 1 1 0 0 0 0 1 0 — — — — 0 — — 0 0 0 — — 3 2 2 2 "-" No cases recorded. "0" Average less than unity. *Average for the five years 1901-05, adjusted to nearest whole number. †Including Membranous Croup. § The case of continued fever is included here under enteric and not puerperal fever. (See Table 7.) 12 diphtheria. Of the 182 cases recorded last year, 163 were primary and 19 secondary, the frequency of multiple attacks in the same house being indicated below. The proportion of secondary cases last year (10 per cent.) was higher than that of 1905 (7 per cent.), but below that of 1904 (14 per cent.). 1906. 1905. 1904. Houses with 2 cases each 13 5 6 ,,3 „ 1 1 5 ,, 4 „ — — - ,, 5 ,, 1 - — The reported cases included 18 which had been erroneously diagnosed and 4 which developed in hospitals away from the Borough. Two cases were apparently due to the return home of patients from hospital, and 15 to infection acquired outside the Borough. In two instances the patients died on or before the days on which the notifications were received. The numbers of cases removed to hospital for isolation from each of the Wards are given in Table 13, the total (136) being equal to 80.2 per cent., as compared with an average of 78 per cent. for the preceding five years. TABLE 13. Removals to Hospital and Deaths. 1906. Distributed among Wards. Diphtheria. Scarlet Fever. Enteric Fever Cases. Deaths. Cases. Deaths. Cases. Deaths. Total Reported. Removed to Hospital. At Home. In Hospital. Total Reported. Removed to Hospital. At Home. In Hospital. Total Reported. Removed to Hospital. At Home. In Hospital. Queen's Park 16 12 1 1 140 137 - 2 3 2 - 1 Harrow Road 37(5) 32(5) 1 4 161(3) 156(3) 1 — 11(2) 8(2) 1 1(2) Maida Vale 38(3) 28(3) 1 — 87(2) 84(1) - 1 4(1) 3(1) - — Westbourne 28(5) 20(5) - — 82(1) 79(1) - 2 2 2 — 1 Church 43(3) 40(3) - 5 177(22) 176(22) - 8 10 9 1 1 Lancaster Gate, West 5(1) 5(1) - — 15 13 - — 2 1 1 — „ East 6 1 - — 18 16 - 2 2 — - — Hyde Park 9(1) 8(1) - — 35(2) 31(2) - 1 1 1 - - Figures in parentheses indicate cases of erroneous diagnosis. Notes.—Queen's Park—A further death from Diphtheria in 1906 -case reported 1905. Harrow Road—A further death from Enteric Fever in 1906—case reported 1905. One case erroneously diagnosed as Enteric Fever ended fatally. Westbourne—One case erroneously diagnosed as Diphtheria ended fatally. Church —Another death from Diphtheria in 1906—reported 1907, after registration of death. One case erroneously diagnosed as Diphtheria ended fatally. Another death from Scarlet Fever, diagnosis by inquest only. Among the 46 cases treated at home, there were 3 deaths; and among the 136 removed to hospital, 10 deaths. After making due corrections for the errors of diagnosis, &c., the fatalities work out at 8.3 and 7.7 per cent. of the cases notified during the year respectively, both being below the means. (Table 14.) 13 diphtheria. TABLE 14. Diphtheria. Scarlet Fever. Enteric Fever. 1906. Mean. 1901-5. 1906. Mean. 1901-5. 1906. Mean. 1901-05. Removed to Hospital* 80.2 78.1 96.7 87.8 74.2 67.7 Fatality† At Home 8.3 21.5 4.5 1.3 30.0 22.3 In Hospital 7.7 8.4 2.4 2.2 18.1 14.5 Total 7.9 12.8 2.4 2.1 21.8 17.1 Mortality‡ 0.10 0.15 0.12 0.05 0.05 0.06 * Per cent. of all cases recorded. †Per cent, of cases after correction for errors, &c., as set out in foot notes to Table 13. ‡Per 1,000 persons of all ages, based on total deaths registered during the year. The total number of deaths from diphtheria was 15, equal to a rate of 0.10 per 1,000 persons, five times that of 1905 (0.02), but 0.05 below the quinquennial mean (0.15). The nett mortality rates for the Borough, Metropolis and Adjacent Districts are given in Table 10. In Table 15 will be found the rates fully corrected for differences in sex-age composition of population. The rates given in both tables are based on the figures published in the Quarterly Reports of the Registrar General. Mortalities from diphtheria in excess of that for the Borough were recorded last year in Kensington (0.13) and Westminster (0.14), while the lowest rate of all was that of Willesden (0.08). TABLE 15. Mortality Rates.* Fully corrected for sex-age composition of populations. Diphtheria. Scarlet Fever. Enteric Fever. Standard. Corrected. Standard. Corrected. Standard. Corrected. 1906 Mean.† 1906. Mean. 1906. Mean. Paddington 0.39 0.12 0.22 0.13 0.15 0.06 0.14 0.03 0.05 London 0.50 0.14 0.19 0.17 0.11 0.09 0.14 0.05 0.07 Kensington 0.36 0.13 0.16 0.12 0.08 0.10 0.14 0.02 02 0.06 Westminster 0.32 0.14 0.12 0.11 0.12 0.09 0.15 0.01 0.06 Marylebone 0.37 0.12 0.20 0.12 0.13 0.13 0.14 0.01 0.05 Hampstead 0.36 0.10 0.14 0.12 0.06 0.62 0.14 0.02 0.05 Willesden 0.56 0.08 0.21 0.19 0.07 0.52 0.14 0.02 0.05 *Per 1,000 persons.—Based on figures given in Quarterly Reports of the Registrar-General. †Mean 1901-05. 14 SCARLET FEVER SCARLET FEVER. Between 1901 and 1905 this disease decreased annually in the Borough, except for a slight rise in 1903, the totals for each of the five years having been 503, 359, 414, 365, and 277 respectively. Last year the total was 715, showing an increase of 257 per cent. In the Metropolis, on the other hand, there has been a progressive increase in prevalence since 1903, when 12,545 cases were recorded, the figures for the past six years having been—1901, 18,386; 1902, 18,258; 1903, 12,545; 1904, 13,451; 1905,19,469; and 1906, 20,326. Last year's total for the Borough is the highest on record since 1896, when 909 cases were reported. A reference to Table 7 will show that while the prevalence of scarlet fever was last year greater in all the Districts mentioned, the morbidity rate of the Borough was the highest of the series. The local returns for the first quarter of the year were eminently satisfactory, only 48 cases being reported, the lowest number for that quarter with the exception of the first quarter of 1890, the first year of notification, when the system was probably not so complete as it is at the present time. The decennial (1896-1905) average for the quarter is 92, nearly double the number recorded last year. About the middle of April (see Diagram facing page 4) the disease began to be more prevalent, mainly in the northern half of the Borough. During the second quarter 164 cases were notified, as compared with a decennial average of 93. Once only has the total for that quarter been higher, namely, in 1893, when it reached 213. The rise in prevalence continued during the third and fourth quarters, the total number of cases being 213 and 290 respectively. Higher totals were recorded in the third quarters of 1892 (222), 1893 (289) and 1896 (310); but the total for the fourth quarter of last year is the highest on record, the nearest being that of 1896 (266). The largest number of cases reported in any week during the past year was 46 (49th week ending December 1st). Oueen's Park, Harrow Road and Church Wards were the districts most affected (Table 6), but the incidence of the disease did not follow the same course in all. Thus Queen's Park Ward shows a decline during the third quarter (Table 12), Harrow Road a progressive increase to the last quarter, and Church a maximum in the third quarter, followed by a considerable reduction in the fourth. There was a decline in prevalence throughout the year in Lancaster Gate, West, Ward, and only slight increases in the two other Wards of South Paddington. It is believed that some explanation for the undue prevalence in Queen's Park and Harrow Road Wards, at least, is to be found in school attendance, which point will be dealt with later in this report. This is confirmed hy the number of attacks at school ages, 5-13 years. (Table 5.) At the same time the great diminution in the numbers of attacks recorded during the past few years undoubtedly contributed to the spread of the disease after it had gained a footing, by reason of the large proportion of children being unprotected.* There is further reason to believe that there were a considerable number of attacks of a specially mild and often abnormal form of the disease, which either escaped observation and medical attendance altogether, or misled the practitioners in attendance. These "missed cases" are a fruitful source of infection owing to no precautions being observed. Certain of such cases come to the knowledge of the Department during the year. In Church Ward the large number reported during the third quarter of the year included an unusually large proportion of the cases erroneously diagnosed. *It has to be remembered that in 1904 and 1905 the morbidity rate for scarlet fever was higher in the Metropolis as a whole than in the Borough. scarlet fever. 15 All the circumstances of the outbreak favoured an unduly large proportion of multiple cases. There were 181 secondary cases last year, equal to rather more than 25 per cent. of all the notified cases as compared with 15 per cent. in 1905 and 23 per cent. in 1904. The numbers of houses with multiple cases during the last three years are given below:— 1906. 1905. 1904. Houses with 2 cases each 77 31 35 ,, 3 „ „ 23 6 10 ,, 4 „ „ 7 3 7 ,, 5* „ „ 4 — 2 ,, 6 „ „ 2 — — ,, 12 „ „ 1 — — It is impossible within the compass of this report to deal fully with the circumstances attending the occurrence of multiple cases, but the following few facts will serve as illustrations of the factors operative in such cases. In 17 houses where multiple cases occurred two families were infected, and in 2 houses, 3 families. Infection from patients recently discharged from hospital was suspected in 20 instances in all, 9 of such cases leading to the occurrence of multiple cases. On 32 occasions two cases were reported from the same house at the same time; on 5 occasions, 3 cases; and on 2 occasions, 4 cases. As regards the two houses from which 6 cases were reported, in one two families were infected, 4 of the reported cases being, however, errors of diagnosis, and in the other 3 families, with 5 errors. At the house from which 12 cases were reported, 3 families were infected, 5 of the cases ultimately being certified to be errors of diagnosis. In the whole Borough 30 out of the 715 reported cases were known to have been wrongly diagnosed, and it is probable that other cases fell within the same category. In 37 instances importation of infection from outside districts was known, or strongly suspected, and one patient contracted the disease while in hospital. Of the cases reported during the year, 692 were removed to hospital for isolation (Table 13), equal to 96.7 per cent., nearly 9 per cent. more than the average for the preceding five years. (Table 14). After making corrections for the known errors of diagnosis, &c., the fatality among the cases treated at home (23) was at the rate of 4.5 per cent. as compared with a mean of 1.3, while the fatality in hospitals was only 2.4, or very little above the quinquennial mean (2.1). According to the Department's figures the mortality from scarlet fever last year was equal to 0.12 per 1,000 persons (Table 14), compared with the mean rate of 0.05, which figures agree with those obtained from data contained in the Registrar-General's Reports (Table 10). The local rate was higher than that of the Metropolis or anv of the adjacent districts. After correction for sex-age constitution of population (Table 15) the local rate becomes 0.15, more than double the mean rate (0.06). The nearest rate to that of the Borough was recorded in Marylebone (0.13, equal to the mean). * In one house whence 5 cases were reported there were really 6, all in one family, with 4 deaths. The first case was not reported during life, the cause of death being arrived at by Inquest. The other cases occurred between the date of the first death and the holding of the Inquest. The first patient was ill less than 24 hours and all the cases sickened within 4 days. The variety of the disease was the most malignant form which has come to the knowledge of the Department. 16 ENTERIC FEVER. ENTERIC FEVER* Since 1901 this disease has decreased in prevalence in the Borough, the cases recorded during the last six years having been in 1901, 92; in 1902, 84; in 1903, 46; in 1904, 48; in 1905, 46; and in 1906, 35, the lowest on record. The average number of cases occurring in each quarter during the last ten years has been:— 1st Qr., 14; 2nd Qr., 10; 3rd Qr., 19; and 4th Qr., 28, which figures compare with 5, 7, 6, and 17 respectively for last year. A comparison with the averages for the past five years is given in Table 12. In Harrow Road Ward only were the cases reported last year (11) in excess of the quinquennial average (8). From Table 6 it appears that the disease was slightly more prevalent last year in Harrow Road and Church Wards than in 1905. A small outbreak in connection with one of the local institutions was responsible for 3 cases, out of the 35 notified. Last year's morbidity rate for the Borough (0.22) is practically half the mean rate for the five years 1901-05 (Table 4) and, with the exception of that of Kensington (0.21), the lowest of the rates included in Table 7. Multiple cases occurred at two (2) houses last year, one house having two (2) cases and the other three (3) in two (2) families. In 9 instances the fact of the infection having been acquired outside the Borough was more or less (generally the former) clearly proved, in addition to which there were several cases of patients who were in the habit of having meals in other parts of the Metropolis, but in connection with whose cases no history of any infection could be obtained. One of the 9 cases was connected with a small milk outbreak at a Hydro in Scotland. One patient contracted the disease while nursing. In one instance only was any history obtained of consumption of shell-fish (mussels). Twenty-six of the patients, including 3 cases erroneously diagnosed as enteric fever, were removed to hospital for isolation (Table 13), equal to 74.2 per cent. of all cases notified, as compared with a mean of 67.7 per cent. for the preceding five years (Table 14). The fatality of the disease, both at home and in hospital, was above the mean (Table 14), but the former was strikingly above the latter. There were 8 deaths during the year from this disease, but one death was that of a patient whose case was reported during 1905. The mortality was equal to 0.05 per 1,000 persons. The Registrar-General gives the total number as 7 equal to a rate of 0.04, which is higher than anv of the rates mentioned in Table 10. Correction for sex-age composition of the populations makes no difference in the order of magnitude of the rates (Table 15). Personal Infection.—The following notes of a small outbreak of enteric fever in connection with one of the institutions in the Borough will be of interest in continuation of the remarks made in the last Report (pp. 25, 26) on the spread of the disease by personal contact:— On October 1st, C.G., f., ætat. 24, probationer nurse, was reported ill with enteric fever. History— C. G. returned to duty after her holiday on August 21. She worked in the Surgical Ward, the only one then open. She was taken ill on September 22nd, and removed to King's College Hospital on the 29th. *In accordance with the practice of former years, cases certified as "Simple Continued Fever" are included under "Enteric Fever." No case of either typhus or relapsing fever has been reported in the Borough for several years. ENTERIC FEVER. 17 On October 2nd, M.S., f., ætat. 6, a patient in the hospital, was reported to have the same disease. History.—M. S. was admitted to the Institution with a psoas abscess on June 2nd; was transferred to the Convalescent Home on July 30th; had a recrudescence of fever on September 24th, and was re-admitted to the Institution on 25th, idem; placed in isolation on October 1st, and died on 6th. Investigations were commenced at the Institution on the same day (October 2nd), when it was ascertained that four other cases had occurred among the patients, two being then at the Institution and two at the Convalescent Home. Suspicion fell almost at once on the case of a child A. F., not then reported as having the disease. History.—A. F., f., ætat. 3, admitted August 21st, for pneumonia. Transferred to Convalescent Home 5th September; recrudescence of fever 19th, idem ; and re-admitted 20th, idem. Between August 21st and September 1st, A. F. was in the Surgical Ward, being transferred to the Medical on the latter date. Steps were taken to trace back the history of this child's case prior to August 21st. It was ascertained that she was admitted from Willesden, where she had been living with her foster-mother (Mrs. B.). A. F.'s mother died in Canning Town on June 20th of last year; on July 31st. A. F. and her brother S. F. were brought to Paddington and there handed over to the care of Mrs. B. Although a doctor had certified at that date that the children were in good health, Mrs. B. stated (on October 3rd) that A. F. was ailing from the day she received her. A doctor who saw A. F. in Willesden suspected the presence of a "fever." A. F. was taken to the Out-patient Department on August 14th and 21st, being found to be so ill (with pneumonia) on the latter day that she was at once admitted as an in-patient. On enquiry being made of the Medical Officer of Health of West Ham as to the cause of death of the mother of A. F., the following account was received:— Mrs. F. was a strong robust woman, aged 22 years, who appeared to have lived a regular life. She is reported to have been fond of shell-fish, and frequently bought fried fish for supper; she is supposed to have bought some cockles about the end of May, and she is known to have partaken of some on the 4th or 5th of June, which were brought from Southend. Soon after the latter date she was attacked with diarrhœa, and became increasingly worse, but continued to carry out her domestic duties. Vomiting supervened, and on the 16th June she went to Poplar Hospital, and from there to the London Hospital, from both of which institutions she received medicine for diarrhœa. With great difficulty she returned home, went to bed, and was so ill that on Sunday the 17th a private practitioner was called in, who attended her until her death on June 20th. Sickness and diarrhoea of a very foul character were constant from the time she went to bed. S.-St. (where the deceased resided) is one of an isolated group of streets separated from the West of the Borough by a railway line, in which group there had been no case of enteric fever for many months; but at another part of my District I had a sudden outbreak of cases of this disease, a large number of which appeared to be associated with the eating of cockles, purchased on the 26th May from a shop in a main thoroughfare, which would on occasions possibly be used by Mrs. F. The whole history of her case is highly suggestive that the pneumonia and heart failure (the certified causes of death) from which she died were complications of an ambulatory form of enteric fever. This information tended to confirm the suspicion that A. F.'s case was really one of enteric fever, a suspicion which was converted to a certainty by the Widal test on 5th October. It was concluded that the child was capable of spreading infection from July 31st, or thereabouts, until October 2nd, when full precautions were put into operation. During that period she had been in Willesden, at the Institution and its Convalescent Home, and had, there was good reason to believe, infected at least 25 persons, directly or indirectly. The cases fall into three groups, as set out below. In Willesden— At 24 Q.-Rd. (where Mrs. B. resided)- W. B., m., ætat. 1.3; sickened 14th August; died 8th September. Widal reaction. 18 ENTERIC FEVER. At 10 B.-Rd. (house immediately abutting rear of the above)— A. N., m., aetat. 30 ; sickened 8th September. At 1b B.-Rd. — C., f., aetat. 51 : sickened 12th September ; died October 1st. (Patient's daughter, not reported to have the disease, much with W. B., the first case of this group.) At 34 Q.-Rd. M. H., f., aetat. 33 ; sickened 9th September. A. H., f., aetat. 9 ; sickened 19th October. At 73 Q.-Rd. — C., f., aetat. 47 ; sickened 25th September. At 1 M.-Av. J. C., m., aetat. 12 ; sickened 18th August. — C., f., aetat. 45 ; sickened 27th August. Widal reaction. At 27 C.-Av. — W., f., aetat. 62 ; sickened 15th August. Widal reaction. In addition to the above reported cases, to which a suspicion of connection with A. F., more or less intimate, attached, there were four others in the family of Mrs. B. (24 Q.-Rd.), namely, Mrs. B., S. F. (brother of A. F.), A. B. and F. B., husband and son of Mrs. B. The Widal reaction was obtained in all four patients. A. N., of 10 B.-Rd., was employed at the Kensington Disinfection Station, and had handled bedding, &c., infected with enteric fever, on 17th August. The bedding had not been "fouled," as the patient had laid up for 2 days only prior to removal to hospital. In addition to the case of M. S. referred to above, the following cases occurred:— At the Institution— E. M., f., aetat. 13; admitted to Medical Ward for heart disease on 13th August; transferred to Surgical Ward 18th idem, and re-transferred to Medical Ward on 1st September; sickened with enteric fever 7th idem; Widal reaction 28th idem; died 16th October. A. L., m., aetat. 2; admitted to Surgical Ward for mastoid disease on 24th August; sickened 13th September; Widal 29th idem; to isolation 29th idem. F.S., m., aetat. 11; admitted for heart disease to Surgical Ward 29th August; transferred to Medical Ward 1st September; sickened 1st October; Widal 15th idem ; to Fever Hospital 20th idem. The above cases and M. S. were all in the Surgical Ward with A. F.,who was in bed No. 6, A. L. and F. S. occupying adjacent beds (Nos. 7 and 5, left and right of A. F.). and E. M. bed No. 8, on the left of A. L. It was this side of the Ward that Nurse C. G. had charge of. At the Convalescent Home the following cases occurred:— E. E., f., ætat. 8; admitted Institution 31st July; to Home loth August; sickened 17th September. M. A., f., ætat. 10; admitted Institution 17th July; to Home 8th August; sickened 22nd September. E. C., f., ætat. 4; admitted Institution 16th August; to Home 18th idem; sickened 24th September. N. A., f., ætat. 9; admitted Institution 2nd June; to Home 15th August; sickened 26th September. W. L., m., ætat. 9; admitted Institution 31st July; to Home 15th August; sickened 26th September. E. L., f., ætat 10 months; admitted Institution (Surgical Ward) 31st July; to Home 29th August; sickened 30th September. T. P., m., ætat. 10; admitted Institution 19th September; to Home 18th August; sickened 3rd October. I.G., f., ætat. 6; admitted Institution (Surgical Ward) 31st July; to Home 5th September; sickened 14th October. Only two of the above patients (viz., E. L. and I.G.) were in the same ward with A. F. at the Institution, between 21st August and 5th September, all being, however, at the Convalescent Home with A.F.,—E. E., M. A., N.A., and E. C. occupying the same room, and W. L, played with her. Two (2) cases occurred among patients discharged from the Institution, viz.:— B. W., f., aætat. 6; admitted Institution 2nd August; to Home 13th idem; discharged 5th September; sickened 22nd idem. SEPTIC DISEASES. 19 J. H., m., ætat. 3 ; admitted Institution 16th July; to Home 30th July; discharged 12th September; sickened 20th October; re-admitted Institution 26th idem ; discharged 30th January, 1907. The above accountillustrates the danger of "missed cases" as well as the possibility of direct personal infection in the absence of proper precautions. It should be stated that as the patients were under treatment for other diseases, nearly all associated with high temperatures, the occurrence of enteric fever, the first symptom of which is usually fever, was obscured by the already prevailing fever. So far as is known, but few of the cases took a typical course, and the small fatality among the cases connected with the Institution suggests that the disease was of a mild type. SEPTIC DISEASES. These include puerperal fever, erysipelas, and certain other diseases of somewhat infrequent occurrence. The first two are scheduled for notification. Puerperal Fever.—In 1905, 7 cases of this disease were reported; last year, 12, a total which has been exceeded three times only since notification was made compulsory, viz., in 1893 (18 cases), in 1896 (13 cases), and in 1902 (14 cases). In each of those three years scarlet fever was exceptionally prevalent, as was the case last year. It is a common observation that the two diseases follow the same curve of prevalence. Seven (7) of the 12 cases reported last year occurred in Oueen's Park and Harrow Road Wards, where the incidence of scarlet fever was heavy in comparison with the other Wards of the Borough. (Table 12.) In Hampstead only (Table 7) was the morbidity rate, calculated per 1,000 persons, below the respective mean rate for the preceding five years. Table 10 gives full information as to the real prevalence, fatality, and mortality from puerperal fever, the rates being calculated on the numbers of births and of married women aged from 15 to 45 years. The morbidity calculated on the number of births was generally above the mean, the rates for Marylebone and Hampstead being exceptions to the rule. On the other hand, the fatality was below the mean, except in Hampstead. Taking the numbers of deaths recorded in each district, the mortality from puerperal fever was below the mean except in Kensington and Westminster. From inquiries made it appeared that six (6) of the patients were primiparae, and that 7 were "nursed" by untrained women. In 3 cases the use of instruments was recorded, and in 3 other cases the child was born dead (mostly premature). One patient had been pregnant three times since February, 1905. Her first pregnancv ended in an abortion in that month, her second had a like ending in the following February, and the third in the succeeding December, with a fatal ending. The mortality from "accidents and diseases of childbirth" was above the mean in Kensington, Marylebone and Hampstead, below in the other districts, if calculated on the births registered; but if calculated on the numbers of married women, above the mean in Kensington and Hampstead, and below in all the others. The "total mortality in childbed," including "puerperal fever" and "accidents, &c., of childbirth," was below the mean except in Kensington, Westminster and Marylebone, when reckoned on the births; in all districts except Kensington, when reckoned on the married women. There appear to be grounds for hoping that the mortality in childbed is diminishing. Erysipelas.—The cases of this disease numbered 138, 2 more than in 1905, the latter total being 19 in excess of that of 1904. In Church Ward only was there any increase in the 20 MEASLES. number reported last year, 42 cases being recorded as compared with 28 in 1905. (Table 6.) There was a slight increase in prevalence in nearly all the adjacent districts. (Table 7.) The deaths in the Borough numbered 7, the same as in the previous year. The remaining "septic diseases" caused 11 deaths, one more than in 1905. (Tables IV. and V., Appendix.) These are usually grouped with those from erysipelas, under the heading "Other Septic Diseases," to distinguish them from puerperal fever. The total number of deaths was 18, one in excess of the number recorded in the previous year, and equal to a mortality of 0.2 per 1,000 persons, being 0.03 above the mean rate (0.09) for the five years 1901-05. TABLE 16. Childbed Mortality. Puerperal Fever. Mortality per 1,000. Puerperal Fever. Accidents & Diseases of Parturition. Total in Childbed. Morbidity % Births. Fatality % Cases. Births. Married Women, 15-45 yrs. Births. Married Women, 15-45 yrs. Births. Married Women, 15-45 yrs. Paddington 1906 Mean.* 0.37 25.0 0.94 0.06 1.89 0.12 2.84 0.18 0.29 53.7 1.38 0.09 2.24 0.15 3.62 0.24 London 1906 Mean. 0.23 64.0 1.48 0.14 1.34 0.13 2.83 0.27 0.20 70.7 1.47 0.15 1.49 0.15 2.96 0.30 Kensington 1906 Mean. 0.39 53.8 2.10 0.10 2.70 0.13 4.81 0.23 0.24 54.7 1.25 0.06 1.76 0.09 3.01 0.15 Westminster 1906 Mean. 0.32 55.5 1.80 0.08 1.44 0.06 3.25 0.14 0.22 56.6 1.23 0.06 1.96 0.10 3.19 0.16 Marylebone 1906 Mean. 0.22 16.6 0.37 0.02 3.01 0.18 3.39 0.20 0.23 16.8 0.40 0.02 2.95 0.20 3.35 0.22 Hampstead 1906 Mean. 0.13 50.0 0.69 0.02 4.18 0.17 4.88 0.19 0.28 40.7 1.87 0.07 3.27 0.13 5.14 0.20 Willesden 1906 Mean. 0.21 5.-5 1.20 0.12 1.44 0.15 2.64 0.27 0.18 73.8 1.28 0.14 1.97 0.22 3.25 0.36 * Mean for 1904-05. MEASLES. The cases of this disease which came to the knowledge of the Department through various channels, principally the public elementary schools, numbered 592, the smallest total reported since systematic efforts have been made to obtain information. The numbers reported in the Borough during each of the quarters of the years 1903-06, based on weekly 21 MEASLES. returns, are given below. For the first time the total of the weekly returns exceeded the corrected total for the year. Quarters 1. 2. 3. 4. Year Uncorrected. Corrected. 1906 105 204 199 89 597 592 1905 227 895 292 288 1,702 1,714 1904 723 94 18 23 858 896 1903 42 147 185 362 736 929 The largest number of cases (136) was reported from Westbourne Ward, the total for Queen's Park Ward (134) being, however, very nearly the same. The statement below shows how the numbers of cases have varied in the different Wards during the past four years. The figures for the three southern Wards (Lancaster Gate, East and West, and Hyde Park) must be accepted with reservation. In the other Wards, it is believed that the totals given are very near approximations. In the former group the children attending public elementary schools form but a small proportion of all children residing there, while the reverse holds good in the latter groups. At present only a small number of the private schools communicate with the Department on the occurrence of the disease in the schools. An increasing number of cases are, however, reported bv parents with a view to securing disinfection. c. d. f. Queen's Park 1906 134 1 0.7 Mortality— 1905 244 3 1.2 1906 0.06 1904 288 15 5.2 Mean 0.361903 50 4 8.0 Harrow Road l906 127 4 3.1 Mortality— 1905 461 20 4.3 1906 0.14 1904 231 10 4.3 Mean 0.32 1903 185 8 4.3 MaidaVale l906 40 3 7.5 Mortality— 1905 185 5 2.7 1906 0.15 1904 69 6 8.7 Mean 0.19 1903 113 2 1.7 Westbourne l906 136 4 2.2 Mortality— 1905 187 7 3.7 1906 0.16 1904 79 1 1.2 Mean 0.20 1903 221 9 4.0 C.D.F. Church 1906 72 4 5.5 Mortality— 1905 434 25 5.7 1906 0.14 1904 129 5 3.8 Mean 0.70 1903 321 15 4.6 Lancaster Gate,West l906 41 — — Mortality— 1905 27 — — 1906 — 1904 54 1 1.8 Mean 0.04 1903 10 — — Lancaster Gate,East 1906 14 — — Mortality— 1905 65 1 1.5 1906 — 1904 27 1 3.7 Mean 0.04 1903 11 — — Hyde Park l906 28 — — Mortality— 1905 111 2 1.8 1906 — 1904 19 — — Mean 0.13 1903 18 1 5.5 C.—Cases. D.—Deaths F.—Fatality per 100 Cases. Mean mortality 1901-05. The average number of cases per house was 1.8 in 1903 and 1904, decreased to 1.7 in 1905 but was again 1.8 last year. The percentage of secondary cases has varied very slightly having been 44.6 in 1903, 47.1 in 1904, 44.1 in 1905, and 44.4 last year. The house distribution of multiple cases is given below. 1906. 1905. 1904. 1903. Houses with 2 cases each 100 257 166 141 ,, 3 ,, 48 143 59 60 ,, 4 ,, 15 43 25 30 „ 5 „ 4 16 5 10 ,, 6 ,, — 4 3 3 ,, 7 ,, 1 — 1 3 ,, 8 „ — — — 2 Sixteen (16) deaths were recorded from the disease during the past year, 10 of males and 6 of females. The fatality of the disease calculated on the number of known cases, not the 22 WHOOPING COUGH. same as the true fatalitv, has declined during the past three years. The fatalities for the two sexes show irregular movements and permit of no deductions. (See below). Fatality at all ages, per 100 cases. Males. Females. Persons. 1906 3.4 2.0 2.7 1905 2.9 4.2 3.6 1904 5.2 3.5 4.3 1903 5.2 3.1 4.1 The numbers of cases and deaths together with the corresponding fatalities at the several ages, for each sex, are given in Table 17. The mortality was 0.10 last vear, calculated on the total population, as compared with a mean rate of 0.31 for the five years 1901-5. The highest mortality last year in any Ward was that of Westbourne (0.16, mean 0.20). In comparison with the rates prevailing in the adjacent districts (Table 10) the local rate 0.10 was lower than all except that of Westminster (0.09). After correction for sex-age composition of the different populations the local rate 0.12 becomes the lowest of the whole series (Table 18) the highest being that of Kensington (0.54). TABLE 17 Measles. 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. Cases 17 14 36 39 27 34 35 36 66 50 104 114 2 1 6 11 Deaths 3 1 7 4 1 _ — — — Fatality per 100 cases known— 1906 17.6 7.1 19.4 10.2 2.9 - - - - - - - - - 1905 13.5 16.9 9.3 15.1 5.8 2.6 - 4.1 1.8 0.6 0.3 0.5 — 1904 26.9 20.9 13.6 3.8 1.7 3.8 3.1 4.7 1.2 1.2 2.2 1.2 — - — 5.5 1903 7.1 12.9 19.1 7.6 14.7 9.6 - — — 1.2 - — — - — — WHOOPING COUGH. The collection of information with regard to this disease is on the same basis as that of measles, but the results do not possess the same value, as it is believed that the cases are not reported so completely. During the past vear 171 cases were reported, as compared with 540 in 1905. The totals reported in each quarter, and the corrected totals for each year are given below. Year. Quarters 1. 2. 3. 4. Uncorrected. Corrected. 1906 57 65 26 26 174 171 1905 ... 241 255 38 36 570 540 1904 ... 23 27 45 98 193 196 1903 281 35 11 2 339 533 WHOOPING COUGH. 23 The distribution of the reported cases among the Wards is given below. c. D. f. c. D. f. Queen's Park 1906 31 1 3.2 Church 1906 96 4 7.1 Mortality— 1905 126 10 7.1 Mortality— 1905 99 8 8.0 1906 0.06 1904 8 2 25.0 1906 0.14 1904 65 3 4.6 Mean 0.40 l903 134 11 8.2 Mean 0.23 1903 56 9 16.0 Harrow Road 1906 27 3 11.1 LancasterGate,West 1906 Mortality— 1905 165 12 7.2 Mortality— 1905 - 1* ? 1906 0.10 1904 58 3 5.1 1906— 1904 7 — — Mean 0.36 l903 147 14 9.5 Mean 0.04 1903 1 1 - Maida Vale 1906 22 1 4.5 Lancaster Gate, East 1906 - - Mortality— 1905 48 8 16.6 Mortality— 1905 17 - — 1906 0.05 1904 4 1 25.0 1906 1904 4 1 ? Mean 0.19 1903 57 5 8.7 Mean 0.12 1903 7 2 ? Westbourne 1906 17 2 11.8 Hyde Park 1906 18 2 11.1 Mortality— 1905 39 5 12.8 Mortalit y-— 1905 46 6 13.0 1906 0.08 1904 45 6 13.3 1906 0.14 1904 5 — — Mean 0.29 1903 121 10 8.2 Mean 0.12 1903 10 1 10.0 c.—Cases, d.—Deaths, f.—Fatality. Mean Mortality, 1901-05. * A death occurred in this Ward, but the case was not reported during life. The cases averaged 1.9 per house, as compared with 1.6 in 1905, 1.8 in 1904, and 2.0 in 1903. The distribution of multiple cases is sufficiently indicated below. 1906. 1905. 1904. 1903. Houses with 2 cases each 31 93 29 71 ,, 3 ,, 17 44 12 44 ,, 4 „ 4 13 5 12 „ 5 „ 1 3 6 8 „ 6 „ — — 2 2 ,, 7 ,, — 1 — 1 TABLE 18. Measles. Whooping Cough. Standard Rate. Fully Corrected Rate. Standard Rate. Fully Corrected Rate. 1906. Mean, 1901-05. 1906. Mean 1901-05. Paddington 0.43 0.12 0.39 0.39 0.10 0.32 London 0.58 0.40 0.44 0.50 0.25 0.34 Kensington 0.47 0.54 0.44 0.35 0.15 0.39 Westminster 0.36 0.14 . 0.37 0.31 0.21 0.28 Marylebone 0.42 0.46 0.47 0.36 0.10 0.31 Hampstead 0.40 0.15 0.15 0.34 0.02 0.25 Willesden 0.66 0.15 0.33 0.57 0.15 0.31 I here were 13 deaths during the year, as compared with 50 in 1905. The deaths comprised 7 of males and 6 of females (Table 19), and were equal to a fatality of 7.6 per cent. of the known cases. That rate is certainly too high, but shows an improvement on the rates of the previous three years. (See below.) Males. Females Persons. 1906 8.3 6.9 7.6 1905 9.6 10.2 9.9 1904 8.0 8.3 8.1 1903 9.0 9.4 9.2 24 TUBERCULAR DISEASES. The deaths were equal to a mortality of 0.09 per 1,000 persons of all ages, the mean rate for 1901-05 being 0.25. According to the figures published by the Registrar-General the local rate was 0.08, equal to that of Marylebone, above that of Hampstead (0.02) but below all the others. (Table 10.) Correction for sex-age makes no change in the order. (Table 18.) TABLE 19. Whooping Cough. 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. Cases 11 11 14 10 13 12 11 18 13 24 20 21 1 1 l Deaths 2 1 4 4 1 1 — — — Fatality per 100 cases known— 1906 18.1 9.0 28.5 40.0 7.7 8.3 - - - - - - - - 1905 44.4 46.1 15.1 42.8 13.3 5.1 6.2 — — 1.7 - 2.9 - - - — 1904 8.3 40.0 21.0 8.3 16.2 11.8 6.6 7.1 — — - — - - - — 1903 60.0 35.3 24.1 39.3 10.3 15.0 - 2.2 - - - - - - - 50.0 TUBERCULAR DISEASES. Phthisis Pulmonalis (Consumption).—The deaths increased from 136 in 1905 to 161 last year, and the nett mortality from 0.92 to 1.09. The deaths comprised 94 of males and 67 of females, as compared with 78 and 58 respectively in the previous year. The deaths during the past year have been tabulated according to sex and age of deceased and locality of residence (Ward) in Tables IV. and V. in the Appendix. The increased mortalitv occurred at ages above 25 years, as may be seen from the appended tabulation of the rates for last year in comparison with the means for the five years 1901-05:— Ages. 0— 15— 25— 65— M. F. M. F. M. F. M. F. Rates for 1906 0.05 0.27 0.92 0.43 2.49 1.12 2.05 1.10 Mean rates, 1901-05 0.14 0.12 0.93 0.57 2.28 1.06 1.76 1.07 To secure greater uniformity in the comparison with other districts (Table 10) the rates obtained from the Registrar-General's reports have been used. The rate for last year (0.12) is below the rates for the adjacent districts, except those of Hampstead (0.66) and Willesden (0.96). After "correction" (Table 20) the local rate for last year (1.05) is lower than all the other rates except that ot Hampstead (0.65). On the other hand, the rates for the Borough and Willesden for last year are the onlv two in excess of the means for 1901-05. The highest nett rate recorded in the Wards of the Borough was that of Church Ward (1.67), and the lowest that of Lancaster Gate, East (0.25). Last year's rates were above the means in five of the Wards, the exceptions being those of Lancaster Gate, West (0.35, mean 0.41) and East (0.25, mean 0.49) and Harrow Road Wards (0.92, mean 0.94). The "corrected" rates will be found in Table 20. In Church Ward only was the corrected rate in excess of the "standard." TUBERCULAR DISEASES. 25 TABLE 20. Percentage of population (Census 190!). Phthisis. Cancer. Persons per acre. "Over-* crowded." Living in homes of less than 5 rooms. Standard Rate. Fully Corrected Rate. Standard Rate. Fully Corrected Rate. 1906. Mean. 1901-5. 1906. Mean. 1901-5. Paddington 106 13.6 50.9 1.80 1.05 1.02 0.98 0.98 0.90 Wards. Queen's Park Not known. 9.1 51.7 1.73 1.19 1.12 0.83 0.81 1.08 Harrow Road 11.5 75.5 1.77 0.90 0.92 0.88 0.90 0.94 Maida Vale 12.6 43.4 1.82 1.20 0.89 1.01 1.17 0.96 Westbourne 13.4 46.3 180 1.17 1.04 1.17 0.88 0.80 Church 32.8 61.3 168 1.72 1.66 0.87 1.33 0.96 Lancaster Gate, West 2.6 15.2 1.84 0.32 0.39 1.02 0.91 0.96 Lancaster Gate, East 2.1 16.2 1.84 0.23 0.47 1.02 0.96 0.68 Hyde Park 5.2 25.3 1.88 0.53 0.61 1.07 0.69 0.89 London 61 16.0 54.0 1.74 1.43 1.56 0.87 1.04 0.98 Kensington 77 14.8 41.7 1.78 1.21 1.25 1.02 0.80 0.83 Westminster 73 13.0 45.7 1.95 1.23 1.49 0.96 0.87 0.89 Marylebone 90 21.1 55.6 1.85 1.45 1.48 0.99 0.94 0.98 Hampstead 36 6.4 29.6 1.75 0.65 0.81 0.92 0.97 0.95 Willesden 21 11.6 50.7 1.65 1.06 0.98 0.71 0.94 1.01 * Census standard. The usual enquiries with offer of disinfection were made after every death recorded, and in connection with 59 cases reported during the patients' life. Sufficient information for tabulation was obtained relating to 120 deaths, including those of 17 of the patients whose cases were reported prior to death. Disinfection was effected after 109 deaths, definitely refused after 6, while in 11 instances the death was reported so late that disinfection could not be pressed. Previous cases of the disease were known to have occurred in 49 families, while in 17 instances no information on the question could be given, and in 60 others the occurrence was negatived. In 50 instances the infectiousness of the disease was reported to have been unknown, but sufficient precautions appear to have been taken, while in 40 other instances nothing seems to have been done to prevent the spread of infection. Of the 59 patients whose illness was reported during the year, 42 were alive at the close of the year. Twelve (12) of the latter admittedly belonged to consumptive families. Due precautions to prevent the spread of infection were being taken in every case. The homes of twenty-three of the patients were disinfected during the year, 6 being done twice; and 15 of the 23 were, in addition, thoroughly cleansed and re-decorated. The 126 deaths occurred in the same number of tenements, comprising:— Homes of 1 room 30, occupied by 56 persons over 10 and 10 persons under 10 years of age; „ 2 rooms 41, „ 120 „ 2 „ „ ,, 3 „ 24, „ 87 „ 13 ,, 4 „ 18, „ 68 „ 18 „ „ ,, 5+ 13, „ 57 ,, 10 ,, ,, 26 TUBERCULAR DISEASES. The average number of persons per room in the above homes is given below, the figures for last year being compared with those for 1905 and 1904. Average number of persons per Home. Phthisis homes. All homes. Borough Census, 1901. 1906. 1905. 1904. Homes of 1 room 2.2 1.6 1.4 1.8 „ 2 rooms 1.6 1.8 2.0 1.7 ,, 3 „ 1.3 1.5 1.5 1.3 ,, 4 ,, 1.0 1.0 1.1 1.2 All the above 1.4 1.1 1.5 1.4 The changes in the averages are unexpected, the worst feature being the increase in density of occupation of the homes of one room, which now exceeds, instead of being less than the average for the whole Borough. The other homes shows a progressive improvement. The proportion of deaths occurring in each class of home were as follows:— Percentage of Deaths. Percentage of such homes to all homes. 1906. 1905. 1904. Census, 1901. Homes of 1 room 23.8 28.5 29.2 14.9 2 rooms 32.5 22.3 24.1 19.8 3 „ 19.0 24.1 24.8 19.4 4 „ 14.2 15.1 10.2 10.6 In 11 instances only were the one-room homes occupied by single persons, which means that the remaining 19 were occupied bv 55 persons, averaging 2.9 persons per room. In such homes the provision of a separate bed is practicallv an unknown luxury. In the other homes, 34 of the deceased persons had separate bedrooms but only 16 had separate beds. Previous cases of the disease were known to have occurred at 36 of the houses included in the returns of last year. In seven of those houses 2 previous cases had occurred and in one, three. Insanitary conditions were discovered at 19 houses, viz.:— Damp—12. Dirt—8. Dilapidations—2. The occupations of the deceased persons are set out on page 27. Other Tubercular Diseases.—These include, among others, "tubercular disease of the brain (acute hydrocephalus)," "abdominal tuberculosis (tabes mesenterica)," and "general tuberculosis." The deaths from these three forms last year numbered 23, 9 and 13 respectively, there being in addition 10 other deaths from tubercular diseases not included under the headings specified. In the appended statement the first two varieties have been kept separate, and all the others grouped under the single heading "other forms of tuberculosis." The numbers of deaths last year compare favourably with the averages for the preceding five years. Tubercular Disease Abdominal Other forms of of the Brain. Tuberculosis. Tuberculosis. 1906 23 9 23 Average, 1901-05 26 10 23 The combined mortality was at the rate of 0.36 per 1,000 persons. Although these forms of tuberculosis are speciallv prevalent among the younger members of the community, no correction factors have, as yet, been calculated. A comparison with the mortalities (nett rates only) in other districts is made in Table 10 (q-v.). In Westminster only was last year's rate above the quinquennial mean. CANCER. 27 Consumption. Occupation of Deceased Persons. 1906. Occupation. M. F. Occupation. M. F. Indoor:— Mixed:— Baker 2 ... Errand Boy 1 ... Bootmaker 2 ... House Painter 4 ... Carpet Planner 1 ... London City Missionary 1 ... Charwoman ... 3 Plumber 2 ... Clerk (Commercial) 5 ... Porter, Packer 3 ... Coach-painter 1 ... Potman 1 ... Dairyman 2 ... Railway Porter 3 ... Dressmaker ... 2 Railwav Ticket Collector 2 ... Furniture Packer 1 ... Tile Layer 1 ... Jeweller 1 ... ... Lace Mender ... 1 18 - Laundryman 1 ... Outdoor:- Licensed Victualler l ... Bargeman 3 ... Mechanical Engineer l ... Bath Chairman 1 ... Musician 1 ... Cabman, Coachman 6 ... Photographer 1 ... Carman 5 ... School Teacher ... 1 Costermonger 2 ... Shop Assistant 1 1 Gatekeeper (Cricket) 1 ... Tailor, Journeyman 3 ... Labourer 14 ... Trunk Maker 1 ... Milk Carrier 1 ... Typist ... 1 Omnibus Conductor 1 ... Upholsterer 1 ... Postman 2 ... Waiter 2 2 School Attendance Officer 1 ... Warehouseman 1 ... Stonemason 1 ... Whitesmith l ... 38 - Domestic Servant l 2 Married Women ... 44 No occupation— ... 31 57 Adults 6 5 Children 1 5 7 10 CANCER. 1 here were 164 deaths from the various forms of malignant new growths included under this heading, 15 more than in 1905, and the highest total since 1901. In 1899 165 deaths were recorded, that being the only occasion since 1891, when last year's total was exceeded. Last year's deaths included 57 of males (compared with 56 in 1905) and 107 of females (93 in 1905), and were equal to a rate of 1.10 per 1,000 persons of all ages, as compared with 1.01 in the previous year, and a mean of the same value (1.01). In Queen's Park, Harrow Road, and Maida Vale Wards, the deaths were fewer last year than in 1905. The greatest increase was in Church Ward where 37 deaths wefe recorded, compared with 19 in the previous year. On the other hand the "nett" rates of mortality for the past year were above the mean rates except in Queen's Park, Lancaster Gate (West), and Hyde Park Wards. The greatest diminution took place in Queen's Park Ward (falling from a mean of 1.03 to 0.78), and the greatest increase in Church Ward (rising from 0.96 to 1.34). Comparing the nett local rate with those of the adjacent districts (Table 10), the highest rate was that of the Borough, and the lowest that of Kensington (0.94), the rates of 28 TABLE 21. "Cancer" Deaths, 1906. Seat of Disease. Description of growth. Carcinoma. Cancer. Epithelioma. Scirrhus. Sarcoma. Malignant Disease. Other Forms. All Forms. m. f. m. f. m. f. m. f. m. f. m. f. m f. m. f. Nervous System. Brain ... ... ... ... ... ... ... ... ... ... ... 1 l(a ... 1 1 Respiratory System. Larynx 2 1 ... ... 1 ... ... ... ... ... 1 ... ... ... 4 1 Lung ... 1 . . . ... ... ... ... ... ... ... ... ... ... 1(a) ... 2. Digestive System. Mouth T ongue 3 ... ... ... 2 ... ... ... ... ... ... ... ... ... 5 ... Throat (Esophagus 6 1 ... 1 1 ... ... ... ... ... ...... ... ... 7 2 Intestines Stomach 11 5 1 1 ... ... ... ... ... ... ... ... ... 12 6 Bowel 3 10 ... 2 ... ... ... ... ... ... 1 1 ... ... 4 13 Rectum 3 6 ... 3 ... ... ... ... ... 1 ... 2 ... ... 3 12 Organs Liver 3 2 1 2 ... ... ... ... ... 1 1 6 ... ... 5 11 Pancreas 1 ... ... ... ... ... 1 ... ... ... 1 2 ... ... 3 2 Peritoneum ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Omentum ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Lymphatic System. Head & Neck Cervical Glands ... ... ... 1 ... ... ... ... ... ... 1 ... l(b) ... ... ... 2 1 Thorax Mediastinal Glands ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Abdomen Mediastinal Glands ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Urinary System. Kidney ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... 2 1 Bladder 2 1 1 ... ... ... ... ... ... ... 1 1 ... ... 4 2 Generative System. Testis, Ovary ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... 1 2 Uterus ... 10 ... 5 ... ... ... ... ... ... ... 2 . . . 1(c) ... 18 External Genitals ... ... ... ... ... 2 ... ... ... ... ... ... . . . ... ... 2 Breast ... 13 ... 5 ... ... ... 4 ... 1 ... 2 ... ... ... 25 Osseous & Muscular System Head and Neck 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Thorax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Extremities Lower ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Cutaneous System. Head and Neck ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Extremities Lower ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Not sufficiently described ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Totals 35 53 3 20 4 3 1 4 4 5 8 20 2 2 57 107 Ages at Death. 0— ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... 10— ... ... ... . . . ... ... ... ... ... 2 ... ... ... ... ... 2 15— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 25— ... 5 ... ... ... ... ... ... ... ... 1 ... ... ... 35— 5 4 ... 2 ... 2 1 ... ... 2 ... 2 ... ... 6 12 45— 12 17 ... 3 1 ... ... ... ... ... 1 4 2 1 16 25 55— 2 12 2 7 2 ... ... 3 ... ... 2 7 ... ... 8 29 65— 9 9 1 5 ... ... ... ... 2 ... 2 5 ... 1 14 20 75- 7 6 ... 3 1 1 ... 1 ... 1 2 2 ... ... 10 14 (a) Endothelioma. (b) Malignant lymphadenoma. (c) Deciduoma maligna. CANCER. OTHER DISEASES. 29 that Borough of Westminster and Marylebone being the only three below the means. The greatest increase was in Willesden, from a mean of 0.82 to 0.96. The "corrected" rates are given in Table 20, and show the mortality in a somewhat different light. Thus in the Borough last year's mortality was in excess of the "standard" in Harrow Road, Maida Vale, and Church Wards, and in the Metropolis as a whole, Hampstead and Willesden. Below the age of 25 years three deaths from "cancer" have occurred in each of the past six years, so that the mortality at those ages may be ignored. At ages above 25, grouped in ten yearly intervals, the rates have been as set out below:— 25- 35— 45— 55— 65- M. F M. F. M. F. M. F. M. F. MF. MF. 1906 0.08 0.28 0.70 0.92 2.57 3.052.01 5.167.83 6.26 18.21 8.58—20.83 Mean, 1901-05 0.03 0.23 0.35 0.95 2.15 2.15 5.05 4.93 6.17 6.31 10.03 10.01 7.16 8.39 The sites of the various forms of growth and the ages of the deceased are given in Table 21, which is a modification of the table usually included in these reports. OTHER DISEASES. The changes in the mortality rates from the remaining diseases which have been specially mentioned in previous reports are set out in Table 22. The only rate showing an increase in the Borough as a whole, is that from "cirrhosis of the liver" (0.17 last year, mean 0.15). Increased mortality from epidemic influenza was recorded in five of the eight Wards, the greatest being in Hyde Park Ward (0.36 last year, mean 0.23). The mortality from the "respiratory diseases"—all forms of bronchitis and pneumonia—was less than the mean in six Wards, some of the reductions being considerable. In Church and Hyde Park Wards, where increased mortalities were registered, the change was in each case only slight. TABLE 22. Epidemic Influenza. Respiratory Diseases. Alcoholism. Cirrhosis of Liver. Suicides. 1906. Mean. 1901-5. 1906. Mean. 1901-5. 1906. Mean. 1901-5. 1906. Mean. 1901-5 1906. Mean. 1901-5. Paddington 0.23 0.28 1.81 2.35 0.08 0.12 0.17 0.15 0.09 0.10 Wards. Queen's Park 0.06 0.33 1.38 2.49 ... 0.08 0.12 0.08 0.06 0.11 Harrow Road 0.14 0.30 1.43 2.54 0.07 0.07 0.14 0.15 0.10 0.10 Maida Vale ... 0.30 0.28 1.82 1.99 0.05 0.18 0.20 0.21 0.10 0.02 Westbourne ... 0.16 0.29 1.86 2.50 0.20 0.12 0.20 0.15 0.04 0.12 Church 0.36 0.25 3.25 3.21 0.04 0.16 0.14 0.18 ... 0.11 Lancaster Gate, West ... 0.24 0.20 0.71 1.26 ... 0.04 0.12 0.11 0.12 0.13 Lancaster Gate, East ... 0.38 0.27 0.38 1.24 0.13 0.07 0.25 0.17 ... 0.14 Hyde Park 0.36 0.23 1.58 1.53 0.14 0.18 0.22 0.09 0.36 0.12 To guage the total mortality from alcohol, the deaths from "alcoholism "—including those from the acute form (delirium tremens) and the chronic—and from " cirrhosis of the liver, are combined. The total for last year was 37 (12 from "alcoholism" and 25 from 30 INFANTILE MORTALITY. "cirrhosis of the liver"), as compared with an average (uncorrected) of 42, while the mortality per 1,000 persons decreased from 0.27 to 0.25. (Table 22.) This is the first occasion for some years that a decreased mortality from alcoholic excess has been recordedIncreased rates were, however, recorded in Westbourne (0.40 last year, mean 0.27),, Lancaster Gate, East (0.38 last year, mean 0.24), and Hyde Park (0.36 last year, mean 0.27) Wards. The appended statement of the numbers of deaths of each sex from the different forms of alcoholic poisoning is not without interest, A difference in the habits of the twosexes is suggested by the smaller numbers of deaths from the acute form and the larger, from, cirrhosis of the liver among females. Acute Alcoholism. Chronic Alcoholism. Cirrhosis of the liver. M. F. M. F. M. F. 1901 1 — 8 7 ... 8 13 1902 3 — 8 12 ... 13 12 1903 3 1 9 12 ... 11 8 1904 2 — 5 9 ... 10 12 1905 1 1 4 8 ... 8 20 1906 1 1 6 4 ... 9 16 INFANTILE MORTALITY. The deaths registered within the Borough during the past year included 395 of infants under one year, 46 less than the number for 1905, and equivalent to a rate of 125 per 1,000 births registered, as compared with 139 in the previous year. The deaths were 117 below the decennial average (512), and the lowest on record. The mortality rate was 26 below the mean (151), and also the lowest on record. (See Table I., Appendix.) The rates for last year are compared with the corresponding means for 1901-05, below:— Quarters 1. 2. 3. 4. Year. 1906 102 88 187 121 125 Mean, 1901-05 140 113 170 140 141 After correcting for deaths of children of non-resident parents dying within the Borough, and for deaths belonging to the Borough taking place beyond its limits, a nett total of 353 is obtained—133 less than the decennial average (486), and the lowest total on record since 1895. The nett mortality rate was 112 per 1,000 births registered within the Borough— 30 less than the mean for the previous five years, and, with the exception of that for 1903 (108), the lowest rate recorded since 1892. The nett totals and rates for the three Registration Sub-Districts are given in Table II., Appendix. In Table 10 will be found the races for the adjacent districts. That of Kensington was the highest of the series, and that of Hampstead the lowest. All the rates for last year were below the mean rates for 1901-05. In calculating the infantile mortality for local comparisons, the births have been corrected by the exclusion of those not belonging to the Borough, &c., in the same way as the deaths. The rates for the year thus obtained in the Borough and the Wards are given in Table 23, rates for the two sexes being included in addition to those for "persons." In four of the wards there was a decrease in the mortality in comparison with the preceding year, the greatest reduction being that in Harrow Road Ward (35 per cent.). In three wards the mortalitv was greater, the worst change taking place in Hyde Park Ward, where the increase amounted to 46 per cent. The mortality in Church Ward was the same in the two vears. INFANTILE MORTALITY. 31 TABLE 23. Infantile Mortality. (Fully corrected.) Infantile Mortality per 1,000 Births. Proportional Mortality.* Males. Females. Persons. Persons. 1906 1905 1906. 1905. 1906. 1905. 1906. 1905. Paddington 115 128 99 109 107 118 160 214 Queen's Park 96 164 87 76 92 122 137 221 Harrow Road 90 116 58 113 75 115 112 209 Maida Vale 145 116 69 124 107 120 160 218 Westbourne 123 111 120 120 121 112 180 203 Church 140 151 155 141 146 146 218 265 Lancaster Gate, West 62 83 32 28 48 55 72 100 Last 86 41 83 71 85 55 126 100 Hyde Park 103 130 154 41 126 86 188 156 Lancaster Gate, East and West 75 59 60 51 67 55 100 100 * Mortality in Lancaster Gate (East and West) Wards = 100. On taking out the rates for each quarter of the year, it is found (Table 24) that the rate for the third quarter was the only one in "excess of that for the previous year (167 in 1906, 131 in 1905) Even in that quarter the mortality prevailing in some of the wards was lower last year than in 1905. It would take too much space to call attention to each individual rate, a reference to the Table last mentioned will make the matter clear, but special attention should be called to the great increase in the rate for Hyde Park Ward during the third quarter (298, as compared with 81). The increase during this quarter was due to the prevalence of infantile, or summer diarrhœa. TABLE 24. Infantile Mortality Per 1,000 Births. Quarters of Year. First. Second. Third. Fourth. 1906. 1905. 1906. 1905. 1906. 1905. 1906. 1905. Paddington 89 114 80 128 167 131 117 120 Wards. Queen's Park 100 115 65 117 130 135 86 137 Harrow Road 59 117 58 165 104 102 97 89 Maida Vale 86 94 105 131 110 157 160 120 Westbourne 71 124 109 118 177 111 144 ] 18 Church 133 125 94 142 269 172 135 180 Lancaster Gate, West 66 63 - - 100 125 — 77 ,, East 71 74 71 - 150 100 48 48 Hyde Park 68 115 60 83 298 81 125 67 32 INFANTILE MORTALITY. The births and deaths of infants belonging to six special insulœ within the Borough have been taken out, and are compared with the corresponding rates for 1905 in Table 25. The decreases noted in five of the six rates were quite unexpected. Attention may be directed to the very low rate for "Queen's Park" (89 last year, 134 in 1905), and to the excessive rate for "Hall Park" (221 last year, 196 in 1905). TABLE 25. Infantile Mortality Per 1,000 Births. 1906. Infantile Mortality. Per 1,000 Births. Births. Deaths, 0—1. 1906. 1905. "Hall Park" 158 35 221 196 "North Wharf" 92 13 141 150 "Alfred Road" 157 18 115 146 "Amberley Road" 72 11 153 192 "Clarendon Street" 312 47 151 165 "Queen's Park" 314 28 89 134 "Hall Park," "North Wharf," and "Clarendon Street," are in Church Ward. If the births and deaths belonging to those insulce be deducted, the infantile mortality for the remainder of the Ward works out at 87 as compared with 146 for the whole Ward. Similarly by deducting "Alfred Road" from Westbourne Ward, "Amberley Road" from Maida Vale, and "Queen's Park" from Queen's Park, rates of 125, 98, and 176 are obtained, as compared with 121, 107, and 92 for the respective Wards. (See below). Wors Rate for Rate for whole Ward. remainder of Ward, Hall Park" Church 146 North Wharf 87 "Clarendon Street" Westbourne 121 Alfred Road" 125 Maida Vale 107 "Amberley Road" 98 Queen's Park 92 "Queen's Park" 176 In Table VI., Appendix, the deaths at ages under one year have been distributed according to sex and age of the deceased and the cause of death. To that Table have been added the averages of the numbers of deaths at the different ages and from the different causes, thus contrasting the records for last year with those for the five years 1901-05. In comparison with the annual average total number of deaths (423), last year's total (353) shows a saving of 70 lives, that is seventy more infants survived their first birthday. The births registered within the Borough last year (3,152) were 137 fewer than the average annual number for 1901—05, viz. 3,289 a fact which lends greater importance to the reduction in the number of deaths. INFANTILE MORTALITY. 33 The diminutions in the numbers dying at different ages are set out below:— 1906. Annual average. 1901-05. Gain (—). Loss ( + ). M. F. M. F. M. F. Under one month 54 46 72 57 —18 —11 Aged 1-3 months 39 30 52 35 —13 —5 Under 3 months 93 76 124 92 —31 —16 Aged 3-6 „ 52 41 47 39 +5 + 2 6-9 „ 24 19 38 27 —14 —8 9-12 „ 28 20 28 28 ±0 —8 In three individual age-groups only were the deaths recorded last year in excess of the average, viz.:— 1906. Annual average. 1901-05. Gain (—). Loss ( + ). M. F. M. F. M. F. Aged 4-5 months 14 15 15 13 —1 +2 5-6 17 11 12 9 +5 +2 9-10 „ 15 10 10 10 +5 ±o The causes of death scheduled in Table VI. fall into five groups, the increases or decreases in the numbers of deaths in each group are indicated below.— 1906. Annual average. 1901-05. Gain (—). Loss ( + ). M. F. M. F. M. F. I.—"Common Infectious Diseases" 6 2 15 16 —9 —14 11.—"Diarrhoea Diseases" 64 60 53 40 + 11 + 20 III.—"Wasting Diseases" 67 43 75 58 —8 —15 IV.—"Tubercular Diseases" 8 6 11 9 —3 —3 V.—Other causes 52 45 82 61 —30 —16 It will be seen that the deaths from the "diarrhœal diseases" last year were in excess of the average, the increase being equal to 33.3 per cent. of the average (93). Such increased prevalence is an unhappy characteristic of a fine warm summer. If the number of deaths from the diarrhœal diseases had been equal to the average, the infantile mortality last year would have been 98 per 1,000 births instead of 107 as recorded. The causes of death in "Hall Park" and "Queen's Park," the insulœ having the highest and lowest infantile mortality rates during the year, have been tabulated in Tables 26 and 27 on the same principles as Table VI., Appendix, with the omission of causes of death which were not operative during the year. The main differences between the mortality in the two districts are the relatively high numbers of deaths from "diarrhœal" and "respiratory diseases," in "Hall Park." The births in "Queen's Park "were almost exactly double the number in "Hall Park," while the deaths from the "diarrhœal diseases" in the latter (12) exceeded the number (10) in the former. Again there were 6 deaths from respiratory diseases ' in "Hall Park," against none in "Queen's Park." The deaths from "suffocation" during the five years 1901-05 numbered 55, and included 50 of children overlaid in bed. On an average 10 deaths are caused each year from this "accident," a sheer waste of life which should not be tolerated. Separate cots for young babies ought to be universally used. They can be provided at small cost, as those who cannot afford to purchase ordinary cots can get banana crates for a few pence. Such crates make admirable beds. It is to be feared that many of the "accidents" occur while the parents are more or less overcome with drink. In this matter England is behind certain of the 34 INFANTILE MORTALITY. nental countries where overlying is held to be equivalent to manslaughter, and the parents do not escape with a reprimand from the Coroner as they almost invariably do here. TABLE 26. Deaths of Infants under One Year. "Hall Park." Total Births, 158. Infantile Mortality, 221. Age at death—month. Totals. 0- 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- P. M. F. Diarrhœa ... 2 ... 2 2 1 1 2 ... 1 ... 1 12 3 9 Enteritis ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Premature Birth 7 ... ... ... ... ... ... ... ... ... ... ... 7 2 5 Congenital Defects ... ... ... 1 1 ... ... ... ... ... ... ... 2 2 ... Injury at Birth 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Atrophy & Debility l ... ... ... ... ... ... ... ... ... ... ... 1 1 ... Tubercular Diseases ... ... ... 1 ... ... ... ... 1 ... ... ... 2 2 ... Convulsions ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Respiratory Diseases ... ... ... 1 ... 1 ... 1 ... 2 1 ... 6 2 4 Other Causes ... ... ... 1 ... ... ... ... ... 1 ... ... 2 1 1 Totals 9 2 ... 6 3 3 1 3 1 4 2 1 35 14 21 Males 3 ... ... 4 1 3 ... 1 1 1 ... ... ... 14 ... Females 6 2 ... 2 2 ... 1 2 ... 3 2 1 ... ... 21 TABLE 27. Deaths of Infants under One Year. "Queen's Park." Total Births, 314. Infantile Mortality, 89. Age at death—month. Totals. 0- 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- P. M. F. Measles . . . 1 . . . . . . ... ... ... ... . . . ... ... ... 1 1 ... Diarrhœa 1 1 2 ... ... ... 1 3 ... 1 ... 1 10 4 6 Enteritis ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Premature Birth 4 ... ... ... ... ... ... ... ... ... ... ... 4 3 1 Congenital Defects ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... Atrophy & Debility ... 1 1 1 ... ... 1 ... ... ... ... ... 4 1 2 Tubercular Diseases ... ... ... ... ... ... ... ... 1 1 1 ... 3 ... 3 Syphilis ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Convulsions ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 Other Causes 1 ... 1 ... ... ... ... ... ... ... ... ... 2 2 ... All causes 6 3 5 2 ... ... 3 3 1 3 1 1 28 14 14 Males 4 2 5 ... ... ... 1 1 ... ... .. . 1 ... 14 ... Females 2 1 ... 2 ... ... 2 2 1 3 1 ... ... ... 14 INFANTILE MORTALITY. 35 The consideration of infantile mortality would not be complete without a reference to the frequent occurrence of the registration of birth after or at the same time as the registration of the child's death. During the past year this happened 89 times. The ages of the deceased children ranged from a few hours to something under 2 months. Reference to Table 28 will show that the bulk of such deaths were practically inevitable, some perhaps, even desirable. On the other hand there can be little doubt that approximately a quarter of such deaths were due to preventible causes, and that had registration been effected at an earlier date something might have been done in that direction. The system inaugurated by the Medical Officer of Health of the County whereby midwives, or some of them, report to him each week the names and addresses of women attended by them, is a step in the right direction, and will, it is hoped, be a prelude to the regular "notification" of births. The returns received by the County Medical Officer of Health are distributed to the medical officers of health of the Boroughs where the parturient women reside. It is thus possible to get into communication with the mothers within a fortnight of the birth of the child. TABLE 28. Infants deceased at time of Registration of Birth. Days. Weeks. Month. Totals 0— 1— 2 3— 4- 5— 6— 1— 2 3— 1 p. m. f. Diarrhœal Dis. - - - - - - - - 2 3 4 9 3 6 Syphilis — — — — — — — 1 1 — — 2 1 1 Premature Birth 13 9 4 2 1 1 — 3 3 1 1 38 19 19 Congenital Malformations 2 1 - 1 - - - 1 - - - 5 3 2 Injury at Birth 3 — — — — — — — — — — 3 2 1 Atrophy and Debility 1 1 1 2 — — — 5 3 3 3 19 13 6 Respiratory Dis. — — — — — — — — 1 — — 1 — 1 Accidents — 1 — — — — — — 1 — 1 3 — 3 Other causes 1 — 1 — 1 — 1 1 3 — 1 9 6 3 Totals 20 12 6 5 2 1 1 11 14 7 10 89 47 42 Males 11 4 4 3 2 1 1 5 8 3 5 47 Females 9 8 2 2 — - — 6 6 4 5 — - 42 Infantile Diarrhœa.—There were in all 124 deaths at ages under one year from the various diseases included under this designation, viz. 54 from "diarrhcea, dysentery," 59 from "epidemic (zymotic) enteritis," and 11 from "enteritis,"* 64 of the deceased being boys and 60 girls. In 1905 the deaths from these causes numbered 68, in 1904, 132, in 1903, 73, in 1902, 70, and in 1901, 124. Last year's total was in excess of the average for the five years 1901-05. The deaths from "diarrhœa "constituted 35.1 per cent. of all deaths under one year of age and were equal to a mortality of 37 per 1,000 births. The highest percentage of deaths from this cause was recorded in Hyde Park Ward (50 per cent.), and the lowest in Lancaster Gate, West, Ward (0), that of Westbourne Ward (26.0) being the next lowest. (See Table 28a). * These deaths included 4 (3 of boys and 1 of a girl) from "enteritis," and 7 (5 of boys and 2 of girls) from gastro-enteritis." There were in addition, 2 deaths (one of each sex) from "gastritis." 36 INFANTILE MORTALITY. TABLE 28a. Diarrhœa. Mortality. Under one year of age. Deaths from Proportion Per cent. Diarrhæa Dysentery. Epidemic Enteritis. Enteritis. Total " Diarrhœa" Births. Deaths. M. F. M. F. M. F. 0—1. Borough 30 24 26 33 8 3 124 3.7 35.1 Wards. Queen's Park 5 3 4 3 1 - 16 3.5 38.0 Harrow Road 5 7 6 3 1 — 22 2.6 35.0 Maida Vale 4 2 2 1 3 — 12 2.8 260 Westbourne 6 2 2 7 — 1 18 3.8 32.7 Church Lancaster Gate— 9 6 11 14 2 2 44 5.7 39.0 West — — — — — — — — — East — — — 2 1 — 3 4.2 50.0 Hyde Park 1 4 1 3 - - 9 4.5 36.0 TABLE 28b. Diarrhœa Mortality. Ages at Death. W eeks. Months. Total under One Year. 0— 1— 2— 3— 1— 2 3- 4— 5— 6— 7— 8— 9— 10 11— Diarrhœa* Qr. 1 - - - - - 1 2 4 - 1 - - 1 - 1 10 2 — — 1 - 1 — 1 — — — 2 - — — 1 6 3 — — 1 5 11 10 13 6 13 4 7 2 5 — 4 81 4 — — 1 — 4 2 1 3 — 1 2 — 1 1 - 16 Year — — 3 5 16 13 17 13 13 6 11 2 7 1 6 113 Enteritis Qr. 1 - - - - 1 - - - 1 - 1 - - - - 3 2 — — — — — — — — 1 — — — — — — 1 3 — — — — 1 — — — — 1 — — — — — 2 4 - - - - - 1 1 1 1 — 1 — — — — 5 Year — — — — 2 1 1 1 3 1 2 — — — - 11 *Including" Diarrhœa, Dysentery," and " Epidemic (Zymotic) Enteritis." It will be seen from Table 28b that the incidence of mortality was greatest at the ages 1—6 months, and that 83 deaths (rather more than two-thirds of the total) occurred in the third quarter of the year. For the latter reason, the deaths during that quarter have been regularly tabulated with great minuteness for some years in connection with the principal meteorological data. A few observations based on the records of the past eight years 1(1899-1906) will not be out of place.† It should be stated that for this work a slightly different classification has been used, deaths from "want of breast milk" and " atrophy'' being included as due (during this quarter of the year, at least) to the causes producing " diarrhœa," and also deaths during the second year of life. 37 INFANTILE MORTALITY. During the eight years the deaths due to "diarrhœa" in each third quarter have ranged from 155 in 1899 to 52 in 1903, viz.:— 1899 155 1901 115 1903 52 1905 68 1900 118 1902 68 1904 119 1906 103 The weekly average for the eight quarters is 5 deaths. Any week in which more than that number of deaths occurs has been deemed to be an " epidemic week." The number of such "epidemic weeks" in each year has been:— 1899 9 maximum number of deaths in any week 30, in the 6th week; 1900 6 „ 20, 9th 1901 9 „ „ 16, 9th 1902 5 „ „ 12, 11th 1903 3 „ „ 8, 10th 1904 7 „ „ 21, 6th and 7th weeks; 1905 5 „ „ 12, 5th and 7th 1906 8 „ „ 25, 10th In one week during 1903 and in two weeks during 1906 no deaths from these causes occurred. The greatest contrast is between the years 1899 and 1903. The meteorological elements for the three years 1899, 1903 and 1906 are compared below:— Mean temperature of air. (No. of weeks.) Mean temperature of earth, (No. of weeks.) 1899. 1903. 1906. at 3 ft. 1899. 1903. 1906. 50° 2 2 1 55 1 4 2 55° 1 6 2 60° 5 9 11 60° 4 5 5 65° 7 - 65° 5 - 5 70° 1 - - Rainfall measured. Indies. 1899. 1903. 1906. 1899. 1903. 1906. •00 1 4 2 10 4 2 5 •01 5 9 11 50 2 4 3 •05 7 — — 1.00 1 5 — Precipitations (total) of one inch or more occurred in the following weeks:— 1899...1.01 in. (13th). 1903...3.18 in. (3rd); 1.52 in. (4th); 2.11 in. (6th); Ml in. (7th); 1.23 in. (8th). The quarters (as wholes) are compared below:— 1899. 1903. 1906.. Mean temperature of air 63.1° 59.0 62.4° Mean temperature of earth at 3 ft.64.03° 60.18° 62.08° Total rainfall (inches) 3.83 12.32 3.78 38 INFANTILE MORTALITY. Assuming that the prevalence and excessive mortality from "diarrhœa" are favoured by high temperatures both of air and earth, and by a deficient rainfall, 1899 should be (as it was) the worst year for diarrhœal mortality, and 1903 the best (as it was). Judging by the meteorological data, last year should have had a total number of deaths from "diarrhœa" next to that of 1899—i.e., second—but the actual number recorded places the year fifth in order.* It is permissible to express some satisfaction in the improvement hinted at by the change in position, although a wholesome respect must be accorded to the post hoc, propter hoc fallacy. It is not intended to convey by the foregoing paragraphs that weather agencies are the prime factors in causing the mortality from "diarrhœa," but only to show that there is a connection between the two. Undoubtedly the improper feeding of the children is a far more efficient cause of the disease than the weather. It may, however, be safely concluded that in some way the latter acts prejudicially on the former, almost always artificial (as distinguished from the natural, i.e., breast milk), whereby a zymotic fermentation is set up in the food, producing those gastric disturbances and systemic poisoning, of which the diarrhoea is but a sign. There is reason to believe that the source of the micro-organisms necessary for that fermentation is to be found in decomposing animal and vegetable matters, and that flies, mostly the ordinary house variety, but also the blue-bottle, are the agents wherebv the infection is conveyed to the food. Rain is fatal to flies and in this way favours a low diarrhoeal mortality, in addition to the benefits accruing from the flushing and cleansing of streets, etc. Evidence in support of the foregoing explanation is afforded by the results of inquiries made after deaths from "diarrhœa." Thus, of 112 children under the age of 2 years whose deaths formed the subject of inquiry, 92 (82 per cent.) were under ten months old. Of the latter, only 9 (less than 10 per cent.) had been naturally fed up to their deaths, while 62 (67 per cent.) had been fed entirely by hand. The remaining 21 had been fed naturally for various periods, some of them however having had mixed (that is, natural and artificial) foods since birth. Of the 20 children aged from 10 months to 2 years, 5 had been fed naturally from birth (4 of them having had the breast alone for more than a year), 10 had been artificially reared from birth, and the remainder (5) had been either given the breast alone for very short periods, or had had breast milk and artificial foods from birth. Grouping the whole of the deaths, it appears that— 10 of the deceased, 8.8 per cent., had been properly fed, i.e., had had the breast up to deaths or 10th month of life; 12, or 10.7 per cent., had been brought up on "mixed" feeding from birth; 72, or 64.2 per cent., had had artificial food only; 14, or 12.5 per cent., had been wearied too early; and 4, or 3.4 per cent., had been suckled too long. *Arranging the years in order according to their meteorological data, those of rainfall being in an inverse order to the others, and the number of deaths which took place, it is found that the placing agrees four times, as regards air temperature and rainfall, but only twice as regards earth temperature. Thus— Averages for Quarter. Mean temperature. Totals. max, min. Air. 1899 1906 1900 1901 1904 1905 1902 1903 max. min. Earth. 1899 1906 1901 1905 1904 1900 1903 1902 min. man. Rainfall 1899} 1906} 1900 1904 1905 1902 1901 1903 ceq. Deaths "Diarrhœa." max. min. 1899 1904 1900 1901 1906 1902} 1905} 1903 ceq. 39 INFANTILE MORTALITY. In 30 of the families visited (112) the "long-tube" bottle was found to have been used, and 90 of the houses (112) had no proper accommodation for the storage of food. The difficulties associated with the proper care of the long-tube bottles are generally known. In such cases the food (possibly, nay, probably) already contaminated, was given in a bottle imperfectly cleansed after previous use, and the child thus received a double dose of poison. Want of larder accommodation entails pollution of the food by flies, etc. The following defects were found at the houses visited:— Dirty premises 5 Defective drainage 2 Dirty cisterns 2 „ dustbins 3 Accumulations of refuse 3 „ paving (yard) 1 Between July, 1905, and January, 1906, the Women Inspectors and Students "visited" 865 babies. Care was taken in selecting the cases to be visited to select addresses which seemed to suggest that the parents would be the most likely to need advice and help in the rearing of the infants—in other words, the cases were such as would furnish, under ordinary circumstances, the highest infantile mortality. Records have been kept of the deaths of the babies visited, pains being taken to trace the children and their deaths. From the records thus made it appears that 61 of the "visited" children did not survive their first birthday, a figure equivalent to a mortality of 70 per 1,000, as compared with a rate of 107 in the whole Borough. The "diarrhœal diseases" caused 19 deaths, or 31 per cent. of the whole, as against 35 per cent. in the whole Borough. Mortality among Illegitimate Children.—Forty-nine (49) deaths of such children were registered in the Borough last year, being 10 more than in 1905. Of the 49 deaths 15 did not belong to the Borough, while 9 deaths belonging to the Borough were registered outside its boundaries. The nett total of such deaths was 43, compared with 34 in 1905 and 69 in 1904. Thirty-four (34) of the children were under one year of age. The infantile mortality among illegitimate children, calculated on the number of such births registered within the Borough, was 254 last year, the corresponding rate for legitimate children being 106. Calculating the rates on the nett totals of births (131 illegitimate, and 3,155 legitimate) the rates become 259 and 101 respectively, a very marked contrast. Particulars as to ages at death, causes of same, &c., are given below.— Deaths of Illegitimate Children. 1906. Ages. M. F. P. 0— 21 13 34 1— 5 2 7 5— 1 1 2 Infantile Mortality. Fully corrected. Illegitimate. Legitimate. 1906 259 101 Mean, 1901-05 213 118 40 INQUESTS. Causes of Death. 0— 1— 5— m. f. m. f. m. f. Measles - - - 1 - - Diphtheria - - 1 - - - Diarrhœal Diseases 8 7 1 - - - Syphilis - 1 - - - - Tubercular Diseases 1 - 1 - - 1 Premature Birth 2 1 - - - - Developmental Diseases 5 1 1 1 - - Meningitis - 1 - - 1 - Respiratory Diseases 3 1 - - - - Other Causes 2 1 1 - - - All Causes 21 13 5 2 1 1 Inquests were held touching 2 deaths. Occupations of Mothers. Domestic Service 27 "Servant" 11 Cook 5 Charwoman 4 Housemaid 3 General Servant 2 Housekeeper 1 Parlour Maid 1 Commercial Employments 13 Laundress 3 Dressmaker 3 Waitress 2 Machinist 1 Needlewoman 1 Fruiterer's Assistant 1 Tailoress 1 Draper's Assistant 1 Occupation unknown 3 INQUESTS. During the year 200 inquests were held in the Borough, 56 of them with reference to the deaths of non-residents. Outside the Borough 15 inquests took place touching deaths of residents, making a nett total of 159 deaths of residents registered after Coroner's inquisition, equal to 8.6 per cent. of all such deaths, as compared with 7.5 per cent. in 1905. In the appended table (No. 28) the numbers of deaths, last year arranged according to the findings of the juries, are compared with the annual averages for the previous five years* TABLE 28. Inquests Held. Finding of Jury. 1906. Average, 1901-05. Males. Females. Males. Females. Natural Causes 33 38 48 43 By Misadventure 4 3 3 3 Accidental Causes 34 21 34 19 Murder 1 - 0 1 Suicide 9 5 12 4 "Open" 2 3 2 1 "Neglect" 4 2 1 1 41 deaths in institutions. The more noteworthy changes are the decrease in the number due to suicide, and the increase in the number due to "neglect." A summary of particulars relating to the deaths is appended to the Table. The mortality rate from suicide was 0.99 last year, being 0.01 less than the quinquennial mean (0.10). Increased rates were recorded in Maida Vale and Hyde Park Wards, viz., from a mean of 0.02 to a rate of 0.10 in the former, and from a mean of 0.12 to a rate of 036 in the latter. (See Table 22.) In the latter Ward the highest mortality from alcoholic excess recorded during the year took place. Misadventure—(7 deaths)— Overlaid in bed 2 Epileptic seizure (suffocation) 1 Injury at birth 1 Burst varicose vein 1 Lead poisoning 1 Overdose of morphia 1 Accident—(55 deaths)— Burns or scalds 12 Suffocation 5 Falls (various) 10 Building operations 2 Vehicular traffic 8 Abortion 2 Overlaid in bed 8 Other accidents 4 On Railways 4 Suicide—(14 deaths)— By poison, 4, carbolic acid (1 male and 1 female), hydrochloric acid (1 male), liquid ammonia (1 female). By coal gas—1 male. By cut throat—1 male. By hanging—1 male, 1 female. By cut arm—1 male. By drowning—3 males. By throwing self from window—1 female. By shooting—1 male. Open—(5 deaths)— Oxalic acid—1 female. Drowning—2 males, 2 females. DEATHS IN INSTITUTIONS. The 775 deaths which occurred last year in local public institutions included 350 deaths of non-residents, while in outlying institutions 172 deaths of residents took place. The nett total of deaths of residents in all public institutions during the year was 597, 19 more than in 1905 (578). The principal causes of death in such places, both local and outlying, are set out in Table IIIa, Appendix. The deaths in institutions constituted 32.4 per cent. of all deaths last year, as compared with 29.4 per cent. in 1905, and a mean of 27.8 for the five years 1901-05. The proportions of deaths in institutions to all deaths belonging to the individual Wards varied last year from 15.5 in Lancaster Gate, West, Ward, to 20.8 in Church Ward. The changes in the proportions in each Ward from the mean of the previous five years are given below:— 1906. Mean, 1906 Mean, 1901-05. 1901-05. Queen's Park 33.0 32.0 Church 40.8 35.1 Harrow Road 30.4 24.8 Lancaster Gate, West 15.5 23.6 Maida Vale 29.6 25.9 „ East 24.5 17.7 Westbourne 29 3 26.9 Hyde Park 27.2 26.2 42 ADMINISTRATIVE WORK. Grouping the institutions according to the sources of their income, from the rates or from voluntary contributions, it appears that 20.8 per cent. of all the deaths took place last year in rate-supported and 11.5 in other classes of institutions. In 1905 the percentages were 19.3 and 10.1 respectively. The percentages of the deaths in the different classes of institutions, are given below, the figures for 1905 being indicated in parentheses and italics. Rate-maintained— Deaths. Percentage of all Deaths. Hospitals of Metropolitan Asylums Board 35 (13) 1.9 (0.6) Poor Law Workhouses and Infirmaries... 307 (318) 16.6 (16.2) Lunatic Asylums 43 (49) 2.3 (2.5) Supported by Voluntary Contributions— Hospitals and Homes (but not private nursing homes) .. 212(199) 11.5 (10.1) ADMINISTRATIVE WORK* Prevention of Infectious Diseases.—The visits made by the Staff for various purposes in connection with infectious diseases, notified and others, numbered 4,388 last year, as compared with 5,107 in 1905, and 4,652 in 1904, rather more than half of them (2,330) by the Women and Student Inspectors with reference to the following diseases:— Measles 853 Chicken-pox 323 "Consumption" 558 Whooping Cough 221 Infantile Diarrhœa 136 Puerperal Fever 35 The visits were more numerous in the third and fourth quarters of the year than in the others—an unusual experience, due to the prevalence of scarlet fever during the latter half of the year. Quarters 1st 2nd 3rd 4th 1906 765 1,069 1,376 1,178 1905 1,092 2,096 964 955 1904 1,732 872 801 1,247 The total number of patients removed to hospital during the year was 882, compared with 387 in 1905, and 478 in 1904. When a patient remains at home, a "letter of advice" covering extracts from the Public Health (London) Act, 1891, and the Factory Act, 1901, and a Memorandum of precautions to be taken, appropriate to the particular disease, is sent to the parent, guardian, or person in charge of the patient. Sixty-seven (67) such letters were dispatched during the year, compared with 44 in 1905, and 72 in 1904. A special communication is addressed to the midwife and (or) nurse in charge of each case of puerperal fever, 8 such communications being issued in 1906, while in 1905 only 2 were required, but in 1904, 8- Hospital Accommodation.—The Metropolitan Asylums Board has made a slight re-arrangement of the accommodation available, allocating to convalescent cases of (scarlet) "fever" some of the beds originally provided for smallpox. The accommodation available at the close of the year was— For "fever" (diphtheria and scarlet, typhus and enteric (typhoid) fevers)— Acute cases 4,827 beds in 10 hospitals. Convalescent 3,349 „ 4†" ,, *Table 29 gives a summary of the principal works executed under the supervision of the District Inspectors. Tabular summaries of the work of the other Inspectors will be found under " Housing,'' " Workshops," etc. †One hospital (The Southern, at Carshalton—800 beds) not yet open. 43 administrative work. TABLE 29. Report of the Work of the District Inspectors during the year 1906. Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Drainage, &c. Water Supply. Dust Receptacles. Miscellaneous. No. of Complaints received. "House-to-House." On Complaint or after Illness. Cellar Dwellings. Re-inspection of all kinds. Entire Reconstruction. Drains Relaid, Trapped, or Ventilated Waste Pipes Disconnected. Rain-water Pipes Disconnected. W.C's.,New Provided, Repaired, &c. Soil Pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New, Provided Cisterns Cleansed, Repaired, &c. Cistern Overflows Disconnected. New, Provided. Repaired, &c. Drains Cleared, Flushed, &c. Houses or Rooms Cleansed, Whitewashed, &c. Cases of Overcrowding Abated. Cellar Dwellings Closed. Yards and Areas Paved and Drained. Manure Receptacles Reconstructed, &c. Accumulations Removed. Improperly-kept Removed. Quarters. No. 1 162 205 616 - 4,546 84 33 28 15 87 33 3 6 9 32 - 25 2 9 27 - - 20 3 8 1 No. 2 202 15 625 1 4,655 82 50 41 18 103 36 6 11 7 14 - 12 3 12 50 2 - 9 4 46 - No. 3 207 58 699 - 4,107 53 42 26 12 78 20 6 5 - 20 - 34 7 24 49 1 - 13 1 39 1 No. 4 147 6 596 - 4,618 101 55 61 25 131 34 4 6 1 34 - 17 10 7 39 1 1 10 - 1 - Year 718 284 2536 1 17,926 320 180 156 70 399 123 19 28 17 100 - 88 22 52 165 4 1 52 8 94 2 44 ADMINISTRATIVE WORK. small-pox— Acute and convalescent cases 2,040 beds in 3 hospitals. Altogether 10,216 beds have been provided for the needs of the Metropolis. The usual standard of accommodation, for all classes of infectious diseases, is one bed to each 1,000 inhabitants, on which scale 4,700 beds should suffice. Seeing that more than double that provision has been made it may be anticipated that further extension of the Board's accommodation will be unnecessary for many years. Disinfection.—The disinfection and cleansing of infected bedding, &c., has been carried out by the Contractor as in previous years. The weight of goods so treated was just on 56 tons, as compared with 67 tons in 1905 and 57 in 1904. The cost of the work was £1,148 as compared with £1,392 and £1,181 in the two preceding years. No difficulty was experienced in the collection of goods for disinfection. Complaints have been rare, and when received have been promptly attended to—to the satisfaction of the complainants—by the Contractor. The rooms disinfected by the Department after all forms of infectious diseases numbered 2,166, as compared with 2,662 in 1905 and 1,795 in 1904. No notices were required to secure the cleansing or whitewashing of premises after infectious illness. In the last report reference was made to the abandonment of a scheme for establishing a disinfection station in Kensal Road, and to communications with the Council of the Royal Borough of Kensington for a joint user of the station then in course of erection for that Borough. Those communications proved fruitless, and further enquiries were made during the past year for sites both within and without this Borough. Ultimately an offer was received of a freehold site on which stand buildings used for some years as a private disinfecting station. The offer was before the Council at the close of the year, and has since been provisionally accepted. Plans and estimates have been prepared and are at the time of writing before the Local Government Board, with a view to the sanctioning of a loan. If all goes well, the Council should be, before the close of the current year, in possession of a station situate some four miles beyond the boundary of the Borough, but readily accessible therefrom, fitted with all the necessarv plant for disinfecting and cleansing all classes of infected goods. Section 60 of the Public Health (London) Act, 1891, requires the Council to provide and maintain a place where persons displaced from their dwellings during the disinfection thereof, may be accommodated until such disinfection be completed. Such a "shelter," frequentlynecessary when the disinfection of rooms was affected by the burning of sulphur or other chemical, a process requiring twenty-four hours for its completion, was provided in 1895, and was used to a considerable extent for some years after. With the substitution of spraying by formaldehyde for sulphur fumigation, the time required for the disinfection of a room has been reduced to a couple of hours at the most, and the "shelter" has in consequence fallen out of use. No one has been received there for the past four years. The only use made of it during the past year has been to provide bathing accommodation for certain midwives or nurses who have had charge of cases of puerperal fever, and have not had proper bathing accommodation in their own homes. Water Supply.—The notices of discontinuance of a water supply, sent by the Metropolitan Water Board to the Council in pursuance of the provisions of Section 49 (1) of the Public Health (London) Act, 1891, increased from 102 in 1905 to 141 last year, the highest 45 ADMINISTRATIVE WORK. number since 1902. The reasons for the cutting off of the supplies were reported by the Inspectors of the Department to be— Empty houses 87, an increase of 23. Defective fittings 31. Premises in course of demolition 13, an increase of 2. Unpaid water rates 10, an increase of 2. The restoration of the supply to occupied houses (41) was effected within 24 hours in 20 instances, the intervals in the other cases being as set out— 2 days, 5 houses. 4, 5 days, 1 each. 17, 21 days, 1 each. 3 days, 4 houses. 6, 7 days, 2 each. 1 month, 1. Notices to restore the supply were required in 6 instances and summonses in 2, Closing Orders being granted with respect to each. It is hoped that the Water Board will ultimately abandon the practice of cutting off the water in default of payment of the rates. It will be seen however from the above figures that there was a slight increase in the number of such cases during the past year. It does appear paradoxical that the Public Health Act should declare that a house without a water supply is to be deemed to be unfit for habitation as a dwelling house, and yet that the Water Authorities are at liberty to render an inhabited house unfit for such purpose, thereby rendering the "owner" thereof liable to quasi-criminal proceedings for what is no more than a debt which should be recovered by civil process. Usually the "owner" is not liable for the debt, and yet he has no remedy, except to take possession of his house, if he can do so under his covenants. Apart from these considerations, there is the danger to public and individual health which attaches to the practice. Mortuaries.—During the year 271 bodies were deposited at the Mortuary on Paddington Green, and 10 at that in Kensal Road. Inquests were held touching 201 of the bodies received at the former place, and 89 post-mortem examinations made. At Kensal Road there were 6 post-mortem examinations and 10 inquests. Although the mortuaries have been erected for many years, no By-laws under Section 88 of the Public Health (London) Act, 1891, are at present in force for the due and proper management of these establishments. During the past year a new series of Regulations have been adopted by the Public Health Committee for the guidance of the attendant, and a set of By-laws has been drafted and submitted to the Local Government Board for confirmation.* Schools and School Attendance.—No changes have to be recorded as to the numbers or administration of the schools within the Borough. The prevalence of measles and scarlet fever has demanded much serious consideration and frequent consultations with the Medical Officer (Education) of the County Council. Daily records are kept of the cases of infectious disease of all kinds occurring among the scholars and in their homes. These have been carefully and frequently scrutinised, and the information afforded by the lists supplemented by frequent visits to the schools by the Medical Officer of Health and the Women Inspectors. Closure of Departments or individual classes has been necessary in 13 instances, nearly double the number in the preceding year (7). Such closure' is not resorted to until a sufficient number of cases occur in the department or class to justify a conclusion that the department or class is really "infected." Efforts are made in the mean time to check the spread of the disease by rigid exclusion of all children from infected homes. At the same time it must be *The By-laws are given on page 77. The proviso to By-law No. 3 is an addition to the Model Series prepared by the Board, which should prove to be of great utility. 40 ADMINISTRATIVE WORK. confessed that cases have occurred during the past year in such numbers in certain schools as to raise a suspicion that they were acting as centres of infection. Until evidence is available that a given class or classroom is the actual seat of mischief it has been held to be inadvisable to resort to closure. The case is complicated by the fact that many families have children attending more than one school. The notices sent to schools during the year numbered 3,232 in all, as compared with 3,707 in 1905 and 2,804 in 1904. In the appended statement the figures for 1905 are given in parentheses to show the changes in character of the diseases in 1906. Exclusion. Re-admission. For notified diseases 1,044 (462) 1,044 (442) For other diseases 827 (1,928) 317 (875) Certain changes in regulations governing exclusion of children from homes infected with measles, whooping-cough, etc., have rendered the issue of re-admission notices unnecessary in a proportion of the cases covered by those requiring exclusion. It is impossible to set out in detail particulars of the numbers of cases in connection with each school, except in the form of a summary for the whole year. This is done in Table 30, TABLE 30. School Attendance. Notified Diseases. Non-notified Diseases. Scarlet Fever. Diphtheria. Measles. Chicken Pox. Whooping Cough. r.a. P.n.a. n.r. p.a. p.n.a. n.r. Provided— Amberley Road 16 ... ... 4 2 ... 26 2 42 Beethoven Street 35 11 7 1 1 2 45 47 2 Campbell Street 24 12 ... 3 4 ... ... 2 1 Droop Street 48 18 5 5 1 2 43 24 1 Essendine Road 44 15 3 14 6 ... 10 14 2 Harrow Road 25 8 3 9 2 1 27 11 3 Kilburn Lane 29 8 14 2 ... 6 19 11 6 Non-Provided— Bayswater Jewish ... ... 3 ... 1 ... ... 1 ... Desborough Street 15 5 ... 1 ... ... 4 14 ... Holy Trinity 15 3 ... 1 2 ... 2 28 ... St. Augustine 6 2 26 2 1 6 ... 3 ... St. James ... 19 5 ... ... 1 ... 5 2 2 St. John, Kilburn Lane ... ... 4 ... ... 1 ... ... ... St. John, Titchborne Street ... 7 2 ... 2 ... ... 13 2 6 St. Luke, Kilburn ... 2 1 7 ... ... 1 2 7 ... St. Mary ... ... 1 ... ... ... ... ... ... St. Mary of the Angels ... 1 ... ... 1 8 ... ... St. Mary Magdalene 36 25 ... 2 2 ... 3 6 4 St. Matthew 4 1 1 2 1 ... 31 ... ... St. Michael 8 1 ... 1 1 ... 7 7 2 St. Paul 13 5 ... 1 2 ... 28 12 1 St. Peter ... 9 2 ... 4 2 ... 1 5 3 St. Saviour 18 7 ... 8 4 ... ... 23 ... St. Stephen 18 7 4 1 1 1 28 7 2 Wilberforce 10 3 7 3 ... ... 10 5 ... Woodfield 7 1 ... ... ... ... 2 ... ... P.A.— Patient a scholar of the school. P.N.A.—Patient not attending school. N.R.—Patient resided outside the Borough. 47 ADMINISTRATIVE WORK. which includes the same particulars as were given in Tables 38 and 39 of the report for 1905. The first point to note is the preponderance of cases in the Provided Schools. This is not a new feature, and has been commented on in previous reports. The following percentages, based on the last available return of average attendances, shows the extent to which the prevalence of disease in these schools exceeds that in the Non-provided. Scarlet Fever. Diphtheria. Measles. Chickenpox. Whooping cough. Provided 2.85 0.49 2.20 1.44 0.73 Non-provided 2.20 0.33 1.70 1.44 0.23 It should be observed that the figures given in Table 30 are based on the weekly tabulation of the notices sent to the schools in pursuance of the Public (London) Health Act. Such returns are continuous throughout the year, and take no account of the occurrence of the holidays. The largest numbers of scholars affected were in Droop Street (Queen's Park Ward), 48 cases of scarlet fever; Essendine Road (Maida Vale Ward), 44 cases of scarlet fever and 14 of diphtheria; St. Mary Magdalene (Church Ward), 36 cases of scarlet fever ; and Beethoven Street (Queen's Park Ward), 35 cases of scarlet fever. Scarlet fever, as has already been stated, was specially prevalent in Queen's Park, Harrow Road, and Church Wards. As the children attending any one school are not drawn exclusively from the Ward in which the school is situated, a closer agreement is not to be expected. Of the 13 closures put into force during the year, one only was by Order of the Borough Council. The remainder were closed by the Medical Officer of the Education Committee, on request of the Medical Officer of Health of the Borough. A list of the closures is appended:— Closure. School. Class-room. Date of. Duration of. Disease. By Order of the Borough Council: — St. Paul (Infants) 3 14th Mar. 3 weeks. Measles. By Education Committee:— Moberley (Infants) D 13th Feb. 2 „ Measles. St. Matthew's (Infants) 2 and 3 9th May 4 „ ,, „ „ 1 14th May 3 „ „ St. Mary of the Angels "Babies" 5th July 3 ,, ,, Droop Street (Infants) F and G „ 3 ,, ,, St. Stephen (Infants) C 4th Oct. 2 „ ,, „ „ B 16th Nov. 2 „ „ St. John, Titchborne St. (Inf.) Whole Department 24th Nov. 2 „ „ Kilburn Lane (Infants) Do. 21st Dec. 2 „ „ Essendine Road (Infants) Do. 9th Nov. 2 „ Scarlet Fever. Droop Street (Boys& Infants) C and C 7th Dec. 2 „ „ Kilburn Lane (Girls) G 28th Nov. 2 „ „ An interchange is effected between the Medical Officers of Health of the adjacent districts and this Borough, of returns relating to children attending schools outside the district in which they reside. Practically all non-resident scholars of Paddington schools reside in 48 ADMINISTRATIVE WORK. Kensington and Willesden. From those districts 101 returns were received last year as compared with 44 in 1005 and G9 in 1904. An analysis of the diseases is appended:— Kensington. Willesden. Scarlet fever 18 58 Diphtheria 3 18 Enteric fever 1 — Other diseases — 6 19 82 The schools to which the returns of scarlet fever and diphtheria related are shown in Table 30. Bacteriological Examinations.—The number of specimens submitted for bacteriological examination rose from 61 in 1905 to 127 last year, and the number of such specimens giving positive results from 40 to 86. Stated as a percentage the ratio of negative to positive results during the past year was 67.7 as compared with a mean of 36.8 during the previous five years. So long as the results can be received with confidence, the increase in the proportion of negative results may be regarded as satisfactory, and as an indication of the saving effected by the use of the bacteriological tests. It may be reasonably concluded that, in the absence of such tests, the majority of the cases giving negative results would have been removed to hospital after being certified to have the disease suspected. The samples submitted during the past year were :— No. of Specimens Results. received. Positive. Negative. Diphtheria 101 30 71 Enteric fever 22 9 13 "Consumption" 4 2 2 It is to be desired that more use should be made of the facilities afforded for the bacteriological examination of the sputum in suspected cases of phthisis, and steps are at present being taken to secure that end. Offensive Refuse.—Trade Refuse.—No complaints were received with reference to this work, the system of which remains as described in a former report. Manure.—The customary notices requiring removal every forty-eight hours were posted throughout the Borough at the beginning of May. Very few complaints of nuisance from manure were received, some being without any real cause, and the rest remedied by stricter supervision. Proceedings were not required. House Refuse.—A weekly collection is in force throughout the Borough, supplemented by a second collection in certain streets. It is hoped that during the coming summer a semiweekly collection will be systematically made from tenement houses and flats. The need for more frequent removal becomes greater each year with the increasing use of gas for cooking purposes. The closed kitchen range forms a suitable cremator for perishable refuse, but, where installed, is rarely put to that use. Drainage Work.—During the past year 696 new drains were constructed in connection with existing premises, as compared with 669 in 1905 and 858 in 1904. In each case the new work was tested in sections and as a whole during construction, and again as a whole after filling in trenches, &c. In 1905 235 of the 669 re-constructions were on the Queen's Park Estate, last year the corresponding figures were 162 out of 696, indicating that the work on 49 ADMINISTRATIVE WORK. the Estate is not progressing at the same rate as in previous years. One hundred (100) old drains were water-tested during the year and found to be sound, the number so tested in 1905 having been 81. The passing of plans and notices for re-constructional work is entirely under the jurisdiction of the Public Health Department, and involves a large amount of correspondence. In 4 cases summonses were required to secure the proper notices, plans, &c. On the whole, better drawings are now submitted, and less difficulty is experienced in obtaining the necessary particulars. All notices and drawings being in duplicate, one set is, by direction of the Public Health Committee, now returned to the party depositing the same with an endorsement stating that the work shown has been carried out under the supervision of the Inspector. Combined Drainage.—The following systems of combined drains, of which no records of approval could be found, were referred to the Surveyor for amendment:— 28, Caroline Place and 5 and 6, Bark Place. 7 and 8, Church Place, Paddington Green. 18 to 34 (even), Clarendon Gardens. 51, 53 and 55, Clifton Gardens. 19 and 20, Durham Terrace. 364 to 374 (even), Ladbroke Grove, and 4, 5 and 6, Church Place. 34 and 35, Northumberland Place. 19 and 20, North Wharf Road. 25, 26, 27 and 28, North Wharf Road. 29 and 30, North Wharf Road. 31 and 33, Richmond Road. 13 and 15, Talbot Road. 33, 35, 37, 39 and 41, Westmoreland Road. The Council contributed £15 towards the cost of the reconstruction of a combined drain at 147, Church Street and Omnibus Yard in rear thereof. Orders under Section 74 of the Metropolis Management Act, 1855, were made for— 49, Bathurst Mews and 11, Sussex Square. 17 and 19, Cirencester Street and Roman Catholic Schools, Desborough Street. 15 to 18 Dudley Street. 19 to 21, Dudley Street. 23 to 29, Dudley Street. 183 and 185, Edgware Road. 19 and 19a, Hermitage Street. 124, 126 and 128, Herries Street. Leinster Yard in conjunction with la, 2a, 3a, and 5a, Chepstow Place, and 129 and 131, Westbourne Grove. 169 and 171, Praed Street. The usual statement of reconstruction of the block combined drainage on the Queen's Park Estate is appended:— Queen's Park Estate. Harrow Road, Nos. 652 to 658 (even) Rain-water Drainage. Huxley Street, Nos. 2 to 48 (even). Fifth Avenue, Nos. 9 to 65 (odd). Droop Street, Nos. 58 to 66 (even). Ilbert Street, Nos. 93 to 101 (odd). Harrow Road, Nos. 608 to 618 (even). Third Avenue, Nos. 2 to 58 (even) Second Avenue, Nos. 1 to 57 (odd). Caird Street, Nos. 33 to 47 (odd). Caird Street, Nos. 4 to 50 (even). Third Avenue, Nos. 60 to 174 (even). Partly done. Owing to the manner of construction, the water-test cannot be applied to the existing systems on the Estate. Special chemical tests were made at 107 houses during the year after sickness; 23 drains were shown to be defective, a larger proportion than in 1905, when 4 out of 24 drains tested gave positive results. In addition to the foregoing, tests were applied to 11 other drains, owing to complaints of drainage smells, rats, &c., 9 proving defective, as compared with 10 out of 21 in 1905. All new drainage work on the Estate has been plotted on the Ward (large ordnance) map, with the date of re-construction noted thereon. 50 ADMINISTRATIVE WORK. Sewers.—Two complaints of offensive smells from sewers in the Bayswater Road reached the Department and were forwarded to the Count}7 Council. No flooding was recorded during the past year. The search for disused and unused drain connections on the sewers in that part of Westbourne Ward lying south of Talbot Road was continued during the past year and 15 connections were closed in Westmoreland Road. Smoke Prevention.—The Inspector charged with the watching of chimneys connected to factories and workshops reports that he has made 239 observations of a total duration of 162 hours, as compared with 131 observations (72¾ hours) in 1905 and 133 (56½ hours) in 1904. Smoke of all descriptions was recorded during 109 1/6 hours last year, as compared with 57¾ and 46½ hours in 1905 and 1904 respectively. Black smoke was recorded less frequently and with shorter emissions during the past year, the total emission amounting to 2 3/6 hours only, as compared with 2½ and 3 hours in 1905 and 1904 respectively. Estimating the total emission of "smoke" and "black smoke" as percentages of the total number of hours spent in the observations, a fair reduction in the former and a large reduction in the latter took place. (See below.) In 100 hours' observation. 1906 1905 1904 "Smoke" 67 79 82 "Black Smoke" 1.7 3.4 5.3 No Smoke 31.3 17.6 12.7 100 100 100 Five (5) complaints of nuisance from smoke were received, one arising from a factory laundry, 2 from workshops (carpenter's and general smith's), and one each from a dairy and restaurant. In two cases the nuisance was abated by the substitution of coke for coal, two by alterations to the smoke stacks, and the fifth by more careful stoking. A list of the premises under observation during the year is appended. (Table 31.) In the absence of any standard of comparison, it is perhaps dangerous to arrive at a definite conclusion, but the records of the past three years appear to justify the opinion that less smoke of all kinds is emitted from the "commercial" chimneys in the Borough. This is a gain not only to the health of the residents and amenities of the District, but also to the consumers of the fuel, as smoke represents waste. As regards the question of standards, experiments are about to be made by the Department with a view to utilising photography to record the actual emissions in comparison with empirical standards. Canal Boats.—The annual report of the Examiner of Canal Boats was submitted to the Council, and forwarded to the Local Government Board, at the beginning of February. The breaches of the Acts reported by the Inspector were of a comparatively trivial character, and were all remedied on attention being called to them. Legal proceedings were unnecessary. Five (5) cases of infectious disease were reported on the boats, viz., 2 of diphtheria and 3 of scarlet fever (all the latter on the same boat). The deaths among the occupants of the boats numbered 3, 2 from phthisis and 1 from accident (fall). Canals.—No complaints were received with reference to these, the supply of water being ample throughout the year. The customary cleaning of the bottom of the "cut" (Paddington Basin) took place at Easter, when some 600 tons of mud were removed and parts of the concrete renewed. workshop supervision. 51 Wharves.—These have been kept under constant supervision. A complaint was received from the Local Government Board, which was of a general character. The complaint formed the subject of a special report, which was forwarded to the Board. TABLE 31. Smoke Observations. Address. Business. Chimney Shaft of 20, Amberley Mews Wheelwright Smith's Forge 18, Beethoven Street Steam Laundry ... Steam Boiler 27. „ „ „ „ „ 29 „ „ „ „ „ Bishop's Road Bridge Refreshment Rooms „ 8, Bishop's Road „ „ Kitchen Stove 26, Brook Mews N. Van Building Smith's Forge 189, Edgware Road Bakehouse Baker's Ovens 319, „ „ Level Bakehouse „ 377, „ „ ,, „ „ 401, „ „ Bakehouse Goods Yard Hydraulic Works Steam Boilers 90, Harrow Road Bakehouse Baker's Ovens 151, „ „ Steam Saw Mill Steam Boiler 292, „ „ Bakehouse Baker's Ovens 423, „ „ Cartage Contracting Refuse Destroying 534, „ Bakehouse Baker's Ovens 156-8, Kensal Road Steam Saw Mill Steam Boiler 12, North Wharf Refuse Destroying Destructor 19, ,, ,, Iron Works Furnace 41-3, Praed Street Hotel Kitchen Stove 49, „ „ Van Buildings Smith's Forge 25, Queen's Road Restaurant Kitchen Stove 143, „ Public Baths Steam Boilers 195, Shirland Road Bakehouse Baker's Ovens 220, „ „ Dairy Steam Boilers 8, South Wharf Builders' Merchants Travelling Crane 33, Westbourne Grove General Stores Steam Boilers Westbourne Terrace Bridge Electric Light Works „ „ WORKSHOP SUPERVISION. Section 132 of the Factory and Workshop Act, 1901, requires the Medical Officer of Health to "report specifically on the administration" of the Act within the district under his supervision. The Home Office now issues special directions as to the matters to be dealt with, and certain tables. (See Table VII., Appendix.) The system of the Department has remained practically unchanged since first described in these reports. Registration.—At the close of 1905, 1,372 premises were on the Registers of the Department. During 1906, 364 premises were added to and 278 removed from the Registers, thus making the effective entries at the close of last year 1,458, comprising 131 factories, 849 workshops, 22 domestic workshops, 63 workplaces, and 393 premises occupied by "single workers," 212 of which were on the Register of Outworkers. The businesses carried on and the number of workers employed are shown in Table 32. The numbers of workers are approximations only, being based on the numbers found at work on the occasions of the last visits paid to premises during the past year. 52 WORKSHOP SUPERVISION. TABLE 32. Factories, Workshops, and Work-places. 1906. No. of Premises. No. of Rooms. Employees. Women. Young Persons. Men. Totals. Clothing— Boot-making 111 (49) 111 (49) 193 (54) 4 (1) 7 (4) 204 (59) Corset-making 9 (1) 11 (1) 22 (1) 2 - 24 (1) Dressmaking 449 (69) 643 (89) 1,893 (191) 271 (38) 12 (2) 2,176 (231) Mantle-making 13 (8) 18 (11) 48 (21) - - 48 (21) Millinery 46 (4) 80 (4) 293 (6) 26 - 319 (6) Millinery and Dressmaking ... 18 55 378 32 8 418 Outfitting and Plain Needlework 30 (17) 33 (17) 80 (18) 1 (1) 1 82 (19) Tailoring 181 (130) 212 (137) 179 (102) 8 (3) 170 (127) 357 (232) „ Ladies' 19 (17) 32 (1) 108 13 21 (1) 142 (1) Various 16 (4) 17 (4) 16 (1) - 16 (1) .32 (2) Fancy Work— Embroidery and Art Needlework 8 (3) 10 (3) 35 (6) 3 7 (1) 45 (7) Other 3 (1) 3 (1) 7 (1) 2 - 9 (1) Cleansing— Dyers and Cleaners' Receiving Offices 16 16 30 6 1 37 Laundries 123 (9) 390 (16) 1,108 (26) 22 (1) 141 (3) 1,271 (30) „ —Receiving Offices 35 35 41 4 1 46 Mangling 23 (1) 23 (1) 23 (1) - - 23 (1) Various 6 (2) 6 (2) 9 (2) 3 1 13 (2) Other Businesses— Blind-making 6 8 3 3 26 32 Bookbinding and Printing 32 48 62 27 209 298 Carpentry and Joinery 12 19 - - 87 87 Chaff-cutting 15 19 - - 50 50 Coach Building 49 82 - 1 351 352 Cycle and Motor Works 23 35 - 10 100 110 Jewellery and Clock-making 8 12 10 15 22 47 Metal-working 33 37 - - 140 140 Saddlery 8 10 - - 24 24 Sign and Ticket Writing 9 9 - 8 25 33 Trunk-making 8 11 - - 32 32 Umbrella-making 7 7 14 3 12 29 Upholstery 47 (16) 75 (19) 83 (20) 14 92 189 (20) Various 95 137 193 135 768 1,096 1,458 (315) 2,204 (355) 4,828 (450) 613 (44) 2,324 (139) 7,765 (633) The figures in parentheses refer to outworkers. See also Table VII., Pt. 3, Appendix. The Home Office forwarded notices of 50 new workshops opened during the past year, most of them being, however, already on the Registers of the Department. Home Work.—The list of "outworkers" received from local firms numbered 22 in February- and 54 in August, making a total of 76 for the year, containing 389 addresses. Of these addresses. 262 were, in accordance with the Act, forwarded to other local authorities, 53 WORKSHOP SUPERVISION. from whom 254 additional addresses were received. The names of the districts from which such addresses were received, and the number of lists sent by each, are set out below:— Kensington 14 lists Westminster 13 „ Finsbury 11 lists Hampstead each Willesden 6 lists Hammersmith 5 „ City of London 3 lists Shoreditch each Chelsea 2 lists Fulham each Marylebone Camberwell 1 lists Lambeth each St. Pancras In addition to the addresses contained in the above lists, 35 other premises came to the knowledge of the Department in the course of other inspections. These will be specially referred to later on. The Register of Outworkers contained 315 effective entries at the close of the year, comprising— Factory, 1; workshops, 101 ; workplaces, 1; and single workers, 212. There is so much ambiguity in the meaning and so many difficulties attend the working of the "Homework" provisions (Part VI.) of the Act, that some space may be usefully devoted to a consideration of the chief of them. It is somewhat remarkable that this Part of the Act, although headed "Homework," contains no reference in any of its Sections to "homework" or "homeworkers." Nowhere in the Act is there a definition of either of those terms, and reliance must be placed on the interpretation to be given to the first sub-section of Section 107 contained in this Part of the Act. That sub-section enacts— (1). The occupier of every factory and workshop and every contractor employed by any such occupier in the business of the factory or workshop shall:— (a) Keep in the prescribed form and manner, and with the prescribed particulars, lists showing the names and addresses of all persons directly employed by him, either as workmen or contractors, in the business of the factory or workshop, outside the factory or workshop, and the places where they are employed; This obligation is not imposed on the occupiers of all factories and workshops, but only on those carrying on certain trades or manufactures specified in the Act, and on such others as the Home Secretary may by special Order direct. Some of the difficulties attaching to the interpretation, of the provisions are exemplified by a Return which was presented to the House of Commons in June of last year, and subsequently sent to all local authorities, with a circular letter from the Home Office calling attention to the duties of the authorities, and urging a more efficient administration of the "Home Work" provisions of the Act. That return was ordered to be prepared from the reports of medical officers of health, "as to the administration during 1904 of the Homework provisions of the Factory and Workshop Act, 1901, giving particularly the following information:— (a) Generally, the number of inspections of home-workers' premises, the number of notices served in respect of them, &c. (b) The number of out-workers' lists received and the number of out-workers shown by them. (c) The number of notices served under Sec. 108. (d) The number of orders under Sec. 110. (e) The number of cases of infectious disease notified in home-workers' premises. 54 WORKSHOP SUPERVISION. (/) The number of cases of non-compliance and the number of prosecutions under Sees. 107, 108, 109 and 110 ; and (g) The number of medical officers of health reporting specially on the administration of those sections." Inasmuch as 727 medical officers of health (of whom 206 held office in England and Wales, 35 in Scotland, and 486 in Ireland) out of 2,959 made no report for 1904* to the Home Office, the figures contained in the Return afford no accurate estimate of the numbers of outworkers, or criterion of the administrative procedure in relation thereto. The figures for the Metropolis are, possibly, an exception, and seem to be worth quoting. Section 107, Lists of Outworkers:— 3,812 lists were received, containing 33,821 addresses, the lists sent to other authorities » contained 16,658 addresses and those received 10,002. The total of 3,812 lists is the sum of those received in February and August. Consequently the number of outworkers in the Metropolis would be (very approximately) 16,910. The inspections of premises during the year were returned as numbering 13,283, involving 1,307 notices and 2 prosecutions. Two hundred and thirty-six cases of infectious disease of all descriptions were reported as having occurred at outworkers' premises. The most interesting part of the Return is to be found in the introductory letter. Speaking of the incompleteness of the returns and the untrustworthy character of the statistics, the writer remarks:— "Further, if the returns had been complete there would still remain considerable sources of error, which would vitiate the result. The first is that the same outworker may work for more than one firm, and will, therefore, appear in several lists. There is no means of eliminating duplicate entries. Another source of error is that the list kept by the occupier, of which he furnishes a copy to the local authority, may contain names of persons who are 'on his books' as having been employed by him, but are not actually employed when the list is sent in. On the other hand, it is to be borne in mind also that the names required to be entered by the person giving out the work in the lists, are the names of persons directly employed by him. Persons who assist in the work, other than the person to whom it is given out, would not appear." If sub-section 1 of Section 107 be strictly interpreted, the occupiers of factories and workshops taking orders from the occupiers of other factories and workshops or contractors would be included in the lists of "outworkers" kept by the latter, as well as the "single workers" who take small jobs to be done in their homes. As an example, the case of a retail draper, having his own workshop, who gives an order to a wholesale house, may be quoted. The draper would be in the position of a "contractor," and the wholesale house in that of an "outworker," although the latter may execute the order in a factory or workshop where a large number of workers are employed, and already on the Register as such. Such interpretation can hardly have been contemplated by the drafter of the Act. Another point is, when is an outworker to be considered as "on the books" of any occupier of a factory or workshop? Perhaps the question may be better put thus: how long is an outworker to be considered as on the books ? Suppose a single job is given (say) in February after that month's return has been sent in. Should that "outworker" be *Medical officers of health were requested for the first time to include tables prepared by the Home Office in their reports for 1904, and consequently some allowances have to be made both for incomplete comprehension of the new forms and, as the forms for 1904 were not issued until the beginning of 1905, inability to get out the required information. WORKSHOP SUPERVISION. 55 included in the August list? If not, the return of outworkers must be always incomplete, and a number never come under the supervision of the authorities. In any case, six months may elapse before a new outworker will come under supervision, and much may happen during that time. It is not uncommon for work to be given out on condition that the outworker takes no work from other firms, a condition which the experience of the Department indicates is frequently evaded. Hence, when "outworkers" are discovered by the Officers of the Department in the course of their other work, it is impossible to get to know the names of the firms from whom such work is received. Of the 35 outworkers already mentioned as discovered during the year, only 12 disclosed the names and addresses of the firms employing them. There is no machinery for dealing with this evasion of the Act. The object of the Act is twofold—to protect the public from the dangers which may arise from work being done under conditions likely to spread disease, and the workers themselves from "sweating" and unfair treatment. The intentions are excellent; the present machinery inefficient, not to say clumsy. What is wanted is some simple system by which "outworkers"—persons who carry on a manufacture outside the factory or workshop of the person giving the work—shall be promptly known to the Factory Department and the Local Authority. The present procedure might be limited to "homeworkers"—persons doing the work in their homes— and all "outworkers" in factories and workshops, which are otherwise dealt with under the Act, be specifically excluded from this part of the Act. The persons giving out the work should be required to keep registers of all work given out, in addition to the names and addresses of the persons to whom the work was given, such registers, as at present, to be open to inspection. No work should be given to any "homeworker" except on production of a certificate from the local authority of the district in which such home is situate, that the premises were on that authority's register. Duplicates of such certificates should be forwarded periodically (say each month) to the Home Office. The issue of the certificate should be simply a record of the inscription of the homeworker on the local register and should be issued without any preliminary requirements as to sanitary condition of the homeworker's home. The provisions of the Public Health and Factory Acts would be sufficient to secure proper sanitation and the due protection of the public against disease, supposing all "homeworkers" be known. It is believed that such procedure would secure a practically complete registration of "outworkers" (who would be more properly described as "homeworkers") and would save a good deal of the labour and worry—not to mention delay in supervision—which attend the present little understood system. Inspections.—During the past year 3,258 inspections were made of the premises on the Registers (see Table 33), as compared with 2,025 in 1905 and 3,414 in 1904. The Inspectors measured up 197 rooms, being 89 more than in the previous year, but 23 less than in 1904. In 107 instances the workrooms were found to be used as bedrooms, an increase of 21 over the number discovered in the previous year (86). The prescribed "Abstract" was not displayed in 50 workshops, as compared with 15 instances in 1905 and 65 in 1904. Each case was duly reported to the Home Office, within whose jurisdiction this offence falls. The notices required to secure the remedying of defects found numbered 133 in 1903, 96 in 1904, 54 in 1905, and 42 last year. The Inspectors, however, always endeavour to secure the rectification of defects without notice whenever possible, and much work is done on such verbal requests. 56 WORKSHOP SUPERVISION. TABLE 33. Inspections of Workshops, &c. 1906. See also Table VII., Pt. 2, Appendix. Miss O'Kell. * Miss Nicolas. * Mr. Wansbrough. † Workshops— On register end of 1905 542* 455* 375 added during 1906 115 94 155 removed „ „ 172 95 11 On register end of 1906 485 454 519 Inspections 109 100 391 Re-inspections and miscellaneous calls .. 927 737 994 Rooms measured 69 95 33 Workrooms used as bedrooms 59 35 13 Workrooms without Abstracts 32 13 5 Notices served, totals 23 16 3 Written intimations 13 10 - Under Sec. 4 Public Health 3 1 - 37 (London) 1 - - 38 Act, 1891. 1 - 3 By-laws, under same Act 5 5 1 Nuisances dealt with— Discovered. Abated. Discovered. Abated. Discovered. Abated. Overcrowding 3 3 5 5 - - Dirty Conditions 17 16 40 35 23 23 Deficient Ventilation 2 - 1 1 - - Temperature too high - - - - - - Temperature too low 1 - 2 2 - - Sanitary conveniences— Insufficient 1 - - - 1 1 Not separately provided 1 - 1 - - - Badly placed - - - - - - Unventilated - - - - - - Defective 12 11 8 8 3 3 Vapour, effluvia not removed Steam in washhouses - - - - - - Gas fumes 5 - 3 3 5 5 Drains - - 1 - - - Wet floors, laundries 4 2 - - - - Accumulations of refuse - - - - 4 4 Other nuisances or offences 37 14 4 3 - - Totals 83‡ 46 65§ 57 46 46 * Including workshops where both sexes are employed. †Workshops where men only are employed (Bakehouses not included.) ‡Twenty-five cases referred to Male Inspectors and four to Home Office. § Two cases referred to Male Inspectors. WORKSHOP SUPERVISION. 57 Complaints.—Nineteen (19) complaints with reference to workshops, &c., were received from the Home Office during the year, 22 having been received in 1905 and 6 in 1904. The complaints received last year referred to the following matters:— Dirty conditions and insufficient ventilation, 3 each ; overcrowding, 4 ; and other matters, 12. One complaint referred to premises which did not appear to the Department to be a workshop, and the Home Office was so informed. From other sources 4 complaints were received, as compared with 7 in 1905, relating to— Defective water-closet, nuisance from drains, overcrowding, and want of dustbin, 1 each. Overcrowding.—The diminution in the frequency of this offence continued during the past year, only 8 cases being discovered, as compared with 44, 31, 16, and 9 in each of the four vears 1902-05. In most cases a re-arrangement of the workers in the workrooms was all that was required. Deficient Ventilation.—This is also becoming rarer, only 3 instances having been reported in each of the last two years, as against 19 in 1903 and 10 in 1904. Warming.—Hitherto the Department has consistently objected to the use of unventilated gas stoves, i.e., stoves not fitted with proper flues to carry off the products of combustion, and a large number of such stoves have been replaced during the past five years by stoves with flues. During the past winter the subject has assumed another aspect, and must now be considered as sub jttdice. No cases of unduly low temperatures in workshops were reported to the Home Office during the year. Sanitary Conveniences.—The improvement in this direction recorded in the last report has been maintained, as will be seen from the appended statement for the past five years. 1902. 1903. 1904. 1905. 1906. Insufficient 9 5 2 — 2 Not separately provided 33 17 4 4 2 Badly placed 18 10 13 4 — Unventilated 8 5 — 1 Defective 29 28 23 7 23 Sickness.—Ninety-two (92) cases of infectious illness were reported on "workshop premises" of all descriptions, 23 of the cases occurring on premises of out-workers. In 1905 the corresponding figures were 70 and 29, and 1904, 53 and 14. The numbers of cases of the different diseases which were reported last year are set out below, the cases in out-workers' premises being indicated in parentheses:— Scarlet fever 33 (9) Diphtheria 7 (3) Enteric Fever 1 (—) Puerperal Fever 2 (—) Measles 17 (3) Whooping Cough 4 (—) Chickenpox1 4 (4) There were 14 deaths from phthisis on such premises, 4 at out-workers', during the year, compared with 8 and 3 respectively in 1905. The precautions taken appeared to be sufficient in every case, all the cases of diphtheria and of scarlet and enteric fevers being removed to hospital. It was unnecessary to put into force the provisions of Section 110 of the Act. 58 HOUSING. Laundries.—These were satisfactorily maintained dnring the vear and call for no special comment. Bakehouses.—The number of these premises was reduced during the past year from 79 to 74, viz., 16 "level" and 58 "underground." Of the bakehouses in use at the close of the year 7 are "factories" and the remainder "workshops." Of the former 96 inspections were made, of the latter 412. On 16 occasions the premises were reported to be dirtv. One case of scarlet fever occurred at a bakehouse. HOUSING. I.—Houses Let in Lodgings. Registration.—At the close of 1905 there were 1,150 houses on the Registers kept for the purposes of Sec. 94 of the Public Health (London) Act, 1891. During the past year 166 houses were visited with a view to registration, 140 of which were ultimately placed on the Registers, while 18 were removed therefrom as having become exempt from the By-laws. The effective entries in the Registers at the close of last year numbered 1,272. To secure the registration of the 140 houses, 156 "Notices to supply particulars" were issued, followed by 56 "Reminder letters," but no summonses were required. A summary of the particulars relating to the houses registered is appended:— Summary of Particulars obtained at Registration, 1906. Housing. Inspector Wingfield. Group A. Inspector Lawrence. Group B. No. of Houses visited with a view to Registration 86 80 Houses Registered 78 62 „ Exempt 8 17 „ Empty — 1 No. of Rooms, registered 364 244 For living only 83 14 For sleeping only 157 84 For living and sleeping 124 146 Other Rooms 298 254 Occupied by landlords 143 98 Exempt by rent . . 54 138 Occupied but not inhabited 88 2 Empty 13 16 Grand Totals, Rooms 662 498 Inhabitants. Group A. Group B. In Registered Rooms, Persons 611 546 Persons under 10 years 139 200 Persons 40 years and upwards 472 346 In other Rooms, Persons 229 310 Persons under 10 years 59 68 Persons 10 years and upwards 170 242 Grand Totals, Persons 840 856 59 housing. Overcrowding. In Registered Rooms— Group A. Group B. Families 21 41 Persons, all ages 70 145 ,, under 10 years 28 59 „ 10 years and upwards 42 86 Abated by re-adjustment of occupants 14 8 Requiring removal 1 13 Cases held over, etc. 6 20 Streets comprised in Group A. Group B. a Hampden Street (34 houses) Amberley Road (1 house ) Hall Place ( 9 houses) Marlborough St. (44 „ ) Braithwaitt Place (3 houses) Hal! Pla;e West ( 1 house ) Bouverie Street (1 house ) Hermitage Street (10 houses) Campbell Street (2 houses) Hethpool Street ( 3 „ ) Church Place (15 „ ) Howell Street (4 „ ) Crompton Street ( 1 house ) Kent's Place ( 1 house ) Cuthbert Street ( 2 houses) Welling's Place ( 9 „ ) The "housing" conditions as found at the time of registration are shown in Table 34. TABLE 34. Particulars as to Numbers of Tenements and Inhabitants therein, registered during 1906. Rooms to Tenement. Group of Streets. 1 2 3 4 5 6 7 8 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 T - T - - T - - T - - T - - T - - T - - T - - 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 1 A 48 48 ... 43 85 1 19 46 11 3 8 4 ... ... ... ... ... ... ... ... ... ... ... ... B 29 29 ... 27 52 2 30 62 28 7 14 14 3 6 9 ... ... ... ... ... ... ... ... ... 2 A ... ... ... 27 54 ... 27 64 17 14 32 24 11 33 22 5 11 19 3 15 6 1 4 4 B 1 1 ... 6 12 ... 8 20 4 16 41 23 25 65 60 12 31 41 3 7 14 ... ... ... 3 A ... ... ... 3 6 ... 5 12 3 4 13 3 4 11 9 2 6 6 ... ... ... 1 7 1 B ... ... ... ... ... ... ... ... ... 1 2 2 ... ... ... ... ... ... ... ... ... ... ... ... T—number of Tenements containing (P/10) Persons over 10 years of age, and (10/P) Persons under 10 years of age. The table may be summarised thus:— Tenements of— Total. Occupants. Average persons per room. Houses registered 1906. Borough Census 1901. 1 room 209 419 2.0 1.8 2 rooms 159 624 1.9 1.7 3 „ 20 81 1.3 1.3 4 „ - - - 1.1 Supervision.—The total number of inspections to registered houses, apart from those in connection with the annual cleansing, was 2,825 last year, as compared with 3,756 in 1905 and 3,511 in 1904. The nuisances discovered are set out in Table 35. To remedy the defects found, 1,091 notices were issued, viz., 369 written intimations, 68 "statutory notices," 418 under various by-laws, and 239 under the London County Council (General Powers) Act, 1904. 60 HOUSING. TABLE 35. Sanitary Defects Remedied in Registered Houses. 1905. 1906. Drain defective 78 44 „ choked 6 3 „ untrapped 33 2 „ unventilated or improperly ventilated 74 24 Manhole cover defective 3 6 Inadequate means of access to drain 1 - Surface inlet improperly trapped 6 7 Gully choked 4 6 Ventilating pipe improperly constructed 3 3 Soilpipe defective 1 - „ improperly constructed - - „ unventilated or improperly ventilated 3 1 Water-closet choked 12 20 „ defective 34 45 „ flushed from drinking water cistern 9 3 „ insufficiently flushed 13 23 „ flushing apparatus defective 29 38 „ without water supply 7 12 „ foul 25 18 „ improperly constructed 14 5 „ accommodation insufficient 10 34 „ without door 8 2 ,, without external light or ventilation 4 1 Rain-water pipe not disconnected from drain or soilpipe 39 4 „ defective 14 22 „ choked - 7 Sink waste pipe not disconnected from drain 5 - „ defective 6 10 „ choked 2 1 „ not provided 1 3 Other drainage defects 10 10 Cistern connected to drain 6 - „ defective 6 4 „ dirty 20 34 „ improperly placed 2 1 „ without proper cover 11 15 „ cover defective 18 7 Dustbin defective 50 54 „ not provided 7 7 „ insufficient - 8 Paving defective in area or yard 42 89 „ „ washhouse 35 48 Guttering defective 14 12 Copper „ — 1 Premises damp 12 8 „ dirty 10 4 Rooms verminous 144 345 Roof defective 134 136 Accumulation of refuse 34 42 Animals improperly kept 2 6 Other defects or nuisances 19 30 Annual Cleansing.—With the increased number of houses on the Registers this very important work becomes heavier each year, and is now more than the two Inspectors who are charged with the supervision of Houses let in Lodgings can manage. Last year a new system was introduced with a view to reducing the amount of labour and the time spent in securing the completion of the work, but the scheme proved unsatisfactory in both respects. During the current year a proportion of the work will be given to the District Inspectors. housing. 61 At the commencement of April of last year, the month in which the By-law requires the cleansing to be carried out, there were 1,212 houses on the Registers. Each of these was inspected and the conditions qua uncleanliness and sanitary defects, &c., noted, a complete record being also made of the occupants of each tenement and house. The inspections required for this work and for the subsequent supervision, numbered 4,649 last year, as compared with 4,002 in 1905. The notices issued numbered 2,025 (as compared with 1,624 in the previous year), and 11 summonses were necessary. The housing arrangements are given in Table 36. TABLE 36. Particulars as to Numbers of Tenements and Inhabitants in Registered Houses 1906. Rooms to Tenement. 1 2 3 4 5 6 7 8 9 10 11[//###] T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 1 626 626 ... 719 1409 29 357 758 313 133 283 249 61 126 179 7 14 28 6 16 26 ... ... ... ... ... ... ... ... ... ... ... ... 38 38 ... 302 600 4 415 1052 193 418 1180 492 364 1058 762 264 775 8D9 105 359 37o 44 153 199 14 51 75 4 15 25 ... ... ... 3 2 2 22 44 ... 60 154 26 97 302 86 84 299 121 73 298 140 53 224 147 30 141 99 13 64 53 4 19 21 2 18 4 4 ... ... ... ... ... ... 6 17 1 11 35 9 8 38 2 10 51 9 6 27 15 3 16 8 5 33 12 2 14 6 2 13 9 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 1 1 4 3 ... ... ... ... ... ... ... ... ... ... ... ... T—number of Tenements containing (P/10) Persons over 10 years of age, and (10/P) Persons under 10 years of age. The Table may be summarised briefly as follows :— Totals. " Overcrowded."* Average number of persons per room. One-room tenements 1,909 564 2.1 Two-room „ 1,968 795 2.2 Three-room „ 440 102 1.7 Four-room „ 53 9 1.5 Five-room ,, 2 not known 1.3 *Registrar-General's standard, inhabitants averaging more than two persons per room, irrespective of ages of occupants. †Irrespective of ages. Overcrowding.—There are two standards of overcrowding, viz., that adopted by the Registrar-General in his Census Reports, and that prescribed by the By-laws. By the former, which can be used only for tenements of less than five rooms, any tenement whose occupants (disregarding their ages) average more than two per room, is deemed to be overcrowded; while the latter is based on the cubic space of the rooms and the ages of the occupants. Where a room is used both for living and sleeping, each occupant must have 400 cu.ft. if over ten years of age, and 200 if under. If the room be used for sleeping only, the allowances are reduced to 300 and 150 cu. ft. respectively. It is with the latter form of overcrowding that the Department deals by legal process, but the former is useful as an index of the general standard of housing. Since 1902 particulars of the "housing" in houses registered during each year have been compiled in the form* used by the Registrar-General, while similar data * The form used by the Department shows the inhabitants in two age-groups, viz., over and under 10 years of age, that of the Registrar-General gives the number of persons (all ages) only. 62 HOUSING. for the whole of the houses on the Registers were collected in 1903, 1904, and 1906. It has been thought that a comparison of the statistics would not only be interesting but useful. On examining the figures for the houses at the time of registration (Table 37) it will be found that the average number of persons of all ages per room in "all tenements of less than 5 rooms" has fallen from 2.06 in 1902 to 1.90 last year, the averages for the intermediate years having been even lower, the lowest being recorded in 1903 and 1905 (1.84). A similar reduction, but not in all cases equal in amount, occurred in each class of tenement. It is not without interest to note that the proportion of children under 10 years of age to the total inhabitants has shrunk from 30.7 per cent. in 1902 to 29.1 in 1906, and was as low as 26.0 in 1903. Turning to the second half of the Table, the "overcrowded tenements," the TABLE 37. Based on data collected on Registration. Tenement of rooms. Year. All tenements. "Overcrowded" tenements. Average per room. Children per cent. total Inhabitants. Percentage of all overcrowded Average per room. Children per cent. total Inhabitants. P p/10 10/P P P/10 10/P 1 1902 2.14 1.68 0.46 21.6 30.7 3.58 2.13 1.45 40.4 1903 1.99 1.66 0.33 16.7 25.3 3.38 2.16 1.22 36.0 1904 2.04 1.63 0.41 20.4 39.8 3.31 2.05 1.26 38.1 1905 1.94 1.59 0.35 18.0 26.1 3.35 2.09 1.26 37.6 1906 2.00 1.67 0.33 16.4 29.6 3.25 2.19 1.06 32.6 2 1902 2.06 1.35 0.71 34.3 39.3 2.94 1.59 1.35 45.9 1903 1.67 1.10 0.57 31.4 26.4 2.85 1.52 1.33 46.7 1904 1.87 1.26 0.61 32.7 28.1 2.88 1.50 1.38 47.9 1905 1.89 1.28 0.61 32.4 32.4 2.78 1.52 1.26 45.3 1906 1.95 1.22 0.73 37.5 37.7 2.76 1.38 1.38 50.0 3 1902 1.92 1.22 0.70 36.4 45.9 2.53 1.43 1.10 43.8 1903 1.52 1.14 0.38 25.1 12.5 2.33 1.75 0.58 25.0 1904 1.41 0.97 0.44 31.3 14.8 2.66 1.33 1.33 50.0 1905 1.54 1.02 0.52 33.2 16.1 2.39 1.26 1.13 47.2 1906 1.35 0.95 0.40 29.6 5.0 2.66 2.33 0.33 12.5 4 1902 1.28 0.87 0.41 32.2 16.6 2.5 1.5 1.0 40.0 1903 0.91 0.83 0.08 9.0 ... ... ... ... ... 1904 1.44 1.17 0.27 18.9 ... ... ... ... ... 1905 0.99 0.87 0.12 12.5 ... ... ... ... ... 1906 ... ... ... ... ... ... ... ... ... All tenements of less than 5 1902 2.06 1.43 0.63 30.7 35.6 3.04 1.70 1.34 44.1 1903 1.84 1.36 0.48 26.0 25.2 3.00 1.73 1.27 42.2 1904 1.85 1.31 0.54 29.1 27.9 2.9] 1.57 1.34 45.2 1905 1.84 1.34 0.50 27.3 27.6 2.93 1.68 1.25 42.6 1906 1.90 1.35 0.55 29.1 31.7 2.92 1.67 1.25 42.9 No. of houses registered : -1902, 198; 1903, 265; 1904, 185; 1905, 140; 1906, 140. P — Persons of all ages. (p/10) Persons aged 10 years and upwards (10/p) Persons under 10 years of age. proportion of all such tenements to all tenements has decreased from 35.6 per cent. in the first year to 31.7 in the last, the lowest proportion (25.2 per cent.) having been noted in 1903. The average number of persons per room has decreased from 3.04 to 2.92. In considering this latter point, attention should be given to the differences in the percentage of children HOUSING. 63 under 10, which was 44.1 in 1902 (compared with 30.7 in all tenements), and had decreased to 42.9 (as compared with 29.1 in all tenements in 1906). It is usual to reckon two children under 10 as equal to one adult. If this proportion be applied to the figures for tenements of all descriptions ("all tenements of less than 5 rooms" in the Table), the averages per room would be— All tenements. "Overcrowded tenements." 1902 1.77 2.40 1903 1.60 2.36 1904 1.58 2.24 1905 1.59 2.30 1906 1.62 2.29 Attention may be called to the fact that in the families occupying two-room tenements the proportion of children to the total inhabitants has increased, the increase being more marked in the "overcrowded tenements" than in the whole group. Passing to the figures collected at the annual cleansing (Table 38*), while a similar improvement can he noted, indications are not wanting that the omission to enumerate the inhabitants in 1905 was a mistake, and led to a check in the decrease in density of occupancy.| TABLE 38. Based on Enumerations of all Houses on the Register at each April. Tenements of rooms. Year. All tenements. "Overcrowded" tenements. Average per room. Children per cent. total Inhabitants. Percentage of all overcrowded. Average per room. Children per cent. total Inhabitants. P P/10 10/P P P/10 10/P 1 1903 2.22 1.73 0.49 22.0 33.3 3.61 2.18 1.43 39.5 1904 2.12 1.69 0.43 20.4 29.3 3.54 2.12 1.42 40.2 1906 2.12 1.69 0.43 20.3 29.5 3.58 2.12 1.46 39.1 2 1903 2.07 1.37 0.70 33.8 39.7 2.94 1.61 1.33 45.2 1904 2.05 1.35 0.70 34.2 38.5 2.92 1.56 1.36 46.5 1906 2.08 1.34 0.74 35.7 40.3 2.92 1.51 1.41 48.2 3 1903 1.77 1.20 0.57 32.3 26.2 2.59 1.47 1.12 43.1 1904 1.75 1.18 0.57 32.4 25.5 2.53 1.37 1.16 45.8 1906 1.70 1.18 0.52 30.8 23.1 2.58 1.52 1.06 41.0 4 1903 1.37 1.15 0.22 16.0 8.0 2.50 1.75 0.75 30.0 1904 1.43 1.22 0.21 14.7 5.0 2.49 1.58 0.91 36.6 1906 1.48 1.15 0.33 22.5 17.0 2.42 1.67 0.75 31.0 All tenements of less than 5 1903 2.33 1.63 0.70 30.2 35.5 3.04 1.72 1.32 43.4 1904 1.99 1.39 0.60 30.0 32.9 2.99 1.65 1.34 44.8 1906 2.01 1.40 0.61 30.4 33.8 3.01 1.65 1.36 45.0 Houses on the Register:—1903, 648; 1904, 901; 1906, 1,212. P Persons of all ages. (p/10) Persons aged 10 years and upwards.(10/p) Persons under 10 years of age. * The figures obtained at the last annual cleansing are given in Table 36. † Unfortunately the arrangements for the annual cleansing of this year were completed before the calculations necessary for Tables 37 and 38 had been made. No enumeration will be made this year, but will be taken as part of the regular routine in future years. 64 HOUSING. The least improvement has taken place in tenements of two rooms where the proportion of children under 10 is highest. The cases of overcrowding with which the Department deals numbered 412 last year as compared with 298 in 1904, the last occasion of an enumeration of the inhabitants of registered houses. The cases discovered last year comprised 62 on registration, 354 at the annual cleansing, and 6 on other inspections, as compared with 59, 233 and 6 respectively in 1904. The figures for 1905 cannot be fairly compared with those for last year, but it may be mentioned that in that year the cases of overcrowding discovered numbered 69 only, viz., 54 on registration, 8 on annual cleansing (there was no enumeration) and 7 on other inspections. The action taken with regard to last year's cases, &c., is sufficiently indicated by the appended statement:— Overcrowding. Registration. Annual Cleansing. Other Visits. Tenements overcrowded 62 354 6 Rooms 62 365 7 Occupants, total 215 1,183 36 Under 10 87 529 12 Ten and upwards 128 654 24 Overcrowding abated— By re-arrangement 22 170 — By voluntary removal 3 53 — By death — 1 — By conflagration — 2 — Under notice 11 11 6 Cases held over 151 No action taken There remained 151 cases to be completed at the close of the year. In 62 of these the deficiency of cubic space was under 100 cubic feet, and in 34 others between 100 and 200 cubic feet. As regards these, no action, except a warning to the occupants of the tenements, was thought to be necessary, but the occupants of the remaining 52 tenements will be obliged to find more adequate accommodation. Vital Statistics.—The number of inhabitants of the "Registered Streets" was found to be, in April of last year, 17,759 persons, of whom 5,159 were children under 10 years of age (29.0 per cent., as compared with 16.7 per cent. for the whole Borough, and 15.9 per cent. for the "Rest of the Borough.") The cases of disease notified in those streets numbered 254, and comprised— Scarlet fever, 177 Diphtheria, 31 Enteric fever, 10 Puerperal fever, 3 Erysipelas, 33 In addition, 290 cases of other forms of infectious illness came to the knowledge of the Department, viz.:— Measles, 136 Whooping Cough, 67 Chickenpox, 87 The notified cases represent a morbidity rate of 14.30 per 1,000 persons, as compared with rates of 7.28 in the whole Borough and 6.33 in the "Rest of the Borough." The deaths, after full correction, numbered 418, equivalent to a rate of 23.53 per 1,000, or more than double that for the "Rest of the Borough" (10.88). As the number of " Registered HOUSING. 65 Streets" increases year by year, it has been thought unnecessary to include any table of the numbers of deaths from the various causes. In Table 39 the morbidity and mortality rates for the past two years are set out in comparison, but those rates require to be received with some caution for the reason already given. The main cause for the increase in the total morbidity rate of last year was the prevalence of scarlet fever. The rates from enteric and puerperal fevers were slightly lower. While the total mortality rates for the two years are practically equal, those from certain causes, notably scarlet fever, diarrhœal diseases, phthisis, and cancer, were considerably higher in 1906 than in 1905. TABLE 3 Rates per 1,000 persons. 1905. 1906. Registered Streets. Rest of Borough. Registered Streets. Rest of Borough. Notifications— Small-pox 0.06 0.00 — 0.00 Diphtheria and Membranous Croup 1.30 0.56 1.74 1.14 Erysipelas 1.80 0.81 1.85 0.80 Scarlet Fever 2.49 1.80 9.97 4.11 Enteric and Continued Fevers 0.62 0.27 0.56 0.19 Puerperal Fever 0.18 0.03 0.16 0.06 All Diseases 6.48 3.48 14.30 6.33 Deaths— Small-pox — — — — Measles 1.18 0.33 0.45 0.06 Scarlet Fever 0.18 0.02 0.56 0.06 Whooping Cough 0.49 0.31 0.28 0.04 Diphtheria 0.06 0.01 0.16 0.09 Enteric Fever 0.06 0.03 0.16 0.03 Diarrhœal Diseases 1.93 0.45 2.92 0.61 Erysipelas 0.06 0.04 0.05 0.04 Puerperal Fever - 0.00 — 0.02 Phthisis 1.86 0.80 2.98 0.82 Other Tubercular Diseases 0.99 0.30 0.90 0.29 Alcoholism 0.12 0.09 — 0.09 Cancer 0.74 1.04 1.23 1.08 Premature Birth 0.74 0.34 0.73 0.23 Developmental Diseases 1.43 0.43 1.18 0.41 Bronchitis 2.24 1.16 2.25 0.90 Pneumonia 2.36 0.94 1.80 0.60 Cirrhosis of Liver 0.12 0.19 0.11 0.17 Accidents and Diseases of Childbirth 0.12 0.05 — 0.04 Suicides 0.00 0.12 — 0.10 Other Causes 8.60 5.30 7.71 5.17 All Causes 23.37 12.04 23.53 10.88 1 he total morbidity and mortality rates in the "Registered Streets" were in each year approximately twice those in the "Rest of the Borough."* The mortality at ages under 10 years were in the "Registered Streets" 34.1. and in the "Rest of the Borough" 17.3. The statistics for the "Clarendon Street Area" have for several years been taken out separately. In Table 40 will be found the morbidity rates from the individual notified diseases * As more streets come under registration the difference between the rates for "Registered Streets" and those for the "Rest of the Borough" tends to become greater. For this reason the slight increase in the ratio for last year as compared with 1905 is taken to have no special significance. 66 HOUSING. TABLE 40. Clarendon Street Area. Morbidity and Mortality Rates per 1,000 persons, except otherwise stated. Clarendon Street Area. Rest of Borough. Mean Rates. 1906. Mean Rates. 1906. 1896-1900. 1901-05. 1896-1900. 1901-05. Morbidity. Small-pox - 1.12 - o.oo 0.14 o.oo Diphtheria 1.85 1.45 1.43 2.17 1.26 1.21 Erysipelas 2.07 1.59 2.00 1.07 0.85 0.87 Scarlet Fever 5.21 4.01 14.59 3.99 2.55 4.31 Enteric Fever 0.95 0.81 0.85 0.54 0.41 0.20 Puerperal Fever 0.05 0.08 0.28 0.07 0.05 o.oo Mortality. At all ages 28.75 25.01 25.18 16.17 13.24 11.77 0—10 years 10. Rates per 1,000 these ages. 46.87 37.58 36.37 ? 25.37 19.35 20.41 19.45 20.49 ? 11.02 10.31 Infants under 1 yr.* 308 289 250 288 204 185 In Institutions † 30.0 40.1 43.7 22.6 26.5 30.7 Infants under 1 yr. ‡ 59.0 62.3 58.7 ? 66.2 67.5 * Per 1,000 deaths at all ages. † Per 100 deaths. ‡ Per 100 deaths, 0—10 years. and the principal mortality rates. The most noticeable points are the increases in the rates from scarlet fever (morbidity), in the mortality at ages above 10 years, and in percentage of deaths in institutions. Generally, however, the rates for last year compare not unfavourably with the mean rates for the five years 1896-1900, but not so well with those for the second quinquennium (1901-05). Verminous Rooms.—The number of rooms dealt with under Sec. 20 of the London County Council (General Powers) Act, 1904, increased from 99 in 1905 to 227 last year. Only 14 of those rooms were in unregistered houses. The work was mainly done at the time of the annual cleansing, which, coming at the commencement of the warm weather, coincides with the breeding time of the vermin. Although so much was done, in two instances only was it necessary to resort to legal proceedings to secure compliance with the notices. It is, or was, a common practice to put a clean paper on walls without stripping off the dirty. This was done in one house last year and a summons for failure to properly "cleanse" the room was dismissed. It was noteworthy that a few months later it became necessary to deal with that particular room as verminous, thereby demonstrating the need of stripping walls before re-papering, and the risks run by not doing so of the breeding of vermin.* II.—Common Lodging Houses. These are registered annually by the County Council under their General Powers Act of 1902. That Council exercises complete supervision over such houses, the only matters dealt with by the Department being the abatement of nuisances and the re-construction of sanitary fittings. * All landlords of registered houses have this year been formally notified that any rooms which are re-papered without preliminary stripping will not be deemed to have been "cleansed" as required by the by-law. FOOD SUPERVISION. 67 At the last registration, one house was dropped, there being now only 7 such houses in the Borough—6 for men (195 beds) and 1 for women (40 beds). Two (2) cases of infectious illness were reported among the inmates, viz., one each of erysipelas and enteric fever, both patients being women. The deaths numbered 6, all the deceased being males whose ages ranged from 33 to 68 years. The causes of deaths during the past three years are given below:— 1904. 1905. 1906. Tubercular diseases 6 1 4 Malignant disease, Cancer — 1 — Respiratory diseases — — 2 Other causes 1 6 — Inhabited House Duty: Revenue Act, 1903.—Eighteen (18) applications were made for certificates to secure exemption or reduction of this duty, three relating to tenement houses and the remainder to flats. Certificates were granted for the tenement houses (9 tenements) and for 81 flats ; definitely refused for 20 flats ; and held over for 38 others. Prior to the issue of the certificate the premises had to be put into good sanitary repair —including water-tight drains, sound soil-pipes, properly arranged waste-pipes, &c. FOOD SUPERVISION. I.—Meat Supply. Slaughterhouses.—There are eight (8) of these in the Borough, situate as here described— 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 slaughter-house in Hero Place is now in course of demolition previous to re-erection. No objections were lodged against any of the premises at the licensing in October last. All the premises have been maintained in a much better condition than prevailed (say) ten years ago. The Inspector reports that he visited these premises 631 times during the past vear, and examined the carcases of 151 bullocks, 5,662 sheep and 49 calves. He estimates that some 1,644 lbs. of meat and offal were destroyed during the year on account of pathological conditions discovered in the course of the dressing of the carcases. The appended summary shows the reasons for such destruction:— Organs. Cause of destruction. Slieep. Livers, 36—parasites 30, cirrhosis and abscesses 3 each. Lungs, 14— „ 6, pneumonia and pleurisy, 4 each. head, 1—actinomycosis. Bullocks. Livers, 36—parasites, 25 ; abscesses, 8 ; necrosis, 2 ; degeneration, 1. Lungs, 4— „ and abscesses, 2 each. head, 1—actinomycosis. 1 cow's carcase and organs } tuberculosis. 3 sets bullocks' organs, lungs, liver, &c. 68 FOOD SUPERVISION. Butchers' shops.—There are 112 such premises in the Borough, 84 being devoted to the sale of beef and mutton, and 28 to the sale of pork. The inspections of these premises numbered 598, the majority being of the pork shops, as the discovery of disease in the other forms of flesh food is a very rare incident. The system of inspection by request of the occupiers of such shops was abandoned in the course of the year, as certain firms made use of the advantages conferred by such system to shield themselves when food had been exposed for sale without preliminary inspection. Food purveyors' premises.—The number of such premises on the Registers at the close of the year was 169, being 8 fewer than the total reported in each of the two preceding years, and 13 fewer than that of 1903. Table 41 gives the numbers of the different classes of premises, and of inspections thereof during the past year, together with a statement of the sanitary defects found and remedied. TABLE 41. Numbers of places where Food is sold:— Butchers 84 Milkshops and Dairies 178 „ Pork 28 Refreshment Houses 142 Fishmongers 29 Fried Fish and Sausages 27 Game and Poultry 13 Ice Cream Makers & Vendors 136 Fruit and Greengrocery 86 Sausage Factories 9 Food Purveyors. Inspections during the year:— Slaughterhouses 631 Cowhouses 3 Butchers' Shops 598 Milkshops, &c. 218 Greengrocers' Shops 26 Restaurants, &c. 251 Costers' Barrows 23 Ice Cream Shops and Barrows 72 Fish Curing Premises 3 Fried Fish Shops 54 Fishmongers' Shops 14 Defects found and remedied:— Milkshops and Dairies.* Restaurants and Eating Houses. Premises occupied by Ice Cream Makers. Drains defective 2 2 ... Soilpipes defective 2 1 ... Water-closets defective 3 1 ... * These were systematically dealt with in 1902, leaving no structural defects unremedied. Canned Goods.—The "meat scandals" which developed in America during the past year led to some attention being given to the quality of canned goods on sale in the Borough. Tins of various commodities were purchased and opened in the laboratoy and examined by the Public Analyst and the Meat and Food Inspector. One tin of flesh food ("Chicken and Veal Pate") was found to contain traces of sulphites—which fact, the Analyst reported, indicated incipient decomposition at the time of canning. Sulphites were also found in one tin each of lobster, apricots, and tomatoes. The remaining tins examined were free from preservatives, and the contents appeared to be in a sound and wholesome condition. All the FOOD SUPERVISION. 69 tins bore American labels except two (one each English and French). The tin with the English label was almost certainly of American production. It is desirable that the use of preservatives should be prohibited entirely. If the food stuff is sound when canned, preservative is unnecessary, as, if properly canned, the contents will keep good for a reasonable period. It is also desirable that the "cans" should bear— stamped in the metal—the name and address of the canning firm and the date of canning. Efficient supervision, including "food inspection" at the canneries, is a sine qua non. II.—Unsound and Diseased Meat, &c. The total weight of foodstuffs seized, or surrendered, during the year was just over 2½ tons, rather less than half a ton below the total weight dealt with in 1905. The weights of goods from the different classes were:— Meat.—In slaughterhouses 1,644 lbs. At butcher's shops 1,975 „ Fish 92 „ Vegetables 567 „ On requisition of the G.W.R. Co., 1,414 lbs. of food stuffs (meat, part suspected to be horseflesh, &c.) were destroyed in course of transit. The principal foods are set out below:— Meat:—(Butchers' Shops) Disease. lbs. 5 Pigs Tuberculosis 390 1 Pig's head „ 9 1 ,, „ Actinomycosis 8 20 Pigs' heads Putrid 270 6 „ mesenteries Tuberculosis 9 1 Pig's caul fat and spleen „ 2 3 Pigs' plucks „ 9 2 „ lungs „ 6 4 ,, „ Parasites 12 2 „ hands and springs Tuberculosis 14 11 Fowls Putrid 40 1 Cow and organs Tuberculosis 966 5 Bullocks' livers Parasites 80 1 Bullock's spleen „ 4 2 Bullocks' lungs „ 10 2 „ „ Tuberculosis 14 1 Bullock's lungs Abscesses 7 Rabbits' livers Parasites 13 Sausage skins Putrid 112 Fish:— Haddocks 70 lbs. Bloaters 18 lbs. Shrimps 4 lbs. Vegetables and Fruit:—* Apples 202 lbs. Cherries 56 lbs. (10) Tomatoes 126 „ (6) Melons 22 „ (22) Oranges 77 „ (65) Onions 14 „ Brazil nuts 60 „ Bananas 10 ,, (10) * The figures in parentheses show the weights seized at shops, the remainder being found on costermongers' stalls. 70 FOOD SUPERVISION. III.—Milk Supply. Cowsheds.—The only one in the Borough is situate at— Star Street, No. 39, is licensed for 10 cows, but not more than 5 are kept. The shed is always in excellent condition. The Inspector reports that he visited the premises three times during the past year. The Officers of the County Council make frequent inspections of the premises and the animals kept there. Dairies and Milkshops.—At the end of 1905, 172 names were on the Register. During the past year 9 names were added, 3 removed, and 19 changed, leaving 178 effective entries at the close of the year. The businesses carried on at the premises where the milk is sold are indicated below:— Dairies: milk, eggs and butter only 91 „ wholesale dep6ts 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 inspected on 218 occasions during the year. Four cases of scarlet fever and 1 of diphtheria were reported on premises where milk was sold; 2 cases of scarlet fever and 1 of diphtheria in the families of milk carriers; and 4 cases of scarlet fever in houses where milk carriers resided. All due precautions were taken to prevent the spread of infection, and no ill results were traced to any of the above cases. During the past year advertisements were inserted in the local papers directing the attention of all milk vendors to their liabilities and duties under the Regulations made pursuant to the Dairies, Cowsheds, and Milkshop Orders, and those Regulations have been printed and distributed to the milk vendors on the Register. IV.—Ice-cream Making. A special Register of the makers and vendors of this commodity is kept for the purpose of enforcing the provisions of Part VIII. of the London County Council (General Powers) Act, 1902. Ten (10) new names were added to the Register during the year and 1 removed, leaving 14(5 effective entries at the end of the year. Of the makers and vendors on the Register, 136 are shop-keepers, and 10 Italian barrow-men. The businesses combined with the sale of ice-cream are indicated below:— Sweet shops 67 Newspapers and Tobacco 6 Bakers 24 Confectioners 5 Milk 6 Cook and Barber 1 (each) Restaurants 16 General 10 In addition to the 10 local barrow-men, 20 from other districts have regular stands in the Borough:— From Marylebone 8 From Islington and Clerkenwell 2 each. „ Kensington 6 „ Chelsea and Willesden 1 „ Five cases of scarlet fever were reported from premises where ice-cream is made. FOOD SUPERVISION. 71 V.—Food Adulteration. The samples purchased and submitted to the Public Analyst numbered 506 last year, 52 of them being found to be adulterated, equal to 10.2 per cent., as compared with 6'5 per cent. in 1905, 8.9 in 1904, and 6.9 in 1903. A list of the samples is given in Table 42. TABLE 42. Summary of Articles submitted to the Public Analyst during the year 1906. Total. Found Adulterated. Percentage Adulterated. Milk 312* 41 13.1 Butter 82 10 12.2 Coffee 26 — — Cheese 18 — — Mustard 13 - — Sweets 9 — — Lard 7 — — Margarine 5 — — Pepper 5 — — Cocoa 4 — — Skim Milk 4 1 25.0 Arrowroot 2 — — Cachous 2 — — Corned Beef 2 — — Ground Rice 2 — — Tinned Lobster 2 — — „ Apricots 1 — — „ Ham 1 — — „ Oxtail Soup 1 — — „ Pears 1 — — „ Salmon 1 — - „ Tomatoes 1 — — „ Tongue 1 — — Chicken and Veal Paste 1 — — Tapioca 1 — — Vinegar 1 — — 506 52 10.2 * Including 98 taken at Paddington (G.W.R.) Terminus in course of delivery; 30 adulterated. Of the 312 samples of milk, 98 were taken at the Paddington (G.W.R.) Terminus at the request of the consignees. Thirty (30) of these samples proved to be adulterated, equal to 30.6 per cent., as compared with 12.6 in 1905, 18.7 in 1904, and 8.1 in 1903. As the consignees have generally tested the milk before requesting the Inspector to take samples, a large proportion of adulterated samples is always expected, but the rise over the proportion of the preceding years is very disappointing. Of the 214 samples procured locally (streets and shops) 11 were found to be adulterated, equal to 5.1 per cent., a proportion slightly lower than any recorded in the past three years, viz., 1905, 5.6; 1904, 5.4; and 1903, 5.3. The purchase of such samples is made periodically on Sundays as well as week-days. I he Use of Preservatives.—The Departmental Committee of the Government Board on the "Use of Preservatives and Colouring Matters in Foods," recommended in their Report (1901) 72 office work. that the use of preservatives and (or) colouring matters in milk should be absolutely prohibited by law.* Nothing has been done to give effect to that recommendation. In July of last year a communication on the subject was received from the Local Government Board, which, while urging greater effort to detect the use of preservatives in milk and the institution of proceedings with that object, practically suggested the fixing of a maximum standard of formalin or boric acid as permissible. The paragraph on this point reads as follows:— "As regards formalin and boron preservatives . . . the Board are advised that the presence in milk of formalin to an amount which is ascertained by examination within three days of collecting the sample to exceed 1 part in 40,000 (1 part in 100,000 of formic aldehyde) raises a strong presumption that the article has been rendered injurious to health, and that the purchaser has been prejudiced.. .; and also that similar presumption is raised when boron preservatives are present in milk to an amount exceeding 57 parts of boric acid per 100,000, or 40 grains of boric acid per gallon." In the earlier paragraphs of the letter the Board advert to the comparative rarity of the use of preservatives in London milk, and to successful proceedings which have been instituted in cases where preservatives have been found. The paragraph quoted above is at variance with the recommendation of the Board's Committee, and will doubtless be quoted in support of the use of preservatives in future proceedings. The views of the Board have no legal status, and may be ignored by magistrates. It does appear to be very desirable that the matter should be dealt with by Parliament at an early date. OFFICE WORK. The bulk of 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 bv 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 3,702 (3,672) Complaints received 845 (729) „ despatched 2,810 (2,342) Plans dealt with 483 (431) Entries in postage book 8,352 (7,932) New openings in Journals 970 (942) Cases of infectious disease entered in Register 1,083 (564) Notices sent re above 7,581 „ „ other diseases 4,962 (3,707) Disinfection Orders (duplicate) 1,879 (2,053) Notices to abate nuisances 1,158 Other notices. 1,250 (376) Figures for 1905 in parentheses. LEGAL PROCEEDINGS. The usual summaries of the results of cases taken into the Police Courts are appended hereto. In addition, a considerable number of cases were referred to the Solicitor, but completed without the intervention of the Courts. * Recommendation B—."That the use of any preservative or colouring matter whatever in milk offered for sale in the United Kingdom be constituted an offence under the Sale of Food and Drugs Acts." LEGAL PROCEEDINGS. 73 The fines and costs imposed and granted amounted last year to £97 16s., as compared with £152 3s. 8d. in 1905. The reduction was entirely in connection with the cases under the Sale of Food and Drugs Acts. The amount received under those Acts was £63 1s. last year, as against £126 17s. in the preceding year. In connection with cases under the "Health Acts," £34 odd were received, rather more than in the previous year. See below : Health Cases. Adulteration Cases. £ s. d. £ s. d. 1906 34 15 0 63 1 0 1905 25 6 0 126 17 0 1904 *62 6 6 101 2 6 1903 63 6 0 100 6 6 1902 32 19 0 175 6 6 1901 40 16 0 138 13 0 *£7 18. 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:— 1906. 1905. 1904. 1903. 1902. 1901. 1900. Average per conviction 1 Fine £0 16 6 £3 8 7 £2 15 2 £3 1 6 £3 3 8 £2 16 0 £3 4 0 Costs 0 15 0 1 2 0 1 5 8 0 15 7 0 16 0 0 15 0 1 2 3 It is a coincidence perhaps and nothing more that there should have been such a remarkable decline in the average of fines and costs in the Food Cases and such a great increase in the proportion of adulterated samples taken at the Paddington Terminus. 74 SUMMARY OF LEGAL PROCEEDINGS. SUMMARY OF LEGAL PROCEEDINGS DURING 1906. Under Public Health (London) Act. Fine. Costs. Section 4. £ s. d. £ s. d. 30, Elnathan Mews No water supply Closing order made. 36, „ „ „ „ „ „ 35, Hethpool Street Overcrowding Room vacated. Summons withdrawn. 13, Maida Hill West Defective drainage, &c. Closing Order made. 25, Oakington Road „ roof Work done. 0 2 0 Section 38. Royal Oak Yard, Bishop's Road ... No sanitary convenience for employees 0 10 0 2 2 0 Section 47. Anness. H.. 396, Harrow Road Exposing unsound pig for sale 5 0 0 2 2 0 Babb, H., 530, Harrow Road . ,, • ,, apples ,, 0 10 0 0 12 6 Looker, W., 106, Westbourne Grove „ „ melons,, 1 0 0 0 12 6 Malpas, J., 71, Hungerford Road... Selling diseased pig's pluck . Summons dismissed. Pain, F., 42, Southwick Street Exposing diseased meat for sale 5 0 0 3 3 0 Swift, R., 328, Harrow Road „ unsound oranges „ 5 0 0 2 9 0 Whiteley, W., Ltd., 159, Queen's Rd. ,, ,, meat „ Summons dismissed. By-laws relating to Houses let in Lodgings. 32, Amberley Road Annual cleansing Work done. Summons withdrawn. 35, „ „ „ „ „ 5, Cuthbert Street ,, „ „ 52, Goldney Road „ Work done. 0 2 0 3, Hall Place „ „ 0 2 0 23, „ „ Summons dismissed. £3 3s.costs against Council 42, „ „ Work done. 0 12 6 148, Kensal Road „ „ 0 2 0 16, Netley Street „ „ 0 12 6 17, „ „ „ 0 12 6 5, Southam Street „ „ 0 2 0 Other By-laws. 13, Maida Hill West Cistern dirty and uncovered Closing Order made. London County Council (General Powers) Act, 1904. Section 20. 16, Brindley Street Room in a verminous condition Work done. 0 2 0 30, „ „ „ „ 0 2 0 Metropolis Management Act, 1855. By-laws pursuant to Section 202. Dosser, 32, Walterton Road Failing to deposit plan of drainage work 0 10 0 3 3 0 Edgar, Garrick Road, West Hendon „ „ „ „ „ Plan supplied 0 2 0 Elkington & Sons, Roman Road, Bow „ „ „ „ „ 0 12 6 Whitemore, 18, Hazlemere Road, Brondesbury „ „ „ „ „ „ 0 2 0 SUMMARY OF LEGAL PROCEEDINGS. 75 SUMMARY OF LEGAL PROCEEDINGS DURING 1906. Under Sale of Food and Drugs Acts, 1875-1899. Fine. Costs. £ s. d. £ s. d. Milk 11% fat abstracted 1 0 0 0 18 6 „ 15% „ 1 0 0 0 12 6 „ 15% „ 1 0 0 0 12 6 „ 19% „ 1 0 0 0 12 6 „ 22% „ 1 0 0 0 12 6 „ 8% „ 0 10 0 1 0 6 „ 10% „ 0 5 0 0 2 0 „ 11% „ 0 5 0 0 2 0 „ 10% „ 0 5 0 0 2 0 „ 10% „ 0 5 0 0 2 0 „ 11% „ 0 5 0 0 2 0 „ 11% „ — 0 17 6 „ 25% „ — 0 17 6 „ 5% „ 0 10 0 1 4 6 „ 20% „ 10 0 0 12 6 „ 19% „ 0 10 0 0 12 6 „ 4% „ 0 10 0 0 12 6 „ 21% „ 0 10 0 0 12 6 „ 8% „ 0 10 0 0 12 6 „ 17% „ 0 10 0 0 12 6 „ 15% „ 0 10 0 0 12 6 „ 5% „ 0 10 0 0 12 6 „ 8% „ 0 10 0 0 12 6 „ 36% „ 0 10 0 5 ft 0 (1) „ 28% „ Dismissec ... — (2) „ 25% „ Dismissed : warranty proved. „ 23% „ 0 5 0 0 16 0 „ 16% „ — 0 17 6 „ 16% „ Dismissed : warranty proved. „ 16% „ 2 0 0 1 5 0 „ 10% „ — 0 12 6 (3) „ 10% „ Dismissed : warranty proved. „ 9% „ „ „ „ „ 17% added water — 0 12 6 (4) „ 16% „ 5 0 0 0 12 6 „ 6% „ 1 1 0 0 15 6 (5) Butter 88½% foreign fat 2 0 0 0 12 6 „ 85% „ 0 10 0 0 12 6 „ 85% „ 1 0 0 0 12 6 (6) „ 83% „ 3 0 0 0 12 6 „ 82% „ 2 0 0 0 12 6 „ 82% „ 1 0 0 0 12 6 „ 80% „ 0 10 0 0 12 6 „ 68% „ 2 0 0 0 12 6 7½% excess of water 0 10 0 0 12 6 Cases against the same Defendant are bracketed together. For Notes see next page. 76 SUMMARY OF LEGAL PROCEEDINGS. NOTES. (1) Defendant fined £3 with 12/6 costs on 17th January, 1897, for selling milk containing of added water. ,, £2 12/6 „ 3rd June, 1897, for selling milk containing 7% of added water. „ £1 12/6 „ 3rd June, 1897, for selling milk containing 6% of added water. ,, £10 25/- „ 5th December, 1902, for selling milk 10% deficient in fat. Defendant fined £40 with £10 10s. costs on 9th June, 1905, for selling milk 12% deficient in fat. Summonses heard on 25th April, 1902, and 11th March, 1904, were dismissed, the defendant proving a warranty in each case. (2) A summons heard on the 27th October, 1906, was dismissed, but the defendants' servant was ordered to pay 1d. for damage done to milk and 40s. for wilfully damaging same, or in default one month. (3) Defendant fined £2 with 12/6 costs, on 18th December, 1903, for selling milk 10% deficient in fat. (4) „ £2 2/- „ 29th May, 1904, for selling milk containing 17% of added water. „ £3 12/6 „ 16th February, 1899, for selling milk containing 17% of added water. „ £3 12/6 „ 8th March, 1901, for selling milk containing 12% of added water. „ £3 23/- „ 1st August, 1902, for refusing to supply sample. „ £10 12/6 „ 23rd January, 1903, for selling milk containing 12% of added water. „ £10 12/6 „ 7th August, 1903, for selling milk containing 7% of added water. Summonses heard on 1st January and 5th February, 1904, were dismissed, the defendant proving a warranty in in each case. (5) „ £2 12/6 „ 12th December, 1902, for selling milk containing 10% of added water. (6) ,, £1 12/6 „ 17th January, 1902, for selling butter containing 80% of foreign fat. 77 METROPOLITAN BOROUGH OF PADDINGTON. By-laws with respect to the management of the Mortuary, made by the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Paddington, in pursuance of Section 88 of the Public Health (London) Act, 1891, and Section 184 of the Public Health Act, 1875 (incorporated in the said Public Health (London) Act, 1891) at a Meeting of the Council held on the 5th March, 1907, at which not less than two-thirds of the whole number of the Council were present. Interpretation. 1.—Throughout these By-laws the expression "the Council" means the Mayor,-Aldermen, and Councillors of the Metropolitan Borough of Paddington. 2.—Every person who, in pursuance of permission obtained from the Council, has caused the body of one who has died of an infectious disease to be deposited in the Mortuary shall cause the body to be removed therefrom for the purpose of interment within a period of three days from the date of death. Provided that if an inquest is about to be held on the body, such person shall not cause the body to be removed except with the authority or on the certificate of the Coroner, but such person shall cause the body to be removed within twenty-four hours after the issue of such authority or certificate. 3.—Every person who, in pursuance of permission obtained from the Council, has caused the body of one who has died of a non-infectious disease to be deposited in the Mortuary shall cause the body to be removed therefrom for the purpose of interment within a period of four days from the date of death. Provided, further, that if before the expiration of the above period the body is in such a state of decomposition as to cause a nuisance, he shall, on receiving a notice from the Borongh Council or the Medical Officer of Health that it is in such a state, cause the body, with all reasonable dispatch, to be removed from the Mortuary for the purpose of interment, or to be placed in an air-tight coffin and fastened down. 4.—Every person for the time being employed in depositing a body in the Mortuary, or in removing a body therefrom, shall, while so employed, conduct himself in all respects with decency and propriety. 5.—Every person who, being a friend or relative of one whose body has been deposited in the Mortuary, has been admitted to view the body shall, while on the premises, conduct himself in all respects with decency and propriety. 6.—Every person who, for the purpose of depositing a body in the Mortuary, uses a shell which has not been provided by the Council, shall, in every case where the body is transferred from the shell before being carried from the premises to the place of burial, cause the shell, as soon as conveniently may be after the transfer of the body therefrom, to be removed from the premises. 7.—Every person who shall offend against any of the foregoing By-laws shall be liable for every such offence to a penalty of Two Pounds, and in case of a continuing offence to a further penalty of Ten Shillings for each day after written notice of the offence from the Council. Provided, nevertheless, that the Justices or Court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think fit, adjudge the payment as a penalty, of any sum less than the full amount of the penalty imposed by this By-law. In witness whereof the Council of the Metropolitan Borough of Paddington have caused their Common Seal to be hereunto affixed this Twenty-second day of March, 1907. A. W. J. RUSSELL, Town Clerk. 78 vital statistics. APPENDIX. TABLE I. Vital Statistics of Whole District during 1906 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 the District. Deaths of Residents registered beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate* Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1896 140,022 3,616 2537 585 162 2,349 16.49 672 316 225 2,258 15.85 1897 140,829 3,554 25.23 559 157 2,168 15.39 519 294 224 2,098 14.89 1898 141,648 3,444 24.31 591 171 2,433 1717 600 330 235 2,338 16.50 1899 142,477 3,452 2422 549 159 2,445 1716 606 298 223 2,370 16.63 1900 143,318 3,370 2351 524 155 2,519 17.57 708 401 218 2,336 16.29 1901 144,188 3,359 2329 484 144 2,163 1500 652 324 218 2,057 14.26 1902 145,052 3,305 22.41 474 144 2,311 15.67 735 366 207 2,152 14.58 1903 145,927 3,302 22.62 425 128 2.103 14.41 743 366 181 1,918 1314 1904 146,815 3,295 22.44 490 148 2,228 15.17 780 387 173 2,014 13.71 1905 147,713 3,184 21.55 441 139 2,210 14.96 806 410 161 1,961 13.27 Averages for years 1896.1905. 143,867 3,388 23.49 512 151 2,293 15.89 682 349 206 2,150 14.91 1906 148,621 3,152 21.22 395 125 2,041 13.73 775 395 197 1,843 12.40 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water), 1,336. Total population at all ages, 143,976 Number of inhabited houses, 13,221 Average number of persons per house, 8.9 At Census of 1901. vital' statistics. 79 TABLE II. Vital Statistics of Separate Localities during 1906 and Ten Previous Years. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond, the Borough. 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. 6. c. d. 1896 140,022 3,616 2,258 564 88,591 2,613 1,583 415 33,695 455 359 62 17,736 548 316 87 1897 140,829 3,554 2,098 535 89,534 2,586 1,455 403 33,678 424 355 45 17,617 544 288 87 1898 141,648 3,444 2,338 567 90,488 2,558 1,663 419 33,660 407 367 57 17,500 479 308 91 1899 142,477 3,452 2,370 530 91,451 2,555 1,709 407 33,643 385 353 36 17,383 512 308 87 1900 143,318 3,370 2,336 545 92,425 2,479 1,675 425 33,626 411 386 52 17,267 480 275 68 1901 144,188 3,359 2,057 455 93,424 2,536 1,452 353 33,612 389 348 40 17,152 434 257 62 1902 145,052 3,305 2,152 433 94,419 2,443 1,556 325 33,595 386 326 32 17,038 476 270 76 1903 145,927 3,302 1,918 388 95,425 2,483 1,376 305 33,578 382 305 40 16,924 437 237 43 1904 146,815 3,295 2,014 449 96,441 2,524 1,420 335 33,561 378 345 43 16,813 393 249 71 1905 147,713 3,184 1,961 391 97,468 2,386 1,397 300 33,544 388 343 39 16,701 410 221 52 Averages of Years 1896 to 1905. 143,867 3,388 2,150 486 93,030 2,517 1,528 369 33,619 400 349 45 17,218 471 273 72 1906 148,621 3,154 1,843 353 98,505 2,356 1,320 269 33,527 360 317 42 16,589 436 206 42 Rates 1906 - 21.22 1240 112 - 23.91 1340 114 - 10.73 945 117 - 26.28 12.41 96 Mean 18961905 - 23.49 14.91 1.42 — 27.02 16.42 1.46 — 11.87 10.34 1.10 — 27.24 15.93 1.52 * 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. 80 DEATHS IN LOCAL INSTITUTIONS. TABLE III. Deaths in Local Institutions. Year. Paddington Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. 1396 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 327 360 92 1 1905 324 387 91 4 Averages 1896-1905 259 335 76 3 1906 314 356 98 7 * Closed part of year for repairs and alterations. TABLE IIIa. Causes of Deaths in Institutions. 1906. 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 1 ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... 16 ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... Whooping-cough ... 1 1 ... ... ... ... ... ... Diphtheria ... 2 2 ... 11 ... ... ... ... Enteric Fever 1 2 2 ... 1 ... ... ... ... Diarrhoea 1 8 1 ... ... ... ... 1 ... Epidemic Enteritis 14 3 12 ... ... ... ... ... 1 Erysipelas 5 ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... 1 ... ... ... Other Septic Diseases 2 8 1 1 ... 4 ... ... ... Tuberculosis of Lungs. 55 15 2 4 ... 6 9 ... ... Other forms of Tuberculosis 15 16 23 1 ... 4 ... 1 1 Cancer 36 40 1 10 ... 18 1 ... 4 Premature Birth 3 ... 4 1 ... 4 ... ... ... Developmental Diseases ... 7 7 1 ... 6 ... 2 1 Old Age 34 ... ... 3 ... 3 5 ... ... Bronchitis 40 6 ... 1 ... 1 2 2 ... Pneumonia 12 25 13 ... ... 1 1 1 3 Cirrhosis of Liver 5 6 ... 1 ... 4 ... ... ... Accidents of Childbirth ... 1 ... ... ... 1 ... ... ... Accidents and Violence 5 44 7 ... ... 3 ... ... 3 Suicides 2 6 ... ... ... ... ... ... 5 All other Causes 83 166 21 18 5 27 25 3 6 All Causes 314 356 98 41 35 83 43 11 25 Non-Residents* 78 254 73 28 ... ... ... ... ... * The deaths of 22 other non-residents took place either in the streets or houses in the Borough. CAUSES OF DEATH AT VARIOUS AGES IN EACH SEX. 81 TABLE IV. Causes of Death : Bofough—Sex and AgE. Distribution. 1906. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond the Borough. L. G. B. 0— 1 — 5— 15 - 25- 65 and upwards. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 1 7 4 ... 1 ... ... ... ... ... ... 10 6 16 Scarlet Fever 1 ... 7 2 4 3 ... 1 ... ... ... ... 12 6 18 Epidemic Influenza 1 1 ... ... ... ... ... 1 3 9 4 16 8 27 35 Whooping-cough 2 1 4 4 1 1 ... ... ... ... ... ... 7 6 13 Diphtheria, Membranous Croup ... ... 4 4 1 5 ... ... ... ... ... 1 5 10 15 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... 1 1 2 3 1 ... ... 4 4 8 Diarrhoea, Dysentery 30 24 3 7 ... ... ... ... ... 1 ... 1 33 33 66 Epidemic, Zymotic Enteritis 26 33 3 3 ... ... ... ... 1 ... ... ... 30 36 66 Enteritis 8 3 2 1 ... ... 1 ... 2 3 ... ... 13 7 20 Other Continued Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 4 3 ... ... ... ... ... ... ... 2 ... ... 4 5 9 Erysipelas 1 1 ... ... ... ... ... ... ... 1 2 2 3 4 7 Puerperal Fever ... ... ... ... ... ... ... ... ... 3 ... ... ... 3 3 Other Septic Diseases:— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stomatitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pyaemia 1 1 ... ... ... ... ... ... 1 ... ... ... 2 1 3 Cellulitis ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... Cancrum Oris ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 2 Infective Endocarditis ... ... ... ... ... ... ... ... 3 ... ... ... 3 ... 3 Angina Ludovici ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Septic Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever ... ... ... ... ... 1 1 1 ... 3 ... ... 1 5 6 Tuberculosis of Meninges 4 4 2 3 3 4 ... 2 1 ... ... ... 10 13 23 Tuberculosis of Lungs ... ... 1 3 ... 2 12 8 76 49 5 5 94 67 161 Other Forms of Tuberculosis 4 2 5 3 1 2 ... ... 5 6 1 3 16 16 32 Alcoholism ... ... ... ... ... ... ... ... 6 4 1 1 7 5 12 Cancer 1 ... ... ... 1 2 ... ... 31 71 24 34 57 107 164 Premature Birth 21 23 ... ... ... ... ... ... ... ... ... ... 21 23 44 Developmental Diseases 49 20 2 5 ... ... ... ... ... ... ... ... 51 25 76 Old Age ... ... ... ... ... ... ... ... ... 2 27 73 27 75 102 Meningitis 2 5 3 3 1 1 ... 1 2 2 ... ... 8 12 20 Inflammation and Softening of Brain ... ... ... ... 1 2 ... ... 3 4 1 3 5 9 14 Convulsions 4 2 ... ... ... ... ... ... ... ... ... ... 4 9 6 Apoplexy ... ... ... ... ... ... ... ... 3 5 4 4 7 9 16 Cerebral Haemorrhage ... ... ... ... ... ... 1 ... 8 12 9 11 18 23 41 Organic Diseases of Heart 1 ... ... ... 2 ... 2 1 15 23 10 12 30 36 66 Heart Disease ... ... ... ... ... ... 1 3 12 17 5 11 18 31 49 Acute Bronchitis 8 9 1 1 ... ... ... ... 4 6 11 12 21 28 52 Chronic Bronchitis ... ... ... ... ... ... ... ... 13 4 9 10 22 14 36 Bronchitis ... ... ... ... ... ... 1 ... 13 9 16 31 30 40 70 Lobar (Croupous) Pneumonia 1 ... ... 1 ... ... ... 1 7 4 1 2 9 8 17 Lobular (Broncho-) Pneumonia 7 8 5 3 ... ... ... ... 4 5 1 6 17 22 39 Pneumonia 3 1 4 3 ... 1 1 ... 20 8 7 7 35 20 55 Diseases of Stomach 1 1 ... ... ... ... ... 1 7 ... 3 2 11 4 15 Obstruction of Intestines. 3 ... 1 ... ... 1 1 ... 3 2 1 1 9 4 13 Cirrhosis of Liver ... ... ... ... ... ... ... ... 8 14 1 2 9 16 25 Nephritis and Bright's Disease 1 ... ... ... 1 ... ... ... 19 15 8 19 29 34 63 Tumours, &c , of Female Genital Organs ... ... ... ... ... ... ... 1 ... 4 ... 2 ... 7 7 Accidents and Diseases of Parturition ... ... ... ... ... ... ... ... ... 6 ... ... ... 6 6 Accidents and Negligence 6 9 5 3 1 1 2 2 21 5 3 6 38 26 64 Suicide ... ... ... ... ... ... ... ... 9 5 ... ... 9 5 14 Ill-defined Causes ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 All other Causes 4 4 9 5 4 10 7 7 51 53 51 41 126 120 246 All Causes 197 156 69 59 21 38 31 32 356 360 205 319 879 964 1843 82 DEATHS AT ALL AGES. TABLE V. Causes of Death : All Ages, Persons.—In Wards and Registration Sub-Districts. 1906. 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 1 4 3 4 4 ... ... ... 15 ... Scarlet Fever 2 1 1 2 9 ... 2 1 13 3 Epidemic Influenza 1 4 6 4 10 2 3 5 21 13 Whooping-cough 1 3 1 2 4 ... ... 2 9 3 Diphtheria, Membranous Croup 3 5 2 ... 5 ... ... ... 12 ... Croup ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 3 ... 1 2 1 ... ... 6 1 Diarrhoea, Dysentery 10 13 6 11 21 ... ... 5 50 6 Epidemic, Zymotic Enteritis 10 11 3 9 27 ... 2 4 49 7 Enteritis 1 6 4 2 5 1 1 ... 16 3 Other Continued Fevers ... ... ... ... ... ... ... ... ... ... Syphilis 2 1 ... 4 2 ... ... ... 7 ... Erysipelas 1 3 ... 1 2 ... ... ... 6 ... Puerperal Fever 2 1 ... ... ... ... ... ... 1 ... Other Septic Diseases:— Stomatitis ... ... ... ... ... ... ... ... ... ... Pyaemia ... ... 1 1 1 ... ... ... 3 ... Cellulitis ... ... ... ... 1 ... ... ... 1 1 Cancrum Oris ... ... ... ... 2 ... ... ... 2 ... Infective Endocarditis ... ... 1 ... 1 ... ... 1 2 ... Angina Ludovici ... 1 ... ... ... ... ... ... 1 ... Septic Laryngitis ... ... ... ... ... ... ... ... ... ... Rheumatic Fever 1 ... 1 ... 2 ... ... 2 3 2 Tuberculosis of Meninges 5 3 3 3 6 ... ... 3 14 4 Tuberculosis of Lungs 20 27 24 31 46 3 ... 8 124 17 Other Forms of Tuberculosis 5 9 6 2 9 1 ... ... 26 1 Alcoholism ... 2 1 5 1 ... 1 2 9 3 Cancer 13 27 27 30 37 9 9 12 118 33 Premature Birth 6 6 4 5 15 ... 2 6 30 8 Developmental Diseases 9 15 13 15 15 ... 1 8 57 10 Old Age 8 17 16 15 25 7 3 11 71 23 Meningitis 3 6 3 1 5 2 ... ... 14 3 Inflammation and Softeningof Brain ... 2 1 8 2 ... ... 1 13 1 Convulsions 1 ... 2 1 2 ... ... ... 5 ... Apoplexy 3 7 2 1 1 ... 1 1 11 2 Cerebral Haemorrhage 2 7 7 8 9 3 2 3 31 8 Organic Diseases of Heart 8 11 7 14 13 1 1 11 45 13 Heart Disease 12 8 3 5 14 ... 2 5 30 7 Acute Bronchitis 2 8 10 8 18 2 ... 4 43 7 Chronic Bronchitis 3 1 6 6 13 2 1 4 26 7 Brenhitis 10 16 6 11 23 ... 1 3 53 7 Lobar (Croupous) Pneumonia 1 2 1 3 7 ... ... 3 12 4 Lobular (Broncho-) Pneumonia 6 8 5 5 9 2 ... 4 26 7 Pneumonia 1 7 8 14 20 ... 1 4 47 7 Diseases of Stomach 2 1 2 5 3 1 ... 1 10 3 Obstruction of Intestines 2 3 3 4 1 ... ... ... 11 ... Cirrhosis of Liver 2 4 4 5 4 1 2 3 17 6 Nephritis and Bright's Disease 9 9 8 5 17 3 4 8 38 16 Tumours, &c., of Female Genital Organs 1 1 2 ... 2 ... ... 1 5 1 Accidents and Diseases of Parturition ... ... 1 1 2 ... 1 1 4 2 Accidents and Negligence 6 9 9 7 25 3 ... 5 47 11 Suicide 2 3 2 1 ... 1 ... 5 6 6 Ill-defined Causes 1 ... ... ... ... ... 1 ... ... 1 All other Causes 27 44 36 37 44 13 13 32 160 59 All Causes 206 319 251 297 486 58 57 169 1,320 317 * The Wards are— I.—Queen's Park. II.—Harrow Road. III.—Maida Vale. IV.—Westbourne V.—Church. VI.—Lancaster Gate (West). VII.—Lancaster Gate (East). VIII.—Hyde Park. The Registration Sub-Districts are— A.—North-West Paddington, co- terminous with Queen's Park Ward. B.—St. Mary. C.—St. John. DEATHS OF INFANTS UNDER ONE YEAR. 83 TABLE VI. Deaths of Infants under One Year. Corrected for Non-Residents, &c., 190(5. L. G. B. Cause of Death. Weeks. Months. All Ages. 0— 1— 2— 3— 0— 1— 2— 3— 4— 5— 6— 7— 8— 9— 10— 11— 1906 Averages 1901-5 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. M. F. I. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 0 Measles ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... ... 3 1 5 6 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0 1 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 2 1 10 8 II. Diarrhoea ... ... ... ... 1 2 1 4 2 6 7 9 8 5 8 9 7 6 7 6 4 2 4 7 1 1 4 3 ... 1 4 2 56 57 47 37 Enteritis ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 8 3 6 3 III. Premature Birth 17 17 2 2 ... 2 1 1 20 22 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 23 35 26 Congenital Defects 3 2 2 ... ... ... ... 1 5 3 ... ... 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 5 6 8 Injury at Birth 4 1 ... ... ... ... ... ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 2 1 Want of Breast Milk ... ... ... ... ... 1 1 ... 1 1 3 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 6 3 2 2 Atrophy, Debility ... ... 1 ... 1 ... ... ... 4 ... 3 ... ... 1 3 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 13 6 18 12 Atelectasis 3 ... ... ... l 1 ... ... 4 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 1 3 3 Debility at Birth 3 2 3 ... 2 ... ... 1 8 3 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 4 9 6 IV. Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... 1 1 ... 1 1 1 4 4 3 5 Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 3 2 Other Tubercular Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 5 2 V. Erysipelas ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 Syphilis ... ... ... ... 1 ... ... ... 1 1 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 4 3 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 0 Meningitis ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... 1 ... 1 ... ... ... 5 3 2 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... 4 ... 11 10 Bronchitis ... ... ... ... ... l ... ... ... 1 1 ... ... 1 ... ... 1 ... ... 2 2 ... ... 1 1 ... 1 2 ... 1 ... ... 8 9 17 11 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0 0 Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 9 1 ... ... 1 ... l 1 ... 2 2 ... 2 1 ... 11 9 24 16 1 1 l 1 1 3 i 3 1 ...' 5 5 6 5 Other Causes 1 1 1 2 4 1 l 1 i 3 2 3 1 1 1 1 5 i 1 16 11 15 15 All Causes 32 24 9 1 6 8 8 5 8 54 46 23 18 16 12 21 15 14 15 17 11 9 6 11 9 4 4 15 10 4 7 9 3 197 56 237 186 Averages—1901-05 43 29 10 12 10 9 9 7 72 57 28 21 24 14 20 17 15 13 12 9 13 10 14 8 11 9 10 10 8 9 10 9 237 186 Population—middle of 1906 ...148,621. Births registered within the Borough, Average 1906. 1901-5. m. f. ... m. f. /legitimate 1,553 1,465 ... 1,598 1,543 (illegitimate 80 54 ... 75 73 Total ... 1,633 1,519 1,673 1,616 Deaths—all causes at all ages ... 1,843. 84 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. TABLE VII. 1.-Inspection. Including Inspections made by Sanitary Inspectors. H.O. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 480 2 ... Workshops (including Workshop Laundries) 1682 31 ... Workplaces (other than Outworkers' premises included in Part 3 of this Report) 447 5 1 Total 2609 38 1 3.—Home Nature of Work. Outworkers' Lists, Section 107. Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Twice in the year. Once in the year. Lists. Outworkers. Lists. Outworkers. Wearing Apparel— (1) making, &c. 44 311 32 78 248 262 (2) cleaning and washing ... ... ... ... 4 ... Lace, lace curtains and nets ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... 2 ... Umbrellas ... ... ... ... ... ... Brush making ... ... ... ... ... ... Electro Plate ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... Total 44 311 32 78 254 262 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. Bootmaking 54 (7) Dressmaking 306 (40) Millinery, and Millinery and Dressmaking 51 Tailoring 103 (43) Other Wearing Apparel 30 (5) Laundries 51 Coach and Van Building 39 Upholstery 32 (5) Bakehouses 69 Other 183 (1) Total number of workshops on Register 918 (101)* * The figures in parentheses refer to Outworkers. factories, workshops, laundries, workplaces and homework 85 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 80 75 ... ... Want of Ventilation 3 1 1 ... Overcrowding 8 8 ... ... Want of drainage of floors 4 4 ... ... Other nuisances 59 52 3 ... Sanitary accommodations insufficent 1 1 ... ... unsuitable or defective 24 23 ... ... not separate for sexes 2 1 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) ... ... ... ... Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) 47 2 46 ... Total 228 167 50 ... Work. Prosecutions. Number of Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Instances. Notices served. Prosecutions Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Failing to keep or permit of lists. Failing to send lists. ... 561 ... ... ... 12 ... ... ... 22 ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... 45 ... ... ... 1 ... ... ... 6 ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... 7 ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... 649 ... ... ... 15 ... ... 5.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 45 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory Act (S. 5) Notified by H.M. Inspector 18 Reports (of action taken) sent to H.M. Inspector 18 Other 5 Underground Bakehouses (S. 101):— Certificates granted during the year - In use at the end of the year 58 86 PROCEEDINGS DURING 1906. TABLE VIII. PROCEEDINGS DURING 1906. L.C.C. Premises. Number of Prices— Number of Inspections, 1906. Number of Notices, 1908. Number of Prosecutions, 1906. On Register at end of 1905. Added in 1905. Registered in 1906 On Register at end of 1906. Milk premises 172 9 3 178 218 7 Cowsheds 1 1 3 Slaughter-houses 8 8 631 Other offensive trade premises Ice cream premises 137 10 1 146 72 Registered houses let in lodgings 1,150. 140 18 1,272 7,474 (a)* 28 (a)* ••• (b)* 4,422 (b)* 13 * (a) For overcrowding. * (i>) For other conditions (including annual cleansing). Total number of intimation notices served for all purposes 960 Overcrowding, 1906— Number of dwelling rooms overcrowded 438 Number remedied 287 Numbers of prosecutions 1 Underground rooms— Illegal occupation dealt with during year JS Number of rooms closed t Insanitary houses— Number closed under the Public Health (London) Act 1891 Number closed under the Housing of the Working Cases Act — Number of prehiises cleansed under Sec. 20 of the L.C.C. (General Powers) Act, 1904 227 Shelters provided under See. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year — Revenue Acts— Number of houses for which applications were received during year 18 Number of tenements comprised therein 148 Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc. — (/) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. 1 (h) With respect to water closets, earth closets, etc. — (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) 4 Mortuaries— Total number of bodies removed 281 Total number of infectious bodies removed 4 Number of tenements tor which certificates were (a) granted 9C (b) refused 20 (c) deferred 38