C 4349 MEDICAL RESEARCH COUNCl LIBRARY. NO 18944 PAD 12 Metropolitan Borough of Paddington. annual report of the council FOR THE YEAR 1907. APPENDIX. REPORT OF THE Medical Officer of Health. LONDON: MORTON & BURT, Ltd., Printers, 187, EDGWARE ROAD, PADDINGTON, W. Metropolitan Borough of Paddington. REPORT ON The Vital Statistics AND Sanitary Work For the Year 1907. BY REGINALD DUDFIELD, M.A., M.B., D.P.H., F.S.S.. Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. CONTENTS. Page Alcoholism, Deaths from 31 Bacteriological Examinations, Results of 50 Bakehouses, Inspection of 57 Births and Biuth-Rates 3 Canals 53 Canal Boats Acts 53 Cancer, Mortality from 24 Cerebro-spinal Fever 17 Childbed, Mortality in 17 Childhood, Mortality of 32 " Clarendon Street Area " 62 Combined Drainage 52 Common Lodging Houses 63 "Consumption" See Phthisis. Cowhouses 65 Dairies and Milkshops b5 Deaths and Death-Rates 7 Deaths in Institutions 45 Death-rates, Factor Corrected 10, 20, 28 Diarrhoea, Deaths from 39 Diphtheria, Cases of 11 „ Mortality from 14 Disinfection, General 47 „ after " Consumption" 23 Draips, Private, Re-laid 51 Enteric Fever, Cases of 16 „ Mortality from 17 Erysipelas 18 Factory and Workshop Act, 1901, Work Under 53 Food Analysis, Summary of Samples taken 67 „ Summary of Proceedings 72 Food Supervision 64 Food Adulteration 6< Food Purveyors 64 "Health Visiting" 42 Home Work 54 Hospital Isolation of " Consumptives " 23 House Refuse 51 Houses let in Lodgings, Annual Cleansing of 60 „ ,, Sickness, etc., in 61 „ „ Registration of 58 „ „ Overcrowding of 60 „ „ Sanitary defects in 61 „ „ Verminous rooms 60 „ „ Vital Statistics 62 Housing of " Consumptives " 22 Ice Cream, Inspection of places where made 65 Illegitimates, Births of 4 ,, Deaths of 39 Infants, ages at death of 36 „ cause of death of 37 „ Mortality among 32 „ in certain districts 35 „ in Wards 35 Page Influenza, Mortality from 31 Inhabited House Duty, Exemption from 63 Inquests held 44 Institutions, Deaths in 45 Intemperance 31 Legal Proceedings, Summary of 69 Manure, Removal of 51 Measles, Cases reported 25 ,, Fatality of 26 ,, Mortality ftom. 28 Meat Supply 64 Meteorology 2 Milkshops, Trades carried on at 6o Mortality among Infants—" Hopeless Births' 34 Mortuaries 48 Notifications 4 Notification of Phthisis ("Consumption ") 21 Offensive Refuse, Removal of 51 Office Work 69 " Other Septic Diseases" ... 19 " Other Tubercular Diseases" 24 Outworkers ... ... ... 54 Phthisis, Mortality from 19 Population, Estimate 1 Preservatives in Foods 68 Prevention of " Consumption" 21 „ of Infectious Diseases 47 Puerperal Fever 17 Respiratory Diseases, Mortality from 31 Scarlet Fever, Cases of lo „ „ Mortality from 16 Schools and Infectious Diseases 48 Septic Diseases, Mortality from 17 Slaughterhouses, Inspection of 64 Small-pox 11 Smoke Prevention 52 Trade Refuse 51 Tubercular Diseases, Mortality from 19 Unsound Food seized 66 Vaccination Water Supply, Cutting off of Whooping Cough, Cases reported 29 „ „ Mortality from 30 Workshops, Inspection of 55 „ Registration of 53 „ Sickness on premises of 57 APPENDIX. Tables required by the Local Government Board, Home Office, and London County Council 73-81 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 the Public Health Department during the past year. Vital statistics may be described as equivalent to a balance sheet — the births figuring on the income side, sickness and deaths on the expenditure, while the estimate made annually of the population stands for the stock-taking. Just as no balance sheet, however accurate the income and expenditure accounts may be, is reliable when the stocktaking is untrustworthy, so are vital statistics but uncertain tests when the estimate of the population is little better than a guess. With ten years' intervals the intercensal estimates become increasingly unreliable. The unreliability is the greater when the rate-books show an increasing proportion of " empties," as do those of this Borough. Unfortunately the system of rating allows no comparison of occupied properties with the number of " inhabited houses" as defined for census purposes. The only available checks on the estimate given in this report, which estimate has been based on an assumption of a constant annual increase equal to that of the decennium of 1891—1900, are those afforded by the " natural increment," or balance of births over deaths of total population (see page 1), and bv the calculated numbers of "survivors" at ages under five (see page 40). In both cases the evidence points to a greater increase than that given by the original estimate. The absolute necessity of an intermediate (or quinquennial) enumeration of the population cannot be too strongly urged. Such enumeration would suffice if limited to the sex and age of each inhabitant. Although improved methods of " clearance " gave a somewhat larger number of births in 1907 than in 1906, no satisfaction attaches to that result. The birth rate is still falling. On the other hand small but satisfactory reductions have to be recorded in the morbidity and mortality (" all ages " and " infantile ") rates. Notification showed that scarlet fever was unduly prevalent both in the Metropolis as a whole and in the Borough. The other diseases were below their respective averages. Of the diseases producing death most interest at the present time attaches to phthisis ("consumption") and "cancer." The former was the subject of a special report presented to the Public Health Committee in February of last year, and forwarded to the Council in March. On the recommendation of the Committee a Conference of representatives from the Metropolitan Sanitary Authorities was held on June 6th. It is unnecessary to repeat at length what was written in the report referred to, but it may be permitted to advert to one or two points which are deemed to be essenital to a successful control of the disease. 11. The first is the need of compulsory notification. That need was endorsed by the Conference by a majority of nearly two to one, but unfortunately the Local Government Board has yet to be convinced. The Scotch Board on the other hand, has urged the adoption of compulsory notification, and the Irish Board has at the present time a Bill before Parliament to make notification compulsory throughout that country. Notification alone, however, is useless, and it is the difficulty of deciding what action should follow thereon which appears to make the Local Government Board hesitate to take any steps to promote compulsory notification. Having regard to the differences between phthisis and those other infectious diseases (commonly known as "specific fevers" or "zymotic diseases") which are already notifiable, it is evident that the preventive measures prescribed against the latter cannot be applied indiscriminately against the former. I think that the spread of tubercular phthisis can be checked most successfully by (a) education of the patient and his relatives, on the infective nature of the disease; (b) provision of sanatoria and hospitals, the former for hopeful, the latter for hopeless cases; and (c) legislation to require disinfection from time to time and (to a very limited extent) removal to hospital of patients whose home surroundings render the spread of the disease almost inevitable. Notification should also be used as a means for searching out early cases of the disease. Many relatives of patients whose cases have been notified have been found (e.g. by the Edinburgh Tuberculosis Dispensarv Staff) to be affected with the disease, the existence of which they were quite ignorant. Early diagnosis affords such persons their best chance of recovery. (It cannot be too strongly stated that the disease is readilv curable if taken in hand in its early stages). The "campaign" indicated above is one in which municipal action requires the co-operation of philanthropic agencies and of the public itself. The Health Society through its Phthisis Committee is rendering valuable assistance by supplementing the work of the Department. The establishment of a " tuberculosis dispensary " in the Borough, working on lines closely following those of the Edinburgh Dispensary which has been so successful during the past twenty years, should prove a notable addition to the existing agencies for coping with the disease. The provision of hospitals (or infirmaries) for hopeless cases may be said to fall naturally within the province of the municipality, but sanatoria should be largely the charge of philanthropic agencies. It is a matter for great regret that the Trade Unions have not initiated insurance of their members against sickness and incapacity, following with suitable modifications the German system which, while securing the insurees against pauperism, has provided a large amount of accommodation in sanatoria, &c., together with maintenance of the patient's dependents during his stay therein. In this country reliance has mainly been placed, up to the present time, on general •sanitary (municipal) work and independent uncorrt Hated philanthropic (hospital) efforts. There is good reason to believe that the maximum results of such procedure have been attained and that to further reduce " consumption " fresh measures duly co-ordinated are necessary. This view is, to a certain extent, confirmed by the experience based on the results .of work directed to reduce the rate of infantile mortality. Until the close of the last century no special efforts were made to limit the mortality of infants which remained equal to, and at times exceeded, that of the earliest days of "sanitary control," although the general death rate had fallen greatly. With the beginning of this century a change was made. For several years past writers and speakers who have studied the question, have invited attention to the continuous decline in the birth-rate, and the consequent decrease in the rate of growth of the Nation. The general public can now III be said to appreciate the importance of the subject and to be anxious to make good, so far as may be possible, the deficiency in the number of children born bv active steps to limit infantile mortality from causes which are largely preventible. It is unnecessary to describe the methods which have been introduced, some of them admittedly temporary palliatives rather than cures, but the results have been satisfactory. During the past year the Health Society has actively co-operated with the Department in this part of its work, not only by undertaking some of the " health visiting " but also by establishing two " Infant Consultation " centres and by assisting to secure an adequate supply of good milk for really necessitous children. The success which has already attended the special efforts made in this Borough is shown by the following comparison of the rates of infantile mortality. As regards this Borough infantile mortality rates for all the years since 1875 are on record. The mean rates for the three quinquennial periods 1875—79, 1896—1900, and 1903—7 were 140, 156 and 121 per 1000 births registered. It will be noticed that in the second period the rate was 11 per cent, above that for the first, although the general (all ages) death rate decreased by 8 per cent, from 17*4 to 16*0. The difference between the rates for the second and third periods represents a decrease of nearly 23 per cent. MEAN RATES. INDEX NUMBERS. Infantile Mortality. All Ages Mortality. Infantile Mortality. All Ages Mortality. 1875-79 140 17.43 100 100 1886-1900 156 16.03 111 92 1903-07 121 13.19 86 76 The figures given above show that the decrease in the infantile rate during the last five years although satisfactory, is still 10 per cent. less than the decrease in the rate at all ages. Nevertheless the figures afford evidence that the recently inaugurated measures are on the right lines and that better results may be hoped for as the subject is better understood and the system better organised. One specially fatal complaint, i.e., summer diarrhoea, yet remains to be provided against. Against this last it is hoped to organize a campaign during the current year. It is a matter for sincere regret that the local health authorities will lose the advantages which would accrue by the co-ordination of inspection of children and supervision of home surroundings, there being no prospect of the administration of the Education (Administrative Provisions) Act, 1907 being connected with the Public Health Department. There is still much room for improvement in the regulation of food supplies. Additional restrictions in the use of preservatives and more direct responsibility for placing diseased meat on the market require to be provided. It is to be hoped that the Local Government Board will deal with these points under the Public Health (Regulation of Foods^ Act, 1907. All the members of the Staff have discharged their respective duties efficiently. Calls to devote part of their leisure to cope with the inevitable increase in work have been cheerfully responded to. It is with pleasure that I record my acknowledgments of the hearty co-operation which I receive at all times from the Medical Profession of the Borough, and my sincere IV. thanks to the Chairman and Members of the Public Health Committee, for their kindly consideration and unfailing sympathy with which the proposals, which I from time to time bring forward are received. I have the honour to be, Mr. Mayor and Gentlemen, Your most obedient servant, m.a., m.b., d.p.h., f.s.s., Medical Officer of Health. Town Hall, Paddington, W. June, 1U08. REPORT. Thk Borough.—The area of the Borough comprises 1,350 acres, including 20 of water (canals) and 175 (approximately) of open spaces. At the last census (1901) there were 17,(584 inhabited houses, occupied by 33,(101 families, of whom 2J ,8]5 lived in homes of less than five rooms. Of the inhabitants of such homes 27.6 per cent, were returned as "overcrowded," that is, the inhabitants of the homes averaged more than two per room, irrespective of the ages of the occupants. The proportions of the total inhabitants of the Borough, so " overcrowded," were 13.5 per cent, in 1901, and 16'7 in 1891 (Old Parish of Paddington). During the past year changes have been effected in the registration areas included irr the Borough, by which the boundaries of the new districts have been made to coincide with those of the Wards. The alterations which have been made are indicated in the following scheme :— Old Registration Sub-Districts. Wards. New Registration Sub-Districts.. North-West Paddington Queen's Park. Harrow Road. Paddington, North. Maida Vale. ) St-Mary Westbourne. Church » Centra1. St. John Lancaster Gate (West) „ „ (East) South. Hyde Park. The present occasion has been taken as a favourable opportunity for abandoning the use of the Registration Sub-Districts for statistical purposes and introducing the long-contemplated substitution of the Wards. Such change involves a break in the continuity of the returns, but the advantages accruing from the use of unit areas of more homogenous characteristics outweigh the disadvantages attaching to the change. Population.—The inhabitants of the Borough were estimated to number 149,542 persons at the middle of 1907. Such estimate, based on an assumption of a continuance of the rate of increase recorded between 1891 and 1901, can be regarded as an approximation only having regard to the interval which has elapsed since the last census. The figure given indicates an increase in the population during the 6£ years (dating from April, 1901) of 5,566 persons. The natural increase in the population during the same period,.being the excess of births (as registered) over the deaths of inhabitants, amounted to 7,493 persons—nearly 35 per cent, more than the estimated increase. On the other hand, the rate books show an increasing proportion of "empties," but it has been found impossible to make any use of the figures from that source owing to the difference in the system of rating and enumerating houses. The estimated numbers of inhabitants of each Ward are given on the next page :— meteorology. Estimated Population. 1907. Males. Females. Persons. Queen's Park 8,259 8,219 16,478 Harrow Road 14,025 15,572 29,597 Maida Vale 8,011 11,990 20,001 Westbourne 10,445 14,961 25,406 Church 13,234 14,603 27,837 Lancaster Gate, West 2,837 5,591 8,428 „ „ East 2,282 5,633 7,915 Hyde Park 4,975 8,905 13,880 Bonough 64,068 85,474 149,542* * The Registrar-General's estimate was 149,909. METEOROLOGY. In comparison with the data for the preceding four years (Table 1), the mean air temperature was lower than usual, and the difference between the mean readings of the wet and dry bulb thermometers smaller. The maximum shade temperature (80°) was recorded unusually early in the season, viz., in May, and was considerably below the maxima recorded in preceding years. The greater amount of watery vapour in the atmosphere, indicated by the small difference between the wet and dry bulb thermometers, probably accounts for the comparatively low reading of the solar thermometer (122°). Rain fell on more days in 1907 than in any of the four preceding vears, but the total amount measured (23.86 in.) was less than the records for 1906 (24.42 in.) and 1903 (38.67 in.). Bright sunshine was recorded on 280 days in 1907, a figure which was exceeded in 1906 only, but the total number of hours of duration (1,304) has been exceeded twice, viz., in 1906 and 1905. TABLE 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. 1907. Totals — — — — — — — — — 23.86 177 1,304 07 280 Means 29.96 49.5 46.2 — — — — — — — — Highest — — — 80.0 May — 122.0 — — — — — Lowest — — — — — 22.0 Jan. — 17.0 — — — — 1906. Totals — — — — — — — — — 24.42 145 1,580 12 292 Means 29.99 51.1 47.6 — — — — — — — — — Highest — — — 94 0 Sept. — — 1280 — — — — Lowest — — — — — 20.0 Dec. 150 — — — — 1905. Totals — — — — — — — — — 23.35 151 1,344 59 270 Means 29.96 50.0 46.9 — — — — — — — — — Highest — — 86.3 July — 135.0 — — — — — Lowest — — — — — 220 Jan. — 15.0 — — — — 1904. Totals — — — — — — — — 2106 157 1,282 52 245 Means 29.97 50.3 46.2 — — — — — — — — — — Highest — 89.2 Aug. — — 130.5 — — — — — Lowest — — — — 25.0 Nov. — 12.0 — — — — 1903. Totals — 38.67 171 1,241 00 265 Means 29.92 50.6 47.3 — — — — — — — — — — Highest — — — 86.0 July — — 128.0 — — — — — Lowest — — — — — 26.0 Jan. — 19.0 — — — — 3 BIRTHS. BIRTHS. The births registered in the Borough during the vear numbered 3,074, viz., 1,586 of boys and 1,488 of girls, and were equivalent to a ("crude") rate of 20.55 per 1,000 persons, the lowest rate on record. The decrease in the number of births recorded vear by year during the past eleven years is indicated in Table I. Appendix. Last year there were 29 twin births, including 8 of mixed sexes and 21 of single, viz., 11 of males and 10 of females. Ninety.three of the births occurred in the Workhouse. The total given above includes the births of 49 children of parents not residing in the Borough. In outlying boroughs 181 births occurred, the parents of those children being residents of the Borough. The nett total of births for the year was 3,206* (1,665 of boys and 1,541 of girls) 80 fewer than the corresponding total for 1906, and equivalent to a " corrected " rate of 21*43 per 1,000 persons, as compared with 22*10 in the preceding year. In Table 2 will be found the rates for the last two years for the Borough and for each Ward thereof. The lowest rate for the past year was that of Lancaster Gate, East, Ward (8.21) and the highest that of Church Ward (27.58). The rates for Westbourne (18.42) and Lancaster Gate, West, (8.54) Wards are the only two which were higher last year than in 1906. (See also Table II., Appendix). TABLE 2. Births. Paddington. Corrected as fully as possible. All Births. Illegitimate Births. Corrected Total. Birth Rates. Corrected Total. Percentage of all Births Per 1,000 persons. Per 1,000 females, aged 15.45 years. 1907. 1906. 1907. 1906. 1907. 1906. Borough. 3,206 21.43 22.10 66.62 68.61 134 4*1 4.0 Queen's Park 436 26.45 27.60 113.36 119.36 10 2.2 2.8 Harrow Road 797 26.91 28.81 100.96 108.05 19 2.3 1.4 Maida Vale 424 21.19 21.72 59.96 61.44 15 3.5 5.1 Westbourne 468 18.42 18.02 56.56 55.33 14 2.9 5.2 Church 768 27.58 27.88 103.70 104.22 56 7.2 6.0 Lancaster Gate, West 72 8.54 7.47 18.85 16.48 3 4.1 4.8 „ East 65 8.21 8.96 16.10 17.58 3 4.6 1.4 Hyde Park 176 12.68 14.25 30.42 34.20 14 7.9 6.5 The birth rate for England and Wales was 26.3 per 1,000 persons, 0.8 below that for 1906, and the lowest on record. Compared with the mean rate for the preceding ten years, last year's rate shows a decline of 1.7 per 1,000. According to the figures given in the Quarterly Reports of the Registrar.General (sec Table 3), the local rate was 1.54 below the * The Registrar.General made the nett total of births 3,258, and the corrected rate 21.8. 4 SICKNESS. mean for the quinquennium 1902.06, and 5.19 below last year's rate for the Metropolis. Of the five circumjacent districts selected for comparison with the Borough, Willesden (rate 27.88) was the only one where the rate was above that of the Borough. In all five districts last year's rate was lower than the mean, the greatest difference being recorded in Willesden (3.13) and the least in Marylebone (0.92). TABLE 3. Births and Birth.Rates. Births Registered, 1907.* Birth Rates. Per 1,000 persons. Per 1,000 females, 15.45 years. 1907. 1902.06. 1907. 1902.06. Paddington 3,073 20.49 22.03 63.44 68.22 London 122,205 25.68 27.66 93.83 101.08 Kensington 3,286 18.07 19.17 50.17 53.24 Westminster 2,734 15.87 16.80 48.21 51.03 Marylebone 2,583 20.22 21.14 61.35 64.14 Hampstead 1,325 14.53 16.77 38.35 44.27 Willesden 4,161 27.88 31.01 100.34 111.64 * From Quarterly Reports of the Registrar.General, but the Marylebone total corrected for Births in Queen Charlotte's Lying.in Hospital not belonging to that Borough. Last year's rate, calculated on the number of women aged 15.45 years, was 2.01 below that for 1906, lower rates being recorded in all Wards (Table 2) except Westbourne and Lancaster Gate, West. According to the Registrar.General's returns, last year's rate for the Borough was nearly 5.0 per 1,000 less than the mean for 1902.06 (Table 3), but was exceeded by the Willesden rate only. In that district there was a difference of over 11 per 1,000 between rates for last year and the quinquennium 1902.06. Illegitimate Births.—Included among the births registered in the Borough were 123 of illegitimate children (75 boys and 48 girls), 62 of whom were born in the Workhouse. In addition, one birth was registered as that of a legitimate child, the mother being at the date of the birth unmarried. Twenty.eight (28) of the children were born of non.resident mothers, 17 of them in the Workhouse. From out.lying districts 39 illegitimate births have been credited to the Borough, of which seven, and probably more, should have been allocated to other districts. The nett total of such births was 134 (81 of boys and 53 of girls) 3 more than in the preceding year, and equal to 4.0 per cent, of all births, the same proportion as in 1906. The numbers belonging to each Ward are given in Table 2. These figures are, however, somewhat unsatisfactory owing to pregnant unmarried women being received at certain homes in the Borough and the proper home addresses of such women not being ascertainable. The illegitimate children of such women are, of necessity, included among the local returns and thus the number and proportion of such births to all births are unfairly increased. SICKNESS. The cases of infectious disease reported during the year in accordance with the provisions of the Public Health (London) Act, 1891, numbered 904, and were 179 fewer than in 1906. (See Table 4). The only disease showing an increase was membranous croup (6 cases last year, none in 1906). The same numbers of cases of enteric (34) and continued (1) fevers 5 SICKNESS- were reported in the two vears- The morbidity (" notification") rate for last year was 6-04 per 1,000 persons, as compared with rates of 7-28 and 3'81 in 1906 and 1905 respectively, and a mean rate of 5-39 for the five years 1902-06- Increases in the total numbers of cases (all diseases) were recorded in Harrow Road, Westbourne, and Hyde Park Wards- (See Table 5)Comparing last vear's rates with the quinquennial mean rates, increases are to be noted in all Wards except Church and Lancaster Gate, West- The greatest increase (2-22) was in Harrow Road Ward, and the smallest (0-02) in Lancaster Gate, East, Ward- TABLE 4- Notifications- Paddington- Corrected for duplicate certificates only- Smallpox-- Diphtheria- Membranous Croup- Erysipelas Fevers- Totals Scarlet- Enteric- Continued- Puerperal Cases certified — 1907 154 6 124 579 34 1 6 904 1906 1 182 — 138 715 34 1 12 1,083 Morbidity Rates 1907 1.3 0.04 0.2 3.87 0.22 o.oo 0.04 6.04 1902-06 0-15 1.2 o.i 0.89 2.88 0.34 0.00 0.09 5.39 0'00=a rate less than O'Ol per 1,000- TABLE 5- NotificationsWard Distribution- Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancasti West. it Gate. East. Hyde. Park. Smallpox -(-) -( 1) -(-) -(-) -(-) -(-) -(-) -(-) Diphtheria 17 (16) 47 (37) 19 (38) 23 (28) 31 (43) 6(5) 6(6) 5(9) MembranousCroup -(-) 1 (-) - (-) 4 (-) 1 (-) -(-) - (-) -(-) Erysipelas 16 (13) 25 (34) 11 (19) 17 (15) 36 (42) 4(3) 3(5) 12 (7) Fevers ( Scarlet -81 (140) 172 (161) 76 (87) 87 (82) 100 (177) 13 (15) 12 (18) 38 (35) I Enteric 3 (3) 7 (10) 4 (4) 6 (2) 7 (10) 2 (2) 1 (5) 4 (1) Continued --- -(-) 1 (1) -(- ) -(- ) -(- ) -(- ) - (-) - (-) [Puerperal 2(3) 1 (4) 2 (5) -(1) 1 (I) -(-) -(-) -(1) Totals 119 (175) 254 (248) 112 (150) 137 (128) 176 (273) 25 (25) 22 (31) 59 (53) Rates, 1907 1.22 8.58 5.59 5.39 6.32 2-.96 2.52 4.52 „ 1902-06 7.00 6.36 5.15 4.70 6.62 3.08 2.50 3.-10 Note-—Figures in parenthesis, numbers for 1906 6 SICKNESS. The sex age-distribution of the cases is given in Table 6, and a comparison of last year's rates (sex incidence) with the mean rates given at the bottom of the table shows— Among males a slightly increased prevalence of diphtheria (after including membranous croup) and a considerable increase in that of scarlet fever. Per contra there was a satisfactory reduction in the prevalence of enteric fever. Among females considerably increased prevalence of scarlet fever, satisfactory reductions in prevalence of enteric and puerperal fevers, and insignificant changes in the other disease. TABLE 6. Notifications. Sex-Age Distribution. Ages. (Years.) Smallpox. Diphtheria. Membranous Croup. Erysipelas. Fevers. Scarlet. Enteric. Continued. Puerperal. M. F. M. F. M. F. M. F. M. F. M. F. M. F. F. 0— ... ... 2 ... 1 ... 3 4 4 4 ... ... ... ... ... ]— ... ... 10 1 1 ... 2 ... 12 5 ... ... ... ... ... 2 ... ... 4 13 ... ... ... ... 12 15 ... ... ... ... ... 3— ...... ... 5 7 ... ... ... 1 27 24 ... ... ... 1 ... 4— ... ...... 9 7 ... ... 1 1 29 23 1 ... ... ... 5— ... ... 28 34 3 1 3 2 124 163 1 1 ... ... ... 13— ... ... 2 3 ... ... 1 1 12 16 1 2 ... ... ... 15— ... ... 4 9 ... ... 3 9 24 45 5 3 ... ... 4 25— ... ... 6 10 ... ... 38 44 12 28 8 11 ... 2 65— ... ... ... ... ... ... 8 3 ... ... ... 1 ... ... ... All Ages. ... ... 70 84 5 1 59 65 256 323 16 18 ... 1 6 Rates, 1907 ... ... 1.09 0.98 0.07 o.oo 0.92 0.76 3.99 3.77 0.24 0.21 ... o.oo 0.07 1902-06 0.0 0.3 1.09 0.97 0.02 o.oo 0.90 0.86 3.11 2.70 0.37 0.31 o.oo o.oo 0.10 0.0=a rate less than 0.01 per 1,000. Diphtheria and scarlet fever being largely diseases of voting life, it has been thought desirable to calculate the rates for each Ward for persons under 15 years of age, after excluding all cases notified in persons above that age. (See below). The highest diphtheria rate was that of Lancaster Gate, East, Ward, and the lowest that of Hyde Park. The highest scarlet fever rate that of Harrow Road Ward and the lowest that of Lancaster Gate, West. The rates of Church Ward have come out unexpectedly low, although that Ward contains the poorest and most densely-inhabited portions of the Borough. Morbidity Rates per 1,000 Persons aged 0-15 Years. Oueen's Park. Harrow Road. Maida Yale. Westbourne. Church. Lancaster West. Gate. East. Hyde Park. Borough.[/### Diphtheria* 2.8 4.6 3.6 3.6 3.3 2.7 5.2 1.3 3.5 Scarlet Fever 12.2 17.5 12.9 11.5 10.1 6.5 7.2 13.2 12.8 * Including membranous croup NOT I FI CATION CHART. Rates per 1000 persons. 1907 Average c/urinq 10 years endinq 1906. Duration of School Holidays. 7 DEATHS. Comparing the Borough with the circumjacent districts and the Metropolis (Table 7) it will be seen that as regards Diphtheria (including membranous croup). Lower rates were recorded last year in Westminster (0.84) and Marylebone (1.00) than in the Borough (1.12) In those two Boroughs and in Willesden last year's rates were below the quinquennial means, but in the others, above. Scarlet fever. Greater prevalence in all districts, the maximum increase over the mean being recorded in Paddington (0.96), but that increase is little more than half the increase which occurred in the Metropolis as a whole (1 .85). The smallest increase took place in Westminster (0.13). Enteric fever (including continued fever). With the exception of Willesden (rate 0.18) the local rate (0.22) is the lowest of the series, last year's rates being in every case lower than the mean rates. Puerperal fever. The Willesden rate (0.08) is the only one above the mean, but in two of the Boroughs . Marylebone and Hampstead—last year's rates were equal to the mean. The local rate was approximately in the middle of the series. TABLE 7. Morbidity Rates.* Circumjacent Districts. Paddington London. Kensington. Westminster. Marylebone. Hampstead. Willesden. 1907 Mean 1902-6 1907 Mean 1902-6 1907 Mean 1902-6 1907 Mean 1902-6 1907 Mean 1902-6 1907 Mean 1902-6 1907 Mean 1902-6 Smallpox 0.16 o.oo 0.37 0.11 — 0.31 o.oo 0.24 o.oo \0.05 _ 0.17 Diphtheria 1.12 1.07 1.84 1.73 1.37 \0.95 0.84 1.05 1.00 1.30 1.22 0.92 1.70 2.38 Erysipelas 0.83 0.88 0.94 1.05 0.70 0.89 0.59 0.70 1.04 1.35 0.61 0.57 0.50 0.66 F evers (Scarlet 3.84 2.88 5.44 3.59 2.92 1.98 2.43 2.30 3.40 2.74 3.51 2.66 I 4.28 3.50 { Enteric 0.22 0.34 0.29 0.46 0.23 0.32 0.30 0.37 0.24 0.49 0.23 0.33 0.18 0.36 ( Puerperal 0.04 0.05 0.05 0.05 0.01 0.05 0.01 0.03 0.05 0.05 0.03 0.03 0.08 0.06 * Compiled from Quarterly Reports of the Registrar.General. Rates per 1,000 persons. The curves in the chart facing this show the weekly fluctuations in the (annual) morbidity rates (per 1,000 persons) from scarlet fever and diphtheria in the Borough and in the Metropolis, based on the numbers of cases recorded during the past year and the weekly averages for the preceding ten years. DEATHS. The deaths registered within the Borough during the year numbered 2,154, being 113 more than the number registered in 1906, and equal to a mortality of 14'40 per 1,000 persons. During the decennium 1897.1900, the average annual number of deaths was 2,262, and the mean mortality 15'62. (Sec Table I., Appendix.) The 2,154 deaths included 372 of non.residents, while 232 deaths of residents occurred outside the Borough. The nett total of deaths of parishioners during the year was, therefore, 2,014, being 171 in excess of the number for the preceding year. The 8 deaths. nett mortality was 13.46 per 1,000 persons, as compared with 12.40 in 1906, and a mean rate of 14.57 for the decennium. (Table I, Appendix.) Comparing the numbers of deaths of residents of the individual Wards for 1906 and 1907 (Table II., Appendix) it is found that more deaths occurred last year in all the Wards except Church and Hvde Park, while a comparison of between last year's returns and those for the five years 1902.06 shows that lower totals were recorded last year in Queen's Park, Church, Lancaster Gate, East, and Hyde Park Wards. (Same Table.) In Table 8 the nett mortality rates, distinguishing the sexes, for the Borough and its Wards are set out, together with the mean rates for the five years 1902.0(5. The highest Ward rate for the past year was that of Church Ward (16.86) but that was 0.79 below the rate for 1906. The lowest rate last year was that of Lancaster Gate, East, Ward (8.08) which was, however, 0.89 above the rate for that Ward in the preceding year, when the lowest rate was that of Lancaster Gate, West, Ward (6.87). TABLE 8. Deaths (Nett Totals) and Mortalities. Deaths. All causes, all ages. 1907. Mortality rates per 1,000 individuals. 1907. 1902.06. Males. Females. Persons. Males. Females. Persons. Males. Females. Persons Borough 1,020 994 2,014 15.92 11.62 13.46 15.08 12.17 13.87 Queen's Park 119 116 235 14.40 14.11 14.26 14.67 13.32 14.00 Harrow Road 208 190 398 14.90 12.20 13.44 13.35 13.12 13.23 Maida Vale 150 142 292 18.72 11.84 14.59 15.70 11.39 13.11 Westbourne 166 171 337 15.89 11.42 13.26 15.07 12.41 13.50 Church 247 223 470 18.64 15.27 16.86 18.77 17.02 17.55 Lancaster Gate, West 33 39 72 11.63 6.97 8.54 9.17 6.48 7.38 Lancaster Gate, East 34 30 64 14.89 5.32 8.08 12.46 6.56 8.26 Hyde Park 63 83 146 12.66 9.32 10.51 14.24 9.54 11.35 The mortality rates for the Borough and its Wards, in six age.groups for each sex, are given in Table 9, contrasted with the mean rates for each group for the years 1902.06. It will suffice to direct attention to the fact that among males in the Borough as a whole, there were increases last year in all the age.group rates except that for " 0.1 year," while among females, increased rates were recorded in two groups only, viz., " 1.5" and "65.." Although not recognised as a safe criterion of infantile mortality, the lower rates for the youngest age (0.1 year) which were recorded in nearly every Ward, may be regarded as satisfactory. The mass of figures contained in Table 9 is too intricate for a complete understanding of their import without lengthy comment. By means of correction factors, based on the populations of the different districts and the average mortality in England and Wales during the decennium 1891.1900, the information set out in detail in the Table referred to can be 9 DEATHS. condensed into two columns of figures. (See Table 10.) The corrected death rate for the Borough for last year, obtained by the use of the factor referred to, was 14.32 per 1,000 persons, as compared with 13.19 in 1906 ; the difference from the "standard rate" amounting to 2.78, equivalent to a saving during the year of 416 lives. In Church Ward only was the corrected rate above the standard, the excess amounting to 0.98 per 1,000, as compared with 1.82 in 1906. Comparing last year's corrected rates with the means for the preceding quinquennium, it is found (Table 10) that higher rates were recorded last year in Queen's Park, Harrow Road, and Lancaster Gate, West, Wards, that of the last being the only increase in excess of unity, viz., 1.40. TABLE 9. Sex.Age Mortality Rates. Per 1,000 individuals in each Sex.Age Group. Sex. Age. Period. Borough. Wards. Queen's l'ark. Harrow Rd. Maida Vale. Westbourne. Church. Lancaster Gate Hyde Park. West. East. Males. 0— 1907 141.56 143.58 128.50 153.40 99.12 166.66 148.14 148.14 166.66 1902-06 154.96 168.34 123.62 161.05 145.67 180.06 81.11 125.33 130.78 1— 1907 22.07 18.92 16.28 33.68 23.69 26.27 15.87 18.34 16.72 1902-06 18.72 17.82 14.49 17.13 18.22 25.77 9.47 18.31 9.32 5— 1907 2.84 1.71 3.43 2.18 3.68 3.07 3.03 6.67 1902-06 2.34 2.22 2.60 1.20 3.15 2.68 1.82 1.98 1.81 15— 1907 2.76 5.70 1.96 2.42 2.72 2.27 — 2.07 3.98 1902-06 2.69 3.32 3.23 3.00 2.61 2.94 2.39 0.82 2.17 25— 1907 12.54 10.84 10.65 15.54 14.98 15.04 8.81 11.44 7.09 1902-06 12.03 12.95 10.07 12.79 11.96 14.99 7.27 9.25 15.65 65— 1907 97.24 137.36 107.72 108.10 64.01 122.44 94.89 76.92 81.96 1902-06 87.83 102.53 76.73 92.87 66.25 116.41 69.83 75.31 96.47 Females. 0. 1907 91.33 98.36 76.33 113.77 103.44 107.78 44.44 44.44 50.63 1902-06 125.54 123.24 94.79 128.52 120.77 165.43 39.99 66.51 110.10 1— 1907 16.76 23.05 12.50 14.58 16.73 22.12 — — 21.05 1902-06 15.75 18.26 14.07 12.68 16.22 22'02 8.08 4.44 15.36 5— 1907 2.11 1.12 1.87 1.99 3.36 1.92 4.97 . 2.55 190-06 2.42 3.17 1.92 1.22 1.82 2.75 1.47 1.73 3.06 15— 1907 1.79 2.51 3.15 1.73 0.90 1.42 1.89 2.60 0.91 1902-06 2.16 3.71 3.15 1.28 1.98 3.07 0.49 0.51 1.35 25— 1907 7.90 11.11 7.45 8.41 7.11 12.86 3.52 2.99 5.89 1902-06 8.57 9.11 9.18 8.47 8.67 13.92 4.84 4.88 6.52 65— 1907 79.91 104.79 85.91 85.03 61.77 75.70 72.91 59.07 81.08 1902-06 76.08 86.91 77.38 78.14 60.18 104.22 58.12 66.36 69.19 10 deaths. TABLE 10. Corrected Mortality Rates. Standard Rate. Corrected Rate, 1907. Excess ( + ) Defect ( —) Mean Corrected Rate, 1902.06. Increase ( + ) Decrease( —) Borough 17.10 14.32 —2.78 14.27 + 0.05 Queen's Park 16.43 15.85 —0.58 15.50 + 0.35 Harrow Road 19.02 12.85 —4.17 12.65 +0.20 Maida Vale 16.62 15.97 —0.65 14.35 —1.62 Westbourne 18.96 12.72 —4.24 12.96 —0.24 Church 17.03 18.01 +0.98 19.07 —1.06 Lancaster Gate, West 15.01 10.35 —4.66 8.95 + 1.40 ,, East 14.76 9.96 —4.80 10.19 —0.23 Hyde Park 16.18 11.81 —4.37 12.76 —0.95 London 17.31 15.29 —2.02 16.48 —1.19 Kensington 17.05 14.56 —2.49 15.18 —0.62 Westminster 1546 15.31 —0.15 16.41 —1.10 Marylebone 16.93 16.07 —0.83 17.42 —1.35 Hampstead 16.19 10.10 —6.09 11.15 —1.05 Willesden 16.98 12.32 —4.66 12.52 —0.20 In England and Wales the mortality last year was at the rate of 15.0 per 1,000, 0.4 below the rate for 1906, and 1'7 below the decennial mean rate (16.7). In the Metropolis the crude mortality for 1907 was 14.55, as compared with 15.06 in' the preceding year and a mean rate of 15.68 during 1902.06. In the circumjacent districts (Table 11) last year's crude mortality was in every case below that for the mean; the Borough, in this respect, occupying an exceptional position. Rates below that for the Borough (13.5) were recorded in Westminster (13.0), Hampstead (9.0) and Willesden (11.5)., but of the corrected mortalities (Table 10) those of Hampstead (10.10) and Willesden (12.12) were the only two below that of the Borough. TABLE 11. Mortality Rates. Period. All Causes Smallpox. Vleasles Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever Diar. rhoeal Dis. Phthisis. Other Tub. Dis. Cancer. Infantile Mortality. Paddington 1907 13.5 0.25 0.09 0.13 0.35 0.03 0.28 1.09 0.41 1.19 109 1902-06 13.5 0.03 0.33 0.07 o.11 0.21 0.06 0.65 1.08 0.40 1.03 118 London 1907 14.6 0.38 0.14 0.16 0.38 0.04 0.32 1.40 0.51 1.03 116 1902-06 15.7 0.06 0.44 0.10 0.17 0.33 0.07 0.77 1.53 0.56 1.00 135 Kensington 1907 13.7 0.17 0.05 0.13 0.45 0.03 0.21 1.03 0.49 1.10 128 1902-06 14.3 0.01 0.37 0.08 0.10 0.24 0.06 0.63 1.28 0.48 0.95 140 Westminster 1907 13.0 ... 0.11 0.07 0.10 0.15 0.05 0.24 1.37 0.33 0.92 102 1902-06 13.9 0.05 0.19 0.07 0.08 0.15 0.06 0.35 1.58 0.39 1.01 115 Marylebone 1907 15.0 0.14 0.15 0.12 0.35 0.02 0.19 1.48 0.39 1.14 101 1902-06 16.3 0.04 0.41 o.u 0.13 0.20 0.06 0.56 1.69 0.43 1.12 130 Hampstead 1907 9.0 0.13 0.06 0.08 0.13 0.02 0.09 0.70 0.34 0.75 69 1902-06 9.9 o.oi 0.13 0.06 0.08 0.12 0.05 0.18 0.78 0.27 1.03 90 Willesden 1907 11.5 0.29 0.12 0.12 0.48 0.02 0.20 0.92 0.33 0.72 109 1902-06 11.7 0.02 0.40 0.06 0.16 0.29 0.05 0.67 0.96 0.36 0.86 118 Rates per 1,000 persons, except Infantile Mortality, per 1,000 Births (corrected). 11 small.pox. The deaths of residents of the Borough during the year are distributed according to causes and sex and ages of the deceased in Table III. of the Appendix, and again according to Wards (causes of death, persons, all ages) in Table IV. SMALLPOX. No case of this disease was reported in the Borough during the past year. In the Metropolis only 9 cases were notified (some of them undoubtedly erroneously diagnosed) as compared with 31 in 1906. There were no deaths from this cause within the Metropolis during the year. As will be seen from the appended statement, compiled from the Weekly Returns issued by the Local Government Board, there were only 119 cases among the inhabitants (amounting to nearly 15 millions at the last census) of the 255 Extra.Metropolitan Boroughs, &c., reporting weekly to the Board the numbers of notifications received. The diminution in prevalence of the disease during the last few years is remarkable and very satisfactory. Metropolis. Extra.Metropolitan Districts. Quarters—1. 2. 3. 4. Year. 1. 2. 3. 4. Year. 1907 2 3 1 3 9 69 32 16 2 119 1906 14 16 1 — 31 545 275 100 70 990 1905 34 36 6 1 77 1,093 602 310 271 2,276 1904 181 251 42 23 497 1,345 1,519 1,098 1,283 5,245 1903 38 162 121 96 417 2,118 3,210 1,424 691 7,443 From information supplied by the Vaccination Officer, the appended table of the results of the Vaccination Acts has been compiled. It is with satisfaction that a slight increase in the proportion of children successfully vaccinated during the last completed year (1906), has to be recorded. Vaccination Returns. Births. Successfully Vaccinated. Insusceptible of Vaccination. Died Unvaccinated. Per cent, of Births. Cols. 2, 3, & 4. Vaccination Postponed. Certificates under Act granted for. Remaining (not traced, &c.)* Per cent, of Births. Cols. 6, 7, & 8. Cols. 1 2 3 4 5 6 7 8 9 1901 3,364 2,676 5 313 89.0 23 34 313 11.0 1902 3,262 2,629 12 291 89.8 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 3,174 2,545 9 224 87.5 36 41 319 12.5 1907t Jan .June | 1,554 1,196 3 120 84.8 41 28 166 15.1 * Including " gone away," " false addresses," apprisals to other districts, &c J Provisional return only. DIPHTHERIA. The cases of diphtheria reported last year numbered 154, 28 fewer than in 1906. There were, however, 6 cases of membranous croup, a term which is deemed to be synonymous with diphtheria, as compared with none in the preceding year. I he total number of cases is, therefore, taken as 160, or 22 less than the total for 1906. In Harrow Road Ward only was 12 TABLE 12. Notifications in each Quarter of the Year. Quarters Borough. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. West. East. 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 (and Membranous Croup) 1907 45 34 38 43 5 3 4 5 13 7 14 14 5 4 5 5 5 10 4 8 8 6 9 9 3 3 3 1 2 3 2 1902-06 40 31 44 40 7 5 6 5 10 9 11 12 4 4 9 6 4 5 7 5 5 9 6 1 I 1 1 2 i 0 2 4 1 1 3 Scarlet Fever 1907 216 112 120 131 28 21 17 15 76 35 27 34 20 22 13 21 20 11 30 26 46 14 21 19 4 1 3 5 4 3 3 2 18 5 6 9 1902-06 66 97 124 139 7 17 21 26 17 22 29 3S 6 10 16 16 14 13 18 14 19 31 28 4 5 4 6 1 3 9 3 3 8 5 6 Enteric Fever (and Continued Fever) 1907 11 5 12 7 1 2 1 1 4 2 2 2 — 3 — 2 1 4 1 2 — — 1 — 1 — 1 — — — — 3 1 1902-06 10 7 14 21 2 1 2 1 1 2 3 2 2 1 3 4 2 1 3 3 1 1 1 9 1 — 0 j 1 0 1 0 1 1 1 1 Puerperal Fever 1907 3 2 — 1 1 — — 1 1 — — — 1 i 1 — — — — — — — 1 — — — — — — — — — — — — — 1902-06 2 2 9 3 0 0 1 1 1 0 0 1 1 0 — 0 0 1 0 0 0 0 1 1 — — — — 0 — — 0 0 1 — — " 0 " An average less than 1, " — " No cases recorded. diphtheria. diphtheria. 13 there a material increase in the number of cases. (Sec Table 5). The numbers of cases reported in each quarter from each Ward are given in Table 12, together with the average numbers for the five years 1902-06. Last year's numbers for the first, second, and fourth quarters were above the average, but only to comparatively small degrees. The figures for Harrow Road and Westbourne Wards alone show any material changes. Of the cases reported, 141 were primary and 19 (11.8 per cent, of all cases) secondary. In 1906, 10 per cent,, and in 1905, 7 per cent, of all the cases were secondary cases. The frequency of multiple cases during the last four years is indicated in the appended statement:— Diphtheria. 1907. 1906. 1905. 1904. Houses with 2 cases 13 13 5 6 3 3115 „ 4 „ 1 ,, 5 ,, 1 In 12 out of the 13 instances where 2 cases were reported from the same house during the year, both cases were reported on the same day. In the household with 3 cases, the second and third were "return cases" following the discharge of the primary case from hospital. There were in all 8 "return cases" during the year, some of them being included among the so-called primary cases. Four (4) of the primary cases developed in hospital, and 7 other cases were believed to have been due to infection acquired outside the Borough. The errors of diagnosis numbered 16. In four (4) instances the death of the patient preceded the notification of the case. The proportion of notified cases removed to hospital for isolation increased from 80"2 per cent. in 1906 to 86'7 per cent. last year (Table 14), the numbers removed from each Ward being given in Table 13. In comparison with the average for the preceding five years (1902-06), last year's proportion shows a rise of 7.2 per cent. The fatality among cases treated at home was 19.0 per cent., compared with an average of 16*5 per cent. (Table 14). while the fatality among cases treated in hospital was 13.9 per cent., average 8.6 per cent. TABLE 13. Number of Cases and Deaths belonging to each Ward. 1907. Diphtheria. Scarlet Fever. Enteric Fever. 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 17 (2) 17 (2) — 2 81 75 — 1 3 2 1 Harrow Road 48 (6) 42 (6) — 6 (1) 172 (9) 162 (9) 1 5 8(2) 5(2) 2 l.d) Maida Vale 18 (2) 16 (2) 1 5 76 (3) 68 (3) — 1 4 3 — — Westbourne 27 (1) 20(1) 2 3 87 (5) 81 (5) — 3 6 (1) 4 1 — Church 32 (4) 32 (4) — 3(1) 100 (7) 100 (7) — 3 7 (1) 7 (1) — — Lancaster Gate, West 6 (1) 3(1) 1 — 13 7 — — 2 1 — 1 East 6 5 — — 12 9 — — 1 1 — — Hyde Park 5 3 —— —— 38 34 — — 4 (1) 3 (1) — — Figures in parentheses indicate case erroneously diagnosed. Notes.— Queen's Park—One death from Diphtheria, included in table, not registered until 1908. Harrow Road—One death from Diphtheria, included in table, not registered until 1908. Maida Vale—One death from Scarlet Fever, not included in table. Case reported some years ago. Church Ward— One death from Diphtheria, not included in table, was that of a patient reported in 190t>. Church Ward— One death from Scarlet Fever, included in table, registered 1908. 14 diphtheria. TABLE 14. Diphtheria. Scarlet Fever. Enteric Fever. 1907. Mean. 1902-06. 1907. Mean. 1902-06. 1907. Mean. 1902-06. Removed to Hospital* 86.7 79.5 92.5 87.9 74.2 70.2 Fatality t At Home 19.0 16.5 2.3 1.2 33.3 27.5 In Hospital 13.9 8.6 2.3 2.3 9.0 12.6 Total 14.6 11.5 2.3 2.2 16.6 17.1 Mortality ‡ 0.13 0.11. 0.08 0.06 0.03 0.05 * Per cent. of all cases reported. ‡ Per cent. of cases after correction for errors of diagnosis. ‡ Per 1,000 persons—all on deaths recorded. The deaths from diphtheria numbered 20 last year, 5 more than in the previous year. The crude mortality was 013 per 1,000 persons, 0.03 above that for 1906, 0.02 above the mean for 1902-06. According to the figures of the Registrar-General, the morbidity rate for the Borough last year was 1.12, Westminster (0.84) and Marylebone (1.00) being the only two districts with lower rates. (See Table 7). The crude mortality rates are given in Table 11, and the corrected in Table 15. According to the figures in the latter table the local rate (0'17) was, with the exception of that of Kensington (0.18) the highest of the series. The differences between the corrected rates and the standard are remarkable, those between last vear's and the mean rates, small. TABLE 15. Mortality Rates.* " Corrected." Diphtheria. Scarlet Fever. Enteric Fever. Standard Rate. 1907 Mean. 1902-06. Standard Rate. 1907. Mean. 1902-06. Standard Rate. 1907. Mean. 1902-06. Paddington 0.39 0.17 0.13 0.13 0.10 0.08 0.14 0.03 0.04 London 0.50 0.16 0.16 0.17 0.13 0.09 0'14 0.04 0.06 Kensington 0.36 0.18 0.11 0.12 0.05 0.09 0.14 0.03 0.05 Westminster 0.32 0.14 0.12 0.11 0.09 0.10 0.15 0.04 0.04 Marylebone 0.37 0.16 0.16 0.12 0.19 0.14 0.14 o.oi 0.04 Hampstead 0.36 0.09 0.10 0.12 007 0.06 0.14 0.02 0.04 Willesden 0.56 0.11 0.14 0.19 0.11 0.05 0.14 0.02 0.04 * Per 1,000 persons, corrected by " factors " for sex-age composition of populations. Deaths corrected for non-residents, &c. scarlet fever. 15 SCARLET FEVER. The increased prevalence of this disease which has been noted in the Metropolis since 1903 was maintained last year. In 190(5 the cases reported numbered 20,326. and last year 25,922—an increase of 27 per cent. In the Borough the notifications received last year showed a decrease amounting to 17 per cent., the cases falling from 715 (the highest total since 1896, 909 cases) to 579. The morbidity rate for the Borough was 3.87, as against 4.81 in 1906, and a mean of 2.88 for the five years 1902-06 (Table 4). In the Metropolis the rate was 5.44 last year, 4.30 in 1906, and 3.59 during 1902-06. In comparison with the circumjacent districts (Table 7) the local rate for last vear was the highest of the series, but on comparing the rates for the two last years, the reduction in last year's rate for the Borough is the greatest (1.00 per 1,000), while increased rates were recorded in Kensington (0.31 per 1,000) and in Marvlebone (0.33 per 1,000). The cases reported in the first half of the year exceeded the quinquennial average for the half year by 165, while those reported in the second half were 12 below the average. The outbieak which began in the second quarter of the 1906 was practically over by the middle of last year, having lasted just a twelvemonth. That is made evident by the appended statement of the quarterly figures for the two years. 1906. 1907. Quarters—1 2 3 4 1 2 3 4 Cases reported 48 1G4 213 290 216 112 120 131 (1901-05.) (1902-06.) Averages 76 84 111 112 66 97 124 139 An outbreak of 16 cases in a training home during the second half of last year checked the fall which was taking place. The incidence of the disease was specially heavy during the first quarter of the year in Queen's Park, Harrow Road, Church and Hyde Park Wards. In Westbourne Ward the numbers for the third and fourth quarters were swollen bv the outbreak already referred to. Regarding the first case reported in a house during the year a primary case, many of such cases were secondary to cases dealt with in 1906, others again " return cases " arising therefrom, last year's total of 579 may be divided in 414 primary and 165 secondary cases, the latter constituting 28.5* per cent. of the whole, as compared with 25 and 15 per cent. in 1906 and 1905 respectively. The numbers of houses with multiple cases during the last four years are indicated below :— 1907. 1906. 1905. 1904. Houses with 2 cases 63 77 31 35 „ 3 „ 21 23 6 10 „ 4 „ . 7 7 3 7 „ 5 „ 2 4 — 2 „ 6 „ 9 1 2 — — ' „ 7 " „12„ 1 1 - - " 16 „ 1 — - -— -— From notes made during the year the following circumstances attending the occurrence of multiple cases have been abstracted In 3 of the 63 houses with two cases the patients were treated at home, and in 9 others both cases were reported at the same time. * By omitting the special outbreak already referred to the percentage of secondary cases is reduced to 26 6. 16 enteric fever. In 2 of the 21 houses with three cases, and 1 of the 7 with 4, the patients were all kept at home. From houses with 3 or more cases, 2 of the cases were reported on the same day on 11 occasions, and 3 or more on 9. In 16 houses occupied by 2 or more families infection spread from the first to a second family In connection with 36 infected houses the infection was believed to have been introduced from beyond the Borough, and in 5 other cases, allocated to houses in the Borough, the disease developed in hospitals. On 32 occasions further cases occurred in households after the return of patients from hospitals, and in one instance a similar occurrence followed the liberation of a patient from home quarantine. The last case gave rise to three (3) cases, the 32 hospital discharges to 44 fresh cases, viz. To one fresh case 26 times. „ two „ cases 5 „ „ three „ „ once each „ five „ „ The cases ultimately found to have been erroneously diagnosed numbered at least 24. The cases removed to hospital (536) constituted 92.5 per cent. of the total reported (Table 13), as compared with 96.7 in 1906 and an average of 87.9 in the five years 1902-06. From Church Ward all the cases were removed to hospital. The fatality of cases treated at home was 2.3 per cent. (Table 14), as compared with 4.5 in the preceding year, and a mean 1.2 for the quinquennium. The fatality at hospital was 2'3 also, as compared with 2.4 in 1906 and 2.3 in 1902-06. The nett mortality was at the rate of 0.08 per 1,000, 0.04 below that of the preceding year, but 0.02 above the quinquennial mean rate (Table 14), while the corrected rate (Table 15) was 0.10, 0'03 below the standard rate, but 0.02 above the mean corrected. The corrected rates for the Metropolis (0.13), Marylebone (0.19),and Willesden (0.11) were above that for the Borough, those of the other districts below. (Table 15). ENTERIC FEVER. The same numbers of cases of enteric fever (34) and of continued fever (1) were reported in 1907 and 1906.* (Table 4.) The only Wards in which the cases reported during the past year were in excess of the number in 1906 were Westbourne and Hyde Park. (Table 5.) The annual average number of cases in the whole Borough during the five years 1902-06 was 52 (Table 12), the totals for each quarter of last year, except the first, being below the corresponding average. In the fourth quarter of last year the cases reported (7) were just one-third of the average. There was a complete absence of the autumnal increase in prevalence of this disease, the cases reported in the third quarter (12) being in excess of those reported in the fourth. In all the Wards last year's returns compared very favourably with the averages for the preceding quinquennium. The records of last year's cases present very little of interest. There were no multiple cases. With regard to origin, 9 cases appeared to have been contracted outside the Borough, some of them out of England. Positive reactions with the Widal test were obtained in 13 instances, including two cases which were clinically regarded as not enteric fever. Histories of the consumption of shellfish were obtained from 4 patients (one each of mussels, oysters and cockles, and one uncertain) and in 1 of watercress. In 2 instances death preceded notification of the disease. * " Continued fever " is deemed to be the same disease as " enteric fever." cerebrospinal fever. 17 Twenty-six (26) patients were removed to hospital (Table 13), equal to 74.2 per cent. (Table 14) of all the cases, as compared with an average of 70.2 per cent. for the quinquennium. In 1906 the percentage was the same as last year. The fatality of the disease among patients treated at home was 33.3 (30.0 in 1900) per cent. (Table 14) as compared with a quinquennial average of 27.5, while among hospital patients the fatality was only 9 per cent. (18T in 1900), the average being 12.0. These fatalities have been calculated after making allowances for known errors of diagnosis. The advantage of hospital treatment for the disease has been commented upon in previous reports. The nett mortality was at the rate of 0.03 per* 1,000 persons, or 0.02 below the quinquennial mean rate (0.05). (Table 14.) The corrected mortality was also 0.03, 0.11 below the standard rate and 0.01 below the mean. (Table 15.) The mortality in the Metropolis was 0.04, the same rate prevailing in Westminster. In the other districts, except in Kensington, where it was equal, the rate was lower than the local rate. CEREBROSPINAL FEVER. In consequence of outbreaks of this disease in certain parts of the provinces an Order was made by the London County Council in February of last year requiring the disease to be notified. Notification was imposed by the first Order for six months, that period being extended by a second Order, issued in the following August, to two years. It may be mentioned that cases practically identical with "cerebrospinal fever" occur in London every winter, and are generally diagnosed as " basic meningitis." In consequence such cases were required by the second Order to be notified. Prior to the making of the first Order certain cases were brought to the notice of the Department which were suspiciously like attacks of cerebrospinal fever. In two instances "gram negative " diplococci were obtained from the cerebrospinal fluid, but in neither case did the cocci give the reactions peculiar to the meningococcus of Weischelbaum. Up to the close of the year no notification of cerebrospinal fever had been received. SEPTIC DISEASES. These are for statistical purposes divided into two groups, viz., "puerperal fever" and " other septic diseases " (including erysipelas, septicarmia, pyaemia, &c.). Of those diseases, puerperal fever and erysipelas are scheduled for notification, nothing being known of the others, except the numbers of deaths. Puerperal Fevfr.—The reported cases of this disease fell from 12 in 1906 to 0 in 1907. In 1905, 7 cases were reported, while the average for the five years 1902-00 was 9. Half the cases of last year occurred in Queen's Park and Harrow Road Wards (Table 5), the numbers recorded in 1907 being, however, well below the averages for those Wards (Table 12). Last year's morbidity rate for the Borough (0.04) was 0.01 below the quinquennial mean (0'05). In the circumjacent districts decreases in the rates were recorded in Kensington and Westminster, an increase in Willesden alone (Table 7). Inasmuch as the frequency of pregnancy is declining, a better measurement of the prevalence of puerperal fever is afforded by the percentage frequency with reference to the births which take place during the year. The morbiditv, per 100 births, during last year 18 septic diseases. was 009 below the mean rate in the Borough (Table 16), decreases being also recorded in all the circumjacent districts except Willesden (rate 1907,0.31; mean, 0.22). In Kensington and Westminster all the cases were evidently not reported during life, inasmuch as the fatalities per cent. of the cases reported, were in those districts over 100 as compared with mean fatalities of little more than 50 per cent. in each case. In the Borough and the other districts increases in the fatality of the disease were recorded in all districts except Hampstead (rate, 1907, 33.3; mean, 34.7). In the Borough last year's fatality was 66.6, and the mean 50.9. TABLE 16. Childbed Mortality. Puerperal Fever. Mortality per 1,000. Puerperal Fever. Accidents & Diseases of Parturition. Total in Childbed. Morbidity per 100 Births. Fatality per 100 Cases. Births. Women, Aged 15-45 yrs. Births. Women, Aged 15-45 yrs. Births. Women, Aged 15-45 yrs. Paddington 1907 0.19 66.6 1.30 0.06 3.57 0.21 4.87 0.27 1902-06 0.28 50.9 1.27 0.07 2.38 0.15 3.63 0.22 London 1907 0.20 59.2 1.23 0.10 1.53 0.14 2.76 0.24 1902-06 0.21 68.5 1.48 0.11 1.42 0.11 2.90 0.23 Kensington 1907 0.06 150.0 0.91 0.02 1.82 0.08 2.73 0.10 1902-06 0.27 51.5 1.27 0.04 1.79 0.07 3.07 0.11 Westminster 1907 0.11 100.0 1.09 0.03 1.09 0.03 2.18 0.06 1902-06 0.24 54.4 1.34 0.05 1.81 0.07 3.15 0.12 Marylebone 1907 0.17 57.1 1.54 0.09 1.54 0.09 3.08 0.18 1902-06 0.25 15.1 0.44 0.02 2.99 0.17 3.43 0.19 Hampstead 1907 0.22 33.3 0.75 0.02 1.50 0.10 2.25 0.12 1902-06 0.23 34.7 1.46 0.04 3.83 0.15 5.29 0.19 Willesden 1907 0*31 69.2 2.16 0.21 2.88 0.28 5.04 0.49 1902-06 0.22 64.9 1.35 0.12 1.92 0.19 3.28 0.31 The mortality in childbed is the sum of the mortalities due to puerperal fever and " accidents and diseases of parturition." Last year's rate (per 1,000 births) for the Borough, was 4.87 (Table 16), as compared with a quinquennial mean of 3.65, whereas the rate (per 1,000 women aged 15.45 years, the fecund ages) was 0.27 and the mean 0.22. Lower rates were recorded last year in all the circumjacent districts except in Willesden. Other Septic Diseases.—Erysipelas.— The notified cases numbered 124 last year, being 14 fewer than the total for 1906 (Table 4). The morbidity was at the rate of 0.82 per 1,000 persons, or 0.07 below the quinquennial mean. Decreased morbidities were recorded tubercular diseases. 19 (Table 7) in all the circumjacent districts except Hampstead (rate, 1907, 0.6] ; mean, 0.57). The deaths of residents of Paddington from this cause numbered 7, the same as in 1906 and 1905. The mortality from the "other septic diseases" was 0.08 per 1,000 persons, as compared with 0.12 in 1906 and 0.09 during 1902-06. The highest Ward mortality last year was 0.21 (Harrow Road and Hyde Park Wards), and the lowest, zero (Westbourne, Lancaster Gate, East and West). The rate for Church Ward was only 0.03, the quinquennial average being 0.19. TUBERCULAR DISEASES. Phthisis Pulmonalis (Consumption).—The corrected number of deaths increased from 136 in 1905 to 161 in 1906, but fell to 157 last year. The mortality per 1,000 persons, without correction for sex-age composition of the population, was 1.04, exactly equal to the quinquennial average. During the five years 1892-96 the mortality averaged 1.27 showing a reduction of 0'23 during the ten years. The nett mortality among males (102 deaths) was 1.59, and that among females (55 deaths) 0.64. The average mortalities for the quinquennium 1902-06 were—males, 1.41 ; females, 0.75. The sex mortalities for the years prior to 1901 are not available, but an examination of those for the last seven years suggests that as regards females the mortality at all ages is becoming stationary, while that for males is increasing. (See below.) Mortality from " Consumption " Per 1,000 Individuals, all ages. 1901. 1902. 1903. 1904. 1905. 1906. 1907. Males 1.37 1.43 1.39 1.57 1.23 1.47 1.59 Females 0.79 0.77 0.77 0.77 0.68 0.78 0.64 On comparing the age-group mortalities for each sex with the quinquennial mean rates (see below) it will be found that—with the exception of the ages 15-20,55-65 and 75all last year's rates for males were above the respective means; while of those for females, the rates at ages 20-25, 65-75 and 75— were the only exceptions to the general reduction. Mortality from " Consumption." Per 1,000 Individuals. Ages 0— 15— 20— 25— 35— 45— 55— 65— 75— Males. 1907 0.27 0.51 1.39 1.77 3.36 3.51 1.74 2.77 — 1902.06 0.13 0.62 1.32 1.44 2.73 3.12 2.68 2.15 0.63 Females. 1907 0.32 0.12 0.67 0.61 0.67 1.16 1.06 1.24 1.46 1902.06 0.13 0.48 0.56 0.79 1.14 1.25 1.61 1.20 0.59 Comparing the nett mortalities of the individual Wards during the past year with their respective quinquennial means (Table 17), increased mortality rates are found to have been recorded last year in Queen's Park, Maida Vale, and Westbourne Wards. Contrarv to expectation there was a decrease in the mortality for Church Ward. 20 tubercular diseases. TABLE 17. Tubercular Diseases. Nett Mortalities Per 1,000 Persons, all ages. Queen's Park. Harrow Road. Maida Vale. West. bourne. Church. Lancaster Gate, Hyde Park. West. East. Phthisis Pulmonalis— 1907 1.75 0.84 1.04 1.18 1.36 0.23 0.38 0.64 1902.06 115 0.96 0.96 110 1.55 0.41 0.52 0.68 Other Tubercular Diseases—1907 0.42 0.47 0.19 0.55 0.64 0.11 0.12 0.21 1902.06 0.67* 0.41 0.30 0.29 0.57 0.09 0.02 0.25 * Mean, 1892.96=0.59. For comparison with the circumjacent districts, the rate (1.09) obtained from data furnished by the Registrar-General's Annual Summary has been used. (Table 11). That rate shows an increase of 0.01 above the quinquennial mean rate, whereas last year's rates in all the other districts show decreases, some of them proportionately large. The "corrected" rates for the Borough, its Wards and the circumjacent districts are given in Table 18. Those figures show that while the Borough rate for last year was 07G below the " standard," it was equal to the mean ; that last year's rate for Queen's Park, was slightly above the standard, the other Ward rates being all below ; that last year's rates for Queen's Park, Maida Vale and Westbourne Wards were in excess of their respective means; and that the rates for last year in the circumjacent districts were all below the respective standards and also below their means. TABLE 18. Rates Corrected for Age and Sex. Based on London Mortality experience. Percentage of total population (Census 1901). Phthisis Pulmonalis. Cancer.[/####] Persons per acre. " Overcrowded." Living in homes of less than 5 rooms. Standard Rate. Fully Corrected Rate. Standard Rate. Fully Corrected Rate. 1907. Mean. 1902-06. 1907. Mean. 1902-06. Paddington 106 13.6 50.9 1.80 1.04 1.04 0.98 1.05 0.91 Queen's Park Not known. 9.1 51.7 1.73 1.75 1.15 0.83 0.69 1.00 Harrow Road 11.5 75.5 1.77 0.82 0.94 0.88 1.12 0.87 12.6 43.4 1.82 0.99 0.91 1.01 1.37 1.03 Westbourne 13.4 46.3 1.80 1.13 1.06 1.17 0.91 0.82 Church 32.8 61.3 1.68 1.40 1.60 0.87 1.11 1.06 Lancaster Gate, West 2.6 15.2 1.84 0.22 0.39 1.02 1.00 0.94 Lancaster Gate, East 2.1 16.2 1.84 0.36 0.49 1.02 0.86 0.72 Hyde Park 5.2 25.3 1.88 0.59 0.63 1.07 1'22 0.83 London 61 16.0 54.0 1.74 1.39 1.51 0.87 1.03 1.00 Kensington 77 14.8 41.7 1.78 1.00 1.22 1.02 0.94 0.81 Westminster 73 13.0 45.7 1.95 1.21 1.40 0.96 0.84 0.92 Marylebone 90 21.1 55.6 3.85 1.38 1.56 0.99 1.01 0.99 Hampstead 36 6.4 29.6 1.75 0.69 0.76 0.92 0.71 0.97 Willesden 21 11.6 50.7 1.65 0.96 1.02 0.71 0.89 101 tubercular diseases. 21 It should be noted that the density of population (persons to the acre) is, or was at the last census, highest in the Borough, but that the percentage of "overcrowding" in Kensington and Marylebone exceeded that in the Borough. Marylebone w ith the second highest density of population (90 persons per acre) and the highest percentages of " overcrowding" (21.1) and of population in homes of less than five rooms (55.6) had the highest mortality from ''consumption" (1.38 in 1907; mean, 1.56) ; Westminster and Kensington, with lower percentages of "overcrowding" and small homes, having higher mean rates (1.56 and l.40 respectively) than the Borough (1.04). Church Ward had the highest proportion of "overcrowding," and in former vears the highest mortality from "consumption." Last year the highest mortality was recorded in Queen's Park Ward, where the proportion of " overcrowding " is, or was in 1901, comparatively low. Prevention of "Consumption." Notification.—Believing that notification to be sufficiently complete to be useful must be compulsory and not voluntary, the adoption of the latter has not been advocated. Persons are, however, brought to the notice of the Department as "consumptives" partly with a view to efforts being made to ameliorate the conditions of the sufferers and partly to secure disinfection of their homes and goods. The first reports of such patients (4 cases) were received in 1903, since which year the annual numbers have grown to 85 last year. Among the 184 patients reported between 1903 and 1907 were 7 who were subsequently declared to be free from " consumption." As may be expected in the absence of any system of notification, the majority of the cases were reported by lay persons—only 15 out of the 184 being reported by the medical profession. A complete analysis of the sources of information is given below :— " Consumption." Cases reported (1903-07) by— Relieving Officers 90 Sanitary Officers 15 Private Practitioners 15 Patients themselves and their relatives 14 Hospital Staffs 2 Other persons*48 * Including the Health Society (27 cases in 1907), Charity Organisation Society, District Nurses, &c., &c. Of the 184 patients, 31 had been lost sight of through removals, 7 (as already stated) were not " consumptives," and 62 had died before the end of last year. The numbers of patients reported and dying each year are given below. " Consumption." Number of Died during Subsequently Lost sight of, Living at cases found not removals, end of reported. 1903. 1904. 1905. 1906. 1907. consumptive. frc. 1907. 1903 4 2 — 2 — 1904 20 — 5 1 1 1 — 5 7 1905 18 10 3 1 — 3 1 1906 57 17 5 2 10 23 1907 85 14 5 13 53 At the close of the year there were 84 persons on the "Consumption Register" of the Department, 47 being males and 37 females. Their occupations are given in the appended table. 22 tubercular diseases. " Consumption." Occupations of Patients living at the end of 1907. Trade. M. F. Trade. M F. Indoor:— Mixed :— Art Metal Worker 1 Electrical Engineer's Fitter 1 Baker 1 ... Engineer's Fitter 1 Butler 1 ... Porter 1 Charwoman ... 1 Shop Porter 1 Clerk 2 Stableman 1 • •• Domestic Duties (Housewives) ... 12 Wood Sawyer 1 „ „ (Servants) ... 3 6 — Dressmaker ... 1 Laundress ... 3 Shoemaker 1 Shop Assistant 1 No occupations:— Tin Worker 1 ... Independent means 1 ... Upholsterer 2 School children 5 12 Wood-binder ... i Other children 2 4 10 21 8 16 Outdoor:— Cabman 1 ... Totals:— Cab Washer 1 ... Indoor Workers 10 21 Carman 3 ... Outdoor „ 23 ... Coachman 1 ... Mixed Occupations 6 ... Commercial Traveller 1 ... No „ 8 16 Flower-seller 1 ... 47 37 Gardener 1 ... Labourer 8 ... Omnibus Conductor 1 ... Painter 4 ... Road Sweeper 1 ... 23 ... Each case reported is visited by one of the Women Inspectors who gives advice as to the precautions necessary to prevent the spread of infection, urges the need of proper medical treatment, reports any insanitary conditions for remedy, and offers disinfection when necessary. The co-operation of the various philanthropic societies working in the Borough is sought on behalf of patients requiring assistance in any form, and especially for such as are suitable cases for sanatorium or hospital treatment. It is believed that the persons brought to the knowledge of the Department have benefited thereby, but a serious gap exists in the present regime which the Department is, at present, unable to fill up. An essential factor in the prevention of consumption is the discovery and safeguarding of incipient cases of the disease. At present few such cases are discovered by the Department which does not possess the necessary staff or powers. The establishment in the Borough of a "Tuberculous Dispensary " (already foreshadowed) with the search of early cases as one of its principal functions would do much to supply the deficiencies of the system now in force. Housing.—The conditions of the home life are important factors in the causation of phthisis, but it is difficult to determine whether in any given case the unsatisfactory surroundings (qud aggregation of individuals in the home) are the cause, or the result, of the disease. It is found impossible to trace the histories of the cases far enough back to say whether the housing arrangements discovered have resulted from the incapacity of the breadwinner to provide better accommodation or whether such arrangements have been inevitably tubercular diseases. 23 forced on the occupants by economic conditions and the disease resulted therefrom. The fact remains that the majority of the patients do live in unsuitable homes, especially if the liability of the disease to spread to other members of the family be taken into consideration. Below is^ajstatement showing the proportions of the known consumptives living at the end of 1907 and of the cases ending fatally during the year (118 out of a total of 157) living in each class of home containing less than five rooms. Percentages residing in each Average number of Inhabitants Tenement. per Room. Rooms " Consumptives." Whole " Consumptives." Whole in Borough, ,Borough, Homes. Living. Dead. 1901. Living. Dead. 1901. 1 23.8 23.7 6.4 3.3 2.1 1.8 2 50.0 22.0 15.6 2.5 1.7 1.7 3 10.7 2.5 17.3 1.6 1.1 1.3 4 7.1 8.4 11.4 1.5 0.9 1.2 No fewer than 74 of the 157 deaths recorded last year occurred in institutions, some after long stay therein. The housing of such cases could not be ascertained, and that fact probably accounts for the differences observed in the proportions of living and dead consumptives in the various classes of home. A consumptive person should have a bed, if not a bedroom, to himself. In the single room homes of the living patients all but two (of a total of 20) were occupied by more than one person, while of the same class of homes of patients dying during the past year only 7 (out of a total of 28) were occupied by the patient alone. Even with tenements of 2 and 3 rooms separate sleeping accommodation is rarely practicable. Among the occupants of all homes of less than 5 rooms hospital accommodation for advanced cases is urgently needed. The enquiries relating to 118 deaths from consumption elicited the fact that 49 of the deceased persons had separate beds, and 34 (of the 49) separate bedrooms. In many cases the Inspectors reported that the homes were unsuited for persons suffering from this disease, being basement rooms inadequately lighted and ventilated. Dampness of the house was reported 3 times, dirty conditions 7, and insufficient ventilation once. Such defects are not reported unless they are really serious, and the figures therefore understate the frequency of such defects. Isolation.—f the cases reported during the past year 7 were sent to sanatoria, 2 (each) to hospitals and "homes," 5 to the Workhouse Infirmary, and 4 left London to reside in the country. Unfortunately a large proportion of the cases do not come to the knowledge of the Department until the disease is too far advanced to be amenable to treatment. Some of the cases have, however, improved greatly under treatment, and, on the whole, the year's experience affords a hope that, with an extension of the work and earlier report to the Department, a larger proportion of good results may be expected. Disinfection.—Disinfection is offered when the patient leaves his home, or dies, and also while continuing his residence. During the past year disinfection after death was secured on 102 occasions, the work being undertaken by the Department in 89. Definite refusals of the offer were given in 6 instances only. The remaining 49 occasions where no disinfection was carried out after death represent institution deaths, the patients having been in most cases away from home for such long periods before death that disinfection was deemed unnecessary. In addition, disinfection was secured after the removal from home of 15 patients, and once during the residence of a patient. 24 cancer. Other Tubercular Diseases.—These caused 62 deaths during the past year, or 8 more than in 1906. Last year's deaths comprised 25 from tubercular disease of the brain, 2 of the larynx, 13 of abdominal organs, 6 of other parts, and 16 of "general tuberculosis." The mortality was at the rate of 0.41 per 1,000 persons, as compared with means of 0.40 for the quinquennium 1902-06 and 0.60 for that of 1892-96. The rates for last year in the Wards in comparison with the mean rates for 1902-06 are given in Table 17. CANCER. The mortality from the malignant tumours, or growths, included under this general heading, still continues to increase. In 1891 there were 108 deaths—equal to a mortality of 0.79 per 1,000 persons ; in 1901, 148 deaths (mortality, 1.02), and last year 178 deaths—equal to a rate of 1T9, which last rate is 0.16 in excess of the average for 1902-06 (1.03). In Queen's Park Ward only was last year's rate below the quinquennial mean (0'66, as compared with 0.95). Comparing 1906 with 1907, there were 14 more deaths in the whole Borough in the latter year. Higher numbers were recorded in 1907 in five out of the eight Wards, the exceptions being Queen's Park (11 deaths in ] 907,13, 1906), Church (31 deaths 1907, 37, 1906). and Lancaster Gate, East (8 deaths, 1907, 9, 1906). In the circumjacent districts (Table 11) increased mortalitv rates were recorded in Kensington (1.19, mean 0.95) and Marylebone (1.14, mean 1.12). In the remaining districts the rates for last year were below the respective means, the greatest difference being recorded in Hampstead (0.75, mean 1.03). The rates for the Borough, its Wards, and the circumjacent districts, obtained bycorrection for variations in the sex-age composition of the populations, are to be found in Table 18, together with the "standard" rates. Last year's rates were below the standards in Kensington, Westminster, and Hampstead, and below the quinquennial mean rates in Westminster, Hampstead, and Willesden. In the Borough the increase in last year's corrected rate over the mean was 0.14, the largest in the table. The highest rate recorded in any Ward was that of Maida Vale (1.37), which also shows the largest increase above the mean (0.34). The lowest rate was that of Queen's Park (0.69), which was 30 per cent. below the mean (1.00). "Cancer" being a disease of adult life, the few deaths at ages under 25 may be left out of consideration in dealing with age incidence. Sex-age mortalities have, therefore, been calculated for ages exceeding 25 years only. (See below). Among males no deaths were recorded last year in the groups " 25-35 " and " 85 and upwards." The rates for the other groups were all in excess of the mean rates for the preceding five years. Among females the group " 25-35 " was the only one with no death, the rates for three out of the six remaining groups were below the means. " Cancer." Mortality per 1,000 Individuals. 25— 35— 45— 55— 65— 75— 85— Males. 1907 - 0.46 3*51 5.24 11.68 16.30 — 1902-06 0-04 0-39 2-07 4.63 6.58 12.54 7.16 Females. 1907 — 1.08 1.98 3.89 11.21 6.82 15.30 1902.06 0.23 0.89 2.30 4.97 6.62 9.24 10.44 measles. 25 The numbers of deaths (for each sex) from the principal forms of malignant disease included under the general term " cancer," with the approximate sites of the growths and the age-distribution of the deceased persons, are given in Table 19. TABLE 19. Deaths from "Cancer." 1907. Seat of Disease. 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. 1. Nervous System II. Organs of Special Sense Ill Respiratory System i "i ... 1 ... ... ... ... ... ... 2 1 IV Circulatory System ... ... ... ... V Digestive System. (a) Mouth 3 l 2 6 . •. ... ... 11 1 (b) Throat 5 l 1 1 ... ... 3 10 1 (c) Digestive tube 18 16 5 5 ... ... ... i ... 2 4 26 25 (d) „ organs 6 8 3 7 ... i ... 2 10 17 (e) Peritoneum 1 . .. ... ... ... 1 (f) Omentum I 2 ... .. . 1 2 VI Lymphatic System 1 i "i ... ... ... ... 1 3 1 VII. Urinary System 3 3 2 ... "i ... ... ... ... 3 2 ... 8 5 VIII Generative System. (a) Uterus . • • 10 4 ... ... ... 1 1(«) ... 16 (b) Breast ■ • • 9 4 1 7 ... ... 21 (c) Other parts 9 ... 1 i ... "i 3 IX Osseous & Muscular Systems ... 1 2 ... i 1 2 2 5. X. Cutaneous System ... 2 ... ... 2 ... XI. Not sufficiently described ... ... ... ... ... ... l(b ... ... 1(c) 1(d) 2 I Totals 40 54 14 22 10 2 ...... 7 5 1 9 12 1 1 79 99 Ages at Death. 0— ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 10— ... ... ... ... ...... ... ...... ... ...... ... ... ...... ... ... ...... ...... 15— ... ... ... ... ... ... ... ... 1 ... ...... ...... ... ... 1 ...... 20— ... ...... ...... ... ...... ... ... ... ...... ...... ...... ...... ... ... ... ...... 25- ...... ... ... ...... ... ... ... ... ...... ... ...... ... ... ... ... 35— 2 8 ... ...3 1 ... ...... ...... ... ...... 1 2 ... ... 4 13 45— ii 6 4 3 4 ... ...... 5 2 ... 1 3 ...... ... 22 17 55— ii 11 4 5 4 ... ...... ...... ...... 1 2 4 ...... ... 21 22 65— 9 20 5 11 1 ...... ...... 1 1 ... 4 3 1 1 21 36 75- 7 9 .1 ...... ...... 1 ...... 1 ...... ... 1 ... ... ...... 9 11 (a) Malignant cyst. (b) Multiple sarcomata. (c) Malignant growth in abdomen. (d) Rodent ulcer. MEASLES. Last year was " an epidemic year " for this disease, 1,284* cases coming to the knowledge of the Department, as compared with 592 in 1906 and 1,714 in 1905. As may be seen from the statement given below the largest number of cases occurred during the fourth quarter of the year, a bad time for an epidemic owing to the special liability to intercurrent respiratory complications. * In addition 27 cases of "German Measles"—presumably rotheln—were reported. 26 measles. Quarters 1. 2, 3. 4. Year Uncorrected. Corrected. 1903 42 147 185 362 736 929 1904 723 94 18 23 858 896 1905 227 895 292 288 1,702 1,714 1906 105 204 199 89 597 592 1907 109 303 276 548 1,236 1,284 The cases reported do not, unfortunately, represent the full number of attacks, the disease not being notifiable and the sources of information as to its occurrence being limited, mainlv, to the public elementary schools. All teachers are not equally careful to report the cases known to them, and information of cases during the school holidays is dependent on the Staff of the Department hearing of the attacks in the course of their other duties. It is, however, believed that the cases reported represent a fairly constant proportion of the total—that is suggested by the approximately constant fatality rates—and, what is of more importance, the cases known are those which require the assistance and advice which the Officers of the Department are able to give. The largest proportion of missed cases are believed to occur in the southern Wards, where medical advice is more freely sought. The average number of cases to a house was 1.9 in 1907, compared with T8 in 1906, 1*7 in 1905 and T8 in 1904 and 1903. The percentage of secondary to all cases was 46'6 last year ; 44.4, 44.1, 47.1, 44.6 in the years 1906 and backwards. year ; 44.4, 44T, 47.1, 44.6 in the years 1906 and backwards. The frequency of multiple cases in each of the five past years was— 1907. 1906. 1905. 1904. 1903. Houses with 2 cases 194 100 257 166 141 ,, 3 ,, 97 48 143 59 60 „ 4 „ 30 15 43 25 30 „ 5 ,, 19 4 16 5 10 „ 6 „ 7 — 4 3 3 ,, 7 ,, 2 1 — 1 3 „ 8 „ 1 — — — 2 The deaths recorded during the year numbered 37, an increase of 21 above the total for the preceding year. and included 20 of males and 17 of females. The deaths certified as due to measles do not represent the total mortality due to that disease, but inquiries are made wherever the omission to mention measles as a cause of death has been suspected. A fatal issue may follow an attack of the disease after a considerable interval, when the original cause has been lost sight of and the death is certified as due to some secondary cause instead of being attributed to the primary (measles). Corrections for such omission are impracticable, and the fatality of the disease based on the known cases and the deaths certified as due to it must be accepted. The 1,284 known cases and the 37 deaths represent a fatality equal to 2'8 per cent, of the cases. Having regard to the fact that there was an epidemic during the year and to its occurrence in the fourth quarter, that fatality is satisfactorily low. Evidence is wanting as to the true fatality of the disease, the estimates published varying from 2 to 10, or even, in certain epidemics to as high .a figure as 40-50 per cent. During the five years 1903-07, 5,415 cases have been reported, and 194 deaths registered as due to measles, which figures give an average fatality of 3'5 per cent. That rate is undoubtedly too high, and it is probable that the true rate for the Borough would be somewhere about 2 per cent. Apparently the disease is more fatal among males than females, as appears from the appended figures :—(See next page) measles. 27 Measles. Fatality at all ages, per cent, of cases. 1903. 1904. 1905. 1906. 1907. Males 5.2 5.2 2.9 3.4 3.3 Females 3.1 3.5 4.2 2.0 2..5 Persons 4.1 4.3 3'6 2.7 2.8 Moreover, the fatality differs very greatly with the age of the patient, being very high at the youngest ages (Table 20). The figures in the table referred to show that the greatest toll on life falls on children aged under 2 years, although the largest numbers of cases occur at ages above 4 years. The latter fact is doubtless due to the greater facilities for the spread of the disease afforded by school attendance. TABLE 20. Measles. Ages. 0— 1— 2— 3— 4— 12— 1 Fi— m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. Cases 23 33 92 84 76 76 87 83 101 26 213 260 1 2 8 14 Deaths 4 5 8 4 5 4 1 — 1 1 1 3 — — — — Fatality per 100 known cases— 1907 17.3 151 8.7 4.7 6.5 5.7 1.1 — 0.9 0.7 0.04 1.1 — — — — 1906 17.6 7.1 19.4 10.9 — 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 — — — —— — — The fatality differs greatly in the various Wards, and ranged last year from 5"2 per cent, in Westbourne to zero in the Lancaster Gate Wards. The mean fatalities for the five years ranged from a maximum of 4'8 in Church Ward to a minimum of 0*6 in Lancaster Gate, West, Ward. The mean fatalities of the three northern Wards of the old parish, viz., Harrow Road, Maida Vale, and Westbourne, are curiously equal. Queen's Park Ward ... Mean Fatality 2'7 c. d. f. 1907 184 2 1.0 1906 134 1 0.7 1905 244 3 1.2 1904 288 15 5.2 1903 50 4 8.0 Church Ward Mean Fatality 4'8 c. d. F. 1907 374 15 4.0 1906 72 4 5*5 1905 434 25 5'7 1904 129 5 3.8 1903 321 15 4.6 Harrow Road Ward... Mean Fatality 3'7 1907 332 8 2.4 1906 127 4 3.1 1905 461 20 4.3 1904 231 10 4.3 1903 185 8 4.3 Lancaster Gate, West, Ward ... Mean Fatality 0.6 1907 16 — — 1906 41 — — 1905 27 — — 1904 54 1 1.8 1903 10 — — Maida Vale Ward Mean Fatality 3'4 1907 203 5 1.4 1906 40 3 7.5 1905 185 5 2.7 1904 69 6 8.7 1903 113 2 1.7 Lancaster Gate, East, Ward ... Mean Fatality 1.5 1907 9 — — 1906 14 — — 1905 65 1 1*5 1904 27 1 3.7 1903 11 — — Westbourne Ward ... Mean Fatality 3'6 1907 133 7 5.2 1906 136 4 2.2 1905 187 7 3.7 1904 79 1 1.2 1903 221 9 4.0 Hyde Park Ward ... Mean Fatality 2'3 1907 33 3 9.0 1906 28 — — 1905 111 2 1.8 1904 19 — — 1903 18 1 5.5 C...Cases. D.—Deaths. F.—Fatality per cent, of Cases. Mean Fatality—for five years, 1903.07. 28 measles. The mortality of the disease last year was at the rate of 0.24 per 1,000 persons, as compared with a mean rate of 0.32 for the five years 1902.6 and one of 0.48 for 1892.96. The comparison appears to be a satisfactory one, hut some reservation must be made for the fact that the epidemic occurred during the last quarter of the past vear and continued into the first quarter of the current one. Consequentlv some of the deaths from measles registered at the beginning of this year ought to be added to the total for last year. Such deaths would (it is known) be very few in number, quite insufficient to raise the mortality figure to the mean for 1902.06. Measles is characterised by the peculiar regularity of its outbreaks, occuring at intervals of eighteen months to two years, and by the varying severity of attack in different outbreaks. It would be unwise, therefore, to speak in too confident a tone of the reduction in the mortality which appears to have taken place. The next outbreak may set the balance on the other side of the account. The mortality varies greatly in the different Wards and ranged last year from 0'53 in Church Ward to zero in the Lancaster Gate Wards. In two Wards only, viz., Maida Vale and Hvde Park, was last year's mortality in excess of the quinquennial mean. (See below.) Measles. Mortality per 1,000 Persons. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. West. East. 1907 0.12 0.27 0.24 0.15 0.53 0.21 1902.06 0.37* 0.32 0.22 0.22 0.71 0.04 0.04 0.12 * Mean, 1892-96, 0*50. In the circumjacent districts last year's nett mortality (Table 11) was below the mean in all districts, but the Willesden rate was higher than that of the Borough. After correction for sex and age, the Borough rate (Table 21) becomes the highest of the series, and the Hampstead rate is found to be exceptional in that it is higher than the mean. TABLE 21. Measles. Whooping Cough. Standard Rate. Corrected Rate. Corrected Rate. 1907. 1902-06. Standard Rate. 1907. 1902-06. M Paddington 0.43 0.32 0.40 0.39 0*43 0.25 London 0.58 0.37 0.43 0.50 0.37 0.32 Kensington 0.47 0.21 0.44 0.35 0.63 0.32 Westminster 0.36 0.18 0.29 0.31 0.23 0.23 Marylebone 0.42 0.19 0.54 0.36 0.47 0.25 Hampstead 0.40 0.19 0.18 0.34 0.19 0.17 Willesden 0.66 0.25 0.35 0.57 0.42 0.25 whooping cough. 29 WHOOPING COUGH. During the year 589 cases of this disease were reported, as compared with 171 in 1906 and 540 in 1905. The disease was much more prevalent in the first than in the second half of the year, as will be seen from the appended summary of the numbers reported in each quarter. Year. Quarters 1. 2. 3. 4. Uncorrected. Corrected. 1903 281 35 11 2 339 533 1904 23 27 45 98 193 196 1905 241 255 38 36 570 540 1906 57 65 26 26 174 171 1907 189 305 73 48 615 589 The observations under " Measles" as to source of information, &c., applv equally to this disease, with the reservation that it is believed that a smaller proportion of the cases are reported, probably because so many of the patients are under school age. The cases averaged 1.7 per house, as compared with 2.0, T8, 16, and 1.9 in 1903 and following years. The distribution-frequency of multiple cases in houses during the five years is given below. 1907. 1906. 1905. 1904. 1903. Houses with 2 cases 99 31 93 29 71 3 „ 49 17 44 12 44 4 „ 12 4 13 5 12 5 „ 4 1 3 6 8 6 86 „ 1 — — 2 2 „ 7 „ 1 — 1 The deaths last year numbered 50, 25 of each sex, the fatality of the disease (subject to reservation as to unknown cases) was 8.4 per cent., or 0.3 below the mean for the preceding four years. The fatality among males has been higher during the past two years than that among females, the reverse of the experience of the earlier years (1903-05). See below. Males. Females. Persons. 1903 9.0 9.4 9.2 1904 8.0 8.3 8.1 1905 9.6 10.2 9.9 1906 8.3 6..9 7.6 1907 9.2 7..8 8.4 The fatality in the different Wards ranged last year from zero (Lancaster Gate, East, and Hyde Park Wards) to 11.8 per cent. (Westbourne), but the range of variation of the mean fatality for the five vears is much less if Lancaster Gate, West, Ward be neglected. There the rate is manifestly misleading. 30 whooping cough. Queen's Park Mean Fatality 8.0 c. d. f. 1907 112 9 8.0 1906 31 1 3.2 1905 126 10 7.1 1904 8 2 25.0 1903 134 11 8.2 Church Mean Fatality 7.9 c. d. f. 1907 75 7 4.0 1906 96 4 7.1 1905 99 8 8.0 1904 65 3 4.6 1903 56 9 16.0 Harrow Road Mean Fatality 7.7 1907 224 17 7.5 1906 27 3 11.1 1905 165 12 7.2 1904 58 3 5.1 1903 147 14 9.5 Lancaster Gate, West Mean Fatality 14.3 {?) 1907 13 1 7.6 1906 — — — 1905 — 1 ? 1904 7 — — 1903 1 1 ? Maida Vale Mean Fatality 11.2 1907 65 7 10.7 1906 22 1 4.5 1905 48 8 16.6 1904 4 1 25.0 1903 57 5 8'7 Lancaster Gate, East Mean Fatality 10.3 1907 1 — — 1906 — — — 1905 17 — — 1904 4 1 ? 1903 7 2 ? Westbourne Mean Fatality 10.7 1907 76 9 11.8 1906 17 2 11.8 1905 39 5 12.8 1904 45 6 13.3 1903 121 10 8.2 Hvde Park Mean Fatality 8.8 1907 23 — — 1906 18 2 11.1 1905 46 6 13.0 1904 5 — — 1903 10 1 10.0 c.—Cases, d.—Deaths, f.—Fatality per cent, of Cases. Mean Fatality—for the five years, 1903.07. The sex.age fatality is given (for what it is worth) in Table 22. The fluctuations are too great and too erratic to allow any deductions to be made at present. TABLE 22. 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 25 30 34 29 36 27 37 33 36 62 98 137 1 1 2 1 Deaths 9 11 10 6 3 2 3 3 — 1 — 2 — — — — Fatality per 100 known cases— 1907 36.0 36.6 29.4 20.6 8.3 7.4 8.1 9.0 — 1.6 — 1.4 — — — — 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 21.0 8.3 16.2. 11.8 6.6 7.1 — — — — — — — — 1903 60.0 24.1 39.3 10.3 15.0 — 2.2 — — — — — — — 50.0 The mortality last year was at the rate of 033 per 1,000 persons, as compared with 0"09 in the previous year and means of 0.20 and 0.38 for the quinquennia 1902.06 and 1892.96 respectively. The rates in all Wards, except Lancaster Gate, East, were above the means. (See below). Mortality from Whooping Cough. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate. Hyde Park. West. East. 1907 0.54 0.57 0.34 0.35 0.25 0.11 0.21 1902-06 0.32. 0.27 016 0.33 0.19 0.04 0.04 0.12 . Means, 1892.96, 0.77 other diseases. 31 In comparison with the rates of the circumjacent districts (Table 11), the local rate (034) was exceeded by those of Kensington (0.44) and Willesden (0.48). In all the districts, except Westminster, last year's rate was above the mean. After correction for sex and age, last year's rate for the Borough becomes 0.43. and was exceeded by the rates for Kensington (0.63) and Marylebone (0.47) only. (Table 21). OTHER DISEASES. The mortality rates for the remaining five diseases selected for separate tabulation are given in Table 23. Increases in last year's rates, as compared with the means for 1902-06, have to be noted from epidemic influenza, the respiratory diseases (bronchitis and the pneumonias) and from cirrhosis of the liver. TABLE 23. Epidemic Influenza. Respiratory Diseases. Alcoholism. Cirrhosis of Liver. Suicide. 1907. 1902-6. 1907. 1902-6. 1907. 1902-6. 1907. 1902-6 1907. 1902-6. Borough 0.34 0.27 2.50 2.20 0.06 0.12 0*19 0.15 0.06 0.10 Queen's Park 0.30 0.26 3.45 2.33 0.07 0.18 0.07 0.06 0.12 Harrow Road 0.27 0.28 2.36 2.26 0.03 0.06 0.13 0.16 0.06 0.10 Maida Vale 0.29 0.31 2.18 1.85 0.14 0.16 0.19 0.20 0.19 0.04 Westbourne 0.43 0.25 1.60 2.35 0.15 0.12 0.39 0.17 0.03 0.11 Church 0.42 0.27 2.45 3.19 0.07 0.16 0.17 0.18 0.03 0.08 Lancaster Gate, West 0.11 0.21 1.77 100 0.04 0.11 0.13 Lancaster Gate, East 0.12 0.29 0.88 1.02 0.07 0.20 0.09 Hyde Park 0.21 0.24 2.15 1.07 0.18 0.21 0.11 0.18 Epidemic Influenza.—Increases occurred in three Wards, Queen's Park, Westbourne and Church. I he highest Ward rate was that of Westbourne Ward (0.43, mean 0.25) and the lowest that of Lancaster Gate, West (0.11, mean 0.21). Respiratory Diseases.—The increase in the rate for the Borough (0'30) was but slight, but large increases were reported in Queen's Park Ward (3.45, mean 2.33) and Hyde Park (2T5 mean 1.07). The rate for the first.named Ward was the highest recorded during the year, the lowest being that of Lancaster Gate, East (0.88, mean 1.02). Increased rates were recorded in Harrow Road, Maida Vale and Lancaster Gate, Weft, Wards. Cirrhosis of the Liver.—The bulk, but not all, of the deaths attributed to this cause are deaths from alcoholism. Although the increase in the Borough was but small (0.04) great increases were recorded in Queen's Park (0.18, mean 0.07), Westbourne (0.39, mean 0.17) and Hyde Park (0.21, mean 0.11). Alcoholism.—The only Ward with an increased rate was Westbourne (0.15, mean 0.12) Intemperance. It is regrettable that the data furnished by the mortality returns show no real decrease in intemperance and an actual increase among females. This conclusion is based on the 32 mortality of childhood. numbers of deaths from " alcoholism, acute and chronic," and from "cirrhosis of the liver." The records, distinguishing the sexes for the last seven years, are given below. Acute Alcoholism Chronic ,, Cirrhosis of the liver Totals Persons 1901. m. f. I — 8 7 8 13 17 20 37 1902. m. f. 3 — 8 12 13 12 24 24 48 1903. m. f. 3 1 9 12 11 8 23 21 44 1904. m. f. 2 1 5 9 10 12 17 22 39 1905. m. f. 1 1 4 8 8 20 13 29 42 1906. m. f. 1 1 6 4 9 16 16 21 37 1907. m. f. — 1 2 7 9 20 11 28 39 Ratio (Census Population) M.: F. = l : 1*33. Averages 1901-03 M. 21, F. 22 1904-06 M. 19, F. 24 1907 M. 11, F. 28 MORTALITY OF CHILDHOOD. To the usual discussion of infantile mortality, i.e., of infants under one year of age, a few paragraphs are added dealing with the mortality in the second to fourth years of life. Infantile Mortality. The deaths of children in the first year of life, registered in the Borough during the past year, numbered 396, equivalent to a crude mortality rate (per 1,000 births registered in the Borough) of 128. The deaths were 97 below the decennial average (493) and the rate 19 below the mean (147). In 1906 the deaths numbered 395, the only year with a total below that of last year. (See Table I., Appendix). As low a rate as 128 was recorded in 1903, and one of 125 in 1906. All the other rates since 1897 have been higher. The crude rates for each quarter of last year are compared with the quinquennial means below. Crude Infantile Mortalitv. Quarters 1. 2. 3. 4. Year. 1907 144 124 108 140 128 1902-06 134 107 167 137 136 The drop in the rate for the third quarter is the most interesting feature of the comparison. Deducting the deaths of non-residents registered in the Borough and adding those of residents in out-lying districts, a nett total of 354 deaths is obtained (viz., 219 of bovs and 135 of girls), equal to a mortality rate, calculated on the births registered in the Borough (the usual basis of comparison), of 115 for persons, 138 for males, and 90 for females. Twice only has a lower rate been recorded, viz., in 1903 (rate 108) and in 1906 (rate 112). The mean rate for the five years 1902-06 (on the same basis) was 122, and that for the five years 1892-96, 149, showing satisfactory reductions. In the Metropolis last year's crude rate was equal to that for the Borough, but the difference from the quinquennial mean was 18, as against 9 for the Borough. In the circumjacent districts lower rates were recorded in all last year than in the quinquennium, but the Kensington rate for last year (134) stands out markedly in contrast with the others. In that district last year's rate was, however, 10 below the mean. mortality of childhood. 33 During the past three years—that is, since the Registrars have supplied particulars relating to the registration of births—those returns have been checked week by week against the death returns to ascertain the numbers of infants dying prior to the registration of their births. In 1905, 87 such deaths were noted; in 1906, 89; and last year, 124. Doubtless increased skill in making the search accounts for a large proportion of the increase noted last year ; but even now there is reason to believe that some deaths are not detected. The period prescribed for the registration of births being limited (under ordinary circumstances) to six weeks, the ages of the infants varied from a few minutes to 6 or 7 weeks. (See Table 24). An analysis of the causes of death shows that 61 (nearly 50 per cent.) of the deaths were attributed to "premature birth," and 25 others to congenital abnormalities which rendered life impossible. In other words, just on 70 per cent. of all the infants whose births were registered during the year were born not to live but to die. Indeed, one may say that the survival of nearly all those 124 children was on eugenic, if not ethical grounds, undesirable. If their survival could be secured by medical care it is highly probable that the majority of them would have developed into hopelessly unfit individuals. TABLE 24. Children Dead at or before Registration of Birth. 1907. Ages at Death. Days. Weeks. Months. All Ages. 0- 1— 2— 3— 4— 5— 0— 0— l- 2 q o— 0— 1— p. m. f. Measles — — — — — — — — — 1 — 1 — 1 1 — Whooping Cough — — — — — — — — — — 1 1 - 1 1 — Diarrhoea 1 1 2 1 3 3 — Enteritis — — — — — — — — 1 — — 1 — 1 1 — Premature Birth 27 3 7 2 6 1 — 46 5 5 2 58 3 61 39. 22 Injury at Birth 2 — — — — — — 2 — — — 2 — 2 2 — Debility* 1 1 1 — — — 3 6 3 2 3 14 4 18 11 7 Malformation 1 3 — 1 — 1 — 6 2 2 — 10 2 12 6 6 Syphilis 1 1 2 — 2 — 2 Erysipelas — — — — — — — — 1 — — 1 — 1 1 — Convulsions — 1 — — — 1 — 2 2 1 1 6 1 7 6 1 Respiratory Diseases 1 1 — 2 8 10 4 6 Overlaid — — — — — — —• — — 2 — 2 — 2 — Other causes — — 1 — — — — 1 1 — — 2 -— 2 1 1 Not certified 1 — — — — — — 1 — — — 1 — 1 1 — Males 18 5 6 3 3 2 3 40 12 9 6 67 12 79 Females 14 3 3 — 3 1 — 24 5 6 3 38 7 45 Persons 32 8 9 3 6 3 3 64 17 15 9 105 19 124 * Includes—" Debility at Birth," " Want of Breast Milk," " Atrophy and Debility." | Includes—" Atelectasis," "Congenital Malformations." 34 mortality of childhood. It appears to be reasonable to exclude the deaths dealt with above from the infant mortality. What the result of such exclusion would be on the infantile mortality rate is seen from the appended figures which compare the rates for the three last years as obtained from the total number of infants dying under one year of age and the corresponding rates after exclusion of the "hopeless births." Total Deaths Total Preventible Total under Infantile "Hopeless Infantile Births. One Year. Mortality. Births." Mortality. 1905 3,336 391 117 87 93 1906 3,152 353 112 89 86 1907 3,074 354 115 124 78 No system of " infant visiting" can be expected to combat infantile mortality among such " hopeless births." The remedy lies in the prevention of antenatal conditions which give rise to such births. Improved parental health is believed to be the essential factor required to prevent the birth of children without prospect of survival. Such improvement will not result from " sanitation" alone. Education in personal hygiene and in all the essentials of home life, and increased restraint of those habits which tend to lowered vitality must be added to municipal control in sanitary matters. As other Medical Officers of Health do not exclude the "hopeless births" from their tables of infant mortality such deaths have been included in all the tables contained in this Report. In Table II will be found the fully corrected rates (i.e., rates obtained after distribution of births and deaths in institutions, exclusion of non-residents, &c.) in the circumjacent districts of the Metropolis. The London rate was 7 per 1,000 above the local, but 19 below the Metropolitan mean rate. The highest rate recorded last year was that of Kensington (128) and the lowest that of Hampstead (69). All rates were considerably below the means. The "fully corrected" rate for the Borough (on the Department's figures) was 110 per 1,000 persons, 131 per 1,000 males and 87 per 1,000 females. Such rates have been available since 1905 only, and the figures for the three years, both for the Borough and the Wards, are given in Table 25. The out-lying births being obtainable, at present, at the conclusion of the year only, quarterly rates can be calculated after partial correction only. They are given in Table 24a. TABLE 24a: Infantile Mortality Births partly, Deaths fully corrected. Quarters First. Second. Third. Fourth. Year 1007. 1906. 1905. 1907. 1906. 1905. 1907. 1906. 1905. 1907. 1906. 1905. Borough 127 89 114 112 80 128 98 167 131 129 117 120 Queen's Park 146 100 115 62 65 117 121 130 135 102 86 137 Harrow Road 125 59 117 133 58 165 66 104 102 130 97 89 Maida Vale 190 86 94 66 105 131 97 110 157 77 160 120 Westbourne 96 71 124 114 109 118 130 177 111 95 144 118 Church 98 133 125 156 94 142 114 269 172 206 135 180 Lancaster Gate, West 130 66 63 — — — — 100 125 154 — 77 „ East 250 71 74 — 71 — 83 150 100 55 48 48 Hyde Park 85 68 115 162 60 83 91 298 81 166 125 67 mortality of childhood. 35 TABLE 25. Infantile Mortality. Births and Deaths fully corrected. Infantile Mortality. Proportional Mortality. Males. Females. Persons. Persons. 1907. 1906. 1905. 1907. 1906. 1905. 1907. 1906. 1905. 1907. 1906. 1905. Borough 131 115 128 87 99 109 110 107 118 126 160 214 Queen's Park 115 96 164 92 87 76 105 92 122 120 137 221 Harrow Road 137 90 116 75 58 113 106 75 115 121 112 209 Maida Vale 118 145 116 96 69 124 108 107 120 124 160 218 Westbourne 102 123 111 98 120 120 100 121 112 114 180 203 Church 154 140 151 99 155 141 128 146 146 147 218 265 Lancaster Gate, West 97 62 83 64 32 28 83 48 55 95 72 100 „ East 125 80 41 60 83 71 92 85 55 105 126 100 Hyde Park 163 103 130 47 154 41 107 126 86 123 188 156 Lancaster Gate, East and West 109 75 59 62 60 51 87 67 55 100 100 100 Ratios of rates (persons) Lancaster Gate Wards. 1905 : 1906 : 1907 100 : 121 : 158. From the figures in Table 25, it will be seen that last year's rates for males were uniformly in excess of the rates for 1906, except in Westbourne Ward, where a reduction of 21 per 1,000 was recorded. In comparison with 1905, lower rates were recorded in Queen's Park and Westbourne Wards ; higher in all the others. As regards the rates for females, lower rates were recorded last year than in 1906 in the Borough, Westbourne, Church, and Hyde Park Wards, while, in comparison with 1905, last year's rates were all lower except in Queen's Park, Lancaster Gate, West, and Hyde Park Wards. Having regard to the general characteristics of the Ward, the rates for Church Ward are the most interesting. Last year's report gave "index numbers" based on the mortality in the two Lancaster Gate Wards. Similar numbers are given in Table 25, but it has to be remembered that the "standard" has increased during the three years in the following proportions :— Ratios of mortality- Lancaster Gate (East and West ) Ward,}1905. 1906 1907=100: 121: 158. Last year's " index numbers " are much more uniform than were those of 1905. Before passing to consider the causes of death, &c., attention may be directed to the mortalities in six selected areas, or insulœ, chosen for their well-defined boundaries and homogeneous characters. (See Table 26). Comparing last year's rates with those of 1906, reductions are noted except in "Alfred Road " and " Queen's Park," while all are lower than those recorded in 1905, some of them markedly so. The reduction in the mortality in " Clarendon Street" is specially satisfactory, having regard to the labour and time devoted to that area. 36 mortality of childhood. TABLE 26. Infantile Mortality In Special Insulœ Infantile Mortality. Births. Deaths, 0—1. 1907. 1906. 1905. " Hall Park " 140 15 107 221 196 "North Wharf" 95 9 94 141 150 "Alfred Road"... 144 19 132 115 146 " Amberley Road " 84 9 107 153 192 "Clarendon Street" 308 55 146 151 165 "Queen's Park" 312 30 96 89 134 If the data for the insulœ be deducted from the figures for the Wards in which the insulœ are situated (see below) three out of the four "remainder" rates for 1906 are found to be lower than those for 1905, and in the case of the fourth the increase is only 2 per 1,000. In three out of the four Wards higher total rates were recorded last year than in 1906. Ward Rate. Church 1907 146 1906 128 Excluding " Hall Park " " North Wharf " " Clarendon Street " Remainder Ward Rate. 89 87 Westbourne 1907 100 1906 121 " Alfred Road " 86 125 Maida Vale 1907 108 1906 107 " Amberley Road " 79 98 Queen's Park 1907 105 1906 92 " Queen's Park " 129 176 An analysis of the deaths at ages under one year, following the form required by the Local Government Board, is to be found in Table VII., Appendix. To the Board's form have been added columns for the average numbers of deaths from each cause during 1902-06, and an extra line for the averages according to ages of the deceased. The most striking items of that table are the increase in the numbers of male children dying at ages under one month ; the decrease in the number of deaths (both sexes) from diarrhoea ; and the increase in the deaths (of males) from premature birth. Those points can be best brought out by condensing the Table separately for (n) ages, and (b) under causes. Age at Death.—In comparison with the averages for 1902-06, last year's numbers of deaths under one month show a debit balance of 17 lives of boys and a gain of 7 of girls. As regards boys, the deaths during the year in the third week of life were equal to the average, but those in the other weeks, above the averages ; while as regards girls, all the weeks show reductions. The deaths of boys in the second and third months of life were above the averages, but after that age below, except in the fifth month, when the number for last year was equal to the average. In the case of girls, the deaths during the year were above the averages in the second and third months of life only. MORTALITY OF CHILDHOOD. 37 Combining the ages in trimestral periods, it is found that last year's deaths at each period were below the average, except in the first among boys. Lives gained (). 1907. 1902.06. Lost ( + ). M. F. M. F. M. F. Under one month 83 46 67 53 + 16 7 Aged 1.3 months 47 35 46 33 + 1 + 2 Under 3 months 130 81 113 86 + 17 5 Aged 3.6 „ 36 21 48 37 12 16 6.9 „ 32 18 38 26 6 8 9.12 „ 21 15 29 26 8 11 Causes of Death.Comparing the numbers of deaths from the causes, arranged in five groups, with the averages, two groupsviz., "diarrhœal diseases" and "other causes". show reductions on the male side, and threeviz., the two already mentioned and "wasting diseases"on the female. The greatest changes are the saving of 19 and 26 lives respectively of boys and girls under "diarrhœal diseases,"and of 12 girls under "other causes,"and the loss of 10 lives among boys under "wasting diseases." Lives gained (). 1907. 1902.06. Lost ( + ). Group. M. F. M. F. M. F. I." Common Infectious Diseases" 15 16 14 14 +1 + 2 II." Diarrhoeal Diseases" 35 14 54 40 19 26 III." Wasting Diseases" 85 46 75 53 +10 7 IV." Tubercular Diseases" 12 10 10 7 +2 +3 V.Other causes 72 49 75 61 3 12 ' Expressing the foregoing figures as mortalities (per 1,000 births registered in each period) and thereby eliminating all ambiguity arising from the differences in the numbers of births, it is found (see below) that among males last year's rates for the second and last groups of diseases were the only two below the averages, while among females lower rates were recorded for the second, third and last. Calculating the percentage of all deaths due to each group of diseases, it is found that the percentages from the second group (both sexes) are the only two below the proportions for 1902.06. Mortalities. Percentages. 1907. 1902.06. 1907. 1902.06. M. F. M. F. M. F. M. F. I."Common Infectious Diseases" 9.45 10.75 8.47 8.76 6.8 11.8 6.1 8.0 II."Diarrhœal Diseases" 22.06 9.40 32.70 25.04 16.0 10.4 23.7 22.9 III." Wasting Diseases" 53.59 30.91 45.42 33.18 38.8 34.1 32.9 30.3 IV."Tuberculous Diseases 7.56 6.72 6.05 4.38 5.5 7.4 4.9 4.0 V.Other Causes 43.59 32.91 45.42 38.19 32.9 36.3 32.9 34.8 The appended tabular statement of rates for the two decennial periods 1877.86 and 1897.06 and for last year, for certain of the diseases included in Table VII. Appendix, shows the changes which have taken place in the incidence of mortality during the last thirty years. The increase in the rate from premature birth is very marked, and, had the sexes been separated, would have been still more striking for males. The reduction in the rate for diarrhoea is very satisfactory, but, having regard to the unusually low temperatures which prevailed during the summer, it would be unwise to lay too much emphasis on that reduction. 38 MORTALITY OF CHILDHOOD. Infantile Mortality, Per 1,000 Births Registered. 1877.86. 1897.1906. 1907. Smallpox 0.20 0.03 Measles 3.23 2.90 2.92 Scarlet Fever 0.65 0.22 0.32 Diphtheria 1.27 0.57 0.32 Whooping Cough 8.05 5.31 6.50 Diarrhoea 17.17 32.25 15.94 Premature Birth 13.90 18.79 23.42 Congenital Defects 2.34 6.35 3.90 Atrophy, &c. 24.17 12.93 12.68 Tubercular Diseases 12.07 6.91 7.15 Erysipelas 0.93 0.63 0.97 Syphilis 3.85 1.78 2.92 Meningitis Convulsions 12.16 7.51 2.92 Bronchial Laryngitis 16.79 12.38 10.40 Pneumonia 7.84 9.33 12.36 Infantile Mortality In Special Insulœ. Causes of, and Ages at Death. Name of Area. " Hall Park." " North Wharf." " Alfred Road." " Amberley Road." " Clarendon Street." " Queen's Park." Year. 1907. 1906. 1907. 1906. 1907. 1906. 1907. 1906. 1907. 1906. 1907. 1906. Cause of Death. Measles 1 1 4 1 Scarlet Fever 1 Whooping Cough 1 1 1 1 2 2 1 Diphtheria Diarrhoea 2 12 3 6 1 9 3 5 6 16 1 10 Gastro.Enteritis 1 3 3 2 ] Influenza 1 1 Syphilis 1 1 1 1 2 2 1 Erysipelas 1 Tubercular Diseases 3 2 2 1 6 3 1 3 Premature Birth 2 7 2 2 1 1 1 13 6 2 4 Congenital Malformations 2 1 3 1 Injury at Birth Debility at Birth 7 Atrophy, Debility 1 1 1 2 3 1 1 4 5 4 Want of Breast Milk 1 2 Convulsions 1 1 1 1 1 1 1 Respiratory Diseases l 6 5 1 1 8 7 9 Dentition 1 Overlaid 2 1 1 1 1 Other Causes 2 2 3 1 2 1 4 1 2 Uncertified 1 1 Totals 15 35 9 13 19 18 9 11 55 47 30 28 Ages at Death. Under 1 week 7 2 2 3 1 1 11 5 2 4 Aged 1.4 weeks 4 2 3 5 5 5 2 2 Under 1 month 4 9 2 2 6 6 1 16 10 4 6 Aged 1.3 months 4 2 4 3 3 1 2 2 13 12 9 8 3.6 „ 2 12 2 6 4 6 2 4 9 12 7 2 6.9 „ 4 5 1 4 4 3 2 12 4 8 7 9.12 „ 1 7 1 1 2 1 1 3 5 9 2 5 MORTALITY OF CHILDHOOD. 39 Infantile Diarrhœa.Enquiries were made as to 35 deaths from this cause, 29 of the children being under 10 months of age. Among the latter, 3 (10 per cent.) were being fed naturally at the time of death, 1 had a mixed diet, and 25 (86 per cent.) were on artificial diets. In 10 (28.5 per cent.) instances the long tube bottle was in use. Only two of the 35 houses had proper larder accommodation. The following nuisances were discovered on the premises defective (or insufficient) dustbins, 3; accumulations of house refuse or manure, 2; and animals improperly kept, 1. The deaths in the insulœ already specified are distributed under "cause of" and "age at death" in Table 27. As only two years are included in that Table it would be useless to attempt to formulate any conclusions therefrom. Mortality among Illegitimate Children.Among the deaths registered in the Borough were 47 of children described as illegitimate, including 12 who were nonresidents. Outside the Borough 4 such deaths were registered, giving a nett total of 39 deaths, compared with 43 in 1906, and 34 in 1905. Of the corrected total number of deaths, 25 were of children under one year of age. The infantile mortality among illegitimate children, calculated on the number of births registered within the Borough (115) was 217 per 1,000, as compared with a rate of 253 in 1906, and a mean rate of 244. Calculated on the fully corrected number of births (134) last year's rate was 186; that of 1906, 258; and the mean, 206. A comparison of the mortalities among illegitimate and legitimate children, the causes of death of the former and occupations of their mothers, will be found below. Deaths of Illegitimate Children. 1907. Ages (yrs.) Males. Females. Persons. 0 19 6 25 1 7 4 11 5 2 1 3 Totals 28 11 39 Infantile Mortality. Fully corrected. Illegitimate. Legitimate. 1907 186 107 190206 206 114 Causes of Death. 0 1 5 m. f. m. f. m. f. Scarlet Fever 1 Diphtheria 1 1 Diarrhœal Diseases 5 2 Enteritis 1 1 Septic Diseases 1 Tubercular Diseases 2 2 Premature Birth 5 1 Developmental Dis. 3 2 2 Respiratory Dis. 3 4 Other Causes 1 1 Totals 19 6 7 4 2 1 One death certified after inquest. Occupations of Mothers. Domestic Service 21 Cook 1 Housekeeper 2 Housemaid 1 Nursemaid 1 Parlourmaid 3 General Servant 6 Scullery maid 1 "Servant" 6 Trades 14 Dressmaker 1 Waitress 1 Mantlemaker 1 Barmaid 1 Machinist 1 Charwoman 3 Packer 2 Laundress 4 No occupation, occupation not stated 4 Mortality among Young Children.No estimates of the numbers of children living at ages between one and five years are available, but approximations have been obtained bv deducting the numbers dying at ages under one year from the births (using the fully corrected totals), carrying the difference (survivors, aged 12 years) to the succeeding year, 40 mortality of childhood. deducting the deaths at ages between one and two years from the last result, and carrying the balance (survivors, aged 2.3 years) to the next year, and so on. It was thought that the numbers of survivors at each age would understate the number living, but it has been found that if all the survivors between one and five years of age be added together, the total considerably exceeds the estimated numbers of living at those ages, as derived from the last census. Thus in 1905, the first year for which the calculation has been made, the total survivors aged one to five years, was 11,730, and the estimated number living, 10,168; a difference of 1,562, or 15 per cent. In 1906 the survivors numbered 11,603, and 1907, 11,575, the estimated numbers living being 10,238 and 10,308 respectively.* The mortality rates based on the numbers of survivors are given in Table 28, last year's rates being contrasted with the means, as indicated. It will be seen that the rate for children aged one year is (taking the mean) less than one.third that for children under one; that for children aged two years, a good less than one.half that for children aged one year; that for children aged three years, rather more than half that for children aged two; and that for children aged four years, about two.thirds of that for children aged three. With the exception of that for the first year of life, all last year's rates were above the means, but, owing to the absence of data for several of the ages, no importance can be attached to the differences. TABLE 28. Mortality in Childhood. Per j ,000 survivors. Paddington. Ages. 1901. 1902. 1903. 1904. 1905. 1906. 1907. Means. Under One Year 130.03 125.00 111.94 129.84 118.52 107.42 110.41 118.54 One Year ? 40.40 38.60 28.27 36.22 25.78 36.82 33.85 Two Years ? ? 18.82 13.04 12.37 8.62 17.29 13.21 Three „ ? ? ? 7.30 8.34 6.43 8.69 7.36 Four „ ? ? ? ? 4.90 3.15 6.13 4.02 Note. Means.First two years of life, for 1902.06; third, 1903.00 ; fourth, 1904.06; fifth, 1905.06. An attempt has also been made to determine the mortality rates for the same ages in each Ward, separating the sexes. The data for this work were first obtainable in 1905, and hence only two ages could be dealt with. (See Table 29.) It appears to be desirable to reserve all comments until further data shall have been collected. The cause of death at each age are set out in Table 30. It is anticipated that much useful information will be afforded by such figures when a sufficiently long period has been covered. *The differences in the mortality from all causes among children aged 1.5 years, calculated on the estimated numbers living and the total survivors, were as follow: 1905 on estimated living 18.09 on survivors 15.69 1906 „ „ 12.50 „ 11.03 1907 „ „ 17.85 „ 15.89 MORTALITY OF CHILDHOOD. 41 TABLE 29. Mortality in Childhood. Per 1,000 survivors. Aged One Year. Aged Two Years. 1906. 1907. 1907. m. f. m. f. m. f. Queen's Park 16.3 36.2 46.0 45.2 11.1 10.7 Harrow Road 16.4 30.6 30.3 15.5 16.7 20.1 Maida Vale 32.9 5.2 65.5 9.9 11.3 21.1 Westbourne 25.9 9.0 38.6 41.8 22.2 9.0 Church 47.3 45.0 60.7 44.2 12.4 30.3 Lancaster Gate, West 33.3 „ East 21.2 31.2 21.7 Hyde Park 11.4 10.7 10.4 39.0 46.5 10.8 TABLE 30. Mortality in Childhood. Causes of Death. Paddington. Age in Years 1 2 . 3 4 Year 1902. 1903. 1904. 1905. 1900. 1907. 1903. 1904. 1905. 1906. 1907. 1904. 1905 1906. 1907. 1905. 1906. 1907. Smallpox . . . . . . . . . . . 1 . . . . . . Measles 31 18 11 27 7 12 14 3 8 3 9 5 5 1 1 4 . 2 Scarlet Fever 2 2 . 2 3 1 2 2 2 1 2 1 . 4 3 1 1 . Whooping Cough 8 21 5 14 6 16 7 3 6 2 5 2 2 . 6 1 . 1 Diphtheria 6 3 2 . 2 1 3 3 2 2 6 2 . 3 2 . 1 4 Diarrhœa 10 3 19 12 15 5 3 4 1 1 2 . 2 . . . . . Influenza 1 . 1 2 . 2 1 1 . . 1 . . . . . . 1 Rickets 2 6 2 1 3 2 . . . . . . . . . . . . Tubercular Diseases 16 12 6 8 6 11 3 7 4 5 7 . 3 4 4 1 2 3 Convulsions 2 5 3 2 . 4 2 . 2 . . . 1 . . . . . Respiratory Diseases 30 32 23 31 16 43 3 8 6 2 11 2 6 . 4 . . 3 Dentition 1 4 . 4 3 1 1 . . . 1 . . . . . . . Gastro. Enteritis . . 2 . 2 . . . . . . . . 1 . 1 . . Violence 1 . 2 . 3 1 2 . 2 3 2 5 2 2 1 1 . 4 Other Causes 13 11 11 6 9 9 4 7 4 6 3 3 3 4 4 2 5 . All Causes 123 117 87 109 75 108 45 38 37 25 49 21 24 19 25 14 9 18 42 MORTALITY OF CHILDHOOD. Health Visiting. Since the fourth quarter of 1905 copies of the entries in the Registers of Births have been received weekly from the Registrars, and from that time the Department has undertaken the visiting of the mothers of new.born children with a view to tendering advice as to the rearing of their children. Registration of a birth can be effected at any date within six weeks of the birth, and usually the interval is something over a month. Since 1905 the Medical Officer of Health of the County has obtained weeklv returns from the midwives of births attended by them, and has distributed the births to the Borough Medical Officers of Health.* The intervals which elapse under the latter arrangement between the birth and the receipt of the information are (a) for births in private houses, two weeks; and (b) for those in hospitals, one month. A child's prospects of surviving the first year of life are very materially affected by the treatment which it receives during the earliest weeks of life. Hence the importance of early advice being afforded to the mothers. The visitor's first call should not be delayed later than the end of the second week, at which time the midwife (usually the only attendant in the cases most requiring attention) will have Ceased her attendance on the mother. Until last October health visiting was principally carried out by the student inspectors working under the direct supervision of the Women Inspectors. During the last three months of 1907 the Paddington Health Society has actively assisted the Department in this work. Through the Society the co.operation of the district visitors of five of the (ecclesiastical) parishes has been obtained, and the Society has appointed a paid Health Visitor.]" Up to the close of the year 137 births had been referred to the District Visitors and 140 to the Health Visitor. The enquiries to be made and the advice given by those ladies have been prescribed by the Medical Officer of Health, who has had opportunities of addressing them on two or three occasions. During the past year the Department (Women Inspectors and Students) has visited 1,255 infants (253 being first borns), including 343 reported bv the Medical Officer of Health of the County. The intervals which elapsed between the births and the visits are given below. Less than 1 month 201 Between 1 and 2 months 444 Less than 14 days 65 „ 2 and 3 „ 349 Between 2.3 weeks 92 „ 3 and G „ 236 „ 3.4 „ 44 „ 6 and 9 „ 25 Only some 16 per cent. of all the visits were made within the period given as likely to produce the best results, but more than half of the children were visited within two months of birth. From the information collected it appears that more than three quarters of the infants were breast.fed at the date of the first visit. It would be interesting and instructive to know how long that form of feeding was carried on, but the staff is insufficient to enable sufficient *Four hundred and eighty.nine (489) births were so reported during 1907, 10 of the addresses given not being in the Borough. Thirty.one (31) families had removed when the first call was made, and 12 were unknown at the addresses given. t The distribution of Health Visiting at the close of the year was District Visitors St. James; St. Luke, Kilburn; St. Mary; St. Peter; St. Stephen. Society's Visitor Christ Church, Harrow Road; Emmanuel; St. Andrew's; St. John, Kensal Green; St. Jude ; St. Paul; St. Saviour; St. Simon. Women Inspectors (Students) Rest of Borough. MORTALITY OF CHILDHOOD. 43 number of revisits* to be made to obtain the information. It may be said that the appended figures indicate that breast feeding is more common than was thought to be the case. Age of Infant. Breast. Hand. Mixed. Under 1 month 180 11 10 „ 12 months 350 62 32 „ 2.3 „ 258 51 40 „ 3.6 „ 168 39 29 „ 6.9 „ 15 4 6 Totals 971 167 117 Percentages 77.3 13.3 9.3 Of the children fed otherwise than by the breast, 225 were bottle.fed" tube "bottles being in use for 50 children, "screw.top" for 42, and "safety" for 133. The remaining 59 children were fed by the spoon. The Inspectors reported that the bottles were dirty on four occasions only. Great care is exercised in selecting the cases to be visited, only those being chosen which appear to be prima facie in need of advice. The criteria for making the selection are knowledge of the character of the street where the parents reside and their occupations. The appended statement of the numbers of rooms in the homes visited indicate one of the results of the selection, but fail to give any clue as to the proportional frequency of births in the different ranks of life as they would if all births were visited. Per cent, of all Whole Borough, No. homes visited. 1907. Homes of 1 room 187 14.9 14.9 „ 2 rooms 586 46.6 19.8 3 „ 380 30.2 19.4 4 „ 102 8.1 10.6 Only 42 of the homes were reported to be "dirty." Separate beds were provided for 462 infants (36'8 per cent.) and were promised for 56 others. A very serious defect noted in the homes was the want of accommodation for the proper storage of food. Larders were found at 92 (7.3 per cent.) of the homes only. Nuisances requiring action by the Department were reported at 72 houses. The mothers visited had given birth, at previous pregnancies, to 3,292 children, including 106 born dead, of whom 2,538 survived. The children dying after birth numbered 648a figure equal to mortality of 196.8 per 1,000 births. Particulars of the ages at which those children died were not obtained, but, as their mothers were still fecund, and therefore in no case much over forty years of age, none of the children could have been anywhere near maturity. The mortality may safely be taken as an indication of the need of advice in the rearing of children. * One hundred and eighty.two (182) children were specially selected for re.visiting owing to their unsatisfactory health, the total number of re.visits being 411. 44 INQUESTS. The only information obtainable as to the causes of death being that given by the mothers, it cannot be regarded as very satisfactory. An attempt has, however, been made to classify the alleged causes in the appended statement. Measles 39 Whooping Cough 36 Scarlet Fever 11 Diphtheria 22 Infantile Diarrhœa 38 Premature Births 66 Died at Birth 5 "Lungs" 126 "Fits" 105 "Wasting" 78 Accidents 13 Causes not sufficiently known 109 "Health visiting" is not a work which can be expected to yield results which can be demonstrated to any large extent statistically. Only those who actually do the visiting derive any immediate satisfaction by seeing the good progress made by the children, and that satisfaction is lost when revisiting is not done. One measure of the success which may be claimed for the work can be given here. In 1906, 2,101 children were visited, of whom 100 failed to survive the first year of life. That number is equal to an infantile mortality of 47 per 1,000. The total infantile mortality (including 89 deaths of "hopeless ones") was at the rate of 107 per 1,000 births (births and deaths fully corrected). INQUESTS. Of the deaths registered within the Borough, 190 were registered after inquest, including 53 of non.residents. In other districts 19 deaths of residents formed the object of Coroners' inquisitions, making a nett total of 156 deaths certified after inquests, equal to 7.7 per cent. of all deaths, as compared with 8.6 in 1906 and an average of the same value. The findings of the juries during the year are given in Table 31, last year's figures being compared with the averages for the preceding five years. There were slight reductions in the numbers of deaths from accidents, and satisfactory reductions from suicide. TABLE 31. Inquests Held. Finding of Jury. 1907. Averages, 1902.06. Males. Females. Males. Females. Natural Causes 45 43 45 44 By Misadventure 4 4 3 Accidental Causes 29 18 32 20 Murder 1 . 0 1 Suicide 7 2 12 4 "Open" 3 3 2 1 "Neglect" . 1 2 1 The mortality rate from suicide (Table 18) was 0.06, or 0.04 below the mean for 1902.06. The only increased rate was recorded in Maida Vale Ward (0.19, mean 0.04). DEATHS IN INSTITUTIONS. 45 A brief statement of the causes of accidents, &c., is appended. M isadventure—(4)— Suicide—(9)— Injury at Birth . Overlaid On Railway Suffocation one each. Poison 2 Hanging 1 Drowning 2 Cut Throat 3 Precipitation from Elevation 1 Accidents—(47)— Vehicular Traffic 7 On Railway 1 Building Operations 3 Burns, Scalds 9 Overlaid 11 Suffocation 2 Falls (various) 13 Otherwise 1 Neglect—(1)— At Birth. Open—(6)— Drowning 5 Not Stated 1 DEATHS IN INSTITUTIONS. The deaths during the year in local public institutions numbered 770, as compared with an average of 092 for the preceding ten years. (See Table V., Appendix). There were in addition 41 deaths in nursing homes in the Borough. The deaths of non.residents in the local institutions numbered 320, and those of residents in out.lying institutions, 205. (Sec Table VI., Appendix). The nett total of deaths of residents in public institutions was 655, as compared with 597 in 1906, and 578 in 1905. Last year's total was equal to 32.5 per cent. of all deaths, as compared with 29.8 for the five years 1902.06. The proportions of deaths of residents in each Ward are given below:— Percentages of ali. Deaths. 1907. 1902.06. 1907. 1902.06. Queen's Park 32.3 31.8 Church 40.0 36.5 Harrow Road 30.4 26.3 Lancaster Gate, West 26.3 21.7 Maida Vale 29.4 27.1 „ East 23.4 19.9 Westbourne 32.0 27.8 Hyde Park 28.7 26.8 From the foregoing figures it will be seen that increased proportions of deaths of residents of all Wards took place in institutions, the greatest increase (4.6) having been recorded in Lancaster Gate, West, Ward, and the least (0.5) in Queen's Park. Dividing the institutions according to the sources of their incomes (see below) it is found that the greatest increase has to be recorded as occurring in Poor Law Institutions (increase 2.0 per cent.), the proportion of deaths in the Hospitals of the Metropolitan Asylums Board being only 0.1 below the average. Rate.maintained— Deaths. Percentages of all Deaths. 1907. 1907. 1902-06. Hospitals of Metropolitan Asylums Board 27 1.3 1.4 Poor Law Workhouses and Infirmaries 357 17.7 15.7 Lunatic Asylums 59 2.9 2.3 Supported by Voluntary Contributions— Hospitals and Homes (excluding Nursing Homes) 212 10.5 9.6 46 administrative work. TABLE 32. Report of the Work of the District Inspectors during the year 1907. Quarters. 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. First 125 109 650 3 1,504 76 36 61 22 98 43 1 9 — 35 — 9 14 22 48 — — 29 5 18 — Second 181 — 620 — 5,713 77 71 51 22 103 30 1 6 2 30 — 17 21 21 53 — — 22 2 10 4 Third 179 8 538 — 4,282 51 31 36 13 89 35 3 3 — 50 — 12 26 25 42 — — 14 1 59 — Fourth 169 62 555 — 4,604 69 68 61 24 183 44 10 4 7 53 — 31 30 27 65 2 — 39 7 12 9 Year 654 179 2,363 3 . 19,103 273 206 209 81 473 152 15 22 9 168 — 69 91 95 208 2 — 104 15 99 13 ADMINISTRATIVE WORK. 47 ADMINISTRATIVE WORK* Prevention of Infectious Disease.—The calls made bv the Staff with reference to all J kinds of infectious disease, numbered 5,734 last year, as compared with 4,388 in 1906, and 5,107 in 1905. The District Inspectors made 2,442 calls with reference to diseases formally notified, as compared with 2,058 in the previous year, and the Women Inspectors and Students, 3,292 calls with reference to diseases not on the schedule for notification. In 1906 the latter made 2,330 calls. Last year's total comprised calls relating to— Measles 1,756 Chicken-pox 344 Whooping Cough 499 Diarrhœa 38 Consumption 635 Puerperal Fever 20 The total number of visits of all kinds in each quarter of the past three years is given below:— Quarters 1st 2nd 3rd 4th 1907 1,411 1,590 1,223 1,510 1906 765 1,069 1,376 1,178 1905 1,092 2,096 964 955 The total number of patients removed to hospital for isolation and treatment, was 694 last year, against 882 in 1906, and 387 in 1905. "Letters of Advice," covering extracts from Public Health (London) Act, 1891, and the Factorv and Workshop Act, 1901, with memoranda of precautions requisite to prevent the spread of infection, were sent out with reference to 55 patients who were treated at home, the number of such letters having been 67 in 1906, and 44 in 1905. In addition six (6) special communications were addressed to midwives and others in charge of cases of puerperal fever, as compared with 8 in the preceding year, and 2 in 1905. Disinfection.—The disinfection of rooms occupied by persons suffering with infectious diseases is carried out by the Department, bv the use of formaldehyde sprays. The rooms dealt with during the year numbered 2,552, as compared with 2,166 in 1906, and 2,662 in 1905. In 16 instances the necessary disinfection was done privately, and the efficiency of the processes employed duly certified by the attendant practitioners. "Cartons" of chloride of lime and cakes of carbolic soap are distributed to a small extent only, the popular use of disinfectants being held to be of little value, and not equal in efficiency to ordinary domestic cleansing. The amount spent on disinfectants of all kinds, including materials for spraving of rooms, was £16 10s. last year. The disinfection of bedding, personal clothing, etc., is still carried out under contract by M essrs. Armfield, who do the work thoroughlv well. The goods removed during the past year weighed 48½ tons, as compared with 56 tons in 1906, and 67 in 1905. The cost of the work amounted to £1,087 last year, £1,148 in 1906, and £1,392 in 1905. Complaints of any description are rare, only 11 of no importance being received during the past year. All complaints were promptly remedied by the Contractors. *Table 32 summarises the work of the District Inspectors not specially dealt with in the following paragraphs. See also Table VIII., Appendix. 48 ADMINISTRATIVE WORK. With regard to the erection of a disinfection station for the Borough, no visible progress has to be reported. Several proposals have been before the Council, duly discussed, and the majority of them rejected. The process of elimination has, it is believed, brought a final settlement nearer, in spite of the apparent stagnation of the negotiations. Water Supply.—There was a considerable reduction (from 141 in 1906 to 81 last year), in the number of notices of discontinuance of water supply, received from the Metropolitan Water Board, in pursuance of Section 49 (1) of the Public Health (London) Act, 1891. The reasons for the discontinuance of the supply were reported by the Inspectors to be:— Empty premises 54 Defective water fittings 19 Houses in course of demolition 4 Unpaid water rates 4 The restoration of the supply was, on the whole, secured to the 21 occupied houses more promptly than in the past. To 9 of such houses the supply was re-established in 24 hours, the intervals in the other cases, being:— 3 days, 2 houses. 4 days, 4 houses. 6, 8, 10 and 14 days. 1 house, each. 3 weeks. 2 houses. Notices demanding restoration of the supply were issued with respect to 5 houses, two being subsequently referred to the Solicitor. Proceedings in the Court were not, however, found necessary in any case. Mortuaries.—During the past year 290 bodies were received at the two mortuaries, an increase of nine over the total for 1906. The principal details of last year's figures are given below:— Paddington Kensal Green. Road. Number of bodies received 269 21 Coroner's cases 192 17 Awaiting burial:— Infectious cases 3 — Other „ 74 4 P.M. examimations made 97 11 The By-laws adopted by the Council in March of last year, were confirmed by the Local Government Board on May 11th. No proceedings have been found to be necessary as yet, but cautionary letters have been addressed to certain undertakers on account of delays in removing bodies for burial. Schools.—The distribution of the infectious disease of childhood, as regards the Public Elementary Schools, is indicated bv the figures given in Table 33. This Table has been constructed in a somewhat different manner to that adopted in previous years. On this occasion the return is limited to the infected families actually sending children to named schools, and does not include all the families in the infected houses. The result is that this year's numbers in the " P.N.A." columns, are smaller than those given in earlier tables. It is ADMINISTRATIVE WORK. 49 believed that the change gives a fairer indication of the frequency of the diseases in connection with the different schools. The notices issued for the exclusion of children from school, numbered 2,238 last year, as compared with 1,871 in 1906. Owing to different practice as to sending notices to re-admit after cases of the non-notified diseases, the numbers of exclusion and re-admission notices do not balance. The complete figures for the last two years (those for 1906 in italics), are given below:— In connection Notices Issued. with Exclusion. Re-admission. Notified diseases 763 (1,044) 763 (1,044) Other diseases 1,475 (827) 560 (317) Closure of classes or departments of schools was resorted to on 13 occasions last year, the same number as in 1906. All closures were effected by the Medical Officer (Education) of the County, at the request of the Medical Officer of Health of the Borough, such procedure ensuring promptitude of action, a most essential part of such closure. School Closures. Closure. School. Class-room. Date of. Duration of. Disease. By Education Committee:— Campbell Street (Infants) D 28th Feb. 18 days Measles. St. Augustine's (Infants) Whole Department 25th April 11 „ „ Moberley (Infants) D 28th May 12 „ „ Beethoven Street (Infants) A 17th June 14 „ „ Kilburn Lane (Infants) E 17th June 7 „ „ Droop Street (Infants) D and G 17th June 14 „ „ Amberley Road (Infants) C 19th June 12 „ „ Holy Trinity (Infants) 4 26th June 12 „ „ Moberley (Infants) E 2nd July 14 „ „ Moberley (Girls) Standard IV. 4th July 4 „ Scarlet Fever. St. Saviour's (Infants) Whole Department 5th July 11 „ Measles. St. Paul's (Infants) „ 7th Nov. 12 ,, Our Lady of Dolours (R.C.) (Infants), Desborough St. „ 9th Dec. 28 „ Chicken-pox, Whooping Cough Measles. Internotification.—With a view to obtaining a more complete knowledge of the prevalence of infectious disease in local schools, duplicate notices relating to non-resident patients attending local schools, are obtained from the Medical Officers of Health of the circumjacent districts, similar information relating to their schools being forwarded to them. The numbers of cases of scarlet fever and diphtheria so reported are given in Table 33 ("N.R." cols.). A complete list of the notices received from Kensington and Willesden, apparently the only two districts from which children attend Paddington schools is given below:— Kensington. Willesden. Scarlet fever 14 40 Diphtheria 7 9 Enteric fever — — Erysipelas — 1 Erroneous diagnosis — 1 21 51 Total number received 72. 50 ADMINISTRATIVE WORK. TABLE 33. Notified Diseases. Non-notified Diseases. Scarlet Fever. Diphtheria. Measles. Chicken Pox. Whooping Cough. p.a. p.n.a. n.r. p.a. p.n.a. n.r. Provided— Amberley Road 17 3 ... 6 2 ... 51 8 4 Beethoven Street 21 9 5 1 ... ... 34 10 35 Campbell Street 10 3 ... 7 3 ... 35 5 7 Droop Street 25 13 3 5 6 ... 54 42 32 Essendine Road 30 8 1 4 1 1 94 11 43 Harrow Road 26 9 5 11 6 3 54 72 64 Kilburn Lane 8 6 7 4 3 2 15 6 17 Royal Oak ... ... ... ... ... ... 36 ... 4 Non-Provided— Bayswater Jewish 2 ... 1 ... ... ... 17 1 ... Desborough Street (R.C.) 8 3 ... ... ... ... 38 13 5 Holy Trinity 9 4 ... ... 1 ... 29 2 1 St. Augustine 3 2 16 2 ... 6 16 ... ... St. James 6 1 ... 2 1 ... 3 11 ... St. John, Kilburn Lane 5 ... 6 ... ... ... 2 3 ... St. John, Titchborne Street 13 2 ... 1 ... ... ... 2 3 St. Luke 4 • • • 10 ... ... ... 5 4 27 St. Mary 1 ... ... ... ... ... 2 1 1 St. Mary of the Angels (R.C.) 1 ... ... ... ... 1 ... 1 6 St. Mary Magdalene 10 7 ... ... 2 ... 2 6 ... St. Matthew 1 2 ... ... ... ... 1 5 16 St. Michael 9 3 ... 2 1 ... 19 1 10 St. Paul 8 7 ... 2 ... ... 36 1 13 St. Peter 16 3 1 4 2 ... 18 3 18 St. Saviour 9 4 ... 2 ... ... 52 5 17 St. Stephen 4 1 1 2 1 3 2 8 1 Wilberforce 6 2 5 2 1 ... 41 10 6 Others— St. Hilda 2 3 1 ... ... ... 6 ... ... Westbourne 9 14 1 ... ... ... ... ... ... Woodfield 2 3 1 2 2 2 P.A.— Patient a scholar of the school. P.N.A.—Patient not a scholar. N.R.—Patient resident beyond Borough: not known whether scholar or not. Bacteriological Examinations.—The number of specimens received during the past year was 135, showing increases of 8 and 74 in comparison with the numbers for 1906 and 1905. Of last year's specimens, 57 gave positive, and 78 negative results. The percentage of positive results was 42.2 as compared with 32.2 in the previous year. The analysis of specimens given below shows that very little use is made of the facilities afforded for the examination of sputum in suspected cases of consumption. The early detection of the bacillus of tuberculosis affords material help not only in diagnosing the disease, but also in deciding the important question as to the regime to be laid down for the patient's guidance. ADMINISTRATIVE WORK. 51 It is very desirable that the fullest use should be made of bacteriological diagnosis, both for the sake of the public and of the individual. [####] No. of specimens Results. received. Positive. Negative. Diphtheria 94 35 59 Enteric fever 29 19 10 "Consumption" 6 2 4 Cerebrospinal Meningitis 4 — 4 Various 2 1 1 Totals 135 57 78 Offensive Refuse: Trade Refuse—This is removed principally by private firms, the Council undertaking the rest on contract. Four (4) complaints were received during the year, none of a serious nature. Visits from the Staff led to prompt remedy of the causes of complaint. Manure.—The Order requiring removal of stable manure every 48 hours was posted throughout the Borough in May, and was very generally complied with. Twenty-two (22) complaints were received during the year, the best remedy for which was found to be systematic visitation. On the whole the removal of manure was carried out more regularly than in previous years. House Refuse.—The collection of this is in the hands of the Works Department, and complaints of non-removal, etc., only occasionally reach the Public Health Department. The majority of complaints received related to collection from flat premises. From such property the dust has recently been removed twice a week. Drainage Work.—In 1904, 858 new drains were constructed to existing buildings, the number falling to 669 in 1905, rising to 696 in 1906, and falling to 584 last year. The reconstruction of the combined drainage on the Queen's Park Estate is still in progress, the drainage of 182 houses being dealt with during the year. Altogether 1,082 houses on the Estate have been re-drained since the work was commenced in 1902. The systems for the following blocks were dealt with during the past year. Nos. 2-52, Caird Street Nos. 60-174, Third Avenue Commenced in 1906. Nos. 84-98, Fifth Avenue. Nos. 2-94, Kilravock Street. Nos. 1-93, Lothrop Street. Nos. 53-69, Third Avenue. Nos. 3a-7, Fourth Avenue Nos. 668-688, Harrow Road Nos. 2a-8, Fifth Avenue Nos. 59-79, Droop Street Not completed at close of 1907. Of 74 drains on the Estate specially tested after infectious illness, 30 proved defective, 40 had been recently relaid, and with 4 old drains, gave negative results. Complaints led to the testing of 14 other drains, 12 proving to be defective. The search for unused drain connections in Westbourne Ward was continued, with the result that 30 such were bricked up in Richmond Road, and 13 in Hereford Road. The administrative work relating to deposit of plans and notices tor re-construction of drainage, etc., is part of the work of the Department. The notices received during the year numbered 470, involving the dispatch of 808 letters and communications. Proceedings with reference to infringements of the by-laws, relating to the deposit of plans, etc., were necessary in 11 instances. 52 ADMINISTRATIVE WORK. Combined Drainage.—In addition to the re-construction of the drainage on the Queen's Park Estate already alluded to, the following systems were re-constructed by the Council, no records of Orders sanctioning the original construction of the systems being traceable. 15-19, Blomfield Street; 5 and 7, Chichester 2a-8, Praed Street; 4, Irongate Wharf Road ; Road and 2-26, Delamere Street. 227, Edgware Road and Red Lion Yard. 14, Campbell Street and 17, Howell Street. 17-21, Talbot Road. 7 and 9, Marlborough Street. 20 and 21, Victoria Place. 36-48, North Wharf Road; 1-14, Dudley 12 and 13, Wellings Place. Street and 147, Harrow Road. 32-38, Woodfield Road. 65-69, Porchester Terrace. Three Orders were made for construction of combined systems, at 8 and 9, Andover Place and 4, Portsdown Place. 7 and 8, Sovereign Mews. 6a, Warwick Place. Smoke Prevention.—During the year 119 observations were taken, covering 79.81 hours. The total duration of emission of "black smoke" was 58 minutes only, but "smoke " of other descriptions was reported with a total duration of 52.3 hours. During the remaining 26.5 hours covered by the observations, "no smoke" was observed. The number of premises kept under regular observation during the year was 22, the list of which is given in Table 34. TABLE 34. Smoke Observations. Address. Business. Chimney Shaft of 23, Beethoven Street Laundry Steam Boiler Bishop's Road Bridge Refreshment Rooms „ „ 8, Bishop's Road „ „ Kitchen Stove 15a, Cambridge Place General Smith Smith's Forge Eastbourne Terrace Refreshment Rooms Steam Boiler 73, Edgware Road „ „ Kitchen Stove 75-7 „ „ Restaurant „ „ 189, „ „ Bakehouse Baker's Ovens 149, Harrow Road Saw Mills Steam Boiler Goods Yard Hydraulic Works „ „ „ „ Electric Light Works „ „ 365, Harrow Road Bakehouse Baker's Ovens 436, „ „ „ „ „ „ 126.8, Kensal Road Saw Mills Steam Boiler 9, London Street Bakehouse Baker's Ovens 15, North Wharf Iron Works Furnaces 41-3, Praed Street Hotel Kitchen Stove G.W.R., Praed Street „ Steam Boiler 120, Shirland Road Dairy „ 195, ,, ,, Bakehouse Baker's Ovens 8, South Wharf Builders' Merchants Travelling Crane 33, Westbourne Grove General Stores Steam Boilers Complaints of smoke nuisance were received with reference to 7 premises, 4 being private houses, and therefore out of jurisdiction of the Department, 2 being restaurants, and the seventh a Government Building (Post Office), also out of jurisdiction. The complaints relating to the restaurants were remedied by the usual procedure, but as regards the others, only advice could be tendered as to the nature of fuel better fitted to prevent nuisance, and as to the use thereof. It remained with the proprietors of the premises to act on that advice, if they chose to do so. WORKSHOP SUPERVISION. 53 The appended comparative statement of the proportions of "black smoke," "smoke," and "no smoke," shows clearly the improvement which has taken place in the Borough, since systematic supervision was first commenced in 1902. In 100 hours' observations. 1907 1906 1905 1904 " Smoke" 65 67 79 82 "Black Smoke" 1.2 1.7 3.4 5.3 No Smoke 33.3 31.3 17.6 12.7 To some extent the diminution in the amount of "black smoke" is due to the removal of the Great Western Company's electric generating station from the Borough. There is, however, far too much "smoke" emitted from business furnaces of all descriptions, with which existing legislation is unable to deal. It cannot be too strongly urged that the production of such smoke is not only prejudicial to the health of the inhabitants, both directly by the inhalation of the particles of unburnt carbon, and indirectly by the impediment to the sun's rays, but is also sheer waste of heat and power, and so unprofitable to the producer. The production of smoke in quantities can be almost completely prevented by experienced and careful stokers. Fresh legislation is needed to deal with the matter. Canals.—Two complaints were received, both of offensive smells from barges laden with refuse. No nuisance which could be dealt with was found to exist in either case. The customary cleansing of the Paddington Basin took place at Easter, when about 500 tons of mud were removed, and about 500 yards of concrete renewed. 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 end of January. There were a few trifling breaches of the Act, which were all remedied. No legal proceedings were necessary. The number of boats at present on the register is 200. No cases of infectious illness were reported during the year, and only two deaths occurred among the occupants of the boats, viz.--One from bronchitis (male, aged 61 years), and one from epidemic enteritis (male, aged 1 year). WORKSHOP SUPERVISION. This subject is dealt with in pursuance of Section 132 of the Factory and Workshop Act, 1901, which requires the Medical Officer of Health to " report specifically" on the adminstration of the Act within his district. The Home Office issues a memorandum on the subjects to be included in such report. In addition to the tables prepared by the Department, which are included in the text, a special form is required by the Home Office, which will be found in the Appendix (Table I X). Registration.—To the Registers of the Department, which contained 1,458 premises at the close of 1906, there were added 181 premises during 1907, and 203 premises were removed, leaving 1,436 effective entries at the close of last year. The premises then on the Registers, included 124 factories, 861 workshops, 23 domestic workshops, 61 workplaces, and 367 premises occupied by " single workers," 215 of the last being included in the Register of Outworkers' premises. Table 35 gives an analvsis of the businesses, and an approximation of the numbers of employees. 54 WORKSHOP SUPERVISION. TABLE 35. Factories, Workshops, and Work-places. 1907. No. of Premises. No. of Rooms. Employees. Women. Young Persons. Men. Totals. Clothing— Boot-making 110 (46) Ill (46) 5 (3) 5 (2) 197 (52) 207 (57) Corset-making 9 (1) 13 (1) 24 (1) 3 — 27 (1) Dressmaking 438 (95) 657 (77) 1,793 (179) 377 (26) 8 (2) 2,178 (207) Mantle-making 10 (5) 15 (8) 32 (7) 1 — 33 (7) Millinery 44 (4) 68 (4) 203 (5) 39 (1) 7 249 (6) Millinery and Dressmaking 21 27 268 49 — 317 Outfitting and Plain work 23 (15) 29 (16) 66 (21) 1 (1) — 67 (22) Tailoring 173 (122) 190 (135) 135 (103) 17 (15) 322 (156) 474 (274) „ Ladies' 20 (1) 42 (1) 40 14 98 (1) 152 (1) Various 20 (6) 26 (6) 51 (6) 6 10 67 (6) Fancy Work— Embroidery and Art work 6 (1) 7 (2) 10 (3) — 1 11 (3) Cleansing— Dyers and Cleaners' Receiving Offices 17 19 22 3 1 26 Laundries 118 (6) 403 (9) 1,303 (8) 39 138 1,480 (8) „ —Receiving Offices 37 38 41 4 1 46 Mangling 22 22 22 — — 22 Various 6 6 6 — 2 8 Other Businesses— Blind-making 6 8 6 3 26 35 Bookbinding and Printing 33 60 47 40 (2) 244 331 (2) Carpentry and Joinery 16 17 — 2 107 109 Chaff-cutting 17 28 — — 57 57 Coach Building 44 74 — — 318 318 Cycle and Motor Works 22 34 — 8 104 112 Jewellery and Clock-making 8 12 — — 22 22 Metal-working 43 58 — — 220 220 Saddlery 8 10 — — 24 24 Sign and Ticket Writing 7 7 3 6 19 £8 Trunk-making 7 10 — — 29 29 Umbrella-making ... 8 9 14 2 16 32 Upholstery 47 (21) 62 (25) 110 (28) 22 (4) 156 (1) 288 (32) Various 96 (2) 135 (2) 318 (2) 84 669 1,071 (2) 1,436 (325) 2,197 (332) 4,519 (366) 725 (51) 2,796 (212) 8,040 (629) Women were employed in 928 workshops, including 181 where men and women were employed. The total number of women therein was 4,780, including 633 "young persons." Women were employed at 172 outworkers' premises, including 42 where men and women were employed. The total number of women employed therein was 409, including 43 "young persons." The Home Office forwarded to the Department 46 notices of the opening of new workshops, but 26 of the premises thus reported were already on the Registers of the Department. Home Work.—In February of last year 43 lists of outworkers were received from employers in the Borough, and in August, 58, making a total of 101 returns for the year, as compared with 76 in 1906. The addresses of outworkers included in the returns, numbered 422, of WORKSHOP SUPERVISION. 55 which 283 were forwarded to other districts in accordance with the Act. From outlying districts, 385 addresses of outworkers resident in the Borough were received, the names of the districts and the numbers of returns from each being given below. Kensington 16 Hampstead 14 Westminster 13 Finsbury 11 City of London 8 Willesden Hammersmith Marylebone Chelsea Fulham 5 4 3 2 each Battersea Camberwell Holhorn Lewisham Shoreditch 1 each At the close of the year the Register contained 325 effective entries, comprising Workshops, 98; "single workers, 227." Inspections.—The time of the Women Inspectors having been much taken up with visits in connection with infectious sickness, etc., the number of inspections of workshops (of all descriptions), fell from 3,258 in 1906 to 2,287. A similar decrease in the number of inspections was recorded in 1905, when measles was, as last year, epidemic. It is, however, to be noted that the present condition of the workplaces in the Borough does not necessitate such frequent visitation as was the case when the work was first commenced. The Staff measured 150 new workrooms last year, 42 more than in 1905. In 93 instances the workrooms were found to be used as bedrooms, 7 more than in 1905. "Abstracts" were found absent in 39 workpremises, each case being duly reported to the Home Office. The notices served last year numbered 26, as compared with 54 in 1905. The number of notices does not properly represent the matters dealt with as most of the works required are carried out on verbal requests of the staff. The defects or infringements of the Act discovered in the course of last year's inspections are given in Table 36. Complaints.—The Home Office forwarded 21 complaints during the year (see below), two more than in 1906, but one less than in 1905. Home Office Complaints— Dirty conditions 7 Insufficient ventilation 3 Overcrowding 2 Other matters 9 From other sources 2 complaints were received, as compared with 4 in 1906 and 7 in 1905. Last year's complaints related to— Defective water-closet and nuisance from drains, one each. Overcrowding.—There was a marked decrease in the number of cases of overcrowding, only 4 instances being reported by'the Inspectors and 2 by the Home Office during the year. In 1906, 8 cases were discovered by the Department and 4 reported by the Home Office. In 1905 and 1904 the total numbers of cases were 44 and 31 respectively. Deficient Ventilation.—In 1905, 3 workshops were reported as insufficiently ventilated, in 1906, 3, and last year 4. Warming.—Although this subject falls under the jurisdiction of the Home Office, the Inspectors of the Department are required to report premises which are either too hot or without adequate means of maintaining a reasonable temperature in cold weather. The latter always receives special attention whenever there is a marked fall in the temperature, but no infringements of the Act were reported last year and only 3 in 1906. The mildness of the past two winters undoubtedly has been partly responsible for such favourable results. One case of excessive temperature was referred to the Home Office during the past year. 56 WORKSHOP SUPERVISION. TABLE 36. Inspections of Workshops, &c. 1907. See also Table IX., Appendix. Mr. Wansbrough. † Miss O'Kell. * Miss Nicolas. * Workshops— On register end of 1906 519 485 454 added during 1907 63 59 60 removed „ ,, 73 65 65 On register end of 1907 509 478 449 Inspections of new workshops 63 59 60 Other inspections 1,097 462 551 Rooms measured 26 33 91 Workrooms used as bedrooms 20 45 28 Workrooms without Abstracts 3 20 16 Notices served, totals 2 10 14 Written intimations 2 8 12 Under Sec. 4 Public Health — — 2 37 (London) — — — 38 Act, 1891. — — — By-laws, under same Act — 2 — Nuisances dealt with— Discovered. Abated. Discovered. Abated. Discovered. Abated. Overcrowding — — 2 2 2 2 Dirty Conditions 32 32 14 14 22 22 Deficient Ventilation — — 2 2 2 2 Temperature too High — — 1 1 — — Temperature too low — — — — — — Sanitary conveniences— Insufficient — — — — — Not separately provided — — — — 1 1 Badly placed — — — — — — Unventilated — — — — — — Defective 6 6 5 4 4 4 Vapour, effluvia not removed Steam in washhouses — — — — — Gas fumes 3 3 1 1 7 6 Drains... 1 1 2 — — — Wet floors, laundries — — — — — — Accumulations of refuse — — — — — — Other nuisances or offences 2 2 6 6 — — Totals 44 44 33‡ 30 38§ 37 * Including workshops where both sexes are employed. † Workshops where men only are employed. (Bakehouses not included.) ‡ Twelve cases referred to Male Inspectors and one to London County Council. § One case referred to Male Inspector. WORKSHOP SUPERVISION. 57 The question as to the use of gas stoves without proper flues is still unsettled. Sanitary Conveniences.—All the existing workshops appear to be adequately provided with closet accommodation, no premises having been reported during the past year as otherwise. The general improvement which has taken place with respect to this part of workshop accommodation is manifest from the appended statement. Water-closet Accommodation. 1902. 1904. 1906. 1907. Insufficient 9 2 2 — Not separately provided 33 4 2 1 Badly placed 18 13 — — Unventilated 8 — — — Defective 29 23 23 15 Sickness.—The cases of infectious disease, of all descriptions, reported during the year on "workshop premises" numbered 111, including 32 cases in the homes of outworkers. Last year's numbers showed increases over the figures for 1906 and 1905, viz., on all premises 92 and 70 respectively, and 23 and 29 on outworkers. Last year's cases are analysed below, the cases reported from outworkers' premises being shown in parentheses. Scarlet Fever 17 (6) Diphtheria 5 (3) Enteric Fever 2 (—) Puerperal Fever 1 (—) Erysipelas 9 (2) Measles 44 (12) Chickenpox 27 (8) Whooping Cough 5 (1) In addition to the above, 5 cases of "consumption" were reported. The deaths from the foregoing disease numbered 14, viz., 10 from "consumption," 2 from whooping cough, and one each from diphtheria and measles, the death from diphtheria being the only fatal case on outworkers' premises. On receipt of information of any case of infectious illness the premises are specially visited. Inasmuch as practically all cases of the notified diseases are removed to hospital it is only necessary to see that any articles liable to convey infection are properly dealt with. No orders to prohibit work were required during the year, and nothing transpired leading to a suspicion of any spread of infection from such source. Bakehouses.—There were 74 such premises on the special Register at the close of the year, 16 being "level" and 58 "underground." Baking was given up during the year in 3 underground bakehouses, and resumed at 2 others, which had been temporarily out of use. When such places are re-opened after closure, a special inspection is made to see that the place is in accordance with the prescribed requirements, and that cleansing, usually with some improvements, is carried out. Of the 74 bakehouses on the Register, 7 are "factories," but are nevertheless under the jurisdiction of the Department, the special provisions of the Public Health (London) Act, 1891, over-riding the general rule under the Factory Act. Seventy-six (76) inspections were made of the "factory bakehouses," and 423 of the remaining 67 premises. 58 HOUSING. HOUSING. Houses Let in Lodgings. Registration.—At the close of 1906, 1,272 houses were on the Registers. It was found that the houses already registered required so much time for supervision that it was thought desirable to devote the best part of the past year to supervision rather than to increasing the number of registered houses. In consequence only 48 houses were registered, as compared with 140 in 1906. There were no removals from the Register, so that the number of "registered" houses at the close of last year was 1,320. The landlord of one house was summoned and fined £1 with 21/- costs for not furnishing a true statement of particulars. The streets in which houses were registered during the year are set out below distinguishing (a) streets visited for the first time, in which all, or nearly all, the houses were to be registered; (b) registered streets with houses left unregistered for various reasons in previous years, requiring to be placed on the Registers; and (c) streets, certain houses of which were specially selected for registration, owing to density of inhabitants, dirty conditions, &c., but where it is not intended to register the whole street. (a) South Wharf Road. Victoria Street. Houses Registered, 1907. (b) Braden Street. Hall Place. Hermitage Street. Kensal Road. (c) Barnsdale Road. Woodfield Place. The customary statement of the housing and numbers of inhabitants in the houses visited for the purposes of registration is given below. This branch of the work required 544 visits. Housing. No. of Houses visited with a view to Registration 67 Houses Registered 48 „ Exempt 19 „ Empty 1 No. of Rooms Registered 147 For living only 14 For sleeping only 63 For both purposes 70 Other Rooms in Registered Houses 155 Occupied by landlords 61 Exempt by rent 76 Occupied, not inhabited 11 Empty 7 Grand Total, Rooms 302 59 Housing. Inhabitants (Registered Houses). In Registered Rooms, Persons 273 Under 10 years of age 66 Aged 10 years and over 207 In other Rooms, Persons 200 Under 10 years of age 39 Aged 10 years and over 161 Grand Total, Inhabitants 473 Table 37 shows how the tenements in the houses registered during the year were occupied. It will be seen that 30 tenements were "overcrowded," that is, were inhabited by persons in excess of an average of two persons per room (the ages of the occupants not being taken into account). On the standards imposed by the by-laws, 22 families comprising 67 persons were overcrowded, but in 13 cases the deficiency in the cubic space was so small that it was thought unnecessary to take any action, for the present at least, with reference thereto. (See below). Overcrowding, at Registration. In Registered Rooms— Families 22 Persons 67 „ under 10 years of age 16 „ aged 10 years and over 51 Overcrowding abated 9 By Re-adjustment of Occupants 2 By Removal 7 Cases held over (deficiency under 100 cu. ft.) 13 TABLE 37. Particulars as to Numbers of Tenements and Inhabitants therein, registered during 1907 Rooms to Tenement. 1 2 3 4 5 6 P 10 P 10 P 10 P 10 P 10 P 10 T — — T — — T — — T — — T — — T — — 10 P 10 P 10 P 10 P 10 P 10P 1 41 41 ... 16 32 ... 8 18 6 8 17 15 ... ... ... 1 2 4 2 ... ... ... 6 12 ... 10 24 6 6 15 9 9 30 15 4 13 11 3 ... ... ... ... ... ... 1 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 thus:— Average persons per room. Tenements of— Total. Occupants. Houses registered 1907. Borough Census 1901. 1 room 74 135 1.8 1.8 2 rooms 35 135 1.9 1.7 3 „ 1 3 1.0 1.3 4 „ — — — 1.1 60 HOUSING. Supervision.—A system has been inaugurated since the last report was written of making quarterly inspections of such houses on the Register as are known to be badly kept, either by the occupants or the landlords, or both. By this practice it is hoped to raise the standard in the worst houses. The method unfortunately means that fewer houses can receive general supervision by the two Inspectors told off to supervise houses let in lodgings. However it is hoped that more will be gained than lost. The total number of inspections during the year, apart from those in connection with registration (544), and annual cleansing (to be hereafter dealt with) was 2,849, as compared with 2,825. It has to be remembered that with the increase in the number of houses on the Register, the annual cleansing takes each year more of the Inspectors' time, and hence the number of general inspections has not increased to the extent that might have been expected. In 1906 the general (including registration, the number of visits in connection therewith, not being separately recorded), numbered 3,756, and in 1905, 3,511. The defects and infringement of by-laws discovered are set out in Table 38. The notices issued during the year, apart from cleansing notices, totalled 1,259, viz.—288 written intimations, 108 "statutory notices," and 696 by-law notices. The notices for verminous rooms, under Section 20 of the London County Council (General Powers) Act, 1904, numbered 146 last year, as compared with 239 in 1906, and for the abolition of old dust bins (Section 23 of the same Act), 21. Annual Cleansing.—This most useful work is carried out under by-law 15, which requires the landlords to thoroughly cleanse and limewash all ceilings, walls, &c.,of their houses during the month of April in each year. It is very rare to require the whole of any house to be so treated, as the by-law allows, but the powers are used to secure that all dirty rooms, closets, washhouses, and yards, shall be thoroughly cleansed and made wholesome, with, it is believed, great benefit to the general health and welfare of the inhabitants of the registered houses, and (indirectly) of the Borough in general. So much work has to be done now—there were 1,268 houses to be specially inspected last April—that part of the work was transferred last year to some of the District Inspectors. Even with that increase in Staff, the cleansing was not completed until after the summer vacation, and, this year, a further change in procedure has been adopted with a view to shortening the time. The inspections necessitated in dealing with the 1,268 houses numbered 5,250, 2,376 rooms being reported as in need of cleansing. No fewer than 2,282 cleansing notices were served, excluding 118 for verminous rooms and 418 for sanitary defects. Four summonses were issued. It is found to be impossible to inspect a house at a single visit, and hence the number of inspections is very great. Overcrowding.—No special enquiries were made during the annual cleansing as to overcrowding, but that defect in last year's arrangements was to some extent remedied by the quarterly inspections. This year full particulars are being taken of the inhabitants in all registered houses. The total number of tenements found overcrowded (including those so found on registration), was 344, in 256 houses, containing 416 rooms and occupied bv 1,538 persons (621 under and 917 over 10 years of age). The overcrowding was abated by re-arrangement of the occupants in 63 cases (47 on attention being called informally to the offence, 16 after notices had been served), in 160 by removal of the families (105 after notice, 55 voluntarily), while in the remaining 121 cases the deficiency in cubic space was so small, that the cases were reserved for future consideration. 61 housing. TABLE 38. Sanitary Defects Remedied in Registered Houses. 1907. 1906. Drain defective 44 28 „ choked 3 8 „ untrapped 2 3 „ unventilated or improperly ventilated 24 16 Manhole cover defective 6 7 Surface inlet improperly trapped 7 11 Gully choked 6 3 Ventilating pipe improperly constructed 3 1 Soilpipe defective — 1 „ improperly constructed — — „ unventilated or improperly ventilated 1 2 Water-closet choked 20 47 „ defective 45 55 „ flushed from drinking water cistern 3 2 „ insufficiently flushed 23 47 „ flushing apparatus defective 38 61 „ without water supply 12 16 „ foul 18 28 ,, improperly constructed 5 5 „ accommodation insufficient 34 36 „ without door 2 10 „ without external light or ventilation 1 — Rain-water pipe not disconnected from drain or soilpipe 4 18 „ defective 22 29 ,, choked 7 12 Waste pipe not disconnected — 1 „ defective 10 9 „ choked 1 2 „ not provided 3 8. Other drainage defects 10 1 Cistern connected to drain — — „ defective 4 7 „ dirty 34 40 „ improperly placed 1 1 „ without proper cover 15 23 „ cover defective 7 21 Dustbin defective 54 145 ,, not provided 7 3 ,, insufficient 8 1 „ disused and not abolished — 11 Paving defective in area or yard 89 95 „ ,, washhouse 48 41 Guttering defective 12 13 Premises damp 8 5 „ dirty 4 4 Rooms verminous 345 231 Roof defective 136 147 Accumulation of refuse 42 12 Animals improperly kept 6 14 Other defects or nuisances 30 49 Vital Statistics.— The inhabitants of the registered houses were estimated to number, last year, 18,490 persons, 5,305 of whom were under 10 years of age. The cases of infectious disease notified in the streets containing such houses (only those streets are here included in which the majority of the houses are on the Register), numbered 160, 113 of the patients being under 10 years old. The cases of each disease were as follow :— Diphtheria (including Membranous Croup) 31 (26). Erysipelas 22 (4). Scarlet Fever 98 (81). Enteric Fever (including Continued Fever) 9 (2). Figures in parenthesis, cases under 10 years of age. 62 housing. The above cases were equal to a morbidity rate of 8.65 per 1,000 persons, as compared with 5.67 for the remaining parts of the Borough. (See Table 39). In addition to the cases of notified diseases set out above, 405 (404) cases of measles, 103 (102) of whooping cough, and 70 (67) of chickenpox came to the knowledge of the Department. The total mortality (Table 39) was at the rate of 24.49 per 1,000, rather more than twice the rate of the Rest of the Borough (11.91), and nearly 1.00 per 1,000 above the rate for the (practically) same streets in 1906 (23.53). The principal increases were recorded for measles (rate 0.97, 1907; 0.45, 1906), diphtheria (rate 0.48, 1907; 0.16, 1906), and respiratory diseases (rate, bronchitis and pneumonia, 4.65, 1907; 4.05, 1906). There was a great decrease in the diarrhœal diseases (rate 0.91, 1907; 2.92, 1906). Last year the deaths at ages under one year constituted 24 per cent. of all deaths in the "Registered Streets," and 16 per cent. in the "Rest of the Borough," while the infantile mortality (per 1,000 births), was 134 in the former and 102 in the latter. TABLE 39. 1906. 1907. Registered Streets. Rest of Borough. Registered Streets. Rest of Borough. Morbidity— Small-pox — o.oo — — Diphtheria and Membranous Croup 1.74 1.14 1.67 0.98 Erysipelas 1.85 0.80 1.18 0.77 Scarlet Fever 9.97 4.11 5.30 3.67 Enteric (and Continued) Fever 0.56 0.19 0.48 0.19 Puerperal Fever 0.16 0.06 — 0.04 All Diseases 14.30 6.33 8.65 5.67 Mortality— Small-pox — — — — Measles 0.45 0.06 0.97 0.14 Scarlet Fever 0.56 0.06 0.32 0.05 Whooping Cough 0.28 0.04 0.32 0.33 Diphtheria 0.16 0.09 0.48 0.08 Enteric Fever 0.16 0.03 — 0.03 Diarrhœal Diseases 2.92 0.61 0.91 0.21 Erysipelas 0.05 0.04 0.05. 0.04 Puerperal Fever — 0.02 — 0.03 Phthisis 2.98 0.82 2.54 0.83 Other Tubercular Diseases 0.90 0.29 1.40 0.27 Alcoholism — 0.09 0.21 0.04 Cancer 1.23 1.08 1.13 1.19 Premature Birth 0.73 0.23 1.02 0.40 Developmental Diseases 1.18 0.41 1.08 0.35 Bronchitis 2.25 0.90 2.65 0.97 Pneumonia 1.80 0.60 2.00 0.99 Cirrhosis of Liver 0.11 0.17 0.21 0.19 Accidents and Diseases of Childbirth — 0.04 0.10 0.06 Suicides — 0.10 0.10 0.05 Other Causes 7.71 5.17 8.92 5.56 All Causes 23.53 10.88 24.49 11.91 The usual statistics for the "Clarendon Street" Area are given in Table 40. In comparison with the mean rates for 1902.06, all the rates for the notified diseases were lower last year, except that for diphtheria, which rose by 0.51 per 1,000. All last year's rates for the Area were higher than the rates for the "Rest of the Borough," the greatest differences being those of erysipelas and enteric fever. 63 housing. TABLE 40. Clarendon Street Area. Rest of Borough. 1907. 1902-06. 1907. 1902-06. Morbidity— Small-pox — 1.09 0.11 Diphtheria 1.85 1.34 1.03 1.03 Erysipelas 1.57 1.52 0.79 0.84 Scarlet Fever 5.15 5.77 3.80 2.74 Enteric Fever 0.43 0.62 0.22 0.33 Puerperal Fever — 0.14 0.04 0.04 Mortality—All Causes— All ages . 27.61 25.52 12.77 12.83 0—10 years 44.61 38.26 21.68 23.68 10— „ 20.49 19.98 11.05 10.85 Infantile Mortality † 285 280 159 198 Deaths under 1 year ‡ 59.7 61.6 59.9 66.2 Institution Deaths § 47.1 40.3 30.9 28.5 * Per 1,000 persons. ‡Per 100 deaths, 0—10 years. † Per 1,000 deaths at all ages. § Per 100 deaths at all ages. The mortality at all ages (27.61) was 2.09 per 1,000 above the mean rate (25.52) the difference between the last year's rate and that for the "Rest of the Borough" (12.77) being greater than the difference between the two mean rates (25.52 and 12.83 respectively). The contrast between the rates at ages under 10 years is much more unfavourable for the "Area " than that between the rates at ages over 10 years. The infantile mortality (per 1,000 births),, was 146 in the Area, and 103 in the " Rest of the Borough." Common Lodging Houses. At the last Annual Licensing, 7 houses were licensed, viz.—6 for men (195 beds), and 1 for women (40 beds). No cases of infectious illness were reported among the occupants of such houses during the past year, the deaths numbering 8. The causes of death were :— Tubercular Diseases (Phthisis) Malignant Diseases 1 each. Respiratory Diseases 3. Other Causes 3. Inhabited House Duty. During the year 19 applications for Certificates under Sec. 11 of the Revenue Act, 1903, for the purpose of securing remission or reduction of this duty, were made to the Medical Officer of Health, and 5 others, remaining over from 1906, were dealt with. Certificates to the number of 13 were issued during the year, and 3 others just after the close thereof. Three applications were withdrawn on account of the amount of work necessary to secure the certificate, one was refused, and four were in suspense at the end of the year. The class of property for which the certificates were sought consisted principally of "flats," only 8 of the 16 certificates issued being for tenement houses. It is doubtful whether the enactment was originally intended to apply to flats at all. It is more probable that the bonus was intended to encourage the provision of better dwellings for the artizan classes. 64 food supervision. One application led to a very lengthy correspondence, the applicants disputing the right of the Medical Officer of Health to set up any standard as a condition precedent to the issue of the certificate. It was contended, in effect, that the provision of the barest accommodation would be sufficient, and that if the premises were constructed to accommodate separate households and some provision made for their sanitary requirements, the Medical Officers of Health was bound to grant the certificate. The advice of the Local Government Board was sought on the interpretation to be placed on the Section. The Board, while declining to give any opinion, stated that the responsiblity of deciding as to the conditions, which in any instance must be fulfilled before the certificate was granted, rested entirely with the Medical Officer of Health. Having regard to the very explicit terms of the Board's letter, it seems doubtful whether an action for a mandamus, such as was threatened in the particular case, would ever be successful, unless the conditions imposed were manifestly unreasonable. An application for a certificate affords an opportunity of securing a better standard of dwelling than is provided by a bare compliance with building laws and regulations, especially if of ancient date. FOOD SUPERVISION. Slaughterhouses.—There were seven (7) slaughterhouses in use during the past year, situate as described below Bishop's Mews, No. 1. Portsdown Mews (No. 249 Maida Vale). Southwick Mews, No. 15. Harrow Road, No. 125. Edgware Road, No. 275. Upper Brook Mews, No. 6. Chippenham Mews, No. 18. The re-erection of the demolished slaughterhouse in Hero Place, Edgware Road, has been abandoned. All the slaughterhouses were found to be well kept and clean during the year, and no objections were raised against the renewal of any of the licences. The Inspector visited the slaughterhouses on 589 occasions when killing was in progress, and examined 5,716 carcases in process of dressing, viz.—149 of bullocks, 5,534 of sheep, and 33 of calves. Those numbers are slightly below the records for 1906, but that may be due to the reduced number of licensed premises. At the same time it has to be observed that local slaughtering is, on the whole, less frequently practised. The following organs (total weight, 670 lbs.) were destroyed during the year, for the reasons assigned in each case :— Organs. Cause of destruction. Sheep. Livers, 22—parasites 16, cirrhosis 2, and abscesses 4. Lungs, 4— „ 2, pneumonia and pleurisy, 1 each. Bullocks. Livers, 16—parasites, 10 ; abscesses, 2; cirrhosis, 4. Lungs, 4— „ 2 ; pneumonia, 2. Skirts, 3—abscesses, 2 ; inflammation,1. 2 sets organs (lungs, liver, &c.), tuberculosis. Food Purveyors' Premises.—The appended statement gives the numbers of the different classes of premises under the supervision of the Department, and of the occasions on which such premises were inspected during the year. Owing to the works carried out in previous years, sanitary defects are rarely discovered. None were reported during the past year. 65 food supervision. Food Purveyors. Numbers of places where Food is sold:— Butchers 83 Milkshops and Dairies 176 „ Pork 28 Refreshment Houses 141 Fishmongers 29 Fried Fish and Sausages 26 Game and Poultry 13 Ice Cream Makers & Vendors 141 Fruit and Greengrocery 85 Inspections during the year :— Butchers' Shops 582 Milkshops, &c. 272 Greengrocers' Shops 17 Restaurants, &c. 236 Costers' Barrows 15 Ice Cream Shops and Barrows 50 Fishmongers' Shops 25 Fried Fish Shops ... 40 Miscellaneous.—In addition to the above, there are 3 premises where fish curing is carried on, and 9 where the manufacture of sausages takes place. Such premises are systematically inspected as to their construction, and maintenance in a proper state and as to the food materials dealt with thereat. 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 1906, 178 names were on the Register. During the past year 6 names were added, 9 removed, and 22 changed, leaving 175 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 depdts 4 Grocers' shops 10 General shops, selling oil 26 „ not „ 29 Sweet-stuff and confectionery 4 Provisions 5 Fish and grocery 2 Off-licensed premises 1 Coal, wood and oil (combined) 2 Refreshment 1 The above premises were inspected on 272 occasions during the year. Four cases each of scarlet fever and diphtheria were reported on premises where milk was sold; and 4 cases of diphtheria in the families of milk carriers. All due precautions were taken to prevent the spread of infection, and no ill results were traced to any of the above cases. 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. Seven (7) names were removed from the Register during the year and 1 added 66 unsound and diseased food. leaving 140 effective entries at the end of the year. Of the makers and vendors on the Register, 136 are shop-keepers, and 4 Italian barrow-men. The businesses combined with the sale of ice-cream are indicated below:— Sweet shops 70 Bakers 24 Milk 6 Restaurants 17 Newspapers and Tobacco 6 Confectioners 5 Cook 1 General 10 In addition to the 4 local barrow-men, 20 from other districts have regular stands in the Borough:— From Marylebone 8 „ Kensington 7 From Islington and Clerkenwell 2 each. „ Willesden 1 UNSOUND AND DISEASED FOOD. In addition to the meat condemned and destroyed in the course of slaughter, 2,850 lbs. of foodstuffs were destroyed as unfit for human food, including 504 lbs. destroyed on requisition of the G.W.R. Co., while in course of transit. The various quantity of foods, and the causes of condemnation are set out below :— Meat (Butchers' Shops) :— Cause of Destruction. Animal. Part Destroyed. Tuberculosis Pig Bullock 1 Carcase. 5 Plucks, 6 Mesenteries, 4 Lungs. 1 Hand and Spring. 8 Lungs, 1 Tongue. Parasites Bullock Sheep Rabbit 1 Lungs (set). 1 Pluck. 2 Carcases, parcel of Livers. Decomposed Pig Sheep 2 Legs. 14 Carcases. 8 Livers, 2 Plucks. Fish :—(decomposed)— Herrings 168 lbs. Haddocks 56 lbs. Vegetables :—(decomposed) — Apples 46 lbs. Tomatoes 440 „ Oranges 60 „ Cherries 60 „ Onions 10 „ Plums 130 lbs. Apricots 40 „ Lemons 20 „ Bananas 31 „ Summary. Meat 1,015 lbs. Fish 224 „ Vegetables and Fruit 837 „ 2,076 Per G.W.R. Co., Geese (24) 280 lbs. Tomatoes 224 „ 504 Grand Total 2,580 lbs. 67 FOOD ADULTERATION. FOOD ADULTERATION. The samples submitted to the Public Anaylst during the year numbered 563, of which 52, or 9.2 per cent. were found to be adulterated. The proportions found adulterated in the three preceding years were:—1906, 10.2; 1905, 6.5; and 1904, 8.9. A list of the samples purchased last year, together with the numbers and proportions found to be adulterated, is given in Table 41. TABLE 41. Total. Found Adulterated. Percentage Adulterated. Milk 347* 42 12.1 Butter 59 1 1.7 Coffee 13 — — Cheese 13 — — Mustard 3 — — Sweets 4 — — Lard 2 — — Pepper 4 — — Cocoa 8 — — Arrowroot 2 — — Ground Ginger 2 — — Cream 20 9 45.0 Jam 8 — — Sal Volatile 2 — — Vinegar 6 — — Cider 2 — — Sweet Spirits of Nitre 4 — — Brandy 6 — — Potted Meat 6 — — Whisky 4 — — Tartaric Acid 10 — — Citric Acid 6 — — Baking Powder 6 — — Cream of Tartar 6 — — Flour 4 — — Ketchup 2 — — Gin 2 — — Bread 4 — — Olive Oil 2 — — Ground Rice 2 — — Preserved Peas 2 — — Ammon. Tinct. Quinine 2 — — 563 52 9.2 * Including 68 taken at Paddington (G.W.R.) Terminus in course of delivery; 22 adulterated. Of 347 samples of milk, 68 were taken at the Paddington (G.W.R.) Terminus at the request of the consignees who had contracts with the farmers sending the milk to London. Of such samples, 22, or 32.3 per cent. were found to be adulterated, as compared with 30.6 in 1906; 12.6 in 1905, and 18.7 in 1904. Samples of milk were purchased in the streets on Sunday on 8 occasions, 74 samples being so taken, of which 11 were adulterated, equal to 14.8 per cent. as compared with 4.4 per cent, of the samples purchased on other days. 68 FOOD ADULTERATION. Use of Preservatives.— Among the samples obtained during the past year were 12 of cream and 9 of milk, containing preservatives (boron preparations, usually boric acid), the amounts being as given— Milk (12). Cream (9). Date of Purchase. Amount of Preservative. Date of Purchase. Amount of Preservative. June 18th *0.018 per cent. Sept. 10th 0.40 per cent. July 25th *0.03 „ 0.40 July 28th— 10 samples from one consignment from the country 0.07 (1) Sept. 27th *0.36 0.078 (5) „ 0.48 0.08 (2) „ 0.40 0.12 (1) Oct. 16th *0.32 0.13 (1) „ *0.31 Nov. 14th 0.46 Dec. 5th. 0.40 * Summonses were not issued in respect of these samples. Summonses were taken out against the vendors of those samples containing preservatives in excess of the amounts suggested in the letter of the Local Government Board of July, 1906. The summonses stand adjourned sine die pending decision of a point of law arising out of the case of McNair v. Cullen (a Westminster prosecution relating to use of preservative 0.313 per cent. of boric acid] in cream). At the present juncture, therefore, nothing can be said about the local cases, but some notes on the evidence in McNair v. Cullen * will be of interest. The London cream trade consists of cream put up in jars ("jar cream") and cream sold by measure ("draught cream"). "Jar cream" is reputed to constitute from 85 to 95 per cent. of the total volume of the trade. It is prepared in the provinces, being generally despatched to London within 12 hours after the milk is taken from the cow. The "life" of the cream—that is the time between milking the cow and consumption—may be taken to average from 3 to 4 days, but in certain cases may be as long as a week or more. "Jar cream" contains some 50 per cent. or more of fat, "draught cream" 30-40 per cent., a difference which materially affects the quantity consumed by the individual, and hence, indirectly, the question of the use of preservatives. Evidence was given as to the periods for which cream without and with preservatives will keep good. Although that evidence was disputed by subsequent witnesses, the latter did not bring forward any proof of their objections based on experiments at all comparable with those made by the first witness. His evidence must be taken, therefore, as uncontroverted. He found that cream kept at summer temperature (60°-75° Fahr.) without added preservatives remained sweet for from l¾1 day,† and in cold storage (40°) for 4 days. After removal from the cold store the cream rapidly turned sour. At summer temperatures cream with 0.25 per cent. boric acid kept from 5-3 days; with 0.30 percent. (60°), 6½ days; with 0.34 per cent., 7½ days; and with 0.5 per cent., 10 davs. It may reasonably be assumed from the foregoing that if cream be prepared under proper conditions qua cleanliness, etc., not more than 0.25 per cent. of boric acid is necessary for all trade purposes. From the evidence given by witnesses put forward by the Protection Association which took up the case, the Trade accepted the contention that " draught cream " should be sold free from preservatives, but desired to be allowed to sell "jar cream" with 0.5 * The Medical Officer of Health was present throughout the hearing of the Appeal in McNair v. Cullen at Clerkenwell in November last and took notes of the evidence given. These notes represent the conclusions he formed from hearing the evidence. † In each case the longer period means that the experiment was conducted at the lower temperature. 69 office work. per cent. of boric acid, subject to declaration by label. The case in point turned upon the addition of 0.313 per cent. The evidence of witnesses who were concerned in the production of "jar cream" indicated that the addition of the preservatives was not made in a scientific manner. Certain of the witnesses admitted that they used proprietary preparations, the composition of which was unknown to them. The amount added appeared to be only approximately measured. Much stress was laid on the difficulties alleged to be inherent to the use of cold storage in the retail trade of "jar cream," but it cannot be said that the arguments were very convincing. An ice-safe is neither costly to purchase nor to maintain. Of the evidence as to the injury likely to result from the use of preservatives, nothing need be said. It was a repetition of records of experiments, conclusions and opinions long since made public. The decision of the Court involved questions of law as well as of fact. The former involved the interpretation to be placed on Section 3 of the Sale of Food and Drugs Act, 1875. That Section reads:—"No person shall mix . . . any article of food with any ingredient or material so as to render the article injurious to health." The Court decided as a point of law that the Section was intended to protect healthy adults, infants, and children, but not abnormal adults or sick persons (including infants). As a question of fact the Court decided (a) that cream is an article of diet of infants and children, and (b) that the addition of 0.313 per cent. of boric acid to cream did render such cream injurious to such persons. The Court dismissed the Appeal, but consented to state a case on the point of law.* OFFICE (CLERICAL) WORK. The appended figures are intended only as an indication of the mass of work which has to be performed by the Clerical Staff. The figures convey but a very imperfect idea of the very large amount of writing which is necessary, the bulk of which cannot be set out in the forms of statistics. Letters received 4,005 (3,702) „ despatched 3,108 (2,810) Entries in postage book 10,237 (8,352) Cases of infectious disease entered in Register 740 (1,083) Notices sent re above 6,594 (7,581) „ „ other diseases 4,800 (4,962) Complaints received 747 (845) Plans dealt with 471 (483) New openings in Journals 786 (970) Disinfection Orders (duplicate) 2,377 (1,879) Notices to abate nuisances 1,254 (1,158) The figures in parentheses are the returns for 1906. LEGAL PROCEEDINGS. The results of the cases which were brought before the Police Magistrate are appended hereto. Only a small proportion of the cases referred to the Solicitor result in actual lega'l proceedings, such cases forming fortunately a very small fraction of the cases dealt with under notices. The Department is able to secure the abatement of nearly all nuisances by service of "written intimations" which are not, in the legal sense, "notices" at all. * The appeal was heard on June 1st, 1908, and dismissed. (See "The Times," June 2nd.) 70 legal proceedings. The fines imposed during the year amounted to £60 10s. and the costs awarded to £41 5s. 6d. Those sums are paid to the Council's account. The following statement compares last year's amounts (fines and costs) with those received during the 5 vears, 1902-06. Health Cases. Adulteration Cases. £ s. d. £ s. d. 1907 69 19 0 31 16 6 1906 34 15 0 63 1 0 1905 25 6 0 126 17 0 1904 62 2 6 101 2 6 1903 63 6 0 100 6 6 1902 32 19 0 175 6 6 Adulteration Cases. 1907. 1906. 1905. 1904. 1903. 1902. Average per conviction f Fine £0 17 0 £0 16 6 £3 8 7 £2 15 2 £3 1 6 £3 3 8 \ Costs 0 12 8 0 15 0 1 2 0 1 5 8 0 15 7 0 16 0 71 SUMMARY OF LEGAL PROCEEDINGS. LEGAL PROCEEDINGS, 1907. Under Public Health (London) Act. Fines. Costs. Section 4. £ s. d. £ s. d. 30, Elnathan Mews Failing to comply with Magistrate's Order to provide water supply 5 0 0 0 2 0 36, „ „ „ „ „ „ 5 0 0 0 2 0 79, Talbot Road Defective drainage Order made for work to be done in 14 days. 0 6 0 24, Carlton Vale Dampness, defective guttering and sink Order made for work to be done in 14 days. 0 6 0 26, Woodfield Road Defective drainage Work done. 0 2 0 79, Talbot Road „ „ Work partly done. Summons adiour ned sine die. I 1 0 Section 47. Whiteley, Ltd., Queen's Road Having upon their premises an article of food liable to be seized 10 0 0 10 10 0 H. Bonest, 381, Edgware Road Having upon his premises two pigs'carcases liable to be seized 1 0 0 2 2 0 E. Beeton, 2, Cowcross Street Selling diseased pig's mesentery Summons dismissed. H. Gillham, 222, Central Meat Market ,, „ pluck )» If Mr. Boyle, Receiver for J. L. Henson Selling bullocks' lights which were unfit for food »! R. Swift Selling unsound cherries 20 0 0 0 2 0 Corne Bros., 93, Cowcross Street Selling diseased pig's pluck Summons withdrawn as purchaser's address could not be ascertained. By-laws relating to Houses let in Lodgings. 2, Braden Street Not furnishing a true statement of particulars 1 0 0 1 1 0 3, Dudley Street Annual cleansing Work done. Summons withdrawn. 126, Kensal Road „ „ „ 0 12 6 128, „ „ „ „ „ 0 12 6 142, „ „ „ „ „ 1 3 0 Other By-laws. 1, Desborough Street W.C. apparatus and dustbin defective „ 0 2 0 Metropolis Management Act, 1855. By-laws pursuant to Section 202. 30, Elnathan Mews Failing to deposit plan of drainage work Plans deposited 0 2 0 66, Fermoy Road „ „ „ „ 0 5 0 21, Waverley Road „ „ „ „ 0 5 0 12, Walterton Road „ „ „ „ 0 2 0 14, ,, ,, 11 11 11 „ 0 2 0 159, Sutherland Avenue „ „ „ „ 2 2 0 32, Cleveland Square „ „ „ „ 5 5 0 202, Harrow Road „ „ „ „ 0 5 0 23, Brindley Street „ „ „ „ 0 5 0 48, Norfolk Square „ „ „ 1 0 0 0 2 0 72 summary of legal proceedings. SUMMARY OF LEGAL PROCEEDINGS DURING 1907. Under Sale of Food and Drugs Acts, 1875-1899. Fines. Costs. £ s. d. £ s. d. (1) Butter 80% foreign fat 5 0 0 0 12 6 Milk 8% fat abstracted 0 10 0 0 14 6 „ 13% added water Dismissed: warranty proved. „ 7% fat abstracted „ „ „ 5% added water „ „ „ 8% 3 0 0 0 14 6 „ 9% — 0 2 0 „ 11% 0 10 0 0 18 6 „ 9% and 22% fat abstracted 0 10 0 0 12 6 „ 14% fat abstracted 0 10 0 0 12 6 „ 22% 1 0 0 0 14 6 „ 10% 1 0 0 0 12 6 „ 12% added water 0 10 0 0 14 0 „ 9% 0 1 0 0 12 6 „ 13% 0 1 0 0 12 6 „ 14% 0 1 0 0 12 6 „ 10% 0 1 0 0 12 6 „ 10% 0 1 0 0 12 6 „ 9% fat abstracted Dismissed: warranty proved. (2) „ 7% Withdrawn: warranty proved. „ 22% Withdrawn on payment of 1 1 0 „ 8% 2 0 0 0 12 6 „ 14% and 3% added water Dismissed: warranty proved. „ 18% fat abstracted 0 10 0 0 12 6 „ 10% added water 0 10 0 0 12 6 „ 13% fat abstracted 0 5 0 0 12 6 (3) „ 12% 1 0 0 0 12 6 „ 8½% 0 10 0 0 12 6 (4) „ 12% Dismissed warranty proved. Cases against the same Defendant are bracketed together. NOTES. (1) Defendant fined £2 with 12/6 costs on the 31st March, 1905, for selling butter containing 89% of foreign fat. (2) Defendant fined £2 with 12/6 costs, on the 6th December, 1901, for selling milk 17% deficient in fat. „ £10 12/6 „ 21st March, 1902, for selling milk 16% deficient in fat. (3) A summons heard on the 25th August, 1905, for selling milk 23% deficient in fat, was dismissed on production of a warranty. (4) Defendant fined £2 with 2/- costs on the 19th May, 1894, 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. „ £5 12/6 ,, 15th June, 1906, for selling milk 16% deficient in fat. Summonses heard on the 1st January and 5th February, 1904, for selling milk containing added water, were dismissed upon warranties being proved by the defendant. APPENDIX. TABLE I. Vital Statistics of Whole District during 1907 and Ten Previous Years. L. G. B. vital statistics. 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 1897 140,829 3,554 25.23 559 157 2,168 15.39 519 294 224 2,098 14.89 1898 141,648 3,444 24.31 591 171 2,433 17.17 600 330 235 2,338 16.50 1899 142,477 3,452 24.22 549 159 2,445 17.16 606 298 223 2,370 16.63 1900 143,318 3,370 23.51 524 155 2,519 17.57 708 401 218 2,336 16.29 1901 144,188 3,359 23.29 484 144 2,163 15.00 652 324 218 2,057 14.26 1902 145,052 3,305 22.41 474 144 2,311 15.67 735 366 207 2,152 14.58 1903 145,927 3,302 22.62 425 128 2.103 14.41 743 366 181 1,918 13.14 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 1906 148,621 3,152 21.22 395 125 2,041 13.73 775 395 197 1,843 12.40 Averages for years 1897-1906. 144,725 3,342 23.08 493 147 2,262 15.62 692 357 204 2,109 14.57 1907 149,542 3,074 20.55 396 128 2,154 14.40 770 372 232 2,014 13.46 * 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. 73 74 Population, Births and Deaths in Borough and Wards thereof. TABLE II. Population, Births and Deaths in Borough and Wards thereof. 1901-06. Population. L. G. B. 1901. 1902. 1903. 1904. 1905. 1906. Averages 1902-06. 1907. Borough 144,188 145,052 145,927 146,815 147,713 148,621 146,836 149,542 Queen's Park 17,152 17,038 16,924 16,813 16,701 16,589 16,814 16,478 Harrow Road 27,775 28,071 28,370 28,672 28,978 29,286 28,679 29,597 Maida Vale 18,769 13,969 19,171 19,375 19,581 19,790 19,380 20,001 Westbourne 23,842 24,096 24,352 24,612 24,874 25,138 24,617 25,406 Church 26,335 26,579 26,826 27,076 27,326 27,580 27,080 27,837 Lancaster Gate West 8,454 8,449 8,445 8,441 8,436 8,432 8,440 8,428 East 7,939 7,935 7,931 7,926 7,923 7,919 7,925 7,915 Hyde Park 13,922 13,915 13,908 13,900 13,894 13,887 13,901 13,880 Births. Borough 3,499 3,464 3,465 3,458 3,299 3,286 3,394 3,206 Queen's Park Not Known. 428 458 ? 436 Harrow Road 818 844 797 Maida Vale 423 430 424 Westbourne 510 453 468 Church 760 769 768 Lancaster Gate West 72 63 72 East 91 71 65 Hyde Park 197 198 176 Deaths, All Ages. Borough 2,057 2,152 1,918 2,014 1,961 1,843 1,978 2,014 Queen's Park 257 270 237 249 221 206 237 235 Harrow Road 401 433 353 402 396 319 381 398 Maida Vale 255 264 244 260 257 250 255 292 Westbourne 354 373 349 310 338 297 333 337 Church 484 539 470 482 448 487 485 470 Lancaster Gate West 77 59 51 68 77 58 63 72 East 61 70 60 66 76 57 66 64 Hyde Park 168 144 154 177 148 169 158 146 Deaths, under One Year. Borough 455 433 388 449 391 353 403 354 Queen's Park 62 76 43 71 52 42 57 46 Harrow Road 105 101 84 96 94 63 88 85 Maida Vale 49 49 44 52 51 46 48 46 Westbourne 75 63 63 62 57 55 60 47 Church 132 117 123 131 111 113 119 99 Lancaster Gate West 9 3 3 7 4 3 4 6 East 4 8 6 7 5 6 6 6 Hyde Park 19 16 22 23 17 25 21 19 75 causes of death at various ages in each sex. TABLE III. Causes of Death: Borough—Sex and Age Distribution. 1907. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond the Borough. L. G. B. Cause of Death. 0— 1— 5— 15— 25— 65 and upwards. All Ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. p. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 5 15 9 1 3 ... ... ... ... ... ... 20 17 37 Scarlet Fever 1 ... 2 4 1 2 2 ... ... 1 ... ... 6 7 13 Epidemic Influenza 1 3 3 1 ... 1 2 ... 17 9 3 12 26 26 52 Whooping-cough 9 11 16 12 ... 2 ... ... ... ... ... ... 25 25 50 Diphtheria, Membranous Croup 1 ... 6 7 2 3 ... ... ... 1 ... ... 9 11 20 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... 3 1 ... ... 3 2 5 Diarrhoea, Dysentery 9 4 2 3 ... ... ... ... ... ... 2 1 13 8 21 Epidemic, Zymotic Enteritis 17 7 2 ... ... ... ... ... ... ... ... ... 19 7 26 Enteritis 9 3 ... ... ... ... ... ... 4 1 ... 1 13 5 18 Other Continued Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 2 7 ... ... ... ... ... ... 3 ... ... ... 5 7 12 Erysipelas 2 1 ... ... ... ... ... ... ... 3 1 ... 3 4 7 Puerperal Fever ... ... ... ... ... ... ... 1 ... 3 ... ... ... 4 4 Other Septic Diseases— Stomatitis ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Pyaemia ... ... 1 ... ... ... ... ... ... ... ... ... 1 . 1 Cellulitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Infective Endocarditis ... ... ... ... ... 1 ... ... 2 ... ... ... 2 1 3 Rheumatic Fever ... ... ... ... 4 1 ... ... 3 ... ... ... 7 1 8 T uberculosis— „ of Meninges 7 3 6 5 2 1 ... 1 ... ... ... ... 15 10 25 „ of Lungs ... 2 4 2 1 2 13 8 79 35 5 6 102 55 157 „ (other forms) 5 5 7 1 2 4 ... 2 3 8 ... ... 17 20 37 Alcoholism ... ... ... ... ... ... ... ... 1 8 1 ... 2 8 10 Cancer ... ... 1 ... ... ... 1 ... 47 52 30 47 79 99 178 Premature Birth 47 25 ... ... ... ... ... ... ... ... ... ... 47 25 72 Developmental Diseases 40 22 1 3 ... ... ... ... ... ... ... ... 41 25 66 Old Age ... ... ... ... ... ... ... ... ... ... 36 75 36 75 111 Meningitis ... ... 3 2 ... ... 1 2 1 1 ... ... 5 5 10 Inflammation and Softening of Brain ... ... ... ... ... ... ... ... 3 4 2 2 5 6 11 Convulsions 7 2 2 2 ... ... ... ... ... ... ... ... 9 4 13 Apoplexy ... ... ... ... ... ... ... ... 1 6 5 8 6 14 20 Cerebral Haemorrhage ... ... ... ... ... ... ... 1 7 8 11 8 18 17 35 Organic Diseases of Heart ... ... ... ... 1 1 2 3 24 24 7 17 34 45 79 Heart Disease ... ... ... ... ... ... 3 1 13 25 13 24 29 50 79 Acute Bronchitis 21 10 4 6 ... ... 1 ... 6 5 5 20 37 41 78 Chronic Bronchitis ... ... ... ... ... ... ... ... 8 4 13 10 21 14 35 Bronchitis ... ... ... ... ... ... ... ... 11 7 17 29 28 36 64 Lobar (Croupous) Pneumonia ... ... 4 ... 1 ... ... 1 7 4 ... 2 12 7 19 Lobular (Broncho-) Pneumonia 10 8 18 14 ... ... ... 1 3 7 6 10 37 40 77 Pneumonia 13 7 7 7 1 ... 3 ... 11 10 6 7 41 31 72 Diseases of Stomach 1 3 ... ... ... ... 1 3 5 7 1 1 8 14 22 Obstruction of Intestines ... ... ... ... ... ... 2 ... 2 4 3 ... 7 4 11 Cirrhosis of Liver ... ... ... ... ... ... ... ... 9 14 ... 6 9 20 29 Nephritis and Bright's Disease ... ... 1 ... 1 1 ... ... 18 14 5 14 25 29 54 Tumours, &c , of Female Genital Organs ... ... ... ... ... ... ... ... ... 6 ... 1 ... 7 7 Accidents and Diseases of Parturition ... ... ... ... ... ... ... 1 ... 10 ... ... ... 11 11 Accidents and Negligence 9 4 3 5 4 ... 2 ... 14 8 ... 5 35 22 57 Suicide ... ... ... ... ... ... ... ... 8 1 ... ... 8 1 9 Ill-defined Causes 2 1 1 ... ... ... ... 1 ... ... 1 ... 4 2 6 All other Causes 2 2 3 4 11 3 3 6 71 56 60 60 150 131 281 All Causes, 1907 219 135 113 87 32 35 36 33 384 348 236 366 1020 994 2014 1906 197 156 69 59 21 38 31 32 356 360 205 319 879 964 1843 76 deaths at all ages. TABLE IV. Causes of Death : All Ages, Persons.— In Wards. 1907. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond, the Borough. L.G.B. Cause of Death. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Small-pox ... ... ... ... ... ... ... ... Measles 2 8 5 4 15 ... ... 3 Scarlet Fever 1 5 2 3 2 ... ... ... Epidemic Influenza 5 8 6 11 12 1 4 5 Whooping-cough 9 17 7 9 7 1 ... ... Diphtheria and Membranous Croup 1 4 6 5 3 1 ... ... Croup ... ... ... ... ... ... ... ... Enteric Fever 1 2 ... 1 ... 1 ... ... Diarrhoea, Dysentery 1 6 2 3 8 1 ... ... Epidemic, Zymotic Enteritis 1 9 4 1 11 ... ... ... Enteritis 9 2 1 4 6 2 1 ... Other Continued Fevers ... ... ... ... ... ... ... ... Syphilis ... 1 1 2 6 2 ... ... Erysipelas 2 3 1 ... 1 ... ... ... Puerperal Fever 1 2 1 ... ... ... ... ... Other Septic Diseases ... 3 ... ... ... ... ... 3 Rheumatic Fever 1 3 1 2 1 ... ... ... Tuberculosis of Meninges 4 4 4 3 8 1 1 ... Tuberculosis of Lungs 29 25 21 30 38 2 3 9 Other Forms of Tuberculosis 3 10 ... 11 10 ... ... 3 Alcoholism ... 1 3 4 2 ... ... ... Cancer 11 34 32 31 31 10 8 21 Premature Birth 9 17 11 4 23 1 4 3 Developmental Diseases 10 9 8 15 18 1 ... 4 Old Age 11 16 21 20 22 3 3 15 Meningitis 1 2 3 1 1 1 1 ... Inflammation and Softening of Brain ... 2 4 1 1 1 1 1 Convulsions ... 5 ... 1 3 1 ... 3 Apoplexy 2 4 2 3 6 1 ... 2 Cerebral Haemorrhage 4 7 4 8 7 1 4 ... Organic Diseases of Heart 8 14 15 15 18 5 2 2 Heart Disease 11 16 14 8 24 2 2 2 Acute Bronchitis 14 15 13 8 18 4 ... 6 Chronic Bronchitis 5 7 6 5 8 ... 3 1 Bronchitis 13 5 2 10 19 4 2 9 Lobar (Croupous) Pneumonia 4 6 4 1 3 ... ... 1 Lobular (Broncho-) Pneumonia 10 17 9 6 21 4 1 9 Pneumonia 11 20 10 11 12 3 1 4 Diseases of Stomach 1 3 5 5 7 ... 1 ... Obstruction of Intestines 1 4 2 1 1 ... ... 2 Cirrhosis of Liver 3 4 4 10 5 ... ... 3 Nephritis and Bright's Disease 3 8 7 13 9 4 2 8 Tumours, &c., of Female Genital Organs ... 1 1 1 ... ... 2 2 Accidents and Diseases of 2 2 2 1 4 ... ... ... rition Accidents and Negligence 8 7 9 8 19 ... ... 6 Suicide 1 2 4 1 1 ... ... ... III-defined Causes ... 2 ... 3 1 ... ... ... All other Causes 29 56 35 53 58 14 18 18 All Causes— 1907 235 398 292 337 470 72 64 146 1906 206 319 251 297 486 58 57 169 77 deaths in local institutions. TABLE V. Deaths in Local Institutions. Year. Paddington Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. 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 1906 314 356* 98* 7 Averages 1897-1906 271 337 81 3 1907 347 332 88 3 * Closed part of year for repairs and alterations. TABLE VI. Causes of Deaths in Institutions. 1907. 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 ... ... ... 1 ... ... 1 ... Scarlet Fever ... 1 ... ... 11 ... ... ... ... Influenza ... ... ... 1 ... ... 1 ... ... Whooping-cough 3 ... 1 ... ... ... ... ... ... Diphtheria 1 7 2 ... 12 ... ... ... ... Enteric Fever 1 3 ... ... 1 ... ... ... ... Diarrhoea 3 2 ... ... ... ... ... ... 1 Epidemic Enteritis 17 ... 6 ... ... ... ... ... ... Erysipelas 2 2 ... ... ... 1 ... 1 ... Puerperal Fever 1 1 ... ... ... 1 ... ... ... Other Septic Diseases ... 7 1 ... 1 ... ... ... 1 Tuberculosis of Lungs 43 10 5 6 ... 13 8 5 2 Other forms of Tuberculosis 14 15 22 1 1 9 3 ... ... Cancer 31 34 1 15 ... 19 5 3 2 Premature Birth 3 ... 1 1 ... 2 ... 1 ... Developmental Diseases 2 4 11 1 ... 1 ... ... ... Old Age 42 ... ... 4 ... 1 1 2 l Bronchitis 42 3 ... 1 ... 1 3 2 ... Pneumonia 28 27 15 1 ... 3 6 ... 4 Cirrhosis of Liver 5 9 ... ... ... 1 ... ... ... Accidents of Childbirth 2 1 ... ... ... 1 ... ... 1 Accidents and Violence 9 36 3 ... ... 4 1 ... 3 Suicides ... 5 ... ... ... 1 ... 1 1 All other Causes 97 165 20 13 ... 38 31 7 9 All Causes 347 332 88 44 27 96 59 23 25 Non-Residents* 13 239 65 33 * The deaths of 22 other non-residents took place either in the streets or houses in the Borough. Total deaths of non-residents—372. 78 TABLE VII. <1 Deaths of Infants under One Year. L. G. B. Groups. Weeks. Months. Totals, under One Year. deaths of infants under one year. 0— 1— 2— 3— 0— 1— 2 3— 4— 5— 6— 7— 8— 9— 10— 11— 1907 1902-06 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 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 ... ... 2 1 ... 2 4 5 6 6 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 0 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0 0 Whooping Cough ... ... ... ... ... ... 1 ... 1 ... 1 1 1 2 ... ... 2 ... ... ... ... 1 ... 2 1 2 ... ... 1 1 2 2 9 11 7 7 ii. Diarrhoea (all forms) ... ... 1 ... 1 ... 1 1 3 1 7 3 2 2 2 ... 2 2 3 2 2 ... 1 ... 3 ... ... ... ... 1 1 ... 26 11 47 36 Enteritis ... ... 1 ... ... ... 1 ... 2 ... 1 1 1 1 1 ... 1 ... ... ... 1 ... 1 ... ... ... 1 1 ... ... ... ... 9 3 7 4 iii. Premature Birth 30 18 5 1 5 4 1 1 41 24 5 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 47 25 33 25 Congenital Defects 1 1 4 ... ... 2 ... ... 5 3 2 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 5 6 7 Injury at Birth 3 ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 1 Want of Breast Milk 1 1 ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 3 2 Atrophy, Debility 1 ... ... ... ... ... 3 ... 4 ... 5 3 1 1 ... ... 3 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 15 8 17 10 Atelectasis 4 1 ... ... ... ... ... ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 3 2 Debility at Birth 2 3 ... 1 1 1 1 1 4 6 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 7 10 6 iv. Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 1 2 ... 1 1 1 ... ... ... 1 ... 7 3 3 5 Tables Mesenterica ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 ... 4 2 3 1 Other Tubercular Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 1 5 4 1 v. Erysipelas ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 1 1 1 Syphilis ... ... ... ... ... 1 ... 2 ... 3 ... 1 ... ... ... 1 ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 2 1 4 3 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 1 0 Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 Convulsions 1 2 2 ... 1 1 5 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 7 2 9 9 Bronchitis ... ... ... ... 1 ... ... ... 1 ... 4 5 3 1 1 ... 1 3 ... ... 2 ... 2 ... ... ... 1 ... 2 1 1 21 10 15 10 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 0 ... Pneumonia ... ... ... 1 ... ... 1 ... 1 1 2 5 2 0 ... 2 3 ... ... 1 2 ... 2 3 3 ... ... 1 2 ... 2 23 15 22 16 Suffocation (overlaid) 1 ... ... ... ... ... 2 1 3 1 2 3 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 9 2 6 6 Other Causes 2 2 ... 2 ... ... ... ... 2 4... ... ... ... 1 1 ... ... ... 3 1 ... 1 1 1 1 ... ... 1 ... ... ... 1 8 10 14 13 All Causes 46 27 15 5 10 8 12 6 83 46 33 22 14 13 7 8 15 7 14 6 10 4 12 9 10 5 3 4 8 4 10 7 219 135 228 175 Averages—1902-06 40 28 10 9 10 9 7 7 67 53 25 21 21 12 20 15 15 13 13 9 14 10 13 8 11 8 11 11 8 8 10 7 228 175 Population— (estimated 1907 149,542. Births registered within Borough 1907. Legitimate— M. 1,511 F. 1,440 Illegitimate— M. 75 F, 48 1902-06 1,574 1,526 77 71 1907. 1902-06. Totals —M. 1,586 1,651 F. 1,488 1,597 P. 3,074 3,248 Deaths— all causes, all ages 1907. 1902-06. 12,014 1,978 79 proceedings during 1907. TABLE VIII. PROCEEDINGS DURING 1907. L.C.C. Premises. Number of Places— Number of Inspections, 1907. Number of Notices, 1907. Number of Prosecutions, 1907. On Register at end of 1906. Added in 1907. Removed in 1907. On Register at end of 1907. Milk premises 178 6 9 175 272 ... ... Cowsheds 1 ... ... 1 3 ... ... Slaughter-houses 8 ... 1 7 589 ... ... Other offensive trade premises ... ... ... ... ... ... ... Ice cream premises 146 1 7 140 141 ... ... Registered houses let in lodgings 1,272 48 ... 1,320 8,643 (a)* 121 (a)*... (6)* 4,295 (b)* 6 * (a) For overcrowding. * (6) For other conditions (including annual cleansing). Total number of intimation notices served for all purposes 746 Overcrowding, 1907— Number of dwelling rooms overcrowded 416 Number remedied 295 Number of prosecutions — Underground rooms— Illegal occupation dealt with during year — Number of rooms closed — Insanitary houses— Number closed under the Public Health (London) Act, 1891 — Number closed under the Housing of the Working Classes Act — Number of premises cleansed under Sec. 20 of the L.C.C. (General Powers) Act, 1904 146 Shelters provided under Sec. 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 19 Number of tenements comprised therein 162 Number of tenements for which certificates were (a) granted 136* (b) refused (c) deferred 73 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. — (f As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (h With respect to water closets, earth closets, etc. 1 (i With respect to sufficiency of water supply to water closets — (j With respect to drainage, etc. (Metropolis Management Act, Sec. 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) 10 Mortuaries— Total number of bodies removed 290 Total number of infectious bodies removed 3 * Including 47 deferred from 1906. 80 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. TABLE IX. 1.—Inspection. Including Inspections made by Sanitary Inspectors. H.O. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 244 2 Workshops (including Workshop Laundries) 1,571 17 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 48 ... Total 1,863 19 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. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) making, &c. 76 2 440 25 ... 42 381 283 (2) cleaning and washing ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... 1 ... Artificial Flowers ... ... ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... ... ... 1 ... Paper Bags and Boxes ... ... ... ... ... ... 2 ... Total 76 2 440 25 ... 42 385 283 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. Workshops 1,436 Do. Bakehouses 67 Total number of workshops on Register 1,503 81 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 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 68 68 ... ... Want of Ventilation 4 3 ... ... Overcrowding 4 4 ... ... Want of drainage of floors ... ... ... ... Other nuisances 22 20 ... ... Sanitary accommodations insufhcent ... ... ... ... unsuitable or defective 17 16 ... ... not separate for sexes ... ... ... ... 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) ... ... ... ... Total 115 111 ... ... 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). cutions (Sections 109, 110). Failing to keep or permit inspection of lists. Failing to send lists. ... ... 311 ... ... ... 11 ... ... ... ... 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 53 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 377 ... ... ... 11 .... ... 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) 39 Action taken in matters referred by H.M. Inspector Notified by H.M. Inspector 19 as remediable under the Public Health Acts, but Reports (of action taken) sent to H.M. not under the Factory and Workshop Act (S. 5) Inspector 18 Other ... Underground Bakehouses (S. 101):— Certificates granted during the year ... In use at the end of the year ...