REPORT OF THE Medical Officer of Health. LONDON: MORTON & BURT, Ltd., Printers, 187, EDGWARE ROAD, PADDINGTON, W. PAD 13. Metropolitan Borough of Paddington REPORT ON The Vital Statistics AND Sanitary Work For the Year 1908. BY REGINALD DUDFIELD, M.A., M.B., D.P.H., F.S.S., Medical Officer of Health. SALUS CIVIUM CIVITATIS OPES. CONTENTS. Page Page Alcoholism, Deaths from 37 Inquests held 47 Bacteriological Examinations, Results of 54 Institutions, Deaths in 48 Bakehouses, Inspection of 60 Intemperance 37 Births and Birth-Rates 3 Internotification 53 Births, Notification of 5 Legal Proceedings, Summary of 72 „ Hopeless 39 Manure, Removal of 54 Canals 56 Measles 31 Canal Boats Acts 56 „ Seasonal Influence on Fatality of 32 Cancer, Mortality from 29 Meat Supply 68 Child Rearing 45 Meteorology 2 Childbed, Mortality in 18 Milkshops, Trades carried on at 70 Childhood, Mortality of 38 Mortality among Infants—" Hopeless Births" 39 "Clarendon Street Area" 66 „ at ages 1—5 years 44 Combined Drainage 55 Mortuaries 51 Common Lodging Houses 68 Notification of Births 5 "Consumption," Administrative Measures „ „ Sickness 6 concerning 26 „ „ Phthisis (" Consumption ") 23 ,, Duration of 27 Offensive Refuse, Removal of 54 „ Notification of 23 Office Work 72 „ Mortality from and Segre- Other Infectious Diseases 37 gation of 28 Other Septic Diseases 19 Consumptives, Occupations of 22, 24 Other Tubercular Diseases 21 Dairies and Milkshops 69 Outworkers 57 Deaths and Death-Rates 8 Phthisis, Mortality from 21 Deaths in Institutions 48 Population, Estimated 1 Death-rates, Factor Corrected 10,29,33 Prevention of Infectious Diseases 50 Diphtheria 13 Puerperal Fever 18 Disinfection 50 Respiratory Diseases, Mortality from 37 „ Conference with Kensington 51 Scarlet Fever 16 Drains, Private, Re-laid 54 Schools and Infectious Diseases 51 Enteric Fever 17 Septic Diseases, Mortality from 19 Erysipelas 18 Slaughterhouses, Inspection of 68 Factory and Workshop Act, 1901, Work Small-pox 12 Under 57 Smoke Prevention 55 Food Analysis, Summary of Samples taken 71 Suicide, Mortality from 37 „ Summary of Proceedings 75 Trade Refuse 54 Food Supervision 68 Tuberculous Diseases, Mortality from 20 Food Purveyors 69 Unsound Food seized 70 Health Visiting 45 Vacant Rooms 67 Home Work 57 Vaccination 12 House Refuse 54 Water Supply, Cutting off of 51 Houses let in Lodgings, Annual Cleansing of 63 Whooping Cough 34 „ „ Sickness, etc., in 65 „ „ Seasonal Influence on „ „ Registration of 60 Fatality of 36 „ „ Overcrowding of 65 Workshops, Overcrowding in 58 „ „ Vital Statistics 65 „ Registration of 57 Housing of " Consumptives" 23,25 „ Sickness on premises of 60 Ice Cream, Inspection of places where made 70 Illegitimates, Births of 5 „ Deaths of 43 Infants, feeding of 45 APPENDIX A. „ mortality among 38 Tables (Local Government Board, Home „ „ in certain districts 42 Office, and London County Council) 76 „ „ in Wards 39 Influenza, Mortality from 37 APPENDIX B. Inhabited House Duty, Exemption from 68 Infantile Diarrhoea 85 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 Vital Statistics for 1908, and the work of your Public Health Department during that year. The statistics for the past year, as presented, are satisfactory, except in one particular namely, the prevalence of scarlet fever. I write "as presented" because, although the greatest possible care has been taken to secure accuracy of the facts under the immediate purview of the Department, meaning thereby the numbers of births, deaths, etc., an equal accuracy cannot be claimed for the other element necessary for the various rates, that is, the numbers of the living. The estimates of population which have been used, derived from the rate of growth of population between 1891 and 1901, are unreliable on account of the interval (over seven years) which has elapsed since the last census, and the changes in housing which are known to have taken place, but cannot be measured. A fairly large number of flat properties have been erected since 1901, capable of housing a large population, and much emigration has taken place to more out-lying districts, partly compensated, no doubt, by immigration from the more central parts of the Metropolis. The number of empty premises has been high during the same period—a rough survey made during the autumn indicating vacant rooms sufficient to accommodate at least 10,000 inhabitants of the working classes (see page 67), to which class of property the survey was limited. All those factors ought to be taken into account in estimating the population, but the necessary arithmetical data are wanting. It is noteworthy, however, that the natural increase in the population (see page 2) does suggest that the estimates used are not very far from accuracy. It remains to add that the rates given must be accepted subject to revision after the next census, some two years hence. For the first time for several years a slight increase in the birth-rate is recorded. When writing on this subject the increase was thought to be a fictitious one, but inasmuch as the rate for the whole country for the first quarter of the current year shows a further increase (slight, it is true) I am inclined to review the opinion first expressed, and to hope that a change in the birth-rate is at length about to be observed. The statistics relating to infectious sickness (see page 6) would have been satisfactory but for the exceptional prevalence of scarlet fever. The total morbidity rate for the year (6.32 or 0.97 per 1,000 in excess of the quinquennial mean) includes a rate of 4.43 due to scarlet fever, 1.26 higher than the mean (3.17). The morbidity rate after excluding scarlet fever is 1.85, or 0.30 less than the corresponding quinquennial mean (2.15). Certain tentative calculations relating to, and analyses of distribution of the prevalence of scarlet fever during the past eight years point to changes in the incidence of the disease, the discussion of which has been reserved for a future report. ii. The smallest total of cases of scarlet fever in any year (277) was recorded in 1905, when the cases among children of school ages (3-13 years) formed 66 per cent. of the total. In the three years (1902-04) preceding 1905, and in the three years following (1906-08), the annual average numbers of cases have been 379 and 658. In the second period the average at all ages shows an increase of 74 per cent., that at school ages 78 per cent. The cases at school ages formed 69 per cent. of the total in the first period and 71 per cent. in the second. It appears, therefore, that the increased prevalence of the disease in the second period fell more heavily on school children than on the rest of the population. The death rate during 1908 (12.36) is the lowest yet recorded, and is more than 1 per cent. 1,000 below that for 1907 (13.46), and 4.52 per 1,000 below the mean rate for 1891-95 (16.88). That fall in the rate is equivalent to a saving of 680 lives in one year. Comparing the mean rate for 1904-08 (13.04) with that for 1891-95 (16.88), a diminution in the former rate equal to 3.84 is noted—representing a saving of over 2,750 lives during the five years. The differences between the rates of last year and the mean rates for 1903-07 are given (passim) in the report. Although in nearly every case the differences are in favour of the past year, too much importance cannot be attached thereto owing to the fluctuations in morbidity and mortality which take place from year to year. I venture to think, however, that the Council is to be congratulated on the improvement in the health of the Borough indicated by the comparison between the mean rates for 1904-08, and those for 1891-95 (see below). Mean Rates. Mean Rates. Index Index Number Number 1891-95 1904.08 1891-95 1904-08 Smallpox 0.008 0.002 25 Puerperal Fever 0.04 0.02 55 Measles 0.32 0.25 78 Other Septic Diseases 0.10 0.10 98 Scarlet Fever 0.16 0.07 47 Epidemic Influenza 0.60 0.31 52 Whooping Cough 0.41 0.19 45 Alcoholism 0.06 0.08 134 Diphtheria 0.46 0.10 21 Apoplexy 0.75 0.38 51 Enteric Fever 0.12 0.04 33 Bronchitis 2.28 1.23 54 Diarrhoea 0.82 0.62 75 Pneumonia 1.24 0.95 77 Phthisis 1.30 1.03 79 Cirrhosis of Liver 0.12 0.16 132 Other Tuberculous Dis. 0.65 0.35 54 Acc. and Dis. of Parturition 0.09 0.06 62 "Cancer" 0.86 1.11 129 Suicide 0.11 0.09 81 * Value of Mean Rate, 1904-08, mean, 1891-95 = 100. Three causes of death only gave higher rates in the second period, viz., cancer, alcoholism, and cirrhosis of the liver, the increase in mortality from cancer being doubtless due to two factors, namely, lengthened duration of life and greater accuracy of diagnosis. As regards the figures for apoplexy, some doubt is entertained whether the reduction be not due to a change in system of classification dating from 1901, but there is no such doubt about the figures for bronchitis and pneumonia. All the rates from the infectious diseases show very satisfactory reductions. Seeing that scarlet fever has been unusually prevalent during the last three years, it is surprising that there should have been a decrease of 53 per cent. in its mortality rate. The mildness of the iii. disease and the consequent "missed" cases doubtless account for much of its prevalence. Until about 1902 nothing was done to limit the prevalence of measles and whooping cough. Since that date every known case has been visited, precautions have been recommended both to prevent the spread of the infection and to secure the due care of the sick, and disinfection largely practised. The reductions in the mortality from those diseases show that the work has not been without success. Although some of the reduction in mortality from diarrhoea (25 per cent.) is attributable to a sequence of cooler—I might almost say inclement—summers, part of it may be safely put down to the health visiting of the last three years. The reduction in the phthisis rate (21 per cent.) is the least among those diseases commonly known as infectious. The infantile mortality rate of last year was 110, calculated on the births registered in the Borough, 105 if calculated on the corrected number of births (see page 38). The former rate is the lowest on record, save that (108) for 1903. The (corresponding) mean rate for 1904-08 was 119, or 28 per 1,000 less than the mean (147) for 1891-95. Prior to 1903 the infantile mortality had never fallen lower than 131 per 1,000 (in 1902) ; since that year a rate exceeding 120 has been recorded twice only, viz., in 1904 (136), and 1905 (122). As regards the work of your Public Health Department, I have little to add to what is written in the report. I should like to be able to extend the operations of the Staff with reference to child rearing and children's diseases. The efforts of the Women Inspectors are so cordially welcomed and have already accomplished so much that I am encouraged to urge that that work should be extended. Even with the help of the workers attached to the Paddington Health Society not much more than half the children who may be expected to benefit, are visited, and a much smaller proportion re-visited (see page 45). The work of the Women Inspectors in connection with children's illnesses such as measles, whooping cough, and diarrhœa, takes up a very large amount of time, but the results achieved justify the work. Work among the children yields the best results, both educative and hygienic. I cannot leave this subject without an acknowledgment of the assistance which this Department has received during the year from the Health Society, whose help in visiting infants and in maintaining the two "Consultation Centres" has been most valuable. For some time past I have felt that general sanitary administration has achieved its maximum effect on consumption, and that more specialised effort is required to hasten the stamping-out of the disease. The preventive work implied in general sanitary administration is seriously handicapped by the lack of precise information as to existing centres of infection, and the compulsory notification of the disease is essential to further progress. That useful adjunct to sanitary administration is at the service of many public health authorities outside England, and its early introduction in this country is very necessary. The notification of Poor Law cases, inaugurated by the Order of the Local Government Board at the beginning of the current year, is a great step in advance. The opening of the " Paddington Dispensarv for the Prevention of Consumption "—the first in England—provides a valuable aid towards checking the disease. Not only will patients receive that advice, both medical and hygienic, which is necessary for the treatment of their disease and the prevention of the spread of infection, but they will be visited in their homes by doctor and nurse, who will instruct the patients how to give effect to the hygienic measures prescribed, and do their best to see that they are carried out. The "dispensary system," however, requires the help of notification to achieve the best results. iv. Of all sanitary measures affecting consumption those affecting housing are of first importance. Apart from schemes dealing with the re-construction of areas, the supervision and regulation secured by the by-laws relating to houses let in lodgings ensure the amelioration of homes of the poorer classes. That work has been carried out energetically for some eight or nine years, and it is, therefore, a pleasure to record (page 67) a diminution in the mortality during the past year in the " Clarendon Street Area," where the by-laws have been longest and most thoroughly enforced. Many undesirable conditions still exist in that Area which cannot be remedied under the by-laws or the Public Health Act. If the Housing and Town Planning Bill now before Parliament be passed in its present form, great and radical improvements will be possible. The spread of tuberculous disease (usually ending in consumption) by the milk from cows infected with that disease is now generally admitted. It will be possible to take effective measures to check the spread of the disease to man by active administration of the Dairies and Milkshop Bill and the Tuberculosis Order, 1909, of the Board of Agriculture. The former measure promises great and useful reforms in the milk supply quite apart from its provisions relating to tuberculosis. The part played by flies in the conveyance of disease is becoming more and more appreciated. As a consequence municipal cleansing, that is scavenging and dust removal, acquires an importance not previously recognised. Increased expenditure in those directions will be recouped with interest by the reduction in losses of life and wealth by sickness. As regards dust removal, I am very strongly of opinion that a weekly removal is not sufficient during the hotter months of the vear (see page 54). In conclusion I desire to tender my sincere thanks to the Chairman and Members of the Public Health Committee for their continued confidence and support in my endeavours to discharge the responsible duties entrusted to me by the Council; to my medical confreres practising in the Borough for their generous co-operation; and to the Staff of the Department who have loyally carried out their duties during the past year. 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. 29th June, 1909. 1 REPORT. The Borough.—The area of the Borough, 1,356 acres, includes 20 acres of water (the canals) and (approximately) 175 acres of open spaces. At the last census (1901) there were 17,684 inhabited houses, occupied by 33,661 families, 21,815 living in homes of less than five rooms. In 1891 16.7 per cent. of the total population, Old Parish, was deemed to be "overcrowded," that is, lived in homes with an average of more than two persons per room, which proportion had decreased to 13.5 per cent., for the present Borough, in 1901. Of the homes of less than five rooms, 27.6 per cent. were "overcrowded" in 1901. The Borough is divided into three Registration Sub-Districts, viz., North, Central and South Paddington, which make up the Registration District of Paddington, co-terminous with the Borough. For administrative purposes, other than Poor Law, the Borough is sub-divided into eight Wards, viz., Queen's Park, Harrow Road, Maida Vale (all in the "North" SubDistrict), Westbourne, Church (in the "Central" Sub-District), Lancaster Gate, East and West, and Hyde Park Wards (in the "South" Sub-District). For the purposes of this Report the Wards have been selected as the unit areas. Population.—Seeing that over seven years have elapsed since the last Census any estimate of the number of inhabitants of the Borough can be but little more than an approximation, and the rates based on such estimates have to be received with reserve. It is to be sincerely hoped that the Bill for the Census of 1911 will provide for at least an enumeration, if not a full Census, of the population every five years. Based on the rate of increase during the ten years 1891 to 1901, and allowing for the changes in boundaries, an estimate of 150,489 persons as the population of the Borough at the middle of 1908, has been obtained. That population was assumed to comprise 64,485 males and 86,004 females of all ages. The populations of the individual Wards are set out below. Estimated Population. 1908. Males. Females. Persons. Queen's Park 8,204 8,164 16,368 Harrow Road 14,177 15,740 29,917 Maida Vale 8,097 12,119 20,216 Westbourne 10,558 15,122 25,680 Church 13,362 14,738 28,100 Lancaster Gate, West 2,835 5,589 8,424 ,, ,, East 2,280 5,631 7,911 Hyde Park 4,972 8,901 13,873 Borough 64,485 86,004 150,489* * The Registrar-General estimated the total population to be 150,923. 2 meteorology. The well-known fact that the number of empty houses in the Borough has increased considerably during the past three or four years suggests that the estimate given above is too high. Differences between the systems of rating and of terminology in census work as regards the meaning of "inhabited house," render a check by means of the rate-books impracticable. A comparison of the estimated increase (the difference between the estimated and enumerated populations), with the natural increment (the excess of births over deaths), favours the view that the estimate given above is somewhat nearer the truth than might be expected. At the Census of 1901 the population of the Borough was 143,976 persons, and last year's estimate (150,489) represents an estimated increase of 6,513 persons, whereas the natural increment during the interval between April, 1901, and June 30th of last year, was 8,784 persons, over 2,000 above the estimated increase. METEOROLOGY. An abstract of the principal elements for the past five years is given in Table 1, based on observations taken at the Botanical Gardens, Regent's Park, as published in The Times. TABLE 1. Meteorological Elements. Means at 9 a.m. Extreme Temperatures. Rain. Sunshine. Barometer reduced to sea level Thermometer. Shade. Max. in Sun. Min. on Grass. Depth of, Inches. No. of Days. Number of Hours. Number of Days. Dry Bulb. Wet Bulb. Maximum. Minimum. f.° f.° f.° f.° f.° f.° h. m. 1908. Totals - - - - - - - - - 24.49 173 1,461.48 285 Means 30.01 50.4 46.5 - - - - - - - - - Highest - - - 85.0 July - - 128.0 - - - - - Lowest - - - - - 16.5 Dec. — 11.0 - - - - 1907. Total - - - - - - - - - 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. Total - - - - - - - - - 24.42 145 1,580.12 292 Means 29.99 51.1 47.6 - - - - - - - - — Highest - - - 94.0 Sept. - - 128.0 - - - - - Lowest - - - - - 20.0 Dec. - 150 - - - - 1905. Total - - - - - - - - - 23.35 151 1,344.59 270 Means 29.96 50.0 46.9 - - - - - - - - - - Highest - - - 86.3 July - - 135.0 - - - - - Lowest - - - - - 22.0 Jan. - 15.0 - - - - 1904. Totals - - - - - - - - - 21.06 157 1,282.52 245 Means 29.97 50.3 46.2 - - - - - - - - - - Highest - - - 89.2 Aug. - - 130.5 - - - - - Lowest - - - - - 25.0 Nov. - 12.0 - - - - The barometric mean (30.01 in.) is the highest recorded during the five years, the minimum temperature (16.5°) the lowest and the total rainfall (24.49 in.) the maximum for the period. The mean difference between the wet and dry bulb thermometers (3.9°) is within 0.2° of the mean for 1904, the maximum difference during the five years. In the latter year 21.06 in. of rain fell, on 157 days, as compared with 24.49 in. on 173 days during last year. The maximum temperature (85.9°) is, with the exception of the record for 1907 (80.0°), the lowest of the series. The number of hours of bright sunshine BIRTHS. 3 recorded during the past year (1,461.75 hours) is second to the record of 1907 (1,580 hours), the numbers of days of record in the two years being 285 and 292 respectively. The increase in the number of days of recorded bright sunshine during the past few years is a very satisfactory feature, and suggests that the atmospheric conditions of London are improving, probably in consequence of the reduced emission of smoke. BIRTHS. The births registered within the Borough during the past year (53 weeks) numbered 3,149, an increase of 75 above the total for the preceding year (52 weeks), and equal to an uncorrected rate* of 20.58 per 1,000 persons. Last year's total was 145 less than the decennial average (3,249) and the rate (20.58) 2.03 less-than the mean (22.61). (Sec Table I., Appendix A.) Last year's rate is lower than any of the rates recorded since 1875, and is believed to be the lowest on record, the slight (apparent) increase above that for 1907 being, it is thought, due to some shortening of the normal interval between the dates of birth and the registration thereof, brought about by the adoption of the Notification of Births Act during the past summer. The births registered locally comprised 1,609 of boys and 1,540 of girls, 104 of the children, viz., 58 boys and 46 girls, being dead at the date of registration of their births. There were 35 twin births, 8 of males, 17 of girls and 10 of mixed sexes. Three sets of twins died at or very shortly after their birth. The births in the Workhouse Lying-in Wards numbered 96, 22 of the children being the offspring of non-residents. The total number of children born in the Borough whose parents were non-residents, was 69, while 216 children of residents were born beyond the Borough.† Deducting the former and adding the latter, a nett total of 3,296 births is obtained equivalent to a corrected rate of 21.48 per 1,000 persons, which is 0.05 above that for 1907, but 0.52 below that for 1906. In Table 2 will be found the corrected births distributed according to the addresses of the parents, and the corresponding rates during the past two years. Increases in the rates for Queen's Park (0.82), Harrow Road (1.22) and Westbourne (0.87) Wards will be noted, the rates in the other Wards being lower. In Table 3 a comparison is made between the rates for the Borough, the adjacent districts and the Metropolis. In this case the numbers recorded by the Registrar-General have been used, except as regards St. Marylebone, where the figure has been corrected for the births of non-resident children in Queen Charlotte's Hospital. The local rate per 1,000 persons (20.46) is considerablv below those for the Metropolis (25.33) and Willesden (25.97), but above all those for the adjacent districts, among which that for Hampstead (14.35) is the lowest. In every case last year's rate is below the quinquennial mean, the greatest decrease (4.27) being recorded in Willesden and the least (0.69) in Hampstead. The decrease in the Borough rate amounted to 1.19 per 1,000. In both Tables rates are given based on the estimated numbers of females aged from 15 to 45 years, but, having regard to the uncertainty attaching to the estimates, it is unnecessary to do more than direct attention to the presentation of the rates. * Throughout this Report the rates, based on the totals for the 53 weeks constituting the year, have been corrected to correspond with rates derived from the records of a year of 52 weeks. † Of the 216 children, 201 were born in Queen Charlotte's Lying-in Hospital, 13 in other Maternity Hospitals in the Metropolis, and 2 at private addresses. It is believed that the total given does not represent the complete number of births which should be added, but it represents the best information obtainable under present circumstances. 4 births. TABLE 2. Births. Paddington. Corrected as fully as possible. All Births. Illegitimate Births. Corrected Totals. Birth Rates. Corrected Totals. Percentage of all Births. Per 1,000 persons. Per 1,000 females. aged 15-45 years. 1908. 1907. 1908. 1907. 1908. 1907. Borough. 3,296 21.48 21.43 66.73 66.62 151 4.5 4.1 Queen's Park 455 27.27 26.45 116.85 113.36 18 3.9 2.2 Harrow Road 858 28.13 26.91 105.49 100.96 23 2.6 2.3 Maida Vale 427 20.72 21.19 58.61 59.96 20 4.6 3.5 Westbourne 505 19.29 18.42 59.23 56.56 23 4.5 2.9 Church 739 25.80 27.58 96.54 103.70 49 6.6 7.2 Lancaster Gate, West 68 7.91 8.54 17.47 18.85 5 7.3 4.1 „ East 65 8.06 8.21 15.80 16.10 2 3.0 4.6 Hyde Park 179 12.67 12.68 30.37 30.42 11 6.1 7.9 TABLE 3. Births and Birth-Ratfs. Birth Rates. Births Registered, 1908* Per 1,000 persons. Per 1,000 females, 15-45 years. 1908. 1903-07. 1908. 1903-07. Paddington 3,148 20.46 21.65 63.35 67.05 London 123,844 25.33 27.09 92.57 99.02 Kensington 3,360 18.03 18.93 50.05 52.55 Westminster 2,674 15.38 16.40 46.73 49.83 Marylebone 2,559 19.78 20.78 57.39 60.30 Hampstead 1,356 14.35 16.04 38.13 42.62 Willesden 4,099 25.97 30.24 93.48 108.78 * 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. BIRTHS. 5 Illegitimate Births.—The births registered locally included 149 of illegitimate children viz., 78 boys and 71 girls, of whom 52 were born in the Workhouse. In 1907 the illegitimate births numbered 123. Twenty-nine of the births recorded last year did not belong to the Borough, and 31 belonging to the Borough were recorded beyond its boundaries, giving a nett total of 151 births, as compared with 134 in the previous year. These births were equivalent to 4.5 per cent. of all births, showing an increase of 0.5 per cent. above the proportions for the two preceding years (4.0). The percentages of these births to all births (Table 2) were higher last year in five out of the eight Wards, those with lower proportions being Church, Lancaster Gate, East, and Hyde Park Wards.* Notification of Births.—The Notification of Births Act, 1907, was adopted by the Council on February 4th of last year, the adoption covering the whole Borough. The Order of the Local Government Board confirming the adoption was received on May 30th, the date for the commencement of the Act being fixed for June 8th. The Act provides for the notification of every birth—whether the child be alive or dead— to the Medical Officer of Health, within thirty-six hours of such birth. The duty of so notifying is imposed on— (a) The father of the child, if actually residing in the house where the birth takes place at the time of its occurrence ; and (b) Any person (i.e., medical practitioner or midwife) in attendance on the mother at the time of the child's birth, or within six hours thereafter. Miscarriages terminating pregnancies of twenty-eight weeks' duration, are to be notified as births. Failure to carry out the requirements of the Act entails a liability to prosecution carrying a penalty not exceeding one pound. Notification of a birth is additional to and not in substitution for the registration of such birth. Medical practitioners and midwives on the Roll are supplied with stamped letter cards on which are printed forms for notifying the births. Although the Act was not in force until June 8th, notifications were received from the beginning of the year, 74 births being so reported. Between June 9th and December 31st, 1,027 births were notified, including 25 relating to illegitimate children, equivalent to 2.4 per cent. of all the births reported. Fifty-two (5.0 per cent.) of the children were reported as born dead, 30 being male births and 21 female, the sex in the remaining case not being stated. One child notified as still-born was subsequently registered as a live birth. Twelve twin births were notified. The notifications were received from the parent in 439 cases, from the medical attendant in 224, from midwives in 298, and from other persons in 66. The provisions of the Act were therefore put into effect by the parent in 42.7 per cent. of the cases, by the medical attendant in 21.8 per cent., and bv midwives in 29.0 per cent. The proportion of registered births to notified rose fairly steadily from the first to the last week of the period here dealt with, but in the last week of the year the births which had not been notified represented 35.4 per cent. of the births registered. No legal proceedings had been instituted for failure to comply with the Act, up to the close of the year.† * It should be stated that the Register at Queen Charlotte's Hospital shows that 15 other illegitimate children were born there, of mothers admitted from Paddington, but further enquiries disclosed the fact that none of those children belonged to the Borough. † The arrangements which have been made to take advantage of the new sources of information, are dealt with under " Infant Rearing." 6 sickness. SICKNESS. After making the necessary deductions for duplicate certificates, the cases reported to the Department under the provisions of Section 55 of the Public Health (London) Act, 1891, numbered 970, an increase of 66 cases above the total for the preceding year. A reference to Table 4 will show that the whole of that increase was due to scarlet fever, of which disease the cases numbered 681 as compared with 579 in 1907. With the exception of puerperal fever, the notifications of which were equal in the two years, all notified diseases, other than scarlet fever, were less prevalent last year. Contrasting last year's morbidity rates with the mean rates for 1903-07 (Table 4), it appears that with the exception of membranous croup (rate, 1908, 0'02; mean, 0.01) and scarlet fever (rate, 1908, 4.43; mean, 3.17), all the rates for last year were lower than the respective means, but that the increase in that for scarlet fever was sufficient to increase the total rate from a mean of 5.35 to a rate of 6.32 last year. TABLE 4. Notifications. Padoington. Corrected for duplicate certificates only. Smallpox. Diphtheria. Membranous Croup. Erysipelas Fevers. Totals. Scarlet. Enteric. Continued. Puerperal Cases certified — 1908 - 142 4 105 681 31 1 6 970 1907 - 154 6 124 579 34 1 6 904 Morbidity Rates 1908 - 0.92 0.02 0.68 4.43 0.20 0.00 0.03 6.32 1903-07 0.01 0.95 0.01 0.86 3.17 0.27 0.00 0.05 5.35 0'00=a rate less than 0'01 per 1,000. A comparison of the morbidity rates in the Metropolis and the districts adjacent to Paddington, for last year, with the mean rates for the preceding quinquennium (based on the figures published by the Registrar-General) is given in Table 5. In Kensington only was last year's rate for diphtheria (1.27) above the mean (1.02). Lower rates were recorded last year in Hampstead (067) and Marylebone (0.91) than in Paddington (0.97). The rates for scarlet fever were in every instance in excess of the mean rates, and last year's rate for the Borough (4.42) was exceeded only by those for the Metropolis (4.51) and Willesden (4.76). In Hampstead, last year's rate for enteric fever (0.26) was equal to the mean, but in all the other districts, below. Last year's rate for Paddington (0.20) was the lowest of the series. The 1908 rates from puerperal fever were above the means in Kensington, Marylebone and Hampstead, equal to the mean in Westminster and below in the other districts. The Paddington rate for 1908 (0.03) was the lowest of any of the year's rates. SICKNESS. 7 TABLE 5. Morbidity Rates.* Metropolis and Districts Circumjacent to the Borough. Paddington. London. Kensington. Westminster. Marylebone. Hampstead. Willesden. 1908 Mean 1903-7 1908 Mean 1903-7 1908 Mean 1903-7 1908 Mean 1903-7 1908 Mean 1903-7 1908 Mean 1903-7 1908 Mean 1903-7 Smallpox - 0-01 0.00 0.04 - 0.00 0.00 0.05 - 0.01 - 0.000 - 0.02 Diphtheria 0.97 0.99 1.63 1.64 1.27 1.02 1.08 0.91 0.91 1.14 0.67 0.94 1.36 2.01 Erysipelas 0.69 0.85 0.86 1.01 0.70 0.83 0.46 0.67 0.97 1.24 0.34 0.56 0.50 0.59 Fevers Scarlet 4.42 3.16 4.51 3.89 2.43 2.15 3.50 2.27 3.17 2.80 2.96 2.76 4.76 3.59 Enteric 0.20 0.27 0.27 0.37 0.22 0.26 0.23 0.28 0.26 0.37 0.26 0.26 0.25 0.28 Puerperal 0.03 0.04 0.04 0.05 0.05 0.03 0.03 0.03 0.06 0.04 0.06 0.02 0.04 0.06 * Compiled from Quarterly Reports of the Registrar-General. Rates per 1.000 persons. Reverting to the figures for the Borough, it will be seen from Table 6 that the morbidity rate for females of all ages from diphtheria (096) was higher in 1908 than the quinquennial mean (0.91), and that the increased prevalence of scarlet fever was greater among males (5.07 compared with 3.36) than females (3.95 compared with 3.02). Ignoring membranons croup, the sex-morbidity rates for all the other diseases during the past year were below the respective means. TABLE 6. Notifications. Sex-Age Distribution. Ages. (Years.) Smallpox. M. F. Diphtheria. M. F. Membranous Croup. M. F. Erysipelas. M. F. Fevers. Scarlet. M. F. Enteric. M. F. Continued. M. F. Puerperal. F. 0— ... ... ... 4 ... ... 1 3 6 4 1 ... ... ... ... 1— ... ... 7 4 ... ... 2 ... 17 11 ... 1 ... ... ... 2— ... ... 8 3 ... ... 1 1 11 13 ... ... ... ... ... 3— ... ... 6 11 1 ... ... ... 28 28 ... ... ... ... ... 4— ... ... 3 4 1 ... ... 1 36 33 ... ... ... ... ... 5— ... ... 21 32 1 ... 1 176 201 3 1 ... ... ... 13— ... ... ... 4 ... ... 1 1 14 10 1 2 ... ... ... 15— ... ... 8 13 ... ... 5 5 24 28 5 3 ... ... 2 25— ... ... 4 10 ... ... 35 40 22 19 6 8 ... 1 4 65— ... ... ... ... ... ... 4 4 ... ... ... ... ... ... ... All Ages. ... ... 57 85 3 1 49 56 334 347 16 15 I 6 Rates,* 1908 0.86 0.96 0.03 0.00 0.73 0.63 5.07 3.95 0.23 0.16 ... 0.00 0.05 1903-07 0.02 0.01 1.01 0.91 0.02 0.00 0.88 0.83 3.36 3.02 0.28 0.26 0.00 0.00 0.08 0.00=a rate less than 0"01 per 1,000. * Per 1,000 of each sex at all ages. 8 deaths. After distributing the notifications among the Wards (Table 7) it is found that fewer cases (all diseases) were reported from Queen's Park, Maida Vale, Lancaster Gate, East, and Hyde Park Wards. Diphtheria was less prevalent in Queen's Park, Harrow Road and Church Wards, and that in none of the Wards was there any material increase. Increases in the numbers of cases of erysipelas were recorded in Westbourne and Church Wards, and of scarlet fever in all Wards except Maida Vale, Lancaster Gate, East and Hyde Park. The total morbidity rates for 1908 exceeded the mean rates in all Wards except Lancaster Gate, East and Hyde Park. TABLE 7. Notifications. Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancast West. er Gate, East. Hyde Park. Smallpox - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) Diphtheria 9 (17) 43 (47) 21 (19) 26 (23) 24 (31) 8(6) 6(6) 5(5) MembranousCroup 2 (-) 1 (1) -(-) 1 (4) -(7) - (-) - (-) - (-) Erysipelas 9 (76) 14 (25) 11 (11) 23 (17) 43 (36) -(4) 3(3) 2(12) | Fevers ( Scarlet 86 (81) 215 (172) 74 (76) 104 (87) 152 (100) 16 (13) 9 (12) 25 (38) Enteric 5 (3) 5 (7) 4 (4) 1 (6) 6 (7) 4 (2) 1 (0) 5 (4) Continued - (-) 1 (7) - (-) - (-) - (-) - (-) k Puerperal 2(2) 1 (7) 1 (2) 1 (-) 1 (1) - (-) -(-) -(-) Totals 113 (119) 280 (254) 111 (112) 156 (137) 226 (176) 28 (25) 19 (22) 37 (59) Rates, 1908 6.77 9.18 5.38 5.96 7.89 3.26 2.35 2.61 „ 1903-07 6.68 6.79 5.30 4.47 6.39 3.07 2.39 3.46 Figures in parentheses—numbers for 1907. Facing will be found a diagram giving the annual morbidity rates for each week of the past year compared with the average (mean) rates for 1898-1907. The maximum rate from scarlet fever recorded in the Borough during the past year was 13.1 per 1,000 in the 41st week, while the maximum for the whole of London was 6.7 in the 38th week. Last year's local rates were above the means in the majority of the weeks. In those returns, three "peaks" stand out prominently, viz., in the 12th, 30th and 41st weeks. In the 12th week 17 cases were reported, the numbers for the 11th and 13th weeks being 6 and 11 respectively. In the 30th week there were 22 cases, as compared with 7 in the 29th and 11 in the 31st. The 38 cases in the 41st were just double the number in the 40th week and 11 above that in the 42nd. There can be little doubt that school infection had a large share in the production of those "peaks" and in maintaining the high average prevalence noted during the year. The curve for diphtheria shows only one real "peak" in the 42nd week, when 11 cases were reported as compared with 6 in the preceding and 1 in the following week. DEATHS. The deaths registered within the Borough during the 53 weeks of last year (2,079) were 75 fewer than the number recorded during the 52 weeks of 1907 (2,154), and the uncorrected death-rate (13.58) for last year, 0.82 less than that for the preceding year (14.40). Last year's total was 182 below the decennial average (2,261) and the rate 1.94 below the mean (15.52). See Table I., Appendix A. NOTIFICATION CHART. Rates per 1000 persons. DEATHS. 9 Four hundred (400) deaths of non-residents were recorded in the Borough, an increase of 28 above the number for the preceding year. In out-lying districts 217 deaths of residents, 15 less than in 1907, took place. The nett total of deaths of residents was, therefore, 1,896, showing a reduction of 118 below the number for 1907, and of 204 below the decennial average, 2,100. (Table I., Appendix A.). The nett mortality was at the rate of 12.36 last year, as compared with rates of 13.46 for 1907, and of 14.42 for the decennium, 1898-1907. The difference between the rate for last year and the maximum rate recorded since 1898, viz., 4.27 in 1899, represents a saving of 643 lives during the year. Table II., Appendix A., shows the nett numbers of deaths of residents of the Borough, and its Wards, for each year since 1901. The causes of such deaths during the past year are given in Tables III. and IV. Table 8 gives the e x-mortality at all ages, and Table 9 for six age-groups, in each case for the whole Borough and each Ward, the quinquennial mean rates being added for comparison. TABLE 8. Nett Totals of Deaths and Mortalities. Deaths, All causes, all ages. 1908. Mortality rates per 1,000 individuals. 1908. 1903-07. Males. Females. Persons. Males. Females. Persons. Males. Females. Persons. Borough 935 961 1,896 14.21 10.95 12.36 14.89 11.92 13.65 Queen's Park 120 105 225 14.34 12.61 13.48 13.91 13.55 13.74 Harrow Road 194 187 381 13.42 11.66 12.49 13.18 12.63 12.88 Maida Vale 114 135 249 13.80 10.91 12.08 16.56 11.11 13.29 Westbourne 149 194 343 13.84 12.57 13.10 14.93 11.84 13.11 Church 230 205 435 16.88 13.63 15.18 17.86 16.68 16.64 Lancaster Gate, West 28 36 64 9.69 6.31 7.45 9.43 6.85 7.72 Lancaster Gate, East 30 23 53 12.90 4.00 6.57 13.03 6.16 8.14 Hyde Park 70 76 146 13.80 8.36 10.32 14.37 9.57 11.42 The rates (Table 8) for both sexes, all ages, were in every instance below the corresponding means, the largest reduction being recorded in Lancaster Gate, East, Ward (1.57)—that noted in Church Ward (1.46) being a good second—and the smallest in Westbourne Ward (0.01). Increased rates for males were recorded in three Wards, viz., Queen's Park, Harrow Road and Lancaster Gate, West, and for females in Maida Vale and Westbourne. The sex-agegroup rates for the Borough as a whole (Table 9) were in every case below the means, but there was no corresponding uniformity in the rates for the individual Wards. The most satisfactory feature about the figures given in the Table, is the general reduction in the rates for ages under five years. Comparing last year's rate for the Borough (12.24 according to the figures published by the Registrar-General) with the rates for the Metropolis and districts adjacent to the Borough (Table 10) it is found that the Borough rate was fifth in order of magnitude, two rates, viz., those for Hampstead (10.57) and Willesden (10.47) being lower. Last year's rate for Hampstead (1057) was the only one in excess of the quinquennial mean (9.46). 10 deaths. TABLE 9. Sex-Age Mortality Rates. Per 1,000 individuals in each Sex-Age Group. Sex. Age. Period. Borough. Wards. Queen's Park. Harrow Rd. Maida Vale. Westbourne. Church. Lancaster Gate Hyde Park. West. East. Males. 0— 1908 124.60 126.43 115.56 121.25 104.81 146.11 36.33 72.61 174.41 1903-07 147-80 154.94 115.88 157.57 133.31 172.27 88.88 111.24 144.44 1- 1908 16-36 20.13 12.92 22-36 15.71 18.92 7.77 9.00 9.84 1903-07 18-88 15.79 15.29 20-93 18.05 24.55 9.52 20.17 10.69 5— 1908 1-53 0.55 1.85 2-11 2.37 0.64 2.97 - 2.97 1903-07 2.24 2.24 2.23 1.18 3.25 2.42 2.42 2.00 1.51 15— 1908 2.39 3.37 2.28 0.56 1.75 3.30 2.63 - 3.91 1903-07 2.48 3.27 2.81 2.61 2.59 2.85 1.34 1.24 3.19 25— 1908 11.94 12.57 10.91 9.87 13.37 15.09 6.65 12.85 9.19 1903-07 11.97 12.18 9.86 14.00 12.51 14.09 7.58 9.94 11.17 65— 1908 89.98 146.21 88.77 101.88 57.12 113.96 93.09 75.39 80.41 1903-07 98.82 106.07 83.17 96.77 63.97 112.56 74.45 78.31 98.34 Females. 0— 1908 98.89 86.25 69.18 121.91 125.78 133.91 21.79 43.60 74.50 1903-07 121.21 108.75 93.18 126.37 117.32 160.38 48.88 66.66 103.79 1— 1908 12.95 8.52 12.13 14.16 17.49 16.54 - - 10.32 1903-07 15.26 19.31 13.52 11.90 15.83 20.63 6.75 4.44 15.43 5— 1908 2.29 2.20 1.81 1.28 1.62 2.98 2.43 8.50 2.50 1903-07 2.46 2.32 1.75 1.49 2.02 2.73 1.98 1.73 3.57 15— 1908 1.06 1.27 1.13 1.34 1.16 1.73 - 0.63 0.43 1903-07 2.04 3.80 3.05 1.19 1.66 2.77 0.75 0.78 1.18 25— 1908 7.83 11.78 8.10 7.85 9.29 8.65 5.96 2.93 5.39 1903-07 8.04 9.78 8-48 7.98 8.24 12.25 5.05 4.36 6.51 65— 1908 72.30 97.80 79.92 73.34 59.06 96.42 51.09 28.97 73.42 1903-07 75.53 95.90 75.51 78.78 57.16 97.25 60.41 62.44 71.09 The rates just referred to take no account of differences in the sex-age composition of the populations. A better comparison would be that of sex-age-group rates such as are given in Table 9, but the necessary data for such comparison are not available. The effects of sex-age variations can be eliminated by the determination of "standard rates" from which " correction factors " can be obtained which, when applied to annual rates, give strictly comparable "corrected rates." Such standard rates and corrected rates are given in Table 11. The standard rate for the Borough (17.10) is higher than all the others, except that of the Metropolis (17.31), the lowest of the series being that of Westminster (15.46). The corrected death rate for the Borough (13.15) is, however, the fifth, instead of the second, in order of magnitude, the rates for Hampstead (11.87) and Willesden (11.22) being the only DEATHS. 11 two below it. In the same two districts the differences between the standard and corrected rates (4.32 and 5.76 respectively) were greater than in the Borough (3.95). Comparing last year's corrected rates with the means for 1903.07 a reduction of 0.89 is noted in the Borough rate, a smaller reduction (0.87) having been recorded in Westminster and an increase of 1.12 in Hampstead. TABLE 10. Mortality Rates. Metropolis and Districts circumjacent to the Borough. Period. All Causes Smallpox. Measles Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever Diar. rhœal Dis. Phthisis. Other Tub. Dis. Cancer. Infantile Mortality. Paddington 1908 12.24 0.22 0.09 0.10 0.07 0.02 0.33 1.00 0.26 1.20 110 1903.07 13.22 0.00 0.26 0.07 0.09 0.24 0.04 0.59 1.08 0.40 1.10 120 London 1908 13.77 ... 0.31 0.11 0.14 0.20 0.04 0.53 1.31 0.51 1.04 112 1903.07 15.15 0.00 0.41 0.09 0.14 0.32 0.05 0.72 1.47 0.55 1.01 128 Kensington 1908 12.89 ... 0.17 0.04 0.14 0.03 0.02 0.47 0.97 0.42 0.99 126 1903.07 13.90 o.oo 0.29 0.06 0.09 0.29 0.04 0.57 1.21 0.48 1.00 142 Westminster 1908 12.60 ... 0.13 0.04 0.09 0.04 0.03 0.24 1.22 0.35 1.15 110 1903.07 13.34 o.oo 0.16 0.06 0.06 0.14 0.04 0.33 1.49 0.37 0.98 117 Marylebone 1908 14.15 • • • 0.19 0.10 0.10 0.10 0.04 0.30 1.15 0.22 1.22 104 1903.07 15.56 ... 0.28 0.10 o.1o 0.22 0.03 0.48 1.58 0.40 1.13 126 Hampstead 1908 10.57 ... 0.05 0.07 0.05 0.05 0.05 0.12 0.77 0.10 0.88 81 1903.07 9.56 ... 0.12 0.04 0.06 0.12 0.02 0.15 0.74 0.28 0.96 88 Willesden 1908 10.47 ... 0.36 0.08 0.08 0.08 0.04 0.34 0.76 0.20 0.76 98 1903.07 11.37 o.oo 0.35 0.06 0.10 0.35 0.04 0.63 0.97 0.35 0.95 113 Rates per 1,000 persons, except Infantile Mortality, per 1,000 births. TABLE 11. Corrected Mortality Rates. Standard Rate. Corrected Rate, 1908. Excess ( + ) Defect ( —) Mean Corrected Rate, 1903.07. Increase (+) Decrease( —) Borough 17.10 13.15 —3.95 14.04 —0.89 Queen's Park 16.43 14.92 —1.51 15.22 —0.30 Harrow Road 19.02 11.94 —7.08 12.32 —0.38 Maida Vale 16.62 13.22 —3.40 14.55 —1.33 Westbourne 18.96 12.56 —6.40 12.58 —0.02 Church 17.03 16.21 —0.82 18.41 2.21 Lancaster Gate, West 15.01 9.02 —5.99 9.26 —0.24 „ East 14.76 8.09 —6.67 10.04 —1.95 Hyde Park 16.18 11.60 —4.58 12.84 —1.24 London 17.31 14.47 —2.84 15.92 —1.45 Kensington 17.05 13.65 —3.40 14.83 —1.18 Westminster 15.46 14.81 —0.65 15.69 —0.87 Marylebone 16.93 15.20 —1.73 16.71 —1.51 Hampstead 16.19 11.87 —4.32 10.75 + 1.12 Willesden 16.98 11.22 —5.76 12.19 —0.97 12 smallpox. The same table also gives the standard and corrected rates for the Wards of the Borough. The standard rates for two Wards, viz., Harrow Road (19.02) and Westbourne (18.96) exceed the Borough rate (17.10), while of the corrected rates recorded last year those of Queen's Park (14.92) and Church Wards (16.21) are higher than that of the Borough (13.15). In every case the corrected rate for last year is below the standard rate and also the mean corrected rate, the most satisfactory reduction in the latter case being that noted in Church Ward (2.21). SMALLPOX. There has been no case of this disease in the Borough for more than two years. In the whole Metropolis only four cases were reported in 1908, as compared with 9 in 1907, and 31 in 1906. In the 255 (extra-metropolitan) cities and towns (with a total population of nearly 15 millions at the last Census) sending weekly returns to the Local Government Board, there were 21 cases last year, a considerable reduction on the number (119) reported in 1907. The numbers of cases reported in each quarter during the last six years are shown below. The figures, undoubtedly, overstate the prevalence of the disease as a fairly large proportion of cases were, in all probability, errors of diagnosis. Smallpox. Uncorrected Returns. Metropolis. Extra-Metropolitan Districts. A Quarters—1. 2. 3. 4. Year. r l. 2. 3. 4. Year. 1908 2 — 1 1 4 4 5 5 7 21 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 Immunity from smallpox conduces to neglect of vaccination. That statement is confirmed from the figures given below, which show that since 1902, when the disease was last prevalent to any extent in Paddington, the proportion of children born each year and left unprotected by vaccination has increased steadily. It will be noticed that in 1907 the number of certificates of " conscientious objection " was more than double that for 1906. In 1907 there was not a rumour of the disease in the Borough; in 1906 there was. The provisional figures for the first half of 1908 promise to be even worse than those for 1907. The number of certificates granted in the first six months of last year exceeded the number for the whole year of 1907. The increased facility in obtaining certificates is doubtless responsible for the larger number of objectors. Vaccination Returns. Births. Successfully Vaccinated. Insusceptible of Vaccination. Died Unvaccinated. Per cent. of Births. Cols. 2, 3, & 4. Vaccination Postponed. Certificates under the . Act. Remainder. 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 1907 3,093 2,349 7 255 86.4 28 97 356 15.6 1908† Jan -June 1,526 1,105 8 126 81.2 42 94 151 18.8 * Including " gone away," " apprisals to other districts," " false addresses," &c.† Provisional return only. 1 Diphtheria. No. o 1908. 1907. 1906. 1905. 1904. Houses with 2 cases 8 13 13 5 6 3 " 3 3 1 1 5 4 " 1 — — — 1 5 " — — 1 — — DIPHTHERIA. 13 DIPHTHERIA. In 1906, 182 cases of diphtheria were reported; in 1907, 154; and last year, 142. Membranous croup is always deemed to be synonymous with diphtheria, and under that title the cases reported during the three years have been 0, 6, and 4 respectively. Combining the two sets of figures, the total numbers of cases reported in each of the three years may be taken as 182, 160 and 146 respectively, showing a reduction of nearly 20 per cent. The combined morbidity rate for last year was 0.94 as compared with a mean rate for the preceding quinquennium of 0.96. (Table 4.) Although the disease, as represented by the notifications, was less prevalent last year in the Borough as a whole than in 1907, yet increases were recorded in Maida Vale, Westbourne and Lancaster Gate, West, Wards. (Table 5.) The greatest decline was recorded in Church Ward. The numbers of cases reported in each quarter of the past year are compared with the averages for 1903-07 in Table 12. Fewer cases were reported in the second and third quarters, more in the first and fourth. Contrasting the local rate with those of the Metropolis and districts adjacent to the Borough (Table 5), it is seen that higher rates were recorded in the Metropolis and three of the adjacent districts. The districts with rates below that of the Borough (0.97) were Marylebone (0.91) and Hampstead (0.07). Last year's rates were generally below the means except in Kensington (1.27, mean 1.02) and Westminster (1.08, mean 0.91). The 146 cases reported in the Borough included 24 erroneously diagnosed, equal to 16.4 per cent., or more than 4 per cent. above the average for the preceding five years (12.0), and 6 cases contracted in institutions beyond the Borough, including 4 of diphtheria following scarlet fever. If the total be corrected by deducting those 30 cases, there remains a nett figure of 116 cases, of which 12 were apparently due to infection contracted away from home, and 4 to patients recently discharged from hospital. The cases comprised 10 primary and 12 secondary, the latter constituting 10.3 per cent. of the corrected total. In previous years the notifications have been analysed as regards multiple cases in houses without corrections for errors. The figures for last year thus obtained are given below:— If, however, corrections be made for erroneous diagnoses, the numbers become— Houses with 2 cases, 7 ; with 3 cases, 1 ; with 4 cases, 1. There were no indications of any special incidence on any locality or in any school in the Borough. Of the 146 cases reported, 129 were removed to hospital, including the 24 cases erroneously diagnosed. The percentage of cases treated in hospital was 88.3 last year compared with an average of 82.1 during the five years 1903-07. (Table 14.) The percentages of cases removed from the different Wards ranged from 66.6 in Lancaster Gate,, East to 100 in Queen's Park Ward. h- TABLE 12. Notifications in each Quarter of the Year. Borough. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Quarters 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Diphtheria (and Membranous Croup) 1908 40 22 38 46 2 1 3 5 13 6 9 6 8 3 8 2 7 4 9 7 8 4 4 8 1 2 2 3 1 2 1 2 — — 2 3 1903-07 35 29 42 39 5 3 3 4 7 8 12 12 3 4 8 7 4 6 7 5 8 5 9 7 1 1 1 I 2 1 1 1 5 1 1 2 Scarlet Fever 1908 105 166 162 248 13 15 33 25 27 58 67 63 12 27 9 26 19 28 27 30 20 27 16 89 5 1 5 5 2 — 2 5 7 10 3 5 1903-07 96 101 132 141 11 18 22 26 29 25 28 38 9 13 16 18 15 12 21 17 20 18 54 27 5 5 3 4 I 3 3 6 7 5 8 Enteric Fever (and Continued Fever) 1908 6 3 8 15 1 - 1 3 1 1 3 1 — 1 — 3 — — 1 2 — 2 1 — — 1 3 — — — 1 1 1 1 2 1903-07 9 6 10 17 1 1 1 1 2 1 2 2 1 1 3 3 1 1 2 3 2 1 1 6 1 — — 1 1 — — — 0 1 1 1 Puerperal Fever 1908 - — 2 4 - - - 2 - - 1 - - - - 1 - - - 1 - - 1 - - - - - - - - - - - - - 1903-07 3 2 1 2 1 0 1 0 I 1 0 0 1 0 — — — 0 0 1 0 1 0 1 - — — — — — — 0 0 — — " 0 " An average less than 1. " — " No cases recorded. DIPHTHERIA. 15 The deaths from diphtheria reported during the year numbered 16, of which one was that of a patient removed to hospital during 1907, and another that of a patient removed during the past year as a case of scarlet fever. These deaths have been omitted from that part of Table 13 which deals with diphtheria. Of the remaining 14 deaths, 3 took place at home and 11 in hospital. The fatality of the disease was equal to 12*2 per cent, of the cases, after deducting those erroneously diagnosed, and was 1*4 above the mean for the preceding five years. The fatality among cases treated at home was 17*6 (mean, 12*0), and among those treated in hospital 10'4 (mean, 105). TABLE 13. Diphtheria (including Membranous Croup). Scarlet Fever. Enteric Fever (including Continued Fever). Cases. Deaths. Cases. Deaths. Cases. Deaths. Total Reported. Removed to Hospital. At Home. In Hospital. Total Reported. Removed to Hospital. At Home. In Hospital. Total Reported. Removed to Hospital. At Home. In Hospital. Queen's Park 11 (3) 11 (3) i 86 (6) 81 (6) — 5 (1) 3(1) Harrow Road 44 (7) 40 (7) 1 3 215 (5) 204 (5) 6 6(1) 5(1) 2 Maida Vale 21 (3) 16 (3) 3 74 (5) 68 (4) — 4 2 — YVestbourne 27 (5) 24 (5) 2 — 104 (6) 102 (6) 4(1) 1 1 — Church 24 (4) 23 (4) — 2 152 (15) 152 (15) 2 6 (1) 6(1) 1 Lancaster Gate, West 8(1) 7 (1) — — 16 15 — 4 (4) 4(4) KD „ East 6(1) 4(1) — 1 9 6 — 1 (1) 1 (1) Hyde Park 5 4 — 1 25(1) 18 (1) — 5 (1) 3(1) — Figures in parentheses indicate numbers of cases erroneously diagnosed. Diphtheria.—Two additional deaths from this disease in Harrow Road Ward : one in a patient admitted to hospital as a case of scarlet fever; the other a patient removed to hospital in 1907. TABLE 14. Diphtheria. Scarlet Fever. Enteric Fever. 1908. Mean. 1903-07. 1908. Mean. 1903-07. 1908. Mean. 1903-07. Removed to Hospital* 88-3 82-1 94-8 89-9 78-1 73-7 Fatality f At Home 17-6 12-0 — 1-3 — 33-3 In Hospital... 10-4 10-5 1-8 2-4 18-7 10-6 Total 12-2 10-8 1-7 2-3 13-0 16-9 Mortality J 0-10 0-09 0-08 0-07 0-02 0-04 * Per cent, of all cases reported. | Per cent, of attacks, after correction for erroneous diagnosis. | Per 1,000 persons—based on all recorded deaths. The mortality due to diphtheria last year was at the rate of 0*10 per 1,000 persons, showing an increase of 0-01 above the mean. (Table 14.) The mortality, corrected for sex-age composition of the population, was 0T2, 0'27 less than the standard rate, but 0'01 above the mean. (Table 15.) In Hampstead and Willesden only were the corrected rates lower than that of the Borough, the rate for the former district (0'09) being 0'01 above the mean (0'08). 16 SCARLET FEVER. SCARLET FEVER. Of all the diseases scheduled for notification scarlet fever alone presented any points worthy of minute study during the past year. The circumstances of its prevalence were somewhat unusual, and it has been thought desirable to reserve a discussion of it for a special report. Only a few figures in continuation of those presented in previous years are given in this part of the Report. The notified cases of scarlet fever numbered 715 in 1906, the highest number on record for any year, fell to 579 in 1907, and rose to 681 last year. The morbidity rate last year was 4*43 per 1,000 persons, as compared with rates of 4'81 in 1906, and 3*87 in 1907, and a mean rate of 3*17 for the five years 1903-07. The prevalence of the disease was generally above the average in the Metropolis (rate, 1908, 4*51; mean, 3'89) and in the districts adjacent to the Borough. The greatest prevalence was recorded in Willesden, where last year's rate was 4*76 as compared with a mean rate of 3'59. (See Table 5.) Although the number of cases in the Borough as a whole was larger than that recorded in 1907, yet fewer cases were recorded in Maida Vale, Lancaster Gate, East, and Hyde Park Wards. (See Table 7.) The most marked increases occurred in Harrow Road and Church Wards. It will be seen from Table 6 that more than half of the recorded cases occurred in children aged from 5 to 13 years. The certified cases included 38 erroneously diagnosed (equal to 5*5 per cent, of the total, average 1903-07,3*8), 50 "return" and 31 "imported." There were definite outbreaks in connection with certain schools and institutions in the Borough. The 681 cases reported during the year included no fewer than 217 secondary cases, equal to 31*8 per cent, of the total, as compared with 28'5 in 1907. This proportion represents cases secondary to the primary attacks of the year. There were in addition a small number of attacks secondary to cases occurring in the previous year. The distribution of multiple attacks in each of the past five years is given below:— Scarlet Fever. 1908. 1907. 1906. 1905. 1904. Houses with 2 cases 57 63 77 31 • 35 3 „ 30 21 23 6 10 4 „ 13 7 7 3 7 >i 5 ,, 5 2 4 — 2 6 „ 1 2 2 — — „ 7 „ or more 2 2 1 — — Of the total of 681 reported cases 646 were removed to hospital, equal to 94"8 per cent., just on 5 per cent, above the average. (See Table 14.) The percentages of cases removed from the different Wards varied from 66'6 in Lancaster Gate, East, to 100 in Church Ward. (See Table 13). The fatality of the disease was singularly low, being only 1*7 per cent, of all cases, after allowing for those erroneously diagnosed, as compared with an average of 2'3 per cent, for the preceding five years. (Table 14.) This low fatality doubtless accounted for the very small increase in the mortality, viz., from a mean (1903-07) of 0'07 per 1,000 persons, to a rate of 0'08 during the past year. According to the Registrar-General's figures (Table 10) the local rate was 0'09 last year, which rate was exceeded only by those of the Metropolis (O'll) and Marylebone (0*10). Last year's rate was above the mean in all cases except Marylebone, where it equalled it. ENTERIC FEVER. 17 Comparing the corrected mortality rates (Table 15) it is seen that the local rate for last year was higher than any of the rates for the adjoining districts but equal to that for the Metropolis. The rates for the Metropolis, Paddington, Hampstead and Willesden were above the respective means, in the other districts below. The greatest proportional increased (100 per cent.) was recorded in Hampstead. TABLE 15. Diphtheria. Scarlet Fever. Enteric Fever. Standard Rate. Corrected Rate. Standard Rate. Corrected Rate. Standard Rate. Corrected Rate. 1908. Mean. 1903-07. 1908. Mean. 1903-07. 1908. Mean. 1903-07. Paddington 0-39 0-12 0-11 0-13 o-ll 0-09 0-14 0-02 0-03 London 0-50 0-14 0-14 0-17 o-ll 0-09 0-14 0-04 0-05 Kensington *... 0-36 0-19 0-12 0-12 0-05 0-07 0-14 0-02 0-04 Westminster 0-32 0-14 0-09 o-ii 0-06 0-09 0-15 0-03 0-03 Marylebone 0-37 0-13 0-14 0-12 0-13 0-14 0-14 0-04 0-02 Hampstead 0-36 0-09 0-08 0-12 0-10 0-05 0-14 0-05 0-02 Willesden 0-56 0-07 0-09 0-19 0*07 0-05 0-14 0-04 0-03 ENTERIC FEVER. Thirty-one cases of enteric fever and one of continued fever (always regarded as the same disease for the purpose of these reports) were reported during the past year, making a total of 32 cases, or three fewer than the totals recorded in 1906 and 1907 (35 each year). The morbidity rate was 0*20 per 1,000 persons, 0*02 less than the rate for 1907 and 0*07 less than the mean (1903-07). It will be seen from Table 5 that the local rate was lower than any of the rates recorded in the Metropolis and districts adjacent to the Borough. In every case except Hampstead (where the rate for last year, 0*26, was equal to the mean) last year's rate was below the mean. Taking the cases as reported, the only Wards showing higher numbers last year than in the preceding are Lancaster Gate, West, and Hyde Park. Those figures are, however, somewhat misleading, as no fewer than 9 out of the 32 reported cases, with a possible other 3, were erroneously diagnosed. The percentage of mistakes was 28T last year, more than double the average for the preceding five years (12*8). The case of continued fever was one of broncho-pneumonia, and all the cases of enteric fever reported from Lancaster Gate, West, Ward were erroneously so diagnosed. Seven cases, not including any of the errors of diagnosis, were believed to have been contracted outside the Borough, so that there remained only 13 cases which could be attributed to local infection. Some of the patients in the latter category worked and took their meals outside the Borough. In five instances histories were obtained of the consumption of shell-fish within the limits of infection, one patient also having had fried fish. In one case there was a history of eating water-cress. In no case was it possible to trace any source of contamination of any of those food-stuffs. 18 septic diseases. Twenty-five of the patients, equal to 78*1 per cent, of the whole, were removed to hospital—an increase of nearly 5 per cent, above the average. (Table 14.) The deaths attributed to enteric fever numbered 4, but in one instance it was practically certain that the death had been attributed to the wrong cause. The diagnosis was arrived at in the absence of any evidence, even after post-mortem examination, of any definite disease, while the clinical indications pointed to enteric fever. The death was the first of the four cases in Lancaster Gate, West, Ward, all the subsequent cases being definitely diagnosed as not enteric fever, but some obscure form of septic (?) poisoning. The three remaining deaths give a fatality of 19*7 per cent, of cases removed to hospital, which is nearly 8 per cent, above the mean, and of 13'0 per cent, of all cases (errors excluded). (Table 14.) The mortality last year was 0*02 per 1,000 persons, half the mean (0*04), and lower than any of the rates given in Table 10, except that of Kensington (0*02). The fully corrected rates are given in Table 15, and may be described as equally satisfactory. SEPTIC DISEASES. Puerperal Fever.—The cases of this disease reported during the year were the same in number as in 1907, viz., C. The morbidity rate per 1,000 persons was 0*03 last year, the mean rate for 1903-07 being 0*05, showing a fair reduction in prevalence. In Westminster last year's rate was equal to that recorded in the Borough, the rates for all other districts (Table 5) being higher. Puerperal fever being a disease which occurs only in connection with child-birth, more reliable information as to its prevalence is obtained by calculating rates on the numbers of births and of women of fecund ages (15 to 45 years). Such rates are given in Table 16, from which it appears that the local rate of last year was equal to 0T8 per 100 births, the same as that for the Metropolis, but lower than those for the adjacent districts except Willesden, where the rate was 0*17. Last year's rates exceeded the means in Kensington, Marylebone and Hampstead. Two deaths were assigned to this disease in the Borough during the year, giving a fatality of 33*3 per cent, of the recorded cases, the mean fatality for the preceding five years being 57T. (Table 16.) The fatality was lower in Paddington than in any other district. The rates for last year were in excess of the respective means in Marylebone and Hampstead. Mortality in Childbed.—This is measured by the total number of deaths (12) from puerperal fever (2 deaths) and accidents and diseases of pregnancy (10 deaths), equal to a mortality of 0*21 per 1,000 women of fecund ages, and differing by 0*01 only from the quinquennial mean rate (0*22). Higher rates were recorded last year in Hampstead (0*36) and Willesden (0*27). Calculating the mortality per 1,000 births registered during the year, a rate of 3*80 is obtained for the Borough, 0"04 less than the mean, higher rates being recorded in Marylebone (3'90) and Hampstead (10*32). Last year's rates exceeded the means in the two districts last mentioned and in Westminster. Erysipelas.—One hundred and five cases were reported during the year, 19 fewer than in 1907. The morbidity rate (0*68) was 0*18 less than the mean (0*86). In comparison with the preceding year (Table 7) increased numbers of cases were reported from Westbourne and Church Wards. SEPTIC DISEASES. 19 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 ... < 1908 0-18 33-3 0-63 0-03 3-17 0-18 3*80 0-21 1903-07 0-24 57-1 1-23 0-06 2-61 0-16 3-84 0-22 London ... < 1908 0-18 60-1 1-11 0-07 1-46 o-io 2-57 0-17 1903-07 0-20 67-4 1-42 0-10 1-41 0-11 2-83 0-21 Kensington ... < 1908 0-32 36-3 1-19 0-05 0-89 0-02 2-08 0-07 1903-07 0-19 74-8 1-17 0-03 1-87 0-08 3-04 0-11 Westminster ... < 1908 0-22 50-0 1-12 0-03 2*24 0-09 3-36 0-12 1903-07 0-23 61-1 1-31 0-05 1-79 0-07 3-10 0-12 Marylebone < 1908 0-31 37-5 1-17 0-05 2-73 0-14 3-90 0-19 1903-07 0-19 23-7 0-61 0-03 2-59 0-15 2-90 0-18 Hampstead •! 1908 0-44 66-6 2-95 o-io 7-37 0-26 10-32 0-36 1903-07 0-19 29-9 0-84 0-02 3-36 0-15 4-20 0-17 Willesden ... j 1908 0-17 42-8 0-73 0-03 2-19 0-24 2-92 0-27 1903-07 0-24 68-7 1-58 0-14 2-35 0-23 3-93 0-37 Twenty-one of the patients received institutional treatment, 16 in the Infirmary, 3 in St. Mary's Hospital, and one in a M.A.B. Hospital (the erysipelas supervened on an attack of scarlet fever), and one in the Fulham Infirmary, where the patient had been an inmate for upwards of two years. I he deaths from erysipelas number 5, representing a fatality equal to 4'7 per cent, of the cases, a fatality which compares somewhat strikingly with that due to scarlet fever (1'7 per cent.). Other Septic Diseases.—From these diseases (not notified) there were 8 deaths during the year, viz., 4 from pyaemia (2 each of males and females), 2 from infective endocarditis (both males) and one each from cancrum oris (a male) and septic pneumonia (a female). In calculating the mortality from " other septic diseases," deaths from ervsipelas are included. The total number of deaths was 13 (9 of males and 4 of females), last year's rate being 008 per 1,000 persons, or 0*02 less than the quinquennial mean (O'lO). 20 TUBERCULOUS DISEASES. TUBERCULOUS DISEASES. The deaths due to the various forms of tuberculosis numbered 190 last year, or 29 fewer than the total for the preceding year (219). Last year's total included 149 deaths from pulmonary tuberculosis (consumption), 14 from cerebral (tubercular meningitis), 5 from abdominal (tabes mesenterica), 10 from generalised and 12 from other forms of the disease. (See Table 17.) The total mortality (T23 per 1,000 persons) showed a decrease of 0*14 below the mean for 1903-07 (1*37), practically all the reduction taking place in the rate for females, which was 0'73 per 1,000 last year, while the mean rate was l'Ol. Last year's rate for males (1'83) was only 0'01 below the mean (1'84). The mortality from "other forms" showed an actual increase, due entirely to the higher rate for males. As regards the other manifestations of the disease, reductions were recorded in the mortalities, those in the rates for females being generally greater than those among the male. TABLE 17. Tuberculous Diseases. Deaths. Mortality Rates. 1908. 1908. 1903-07. Males. Females. M. F. P. M. F. P. Pulmonary 95 54 1-44 0-60 0-97 1-45 0-72 1-03 Cerebral 11 3 0-16 0-02 0-09 0-17 0-14 0-15 Abdominal 1 4 o-oo 0-03 0-03 0-05 0-04 0-05 General 5 5 0-06 0-04 0-06 0-11 0-07 0-09 Other forms ... 7 5 0-17 0-04 0-07 0-06 0-04 0-05 All Forms 119 71 1-83 0-73 1-23 1-84 1-01 1-37 The numbers of deaths recorded among the residents of the different Wards are too few to permit of a useful tabulation for the five varieties of the disease given in Table 17. It is more profitable to limit the classification to " pulmonary tuberculosis " and " other tuberculous diseases" as is done in Table 18. It will be seen that in Queen's Park Ward only did last year's mortality from pulmonary tuberculosis exceed the mean rate (rate, 1908, 1*73; mean rate, 1*32). As regards the mortality from other tuberculous diseases, last year's rates were below the means in all the Wards except Lancaster Gate, East, where the increase (due to a single death) may be ignored. TABLE 18. Phthisis. Other Tuberculous Diseases. Deaths, 1908. Mortality. Deaths, 1908. Mortality. 1908. 1903-07. 1908. 1903-07. Borough 149 0-97 1-04 41 0-26 0-41 Queen's Park 29 1-73 1-32 7 0-41 0-57 Harrow Road 26 0-85 0-89 8 0-26 0-42 Maida Vale ... 12 0-58 0-98 8 0-38 0-33 Westbourne ... 31 1-01 1-16 3 0-11 0-31 Church 40 1-39 1-52 12 0-41 0-58 Lancaster Gate, West 2 0-23 0-32 — — 0-09 Lancaster Gate, East 3 0-37 0-45 1 0-12 0-04 Hyde Park 6 0-42 0-67 2 0-14 0-27 TUBERCULOUS DISEASES. 21 For the reason assigned above it is useless to give the sex-age mortalities save in the two larger groups and for the whole Borough. Below are last year's rates from pulmonary tuberculosis contrasted with the mean rates for the preceding quinquennium. It will be seen that higher rates were recorded last year among males at ages 15—, 35—, 45—, and 55—, while among females higher rates were recorded at two ages only, viz., 25—, and 35—. Pulmonary Tuberculosis. Ages 0— 15— 20— 25— 35— 45— 55— 65— 75— Males. 1908 ... 0T5 0-66 1-35 1-23 3-15 3-58 2-66 1-07 — 1903-07 ... 0-16 0-51 1-43 1-46. 2-78 3-29 2-57 2-24 0-31 Females. . 1908 ... 0-14 0-11 0-55 0-87 1-21 0-67 0-68 0-90 — 1903-07 ... 0-19 0-42 0-59 0-74 1-05 1-24 1-35 1-25 0-73 The mortality from the other forms of tuberculosis is more uniformly distributed throughout life, and hence a somewhat more extended tabulation is required. The figures given below show a considerable reduction in the mortality among males and females at the younger ages of life. The few exceptions to the general reduction recorded do not carry much weight, as they are based on very small numbers of deaths at each age. The almost universal decrease in the rates is the more significant feature. Other Tuberculous Diseases. Ages 0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— Males. 1908 ... 1-77 2-44 0-16 — 0-32 — 0-07 0-33 — —" 0-39 1903-07 ... 5-26 1-65 0-31 0-24 0-03 o-o I 0-19 0-12 0-12 o-io 0-24 Female; > 1908 ... 2-60 1-10 0-60 0-21 — — — — 0-10 — — 1903-07 ... 5-18 1-47 0-40 0-28 0-10 0-11 0-11 0-14 0-06 0-13 0-39 The mortality rates from " phthisis" given in Table 10, have been obtained from the figures published in the Quarterly Reports of the Registrar-General, those for " other tuberculous diseases " from the Medical Officers of Health of the districts, save that the Metropolitan rate has been calculated from the figures given in the Weekly Returns. The local rate for phthisis (TOO) was exceeded only by the rates for the Metropolis (T31), Westminster (1*22) and Marylebone (1*15). The Hampstead rate (0*77) was the only one in excess of its mean (0*74). Higher rates from other tuberculous diseases than that for the Borough (0"26) were recorded in the Metropolis (0*51), Kensington (0*42) and Westminster (0-35). Owing to differences in the sex-age composition of the populations, the " corrected " rates from phthisis,* given in Table 19 (page 29), are to be preferred to those already quoted. The general conclusion which may be drawn from the figures in that Table, is that the local rate does not show a reduction in the mortality from phthisis equal to that shown in the other districts. Such conclusion is based on the smaller differences between last year's rate and the standard, and the mean rate for 1903-07. Some allowances must be made for the greater density of population to the acre (highest (106) in the Borough) and for the larger proportion of population living in tenements of less than five rooms, the local percentage (50'9) being exceeded only by that for Marylebone (55'6). * The data necessary for obtaining similar rates for other tuberculous diseases are not at present available. 22 TUBERCULOUS DISEASES. The occupations of the 149 persons dying of pulmonary tuberculosis are set out below, but it is believed that in a certain proportion of the cases, the occupations at the date of decease represent the last work the deceased could do, not his original avocation. The figures should not be taken as representing the proportional incidence of the disease on the occupation specified. Occupation. M F. Occupation. M. F. Occupation. M F. Indoor:— I Outdoor:— Mixed:— Domestic Servant... 1 4 Labourer 14 ... Potman 1 Charwoman 2 Carman ... ... 11 ... Engineer ... ... 1 Housewife ... 28 Cab or Omnibus Porter ... ... 6 School (Teacher) ... 1 0 o* Service 3 ... Carpet-beater ... 1 „ Child ... J " ° Stableman ... ... 4 ... Shop Assistant ... 1 Dentist ... ... 1 ... Building Trades ... 8 Baker ... ... 1 ... Roadman ... ... 3 Clerk, Typist ... 5 ... Postman ... ... 1 Shop Assistant ... 7 2 Coachman... ... 4 ... No Occupation ... ^ Stoker ... ... 1 ... Canvasser (Trade) 1 ... Occupation not J>6 8 Dressmaker, Tailor ... 6 Policeman 1 ... known J Skilled Artizan ... 9 ... Hawker ... ... 1 Laundry-worker 1 Shop Keeper ... 1 * Including 2 Teachers. Of the 149 deaths, 17 occurred in out-lying institutions and the housing conditions of the deceased were not ascertained, while four deaths occurred in two families. There remain, therefore, 130 families as to whose housing particulars are available. These are given on next page. The numbers of children under 10 included in the families have been given in each class of tenement, in the belief that such data should be taken into consideration in gauging theoretical overcrowding, the standard of which is any excess of an average of two persons (irrespective of their ages) per room. It is customary to count two children under 10 as equivalent to one adult for legal overcrowding. The data available are too few for any generalisation, but they do suggest that the theoretical overcrowding shown by the figures is not of very material importance. The fact that 113 of the 132 persons who died at home shared bedrooms, and 87 shared beds with other members of their families, are of more weight than the theoretical overcrowding disclosed in the table. Of legal overcrowding there was none. The knowledge of the infectiousness of the sputum and of the need of proper precautions as to its disposal appears to be spreading. The Inspectors reported that in 13 cases (out of 132 deaths) there was no sputum, while 88 of the remainder (119) were aware of its infectiousness, proper precautions being taken in 77 instances. In 46 of the 146 houses to which the 149 deaths were allocated, previous 70 deaths from pulmonary tuberculosis occurred between 1891 and 1908, viz. : 1 death at each of 30 houses, 2 deaths „ 12 „ and 4 4 In addition three deaths from other forms of tuberculosis were recorded at three houses (one at each) during the same period. TUBERCULOUS DISEASES. 23 Housing of Persons Dying of Pulmonary Tuberculosis. No. of rooms occupied. Total Occupants (persons, all ages). 1 2 3 4 5 6 7 8 9 10 1 Total families ... 13 16 5 2 2 ... ... ... No. of families of children under 10 years. 0 13 16 3 1 ... ... ... ... ... ... 1 ••• ... 2 ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... . . . 3 ... ... 2 ... ... ... ... ... 2 Total families ... ... 5 10 10 2 4 4 1 ... ... No. of families of children under 10 years. 0 5 8 6 1 1 ... 2 1 i 1 ... ... 2 3 1 1 1 ... 3 • . . ... 1 2 ... 4 ... . . • ... ... . . . ... 1 5 ... ... ... ... 1 ... 3 Total families ... ... 4 5 3 6 3 6 ... 1 ... No. of families of children under 10 years. 0 4 4 1 5 2 1 1 1 1 ... . . • 2 ... ... 2 2 1 ... 3 ... ... 1 1 1 4 ... ... . .. ... 1 ... ... 5 ... ... ... ... ... ... ... ... 4 Total families ... ... ... 1 1 1 3 1 ... ... No. of families of children under 10 years. 0 1 1 1 2 1 . . . ... ... ... 2 ... ... 1 ... 3 ... . . . ... ... 4 5 ... ... ... 1 ... Notification.—The adoption of voluntary notification of consumption has never been recommended, the system being thought to be illusory. At the same time information of any cases of the disease is welcomed, and since 1903 cases have been brought to the notice of the Department in increasing numbers (see below) by medical practitioners and others. Total Died during Rerorted First diagnosis Lost sight of, Living at cases , * j of consumption removed, end of reported. 1903. 1904. 1905. 1906. 1907. 1908. recoverea- not confirmed. &c. year 1908. 1903 4 2 ... 2 1904 20 ... 5 1 1 1 1 ... ... 9 2 1905 18 10 3 1 ... 3 1 1906 57 17 5 7 ... 2 13 13 1907 84 14 12 ... 5 19 34 1908 173 25 2 27* 6 113 * 26 suspected to be consumptive: 1 suffering from tuberculous disease (not pulmonary). 24 TUBERCULOUS DISEASES. Last year 210 persons were made known to the Department as consumptive patients, tuberculosis being subsequently diagnosed in 173, 26 of the patients being suspected to have " consumption," one other was found to have the disease in a form other than the pulmonary, and 146 were pronounced to be " consumptive." The ages of t!ie last (85 of whom were males, and 61 females) are given below. It will be observed that nearly ten per cent, of the patients (10 out of 173) were under 5, and over 12 per cent, under 15 years of age. Ages of Patients (" Consumptives ") reported during 1908. Ages. 5- 10- 15- SO- 25- 35- 45- 55-65 Totals. Males ... 8 3 5 10 18 26 8 7 85 Females 2 8 4 7 13 10 2 5 61 The occupations of the patients are given below. The table cannot be fairly compared with the corresponding table given previously for persons dying of the disease. In future reports the occupations of the latter will be omitted, and more attention be given to those of patients known during life. Occupation. New cases reported, 1908. All survivors at end of 1908. Occupation. New cases reported, 1908. All survivors at end of 1908. Occupation. New cases reported, 1908. All survivors at end of 1908. M. F. M. F. M. F. M F. M. F. M. E. Indoor— Outdoor— M ixed— Domestic Servant 2 5 6 Labourer ... 4 ... 6 Butcher 1 ... 1 ... Carman 4 3 Soldier 1 1 Charwoman 3 3 Railwayman 5 4 . . . Woodyard... 1 1 1 "i Housewife ... ... 21 ... 20 Cabman or^j Omnibus man J 4 ... 6 ... Odd jobs \ and errands J 4 ... 4 ... Schoolchild ^ School- > teacher J 11 20* 11 30* No occupa-^ tion, or 1 occupation j not known J 10 1 9 l Painter 8 5 Shop Assistant 6 2 5 2 Farrier 1 ... .. Clerk 5 1 5 Stableman... 3 ... 3 ... Stoker 1 ... ... ... Building Trades 5 5 Dressmaker, Tailor 1 4 1 4 Roadman ... ... 1 ... Skilled Artizan 8 9 Hawker 1 1 ... Baker 1 ... 1 ... Bootmaker ... 2 ... 3 ... Laundry worker 1 ... 3 * Including 1 Teacher. The 146 consumptive patients belonged to 141 families, records of whose home surroundings were recorded in all cases save 2. An analysis of the housing, as regards tenements of less than 5 rooms (132), is given on the next page. TUBERCULOUS DISEASES. 25 Housing of "Consumptives" Reported during 1908. No. of rooms occupied. Total Occupants (persons, all ages). 1 2 3 4 . 5 6 7 8 9 10 1 Total families ... 8 22 4 3 3 ... ... ... ... No. of families of children under 10 years. 0 8 22 2 2 1 2 1 ... ... ... 2 2 3 ... ... 1 ... 2 Total families ... 4 15 11 5 12 7 1 ... ... No. of families of children under 10 years. 0 2 9 2 2 2 1 2 6 1 . . . ... 2 ... 8 1 3 1 . . . ... 3 • •• ... 2 3 2 i ... 4 4 2 ... 5 ... ... ... 2 3 Total families ... 4 4 3 4 6 4 1 l No. of families of children under 10 years. 0 4 3 2 1 1 ... 1 1 ... *. » 0 ... i 3 3 1 ... 3 1 2 1 l 4 ... ... ... • •• .... 5 ... ... ... ... ... 1 i ... 4 Total families ... ... 2 ... 1 3 ... 1 l ... ... No. of families of children under 10 years. 0 2 1 1 1 1 ... ... ... ... ... ... ... 2 2 3 ... ... ... ... ... 4 ... ... ... ... ... l ... The locations of 126 of the tenements, qua houses, were :— In basement ... 22 17*4 per cent. On ground floor ... 27 21*4 ,, On first „ ... 37 29*3 ,, On second „ ... 40 31*7 „ A comparison of the housing table for living cases with that for deaths, shows that the conditions at decease were slightly worse, and may be taken as an indication of the deterioration of home surroundings which results from the continued incapacity due to the disease. Number of Rooms to a tenement. Percentages residing in each class of Tenement. " Consumptives." Whole Borough, 1901. Average number of persons per Room. " Consumptives." Whole Borough, 1901. Living. Dead. Living. Dead. 1 28-7 29-2 6-4 2-3 2-0 1-8 2 39-5 27-7 15-6 4-5 4-1 1-7 3 19-4 21-5 17-3 5-0 4-7 1-3 4 5-7 5-4 11-4 4-7 5-2 1-2 26 TUBERCULOUS DISEASES. It must be remembered that 17 of the deaths recorded during the year occurred in public institutions, and it may reasonably be supposed that the majority of the deceased, whose cases were not included in the above calculations, lived under the worse and not the better conditions of life. Of the 146 cases accepted as pulmonary consumption, 2 were reported as recovered (" arrested ") before the end of the year, 6 patients were lost sight of by removal, and 25 died, leaving 113 survivors. To these have to be added 50 survivors remaining from the period 1903-07, making a total of 163 persons (85 males and 78 females) known to the Department at the beginning of the current year as suffering from "consumption " in various stages. The occupations of these persons are given in the second of the tables of occupations (See page 24). Action taken.—Every case reported and every death formed the subject of special enquiry by the Women Inspectors. Disinfection is offered after a death at home, and generally accepted, but there is no power to compel disinfection, no matter how necessary it may be thought to be. Disinfection is also effected when possible after removal of a patient. After notification advice is given as to precautions to be observed, and as to the best method of living, etc. Frequent communications are addressed to the medical practitioners in charge of the patients to learn what rules they desire their patients to adopt, and to ascertain whether the cases are in need of and suitable for treatment in sanatoria or country. In the last direction the help of the local Health Society and Committees of the Invalid Children's Aid Association and Charity Organisation Society has been sought. The Charity Organisation Society has given material relief in suitable cases. Twenty-one adult and 20 children patients were sent away to sanatoria or country through the co-operation of the agencies mentioned. In the majority of the cases the results were satisfactory, but certain patients refused to remain a sufficiently long time under treatment to obtain its full benefit. Records of all cases are in the possession of the Department. The Women Inspectors included in their reports on the year's work accounts of special cases of great interest—many illustrating the infectious character of " consumption." The following histories are selected as the two most interesting recorded. H. E., aet. 24 ; C. E., aet. 21. Enquiries following the death of H. E. in November elicited a history of consumption first in C. E. " in early spring of the year," and two months later in H. E. They attended Brompton Hospital as out-patients, and were advised to go to sanatorium. Unable to obtain the necessary letters, they both became rapidly worse. C. E. died in December, five weeks after his brother. The E. family occupied the ground floor rooms of the house. In December, 1907, A. B., a consumptive, died in the back bedroom on the same floor ; I. B. and — B. (daughter and wife of A. B.) were known (in December last) to be ill with the same disease, but had then moved to another house. M. J., another consumptive, died in January, 1908, on the second floor of the house, and — T., a former occupant of the same floor, had a " spot on her lung," and is suspected to be consumptive. The house was a clean one of recent construction, not overcrowded, but there were slight evidences of dampness and the drains were found to be defective. M. B., aet. 20, had pleurisy some four years ago, and had been under medical treatment off and on ever since. There was a family history of consumption. Last year she was recommended for admission to Brompton Hospital, but refused on account of her husband. Home sanatorium treatment was undertaken, the windows of the rooms (top floor) being kept open (full, day; half, night) from February onwards. Proper nourishment was obtainable, and the patient spent part of each day in Kensington Gardens. She made good progress up to last autumn, when she was lost sight of through removal from the Borough. TUBERCULOUS DISEASES. 27 Duration of Consumption.—During the eight years 1901-8, 1,223 deaths of residents of the Borough have been registered with phthisis as the primary cause of death. There have been other deaths with that disease as a secondary cause, but the number of such deaths has not been noted. During the same period enquiries have been made after the deaths taking place in the Borough. It has been thought desirable to examine the reports with a view to determining, if possible, the reputed duration of the disease. On scrutiny of the reports, those relating to 478 deaths, dating from 1903, were found suitable for the present purpose. The test of suitability was the inclusion in the report of a definite turn to the disease. It must be admitted at this stage that there are many difficulties and uncertainties attaching to all estimates of the duration of consumption, but the discussion of such points cannot be taken here. A brief note of the results obtained is all that can be given. By summation of the reported durations of the disease, the average duration for males (all ages), was found to be 22T4 months, for females 27*78 months, and for persons, 24'20 months. Below is given a table of the numbers of instances of reported durations of selected terms, recorded at different ages of life, for each sex. It should be noted that the average duration has not been calculated from the figures given in the table. Duration of Disease. Males. Females. 0— 5— 10— 15— 25— 35- 45— 55— 65— All Ages. 0— 5— 10— 15- 25— 35— 45— 55— 65— All Ages. Months. f 1— 2 1 1 1 5 1 1 2— 1 1 1 1 1 5 1 1 1 1 4 3— 2 1 1 3 3 1 11 2 2 2 1 7 4— 2 9 2 6 3 2 2 7 5— 1 i 2 2 6 1 1 1 1 2 6 6— 1 11 6 12 6 3 1 40 2 4 3 7 2 3 1 ?.?, I 9- 1 1 6 6 8 3 1 1 27 2 3 1 6 Years. ( °— fi 3 3 19 15 29 17 6 2 100 7 3 1 10 10 14 3 3 2 53 1— 1 1 12 17 23 16 10 4 84 1 10 15 7 4 8 1 46 2— 1 6 16 19 11 4 57 1 5 14 9 5 3 2 39 3— 4 4 9 3 4 24 3 2 5 1 11 4— 1 2 2 6 3 14 1 4 3 2 1 2 13 5 6 5 6 3 20 1 4 3 g 10— 1 2 3 1 1 1 3 15— 20— 1 1 1,25—30 1 1 Average duration (Months). 7-25 7-00 466 15-50 2463 21-96 24-00 32-56 11-50 22-14 6-37 15-25 32-66 21-86 25-00 21-52 39-33 4111 65-87 27-7 While it is thought that the averages given for each sex-age group may be accepted as approximations to the true averages, those given for males, females and persons at all ages cannot be so accepted, unless it is shown that the sample of 476 deaths used for the estimation has a sex-age composition corresponding with that of the total deaths recorded. On page 28 is given a tabulation of the percentages of deaths at each age (sexes distinguished) in the sample 476 deaths, and in the total deaths during 1901-08. 28 TUBERCULOUS DISEASES. Males. Females. 0— 5— 10—15— 25— 35— 45— 55—65— J^11 0- 5-10- 15—25- 35—45—55—65- AU ages ages Total Deaths, Nu mbe rs. 1901-08 13 5 4 101 136 195 162 80 33 729 10 8 8 75 118 100 78 59 38 494 Sample, 1903-08 8 4 3 42 60 88 59 32 6 302 8 4 3 30 49 38 18 18 8 176 Pg rcen tci^c s. Total Deaths ... 1*8 0*7 0*5 13*8 18'6 26*7 22*2 11*0 4*5 100 2 0 1*6 1*6 15 2 23'9 20 2 15*8 11/9 7 7 100 Sample 2*6 13 1*0 13'9 19'9 29 1 19 5 10 6 2*0 100 4 5 2*3 1*7 17 0 27'8 21*6 10*2 10*2 45 100 The figures given in the foregoing table show that corrections are necessary in the averages already given for males, females, and persons at all ages. Such corrections have been made by applying the averages for each sex-age group to the actual numbers of deaths recorded, and by striking averages of the theoretical total durations thus obtained. By this method the following averages were obtained :— Males, all ages ... 22*23 months Females, all ages ... 30*73 ,, Persons, ,, ... 25*66 ,, At present the only known records of any calculation of the average duration of •consumption are those of Bayle and Louis, quoted in the "Encyclopaedia of Medicine" (1835), Vol. IV., p. 276. The average duration obtained from their observations (based on hospital experience) was 23 months, or nearly 3 months less than the average (25*66, say, 26 months) given above. Bayle's and Louis's observations are of great age, and do not distinguish the sexes or the ages at death. It may be added in conclusion lhat among their cases were 2 lasting less than one month, and 5 lasting from 25 to 40 years. The 476 " sample " cases included 6 with durations of 1—2 months, while the longest durations were among men, 10 years, and among women, 30 years. Institutional Segregation.—So much stress has been laid on the part played by the isolation of consumptives in the recorded diminution of the mortality from the disease, that it has been thought desirable to place on record the proportions (percentages) of deaths in institutions of all classes. At present the records go back to 1901 only, but it is hoped to be able to carry them back to 1891 at least. Percentage of all Mortality from deaths from Phthisis Phthisis at Averages, in Institutions. all ages. 1901 ... 41*7 ... 1*041 1902 ... 39*8 ... 1*03 [ Percentage 42*3 1903 ... 42*1 ... 1*04 j Mortality 1*06 1904 ... 45*7 ... 1*12 J 1905 ... 40*4 ... 0*92' 1906 ... 41*0 . ... 1*09 Percentage 44*9 1907 ... 47*1 ... 1*04 Mortality 1*00 1908 ... 51*0 ... 0*97. CANCER. 29 CANCER. The deaths from the various new growths which are included under this general term numbered 159 in 1903, fell to 156 and 149 in 1904 and 1905, and increased thereafter to 164 in 1906, 178 in 1907, and 185 last year. The mortality (l-20) of the past year is the highest on record, and, while exceeding that of the previous year by 0*01 only, was 0*12 above the quinquennial mean rate (1'08). The mean rate for the five years 1891-94 was 0'86, 0'34 less than the rate for the past year. Referring to Table 10, it will be seen that the local rate (as recorded) was exceeded by that for Marylebone (1*22), and that in Hampstead and Willesden only were sensible reductions from the mean rates observed. In Table 19 the rates obtained by correction for sex-age variations in the populations are set out. The rates for the past year in Queen's Park (1*49), Maida Vale (1*32) and Church (1'42) Wards exceeded that for the Borough (1'07), while those for Westbourne (0*67), Lancaster Gate, West (0'88), and Hyde Park (0*85) were the only three lower than the mean rates. In the majority of the Wards the rates, both for 1908 and for 1903-07, exceeded the standard rates. Of the rates recorded during the year in the Metropolis and the districts adjacent to the Borough, those of Kensington and Hampstead were the exceptions to the general increase above the standard rates. TABLE 19. 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. 1908. Mean. 1903-07. 1908. Mean. 1903-07. Paddington 106 13-6 50-9 1-80 0-97 1-04 0-98 1-07 0-96 Queen's Park 152 9-1 51-7 1-73 1-72 1-32 0-83 1-49 1-03 Harrow Road 182 11-5 75-5 1-77 0-83 0-87 0-88 0-96 0-94 Maida Vale 68 12-6 43-4 1-82 0-55 0-93 1-01 1-32 1-18 Westbourne 104 13-4 46-3 1-80 0-96 111 1-17 0-67 0-85 Church 131 32-8 61-3 1-68 1-43 1-57 0-87 1-42 1-03 Lancaster Gate, West 70 2-6 15-2 1-84 0-21 0-30 1-02 0-88 0-96 Lancaster Gate, East 56 2-1 16-2 1-84 0-34 0-42 1-02 1-05 0-72 Hyde Park... 108 5-2 25-3 1-88 0-38 0-61 1-07 0-85 0-92 London 61 16-0 54-0 1-74 1-31 1-47 0-87 1-04 1-01 Kensington 77 14-8 41-7 1-78 0-94 1-18 1-02 0-84 0-85 Westminster 73 13-0 45-7 1-95 1-09 1-32 0-96 1-05 0-89 Marylebone 90 21-1 55-6 ]-85 1-08 1-48 0-99 1-08 0-99 Hampstead 36 6-4 29-6 1-75 0-76 0-73 0-92 0-83 0-91 Willesden 21 11-6 50-7 1-65 0-79 1-03 0-71 0-93 1-00 The numbers of deaths from the various forms of malignant new growths, and the parts affected by such growths, are given in Table 20, to which are appended the ages at death. The deaths comprised 70 of males and 115 of females, equivalent to mortalities of 1'06 and 1*30 per 1,000 of each sex, all ages. The mean rates for 1903-07 were 0*96 and 1T6 respectively. 30 CANCER. TABLE 20. Deaths from "Cancer." 1908. Seat of Disease. Carcinoma. Cancer. Epithelioma. Scirrhus. Sarcoma Malignant Disease. Other Forms. All Forms. m. *• m. f. m. f. m. f. m. f. m. f. m. f. m. f. I. Nervous System ... 1(< «)... 1 II. Organs of Special Sense III. Respiratory System i i i i 1 3 IV. Circulatory System ... ... . • . ... • . . ... ... ... ... ... ... ... ... ... . .. V. Digestive System. (a) Mouth 3 1 ... 2 . . . . •. ... . . . 1 ... ... ... ... 6 1 (b) Throat 4 ... 2 ... 1 ... ... ... ... 4 ... . . . ... 11 ... (c) Digestive tube 20 22 2 7 1 ... ... ... 1 ... 2 3 ... ... 26 32 (d) „ organs 2 9 3 6 ... ... ... l ... 1 1 1 ... 6 18 (e) Peritoneum ... ... 1 ... ... ... ... ... ... 1 (/) Omentum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VI. Lymphatic System 2 ... ... ... ... ... 2 ... ... 3 ... ... 2 5 VII. Urinary System 5 1 1 6 1 VIII. Generative System. (a) Uterus 15 ... 4 ... ... ... 1 ... 4 ... ... ... 24 (b) Breast i 14 5 "2 2 1 23 (c) Other parts ... .. • 1 1 1 ... . *. 2 ... 1 ... ... 3 3 IX. Osseous & Muscular Systems ... 2 1 2 1 5 1 X. Cutaneous System... ... 1 ... ... ... ... ... "i(fc ) i(c) 2 1 XI. Not sufficiently described ... ... ... ... ... ... ... 2(d) ... 2 Totals 36 66 10 23 7 1 ... 3 7 5 8 16 2 1 70 115 Ages at Death. , -*■ v 0— 10— . . . . .. . . . ... ... ... ... ... ... ... 15— 20— i i 25— "i "3 2 i 3 4 35— • 1 4 2 2 1 i 'l 5 7 45— 9 17 5 i 1 2 3 4 1 15 28 55— 10 17 *4 10 2 ... i 2 2 ... 6 1 ... 19 36 65— 11 16 4 4 2 ... 1 ... 3 3 ... 1 20 26 75— 4 9 ... 2 2 ... ... 1 ... ... 1 2 ... ... 7 14 (a) Glioma of rolandic area. (b) Rodent ulcer, left frontal region. (c) Rodent ulcer of forehead. (d) Malignant disease of pelvis and pelvic organs. A comparison of the returns for the two quadrennial periods 1901-04 and 1905-08 (not reproduced here) shows that there has been a considerable increase in the accuracy of diagnosis, shrinkages having taken place in the numbers of deaths certified under the more indefinite terms (e.g. "cancer" and "malignant disease") and in the determination of the site of the growth. As will be seen from the lower half of Table 20, the mortality from these growths falls mainly on persons of mature age. During the eight years, 1901-08, only 21 deaths (and those almost entirely from sarcoma) occurred at ages under 25 years. Below is a comparison of the mortality at ages above 25, for each sex, recorded during the past year and the quinquennium 1903-07. Cancer. Mortality per 1,000 Individuals. • 25— 35— 45— 55— 65— 75— 85— Males. 1908 ... 0-24 0*55 2-33 4'67 10-83 8'82 34'22 1903-07 ... 0-04 0-37 2-54 4-90 7-54 13-93 4'76 Females. 1908 ... 0'21 0-57 3-18 6*19 7*30 11*61 — 1903-07 ... 0-20 0-92 2-28 4-76 7-93 4-65 11-40 measles. 31 MEASLES. Nominally 1908 was a non-epidemic year as regards measles, and the reported cases, which numbered 1,236 in 1907, fell to 820. In the first quarter of the year the cases numbered 413, a figure in excess of the quarter's returns for all years except 1904. (See below.) The minimum number for any quarter during the year was that of the third, when 32 cases were reported, the smallest total for any quarter since 1904. A scrutiny of the enquiry cards reduced the total number of cases of measles to 779, excluding 28 cases of german measles, not always distinguished in the weekly analysis. 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 1908 413 301 32 74 820 779 The 779 cases occurred in 460 houses, giving an average of 1*6 cases per house, as compared with 1*9 in 1907, and 1*8 in 1906. The frequency of multiple cases in each of the six years, 1903-08, is indicated below :— 1908. 1907. 1906. 1905. 1904. 1903. Houses with 2 cases ... 130 194 100 257 166 141 3 „ ... 55 97 48 143 59 60 4 „ ... 15 30 15 43 25 30 5 „ ... 6 19 4 16 5 10 6 „ ... - 7 - 4 3 3 7 „ ... - 2 1 - 1 3 8 „ ... — 1 - - — 2 „ 9 ,, ... 1 The secondary cases numbered 319 and constituted 40'9 per cent, of the total, showing considerable reductions below the percentages for the two preceding years, viz., 46*6 and 44*4 respectively. The deaths registered as due to the disease numbered 36, one less than the total for the preceding year, recognised an epidemic year, when 1,284 cases were known. The 36 deaths comprised 19 of males and 17 of females, 2 of the latter at ages over 25 years. The fatality of the disease was 4'6 per cent., the highest recorded since 1903, when the disease was first statistically dealt with. The mean fatality for the five years, 1903-07, was 3*5 per cent. The fatality among males was 5*3, 1'3 above the average, and that among females 4T, IT above the average. The rates recorded in each of the past six years are given below. Measles. Fatality at all ages, per 100 cases. 1908. 1907. 1906. 1905. 1904. 1903. Males 5-3 3-3 3-4 2-9 5-2 5-2 Females 4-1 2-5 2-0 4-2 3-5 3-1 Persons 4-6 2-8 2-7 3-6 4-3 4-1 The fatality among males was the highest of the series, that for females being exceeded by the rate for 1904 only. 32 measles. TABLE 21. Measles. 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 26 18 42 42 42 35 48 55 62 58 134 179 1 6 6 25 Deaths 4 3 11 8 1 1 3 2 1 2 Fatality— 1908 ... 15-3 16-6 26-1 19-0 2-3 — 2-0 5-4 3-2 0-5 — — 8-0 1907 ... 17-3 151 8-7 4-7 6-5 5-7 1-1 — 0-9 0-7 0-4 1-1 —- — — 1906 ... 17-6 7-1 19-4 10-2 — 2-9 1905 ... 13-5 16-9 9-3 15-1 5-8 2-6 — 4-1 1-8 0-6 0-3 0-5 — — 1904 ... 26-9 ?0-9 13-6 3-8 1-7 3-8 3-1 4-7 1-2 VP, 2-2 1-2 ___ __ 5-5 1903 ... 7T 12-9 19-1 7-6 14-7 9-6 1-2 — — — The cases and deaths recorded during the year are distributed according to the sex and age of the patients in Table 21. It will be seen that the greater part of the increased fatalitv of last year fell on children in the second year of life, the fatalities at that age, viz., males, 26*2 and females, 19'0, exceeding all others with the exception of those at ages under one year recorded in 1904. The fatalities recorded in the different Wards ranged from 12"3 in Westbourne to zero in Lancaster Gate, East. Last year's rates were higher than the averages in four out of the eight Wards. (See Table 22.) The seasonal prevalence of the disease greatly influences the fatality. Patients attacked during the more inclement months of year, especially if proper care and nursing are wanting, are very prone to succumb to intercurrent attacks of bronchitis or other lung affection. With a view to illustrating this the following figures are submitted :— Percentages of Total Cases reported Non-Epidemic in each Quarter. Fatality Years. 1. 2. 3. 4. percent. 1908 50-3 36-7 3-9 9*0 4-6 1906 17-5 34-1 33-3 14-9 2-7 1904 84-2 10-9 2-0 2-6 4*3 Epidemic Years. 1907 8-8 24-5 22-3 44-3 3-1 1905 13-3 52-5 17-1 16-9 3-6 1903 5-6 19-9 25-1 49-1 4*1 During the three non-epidemic years, 1904, 1906 and 1908, the highest fatality was recorded in the last, when 50" 3 per cent, of all cases occurred in the first or winter, and 36*7 per cent, in the spring (last year more like winter) quarter, and the lowest in 1906, when nearly three-fourths of all the cases occurred in the second and third quarters. Of the fatalities recorded in the three epidemic years that of 1907 was the lowest, the attacks being almost entirely in the second, third and fourth quarters of the year. The highest fatality was recorded in 1903, when the disease prevailed mainly in the third and fourth quarters, nearly half of all the cases occurring the latter. To demonstrate the point fully the meteorological elements for each quarter require to be set out, and the deaths distributed according to date of attack not of death, as has been done in the figures given above. Limitations of time and space prohibit that work being undertaken for the present. measles. 33 TABLE 22. Measles. Ward Distribution of Cases and Deaths. 1903. 1904. 1905. 190C. 1907. 1908. Mean Fatality, 1903-07. Queen's Park ... i I C* 150 288 244 134 184 148 D. 4 15 3 1 2 8 F. 8-0 5-2 1-2 0-7 1-0 5-4 2-7 Harrow Road ... / C. 185 231 461 127 332 152 D. 8 10 20 4 8 6 F. 4-3 4-3 4-3 3-1 2-4 3-2 3-6 Maida Vale ... C. 113 69 185 40 203 63 D. 2 6 5 3 5 1 F. 1-7 8-7 2-7 7-5 1-4 1-5 3-4 Westbourne C. 221 79 187 136 133 73 D. 9 1 7 4 4 9 F. 4-0 1-2 3-7 2-2 3-0 12-3 3-2; Church ... " C. 321 129 434 72 374 160 D. 15 5 25 4 15 9 F. 4-6 3-8 5-7 5-5 4-0 5-6 4-S Lancaster Gate, < West L C. 10 54 27 41 16 29 D. — 1 — — — 1 F. — 1-8 — — — 3-4 0-6 Lancaster Gate, East t C. 11 27 65 14 9 48 D. — 1 1 — — — F. — 3-7 1-5 — — — 1-5 Hyde Park ... -j C. 18 19 111 28 33 106 D. 1 — 2 — 3 2 F. 5-5 — 1-8 — 9-0 1-8 2-9 Bokough 1 C. 929 896 1714 592 1284 779 D. 39 39 6# 16 40 36 F. 4-1 4-3 3-6 2-7 3-1 4-5 3-d * C.—Cases. D.—Deaths. F.— Fatality per cent. The mortality of the disease last year was at the rate of 0'23 per 1,000 persons of all ages, the mean rate for 1903-07 being 0*25 (0*26 nearly). From the figures in Table 10, it will be seen that the local rate (there given as 0*22) was exceeded by the rates for the Metropolis (0'31) and Willesden (0'36) only. The rate in the last named district was the only one in excess of the quinquennial mean. After correction for sex and age (Table 23) the Kensington rate (0*36) is found to exceed that in the Borough (0*28), as well as those of Willesden and the Metropolis (both 0'31). TABLE 23. Measles. Whooping Cough. Standard Rate. Corrected Rate. Standard Rate. Corrected Rate. 1908. 1903-07. 1908. 1903-07. Paddington 0-43 0-28 0-32 0-39 0-09 0-30 London... 0-58 0-31 0-41 0-50 0-20 0-32 Kensington 0-47 0-36 0-36 0-35 0-04 0-42 Westminster ... 0-36 0-05 0-26 0*31 0-06 0-22 Marylebone 0-42 0-19 0-38 0-36 0-14 0-30 Hampstead 0-40 0-07 0-17 0-34 0-07 0-17 Willesden 0-66 0-31 0-30 0-57 0-07 0-30 34 WHOOPING COUGH. The variations in the mortality recorded in the different Wards are shown below. Oueen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1908 ... 0-47 0*19 0*04 0-34 0-31 0*11 0-14 1903-07 0-29 0-34 0-20 0-19 0-46 0-02 0-04 0-08 WHOOPING COUGH. This disease was non-epidemic during the year and the 170 cases reported constituted the smallest total on record, but was only one case less than the number reported in 1906. The diminution in the number of cases reported is the more satisfactory as it is believed that more attention has been given during the past year to reporting cases. The numbers of cases reported in each quarter of the past six years are given below. Year. Quarters 1. 2. 3. 4. Uncorrected. Corrected. 1903 ... 281 35 11 12 ... 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 1908 ... 34 65 37 35 ... 171 ... 170 The 170 cases occurred in 101 houses, giving an average of 1*6 cases per house, the averages in the three preceding years having been T7, 1*9 and 1*6. The frequency of multiple cases is indicated in the appended tabular statement. The secondary cases numbered 69, equal to 40'5 per cent, of the total. 1908. 1907. 1906. 1905. 1904. 1903. Houses with 2 cases ... 22 99 31 93 29 71 „ 3 „ ... 16 49 17 44 12 44 4 „ ... 5 12 4 13 5 12 5 „ ... — 4 1 3 6 8 6 „ ... — 1 - — 2 2 7 - — 1 - 1 The deaths from whooping cough numbered 11, viz., 7 of males and 4 of females. The fatality of the disease was at the rate of 6*5 per cent., the lowest recorded since 1903, when statistics of this disease were first compiled. The fatality among females (4*3) was half the average for the preceding five years (8'6), while that among males (8'8) was equal to the average. whooping cough. Fatality per cent, of cases. 1908. 1907. 1906. 1905. 1904. 1903. Males 8-8 9-2 8-3 9-6 8-0 9-0 Females 4-3 7-8 6-9 10-2 8-3 9'4 Persons 6-5 8-4 7-6 9-9 8-1 9-2 In Table 24 the cases and deaths have been distributed according to the residences of the patients (in Wards). The fatalities in Harrow Road (10*5) and Church (12*5) Wards were the only two in excess of the averages. In Table 25 the sex and age-groups fatalities are given. WHOOPING COUGH. 35 TABLE 24. Whooping Cough. Ward Distribution of Cases and Deaths. 1903. 1904. 1905. 1906. 1907. 1908. Mean Fatality, 1903-07. Queen's Park ...{ C.* 134 8 126 31 112 41 D. 11 2 10 1 9 1 F. 8-2 25-0 7-1 3-2 8-0 2-4 8-0 Harrow Road ...<| C. 147 58 165 27 224 38 D. 14 3 12 3 17 4 F. 9-5 5*1 7-2 11-1 7-5 10-5 7-8 Maida Vale " \ C. 57 4 48 22 65 16 D. 5 1 8 1 7 1 F. 8-7 25-0 16-6 4-5 10-7 6-2 11-2 Westbourne " ^ C. 121 45 39 17 76 13 D. 10 6 5 2 9 — F. 8-2 13-3 12-8 11-8 11-8 — 10-7 Church ... . C. 56 65 99 56 75 40 D. 9 3 8 4 7 5 F. 16-0 4-6 8-0 7-1 4-0 12-5 8-8 Lancaster Gate, < West ( C. 1 7 — — 13 2 D. 1 — 1 1 F. ? — ? — 7-6 14-2 Lancaster Gate, < East ( C. 7 4 17 — 1 9 D. 2 1 F. ? ? 10-3 Hyde Park " f C. 10 5 46 18 23 11 D. 1 — 6 2 — — F. 10-0 — 13-0 11-1 — — 8-8 C. 533 196 540 171 589 170 Borough ...< D. 53 16 50 13 50 11 F. 9-9 8-1 9-2 7-6 8-4 6-4 8-9 * C.—Cases. D.—Deaths. F.—Fatality per cent. TABLE 25. Whooping Cough. 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 7 .7 10 10 10 9 6 12 18 14 28 39 ___ Deaths 2 3 3 1 ~~~ 1 1 ■ Fatality— 1908 ... 28-5 42-8 30-0 10-0 16-6 8-3 — — — 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 36 OTHER INFECTIOUS DISEASES. That the time of year has an influence on the mortality from whooping cough similar to that noted in the case of measles, is evidenced by the following figures:— Percentage Distribution of Cases. Fatality Quarters 1. 2. 3. 4. Year. 1903 82-8 10-3 3-2 3-5 9*9 1904 11-9 13-9 23-3 50-7 8-1 1905 42-2 44-7 6-6 6*3 9-2 1906 32-7 37-3 14-9 14-9 7*6 1907 30-7 49-5 11-8 7-8 8-4 1908 19-8 38-0 21*6 20*4 6-4 In the year with the highest fatality (1903, 9*9 per cent.) over 80 per cent, of the cases occurred in the winter quarter, while in that with the lowest (1908, 6*4 per cent.) not quite 20 per cent, of the cases occurred in that quarter. The mortality from the disease in the whole Borough was 0*07 per 1,000 persons the lowest on record since 1891. The mean rate for the five years 1903-07 was 0*24, rather more than three times the rate for last year. Rates lower than that for the Borough were recorded in Kensington (0*03), Westminster (0*04) and the Hampstead (0*05). Last year's rates were in every instance below the means. The mortalities in the Wards of the Borough are given below, that in Church Ward (0'17) being the highest. Whooping Cough. Mortality rates, per 1,000 persons. Queen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1908 ... 0-05 0-13 0-04 0-17 1903-07 0-39 0-33 0-22 0-25 0-22 0-06 0-07 0-12 OTHER INFECTIOUS DISEASES. The Staffs of the Public Elementary Schools report to the Department all cases of german measles, mumps, and ringworm—in addition to those of measles and whooping cough already dealt with—occurring among their scholars. Last year 28 cases of german measles, 241 of chicken pox (subsequently corrected to 229), 93 of ringworm and 56 of mumps were so reported. The attacks of german measles are so frequently confused with those of measles, that no separate weekly tabulation is kept of the two diseases. As regards the others the numbers reported in each quarter of last year are set out below. One death only (from chickenpox) occurred among the cases reported. Quarters 1. 2. 3. 4. Year. Chickenpox ... 46 78 34 83 241 Ringworm ... 18 35 18 22 93 Mumps ... ... 10 8 3 35 56 OTHER DISEASES. 37 OTHER DISEASES. Table 26 contains the mortality statistics relating to the remaining diseases selected for special comment. Epidemic influenza caused a slightly increased mortality (0*40, mean 0*26), the increase being most marked in the Lancaster Gate Wards (West, rate, 0*69, mean 0T8; East, rate 0*74, mean 0*25). TABLE 26. Epidemic Influenza. Respiratory Diseases. Alcoholism. Cirrhosis of Liver. Suicide. 190S. 1903-7. 1908. 1903-7. 1908. 1903-7. 1908. 1903-7 1908. 1903-7. Borough 0*40 0-26 2-11 2-17 0-05 o-io o-io 0-16 o-ii 0-09 Queen's Park... 0-41 0-24 2-80 2-44 O'll 0-05 o-io o-ll 0-10 Harrow Road 0-32 0-21 1-96 2-11 0-05 0-16 0-17 0-09 Maida Vale ... 0-48 0-31 1-73 1-75 0-09 0-14 0-14 0-21 0-14 0-06 Westbourne ... 0-38 0-26 2-44 2-06 0-07 0-13 0-15 0-20 0-19 0-09 Church 0*27 0-28 2-37 2-97 0-03 0-13 0-03 0-14 o-io 0-07 Lancaster Gate, West ... 0-G9 0-18 1-62 V22 ... 0-04 ... 0-11 0-11 0-11 Lancaster Gate, East ... 0-74 0-25 0-99 1-08 0-12 0-07 0-28 0-20 0-02 Hyde Park 0-42 0-27 1*97 1-66 0-07 0-14 0-07 0-11 0-21 0-15 The mortality from the respiratory diseases was a little below the mean (2*11, mean 2T7), but the rates for Westbourne, Lancaster Gate, West, and Hyde Park Wards were above their means. In Lancaster Gate, West, Ward the increased rate was doubtless due to epidemic influenza. Although no deaths from suicide were registered in Harrow Road and Lancaster Gate East, Wards, the rate from this cause in the whole Borough was slightly above the mean The largest increases were recorded in Maida Vale and Westbourne Wards. Alcoholism.—The mortality from the more severe forms of this habit was half the mean rate, but was in excess of the mean in Queen's Park and Lancaster Gate, East, Wards. The mortality from cirrhosis of the liver (taken as an index of the milder, and more insidious, habit of drinking) showed a decline from a mean rate of 0T6 to 0T0. The rate in Lancaster Gate, East, Ward was the only one in excess of the mean. The combined rates from "alcoholism" and "cirrhosis of the liver" are given below. To the general reduction in the rates of last year, that in Lancaster Gate, East, Ward is the solitary exception, last year's rate (0*40) comparing very unfavourably with the mean rate (0'27). Alcoholic Excess. Mortality per 1,000 persons. Borough. Oueen's P-\rk. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. 1908 0*15 o-ii 0-16 0*23 0-22 0-06 0-40 0-14 1903-07 0-26 0-15 0-22 0-35 0-33 0-27 0-15 0-27 0-25 38 MORTALITY OF CHILDHOOD. MORTALITY OF CHILDHOOD. This section of the report will deal with the mortality among children at ages under five years. Infantile Mortality.—The deaths of 374 infants under one year of age were registered within the Borough during the past year (53 weeks), equal to crude mortality of 118 per 1,000* births (uncorrected*), the lowest rate on record. In 1907 the mortality was 128, and the mean rate for the ten years, 1898-1907, 144. (Table I., Appendix A.) In the subjoined statement the crude rates for the four quarters of the past year are compared with the corresponding rates for the previous quinquennium. Crude Infantile Mortality. Quarters 1. 2. 3. 4. Year. 1908 134 90 119 131 118 1903-07 132 108 158 137 134 After correcting the deaths for non-residents and for out-lying deaths, a total of 348 is obtained, 6 fewer than that for 1907 (52 weeks). Calculating the rate on the uncorrected births, the usual practice, the infantile mortality last year was 110, 5 per 1,000 less than in 1907 (115), and 8 less than the mean rate for 1903-07 (118). The mean rate for the five years 1893-97, was no less than 150. The rates just given may be used for comparison with the experience of other districts. (See Table 10.) The rates for the Metropolis (112) and Kensington (126) were only two which exceeded the local rate for last year. In every area last year's rate was less than the mean, the greatest difference (a decrease of 22 per 1,000) being recorded in Marylebone. In studying the mortality experience in the different divisions of the Borough (since 1905) it is customary to use rates based on the corrected deaths and births. The fully corrected rates for the whole Borough during the past four years have been—1905, 118; 1906, 107; 1907, 110; and 1908, 105. The 348 deaths at ages under one year, recorded last year, comprised 198 of males and 150 of females, the mortalities being 118 for males and 92 for females, both "minimal records. (See Table 27.) In three Wards, viz., Westbourne (108), Church (138) and Hyde Park (122), the rates exceeded that for the Borough (105). The lowest rates were those of the two Lancaster Gate Wards, viz., 29 in the Western and 61 in the Eastern. The total mortality for the two Wards was 45 per 1,000, and if that rate be taken as a standard (expressed as "100") the "index numbers" for the separate Wards and the Borough given in Table 27, show the extent to which the actual rates differed from the standard. Those "index numbers" ranged from 64 for Lancaster Gate, West, Ward to 306 for Church Ward. In judging the value of the index numbers it has to be borne in mind that the standard is based on very small numbers, viz., 133 births and 6 deaths. A difference of 2 deaths (say, one in each Ward) would increase the mortality selected as the standard by onethird, from 45 to 60. A surer guide would be a standard based on an average experience of five or more years, but the necessary data are not yet available. * The uncorrected births represent the births registered within the Borough ; the corrected births, the total arrived at by deducting those children who were born in the Borough to non-resident parents and adding the births of children bom in out-lying districts to residents of the Borough. MORTALITY OF CHILDHOOD. 39 TABLE 27. Infantile Mortality. Proportional Mortality. Males. Females. Persons. Persons. 1908. 1907. 1906. 1905. 1908. 1907. 1906. 1905. 1908. 1907. 1906. 1905. 1908. 1907. 1906. 1905. Borough ... 118 131 115 128 92 87 99 109 105 110 107 118 233 126 160 214 Queen's Park 110 115 96 164 69 92 87 76 90 105 92 122 200 120 137 221 Harrow Road ... 113 137 90 116 68 75 58 113 92 106 75 115 204 121 112 209 Maida Vale 101 118 145 116 99 96 69 124 100 108 107 120 222 124 160 218 Westbourne 99 102 123 111 118 98 120 120 108 100 121 112 240 114 180 203 Church ... 149 154 140 151 126 99 155 141 138 128 146 146 306 147 218 265 Lancaster Gate, West ... 29 97 62 83 29 64 32 28 29 83 48 55 64 95 72 100 „ East ... 69 125 86 41 58 60 83 71 61 92 85 55 135 105 126 100 Hyde Park 163 163 103 130 74 47 154 41 122 107 126 86 271 123 188 156 Lancaster Gate, East and West ... 47 109 75 59 42 62 60 51 45 87 67 55 100 100 100 100 Ratios of rates (persons) Lancaster Gate Wards. 1905: 1906: 1907: 1908:=: 100: 121: 158: 81. In past years, when the earliest intimation of a birth which the Department received was its registration, attention was called to the number of births described (for want of a better term) as " hopeless," being the births which were registered simultaneously with, or subsequent to, the registration of the children's deaths. In 1905, 87 such births were reported; in 1906,89; and in 1907, 124. The increase in number was attributed more to greater expertness in checking the two sets of returns rather than to any increase in the numbers of such births. Last year 104 such births were recorded, 58 of boys and 46 of girls. All but 10 of the children died before completing the first month of life, 74 of the deaths being attributed to diseases of development (premature birth, &c.). (See Table 28.) At least 13 of the deaths, namely those from diarrhoea (6), respiratory diseases (5), and overlaying (2), were due to preventible causes. If the 104 "hopeless" births be eliminated from calculation, the infantile mortality for last year is 76 per 1,000 and not 105. By the adoption of the Notification of Births Act the Department should receive information of a birth within two days of its occurrence, instead of six or seven weeks as under the old system. The usual period of attendance by a doctor or midwife after a birth is 10 to 14 days. It is undesirable, except in particular cases, for a visit to be made by the Officers of the Department until that period has expired. It may, therefore, be assumed that all cases requiring advice and help will be visited within three, or at the most four, weeks of the date of the birth of the child. Under the new regime children dying, from any cause except accident (overlaying, &c.), under one month old, and those dying from premature birth and congenital malformations at older ages, should, it is thought, be regarded as "hopeless births." A reference to Table VII., Appendix A., will show that 124 children died last year under one month old, including 4 from overlaying, and that there were 17 deaths from premature birth, and congenital malformations, and one from injury at birth, at ages over one month, giving a total of 138 "hopeless births" according to the rule just suggested. The elimination of those 138 children from the calculations of infantile mortality would reduce the rate from 105 to 66 per 1,000 births, which latter figure may be taken as the datum from which the results of health visiting should should be measured. 40 MORTALITY OF CHILDHOOD. TABLE 28. " Hopeless Births." Days. Week'. Month. Total. 0— 1— 2— 3— 4— 5— 6— 1— 2— 3— 1—2 M. F. M. F. M. F. M. F. M. F. M. F. M. F. J I. F. M. F. M. F. M. F. M. F. p. Not certified 2 3 — 1 3 3 6 Diarrhoea ... — — — — — — — — 1 1 1 — 1 2 — 4 O u 6 Premature Birth ... 9 4 1 3 1 1 2 2 1 2 2 2 2 2 3 1 1 23 16 39 Congenital Defects. 1 1 — 1 1- 2 2 — 1 1 5 5 10 Injury at Birth 2 1 1 — —r — — — — — 3 1 4 Want of Breast Milk — — — — —" 1 — — — — 1 — 1 Atrophy, Debility... — — — — 1 — 1 — 1 1 2 Atelectasis ... 2 4 — — — — 2 4 6 Debility at Birth ... —. 1 2 1 2 — 1 —[ 1 1 1 — 2 6 6 12 Syphilis — — — — —- 1 — — — 1 1 1 2 Convulsions — 1 — — 1 —r 2 1 — 1 — — — — 4 2 6 Respiratory Diseases — — — — — — —" 1 — 2 — 1 1 4 1 5 Suffocation (Overlaid) 1 L 1 2 2 Other causes — — 1- 1 — ] — — — — 1 2 3 All Causes 16 12 5 6 3 1 3 4 2 1 2 1 1 1 8 5 9 5 4 5 5 5 58 46 104 Comparing the 348 deaths of last year (Table VII., Appendix A.) with the average number for the five years 1903-07 (not corrected for the reduced numbers of births), it appears that the former figure represents a saving of 39 lives, 20 of male and 19 of female. On grouping the deaths according to ages (see below) it is found that at ages under one month there were 8 more deaths last year than the average, viz., 205 deaths, 1908; 197, 1903-07. The whole of the decrease in mortality occurred among children surviving the first month of life. Lives gained (—). 1908. 1903-07. Lost ( + ). M. F. M. F. M. F. Under one month ... 66 58 ... 66 52 ... +0 +6 Aged 1-3 months ... 50 31 ... 46 33 ... +4 —2 Under 3 months ... 116 89 ... 112 85 ... +4 +4 Aged 3-6 „ ... 38 29 ... 45 37 ... —7 —8 6-9 „ ... 20 15 ... 33 24 ... —13 —9 9-12 „ ... 24 17 ... 28 23 ... —4 —6 Examining the causes of death it will be found that the numbers of deaths from all the groups of diseases, except the "Wasting Diseases" (premature birth, malformations, &c.), were lower last year than during the preceding quinquenninm. The diminution in the numbers of deaths from the " Diarrhceal Diseases " * is gratifying and may be accepted as some evidence of the benefits accruing from the health visiting which has been accomplished during the past few years. * A Special Report on Infantile Diarrhoea will be found under Appendix B. at the end of this Report. 41 mortality of childhood. 4 1908. 1903-07. Lives gained (-). Lost ( + ). Group. M. F. M. F. M. f. I.-" Common Infectious Diseases " 7 8 12 13 -5 -5 11.-" Diarrhoeal Diseases " 42 25 52 38 -10 -13 III.—" Wasting Diseases " 76 61 73 54 +3 + 7 IV.—" Tuberculous Diseases " 4 4 11 7 -7 -3 V.—Other causes 66 48 70 57 -4 -9 The comparison of the distribution by causes is even more satisfactory when rates per 1,000 births are used instead of numbers. (See below.) Infantile Mortality. Per 1,000 Births registered within the Borough. 1908. 1903-07. Group. M. F. M. F. I.-"Common Infectious Diseases" 4.35 5.19 7.36 8.26 II.-" Diarrhœal Diseases " 26.10 16.23 31.92 24.17 III.-" Wasting Diseases " 47.23 39.61 44.81 34.35 IV.-" Tuberculous Diseases " 2.48 2.59 6.57 4.45 V.—Other Causes 41.01 31.16 42.97 36.25 The mortality rates which prevailed last year in the insnlœ specially marked out on account of their conditions of housing, class of inhabitants, &c., are given in Table 29. It will be seen that, with the exception of "Queen's Park" (the Estate) all the rates were considerably in excess of that prevailing in the Borough as a whole (105). On the other hand, except in "Clarendon Street," where last year's rate was the highest since 1905, the mortality shows a tendency towards reduction when the rates for the five years are examined. If the total mortality in the six insulaœ combined, the rates for the last three years are found to be 1906, 137; 1907, 126; and 1908, 120. The extent to which the high rates in the insulœ affect the rates of the Wards within which such insulœ are situated, is shown from the appended statement. In Queen's Park Ward only, is the rate raised by excluding the mortality in the " Queen's Park " insula. Ward No. 1908. 1907. 1906. I.—Queen's Park— Whole Ward 90 105 92 Remainder 161 129 176 III.—Maida Vale- Whole Ward 100 108 107 Remainder 93 79 98 IV.—Westbourne— Whole Ward 108 100 121 Remainder 90 86 125 V.—Church— Whole Ward 138 128 146 Remainder 114 89 87 In Table 30 the combined mortality rates in the insulœ are compared with those for the rest of the Borough. The rates at ages under three months are considerably higher in the insulœ than those in the rest of the Borough, but it is somewhat unexpected to find that 42 MORTALITY OF CHILDHOOD. TABLE 29. Infantile Mortality In Special Insulœ. Ward. 1908. Infantile Mortality. Births. Deaths, 0—1. 1908. 1907. 1906. 1905. V. "Hall Park " 152 18 118 107 221 196 V. "North Wharf" 105 13 123 94 141 150 IV. "Alfred Road" 151 23 152 132 115 146 III. "Amberley Road " 83 11 132 107 153 192 V. "Clarendon Street" 281 48 170 146 151 165 I. "Queen's Park " 324 19 58 96 89 134 TABLE 30. No. of Deaths. Mortality Rates. Combined Insulœ. Rest of Borough. Combined Insulcœ. Rest of Borough. Causes of Death. Not Certified 4 3 - - Measles 2 5 1.84 2.26 Scarlet Fever 1 - 0.92 - Diphtheria - 2 - 0.90 Whooping Cough 2 3 1.84 1.35 Diarrhœa 13 34 11.97 15.38 Enteritis 8 12 7.36 5.43 Premature Birth 13 42 11.97 19.00 Congenital Defects 1 25 0.92 11.31 Injury at Birth 1 6 0.92 2.71 Atrophy, Debility 17 29 15.65 13.12 Tuberculous Diseases 2 6 1.84 2.71 Syphilis 4 4 3.68 1.81 Convulsions 5 4 4.60 1.81 Respiratory Diseases 33 25 30.38 11.31 Violence 9 5 8.28 2.26 Other Causes 19 9 17.49 4.07 134 214 119.70 95.47 Ages at Death. Under 1 month 45 79 41.43 35.74 1-3 months 35 46 32.22 20.81 Under 3 months 80 125 73.66 56.56 3- „ 26 41 23.94 18.55 6- „ 12 23 11.04 10.40 9- „ 16 25 14.73 11.31 MORTALITY OF CHILDHOOD. 43 the rates from premature birth, congenital defects and injury at birth in the rest of the Borough exceed those in the insnlœ. Looking at the mortalities by causes and by ages together, the conclusion suggested is that in the insulœ the children are more vigorous at birth, but suffer more heavily from parental neglect and ignorance than do those in the rest of the Borough. The mortalities by causes are summed up below in the five groups used in other parts of this report. Combined Rest of Group. Insulœ. Borough. I.-" Common Infectious Diseases" 4. 60 4.52 II.-" Diarrhœal Diseases" 19.33 20.81 III.-"Wasting Diseases" 29.45 46.15 IV.-" Tuberculous Diseases" 1.84 2.71 V.-Other causes 64.45 21.27 Mortality among Illegitimate Children.—Among the deaths registered during the past year in the Borough were 44 of children entered as illegitimates, including 5 of non-resident parents. Outside the Borough there were 3 deaths of such children belonging to the Borough, making a nett total of 42 deaths, 23 of males and 19 of females, 32 of them being under one year of age. The infantile mortality among such children was at the rate of 214 per 1,000 births registered within the Borough, the corresponding quinquennial mean being 256. Among legitimate children the mortality last year was 105, and the mean, 113, demonstrating the heavy incidence of mortality among the former class. A comparison of the rates calculated on the fully corrected numbers of births, makes the case rather worse, the mortality among illegitimate children for last year being not only more than double that among legitimate, but also showing no reduction from the mean rate. (See below.) Among illegitimate male children last year's mortality was 250 per 1,000, that among female 173, the corresponding rates for legitimate males being 111, and for females 88. The causes of death of illegitimate children during the past year, and certain other particulars relating thereto, are set out in tabular form below. Infantile Mortality. Fully corrected. Legitimate. Illegitimate. 1908 100 211 1903-07 110 212 Occupations of Mothers. Domestic Service 26 Cook 3 Housekeeper 3 Housemaid 4 "Servant" 10 Parlourmaid 1 General Servant 4 Companion 1 Trades, &c. 14 Post Office 1 Dressmaker 1 Book-keeper 2 Machinist 1 Barmaid 1 Laundress 1 Flower-seller 2 Ironer 1 Charwoman 4 No occupation, occupation not stated 2 Deaths of Illegitimate Children. 1908. Ages (yrs.) Males. Females. Persons. 0- 19 13 32 1- 4 6 10 5- - - - Totals 23 19 42 Causes of Death. 0- 1- m. f. m. f. Scarlet Fever - 1 2 1 Diarrhceal Diseases 5 2 2 Enteritis 4 - - 1 Syphilis 2 - - - Tuberculous Diseases - - - 1 Premature Birth 2 2 - - Developmental Diseases 5 4 1 — Respiratory Diseases 1 2 1 1 Overlaid - 1 - - Not Certified - 1 - - Totals 19 13 4 6 Four deaths certified after inquest. 44 MORTALITY OF CHILDHOOD. Mortality at ages one to five years.—In Table 9 the sex mortalities are given for the combined age-group 1-5 years. Last year the rates for the whole Borough were 16.36 for males and 12.95 for females, the quinquennial mean rates being 18.88 and 15.26 respectively. On calculating the rates for each year, it is found that at ages of 1 and 2 years, last year's rates were below the mean rates and those for ages 3 and 4 years, above. (See below.) Mortality rates per 1,000 persons. Ages 1- 2- 3- 4-5 1908 28.05 11.32 10.41 4.91 (1903-07) (1904-07) (1905-07) Mean rates 33.13 13.23 7.69 4.72 The figures given in Table 31 help to explain the increased mortality at the older ages, which was due, at ages 3-4 years, to increased mortality from measles, scarlet fever and diphtheria, and, at ages 4-5 years, to increased mortality from the tuberculous diseases. Those increases would be greater were the numbers of deaths during the past year increased to compensate for the smaller numbers of the estimated living at each age. It has to be remembered that with such small numbers of living, very slight increases in the numbers of deaths make considerable variations in the mortality. Further, such diseases as measles and whooping cough are so peculiarly special to the ages now dealt with that the epidemicity or otherwise of those diseases, which occurs with almost uniform regularity each alternate year, gives rise to wide fluctuations in the mortality of each successive year. A long series of years is requisite to yield averages suitable for the study of the mortality at these ages. TABLE 31. Ages (Years). 1- 2- 3- 4-5 1908. Averages 1903-07. 1908. Averages 1903-07. 1908. Averages 1904-07. 1908. Averages 1905-07. Smallpox - - - - - 0 - - Measles 19 15 1 8 4 3 2 2 Scarlet Fever 1 2 2 2 6 2 - 1 Whooping Cough 3 12 1 5 2 3 - 1 Diphtheria 3 2 2 3 5 2 - 2 Diarrhœa 9 11 - 2 1 0 - - Influenza - 1 2 1 - - - 0 Syphilis - - - 0 - - - - Rickets 1 3 - - - - - - Tuberculous Diseases 7 8 5 5 3 3 6 2 Congenital Malformations - 0 - - - - - - Convulsions 2 3 2 1 1 0 - - Respiratory Diseases 25 29 11 6 - 3 2 2 Dentition 2 2 2 0 - - - - Gastro-Enteritis 1 1 - - 1 0 - 0 Accident, Violence 2 1 2 2 3 3 3 2 Atrophy, Debility 1 1 - 0 - - - - Other Causes 4 8 2 4 3 3 1 2 All Causes 80 99 32 39 29 22 14 14 Estimated Living 2,852 2,992 2,825 2,912 2,784 2,895 2,850 2,880 MORTALITY OF CHILDHOOD. 45 In Table 32 the mortality for each age recorded in the Wards of the Borough since 1906 are given, distinguishing the sexes. The violent fluctuations in the figures are explained by what has been written above. Such a table as the last will attain much value a few years hence. TABLE 32. Ages (Years) 1- 2- 3-4 1908. 1907. 1900. 1908. 1907. 1908. m. f. m. f. m. f. m. f. m. f. m. f. Borough 30.4 25.6 44.0 29.0 26.6 24.9 14.4 8.0 16.8 17.7 7.8 13.0 Queen's Park 32.7 22.7 46.0 45.2 16.3 36.2 19.3 5.2 11.1 10.7 5.5 5.4 Harrow Road 23.2 21.7 30.3 15.5 16.4 30.6 7.8 7.8 16.7 20.1 8.4 14.6 Maida Vale 40.0 16.8 65.5 9.9 32.9 5.2 17.5 5.0 11.3 21.1 - 21.6 Westbourne 29.7 36.5 38.6 41.8 25.9 9.0 10.0 5.4 22.2 9.0 18.1 18.3 Church 31.9 36.9 60.7 44.2 47.3 45.0 23.5 14.2 12.4 30.3 9.4 10.4 Lancaster Gate, West 27.0 - 33.3 - - - - - - - - - „ East 35.7 - 31.2 - 21.2 - - - 21.7 - - - Hyde Park 25.9 12.0 10.4 39.0 11.4 10.7 10.5 13.5 46.5 10.8 - 10.9 Child Rearing.—The record of the efforts made during the past year towards limiting the mortality of infants would be very incomplete if no mention be made of the work done by the visitors of the Health Society. While the Staff of the Department (Women Inspectors and students) visited the mothers of 1,007 children, the Society's workers visited those of 949 children, making a total of 1,956 children, equivalent to 62 per cent. of the births registered during the year. Speaking generally the visits are so welcomed (refusals of advice were less than 4 per cent.), and the progress of the children visited so satisfactory, that it is much to be desired that more work should be done in this direction. The calls paid by the Staff of the Department numbered 2,048, and those by the paid Visitor of the Society (3 days a week) 1,679. While the calls of the voluntary workers cannot be stated exactly, they may be estimated at 1,000, making a grand total of 4,727, not including calls which were useless owing to false addresses, removals, etc., estimated at 300. It has already been stated that the first visit is most conveniently made at some time during the 3rd or 4th weeks after the confinement. An analysis of the ages of the infants at the dates of the first visits show that 323 (16.5 per cent.) were paid before the infant was three weeks old, 961 (49T per cent.) when the infants were aged from 3—8 weeks, and 672 after that age. The methods of feeding at the time of the first visits are recorded, but hitherto it has not been the practice to note changes in feeding, date of weaning, etc. This has been due in part to the fact that only a (comparatively) small proportion of the children can be re-visited. As soon as the work can be extended to include more re-visits, more attention will be given to these important details. Of the infants under three months old, 80.7 were breast-fed, the 40 MORTALITY OF CHILDHOOD. remainder numbering 76, including 49 fed entirely by hand (bottle), 19 fed by the breast supplemented by various food, and 8 whose method of feeding was not stated. Of the infants of all ages, 78.6 were fed entirely on the breast. (See belcnv). Method of Feeding. Age of infant. Breast. Breast, etc. Bottle. Not stated. Totals. Weeks. 0- 28 - - - 28 1- 91 1 3 6 101 2- 171 7 14 9 191 13- 200 22 29 4 255 Months. 0- 490 30 46 12 578 1- 560 37 99 10 706 2- 254 19 49 8 330 3- 81 9 26 1 117 4- 32 7 8 1 48 5- 18 1 13 1 33 6- 13 1 8 - 22 19- - - - 1 1 Age not stated 91 4 17 9 121 A very considerable proportion of the children whose mothers were visited were firstborns, a fact of some importance, as any advice successfully inculcated on this occasion may be expected to bear fruit in the future. Notes as to the number of elder children were made with respect to 1,116 families, such children numbering 3,800—not including the infants whose births led to the calls—giving an average of 3.4 children per family. Losses of children by death were reported in 376 families (33.6 per cent.), the children dead numbering 665, equal to an average of 1.7 per family. The mortality was equivalent to 175 per 1,000 children— a high figure, but less than the rate (196.8) recorded among families visited in 1907. The visits are made the occasion for distributing the Department's booklet on Infant Rearing, or leaflets on the subject, as well as giving verbal advice. So far as the Staff of the Department is concerned, every endeavour is made to avoid any tendency to officialism, and to seek to cultivate the goodwill of the mothers. Most of the Society's workers are District Visitors well known to the mothers, and it is such workers who visit nearly all the infants before the third week. In addition to calls at the homes two "Consultation Centres" are maintained by the Societv, where infants can be weighed and medical advice obtained as to the methods best suited to each individual child. The Northern Centre was opened in April, 1908, and the Southern in November, 1907. The infants brought for advice during the past year numbered 209, and the attendances totalled 705. It is possible, from personal observation, to say that many of the children who were not progressing satisfactorily before being brought to the Centres, made steady improvement almost from the date of their first attendance. To encourage the continuance of suckling, grants of milk are made to mothers, 42 such grants being given during the year. Hand-fed children are also given milk, when the circumstances of the parents render such allowances necessarv. Twenty-three such grants were given. During 1907, 1,255 infants were visited, 57 of whom were known to fail to survive the first year of life, equal to a mortality of 42 per 1,000. Among the infants visited during 1906 the mortality was at the rate of 47 per 1,000. INQUESTS. 47 Distributing the 57 deaths according to the manner of feeding reported as being followed at the date of visit, it appears that 36 children were breast fed, 5 were fed on the breast supplemented by other food, and 16 were entirely artificially fed—or in two main groups, 36 naturally fed, 21 artificially. Those figures represent mortalities at the rate of 37 per 1,000 among naturally-fed children, and 74 per 1,000 among those fed artifically. The differences in age distribution of death in the groups is somewhat interesting. Age at death. Method of feeding, (months) Natural. Artificial. Under 1 month - 1 0- 5 5 3— 11 8 6— 14 7 9-12 6 1 It is surmised that the larger numbers of deaths among the naturally-fed at ages between 3 and 9 months—the largest numbers occurred in the 7th and 8th months of life—are connected with changes of diet due to weaning. The principal causes of death were respiratory diseases (20 deaths), developmental disorders (9 deaths), diarrhœal diseases (8 deaths), measles and whooping cough (4 deaths each). Below the deaths are grouped in the same manner as in other parts of this report. No comparative figures are available. Deaths. Mortality. N. A. N. A. I.-" Common Infectious Diseases" 6 2 6.1 7.0 II.-" Diarrhoeal Diseases" 2 6 2.0 21.1 III.-" Developmental Diseases" 5 5 5.1 17.6 IV.-"Tuberculous Diseases'' 2 - 2.0 V.-Other causes 21 8 21.6 28.1 " N "—Breast fed children (971). " A "—Children fed otherwise (284). Mortality rate per 1,000. There is no room for dispute as to the proper method of feeding infants. INQUESTS. Of the deaths registered within the Borough, 227 were certified after Coroner's Inquisition, 61 of the deceased persons being non-residents. Outside the Borough, 63 deaths of residents were certified under the same conditions, giving a nett total of 189 deaths dealt with by Coroners, equal to 9.9 per cent. of the total, the average for the preceding five years being 8.5 per cent. Table 33 gives a classification of the findings of the juries, in comparison with the averages for the preceding quinquennium. There Was a decrease in the number of deaths returned as due to "natural causes." Of the deaths found due to accidental causes, 11 were due to vehicular traffic, 4 to building operations, 12 (including 7 of young children) to fire (not conflagrations), 3 to surgical narcosis, 6 to drowning, 10 (all of young children) to overlaying in bed, 4 (including 3 of young children) to other forms of suffocation, 1 to ptomaine poisoning and 2 to injury at birth. 48 DEATHS IN INSTITUTIONS. TABLE 33. Inquests Held. 1908. Averages, 1903-07. Males. Females. Males. Females. Natural Causes 38 54 46 42 By Misadventure 6 3 3 3 Accidental Causes 34 31 31 20 Murder 1 - 0 0 Suicide 15 2 11 3 "Open" 2 1 2 2 "Neglect" 1 1 2 1 DEATHS IN INSTITUTIONS. The deaths in the local public institutions, which numbered 770 in 1907, increased to 815 last year. At all the institutions (Table V., Appendix A) last year's numbers exceeded the averages, especially that of the deaths in the Workhouse and Infirmary (373, average, 287). Included in the foregoing numbers are the deaths of 341 non-residents, while 187 deaths of residents occurred in outlying institutions (see Table VI., Appendix A), so that the nett number of deaths of residents was 662, equal to 35 per cent. of all deaths, as compared with 32.5 in 1907 and an average of 30.5 for the preceding quinquennium. Below are the percentages for each Ward, from which it will be seen that the figures for four out of the eight were below the average, but none of them to any great extent. On the other hand, the increases noted in Westbourne and Church Wards, especially the latter, were very great. Percentages of all. Deaths. 1908. 1903-07. 1908. 1903-07. Queen's Park 29.7 31.3 Church 50.2 37.3 Harrow Road 33.3 28.0 Lancaster Gate, West 17.1 23.2 Maida Vale 29.6 27.1 „ East 18.8 21.7 Westbourne 34.6 29.8 Hyde Park 27.3 27.5 The proportion of deaths in lunatic asylums was a little below the average (2.2 per cent., compared with 2.4), the bulk of the increase last year being in the proportion dying in Poor Law Institutions, other than lunatic asylums. Rate-maintained— Deaths. Percentages of all Deaths. 1908. 1908. 1903-07. Hospitals of Metropolitan Asylums Board 30 1.5 1.2 Poor Law Workhouses and Infirmaries 377 19.8 16.5 Lunatic Asylums 42 2.2 2.4 Supported by Voluntary Contributions— Hospitals and Homes (excluding Nursing Homes) 212 11.3 10.1 49 TABLE 34. Report of the Work of the District Inspectors during the year 1908. Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Drainage, &c. Water Supply. Dust Receptacles. Miscellaneous. Quarters. 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 129 155 498 - 4,619 70 40 44 21 103 29 5 2 2 30 - 10 20 30 62 4 - 36 5 22 - Second 136 77 577 - 4,734 72 24 47 36 116 44 5 3 - 15 - 11 6 22 53 1 - 5 1 30 2 Third 76 30 667 - 4,110 46 39 78 34 147 39 6 2 1 35 - 21 17 20 52 7 - 25 - 43 - Fourth 115 77 815 - 4,526 115 48 66 45 150 42 6 3 - 35 - 38 18 25 47 5 - 25 - 14 1 Year 456 339 2,557 - 17,989 303 151 235 136 516 154 22 10 3 115 - 80 61 97 214 17 91 6 109 3 administrative work. 50 ADMINISTRATIVE WORK. ADMINISTRATIVE WORK* Prevention of Infectious Disease.—The calls made by the Staff with reference to all kinds of infectious disease, numbered 6,712 last year, as compared with 5,734 in 1907, and 4,388 in 1906. The District Inspectors made 2,747 calls with reference to diseases formally notified, as compared with 2,442 in the previous year, and the Women Inspectors and Students, 3,965 (3,292 in 1907) calls with reference to diseases not on the schedule for notification. In 1906 the latter made 2,330 calls. Last year's calls by the Women Inspectors related to— Measles 1,285 Chicken-pox 202 Whooping Cough 163 Diarrhœa 1,188 Consumption 1,119 Puerperal Fever 8 The number of patients removed to hospital for isolation and treatment, was 707 last year, against 694 in 1907, and 882 in 1906. "Letters of Advice," covering extracts from Public Health (London) Act, 1891, and the Factory and Workshop Act, 1901, with memoranda of precautions requisite to prevent the spread of infection, were sent out with reference to 46 patients who were treated at home, the number of such letters having been 55 in 1907, and 67 in 1906. In addition 3 special communications were addressed to midwives and others in charge of cases of puerperal fever, as compared with 6 in the preceding year, and 8 in 1906. Disinfection.—The disinfection of rooms occupied by persons suffering with infectious disease is carried out by the Department, by the use of formaldehyde spray. The rooms dealt with during the year numbered 2,223 (including 172 rooms after consumption), as compared with 2,552 in 1907, and 2,166 in 1906. In 7 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 of little value, and not equal in efficiency to ordinary domestic cleansing. The amount spent on disinfectants of all kinds, including materials for spraying of rooms, was £14 14s. last year. The disinfection of bedding, personal clothing, etc., is still carried out under contract by Messrs. Armfield, who do the work thoroughly well. 1 he goods removed during the past year weighed 53¼ tons, as compared with 48½ tons in 1907, 56 tons in 1906, and 67 in 1905. The cost of the work amounted to £1,082 last year, £1,087 in 1907, £1,148 in 1906, and £1,392 in 1905. Complaints of any description are rare, only 6 of no importance being received during the past year. All complaints were promptly remedied by the Contractors. * Table 34 summarises the work of the District Inspectors not specially dealt with in the following paragraphs. The total number of visits of all kinds by the whole Staff in each quarter of the past three years is given below— Quarters 1st 2nd 3rd 4th 1908 1,440 1,509 1,901 1,862 1907 1,411 1,590 1,223 1,510 1906 765 1,069 1,376 1,178 ADMINISTRATIVE WORK. 51 At the request of the Local Government Board the Kensington Borough Council was approached with a view to a joint user of that Council's disinfecting station by the Council of this Borough. In July of last year a conference took place between representatives of the two Councils under the Chairmanship of Dr. Sweeting, one of the Medical Inspectors of the Local Government Board. The Conference was adjourned for a scheme for the joint ownership and user of the station to be prepared by the Council of this Borough and to be submitted to the Kensington Council. Such scheme was prepared and forwarded to Kensington in the following autumn. At the close of the year the reply from Kensington had not been received, and the Conference had not re-assembled. Water Supply.—There was a slight increase in the number of notices of discontinuance of water supply, from 81 in 1907 to 88 last year. In 1906 the notices numbered 141. The Inspectors reported the cutting off to be due to— Empty premises 75 Defective fittings 1 Unpaid rates, etc. 12 The last cause shows a three-fold increase, only 4 such cases being reported in 1907. Notices demanding restoration of the supply were served with respect to 9 houses. Six of the thirteen inhabited houses were subsequently vacated, while the water was restored to 7 after the following intervals— 7 days 2 houses 8, 9, 14, 15 and 23 days (after being vacated) 1 house each In one case, occupied but not inhabited premises, the water for flushing closets was taken from the canal. No proceedings have been necessary under the By-laws relating to the Mortuaries. Schools.— In Table 35 will be found an analysis of the incidence of infection on the Public Elementary Schools of the Borough, as evidenced by the cases occurring among resident scholars ("P.A.") and other members of their families ("P.N.A.") The returns relating to non-residents ("N.R.") cannot be so distinguished. It will be seen that the numbers of attacks of scarlet fever among the scholars at Harrow Road (Moberly) and Royal Oak (temporary), and St. Mary Magdalene's Schools, were markedly above the average, and that there was a similar excess among non-residents in connection with St. Augustine's School. The incidence among resident scholars will be dealt with in a special report on the prevalence of scarlet fever which is in course of preparation. As regards St. Augustine's School, the contrast between the numbers for residents and non-residents is due to the preponderance of the latter at that school. Mortuaries.—During the year 292 bodies were deposited at the Mortuaies,2 more than in 1907. (See below.) Paddington Green. Kensal Road. Number of bodies deposited 273 19 Coroner's cases 210 19 Awaiting burial:— Infectious 3 - Non-infectious 60 - P.M. examimations made 93 13 52 ADMINISTRATIVE WORK. TABLE 35. 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 32 4 1 4 2 ... 2 11 ... Beethoven Street 20 4 1 2 2 ... 39 6 11 Campbell Street 12 8 ... 3 4 ... 40 17 ... Droop Street 33 8 1 4 1 ... 13 7 11 Essendine Road 34 9 6 4 4 1 18 17 10 Harrow Road 80 15 9 8 7 ... 36 6 1 Kilburn Lane 9 3 9 2 ... ... 16 19 3 Royal Oak 22 6 1 1 2 ... 5 4 ... Saltram Crescent (Tech.Instit.) ... ... 1 ... ... ... ... ... ... Non-Provided— Bayswater Jewish 5 ... 3 ... ... 2 ... 2 ... Desborough Street (R.C.) 16 2 ... ... ... ... 4 3 13 Holy Trinity 5 2 ... ... ... ... ... 6 ... St. Augustine 8 6 31 2 2 4 1 2 3 St. James 2 3 ... ... ... ... 37 3 ... St. John, Kilburn Lane 3 ... 3 ... ... 1 8 ... ... St. John, Titchborne Street 2 1 ... ... ... ... 45 3 ... St. Luke 6 ... 11 1 ... 1 5 3 ... St. Mary 1 1 ... ... ... ... ... ... ... St. Mary of the Angels (R.C.) ... ... 4 ... ... ... 4 ... ... St. Mary Magdalene 25 7 ... ... ... ... 1 1 ... St. Matthew 12 2 1 ... 1 1 23 1 ... St. Michael 2 ... ... ... ... ... 19 ... 1 St. Paul 8 3 ... 4 1 ... 1 11 5 St. Peter 9 2 ... 2 3 ... 21 12 3 St. Saviour 10 3 ... ... ... ... ... 1 ... St. Stephen 6 4 5 1 1 1 2 6 ... Wilberforce 5 4 7 1 ... ... 2 ... ... Others— St. Hilda ... ... ... ... ... ... 8 ... ... Westbourne 2 5 3 1 1 1 ... ... ... Woodfield 1 ... ... 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. The notices issued for the exclusion of children from school, numbered 1,883 last year, as compared with 2,238 in 1907, and 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 with respect to those diseases do not balance. The complete figures for the last two years (those for 1907 in italics), are given below:— In connection Notices Issued. with Exclusion. Re-admission. Notified diseases 1,083 (763) 1,083 (763) Other diseases 800 (1,475) 502 (560) Closure of classes or departments of schools was resorted to on 21 occasions last year, 8 more than in 1907 and in 1906. In addition there were 8 cases of exclusion of "unprotected children" from classes in which cases of measles occurred. All closures and exclusions ADMINISTRATIVE WORK. 53 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:— St. Matthew's (Infants) I. Jan. 10th 14 days Measles. „ „ II. „ 28th 14 „ „ „ „ II. and III. Mar. 10th 10 „ „ Campbell Street „ C and D Jan. 16th 11 „ „ „ „ D June 15th 7 „ „ Amberley Road „ C Jan. 18th 9 „ „ Kilburn Lane „ F and F1 ,, 20 th 14 „ „ „ „ E Feb. 13th 11 „ „ Beethoven Street „ A Jan. 20th 7 „ „ „ „ C „ 31st 10 „ „ „ „ B Feb. 14 th 10 „ „ „ „ G Mar. 2nd 7 „ „ Moberly „ D Jan. 23rd 11 „ „ „ „ E Feb. 14th 10 „ „ „ „ F May 19th 6 „ „ „ „ F June 9th 7 „ „ „ „ D July 14th 2 „ Scarlet fever St. James' „ C Mar. 9th 7 „ Measles „ „ G „ „ 12 „ „ St. John's, Kilburn Lane (Infants) I „ 10th 6 „ „ St. Michael's (Infants) C May 2nd 6 „ „ "Unprotected" Children Excluded. Exclusion. School. Class-room. Date of. Duration of. Disease. Beethoven Street (Infants) D June 8th 7 days Measles ,, ,, C ,, 9th 7 ,, ,, ,, ,, C ,, 25th 7 ,, ,, Moberly ,, A July 6th 18 ,, ,, St. Luke's I Oct. 21st 12 ,, ,, Our Lady of Dolours ,, B Nov. 3rd 8 ,, ,, Amberley Road ,, A „ 6th 10 ,, ,, Campbell Road ,, C and D ,, 23rd 7 ,, ,, Internotification.—Duplicate notices relating to non-resident patients attending local schools, are received 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 35 (" N.R. " cols.). A complete list of the 114 notices received from Kensington, Hampstead, and Willesden, is given below :— Kensington. Willesden. Hampstead. Scarlet fever 22 64 4 Diphtheria 6 8 2 Enteric fever - 3 — Measles - 5 — 28 80 6 54 ADMINISTRATIVE WORK. Bacteriological Examinations.—The specimens received during the year numbered 137 (see below), as compared with 135 in 1907, 127 in 1906, and 61 in 1905. Positive results were obtained in 57 instances (41.6 per cent.), the percentages in 1907 and 1906 having been 42'2 and 32.2 respectively. The increase in specimens of sputum is satisfactory from an administrative point of view. No. of specimens Results. received. Positive. Negative. Diphtheria 96 34 62 Enteric fever 21 12 9 "Consumption" 19 10 9 Other 1 1 — Totals 137 57 80 Offensive Refuse: Trade Refuse.—This is removed principally by private firms, the Council undertaking the rest on contract. No complaints were received during the year, but one complaint of offensive smell from a rag and bone shop (not an "offensive trade") received attention. Manure.—An Order requiring removal of stable manure three times a week (either on Monday, Wednesday and Friday, or Tuesday, Thursday and Saturday) was posted throughout the Borough in May, and was very generally complied with. Nineteen (19) complaints were received during the year, the best remedy for which was found to be systematic visitation. House Refuse.—A larger number of complaints as to irregularity and infrequency of removal from dwelling houses were received throughout the year, but more particularly during the summer months. The complaints investigated by the Department numbered 50. A special inspection made in Queensborough Terrace during October resulted in the discovery of 17 offensive dustbins out of a total of 92. It cannot be denied that much of the nuisance arising from house refuse is due to the neglect of householders to burn greenstuff and other putrescible matters as produced. This can be done in the kitchen stove without inconvenience or smell. On the other hand it must be recognised that gas cooking becomes each year more in vogue, with a consequent disuse of any coal stove in the kitchen. Many flats have been built without such stoves. An interval of a week—occasionally longer—cannot fail to result in effluvia from dustbins which are only too frequently very close to the windows of inhabited rooms. From May to October the collection of house refuse requires to be at shorter intervals than seven days, if not from all houses then at least from flat properties and tenement houses, where the aggregation of persons on a comparatively restricted site leads to aggravation of the nuisance. It is believed that if houses were kept free from putrefying refuse, an important measure towards the limitation of summer diarrhoea would be inaugurated. Drainage Work.—The reconstructions of drainage of existing premises during the past year numbered 605, showing a slight increase over the number for 1907 (584), but not equal to the numbers for 1906 and 1905, viz., 696 and 669 respectively. In addition to the drains reconstructed to stand the water test, 68 others of earlier construction were so tested and found sound. The reconstruction of the combined drainage on the Queen's Park Estate is still in progress, the drainage of 218 houses having been dealt with during the year. Altogether ADMINISTRATIVE WORK. 55 Of 61 drains on the Estate specially tested after infectious illness, 10 proved defective, 45 had been recently relaid, and with 6 old drains, gave negative results. Complaints led to the testing of 12 other drains, 10 proving to be defective. The administrative work relating to deposit of plans and notices for reconstruction of drainage, etc., is in the hands of the Department. The notices received during the year numbered 376, involving the despatch of 679 letters and communications. Proceedings with reference to infringements of the by-laws, relating to the deposit of plans, etc., were necessary in 11 instances, the same as in 1907. Combined Drainage.—The reconstruction of the combined drains on the Queen's Park Estate is being carried out by the Company owning the Estate. In other parts of the Borough 6 defective combined systems were discovered and reconstructed by the Council during the year. (See below). Chichester Road, Nos. 10 & 12. Spring Street, Nos. 30-40 (even). Harrow Road, Nos. 43 & 45. Sutherland Place, Nos. 27 & 28. Kent's Place, Nos. 4 & 4a. Talbot Road, Nos. 79 & 81. The reconstruction by the Council was necessitated by the absence of any record of approval of, or order for, the original construction of the systems. Five new systems of combined drainage were sanctioned by the Council under Sec. 74 of the Metropolis Management Act, 1855, viz.:— Adpar Street, Nos. 1-7 (odd) Andover Place, No. 8, and Portsdown Place, No. 4. 5 ,, ,, 9, ,, ,, ,, ,, Kilburn Lane, Nos. 290 & 292, and Lancefield Street, No. 146. Westbourne Park Villas, No. 2, and Congregational Church. Smoke Prevention.—Although the number of premises (28) watched during 1908 exceeded the number (22) for 1907, and the number of hours of observation (148.8) was nearly double that for the previous year (79.8), yet the total emission of "black smoke" observed was 59 minutes only, as compared with 58 in 1907. Other colours (shades) of smoke were observed during 110'2 hours last year, as compared with 52*3 in the preceding. Twelve complaints of nuisance from smoke were received, 4 relating to smoke from refreshment houses, 6 from laundries, factories and workshops, and 1 each from a brewery and a bakehouse. 1,300 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. 716-738, Harrow Road Commenced in 1907 Nos. 620-664, Harrow-Road Nos. 3a-7, Fourth Avenue Nos. 2a-8, Fourth Avenue Nos. 668-688, Harrow Road Nos. 1-57, Droop Street Nos. 2a-8, Fifth Avenue Nos. 1-7, Third Avenue Nos. 59-79, Droop Street Nos. 84-98, Fifth Avenue Commenced in 1907 Nos. 690-714, Harrow Road Nos. 2-94, Kilravock Street Nos. 2a-8a, Sixth Avenue Nos. 1-93, Lothrop Street Nos. 81-113, Droop Street Nos. 53-69, Third Avenue Nos. 1a-7, Fifth Avenue Nos. 126-140, Ilbert Street Nos. 2-72, Oliphant Street Not completed at close of 1908 Nos. 150-216, Droop Street Nos. 201-263, Droop Street Nos. 74-88, Oliphant Street Nos. 142-156, Ilbert Street Nos. 51-123, Sixth Avenue 56 ADMINISTRATIVE WORK. 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, and at the same time affords evidence of the need of legislation to control the emission of "smoke." In 100 hours observations. 1908 1907 1906 1905 1904 "Smoke" 74 65 67 79 82 " Black Smoke " 0.6 1.2 1.7 3.4 5.3 No Smoke 25.3 33.3 31.3 17.6 12.7 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 400 tons of mud were removed, and about 800 square 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 202, but it is believed that some of the boats ought to be struck off. One case of erysipelas (f., aetat. 39) and two deaths occurred among the occupants of the boats, viz.:—One from convulsions (m., ætat. one week), and one from drowning (f., ætat.37). TABLE 36. Smoke Observations. Address. Business. Chimney Shaft of 23, Beethoven Street Laundry Steam Boiler 27, ,, ,, ,, — Bishop's Road Bridge Refreshment Rooms Kitchen Stove 8, Bishop's Road ,, ,, ,, ,, 26, Brook Mews North Carriage Works Smith's Forge 16, Craven Terrace Bakehouse Baker's Oven — Eastbourne Terrace Dining Club Kitchen Stove and Steam Boiler 73-5, Edgware Road Restaurant ,, ,, 189,,, ,, Bakehouse Baker's Ovens 401, „ „ ,, ,, ,, — Goldney Place Saw Mills Drying Apparatus 90, Harrow Road Bakehouse Baker's Ovens 149, ,, ,, Saw Mills Steam Boiler — Goods Yard Hydraulic Works ,, ,, 365, Harrow Road Bakehouse Baker's Ovens 76-8, Herries Street Laundry Steam Boiler 126-8, Kensal Road Saw Mills ,, ,, 5-10, North Wharf Refuse Destructor Destructor 41-3, Praed Street Hotel Kitchen Stove 134, ,, „ Refreshment Rooms ,, ,, 136, „ „ ,, ,, ,, ,, 142, „ ,, ,, ,, ,, - ,, ,, Hotel ,, ,, 25, Queen's Road Restaurant ,, ,, 24- 6, „ „ Brewery Steam Boilers 120, Shirland Road Dairy ,, ,, 3, Spring Street Bakehouse Baker's Ovens 33, Westbourne Grove General Stores Steam Boilers 57 WORKSHOP SUPERVISION. 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 Appendix A. (Table VIII). Registration.—To the Registers of the Department, which contained 1,436 premises at the close of 1907, there were added 173 premises during 1908, and 77 premises were removed, leaving 1,532 effective entries at the close of last year. The premises then on the Registers, included 143 factories, 885 workshops, 25 domestic workshops, 69 workplaces, and 410 premises occupied by "single workers," 250 of the last being included in the Register of Outworkers' premises. Table 37 gives an analysis of the businesses, and an approximation of the numbers of employees, the figures relating to homeworkers are shown in parentheses. The Home Office forwarded to the Department 32 notices relating to the opening of new workshops, the majority of which had, however, been previously inspected by the Staff of the Department. Home Work.—Employers of homeworkers (outworkers) forwarded 83 lists in February and 67 in August of last year, making a total of 150, as compared with 101 in 1907, and 76 in 1906. The addresses included in the returns numbered 580, of which 298 had to be forwarded to other districts in accordance with the Act. From other districts 359 (385 in 1907) addresses were received. (See below). Kensington 5 (16) Willesden 8 (5) Battersea 1 (1) Hampstead 10 (14) Hammersmith 1 (4) Camberwell 0 (1) Westminster 5 (13) Marylebone 3 (2) Holborn 2 (1) Finsbury 4 (11) Chelsea 2 (2) Lewisham 0 (1) City of London 9 (8) Fulham 1 (2) Shoreditch 2 (1) London County Council 2 (0) Hackney 1 (0) Islington 1 (0) Lambeth 1 (0) Southwark 1 (0) Note.—Figures in parentheses are the numbers for 1907. At the close of the year the Register contained 349 effective entries, a nett increase of 24 above the number for 1907, comprising:— Workshops, 99 ; " Single " workers, 250. Inspections.—The supervision of workshops has rested almost entirely with Inspector Wansbrough, the time of the Women Inspectors having been fully occupied with visits and inspections with reference to sickness among children. The inspections of workshops made during the year numbered 1,583, as compared with 2,287 in 1907. The principal results of the inspections are set out in Table 38. Notices are required but infrequently, a verbal request to set matters right being usually sufficient. Complaints.—The Home Office forwarded 11 complaints during the year (see below), two more than in 1906, but one less than in 1905. Home Office Complaints— Dirty conditions 4 Other matters 3 Overcrowding 4 58 WORKSHOP SUPERVISION. TABLE 37. Factories, Workshops, and Work-places. 1908. No. of Premises. No. of Rooms. Employees. Women. Young Persons. Men. Totals. Clothing— Boot-making 139 (70) 140 (70) 10 (6) 6 (2) 210 (70) 226 (78) Corset-making 9 (1) 12 (1) 30 (1) 3 - 33 (1) Dressmaking 433 (66) 624 (83) 1,666 (182) 321 (50) 20 (2) 2,007 (234) Mantle-making 11 (6) 16 (9) 40 (11) 1 - 41 (11) Millinery 46 (3) 69 (3) 276 (3) 43 2 321 (3) Millinery and Dressmaking 22 59 405 73 - 478 Outfitting and Plain Needlework 38 (24) 41 (25) 102 (28) 9 (2) - 111 (30) Tailoring 195 (135) 203 (147) 159 (99) 14 (6) 313 (161) 486 (266) „ Ladies' 23 (3) 49 (6) 183 (2) 19 (3) 52 (3) 254 (8) Various 19 (3) 22 (3) 31 (3) 3 15 49 (3) Fancy Work— Embroidery and Art Needlework 14 (8) 17 (8) 43 (13) 7 (1) 7 (1) 57 (15) Cleansing— Dyers and Cleaners' Receiving Offices 16 16 34 6 1 41 Laundries 114 (9) 371 (10) 1,067 (10) 18 126 1,211 (10) „ —Receiving Offices 40 40 47 3 1 51 Mangling 20 (1) 20 (1) 20 (1) - - 20 (1) Various 4 (1) 4 (1) 9 (1) 1 1 11 (1) Other Businesses— Blind-making 6 8 5 1 27 33 Bookbinding and Printing 43 66 101 14 346 461 Carpentry and Joinery 26 43 - 22 235 255 Chaff-cutting 18 22 - - 61 61 Coach Building 48 79 - 1 328 329 Cycle and Motor Making and Repairing 27 40 - 8 110 118 Jewellery and Clock-making 8 9 - 2 22 24 Metal-working 35 40 - 1 142 143 Saddlery 13 15 - 1 46 47 Sign and Ticket Writing 7 7 3 7 14 24 Trunk-making 10 13 - - 34 34 Umbrella-making 8 9 15 3 12 30 Upholstery 53 (17) 85 (22) 101 (26) 23 (4) 174 (4) 298 (34) Various 86 (2) 121 (2) 196 (2) 114 647 957 (2) 1,532 (349) 2,260 (391) 4,543 (388) 724 (68) 2,944 (241) 8,211 (697) Women were employed in 962 workshops, including 203 where men and women were employed. The total number of women therein was 5,160, including 617 "young persons." Women were employed at 199 outworkers' premises, including 32 where men and women were employed. The total number of women employed therein was 445, including 67 "young persons." From other sources 8 complaints were received, as compared with 4 in 1906 and 7 in 1905. Overcrowding.—Nine (9) cases of overcrowding were reported by the Inspectors and 4 by the Home Office during the year. In 1907, 4 cases were discovered by the Department and two reported by the Home Office. WORKSHOP SUPERVISION. 59 TABLE 38. Inspections of Workshops, &c. 1908. See also Table VIII., Appendix A. 1908. 1907. Workshops— On register end of previous year 1,436 1,457 added during year 173 182 removed „ „ 77 203 On register end of year 1,532 1,436 Inspections 179 182 Re-inspections and miscellaneous calls 1,404 2,110 Rooms measured 42 150 Workrooms used as bedrooms 86 93 Workrooms without Abstracts 5 39 Notices served, totals 12 26 Written intimations 7 22 Under Sec. 4 37 38 Public Health - 2 (London) 1 - Act, 1891. 3 - By-laws, under same Act 1 2 Nuisances dealt with— Discovered. Abated. Discovered Abated. Overcrowding 9 5 4 4 Dirty Conditions 34 32 68 68 Deficient Ventilation 6 7 4 4 Temperature too high - - 1 1 Temperature too low 1 - - - Sanitary conveniences— Insufficient 2 1 - - Not separately provided 2 2 1 1 Badly placed 3 2 - - Unventilated - - - - Defective 11 13 15 14 Vapour, effluvia not removed - - - - Steam in washhouses Gas fumes 1 - 11 10 Drains - - 3 1 Wet floors, laundries - - - - Accumulations of refuse - - - - Other nuisances or offences 7 5 8 8 Totals 76 67 115 111 Deficient Ventilation.—In 1906, 3 workshops were reported as insufficiently ventilated, in 1907, 4, and last year 6. 60 HOUSING. 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 only once was a workshop reported as too cold during the year. Sanitary Conveniences.—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. 1908. Insufficient 9 2 2 - 2 Not separately provided 33 4 2 1 2 Badly placed 18 13 - - 3 Unventilated 8 - - - - Defective 29 23 23 15 11 Sickness.—The cases of infectious disease, of all descriptions, reported during the year on "workshop premises," numbered 93, including 21 cases in the homes of outworkers, shown in parentheses in the appended statement. Scarlet Fever 46(13) Puerperal Fever 1(—) Measles 28 (5) Diphtheria 5 (—) Erysipelas 7 (3) Chickenpox 6 (—) In addition to the above, 1 case of "consumption" was reported. The deaths from the foregoing diseases numbered 8, viz., 4 from "consumption," 2 from measles, and one each from diphtheria and scarlet fever, the deaths from measles being the only fatal cases 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 57 "underground." Baking was given up during the year in 2 underground bakehouses, and resumed at 1 level bakehouse, 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 73 bakehouses on the Register, 9 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. Fifty-nine (59) inspections were made of the " factory bakehouses," and 371 of the remaining 64 premises. HOUSING. Houses Let in Lodgings. Registration.—At the close of 1907, 1,320 houses were on the Register. During the year, 47 were added to and 24 removed from the Register, leaving 1,343 effective entries at the end of 1908. The registration of the 47 houses involved 831 visits. With the present exemptions, comparatively few houses can be added to the Register, although many of the houses now exempt ought, it is believed, to be registered. HOUSING. 61 The streets in which houses were registered during the year are set out below, in three groups, viz.:— (a) Those inspected for the first time with a view to registration ; (b) Those in which houses previously passed over were registered; and (c) Those in which one or more houses were specially marked for registration, in sequence of the density of inhabitants, dirty conditions, &c. (a) Albert Street. Carlton Mews. Green Street. Houses Registered, 1908. (b) Campbell Street. Crompton Street. Dudley Street. Hall Place. Kensal Road. (c) Harrow Road. The housing conditions in the premises added to the Register were as below:— No. of Houses visited with a view to Registration ... 77 Houses Registered 47 „ Exempt 28 „ Empty 2 No. of Rooms Registered ... 166 For living only 17 For sleeping 69 For living and sleeping 80 Other Rooms in Registered Houses ... 126 Occupied by landlords 46 Exempt by rent 51 Occupied, not inhabited 10 Empty 19 Grand Total, Rooms ... 292 Inhabitants (Registered Houses). In Registered Rooms, Persons ... 336 Under 10 years of age 108 Aged 10 years and over 228 In other Rooms, Persons ... 135 Under 10 years of age 34 Aged 10 years and over 101 Grand Total, Inhabitants ... 471 Table 39 shows how the tenements in the houses registered during the year were occupied. It will be seen that 36 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, 28 families comprising 98 persons were overcrowded, but in 20 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 next page). 62 HOUSING. Overcrowding, at Registration. In Registered Rooms— Families 28 Persons 98 „ under 10 years of age 40 „ aged 10 years and over 58 Overcrowding abated 7 By Re-adjustment of Occupants 1 By Removal 6 Under Notice 2 Cases held over 20 TABLE 39. Numbers of Tenements and Inhabitants therein. Registered during 1908. to Tenement. 1 2 3 4 5 6 7 T P 10 10 P T P 10 10 P T P 10 10 P T P 10 10 P T P 10 10 P T P 10 10 P T P 10 10 p 1 26 26 ... 14 27 1 6 12 6 10 20 20 4 9 11 ... ... ... ... ... ... 2 ... ... ... 11 22 ... 8 21 3 15 42 18 10 26 24 5 12 18 1 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 1 4 2 ... ... ... T—number of Tenements containing (p/10) Persons over 10 years of age, and (p/10) Persons under 10 years of age. The table may be summnarised thus:— Tenements of— Total. Occupants. Average persons per room. Houses registered 1908. Borough Census 1901. 1 room 60 132 2.2 1.8 2 rooms 50 . 193 1.9 1.7 3 „ 2 11 1.8 1.3 4 „ - - - 1.1 Supervision.—The work connected with the "annual cleansing" occupies nearly the whole of the time of the two inspectors in charge of houses let in lodgings from March to September or later. During that time all houses on the Register are inspected 3, 4, or more times. At other times a general supervision is exercised over the whole, and full inspections made once a quarter of houses known to be badly kept and likely to be overcrowded. The numerous complaints received involve many inspections. The inspections made last year numbered 2,499, that total not including the inspections in connection with the "annual cleansing," registration, or sickness. The defects and infringements of the by-laws discovered (including those at annual cleansing) are set out in Table 40. Notices to the number of 1,261 were served during the year, viz.: written intimations, 329; statutory notices, 61; and notices under the various by-laws, 674. The notices pursuant to provisions of the London County Council (General Powers) Acts numbered 197, viz.: verminous rooms, 137 ; abolition of dustbins, 18; and additional supplies of water, 42. HOUSING. 63 TABLE 40. Sanitary Defects Remedied in Registered Houses. 1908. 1907. Drain defective 34 44 „ choked 9 3 „ untrapped 7 2 „ unventilated or improperly ventilated 24 24 Manhole cover defective 1 6 Surface inlet improperly trapped 9 7 Gully choked 9 6 Ventilating pipe improperly constructed 1 3 Soilpipe defective 2 - „ improperly constructed 2 - „ unventilated or improperly ventilated 2 1 Water-closet choked 39 20 „ defective 49 45 „ flushed from drinking water cistern 2 3 „ insufficiently flushed 42 23 „ flushing apparatus defective 36 38 „ without water supply 8 12 „ foul 20 18 „ improperly constructed 14 5 „ accommodation insufficient 14 34 „ without door 9 2 „ without external light or ventilation 1 1 Rain-water pipe not disconnected from drain or soilpipe 18 4 „ defective 24 22 „ choked 3 7 Waste pipe not disconnected 4 - „ defective 7 10 „ choked - 1 „ not provided 3 3 Other drainage defects 3 10 Cistern defective 2 4 „ dirty 70 34 „ improperly placed - 1 „ without proper cover 12 15 „ cover defective 27 7 Dustbin defective 105 54 „ not provided 4 7 „ insufficient - 8 „ disused and not abolished 5 - Paving defective in area or yard 85 89 „ „ washhouse 40 48 Guttering defective 21 12 Premises damp 10 8 „ dirty 9 4 Rooms verminous 258 345 Roof defective 142. 136 Accumulation of refuse 3 42 Animals improperly kept 6 6 Other defects or nuisances 13 30 Annual Cleansing.—There were 1,323 houses on the Register in March of last year, all of which required to be inspected in connection with the "annual cleansing" which the byelaws provide shall be carried out during the month of April of each year. Although the work was divided among five Inspectors, it was not completed before October last. The inspections made numbered 4,611, 2,154 rooms being reported to be in need of cleansing. The corresponding figures for 1907 were 5,250 and 2,376. The notices served as a result of these inspections (included in the figures given in the preceding paragraph) numbered 2,771 (2,818 in 1907), viz.: cleansing notices, 2,126; for verminous rooms, 120: and for defects of all descriptions, 525. One hundred and forty-seven (147) cases were referred to the Solicitor, but only 23 summonses were issued. 64 HOUSING. An enumeration of the occupants of registered tenements was made in connection with the annual cleansing. The enumeration covered 4,902 tenements, comprising 8,192 rooms, occupied by 15,168 persons, averaging 3.0 persons to a tenement, and 1.8 to a room. The distribution of occupants according to tenement was:— Per room. Per Registered Borough tenement. tenements. Census, 1901. In 2,160 tenements of one room, 4,590 persons, averages 2.1 2.1 1.8 2,230 two rooms, 7,962 „ 3.1 1.7 1.7 478 three „ 2,419 „ 5.0 1.6 1.3 32 four „ 185 „ 5.8 1.5 1.1 2 five „ 12 „ 6.0 1.2 ? A complete analysis of the tenements of less than five rooms is given in Table 41, the numbers of children under 10 years being shown separately. TABLE 41. Numbers of Registered Tenements (of less than five rooms) and Inhabitants therein. 1908. to Tenement. 1 2 3 4 5 6 7 8 9 10 11 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 T P 10 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 10 P 1 737 736 1 767 1489 45 391 826 347 194 396 380 60 124 176 7 16 26 4 21 7 ... ... ... ... ... ... ... ... ... ... ... ... 2 38 38 ... 311 616 6 391 956 217 431 1182 542 365 1025 800 239 681 753 111 323 454 30104 136 11 44 55 3 14 16 ... ... ... 3 4 4 ... 31 62 ... 69 181 26 78 233 79 100 348 152 94 343 221 61 257 170 30 122 118 7 37 26 4 25 15 ... ... ... 4 ... ... ... ... ... ... 3 8 1 4 16 ... 9 35 10 7 32 10 4 22 6 2 11 5 2 13 5 ... ... ... 1 7 4 T—number of Tenements containing (p/10) Persons over 10 years of age, and (p/10)Persons under 10 years of age. The last enumeration taken previous to 1908 was that of 1906, which dealt with 4,372 tenements and 14,862 inhabitants. The increase in proportion of smaller tenements enumerated last year is shown by the following figures :— Rooms in tenement 1 2 3 4 5 1906 43.6 45.0 10.0 1.2 0.0.41 per cent. of all tenements 1908 44.0 45.4 9.7 0.6 0.04 enumerated. At the same time, there has been some reduction in the average numbers of occupants per room:— Rooms in tenement 1 2 3 4 5 1906 2.1 2.2 1.7 1.5 1.31 average number of occupants per room. 1908 2.1 1.7 1.6 1.5 1.2 In 1906 the 14,862 inhabitants included 4,531 children under 10 years, equal to 30.4 per cent. of the total, as compared with 31.6 per cent. in 1908. HOUSING. 65 Taking the usual theoretic standard of overcrowding—viz., an average exceeding two persons per room—it appears that, in 1906, 1,470 tenements and 7,526 persons were "overcrowded," and, in 1908, 1,820 tenements and 7,523 persons. Reducing those figures to percentages, they compare thus:— "Overcrowded." 1906. 1908. Percentage of all tenements 33.6 37.1 Percentage of all inhabitants 50.6 49.3 Percentage of children under 10 years 74.6 72.5 The changes in housing after registration are suggested by the comparison of the percentages of " overcrowding " as determined at registration, and in houses which have been on the Register for some time. The average numbers of occupants per room in the houses added to the Register during the year, and those in houses registered earlier, compare thus:— No. of rooms. 12 3 4 Newly registered, 1908 2.2 1.9 1.8 - On Register 2.1 1.7 1.6 1.5 and the percentages of "overcrowded " tenements and inhabitants:— Overcrowding. Tenements. Inhabitants of all ages. Inhabitants under 10 yrs. Newly registered, 1908 32.1 52.0 75.0 On Register 37.1 49.3 72.5 Overcrowding.—The actual cases of legal overcrowding reported during the year numbered .300, as compared with 344 in 1907 and 412 in 1906, showing a decided improvement. Of the 300 cases, in 171 the degree of overcrowding—i.e., deficiency in cubic space prescribed by by-law—was so slight, many being under 100 cubic feet, that the cases were reserved for observation. The full analysis of cases is given below. Overcrowding, 1908. Registration. Annual Cleansing. Other Visits. Totals. Tenements overcrowded 28 202 70 300 Rooms overcrowded 29 213 80 322 Occupants, total 98 883 296 1,277 Under 10 years 40 332 120 492 Ten and upwards 58 551 176 785 Overcrowding abated (rooms)— By re-arrangement 1 17 11 29 By voluntary removal 6 12 7 25 Under notice 2 60 35 97 Cases held over 20 124 27 171 Vital Statistics.—The morbidity rate for the "Registered Streets" (12.58 per 1,000, sec Table 42) was nearly 4 per 1,000 above the rate for 1907 (8.65), and rather more than 2¼ times the 1908 rate for the "Rest of the Borough" (5.44). The 1908 rate for "Registered Streets" showed an increase of 45 per cent. above that for 1907, while that for the "Rest of the Borough" a decrease of rather more than 4 per cent. The whole of the increased morbidity in the "Registered Streets" was due to an exceptional prevalence of scarlet fever—increase in rate equal to 76 per cent.—and to a smaller increase (42 per cent.) in the number of cases of erysipelas. 66 HOUSING. TABLE 42. Registered Streets. Rest of Borough. 1908. 1907. 1908. 1907. Morbidity*— Small-pox - - - - Diphtheria and Membranous Croup 1.36 1.67 0.89 0.98 Erysipelas 1.68 1-18 0-53 0.77 Scarlet Fever 9.33 5-30 3-74 3-67 Enteric (and Continued) Fever 0.21 0-48 0-20 0-19 Puerperal Fever - - 0-03 0-04 All Diseases 12.58 8.65 5.44 5.67 Mortality*— Small-pox - - - - Measles 0.63 0.97 0.17 0.14 Scarlet Fever 0.31 0.32 0.05 0.05 Whooping Cough 0.21 0.32 0.04 0.33 Diphtheria 0.15 0.48 0.09 0.08 Enteric Fever 0.06 - 0.01 0.03 Diarrhœal Diseases 1.25 0.91 0.26 0.21 Erysipelas - 0.05 0.02 0.04 Puerperal Fever - - 0.00 0.03 Phthisis 2.10 2.54 0.80 0.83 Other Tuberculous Diseases 0.63 1.40 0.21 0.27 Alcoholism - 0.21 0.05 0.04 Cancer 1.52 1.13 1.15 1.19 Premature Birth 0.63 1.02 0.31 0.40 Developmental Diseases 1.57 1.08 0.46 0.35 Bronchitis 2.57 2.65 0.94 0.97 Pneumonia 1.94 2.00 0.83 0.99 Cirrhosis of Liver 0.16 0.21 0.08 0.19 Accidents and Diseases of Parturition 0.16 0.10 0.04 0.06 Suicides 0.21 0.10 0.08 0.05 Other Causes 9.53 8.92 4.90 5.56 All Causes 23.55 24.49 10.78 11.91 * Rates per 1,000 persons. There was a decreased mortality rate in the "Registered Street" (from 24.49 to 23.55, fall of 3.9 per cent.), but the ratio of the rates for the two years to those of the "Rest of the Borough" remained practically unchanged, the former rates being in each year a little more than twice the latter. (Actual ratios: 1907, 2.0: 1; 1908, 21: 1). Higher mortality rates were recorded last year in the "Registered Streets" from diarrhœal diseases, cancer, developmental diseases, accidents, etc., of parturition, and other causes. The principal decreases were recorded from the infectious diseases, including phthisis and the respiratory diseases. The decreased mortality from scarlet fever, although slight, is the more satisfactory having regard to the great increase in morbidity. The infantile mortality in the "Streets" was 148 per 1,000 births, while that in the " Rest" was 91. Clarendon Street Area.—From a comparison of the results of the enumeration made last year with the records of the Special Inquiry of 1901, it would appear that some improvement in the sanitary condition of the Area has been effected. The tendency to occupy smaller tenements is markedly shown in the "Area," where 835 one-room tenements were found last year as compared with 662 in 1901, the number of occupants of such rooms being 1,973 in 67 HOUSING. 1908, and 1,556 in 1901. The increase in both sets of figures was the same, viz., 26 per cent. In spite of that increase, the actual overcrowding (by-law standards) decreased. In 1901 97 tenements (14*6 of the total) were overcrowded, and in 1908 29 tenements (3*4 per cent.) showing a reduction of 77 per cent, below the proportion for 1901. Overcrowding is less prevalent in the other classes of tenements, as is evident from the following figures. In 1901 204 (10*7 per cent.) tenements of all sizes were overcrowded, such tenements being occupied by 1,174 persons (including 441 children under 10). In 1908 45 tenements (2'6 per cent.) were overcrowded, the occupants numbering 232 (with 99 children under 10). The average numbers of inhabitants per overcrowded tenement was 5*7 in 1901, and 5*1 in 1908. During 1908 the morbidity rates in the "Area" (Table 43) from diphtheria (0*71) and puerperal fever (zero) were below those in the " Rest of the Borough "—viz., 0"96 and 0"03— while, in comparison with the 1907 rates, lower rates were recorded last year from diphtheria and enteric fever. On the other hand, the rates from scarlet fever (14T7) and erysipelas (2'55) were much higher than those for 1907, and quite out of proportion to those of the " Rest of the Borough." There was a substantial fall in the death-rate from 27-61 in 1907 to 23*08 last year—a drop of 17 per cent.—the decline in rates for the "Rest of the Borough' (from 12*77 to 11*78) being only 7 per cent. The decrease in mortality appears to have been common to all ages of life, the infantile mortality having fallen from 181 to 173, that at ages under 10 from 44*61 to 32*11, and that at higher ages from 20*49 to 18*88. The percentage decreases in the rates were 5, 28, and 8, while the corresponding figures for the " Rest of the Borough" were 4, 10, and 7—showing greater reductions in each case in the "Area." The percentage of deaths in institutions to all deaths (63*1) shows an increase of nearly one-third of the proportion in 1907. TABLE 43. " Clarendon Street Area." Rest of Borough. 1908. 1907. 1908. 1907. Morbidity*— Diphtheria 0.71 1.85 0.96 1.03 Erysipelas 2.55 1.57 0.58 0.79 Scarlet Fever Enteric Fever 14.17 0.42 5.15 0.43 3.92 0.19 3.80 0.22 Puerperal Fever - - 0.03 0.04 Mortality—All Causes— All ages * 23.08 27.61 11.78 12.77 0—-10 years 32.11 44.61 19.57 21.68 10- „ 18.88 20.49 10.38 11.05 Infantile Mortality † 173 181 99 103 Institution Deaths‡ 63.1 47.1 32.3 30.9 * Rates per 1,000 persons. † Per 1,000 births, fully corrected. ‡Per 100 deaths. In November of last year enquiries were made by the Staff as to the numbers of empty tenements in streets occupied mainly by the " working classes." The reports handed in showed that some 3,382 rooms were then vacant, which number, at an allowance of 2 persons per room, represented accommodation for (say) 6,750 persons. As a matter of fact, many of the rooms were known to be large enough to accommodate at least 2 adults and 3—5 68 food supervision. children under 10 without any (legal) overcrowding. It is believed that the empty rooms would have accommodated over 12,000 persons without causing overcrowding (if anvthing more than half the occupants were children under 10), which would come under the by-laws. It is not intended to suggest that such an aggregation would be either healthy or desirable, the figures being given merely as an approximation of the accommodation at that date available. The distribution of the accommodation (numbers of rooms) in the different Wards is indicated below — Numbers of Empty Rooms. November, 1908. In unregistered houses. In registered houses. Queen's Park 488 — Harrow Road 1,272 — Maida Vale 156 72 Westbourne 297 202 Church 368 479 Lancaster Gate, West — — ,, ,, East — — Hyde Park 48 — 2,629 753 Common Lodging Houses. At the Licensing Session of last year 7 houses were licensed in the Borough—6 for men (195 beds) and 1 for women (40 beds). Such premises are under the supervision of the County Council, but the Inspectors of the Department visit them from time to time. One case of enteric fever occurred during the year among the lodgers, and 10 deaths, the causes of which were:— Tubercular Diseases (Phthisis) 2 each. Influenza 1 each. Old age Respiratory Disease Other Causes, 4. Inhabited House Duty. In addition to the 5 applications for Certificates under Sec. 11 of the Revenue Act, 1903, remaining over from 1907, 16 fresh applications were dealt with. The 21 applications were covered by 7 certificates, 5 of which were issued prior to December 31st, and 2 just after. The certificates referred to 65 tenements. 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 renewal of the licence for No. 1, Bishop's Mews, was opposed on the ground that the licence had lapsed from non-user. The Licensing Committee overruled the objection and renewed the licence. 69 FOOD SUPERVISION. The Inspector visited the slaughterhouses on 582 (589) occasions when killing was in progress, and examined 5,363 (5,716) carcases in process of dressing, viz.—152 (149) of bullocks, 5,206 (5,534) of sheep, and 5 (33) of calves. Those numbers are slightly below those for 1907, given in parentheses. The following organs (total weight, 1,800 [670] lbs.) were destroyed during the year, for the reasons assigned in each case :— Sheep. Livers, 41—parasites 30, cirrhosis 5, and abscesses 6. Lungs, 4— „ 2, pneumonia and pleurisy, 1 each. F orequarter—pleurisy. Bullocks. Livers, 39—parasites 28, abscesses 7, cirrhosis 3, tuberculosis 1. Lungs, 6— ,, 3, pneumonia 2. Carcase and organs—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. The drains at two milk-shop and ice-cream premises, and three restaurants were reconstructed during the year. Food Purveyors. Numbers of places where Food is sold:— Butchers 83 Milkshops and Dairies 176 „ Pork 26 Refreshment Houses 128 Fishmongers 29 Fried Fish and Sausages 29 Game and Poultry 12 Ice Cream Makers & Vendors 136 Fruit and Greengrocery 84 Margarine Dealers 12 Inspections during the year:— Butchers' Shops 605 Milkshops, &c. 293 Greengrocers' Shops 22 Restaurants, &c. 230 Costers'Barrows 24 Ice Cream Shops and Barrows 50 Fishmongers' Shops 26 Fried Fish Shops 50 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 3 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 1907, 175 names were on the Register. During the past year 12 names were added, 11 removed, and 29 changed, leaving 176 effective entries at 70 UNSOUND AND DISEASED FOOD. 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 80 „ wholesale dep6ts 4 Grocers' shops 10 General shops, selling oil 43 „ not „ 11 Sweet-stuff and confectionery 10 Provisions 1 Off-licensed premises 2 Refreshment 10 Bakers' shops 4 Private house 1 The above premises were inspected on 293 occasions during the year. Three cases of scarlet fever and two of diphtheria were reported on premises where milk was sold; and 1 case of scarlet fever in a milk carrier, and 2 cases of scarlet fever and 5 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. Four names were removed from the Register during the year, there being 136 effective entries at the end of the year. Of the makers and vendors on the Register, 132 are shop-keepers, and 4 Italian barrow-men. The businesses combined with the sale of ice-cream are indicated below:— Sweet shops 64 Newspapers and Tobacco 3 Bakers 24 Confectioners 5 Milk 6 Cook 1 Restaurants 17 General 12 In addition to the 4 local barrow-men, 14 from other districts have regular stands in the Borough: From Marylebone 6 From Islington 1 „ Kensington 5 Willesden 2 One case of scarlet fever occurred on an ice-cream shop premises. UNSOUND AND DISEASED FOOD. In addition to the meat condemned and destroyed in the course of slaughter, 7,185 lbs. of foodstuffs were destroyed as unfit for human food, including 4,480 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. pig 1 Carcase. Tuberculosis 1 Pluck, 1 Mesentery. Bullock 9½ Lungs, 1 Tongue. Bullock 1 Lungs (set), 1 Liver. Parasites Sheep 1 Liver. 71 FOOD ADULTERATION. Pig 8 Pieces. Decomposed Bullock 1 Pieces. Abscess Calf 1 Piece. Fish:—(decomposed)— Skate 112 lbs. Haddock 218 lbs. Hake 336 lbs. Vegetables:—(decomposed) — Apples 33 lbs. Plums 60 lbs. Tomatoes 152 „ Pears 213 „ Oranges 406 ,, Lemons 404 „ Cherries 4 „ Bananas 6 „ Onions10 „ Grapes 10 „ Currants 36 „ Gooseberries 20 „ Potatoes 336 „ Summary. Meat 2,139 lbs. Per G.W.R. Co., Fish 666 „ Vegetables and Fruit 4,480 lbs. Vegetables and Fruit 1,700 „ 4,505 4,480 Grand Total 8,985 lbs. FOOD ADULTERATION. The samples submitted to the Public Anaylst during the year numbered 604, of which 16, or 2.6 per cent. were found to be adulterated. The proportions found adulterated in the three preceding years were:—1907, 9.2; 1906, 10.2; and 1905, 6.5. A list of the samples purchased last year, together with the numbers and proportions found to be adulterated, is civen in Table 44. TABLE 44. Total. Found Adulterated. Percentage Adulterated. Milk 340* 6 1.8 Butter 178 10 5.6 Coffee 12 — — Jam 10 — — Cheese 8 — — Cocoa 6 — — Cream 4 — - Cream Cheese 4 — — British Wine 4 — — Potted Meat 4 — — Mustard 4 — — Vinegar 4 — — Lard 4 — — Skim Milk 3 — — Ammon. Tinct. Quinine 3 — — Preserved Fruit 2 — — Arrowroot 2 — — Lime Juice 2 - — Bread 2 — — Rum 2 - - Olive Oil 2 - - Ground Ginger 2 — — Nougat 1 — — Sweet Spirits of Nitre 1 — — 604 16 2.6 * Including 31 taken at Paddington (G.W.R.) Terminus in course of delivery; 2 adulterated. 72 OFFICE WORK. Of 340 samples of milk, 31 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, 2, or 6.4 per cent, were found to be adulterated, as compared with 32.3 in 1907 ; 30-6 in 1906; and 12.6 in 1905. Samples of milk were purchased in the streets on Sunday on 8 occasions, 61 samples being so taken, none of which were adulterated. OFFICE (CLERICAL) WORK. The appended figures are intended only as a suggestion of the mass of work which has to be performed by the Clerical Staff, conveying as they do 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 form of statistics. Letters received 4,014 (4,005) Complaints received 817 (747) „ despatched 2,836 (3,108) Plans dealt with 403 (471) Entries in postage book 12,341 (10,237) New openings in Journals 890 (786) Cases of infectious disease entered in Register 971 (740) Disinfection Orders Notices sent re above and (duplicate) 1,424 (2,377) other diseases 7,428 (6,594) Notices to abate nuisances 1,197 (1,254) The figures in parentheses are the returns for 1907. LEGAL PROCEEDINGS. The results of the cases which were brought before the Police Magistrate are appended hereto. 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, and the cases taken into Court form but a small proportion of the total dealt with during the year. The fines imposed during the year amounted to £48 5s. and the costs awarded to £51 2s. 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. 1908 43 10 0 55 17 6 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 Adulteration Cases. 1908. 1907. 1906. 1905. 1904. 1903. Average per conviction Fine £1 2 3 £0 17 0 £0 16 6 £3 8 7 £2 15 2 £3 1 6 Costs 0 13 9 0 12 8 0 15 0 1 2 0 1 5 8 0 15 7 73 SUMMARY OF LEGAL PROCEEDINGS. LEGAL PROCEEDINGS, 1908. Under Public Health (London) Act, 1891. Fines. Costs. Section 4. £ s. d. £ s. d. 153, Harrow Road No water supply to premises Closing Order made. (Suspended for 7 days.) 34, Clarendon Street Premises insanitary and dilapidated Work done. 7 7 n 30, „ „ ,, (See foo tnote)* 38 ,, 66, Westbourne Park Road Drains defective Order made. ,, ,, Neglecting to comply with Magistrate's Order 2 10 0 2 2 0 4, Hyde Park Terrace Drain under roadway defective Summons dismissed. Council ordered to pay 12s. cosis. 37, Clarendon Street Drains defective Work done. Amount paid 1 1 0 24, Carlton Vale Failing to pay costs awarded by Magistrate 0 2 0 Section 47. J. J. Cridlan, 73, Westbourne Grove Exposing diseased ox tongue for sale 1 0 0 3 3 0 S. Sinfield, 120, Chippenham Road Exposing unsound bananas for sale 5 0 0 1 5 0 L. E. White, 125, Harrow Road Exposing diseased veal for sale 2 0 0 0 12 0 Warman & Son, 1, St. John St., E.C Selling unsound bullock's liver Summons dismissed. G. Watts, 70, Hall Place Exposing unsound fruit for sale 0 10 0 0 2 0 By-laws relating to Houses let in Lodgings. (See 94.) 33, Hethpool Street Neglecting to complete annual cleansing. Work done. 0 2 0 5, Hermitage Street ,, ,, ,, ,, 0 2 0 5, Waverley Road ,, ,, ,, ,, 0 2 0 3, South Wharf Road ,, ,, ,, ,, 0 2 0 19, Hall Place ,, ,, ,, ,, 0 2 0 19, Kensal Road ,, ,, ,, ,, 0 5 0 26, Cuthbert Street ,, ,, ,, ,, 0 12 6 7, Elcom Street ,, ,, ,, ,, 1 1 0 3, Dartington Terrace ,, ,, ,, Summons Work done. withdrawn. 5, Elcom Street ,, ,, ,, 0 2 0 11, „ ,, ,, ,, ,, 0 2 0 2, Dartington Terrace ,, ,, ,, ,, 0 10 6 62, Hall Place ,, ,, ,, 0 10 0 0 12 6 82, Woodchester Street ,, ,, ,, Work done. 0 2 0 86, „ ,, ,, ,, ,, 0 2 0 88, ,, ,, ,, ,, 0 2 0 8, Desborough Street ,, ,, ,, ,, 0 12 6 136, Clarendon Street ,, ,, ,, ,, 0 10 6 138, ,, ,, ,, ,, 0 10 6 140, ,, ,, ,, ,, 0 10 6 52, Brindley Street ,, ,, ,, ,, 0 10 6 56, „ ,, ,, ,, ,, 0 2 0 58, „ ,, ,, ,, ,, 0 2 0 29, Kensal Road Neglecting to furnish Statement of Particulars Defendant ordered to in 7 days. 0 2 0 Borani & Co., Horsenden Wood Farm, Harrow make return Other By-laws. Removing offensive matter in an improper manner 0 5 0 0 12 6 ,, ,, ,, ,, ,, 0 5 0 0 2 0 Wickens, Pease & Co, 31, mondsey Wall ,, ,, ,, 0 10 0 0 2 0 Cockman Bros., Marshgate Lane, Stratford Removing offensive matter during prohibited hours 0 5 0 0 2 0 133, Edgware Road Altering sanitary fittings without giving notice 0 5 0 0 2 0 ,, ,, Executing work in an improper manner 0 5 0 0 2 0 12, Campbell Street ,, ,, ,, 0 5 0 1 1 0 34, Clarendon Street Yard paving defective (See footnote)* 36, „ Water-closet defective 38, „ ,, ,, 6, Philip Terrace Neglecting to provide additional water-closet accommodation Work done. 0 10 6 65, Cirencester Street ,, ,, ,, ,, 0 10 6 * £7 7s. costs were awarded in respect of 9 summonses. 74 SUMMARY OF LEGAL PROCEEDINGS. London County Council (General Powers) Act, 1904. Section 20. £ s. d. £ s. d 34, Clarendon Street Rooms in a verminous condition (See footnote)* 36, ” ” 38, ” ” Metropolis Management Act, 1855. By-laws pursuant to Section 202. 23, Hampden Street Neglecting to submit plans of drainage works 0 5 0 0 2 0 28, Beethoven Street ” ” ” Plans submitted. 0 2 0 66, Queensborough Terrace „ „ „ ” 0 5 0 5, Brook's Mews North ” ” ” ” 0 7 0 2, Victoria Street ” ” ” ” 0 2 0 9, ” ” ” ” 0 2 0 33, Hormead Road ” ” ” ” 0 2 0 85, Cirencester Street ” ” ” ” 0 10 6 597, Harrow Road ” ” ” ” 0 10 6 10, Porchester Terrace ” ” ” ” 1 1 0 309, Edgware Road ” ” ” ” 0 10 6 75 SUMMARY OF LEGAL PROCEEDINGS. SUMMARY OF LEGAL PROCEEDINGS DURING 1908. Under Sale of Food and Drugs Acts, 1875-1899. Fines. Costs. £ s. d. £ s. d. Milk 12% fat abstracted 0 10 0 0 12 6 ” 5% added water 1 0 0 0 14 6 ” 6% „ 5 0 0 0 12 6 ” 8% „ Summons withdrawn. (1) ” 6% „ Do. 10% „ Do. ” 9% „ Summons dismissed: warranty proved. Council ordered to pay 21s. costs. ” 25% fat abstracted ” ” Summons dismissed: warranty pleaded. ” 25% „ ” Summons dismissed: warranty pleaded. Defendant ordered to pay costs 13 0 ” ” ” 7% added water — 2 14 6 ” 11% fat abstracted Summons withdrawn on payment of costs 110 ” 12 100ths of a per cent, of boric acid (2) ” 0 10 0 1 0 6 ” 12 100 ths „ — ... 0 2 0 ” 78 1000ths „ „ — ... 0 2 0 ” — ... 0 2 0 ” 7 100ths — ... 0 2 0 ” 7 8 ths l000 — ... 0 2 0 ” —— ths 8 100 — ... 0 2 0 ” 78 1000ths — ... 0 2 0 ” — ... 0 2 0 ” 8 100ths „ „ — ... 0 2 0 Cream 0.46% boron preservative. summonses withdrawn on payment of costs. 1 1 0 ” 0.4 % „ 1 1 0 ” 0.4 % „ 1 1 0 ” 0.4 % „ 1 1 0 ” 0.48% „ 1 1 0 ” 0.4 % „ 1 1 0 Butter 23% foreign fat 0 10 0 0 12 6 ” 82½% „ 1 0 0 0 12 6 ” 77¼% „ 5 0 0 0 12 6 ” 70½% „ 2 0 0 0 12 6 ” 77% „ 10 0 0 0 12 6 (2) ” 78% „ 1 0 0 0 12 6 ” 80% „ 1 0 0 0 12 6 ” 82% „ 1 0 0 0 12 6 ” 81½% 5 0 0 0 12 6 ” 76½% 1 0 0 0 12 5 NOTES. (1) This milk had been purchased from vendor of the preceding sample, in regard to which a fine of £5 and 12s. 6d. costs were imposed. (2) The same defendant. 79 APPENDIX.-A. TABLE I. Vital Statistics of Whole District during 1908 and Ten Previous Years. L. G. B. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in the District. Deaths of Residents registered beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate* Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 vital statistics. 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 1907 149,542 3,074 20.55 396 128 2,154 14.40 770 372 232 2,014 13.46 Averages for years 1898-1907. 145,595 3,294 22.61 477 144 2,261 15.52 717 365 204 2,100 14.42 1908 150,489 3,149 20-58 374 118 2,079 13.58 825 400 217 1,896 12.36 * 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 At Census of 1901. Average number of persons per house, 8.9 77 estimated populations of and numbers of births and deaths in borough. TABLE II. Estimated Populations of and Numbers of Births and Deaths (both corrected) in Borough and its Wards. L. G. B. Year. Borough. Oueen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Estimated Population. 1901 144,188 17,152 27,775 18,769 23,842 26,335 8,454 7,939 13,922 1902 145,052 17,038 28,071 18,969 24,096 26,579 8,449 7,935 13,915 1903 145,927 16,924 28,370 19,171 24,352 26,826 8,445 7,931 13,908 1904 146,815 16,813 28,672 19,375 24,612 27,076 8,441 7,926 13,900 1905 147,713 16,701 28,978 19,581 24,874 27,326 8,436 7,923 13,894 1906 148,621 16,589 29,286 19,790 25,138 27,580 8,432 7,919 13,887 1907 149,542 16,478 29,597 20,001 25,406 27,837 8,428 7,915 13,880 Averages 146,865 16,815 28,686 19,885 24,624 27,086 8,441 7,927 13,901 1908 150,489 16,368 29,917 20,216 25,680 28,100 8,424 7,911 13,873 Births. 1901 3,499 not known. 1902 3,464 1903 3,465 1904 3,458 1905 3,299 428 818 423 510 760 72 91 197 1906 3,286 458 844 430 453 769 63 71 198 1907 3,206 436 797 424 468 768 72 65 176 Averages 3,382 ... ... ... ... ... ... ... ... 1908 3,296 455 858 427 505 739 68 65 179 Deaths. All Ages. 1901 2,057 257 401 255 354 484 77 61 168 1902 2,152 270 433 264 373 539 59 70 144 1903 1,918 237 353 244 349 470 51 60 154 1904 2,014 249 402 260 310 482 68 66 177 1905 1,961 221 396 257 338 448 77 76 148 1906 1,843 206 319 250 297 487 58 57 169 1907 2,014 235 398 292 337 470 72 64 146 Averages 1,994 239 386 260 337 483 66 79 144 1908 1,896 225 381 249 343 434 64 53 147 Under One Year. 1901 455 62 105 49 75 132 9 4 19 1902 433 76 101 49 63 117 3 8 16 1903 388 43 84 44 63 123 3 6 22 1904 449 71 96 52 62 131 7 7 23 1905 391 52 94 51 57 111 4 5 17 1906 353 42 63 46 55 113 3 6 25 1907 354 46 85 46 47 99 6 6 19 Averages 403 56 90 48 60 118 5 6 20 1908 348 41 79 43 55 102 2 4 22 78 causes of death at various ages in each sex. TABLE III. Causes of Death : Borough—Sex and Age Distribution. 1908. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond the Borough. L. G. B. Cause of Death. Age at Death. All Ages. 0— 1— 5— 15— 25— 65 and upwards. Persons. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1908 1907 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 3 15 11 ... 1 ... ... ... 2 ... ... 19 17 36 37 Scarlet Fever 1 ... 4 5 2 3 ... ... ... ... ... ... 7 8 15 13 Epidemic Influenza 2 ... 1 1 1 1 ... ... 19 12 10 16 33 30 63 52 Whooping-cough 2 3 5 1 ... ... ... ... ... ... ... ... 7 4 11 50 Diphtheria, Membranous Croup ... 2 5 5 1 2 ... ... 1 ... ... ... 7 9 16 20 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 ... ... ... ... ... 1 ... 1 1 ... ... 3 1 4 5 Diarrhoea, Dysentery 14 13 2 5 ... ... ... ... ... ... 1 2 17 20 37 21 Epidemic, Zymotic Enteritis 16 4 2 1 ... ... ... ... ... ... ... ... 18 5 23 26 Enteritis 12 8 ... 2 ... ... ... ... 1 ... ... 12 11 23 18 Other Continued Fevers— ... Chicken-pox ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... Mumps ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Cerebro-Spinal Fever ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... Syphilis 6 2 ... ... ... ... ... ... ... 2 ... 1 6 5 11 12 Erysipelas 1 ... ... ... ... ... ... ... 2 1 1 ... 4 1 6 7 Puerperal Fever ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 4 Other Septic Diseases— Pymæia ... ... ... ... ... ... 1 ... 1 2 ... ... 2 2 4 1 Cancrum Oris ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... Infective Endocarditis ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 2 3 Septic Pneumonia ... ... ... ... ... .... ... ... ... 1 ... ... ... 1 1 ... Stomatitis ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... 1 Cellulitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Rheumatic Fever ... ... ... ... ... ... ... 1 1 3 ... ... 1 4 5 8 Tuberculosis— „ of Meninges 2 1 9 1 ... 1 ... ... ... ... ... ... 11 3 14 25 „ of Lungs 1 ... ... 2 2 1 14 7 76 41 2 3 95 54 149 157 „ (other forms) 1 3 4 5 1 5 2 ... 4 1 1 ... 13 14 27 37 in Alcoholism ... ... ... ... ... ... ... ... 4 4 ... 1 4 5 9 10 Cancer ... ... ... ... ... ... 1 ... 42 75 27 40 70 115 185 178 Premature Birth 33 22 ... ... ... ... ... ... ... ... ... ... 33 22 55 72 Developmental Diseases 47 40 4 2 ... ... ... ... ... ... ... ... 51 42 93 66 Old Age ... ... ... ... ... ... ... ... ... 2 32 71 32 73 105 111 Meningitis 2 1 4 ... 2 ... 1 ... 1 ... ... ... 10 1 11 10 Inflammation and Softening of Brain ... ... ... 1 ... ... ... ... 2 6 5 7 7 14 21 11 Convulsions 6 3 ... 5 ... ... ... ... ... ... ... ... 6 8 14 13 Apoplexy ... ... ... ... ... ... ... ... 5 4 3 8 8 12 20 20 Cerebral Hœmorrhage ... ... ... ... ... ... ... ... 8 10 11 12 19 22 41 35 Organic Diseases of Heart ... ... ... ... ... 3 1 ... 12 21 7 14 20 38 58 79 Heart Disease ... ... ... ... 2 3 ... 1 20 21 13 15 35 40 75 79 Acute Bronchitis 5 3 2 ... ... ... ... ... 5 4 11 14 23 21 44 78 Chronic Bronchitis ... ... ... ... ... ... ... ... 4 7 13 9 17 16 33 35 Bronchitis 4 10 3 2 ... ... ... ... 10 8 26 36 43 56 99 64 Lobar (Croupous) Pneumonia ... ... ... 1 ... ... 1 1 8 8 1 6 10 16 26 19 Lobular (Broncho-) Pneumonia 12 6 8 10 ... ... ... ... 1 2 4 6 25 24 49 77 Pneumonia 12 6 9 3 1 ... 2 ... 16 10 7 8 47 27 74 72 Diseases of Stomach ... ... ... ... ... ... ... ... 4 3 1 2 5 5 10 22 Obstruction of Intestines 2 2 ... ... ... ... 1 ... 1 ... 2 2 6 4 10 11 Cirrhosis of Liver ... ... ... ... ... ... ... ... 6 10 ... ... 6 10 16 29 Nephritis and Bright's Disease 1 ... ... ... ... ... 1 ... 9 14 10 10 21 24 45 54 Tumours, &c., of Female Genital Organs ... ... ... ... ... ... ... 1 ... 4 ... 3 ... 8 8 7 Accidents and Diseases of Parturition ... ... ... ... ... ... ... 1 ... 9 ... ... ... 10 10 11 Accident and Negligence 4 10 6 4 2 1 1 1 24 6 1 11 38 33 71 57 Homicide ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... Suicide ... ... ... ... ... ... ... ... 13 2 2 ... 15 2 17 9 Ill-defined Causes 3 4 ... ... ... ... ... ... 1 ... ... 4 4 8 6 All other Causes 4 3 2 2 3 7 5 5 73 56 33 43 120 116 236 281 All Causes, 1908 198 150 86 69 18 28 82 20 376 354 223 340 935 961 1896 1907 219 135 113 87 32 25 36 33 384 348 236 366 1020 994 2014 79 DEATHS AT ALL AGES. TABLE IV. Causes of Death : All Ages, Persons.—In Wards. 1908. Corrected for Non-Residents dying within, and (as far as possible) for Residents dying beyond, the Borough. L.G.B. Cause of Death. Oueen's Park. Harrow Road. Maida Vale. Westbourne. Church. Lancaster Gate, Hyde Park. West. East. Small-pox ... ... ... ... ... ... ... ... Measles 8 6 1 9 9 1 ... 2 Scarlet Fever ... 6 2 3 4 ... ... ... Epidemic Influenza 7 10 10 10 8 6 6 6 Whooping-cough 1 4 1 ... 5 ... ... ... Diphtheria and Membranous Croup 1 6 3 2 2 ... 1 1 Croup ... ... ... ... ... ... ... ... Enteric Fever ... 2 ... ... 1 ... ... 1 Diarrhœa, Dysentery 8 8 6 2 12 ... ... 1 Epidemic, Zymotic Enteritis ... 7 1 8 6 ... ... 1 Enteritis ... 3 8 2 8 1 ... 1 Other Continued Fevers— ... ... Chicken-pox ... ... ... ... 1 ... ... ... Mumps ... ... ... 1 ... ... ... ... Cerebro-Spinal Fever ... 1 ... ... ... ... ... ... Syphilis 4 1 1 4 1 ... ... ... Erysipelas 1 1 ... 1 1 ... 1 ... Puerperal Fever ... 1 1 ... ... ... ... ... Other Septic Diseases— ... ... Pyæmia ... ... ... ... 3 1 ... ... Cancrum Oris ... ... 1 ... ... ... ... ... Infective Endocarditis ... ... ... ... 2 ... ... ... Septic Pneumonia ... ... ... ... ... ... ... 1 Rheumatic Fever ... 1 1 1 1 1 ... ... Tuberculosis— Of Meninges 2 2 3 3 3 ... ... 1 Of Lungs 29 26 12 31 40 2 3 6 Other Forms 5 6 5 ... 9 ... 1 1 Alcoholism 2 ... 2 2 1 ... 1 1 Cancer 24 30 32 24 41 9 10 15 Premature Birth 5 15 8 8 17 ... 1 1 Developmental Diseases 14 19 4 18 25 ... 3 10 Old Age 9 25 13 21 23 3 1 10 Meningitis 1 2 1 ... 5 ... ... 2 Inflammation andSofteningof Brain 3 6 2 3 5 ... ... 2 Convulsions 2 2 1 2 7 ... ... ... Apoplexy 1 6 ... 3 5 2 1 2 Cerebral Hæmorrhage 1 9 7 8 9 5 ... 2 Organic Diseases of Heart 3 18 9 12 8 4 1 3 Heart Disease 7 16 13 13 16 4 3 3 Acute Bronchitis 5 3 5 9 6 6 2 8 Chronic Bronchitis 8 3 7 3 7 1 1 3 Bronchitis 10 21 9 25 26 2 2 4 Lobar (Croupous) Pneumonia 3 9 1 5 3 1 1 3 Lobular (Broncho-) Pneumonia 6 9 9 6 11 1 ... 7 Pneumonia 15 15 5 16 15 3 2 3 Diseases of Stomach 2 2 1 1 1 ... 1 2 Obstruction of Intestines 3 1 1 1 1 ... ... 3 Cirrhosis of Liver ... 5 3 4 1 ... 2 1 Nephritis and Bright's Disease ... 12 7 9 7 2 2 6 Tumours, &c., of Female Genital Organs 1 ... 2 1 3 1 ... ... Accident and Diseases of Parturition 1 1 2 1 3 1 ... 1 Accidents and Negligence 3 16 10 15 16 ... 2 9 Homicide ... 1 ... ... ... ... ... ... Suicide 2 ... 3 5 3 1 ... 3 Ill-defined Causes ... 2 2 1 3 ... ... ... All other Causes 28 42 34 50 51 6 5 20 All Causes— 1908 225 381 249 343 435 64 53 146 1907 235 398 292 337 470 72 64 146 80 deaths in local institutions. TABLE V. Deaths in Local Institutions. Year. Paddington Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital. 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 1907 347 332 88 3 Averages 287 344 83 3 1898-1907 1908 373 351 91 — * Closed part of year for repairs and alterations. TABLE VI. Causes of Deaths in Institutions. 1908. Causes of Death. Local Institutions. Deaths of Residents recorded beyond the Borough. Workhouse and Infirmary. St. Mary's Hospital. Children's Hospital. Lock Hospital, and Nursing Homes. Hospitals of Metropolitan Asylums Board. Special and General Hospitals. Lunatic Asylums. Poor Law Institutions. Elsewhere. Small-pox ... ... ... ... ... ... ... ... ... Measles 8 1 2 ... 1 ... ... ... ... Scarlet Fever ... ... ... ... 15 ... ... ... ... Influenza 3 1 ... ... ... ... ... ... 1 Whooping-cough 2 1 ... ... ... 1 ... ... ... Diphtheria ... 7 ... ... 12 ... ... ... ... Enteric Fever ... 4 1 ... 1 ... ... ... ... Diarrhœa 1 4 13 1 ... 1 1 1 1 Epidemic Enteritis 13 2 1 ... ... ... ... ... ... Erysipelas 3 ... ... ... ... ... ... ... ... Puerperal Fever ... 3 ... ... ... 1 ... ... ... Other Septic Diseases 1 14 3 1 ... 1 ... ... ... Tuberculosis of Lungs 55 8 2 10 ... 12 5 3 2 Other forms of Tuberculosis 6 19 15 2 ... 6 ... ... ... Cancer 38 48 2 12 ... 24 2 2 4 Premature Birth 3 ... 2 ... ... 4 ... 1 ... Developmental Diseases 1 1 5 ... ... 7 ... ... ... Old Age 42 ... ... 1 ... 1 3 ... 1 Bronchitis 52 4 ... ... ... 2 1 ... 1 Pneumonia 23 19 3 2 ... 3 4 ... ... Cirrhosis of Liver 4 1 ... ... ... 1 ... ... ... Accidents of Childbirth 4 1 ... ... ... 1 ... 1 ... Accident and Violence 5 51 6 ... 1 5 ... ... 7 Suicide ... 5 ... ... ... ... ... ... 3 All other Causes 109 157 36 18 ... 32 26 5 10 All Causes 373 351 91 47 30 102 42 13 30 Non-Residents* 9 265 67 30 * The deaths of 29 other non-residents took place either in the streets or houses in the Borough. Total deaths of non-residents—400. 18 TABLE VII. 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— 1908 1903-07 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. Not Certified 3 4 ... ... ... ... ... ... 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 3 1 4 3 4 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... 1 2 3 7 8 II. Diarrhœa (all forms) ... ... ... ... 1 1 1 1 2 2 5 3 4 9 3 2 3 1 5 3 1 9 1 1 1 ... 4 ... 1 ... ... 1 30 17 45 34 Enteritis ... 1 1 ... 1 ... ... ... 2 1 3 ... 1 1 1 2 1 2 2 1 1 ... ... ... ... ... 1 1 ... ... ... ... 12 8 7 4 III. Premature Birth 21 13 2 2 2 2 3 27 18 4 2 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 33 99 33 25 Congenital Defects 2 2 ... 2 2 1 ... 1 4 6 3 1 ... 1 ... ... 1 ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... 3 11 6 8 Injury at Birth 2 4 ... ... ... ... ... ... 2 4 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 3 ... Want of Breast Milk ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 1 3 2 Atrophy, Debility ... ... 2 ... ... 2 1 ... 3 2 5 1 3 ... 2 1 1 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 18 6 17 10 Atelectasis 2 5 ... ... ... ... ... ... 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 5 3 2 Debility at Birth 4 3 1 1 2 1 ... ... 7 5 2 4 1 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 12 8 7 IV. Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 4 4 Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 1 Other Tuberculous Dis. ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 2 4 2 V. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Syphilis ... ... 1 ... 1 1 ... ... 2 1 ... 1 1 ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 6 2 3 4 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Meningitis ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... l ... ... ... ... ... ... ... ... ... 2 1 2 2 Convulsions 2 ... 2 1 ... 1 ... ... 4 2 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 3 9 6 Bronchitis ... ... ... ... 1 ... 1 ... 2 ... 2 5 ... ... ... 2 1 2 ... ... 2 1 1 2 ... ... 1 ... ... ... ... 1 9 13 14 11 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... 1 ... ... 2 ... 2 1 3 ... 2 1 ... ... 1 3 4 1 4 1 ... 1 ... ... 3 ... 1 2 1 I 24 12 20 16 Suffocation (overlaid) 1 2 ... ... ... l ... ... 1 3 ... 3 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 6 7 5 Other Causes ... 2 1 ... ... l 1 1 2 4 1 ... 3 1 ... 1 ... ... 5 1 ... 2 l 1 1 ... 2 ... ... 1 ... ... 15 11 13 12 All Deaths, 1908 ... 37 36 10 7 11 9 8 6 66 58 30 22 20 9 8 12 11 10 19 7 10 8 4 6 6 1 13 5 5 6 6 6 198 150 Averages—1903-07 ... 38 28 11 7 10 9 7 8 66 52 26 21 20 12 16 14 15 13 14 10 12 9 12 8 9 7 10 9 8 8 10 6 218 169 Population— 1 150,489. (estimated 1908 1908. Births registered M. 1,609 within Borough F. 1,540 1903-07. 1,629 1,572 1908. 1903-07. Deaths- 1,896 1,950 all causes, all ages 82 factories, workshops, laundries, workplaces and homework. TABLE VIII. 1.—Inspection. Including Inspections made by Sanitary Inspectors. H.O. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 165 ... ... Workshops (including Workshop Laundries) 1,338 9 ... Workplaces (other than Outworkers' premises ineluded in Part 3 of this Report) 50 3 ... Total 1,553 12 ... 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. Notices served on Occupiers as to keeping or sending lists. Twice in the year. Once in the year. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— 1,506 (1) making, &c. 102 ... 476 10 ... 27 346 316 (2) cleaning and washing 6 ... 21 14 ... 21 ... ... Lace, lace curtains and nets 10 ... 10 ... ... ... ... ... Artificial Flowers ... ... ... ... ... ... ... ... furniture and Upholstery 4 ... 22 2 ... 2 1 ... Jmbrellas, etc. ... ... ... 1 ... 1 ... ... Paper Bags and Boxes ... ... ... ... ... ... 3 ... Total 122 ... 529 27 ... 51 350 316 1,506 4.—Registered Workshops. Workshop on the Register (s. 131) at the end of the year. Number. Workshops ... ... ... ... ... ... ... ... ... 1,532 Do. Bakehouses . ... ... ... ... ... ... ... ... ... 73 Total number of workshops on Register 1,605 83 factories, workshops, laundries, workplaces and homework. 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances tinder the Public Health Acts:— Want of Cleanliness 33 32 ... ... Want of Ventilation 7 7 ... ... Overcrowding 7 7 ... ... Want of drainage of floors ... ... ... ... Other nuisances 6 6 ... ... Sanitary accommodations insufficent 2 2 ... ... unsuitable or defective 11 11 ... ... not separate for sexes 1 1 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) ... ... ... ... Other offences (excluding offences relating to outework ... ... ... ... which are included in Part 3 of this Report) ... ... ... ... Total 67 66 ... ... Work. Prosecutions. Number of Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Instances. Notices served. Prosecutions Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Failing to keep or permit inspection of lists. Failing to send lists. ... ... 240 ... ... ... 24 ... ... ... ... 33 ... ... ... ... ... ... ... ... 7 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 14 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... 299 ... ... ... 24 ... ... 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) 5 Action taken in matters referred bv H.M. Inspector i Notified by H.M. Inspector 11 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) t Inspector 8 Other ... Underground Bakehouses (S. 101):— Certificates granted during the year ... In use at the end of the year 57 84 PROCEEDINGS DURING 1908. TABLE IX. PROCEEDINGS DURING 1908. L.C.C. Premises. Number of Places— Number of Inspections, 1908. Number of Notices, 1908. Number of Prosecutions, 1908. On Register at end of 1907. Added in 1908. Removed in 1908. On Register at end of 1908. Milk premises 175 12 11 176 293 2 ... Cowsheds 1 ... ... 1 3 ... ... Slaughter-houses 7 ... ... 7 582 ... ... Other offensive trade premises ... ... ... ... ... ... ... Ice cream premises Registered houses 140 ... 4 136 50 1 ... let in lodgings 1,320 47 24 1,343 7,941 (a) 59 (b) 3,387 (a) ... (b) 36 (a) For overcrowding. (6) For other conditions (including annual cleansing). Total number of intimation notices served for all purposes 792 Overcrowding, 1907— Number of dwelling rooms overcrowded 339 Number remedied 168* Number of prosecutions — Underground rooms— Illegal occupation dealt with during year 1 Number of rooms closed 1 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 137 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 16 Number of tenements comprised therein 50 ( (a) granted 57† Number of tenements for which certificates were (b) refused — (c) deferred 8 Number of prosecutions under By-laivs 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 1 (e) In connection with the removal of offensive matter, etc. 4 (/) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (^i) With respect to water closets, earth closets, etc. 7 (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) — (It) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) 11 Mortuaries— Total number of bodies removed 292 Total number of infectious bodies removed 3 * In 171 cases no action was taken, the deficiency of air space being very slight. j" Including 15 deferred from 1907. 85 infantile diarrhoea. APPENDIX B. Infantile Diarrhiea. The deaths from the " diarrhoeal diseases "* numbered 60, 57 of the deceased persons being under 5 years of age. The number of deaths in each Ward is given in the table below. The mortality (per 1,000 persons of all ages) was 0*39, as compared with 0*31 in 1907, and mean quinquennial rates of 0-63—1903-07; 1-07—1898-1902; 0-96—1893-97. In two Wards (see below) the mortality last year was nil, the highest rate for any Ward being that of Church Ward (0*62). In each case last year's mortality was below the quinquennial mean rate. "Diarrheal Diseases." Ward. 1908. Mean Rates. 1903-07. Deaths, (all ages.) Mortality. Queen's Park 8 0.47 0.85 Harrow Road 15 0.49 0.65 Maida Vale 7 0.33 0.50 Westbourne 10 0.38 0.55 Church 18 0.62 1.20 Lancaster Gate West — — 0.02 East — — 0.07 Hyde Park 2 0.14 0.27 The main interest in the " diarrhoeal diseases " lies in the mortality therefrom among children under 5 years of age. As already stated, there were 57 deaths from these causes, there having been 22 other deaths from " enteritis." The appended statement indicates that the last is not due to the same causes as the other two, which are specially characterised by their prevalence during the third and fourth quarters of the year, i.e., during the hottest part of the year, the deaths during the fourth quarter occuring almost exclusively during the first half thereof. " Diarrhoea " Epidemic Dysentery." (Zymotic) Enteritis." " Enteritis." m. f. m. f. m. f. 1st Quarter 2 2 — — 3 4 2nd „ - 1 1 — 2 3 3rd „ 10 10 13 3 4 2 4th „ 4 5 4 2 3 1 Year 16 18 18 5 12 10 It is usual to take the deaths during the third quarter of the year as the index of the mortality from "summer diarrhoea" among infants. During the past ten years the numbers * The "diarrhoeal diseases" are "diarrhoea, dysentery" (37 deaths) and "epidemic (zymotic) enteritis" (23 deaths). There were also 23 deaths from " enteritis." In scheduling the certified causes of death, the rules laid down by the Society of Medical Officers of Health have been followed. 86 INFANTILE DIARRHOEA. have been tabulated weekly in comparison with the principal meteorological data. The quarterly and weekly averages are set out below. Mean Temperature Rainfall. " Diarrhœal Diseases." Air. F° (Quarter). Earth. F° Average Weekly., in. Weeks Without. Average weekly No. of Deaths. 1899 63.1 64.03 0.29 2 11 1900 61.9 61.35 0.33 4 8 1901 61.8 62.06 0.46 5 8 1902 59.1 59.68 0.45 1 4 1903 59.0 60.18 0.94 1 3 1904 60.9 61.47 0.37 — 8 1905 60.0 61.61 0.42 — 5 1906 62.4 62.08 0.29 3 7 1907 58.8 59.15 0.26 3 1 1908 59.3 60.35 0.62 1 3 It will be noticed that relatively high air and ground temperatures have been associated with low (weekly average) rainfalls and vice versa. If the years be grouped according to rainfall, a reduction in the mortality is observed to accompany reductions in mean temperatures, and the average mortalities for the rainfall groups diminish as the rainfall increases. In other words, the mortality is a resultant of the combined effects of temperature and rainfall, varying directly as the former and inversely as the latter—a conclusion which lends support to the (comparatively new) theory of the transmission by flies of the matcries morbi. Experience has demonstrated that a very potent factor in the causation of infantile diarrhoea is the increasing practice of hand-rearing of children, associated with the use of unsuitable foods. This knowledge was used to secure the co-operation of the Health Society to provide a supply of milk and other preparations deemed suitable for very young children attacked with diarrhoea. Arrangements were made with the Staffs of the Out-Patients' Departments of St. Mary's and the Children's Hospitals, and Ihe Poor Law Medical Officers, whereby information of cases receiving treatment was obtained daily. All patients suffering from diarrhoea were visited by the Women Inspectors, who carried out certain enquiries, some of the results of which have now to be reported. A special leaflet of precautions deemed suitable was circulated, a reprint of which is appended to this Report. In conjunction with the above work, specimens of fasces, milk and flies were collected and sent to the Lister Institute for bacteriological investigation, and of flies (at the request of the Local Government Board) for determination of the varieties. The campaign (as it may be called) lasted from the last week of July until the end of October. During that period 301 entries were made in the "Diarrhoea Register," 108 from St. Mary's Hospital, 56 from the Children's Hospital, 23 from the Poor Law Medical Officers, and the remainder from various other sources. The largest number of entries (141) was made in August, October being next with 76. In July and September the numbers were 16 and 62 respectively. During the week ended August 15th there were 41 entries (the maximum), the return for the next being, however, only 3 fewer. After making all necessary corrections for age, &c., a nett total of 248 cases is obtained, all the patients 87 INFANTILE DIARRHOEA. being under 2 years of age. Of the patients, 4 (1 male and 3 females) were under 1 month old, the age distribution of the 248 (in trimestral groups) being:— Months. A Years. Totals. 0— 3- 6— 9— r 0— 1—2 Males 15 20 12 21 68 58 126 Females 10 20 13 28 71 51 122 The ratio of births of boys to those of girls being approximately 100 : 96, and the ratio of attacks being 100 : 97. There wer? 17 deaths among the 248 children up to the end of October, 9 being ascribed to " diarrhoea "*—under one or other of its synonyms—and 8 to other causes. If only the former deaths ("9) be taken into account, the fatality of the disease was 3'6 per cent.—a very low figure. As, however, it seems probable that the 8 other deaths were really due to the attack of diarrhœa, the debility resulting therefrom when super-added to the other malady leading to a fatal issue, it is fairer to calculate the fatality on the total of 17 deaths, which works out at 6.8 per cent. When these figures were first collated there were no data available for purposes of comparison. Quite recently a report has been issued by the Medical Officer of Health of Woolwich giving the results of a four years' experience of a voluntary system of notification of diarrhoea. From the figures given in that report the fatality (per 100 attacks) among cases at ages under 2 years has been calculated at 15.8 (mean for four years 1905-08), with a maximum of 19.3 (1905) and a minimum of 13.9 (1907). The Woolwich rate appears to be based on deaths from diarrhcea only. It is difficult, if not impossible, to institute a satisfactory comparison between the fatalities observed in Woolwich and Paddington, inasmuch as much larger proportions of the fatal attacks were known during life in Woolwich than in Paddington.j This is clear from the appended figures, which contrast the returns at ages under one year for 1908 in the two Boroughs. Ages (months) 0- 3— 6— 9— c. d. d. c. d. d. c. d. d. c. d. d. Woolwich 11 4 6 28 7 9 25 5 9 27 4 7 Paddington 25 5 14 40 2 16 25 — 6 49 1 3 c.—Cases reported. d.—Deaths among same. d.—Total deaths recorded. The fatalities of the local cases (including deaths from " other causes ") were 7'1 percent, among males and 6.5 per cent, among females. At ages under one month, all the cases (4) terminated fatally, the fatality decreasing somewhat rapidly with increasing age. Thus at 0.3 months the fatality was 40 per cent.; 3.6 months, 5 per cent; 6.9 months, zero (evidently due to the small number of observations); and at 9.12 months, 4 per cent. At all ages under one year the fatality was 10.0 per cent., and at ages between 1 and 2 years, 2.7 per cent. The foregoing fatalities are not given as absolutely reliable results, but as indicators of the improved chances of recovery enjoyed by the elder children. Methods of Feeding.—In eleven (11) instances this was not recorded, but the omission of any record in all, save 2 cases, may safely be taken to indicate that the infants were breastfed. The children reported as being entirely breast-fed numbered 53 (62 if the 9 referred to above be included), equal to 21.3 per cent, of all, of whom 20 were aged 10 months and upwards. There were 3 deaths (2 at ages under one month and 1 aged 2.3 months), *There were in addition 38 other deaths from " diarrhoea" during the same period, but the cases, first known through the registration of the deaths, are not included in this report. f In Woolwich 23 out of 38deaths occurred among the notified cases; in Paddington 9 out of 47 only. 88 INFANTILE DIARRHOEA. giving a fatality of 5.6 per cent. Among the remaining 195 children there were 14 deaths, equal to a fatality of 7'1 per cent. The advantages of breast-feeding are better demonstrated by the appended tabular statement:— Months. Ages 0— 3— 6-10 Breast-fed— Cases 11 12 10 Deaths 3 — — Fatality 27.2 — — Other Feeding— Cases 14 28 29 Deaths 7 2 1 Fatality 50 7.1 3.4 Housing.—The 248 cases occurred in 241 homes, situated in 217 houses. In 4 instances, 2 cases were reported in the same family, multiple cases occurring in 22 houses (47 cases). At some of the houses cases were known to occur among elder inmates, but the particulars have not been taken out. The percentage distribution* according to number of rooms was:— Diarrhœa Cases. Whole Borough. Homes of one room 30.7 14.9 „ two rooms 47.7 19.8 „ three „ 15.3 19.4 „ four „ 3.3 10.6 The larger proportion in homes of 2 rooms, as compared with homes of 1 room, is accounted for by the smaller number of children living in the latter class of home. Taking the usual " overcrowding " standard (an average of more than two persons per room), it appears that :— In 163 "overcrowded " homes, occupied by 863 persons (477 under 10), there were 170 cases and 13 deaths, equal to a fatality of 7.6 per cent. In 70 homes not overcrowded, occupied by 291 persons (140 under 10), there were 70 cases and 4 deaths, equal to a fatality of 5.7 per cent. The storey on which the home was located was noted in 233 instances. As the houses were not uniform as to number of storeys, the following is the only useful analysis:— In basement and on ground floor 93 homes 39.9 per cent, of total On first floor 76 „ 32.6 „ „ On 2nd or higher floor 64 „ 27.5 „ „ That analysis may be regarded, without being too dogmatic, as affording evidence of the advantages, qua, diarrhoea, of being above ground level, that is, farther away from the house refuse in the dustbin and clear of the street dust, and also lends some support to the fly-theory of the transmission of the disease. It is significant that the Inspectors reported that provision of adequate accommodation for the storage of food was found in 19 homes only (17.8 per cent.) of the total. * The corresponding figures for fatal cases not reported during life are :— Homes of 1 room 5'2 Homes of 3 rooms 26.3 „ 2 rooms 31.5 „ 4 „ 5.2 89 INFANTILE DIARRHOEA. Occupations of Parents.—Information was not obtained in 6 of the notified cases as to the occupation of the father; 5 children were illegitimate and 2 fatherless. Of the remaining 228 children, the fathers of 49 (21*4 per cent.) were reported as "out of work," and those of 109 (47*8 per cent.) were employed in unskilled and generally uncertain occupations, such as labourers (39), carmen (37), porters (18), etc. Mechanics numbered 16 and shop assistants 6. The remainder of the cases were children of parents following diverse occupations. In 44 instances the mothers were returned as employed, 19 being charwomen, 10 laundryworkers, 5 domestic servants, 4 hawkers, and the remaining 5 miscellaneous. Bacteriological Work.—The Lister Institute arranged to examine daily 4 lots of flies, 12 specimens (each) of fasces and milk (equally divided between cases of diarrhoea and controls). The following routine was laid down for the Inspectors' guidance, and applied to each notified case. Diarrhœa Cases Controls First day Make enquiries Take Sample of Milk. Take sample of milk Set flytrap Set flytrap Take sample of fceces. Take sample of fasces Second day Pack up flytrap Pack up flytrap Take sample of faeces Third day Take sample of faeces (No call) The limits imposed by the Institute allowed 9 fresh diarrhoea cases (with their controls) to be dealt with each week. No selection was exercised in the cases, except such as arose from any objections being raised by the parents of the children. Much interest in the work was exhibited by the public, and no serious difficulties were met with. The "controls" were children of approximately the same ages as the patients, and in the same conditions of life, care being taken to avoid ailing children, and (so far as was known,) houses infected with diarrhoea. Forty-six (46) specimens from diarrhoea patients and 45 from "controls" were submitted to the Institute. A preliminary letter from the Institute reported that " Morgan No. 1 " bacillus had been found in 12 of the specimens of fasces from diarrhoea patients, in 6 lots of flies from infected premises (2 from homes of children in whose fasces the bacillus had been found) and in one specimen of milk, that provided for a child with the bacillus in the faeces. The specimens from the " controls " furnished the bacillus—in faeces, 14 cases; and in flies, 5 cases, one lot of flies from the home of a control with the bacillus in the fasces. Subsequent special enquiries disclosed the occurrence of diarrhœa in 9 of the 14 " controls " in whose fasces the bacillus had been found, one of them dying of the disease. Five who were attacked with diarrhœa within a few days of the collection of the specimens were transferred to the patients' list by the Institute, and at least 2 others may very properly be similarly dealt with. Of the remaining 2 who had diarrhœa, one was ill some 3 or 4 months subsequent to the taking of the specimen, and in the other the diarrhœa accompanied an attack of measles. 90 INFANTILE DIARRHOEA. The adjusted figures are therefore:— 51 specimens from " patients," 38 from " controls," and 2 from " uncertain. ' The " Morgan No. 1 " bacillus was found in:— 17 " diarrhoea " specimens, or 33.3 per cent., and 7 " controls" „ 18.4 ,, Of the five " control " homes yielding infected flies one only, or possibly two, can be properly so designated. At one of the latter, the " control " child, although the bacillus was found in the faeces, remained quite well, and no cases were known in the other residents of the house. In the other case, the " house " consists of a number of self-contained workmen's dwellings. The flies were taken from Flat No. 9, where no diarrhoea is known to have occurred, but 5 cases of diarrhoea occurred some two months prior to the taking of the flies, etc., in Flat No. 10. As regards the remaining 3 "control" homes furnishing infected flies, later enquiries brought to light the following information:— Home " A."—Flies caught August 12th. Cases of diarrhœa in other families in the house on August 7th and 15th. The bacillus " No. 1 " was not isolated Irom the fceces of the " control " child, but the child had diarrhœa in October. Home " B."—Flies caught August 23rd. A case of diarrhœa occurred in another family in the house on August 4th. Home " C."—Flies caught August 26th. A case of diarrhoea in a child over 2 years of age (another family) on August 21st. Special Preparations.—The formulas of the preparations of milk, etc., provided by the Health Society are given at the end of this report. The preparations were supplied to orders by the medical practitioners attending the patients, 207 orders being issued, 85 by the Staff of St. Mary's Hospital, 25 by that of the Children's Hospital, 70 by the Poor Law Medical Officers, and 23 by the physicians at the Consultation Centres. The children thus treated numbered 83, but 2 were over 2 years of age (and therefore not included in this Report), and 2 others were not suffering from diarrhœa. Of the five preparations, No. 2 was most used (103 orders), and No. 4 least (5 orders.) The fatality among the 79 children under 2 years old was 3.8 per cent., if deaths from diarrhoea only be counted, 10*1 per cent, if deaths from " other causes " be included. The corresponding figures for the whole group of diarrhœa cases were 3*6 and 6'8 per cent, respectively, so that the fatality was higher among the " depot children " than " all children." * That higher fatality can be accounted for, two causes being operative. It has already been pointed out that the disease is more fatal to very young children, and also to those fed otherwise than by the breast. Both of those less hopeful classes formed larger proportions of the " depot children " than of " all children." The age-compositions of the two groups is given below:— Months. Years. Percentages of children at ages of 0— 3— 6— 9— 1—2 » " Depot children" 18.9 18.9 4.3 14.4 43.4 " All children" 10.0 16.1 10.0 19.7 43.9 X. * " Depot children " are those treated with the special preparations ; "all children " the 248 reported cases. The latter includes the former. 91 INFANTILE DIARRHCEA. The " depot children " included 33 infants under 10 months (taken as the normal age for weaning), seven of whom were reported to be breast fed, equal to 21*8 per cent. The " all children " group included 104 infants under 10 months, 30 of whom were breast fed up to the date of sickening, equal to 29.4 per cent. A third factor was believed to be operative in producing the higher fatality among the "depot children," namelv, greater severity of attack. No direct proof of that belief can be adduced, but it seems reasonable to assume that such children were selected for the treatment on that account. Moreover, the higher fatality from "other causes " among such children suggests that they suffered from more severe forms of diarrhœa. INFANTILE DIARRHCEA. Leaflet of Special Precautions. This advice to Mothers is supplementary to the general rules given in the Department's pamphlet "Infant Rearing." For Breast Fed Babies. Be particular to keep your nipples clean, washing them before and after feeding the baby. Your hands should be washed after changing the napkin. Do not wean the baby during the hot weather. If your milk appears to be less than the baby wants, drink a glass of milk three or four times a day, about half-an-hour before feeding the baby. For Bottle Fed Babies. Be very careful to use perfectly sweet milk. Boil the milk as soon as bought and keep it in the coolest place, with a piece of clean linen or muslin over the jug. The milk must not be kept near a dustbin, water closet, sink or drain. During the hot weather the feeding bottle must have very special care and attention. The bottle must be cleaned as soon as the child has finished the meal, and must be kept in clean cold water after cleaning. General Rules. Give no fruit to the baby. If the baby has diarrhœa, stop the milk, call a doctor in, and inform the Medical Officer of Health, at the Town Hall. If any other member of the family has diarrhoea, do not neglect the attack, as the baby may "catch " the diarrhœa. Keep the closets, sinks and gullies well scoured, and use plenty of water. Leave no food uncovered. Get rid of all slops as soon as possible. Keep the garden, yard and area clean. Allow no refuse of any kind to lie about. If flies are seen, look for the refuse where they have bred. Flies spread diarrhœa and disease. Burn as much house refuse as you can. If the dust is not taken away on the proper day, report the delay at once to the Medical Officer of Health, at the Town Hall. SPECIAL PREPARATIONS. I.—Sterilised Prepared Milk. Milk 10 fluid ounces Water 10 fluid ounces Dissolve the milk sugar in the water,add the milk and sterilise. Milk sugar 6.5 drachms II —Sterilised Prepared Citrated Milk. Milk 10 fluid ounces Water 10 fluid ounces I Dissolve the citrate of soda and milk sugar in the water, add Milk sugar 6.5 drachms f the milk and sterilise. Citrate of soda 10 grains III.—Peptonised Milk. Sterilised milk 14 fluid ounces Water 6 fluid ounces Mix the milk and water, heat to 100°F., add the bicarbonate of Bicarbonate of soda 20 grains soda and Liquor Pancreaticus. Digest at 1009F. for 20 Benger's Liq. Pancreaticus 2 drachms minutes. Then boil and sterilise. 92 INFANTILE DIARRHCEA. IV.—Whey. Heat to 100°F., add 2 teaspoonfuls of essence of rennet. Keep at the given temperature for a few minutes. When the clot has Fresh milk 1 pint formed strain off the clear whey, without breaking the clot, and boil it. Sterilise the whey in bottles as usual. V.—Albumen Water. Dissolve the salt and milk sugar in the water. Add the whites of three fresh eggs, taking care that the outsides of the eggs have been well cleaned with soda and water and then with Co d water (steri lse ) pin pure water, before the shells are broken. Break up the whites Common sat drachm of the eggs and mix thoroughly with the solution of the Milk sugar 9 drachms salt and milk sugar. (This preparation will not keep for more than 24 hours, and must be kept in a cool place.)