PLON 10 REPORT, For the Year ended 31st December, 1904, OF THE MEDICAL OFFICER OF HEALTH FOR THE PORT OF LONDON. by HERBERT WILLIAMS, M.D., M.D. (State Medicine), London University, M.R.C.S Eng., L.R.C.P.Lond., D.P.H.Camb., medical officer of health, port of london, fellow and member of council, royal sanitary institute, fellow of the incorporated society of medical officers of health, fellow of the royal geographical society. LONDON: Printed by Charles Skipper & East, 49, Great Tower Street, E.C. 1905. POUND, Mayor. A Common Council holden in the Chamber of the Guildhall of the City of London, on Thursday, the 13th day of April, 1905. THE Port of London Sanitary Committee did this day deliver into this Court a Report in writing under their hands, of their proceedings, and submitting the Annual Report of the Medical Officer of Health of the Port to the 31st December, 1904; which was read. And a Motion being made and Question put, That this Court doth agree with the Committee in their said Report, the same was resolved in the Affirmative. Ordered, That the Report be printed, and a copy sent to every Member of this Court. BELL. To the Right Honourable the Lord Mayor, Aldermen and Commons of the City of London, in Common Council assembled. WE, whose names are hereunto subscribed, of your Port of London Sanitary Committee, to whom it has been referred to carry into execution the powers assigned to the Corporation, as the Port of London Sanitary Authority, by the Local Government Board, under the Public Health (London) Act, 1891, beg to submit for the information of your Honourable Court the Annual Report of Dr. Herbert Williams, the Medical Officer of Health for the Port of London, for the year ended the 31st December, 1904, which Report contains a full and detailed account of the work done in the Port during that period by the Medical Officers and Inspectors. The Report gives an account of the cases of Infectious Disease dealt with during the year, including a case of Plague which was successfully treated in the Port Sanitary Hospital at Denton. It is satisfactory to note that the precautions taken were sufficient, and no further case of Plague arose. The Report gives an abstract of the proceedings of the International Sanitary Conference held at Paris in 1903, to consider the precautions to be adopted for the prevention of the introduction of Plague, Yellow Fever and Cholera, and also gives at length the staff and equipment possessed by the Port Sanitary Authority for dealing with such cases, It will be noted that the recommendations of the Convention have been, as a matter of fact, anticipated by the Port of London Sanitary Committee, and have been at work in the Port of London for several years past. The Medical Officer remarks that any probable epidemic of either of the diseases mentioned can be met with absolute confidence. Among other matters included in the Report is an account of the large quantities of unsound food dealt with, the quantities being set out at length. The Medical Officer again draws attention to the insufficient and unsatisfactory accommodation provided on ships for the crews, especially with regard to ventilation and lighting, and the opinion is strongly expressed that no practical reasons exist why the standard of comfort on ships should not be materially increased, and it is recommended that, when ships are being built, plans of the crews' quarters should be submitted to the Local Sanitary Authority for their approval, and that to ensure uniformity the Government should formulate certain requirements, which will govern the Sanitary Authority in their consideration of such plans. The sanitary inspection of ships arriving from "foreign" ports and those engaged in "coastwise" trade and in "inland navigation," including canal boats, has received careful attention, and, as the result, many defects have been remedied. Legal proceedings have been instituted where required, and in each case a conviction has been obtained. A list of these is set out in tabular form. In accordance with the Order of your Honourable Court, an account of Receipts and Expenditure in connection with the Port of London Sanitary Authority for the year ended the 31st December last is appended. All which we submit to the judgment of your Honourable Court. Dated this fourth day of April, 1905. John Harris. Edward Hughes. Robt. Gresley Hall T. Hastings Miller. W. H. Williamson. Horace S. Dove. Richard Stapley. James Lake. Benj. Turner. David Haydon. S. Pollitzer. E. Horace Green. Edward Ajrdley. J. Cloudsley. INDEX. PAGE. List of Members of Staff 4 Introductory and Statistical 5 Medical Inspection 8 A lien Immigration 9 Infectious Disease— General 11 Cholera 11 Yellow Fever 12 Plague13 International Sanitary Conference 18 Small-pox 27 Enteric Fever 27 Beri-beri28 Training Ships 29 Nuisances— General 31 Offensive Cargoes 31 River Water—Condition of 35 Carcasses of Dead Animals in River 35 Unsound Food 37 Hospital38 Launches40 Crews' Quarters 40 London County Council (General Powers) Act, 1904 45 Canal Boats 47 Account of Receipts and Expenditure 51 Appendix52 INDEX TO TABLES. table. page. I. Medical Inspection—Gravesend 6 II. Ditto —Sheerness 6 III. Sanitary Inspection—General Summary 7 IV. Infectious Disease 10 V. Rats caught and destroyed 17 VI. Training Ships—Infectious Disease 29 VII. Nuisances 30 VIII. Unsound Food destroyed 36 IX. Hospital Statement 38 X. Canal Boats 50 4 STAFF. List of Officers at present forming the Staff of the Port of London Sanitary Authority. Each of the Inspectors holds the Certificate of the Sanitary Institute, and those marked thus * hold in addition the Special Certificate for Inspectors of Food. Office. Name of Officer. Date of Appointment. MEDICAL OFFICER OF HEALTH Herbert Williams,M.D.,M.R.C.S., L.R.C.P., D.P.H. June, 1901. MEDICAL OFFICERS FOR BOARDING PURPOSES— Gravesend G.C. Hancock,MR.C.S.,L.R.C.P., D.P.H. October, 1897. W. M. Willoughby, B.A., M.D., B.C., D.P.H. May, 1901. J. S. Warrack, M.A., M.D.. C.M., D.P.H. April, 1903. Sheerness E. V. Legge, M.A., M.D., B.C., B.A.O., L.M. (Temporary). September, 1902. GREENWICH OFFICES— Clerk W. J. Albrow March, 1890. 1st Assistant E. A. Sorrell October, 1894. 2nd ditto W. C. Barham June, 1903. Junior ditto H. N. Jones June, 1903. FOOD INSPECTORS *H. Spadaccini July, 1898. *W. Anderson July, 1898. *T. W. Bailey July, 1901. SANITARY INSPECTORS *W. G. Romeril August, 1892. *A. Garland May, 1894. *W. G. Wetjen August, 1898. *W. W. Burr August, 1898. *H. R. Hopkins February, 1899. P. R. Lambe January, 1900. DENTON HOSPITAL— J. H. Rolfe September, 1901. Medical Officer G.C.Hancock, M.R.C.S..L.R.C.P., July, 1901. D.P.H. Nurse Matron J. Hughes April, 1904. Assistant Nurse I. Deehan July, 1904. Nurse Probationer N. Ovenden Ditto I. Walker Maidservant C.Bates July, 1904. Caretakers T. Bradley May, 1904. L. Bradley May, 1904. STEAM LAUNCHES— "David Burnett"— Master J. G. True July, 1893. Engineer G. H. Bagshaw July, 1893. Deckhand C.Boyd July, 1902. Stoker E. Coppin July, 1903. "Clotho"— Master W. Jarvis June, 1902. Engineer W. J. Hardman July, 1901. Deckhand E. Patrick July, 1903. "Denton"— Master C. Strange June, 1902. Engineer G. Lane July, 1901. Deckhand S. Bromley July, 1903. GREENWICH MOORINGS— Watchmen J. Howell April, 1897. W. Shaw HULK "HYGEIA"— Shipkeeper I. Rogers April, 1893. Ditto A. Salter July, 1898. PORT OF LONDON SANITARY OFFICES, GREENWICH, S.E. March, 1905. TO THE WORSHIPFUL THE PORT OF LONDON SANITARY COMMITTEE. Gentlemen, I have the honour to present herewith my Annual Report for the year ending 31st December, 1904, with Tables indicating the work as carried out in its different branches, and its bearing upon the public health in the Port of London. It has been necessary to maintain a careful medical supervision of vessels entering the Port, firstly, with a view to the protection of the community from the danger due to the introduction of cases of dangerous infectious disorders ; secondly, in the interest of the commerce of London, for certain foreign countries are not unwilling to impose restrictions with regard to vessels arriving from English ports, and they would readily do so if Port Sanitary Authorities showed any laxness in respect of carrying out the international conventions. The total number of vessels medically inspected during the year 1904 at Gravesend was 2,559, the mean annual number for the past five years being 1,560.4. At Sheerness the total number medically inspected was 308, which, though slightly lower than the number inspected last year, is still considerably above the mean for the preceding five years. Details of these figures will be found in Tables I. and II. With regard to the inspection of vessels by the Sanitary Inspectors (see Table III.) it will be seen that the total number of inspections made of all kinds was 35,385, a figure which is substantially above the mean for the previous five years. A reduction will be noticed in the number of inspections made on foreign arrivals, this being the lowest since the year 1900 (see also Table I.). The class of vessels known as "Coastwise," barges, &c., shows a considerable increase on any previous year. Of the total number of inspections, 151,685 were made on vessels from foreign ports, 4,293 on those from ports in the United Kingdom, 13,515 on barges, canal boats, lighters, and other vessels not engaged in sea trade, and 1,892 of buildings and other premises on shore within the area of the docks, &c. The cleansing of crews' quarters was ordered and carried out in 3,514 instances, or 12.75 per cent. of the total number of vessels inspected. With regard to nationalities of the vessels inspected, 83.99 per cent. were under the British flag, Scandinavia coming next with 4.99 per cent., and Germany with 3.53 per cent., followed in order of importance by the Dutch, Danish, French, Belgian, Russian, Spanish, Finnish, Austrian, Italian, Greek, American, Japanese and Argentine Republic. 6 TABLE I. MEDICAL INSPECTION—GRAVESEND. From 1st January to 31st December, 1904. Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total. Number of foreign arrivals 792 754 857 712 859 909 898 915 845 900 828 761 10,030 Number medically inspected 196 184 227 196 213 214 221 237 249 268 238 116 2,559 Number of passengers 8 56 241 29 129 137 105 2,067 3,213 4,168 4,649 5,553 20,355 Number of crew 5,465 5,605 6,372 5,264 5,394 5,356 5,549 6,082 6,360 5,889 5,927 5,645 68,908 COMPARATIVE TABLE. GRAVESEND. 1899. 1900. 1901. 1902. 1903. Mean annual number for the 5 years. 1904. Number of foreign arrivals 10,297 10,394 10,521 10,520 10,711 10,488.6 10,030 Number of vessels medically inspected 1,276 1,256 1,080 1,668 2,522 1,560.4 2,559 Total number medically inspected at Gravesend— From August, 1892, to December, 1903 20,843 „ 1st January to 31st December, 1904 2,559 Total 23,402 TABLE II. MEDICAL INSPECTION—SHEERNESS. From 1st January to 31st December, 1904. Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total. Number of foreign arrivals 17 24 23 20 40 43 29 41 25 32 32 18 344 Number medically inspected 15 21 19 17 38 40 26 37 25 26 28 16 308 Number of passengers 1 5 — 6 5 21 16 13 6 4 — 1 78 Number of crew 144 225 193 168 403 444 233 323 242 269 315 203 3,162 COMPARATIVE TABLE. SHEERNESS. 1899. 1900. 1901. 1902. 1903. Mean annual number for the 5 years. 1904. Number of arrivals 309 374 330 387 402 360.4 344 Number of vessels medically inspected 263 243 212 244 342 260.8 308 Total number medically inspected at Sheerness— From 1st September, 1894, to 31st December, 1903 2,715 „ 1st January to 31st December, 1904 308 Total 3,023 7 TABLE III. General Summary, and Analysis, of the Sanitary Inspection of Vessels, &c., in the Port of London, for the year ending 31st December, 1904. Foreign. Coastwise. Inland Navigation. Shore Premises. Sick Seamen referred to Hospital. Water Barges. Steam. Sail. Steam. Sail. Steam. Sail. Lighters (uninhabited) Canal Boats. Inspected. Defective. To be Cleaned. Inspected. 1 Defective. To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. | To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. 1 To be Cleaned. Inspected. Defective. | To be Cleaned. Inspected. Defective. To be Cleaned. No. in District in good condition, 31st December, 1903. New Barges. Condemned. No. in District, 31st Dec., 1904. 13542 144 1731 2143 43 311 2847 41 306 1446 39 235 823 6 30 10780 137 609 890 3 62 1022 86 49 1892 75 181 l1 23 1 1 24 Total Inspections to 31st December, 1903 686,087 Docks and River. No. Nationality. No. Per cent. of Total. Total Inspections from 1st January to 31st December, 1904 — St. Katharine's 793 Argentina 11 .03 London 1,514 American 17 .05 "Foreign" 15,685 Regent's Canal 824 Austrian 57 .17 " Coastwise " 4,293 Millwall 2,321 Belgian 266 .79 " Inland Navigation " 13,515 West India 1,924 British 28,131 83.99 Premises on shore 1,892 Poplar 144 Danish 484 1.44 35,385 East India 723 Dutch 708 2.11 Total 721,472 Victoria 1,548 Finnish 77 .22 Cleansing of Crew's Quarters, &c. :— Royal Albert 1,971 French 374 1.11 Total to 31st December, 1903 39,788 Commercial 1,987 German 1,184 3.53 Total No. of Vessels from 1st January to 31st December, 1904 3,514 Tilbury 2,359 Greek 47 .14 Gravesend District 4,176 Italian 55 .16 Total 43,302 River—*Upper District 5,137 Japanese 13 .08 Number of vessels inspected:— In the Launches— *Middle „ 3,719 Russian 217 .64 *Lower „ 4,298 Spanish 178 .53 " David Burnett " 2,657 "Clotho" 2,787 Medway 55 Swedish & Norwegian 1,674 4.99 "Denton" 4,824 Total vessels 33,493 Total vessels 33,493 Total 10,268 Shore premises 1,892 Shore premises 1,892 5.60 In the Docks, &c. 23,225 Total 35,385 Total - 35,385 Total 33,493 *'Upper District extends from *Middle „ „ „ *Lower „ „ „ n Limehouse to Teddington. Limehouse to Erith. Erith to outer limits of Port of London. COMPARATIVE TABLE. Total number of Inspections of vessels from— 1899. 1900. 1901. 1902. 1903. Yearly average for the 5 years ending 31st December, 1903. 1904. "Foreign" 14,564 14,966 16,844 16,336 15,989 15,739.8 15,685 " Coastwise," " Inland Navigation," and other Inspections 19,052 15,839 15,231 17,270 19,496 17,377.6 19,700 Total - 33,616 30,805 32,075 33,606 35,485 33,117.4 35,385 8 MEDICAL INSPECTION. The arrangements for the medical inspection of vessels by your Medical Officers at Gravesend continue to work in a most satisfactory manner, owing largely to the courteous co-operation of the Inspector of the Waterguard, J. C. Elliott, Esq., I.S.O., and the Officers of H.M. Customs stationed at Gravesend. There has been a large influx of alien immigrants during the past year, principally from Russian ports. The passage is short, these vessels carry no Medical Officer, and one or two children on landing were found to be suffering from Measles. This disclosed the necessity for medical inspection at Gravesend. A letter, enclosing a copy of the bye-laws relating to infectious disease, was sent to all the shipping companies bringing alien immigrants to London pointing out the responsibility of the Master, who should satisfy himself before the arrival of the vessel at Gravesend that no person was ailing, and reporting accordingly to the Boarding Medical Officer, In all, seven cases were found, four of these were Measles and three Continued Fever. This special arrangement accounts in a great measure for the increase in the number of passengers medically inspected, as shown in Table I. No relaxation has taken place in the medical inspection of vessels from ports where Cholera, Plague or Yellow Fever are known or suspected to exist, and the number of vessels medically inspected during the year shows an increase over the return for previous years. The arrangements for the boarding of vessels at Sheerness, in conjunction with His Majesty's Coastguard, are still carried out in a very satisfactory manner by your Medical Officer, Dr. Legge. The number of vessels at present which succeed in passing the Station and proceeding up the River Medway without a visit from your Medical Officer is so small as to be practically unimportant. The s.s. " Beethoven," of Sunderland, from Odessa, arrived at Gravesend on the 23rd July, and in reply to questions put to the Master he stated that " all were well on board and no sickness had occurred during the voyage." Vessels arriving from Black Sea ports are all medically inspected, and your Boarding Medical Officer went on board the vessel. During his inspection of the crew he found a man in the wheel-house suffering from Enteric Fever, who was removed to the Port Sanitary Hospital. Enquiry showed that this man had been ill in his bunk for a week previous to the arrival of the vessel, and that on reaching Gravesend the captain had ordered him to stand in the wheel-house while the "doctor" was on board. But for the detailed examination and medical inspection of the crew, this case, in all probability, would have escaped attention owing to the false statement made by the Master. 9 It being clear that there had been an infringement of the Bye-laws relating to infectious disease, by direction of your Worshipful Committee the facts were laid before Mr. Solicitor. He was of the opinion that legal proceedings should be taken, and accordingly the Master was summoned at Gravesend Police Court on the 4th November, convicted and fined 1/. and costs, bringing the total up to 4/. 13s. 6d. The maximum penalty is 40s., a sum quite inadequate to act as a deterrent. ALIEN IMMIGRANTS. On the 20th November I received information from the City Police that a party of foreign gipsies, numbering about 50, having been expelled from Holland, were expected to arrive at Queenboro' from Flushing. On enquiry at Queenboro' I was informed that although the party had been expected, the Zeeland Steam Ship Company declined to convey them, and the party had gone to Hamburg and were not coming to this country. Notwithstanding this, as is well known, the gang of gipsies arrived in London by one of the Dutch steamers and landed in the City, and their wanderings through the country have been duly chronicled in the public Press. They were inspected by the Boarding Medical Officer at Gravesend, and found free from infectious disease. They were therefore allowed to proceed in the vessel and land in London. 10 TABLE IV. INFECTIOUS DISEASE. Disease. 1899. 1900. 1901. 1902. 1903. Mean Annual number for the 5 years. 1904. (a) Cases reported : Cholera (including suspected cases) ... 1 ... 20 9 6.0 4 Plague (ditto) 4 6 19 10 6 9.0 6 Small-pox 12 15 13 93 13 29.2 11 Scarlet Fever 5 14 27 13 11 14.0 11 Diphtheria 7 20 28 26 7 17.6 3 Enteric Fever 66 126 78 66 88 84.8 50 Measles 38 67 83 36 14 47.6 38 Erysipelas 10 2 5 2 4 4.6 1 Typhus Fever ... ... ... ... 1 0.2 ... Continued Fever ... 1 2 5 2 13 4.6 12 Other diseases (including Chickenpox 17 12 9 14 9 12.2 17 Total 160 265 267 282 175 229.8 153 (b) Treated in Port Sanitary Hospital: Cholera (including suspected cases) ... ... ... ... ... ... ... Plague (ditto) 1 3 13 4 3 4.8 4 Small-pox 8 9 7 29 11 12.8 5 Scarlet Fever 1 2 5 2 5 3.0 7 Diphtheria ... 1 5 2 4 2.4 ... Enteric Fever 23 55 37 27 55 39.4 33 Measles 7 4 5 11 7 6.8 8 Erysipelas 3 ... 1 1 1 1.2 ... Typhus Fever ... ... ... ... ... ... ... Continued Fever 1 2 5 4 13 5.0 12 Other diseases (including Chickenpox) 6 8 1 8 4 5.4 4 Total 50 84 79 88 103 80.8 73 11 INFECTIOUS DISEASE (See Table IV.) So far as imported infectious disease is concerned there have been fewer cases requiring to be dealt with than in previous years, the total number of cases reported being 153, which is 76.8 below the mean for the preceding five years, while the number treated in the Port Sanitary Hospital was 73, or 7.8 below the mean for the preceding five years. The most noticeable reduction is with regard to the number of cases of Small-pox, Diphtheria, Enteric Fever and Measles. With regard to Small-pox, the mean annual number for the past five years treated in the Port Sanitary Hospital is 12.8. During the past year only five have been admitted, but the quinquennial mean is high by reason of the cases occurring in 1902, when Small-pox was epidemic in London. No cases of Diphtheria were admitted. The mean for this disease is low, being 2*4 only. Thirty-three cases of Enteric Fever were admitted and treated, which is 6'4 below the mean. Diphtheria generally occurs on the training ships in the Port, and this subject is specially dealt with elsewhere. CHOLERA. At the close of the year 1903, as indicated in my last Annual Report, this disease was prevalent in Syria and the Eastern Levant. During the current year its distribution has been as follows:—In the early part of the year it invaded many towns in Persia and along the shores of the Persian Gulf as far south as Muscat. Mesopotamia and Arabia also suffered from epidemics. It is somewhat singular to note that no cases are known to have occurred during the annual pilgrimage to Mecca of 1904. The disease appears to have been carried across the frontier from Mesopotamia during June, and to have spread rapidly from the latter country. From Persia the disease also invaded the Russian Transcaspian provinces during July, being probably conveyed by Russian troops. Thence the disease spread westward along the railway line towards the Caspian Sea, and across this sea to the port of Baku in August, and by rail to other towns, including, Batoum, but without giving rise to any epidemic in the latter port. The disease seems, further, to have been carried from the Asiatic shores of the Caspian Sea northward to the estuary of the Volga, up that river as far as Nijni-Novgorod and Yaroslav. At the present time Cholera is still prevalent in Eastern European Russia, hence the danger of its introduction to the remainder of Europe, and even to England, is not absent. 12 At the time of the outbreak of Cholera in the Volga Provinces, rumours appeared in the Press of outbreaks at St. Petersburg and Hamburg, to which attention was called at the time, but these reports were not confirmed. The history of the disease concerns the Port of London from the fact of its constant trade with ports on the Persian Gulf, Eastern Levant and Black Sea. Special attention has been paid during the past year to vessels from these ports. The number of cases reported on vessels arriving in the Port of London during the year was four. The following are short notes of the cases:— On the 10th January, the s.s. "Warwickshire," of Belfast, from Rangoon, arrived at Gravesend and reported that one of the crew, a native, had been landed at Rangoon on the arrival of the vessel there on the 5th December, on the outward voyage. The vessel was thoroughly disinfected and painted out before leaving. No case occurred on the homeward voyage. Further precautions were therefore considered unnecessary. On the 29th March, the s.s. "Clan Stuart," of Glasgow, from Calcutta, arrived at Gravesend and reported that the vessel, being two days out from Calcutta, a native fireman died suddenly from supposed Cholera, and that the body was buried at sea. Five days later, on the 1st March, another native was attacked, and was removed to hospital at Colombo the same day. No further cases occurred during the voyage, and on medical inspection at Gravesend all were found to be well on board, and the vessel was not detained. The vessel had been thoroughly disinfected, together with all effects, at Suez. No further precautions were therefore considered necessary beyond a daily medical inspection of all persons on board while the vessel remained in the Port. On the 1st July the s.s. "Arabistan," of Swansea, from Busreh, arrived at Gravesend and reported that on the 13th May, the day of leaving Busreh, a native fireman was attacked with Cholera, died on the following day, and was buried at sea. The ship was disinfected at Busreh, Kurachi and at Suez. No further cases occurred on the voyage, and the medical inspection being satisfactory, no further precautions were considered necessary. YELLOW FEVER. No cases of this disease have been reported on vessels arriving during the past year. There have been outbreaks and epidemics of the disease in Mexico, Cuba, South America and West Africa, but on the whole there appears to have been a diminution in the virulence of the disease. 13 PLAGUE. In my last Report I was able to show that the existence of Plague was distributed in all the Continents, and the Islands of the Pacific and Indian Oceans. The history of this disease during 1904 shows that it is still pandemic, though Europe—except for a few imported cases—has been free from the disease, and in consequence, with such a number of ports considered either infected or suspected, much work has been done by your Boarding Medical Officers at Gravesend. In India the number of deaths from Plague appears to have been greater in 1904 than during the previous year. The disease was also persistent in China and widely distributed in that country. In Japan there appears to have been no epidemic, but some cases appear to have been imported there by vessels. It is interesting to note that an epidemic among rats is reported as having been observed at Tokio, and that successful measures were adopted for its suppression. Comparatively few cases are reported from the Philippine Islands or from Singapore. Small outbreaks have occurred in the Malay Peninsula, the Persian Gulf, and some imported cases at Aden. In Egypt the disease has existed throughout the year, but without developing into epidemic form. Other places affected have been: British and German East Africa, Central Africa, Mozambique, Lorenzo Marques, Transvaal, Port Elizabeth, East London, Natal, Mauritius, New South Wales, Queensland, Western Australia, Auckland, Sandwich Islands, San Francisco, Brazil, Argentina, Paraguay, Chili, Peru, and Mexico. Returning to Europe, cases of Plague are known to have occurred at Smyrna. Reports of the existence of Plague at Oporto during November were not confirmed. On a vessel which arrived at Havre from Bombay, five cases of sickness occurred, with four deaths, which are believed to have been Plague. 14 A case was reported as having been removed from a vessel in the River Tyne, and the following cases were reported on vessels arriving in the Port of London:— On the 5th March the s.s. "Persia," of Greenock, from Bombay, arrived and reported that on arrival at Aden on the 9th March, a post office sorter left the vessel, and that three days after landing he was taken ill and found to be suffering from Plague. The vessel was thoroughly disinfected at Suez. No further cases occurred, but the surgeon of the vessel was found to be suffering from feverish symptoms of an obscure nature, and was landed at the Port Sanitary Hospital for observation. The bacteriological and other tests applied proved, however, that the disease was not Plague. As a precautionary measure, the vessel was kept under daily observation while staying in the Port. On the 5th May the s.s. "Pekin," of Liverpool, arrived from Bombay. On April 30th a native fireman had complained of pain, and on examination was found to have a large swelling on the left side, and on arrival of the vessel at Gravesend he was removed to the Port Sanitary Hospital for observation, but on examination by Dr. Klein of material furnished, he reported that the results were negative as regard Plague. On the 10th June the s.s. " Bavaria," of Glasgow, from Calcutta, arrived and reported that on the 4th May, one day after leaving Calcutta, a native became ill, died on the 6th and was buried at sea. The history of the case was most suspicious of Plague. Careful medical inspection was therefore made of all persons on board before the vessel proceeded to dock. The vessel, with all bedding and effects, had been disinfected at Suez. No further case of sickness occurred on the vessel. On the 10th July the s.s. "Malta," of Greenock, from Bombay, arrived and reported that in the early part of the previous December the vessel had landed a case of Plague at Bombay, and that there were then on board two natives with glandular swellings and fever suspicious of Plague. These cases were removed to the Port Sanitary Hospital and the bacterioscopic examination was at once conducted by Dr. Klein, but with negative results. Precautionary measures were, however, taken, all bedding and effects, together with native quarters, being thoroughly disinfected by your officers. No further cases occurred. The s.s. "Weybridge," 98,156, registered in the Port of London, left Colastine, River Plate, on October 13th, 1904, calling at Rosario in order to complete loading on the same day. She sailed thence for London, calling at St. Vincent, November 12th, and at Ferrol, in Spain, November 23rd. Neither Plague, Yellow Fever or Cholera was known to exist at either of these ports, the Bills of Health were 15 marked Clean," but as the existence of Plague at all South American ports has been suspected for some time past, the vessel was boarded by your Medical Officer on her arrival at Gravesend at 11 a.m. on November 30th, 1904. Whilst lying at Ferrol, in Spain, on November 25th, a coal trimmer, of Spanish nationality, complained to the Master of not feeling well. On November 26th he felt worse, and suffered with severe pain in his left groin. A doctor was obtained from the shore, but he apparently did not think there was much the matter with the man, and the vessel proceeded on her voyage. The man became worse, with the symptoms associated with fever, his temperature taken in the evenings being 105° F. The Boarding Medical Officer at Gravesend, Mr. Hancock, thought the man's complaint was very suspicious of Plague, he ordered his removal, with effects, to the Port Sanitary hospital at Denton, informing me of the fact by wire. I immediately proceeded to Gravesend, supervised the patient's removal to Hospital and thoroughly examined him. The man was very ill, feverish, and had a small, painful and tender swelling in the upper part of the left thigh. From the clinical symptoms I formed the opinion that he was suffering from Plague, and injected a full dose of Anti-Plague serum. I incised the swelling, collected some of the fluid therefrom, and sent it to the Local Government Board for bacteriological examination. Many rats were seen and caught on board during the voyage, but no sick or dying rats were noticed. It was stated that the patient had been seen catching rats with his hands. The crew, with all their effects, were landed at the Hospital, where they were thoroughly disinfected, the effects being exposed to the action of superheated steam, whilst the men were given a bath containing a solution of disinfecting fluid. The vessel was thoroughly fumigated from stem to stern, with the exception of the holds, and on receiving an undertaking from the owners that they would have the holds disinfected with sulphur-dioxide gas as soon as she arrived in dock, the vessel was, on the morning of December 2nd, allowed to proceed to the West India Dock, where she arrived at 9.30 a.m., and was moored to buoys in the middle of the dock. Sulphur-dioxide gas was pumped into the holds, engine room, and crew's quarters, and at noon on December 3rd permission was given to discharge cargo. On December 5th the discharging of the cargo was commenced. Owing, however, to a live rat having been seen in the saloon on the previous night, it was deemed advisable to fumigate that part of the ship again. The names and addresses of all the men employed on the ship during the process of discharging were recorded and notified to me each day, and these were forwarded to the Medical Officers of Health of the districts in which they were living. The majority of the crew were paid off, and on furnishing satisfactory names and addresses were allowed to leave, this information being sent to the Medical Officers of Health of the places to which they were proceeding. 16 One man was told off to collect all dead rats, and was carefully instructed to handle them only with a pair of tongs and place them at once into a bucket containing a solution of corrosive sublimate (strength 1 in 1,000). These were then conveyed to the ship's furnace and there cremated. The vessel was visited daily, but no further cases occurred either among the crew or the men engaged in discharging the ship. After the vessel was discharged, the linings of the ship were taken down and all dead rats collected and burnt, the holds were washed down with a solution of disinfecting fluid, the bilges disinfected, and the water tanks emptied and cleansed. The measures of disinfection, &c., seem to have been efficient, for no case of actual or even suspected Plague arose amongst the crew or persons employed in the unloading of the ship. The number of rats destroyed was 245, of which 101 were destroyed as a result of fumigation by your officers. The fluid collected from the bubo was examined by Dr. Klein, the result being positive in every respect, and he even succeeded in producing the disease of Plague in a captive rat by means of this fluid. The man's condition improved in a remarkable manner after two injections of the Anti-Plague serum, and he ultimately left the Hospital convalescent and returned to Spain. The vessel proceeded to Barry to load a cargo on her outward voyage, and the fact was duly notified to the Medical Officer of Health for that Port. This Anti-Plague serum was prepared after the method of Dr. Haffkine by Dr. Klein in 1901 for this Authority, about 950 doses remain, kept in a cool place ; Dr. Klein reports that it is still efficient, and the opinion would seem to be confirmed by the rapid improvement in the patient after the first injection. The following Table shows the number of rats caught and destroyed on vessels visiting the Port, and in the Docks, during the year 1904, and the total since the introduction of this control in 1901. 17 TABLE V. Return of Rats caught and destroyed during 1904. Jan. Feb. Mar. April. May June. July. Aug. Sept. Oct. Nov. Dec. Totals. Millwall Dock— Warehouses 262 271 240 309 259 311 307 217 218 222 171 197 2,984 Vessels during voyage 203 48 15 252 24 272 — 150 36 156 6 9 1,171 „ in dock 94 36 65 129 24 23 75 22 72 80 — — 620 Surrey Commercial Dk.— Warehouses 112 87 80 115 94 82 95 82 126 167 126 140 1,306 Vessels during voyage 20 23 17 20 4 — — 19 — — — 20 133 ,, in dock — — 13 51 — — — — — 10 — — 74 Regent's Dock— Warehouses 8 9 7 7 8 5 14 31 12 12 13 7 133 Vessels during voyage — — — — — — — — — — — — — „ in dock — — — — — — — — — — — — — St. Katharine's Dock— Warehouses 133 108 77 83 57 97 114 80 91 159 89 77 1,145 Vessels during voyage — — — — — — — — — — — — — „ in dock London Dock— Warehouses 108 81 114 184 172 205 187 141 151 227 160 108 1,838 Vessels during voyage — 8 5 12 — — — 20 — — 10 30 85 „ in dock — — — 80 59 20 48 62 — 76 4 349 Albert and Victoria Dk.— Warehouses 235 198 267 408 415 442 659 574 531 821 469 592 5,611 Vessels during voyage 845 297 593 469 387 246 234 184 164 554 470 1,159 5,602 „ in dock 808 630 312 615 807 289 552 222 293 803 358 371 6,060 West India Dock— Warehouses 261 235 283 321 226 284 250 234 267 335 280 199 3,175 Vessels during voyage 380 276 235 116 124 192 31 243 112 153 197 185 2,244 „ in dock 767 738 572 379 552 513 327 308 315 547 588 568 6,174 East India Dock— Warehouses 41 46 51 47 48 54 57 46 49 62 57 57 615 Vessels during voyage — — 13 — — — — — — 38 — — 51 „ in dock 58 88 24 52 60 21 21 — 8 134 26 61 553 Tilbury Dock— Warehouses 514 345 330 305 259 227 370 282 304 395 328 338 3,997 Vessels during voyage 1,158 698 883 1,636 945 722 749 1,026 1,361 1,187 1,219 1,397 12,981 „ in dock 1,034 688 701 554 629 600 817 345 730 884 785 927 8,694 Poplar and Midland Dks. — — — — — — — — — — — — — River — — — — — — — — — — — — — Totals 7,051 4,910 4,897 6,124 5,153 4,585 4,879 4,274 4,902 6,946 5,428 6,446 65,595 Total brought forward from last Report 262,782 Total from 1st January to 31st December, 1904:— In Dock Warehouses 20,804 65,595 On Vessels while in dock 22,267 On Vessels during voyage 22,524 Total 328,377 18 INTERNATIONAL SANITARY CONFERENCE, PARIS, 1903. At the end of the year 1903 an International Conference was held at Paris, on the subject of the precautions to be taken with regard to Plague, Yellow Fever and Cholera. A translation of the Convention agreed to at that Conference has now been published, and I give herewith an abbreviated account of the provisions affecting this country and the Port Sanitary Authorities therein. Part I.—General Provisions. Chapter 1. Provisions to be observed by the countries signing the Convention on the appearance of Plague or Cholera in their territory. Articles 1-2.—The first appearance of recognised cases of plague or cholera must immediately be notified to the other countries, accompanied by information as to— (1) Where the disease has appeared; (2) The date of its appearance, its source and its type; (3) The number of known cases and deaths; (4) In the case of plague, the presence of that disease or of unusual mortality among rats or mice; (5) The measures taken immediately on the first appearance of the disease. Article 4.—Information shall be furnished at least once a week as to the course of the epidemic, stating with precision— (1) The preventive measures taken in the way of sanitary inspection or of medical investigation, of isolation, and of disinfection. (2) The-measures adopted in the case of outgoing vessels to prevent exportation of the disease, and, particularly, in the case contemplated (4) the measures taken against rats. Article 5.—Governments should order compulsory notification of plague, cholera and yellow fever, and should ascertain the existence of any unusual mortality among rats or mice, particularly in ports. Article 7.—A local area shall be declared infected only when several non-imported cases of plague have occurred, or when cases of cholera constitute a fcyer, i.e., a centre of dissemination. 19 Article 9.—A local area shall cease to be regarded as infected when— (1) No death from, nor fresh case of, plague or cholera has occurred within five days following the isolation, or death, or recovery, of the last case of plague or cholera. (2) All measures of disinfection have been carried out, and, in case of plague, measures have been taken against rats. Chapter 2. Prescribes measures of defence against territories that have been declared infected. Section I.— Publication of Measures prescribed. Article 10.—The Public Health Act, 1904, has been passed enabling the Local Government Board to make regulations embodying the results of this Convention. These will doubtless be issued at an early date. Section II.—Merchandise Disinfection. Article 11.—No article of merchandise is in itself capable of conveying plague or cholera. Merchandise becomes dangerous only when contaminated by plague or cholera products. Article 12.—Only such merchandise and things as the local sanitary authority considers infected may be subjected to disinfection. Provided always that the merchandise or things hereinafter specified may be subjected to disinfection, or their importation may even be prohibited irrespective of any evidence as to whether or not they are infected:— (1) Body linen, wearing apparel and bedding that have been in use. (2) Rags, save, as in the case of cholera, rags compressed and carried in bound bales as merchandise in bulk. Articles 13-14.— Transit shall not be prevented if packed so that they cannot be manipulated on the way, and importation of articles 1 and 2 of Article 12 shall not be prohibited if it be proved that they were despatched not less than five days before the epidemic commenced. Article 15.—It rests with the authority of the country to which the merchandise and things are consigned to decide in what manner and at what place disinfection shall be carried out, and what shall be the methods adopted to secure destruction of rats. Tariff of charges for destruction of rats must be made beforehand, and sanitary authority shall derive no profit therefrom. Article 17.—If articles of merchandise known to be infected with plague cannot be disinfected, the destruction of the germs may be secured by storing the merchandise during a period not to exceed two weeks. 20 Article 18.—The given proprietor of such merchandise, or his representative has the right to exact from the sanitary authority a certificate showing the measures that have been taken for disinfection or storage. Article 19.—Soiled linen, clothing and articles carried as baggage, or as household goods, from an infected local area, shall be disinfected only when the sanitary authority considers them infected. Article 20.—Classification of ships— (a) " Infected." (b) " Suspected." (c) " Healthy." (a) " Infected," where there has been one or more cases of plague or cholera on board within seven days. (b) " Suspected," if there have been cases of plague or cholera on board at the time of departure or during the voyage, but no fresh cases within seven days. 0) "Healthy," notwithstanding that the vessel has come from an infected port, if there has been no death from nor case of plague or cholera on board either before departure or during the voyage or on arrival. Article 21.—(a) Infected ships, on arrival, shall undergo the following measures:— (1) Medical inspection. (2) The sick shall immediately be disembarked and isolated. (3) The other persons must also be disembarked if possible, and may be kept under observation on board ship or in a sanitary station for five days, which may be followed by surveillance of not more than five days' duration, or merely be subjected to surveillance during a period not exceeding 10 days, dating from the arrival of the ship. (4) Any soiled linen, wearing apparel, and articles belonging to the crew and passengers as are, in the opinion of the sanitary authority, infected, shall be disinfected. (5) The parts of the ship that have been occupied by persons ill with plague, or that, in the opinion of the sanitary authority, are infected, must be disinfected. In the case of Plague— (6) Rats on board must be destroyed, either before or after discharge of cargo, as quickly as possible, and, in any case, within 21 a maximum time of forty-eight hours, and so as to avoid damage to merchandise and to the ship's plating and engines. In the case of ships in ballast, this process must be carried out as soon as possible before taking in cargo. Article 26.—In the case of Cholera, in addition to above general measures of precaution— (1) A supply of wholesome drinking water may be substituted for that stored on board. (2) Bilge water shall be disinfected and pumped out. (3) Human excreta shall not be cast or allowed to pass into the waters of the port without preliminary disinfection. (6) Suspected ships.—The same precautions shall be adopted, but the total surveillance shall not exceed five days dating from the arrival of the ship. In the case of Plague— The destruction of rats on board is only recommended, not obligatory, and may be carried out either before or after discharge of the cargo. In the case of Cholera— (1) Bilge water shall be disinfected and pumped out. (2) It is recommended the crew be prevented for a similar period from leaving the ship except on duty. (c) Healthy ships should be given free pratique immediately, whatever their bill of health may be, after medical inspection, disinfection of soiled linen, or other articles which the sanitary authority has special reasons for regarding as infected. The crew and passengers may be subjected to surveillance during a period not exceeding five days, reckoned from the date of the ship leaving the infected port, and it is recommended that the crew should not leave the ship except on duty during the period. In the case of Plague— The destruction of rats on board is optional, but the process must not take longer than twenty-four hours. In the case of Cholera— (1) Medical inspection. (2) Disinfection of infected articles. (3) Disinfect and pump out bilge water. 22 A certificate given on oath may be exacted from the doctor of the ship, or, in his default, from the captain, testifying that there has not been a case of plague on board since departure, and that unusual mortality among rats has not been observed Ships infected with rat plague are subject to the same measures of precaution, except that the rats must be destroyed either before or after discharge of the cargo. On ships where an unusual mortality among rats has been observed, the rats should be examined for plague as quickly as possible, and until all suspicion shall be removed, passengers and crew may be subject to surveillance for a period not exceeding five days from the date of arrival. Article 25.— The sanitary authority of the port shall, if requested, furnish a certificate stating that measures of rat destruction have been carried out, and giving the reasons why they were resorted to. Article 29.—Due consideration shall be given to vessels carrying a doctor, also disinfecting apparatus, and in the case of plague, when the ship is provided with an apparatus for the destruction of rats. Article 30.—Special measures may be prescribed for ships that are overcrowded, more especially emigrant ships or ships that are in an unsanitary condition. Article 31.—Ships refusing to submit to measures prescribed by a port authority, shall be at liberty to put out to sea, but passengers may be allowed to disembark at their request on the condition that they shall submit to the measures prescribed by a local authority, and goods may be landed under certain conditions. Article 32.—Ships that have been disinfected and rats destroyed in one port shall not be subjected to further disinfection or further destruction of rats in proceeding to another port unless there is reason to believe that the rats on board are affected with plague on arrival at the second port. Article 33.—Passengers are entitled to a certificate from the sanitary authority showing the date of their arrival, and the measures taken as regards themselves and their baggage. Article 35.—States that in every country, ports open to arrival of ships from ports infected with plague or cholera, must be so equipped that healthy ships can there undergo the prescribed measures upon their arrival, and not be sent to another port for the purpose. 23 Article 36.—It is recommended that there be provided in large sea-ports:— (a) A properly organised port medical service and permanent medical supervision of the health and conditions of crews, and of the population of the port; (b) Suitable accommodation for the isolation of the sick and for keeping suspected persons under observation; (c) Bacteriological laboratories and the buildings and plant necessary for efficient disinfection; (d) A supply of drinking water of quality above suspicion at the disposal of the port, and a system of scavenging that offers every possible guarantee for the removal of excrement and refuse. Part II.—Measures to be adopted at Infected Ports on the Departure of Vessels. Article 46.—The competent authority shall take effectual measures to prevent the embarkation of persons showing symptoms of plague or cholera. Every person taking passage by a ship must be individually examined at the time of embarkation, by day and on shore, during such time as may be necessary, by a doctor appointed by the public authority. The Consular authority of the country to which the ship belongs may be represented at this examination. Article 47.—The competent authority shall take effectual measures— (1) To prevent the exportation of such merchandise or articles of any sort as it may regard as infected, and which have not previously been disinfected on shore under the supervision of a doctor appointed by the public authority. (2) In the case of plague, to prevent rats gaining access to ships. (3) In the case of cholera, to see that drinking water taken on board is wholesome. Article 177.—Each Government shall decide as to the means it shall adopt to secure disinfection and the destruction of rats. The following methods of disinfection are given by way of guide:— Articles of a textile material and paper of no value should be burnt. Personal effects and bedding can be efficiently disinfected by steam at a minimum temperature of 100 degrees Centigrade, or by exposure to 24 formol vapours. Articles that can be steeped in antiseptic solutions can be disinfected by— (1) A solution of perchloride of mercury, strength 1 in 1,000. (2) A solution of carbolic acid, 3 per cent. (3) A solution of lysol or commercial cresyl, 3 per cent. (4) A solution of formol, 1 per cent. (1 per cent. of the commercial solution of 40 per cent. of formaldehyde). (5) A solution of alkaline hypochlorites (sodium or potassium), 1 per cent. of the ordinary commercial solution. The period of contact allowed being long enough to permit of the antiseptic solution thoroughly penetrating any dried germs, say, from four to six hours. To secure destruction of rats, three processes are specified as being those to which Governments might resort, and the opinion was expressed that the sanitary authority should, in every instance where it did not itself do the work, superintend its performance, and make sure that the rats had been killed. (1) Sulphurous acid mixed with a small quantity of sulphuric anhydride, driven under pressure into holds and mixed with the air. This destroys rats and insects, and will, it is stated, destroy the plague bacillus also if the proportion of sulphuro-sulphuric anhydride be sufficiently great. (2) An incombustible mixture of carbon monoxide and carbon dioxide passed into holds. (3) Carbonic acid so employed as to constitute 30 per cent. of the air in the ship. The last two methods kill rodents, but it is not claimed that they destroy insects or the plague bacillus. Yellow Fever. Article 182.—The countries concerned are recommended to modify their sanitary regulations in such fashion as to bring them into harmony with the present scientific data as to the manner in which Yellow Fever is transmitted, and, in particular, as to the part played by mosquitoes in carrying the germs of the disease. The evidence at present available indicates that certain mosquitoes play the same part in the dissemination of Yellow Fever as other species of the same insect do in spreading Malaria, that is, they suck infected blood from a patient, and then inject their infected virus into the body of a healthy person, who becomes in this manner infected with the same disease. 25 The mosquito which plays the part of medium in Yellow Fever probably can only exist in warm climates, and this accounts for the freedom of this country from the disease. In connection with the Paris Convention, 1903, it may be convenient to recapitulate the means and measures provided for dealing with cases of infectious disease on vessels arriving in the Port of London, and to meet the requirements of Article 36. The staff available for dealing with cases of infectious disease, comprises:— 1. Medical Officer of Health. 2. Four Boarding Medical Officers. 3. Seven Sanitary Inspectors. 4. Three Steam Launches for removing patients. 5 Nursing Staff, &c., at Hospital. All vessels from foreign ports, on arrival at Gravesend, are visited by the Boarding Medical Officer, who is appointed by your Committee for this purpose. He investigates every case of illness then on board, or that has occurred during the voyage, and in the case of vessels arriving from ports infected, or suspected to be infected with Plague, Yellow Fever or Cholera, he proceeds on board and makes a personal examination of the persons thereon. All cases of infectious disease are removed to the Port Sanitary Hospital at Denton, which consists of three pavilions each containing two wards, and one pavilion with one ward (used exclusively for the reception and treatment of patients suffering from Small-pox), making four pavilions in all. The Hospital is fully equipped, the staff consisting of a Matron and three Nurses, Caretaker and wife—the former removes patients and disinfects, the latter doing the laundry work. A Washington-Lyons Disinfector is provided for the disinfection of infected articles. This is supplied by steam from a water-tube boiler, which permits of steam being obtained very quickly and enables the process of disinfection to be carried out with as little delay as possible. The contents of the chamber are exposed for a period of 30 minutes to a temperature of 255° Fahrenheit. The effects—after disinfection—are either returned to the ship at once or stored in a weatherproof shed. The patients are removed from the ship in an ambulance boat towed by a launch, as owing to the shallowness of the water in the vicinity of the Hospital, the launch is unable to get near enough to the landing stage. In the case of vessels infected with Plague, Yellow Fever or Cholera, they are ordered to moor opposite the Hospital, this being the place appointed in accordance with the Local Government Board Regulations relating to those diseases. 26 The Boarding Medical Officer stationed at Sheerness adopts the same routine in respect to vessels entering the River Medway, which is within the jurisdiction of this Authority. When a case of infectious disease is found, the vessel either proceeds to Denton to land the case and be disinfected, or the launch proceeds to Sheerness and the patient and infected effects are brought to Denton. Disinfection of the vessel in the latter case is done at Sheerness. Cases of infectious disease occurring on vessels within the limits of the Port are removed by launch, when practicable, with all infected effects, to Denton. The procedure of disinfection is the same in all infectious diseases, but in the case of Plague, where a case of human or rat Plague is proved to exist on board the ship, that vessel must be fumigated with a view to the destruction of all rats and vermin on board. The terms of the Paris Convention, 1893, permit this to be done either before or after discharge of the cargo, and I propose in future to fumigate and disinfect all parts of the vessel that can be done at Gravesend, with the exception of the holds. The vessel will then be allowed to proceed to dock, and arrangements will be made for mooring her and discharging her cargo into lighters whilst lying out in the middle of the dock. After the cargo has been discharged the vessel will be fumigated throughout from stem to stern with a view to destroying any rats, &c., on board. These will be carefully collected and cremated in the ship's furnace. It is not practicable to fumigate the holds of a ship previous to the discharge of cargo, except by means of an expensive and complicated apparatus, and indeed, it is not advisable that this Committee should take the responsibility of so doing, as they may have to meet and contest claims made in respect of actual or alleged damage done to the cargo by the process of disinfection. An enquiry is being made by the Local Government Board as to the best method of destroying rats and vermin on board vessels without damaging the cargo. Any bacteriological examination that may be necessary to confirm the diagnosis of Plague and Cholera has been performed hitherto by Professor Klein, F.R.S., on behalf of and at the expense of the Local Government Board. This procedure will in all probability continue. Any further necessary examination will also be performed by Professor Klein, but at the expense of the Port Sanitary Authority. An ample supply of drinking water of good quality is available at Gravesend for supply to vessels. It will therefore be seen that the Port Sanitary Authority is in a position to deal with any possible epidemic with absolute confidence. 27 ENTERIC FEVER. Fifty cases of this disease have been reported, and 33 treated in the Port Sanitary Hospital. A severe case of the disease was being treated in the Hospital during September, and, unfortunately, two of your Nurses contracted the disease and had to be treated in hospital, whilst a Nurse engaged from outside to assist in nursing the sick nurses, in her turn was infected and had to be isolated with the others. All three fortunately recovered. It was considered advisable to analyse the water supply of the Hospital. This was done, the result being that the water was found to be absolutely pure, and a good sample of water for drinking purposes. SMALL-POX. The total number of cases of Small-pox reported during the year was 11, of which five were treated in the Port Sanitary Hospital. I give below short notes of the cases presenting points of interest. The s.s. "Monkseaton," of Newcastle, from Smyrna, arrived at Gravesend on the 14th February, and landed the steward at the Port Sanitary Hospital suffering from Small-pox. The vessel was thoroughly disinfected as usual, and the majority of those on board accepted vaccination, which was offered gratuitously. On the 20th, as the vessel was on the point of sailing, the chief officer and another of the crew were reported to be ill with suspicious symptoms, and the vessel was accordingly stopped at Gravesend, outward bound, for the purpose of permitting your Medical Officer to examine the sick persons. The men were examined, but were not apparently suffering from Small-pox. They were therefore allowed to proceed in the vessel, the Medical Officer of Health at the port of destination being advised of the facts. From the subsequent history, it would appear that none of the men developed Small-pox. On the 18th February, information was received from the Medical Officer of Health for Poplar, that a seaman had been discovered that day in the Seamen's Institute, Poplar, suffering from Small-pox. Subsequent enquiry showed that the man was a cattleman who had arrived from Norfolk, Virginia, in the s.s. "Austriana," then lying in the Royal Victoria Dock. All of the crew, numbering 31 hands, and in addition 11 cattlemen, companions of the sick man, had left the vessel for addresses unknown. 28 After considerable difficulty their names and addresses were, as far as possible, obtained and communicated to the Medical Officers of Health for the London County Council and of the Sanitary districts to which the men were believed to have gone. Every possible precaution was taken, but, unfortunately, some twenty persons contracted the disease from contact with this man. The cattlemen who had been in contact with the patient were not allowed to return to North America until they had been individually inspected by your Medical Officer with a view to determining whether they had been vaccinated and were free from symptoms of Small-pox, and a certificate granted to that effect in each case. The certificate of the Medical Officer of the Port Sanitary Authority, vised by the Consul-General for the United States in London, was the only document which would be accepted by the Government of the United States under the circumstances. This case is important as showing the occasional danger which exists from imported Small-pox. As was pointed out at the time, the Port Sanitary Authority has no power to detain vessels for inspection unless they come from places infected with Cholera, Yellow Fever or Plague. In this particular case the result of very careful enquiry went to show that the man was apparently well up to the time of leaving the ship, and there was nothing in his appearance to excite alarm amongst persons with whom he associated. The rash typical of such cases was, in this instance, obscured—except to the practised eye—by the black skin of the negro. BERI-BERI. Much public prominence was given during the year to this disease, and many exaggerated views expressed as to danger to the public health from the alleged infective nature of Beri-Beri. This arose from cases which were reported to have occurred among the Chinese coolies carried to South Africa for employment in the mines. This disease does not appear to be infectious in the ordinary sense of the term, although it is an illness of a serious nature requiring careful treatment. The following cases have occurred on vessels arriving during the year:— Date. Name of vessel. Where from. Number of cases. 15th June, 1904 "Passe Partout" Wilmington Six 16th July, 1904 ”Batavier V" Rotterdam Four 7th October, 1904 "Diaz" Sourabaya One 8th October, 1904 "West Lothian" Iquique One 18th October, 1904 "Peleus" Yokohama Two 5th November, 1904 "Persia" Bombay One 12th November, 1904- "Heathburn" Hong Kong Fifteen 29 The following table gives the number of cases treated in the Institutions of the Seamen's Hospital Society during the five years ending 31st December, 1903:— 1899 28 1900 23 1901 21 1902 29 1903 27 128 and the total number of deaths from the disease during the same period was 13, or 10.1 per cent. TRAINING SHIPS. With the exception of 26 cases of Measles which occurred on the "Worcester" during February, the training ships have been exceptionally free from infectious disease during the year; only two cases of Diphtheria and two of Scarlet Fever were reported. This freedom of infectious disease appears to be noticeable with regard to the "Warspite," a vessel which, when moored in the River at Charlton, was repeatedly subject to epidemics of Diphtheria. No cases of this disease appeared on the ship during the past year. Only one case of an infectious nature occurred. The following cases of infectious disease were reported during the year:— TABLE VI. Name of Vessel. Diphtheria. Measles. Scarlet Fever. Total. "Arethusa" ... ... ... ... "Cornwall" 2 ... 1 3 "Ex mouth" ... ... ... ... "Shaftesbury " ... ... ... ... "Warspite" ... ... 1 1 "Worcester" ... 26 ... 26 Totals 2 26 2 30 30 TABLE VII. NUISANCES REPORTED AND DEALT WITH during the year ending 31st December, 1904. Description of Nuisance. January February March April May June July August September October November December Total. Smoke Nuisances:— Number of complaints received 12 18 23 30 72 101 50 38 38 23 32 25 462 Number of written intimations* 11 13 20 26 66 78 39 32 28 7 25 20 365 Number of Statutory Notices served ... 11 11 16 15 56 30 1 ... 59 8 13 220 Number of recurrences reported 2 6 7 7 22 16 11 2 5 5 11 3 97 Number of Police Court cases ... ... ... 2 2 2 2 ... 1 ... 1 3 13 Dilapidations and Structural Defects:— Ventilation 4 5 4 5 11 9 8 4 9 11 12 2 84 Lighting, Heating, &c. 40 55 46 35 36 35 25 21 25 41 41 28 428 Water supply 1 ... 2 6 6 1 2 2 1 4 3 1 29 Drainage 1 2 2 4 8 2 1 1 1 1 ... ... 23 Total number of defects reported 46 62 54 50 61 47 36 28 36 57 56 31 564 Total repairs and alterations reported as carried out. 26 55 81 33 19 30 44 66 34 38 66 68 560 Number of vessels, &c., on which structural alterations were ordered. 45 58 50 40 42 40 29 25 31 45 40 27 472 Barges (Insanitary Cabins), Foul Bilges, &c:— Number reported 2 4 10 1 10 3 5 1 7 1 4 4 52 Number of written intimations* 2 4 9 ... 9 2 5 1 7 1 4 4 48 Number of Statutory Notices served ... 4 4 8 ... 10 1 ... ... 10 1 3 41 Number of recurrences reported 1 ... 1 ... ... 1 1 ... ... ... ... ... 4 Offensive Cargoes (Bye-laws):— Number of Infringements reported 4 3 ... 2 1 1 ... 1 ... ... 1 29 42 Number of Notices given 4 3 ... 2 1 1 ... 1 ... ... 1 29 42 Number of Police Court cases ... ... ... ... ... ... ... ... ... ... ... ... Foul Lighters ... ... ... ... ... ... 2 ... 1 1 4 Foul Closets and Urinals ... ... 4 7 ... 1 4 ... 2 ... 1 2 21 Accumulations of offensive matter ... 2 4 4 3 4 6 5 2 2 1 1 34 Miscellaneous Nuisances 1 2 2 4 4 3 8 5 3 2 3 5 42 Total number of Nuisances reported 67 93 101 95 154 170 114 77 90 78 94 97 1,230 Total number of Notices and written intimations given. 61 99 92 91 131 184 101 55 63 106 63 95 1,141 Total number of Police Court cases ... ... ... 2 2 2 2 ... 1 ... 1 3 13 *Refers to primary warning only. 31 NUISANCES. In Table VII. are set out the various classes of Nuisances dealt with during the year. From this it will be seen that a large number of complaints of smoke nuisance have been dealt with. The total number of complaints received was 462. Eliminating duplicates and those complaints received from outside sources, where either the evidence was inconclusive or identification of the vessel impossible, 365 intimations were sent to the persons responsible. It was necessary in 220 cases to serve Statutory Notices. This generally has a temporary effect, and there is no immediate recurrence of the nuisance. In 97 cases, however, recurrences were reported, and in 13 instances, owing to the failure of all other methods to prevent a recurrence of the nuisance, legal proceedings were taken and convictions obtained in every case. Details of these will be found in Appendix "E." Structural alterations affecting ventilation, lighting and heating of crews' quarters, water supply and drainage, numbered 564. These were found on 472 vessels or other premises. Five hundred and sixty such alterations and repairs are reported to have been carried out during the year. The total number of Nuisances reported and dealt with during the year was 1,230. 1,141 written intimations of nuisances were sent, and the total number of prosecutions was 16. INSANITARY BARGES. The number of insanitary barges reported was 52. Forty-one Statutory Notices were served, and only four cases of recurrence of the nuisance have been reported. OFFENSIVE CARGOES. Infringements of the Bye-laws relating to Offensive Cargoes have occurred to the number of 42. In every case attention has been paid to the notification sent to the owner, and it has not been deemed necessary to prosecute in any instance. Another death has to be reported of a man who fell a victim to the dangerous practice of carrying foul matter in barges not properly constructed for the conveyance of such cargoes. 32 On the 28th October last, the Master of the sailing barge "Grange" of Rochester, was found dead in the fore-cabin. The cargo consisted of stable refuse, composed principally of moss litter and horse dung. In the forecabin it was found that a light when lowered into the cabin was always extinguished at a distance of about two feet six inches from the floor. The air of the lower parts of the cabin was very pungent, and of a nature which would speedily induce unconsciousness. On removing the floor of the cabin, the bilges were found to be filled with a quantity of black, filthy and offensive liquid. The bulkhead dividing the hold from the cabin was of the usual insufficient type, permitting free passage of foul gases from the cargo into the cabin. I attended the inquest subsequently held on the body of the Master of the barge, and was permitted by the Coroner to question the witnesses and to give evidence, with the result that the jury, at my suggestion, unanimously recommended that the facts should be brought to the notice of the owner, and that this barge should have the hold absolutely cut off from the inhabited quarters by a properly constructed gas-tight bulkhead ; these alterations have since been carried out. As recorded in previous Reports, whenever barges are found carrying these cargoes and not fitted with proper bulkheads, action is promptly taken by your officers, and when the recommendations usually made are disregarded, Statutory Notices have been served upon the owners. In this way, during the past four years, eighty-four barges have been altered in accordance with the recommendations of the Port Sanitary Authority, viz.:— "That the existing bulkhead be removed and re-erected in double "form extended to and connected with the outer skin of the vessel. The "space between the two bulkheads freely ventilated, and the whole of the " space under the cabin floor filled with a mixture of cement and coke " breeze." The recommendations follow closely the lines laid down by the Canal Boats Act for canal boats engaged in the carriage of offensive cargoes, and the recommendations as made were approved by the predecessor of the present Principal officer of the Board of Trade. Your Worshipful Committee, at my recommendation, wrote to the Board of Trade calling their attention to the danger to life arising from the carriage of offensive and dangerous cargoes on barges which were not properly constructed for the purpose. I was requested to call on the Board's Principal officer and discuss the matter. I ascertained that the importance of this question was realised, but 33 that there was a difference of opinion as to the best method of cutting off the hold space from the inhabited quarters. There was the method recommended by the Port Sanitary Authority above referred to, whilst three shipwright surveyors of the Board of Trade each suggested a different plan, but each plan agreed with the principle that no gases or liquid must be allowed to pass from the hold to the inhabited quarters. Finally the Board of Trade issued instructions to their Surveyors, which I append herewith, which should effect the desired end if properly carried out:— The Surveyors, London District, are informed that the Board of Trade have had under consideration the desirability of affording additional protection from effluvium in the case of the crew spaces of barges carrying offensive cargoes. The majority of the barges referred to are registered under the Merchant Shipping Act, 1894, and the Board of Trade have decided that the following requirements shall be made as to the construction of the crew space whenever such a vessel is inspected by a Surveyor, either upon registry or re-registry, or upon a complaint being made. The bulkhead between the crew space and cargo space should be a single watertight bulkhead of two thicknesses of wood, tongued and grooved, with a layer of felt and coal tar between, and with angle strips of lead on both sides of the bulkhead all round its boundary, to prevent loss of tightness due to working. Any case in which it appears that the crew space is not sufficiently protected from the danger of effluvium arising from an offensive cargo, and that additional measures should be taken to prevent such danger, should be reported to the Board of Trade for instruction. Paragraph 25 of the Instructions, as to the Survey of Masters and Crew Spaces should, for the purpose of these vessels, be read as amended by this Minute. The Surveyors are informed that the Port of London Sanitary Authority will co-operate with the Board of Trade in requiring the crew spaces of the barges referred to, to be protected in the manner described. 5th January, 1904. Since that time the Statutory Notices served by direction of your Worshipful Committee have merely required the nuisance to be abated, and such works to be carried out as will prevent a recurrence of the same, leaving the owners the option of adopting whichever method they like ; but the onus of preventing a recurrence must rest with them. 34 During the past year 41 such notices have been given, 25 are known to have been fitted with double bulkheads, and in each instance where this has been properly done there has been no recurrence of the nuisance, and the men on board have expressed their satisfaction with the result. In many instances, after service of this notice, the owners discontinue altogether the carriage of cargoes of this nature. In the course of my interview with the Principal Officer, I ascertained that the Board could not interfere except when a barge came up for registration or re-registration on account of injury or some condition affecting the terms of the original registration, or on complaint being made. I made complaint of a number of barges forthwith, with the result that one of the barges, on which a deduction from the tonnage on account of crew's quarters had been made, had that deduction disallowed, a punishment which would not affect the barge in question, as it only plied within the limits of the Port. I pointed this out, and received a letter to the effect that the Board of Trade thought this question had better be dealt with by the Port of London Sanitary Authority, and that the Board had instructed their Principal Officer to co-operate as far as he possibly could. During May it was necessary to deal with a nuisance arising from a large quantity of unsound potatoes which had been brought by the s.s. "Clio," of Trieste, during the previous April. On the arrival of the vessel in London it was noticed, on removing the hatches, that the cargo had sunk from 15 to 20 feet, and that the potatoes were heated and offensive. The vessel when docked was berthed close to a public road, with the natural consequence that complaints of the nuisance were soon made to your Officers. Some of the potatoes were found to be sound, and these were got rid of as quickly as possible, but very slow progress was made with the work, and it became necessary to serve a Notice under the Public Health Act requiring the abatement of the nuisance by the removal of the vessel from the dock within forty-eight hours. The terms of the Notice were complied with, a gang of men being taken in the vessel for the special purpose of throwing the potatoes overboard during the trip from London to Hull. The vessel sailed for Hull on the 10th May, and the remainder of the cargo, consisting of over 40,000 bags of potatoes, were thrown overboard at sea. 35 CARCASSES OF DEAD ANIMALS IN THE RIVER. Early in the past year an unusual form of nuisance arose from the presence in the river of the carcasses of a number of dead horses, the animals having been drowned by the sinking of a steamer in the Pool, and subsequently floating out of the wreck. The tide brought the carcasses down and stranded them at various parts of the river. Beyond keeping the carcasses as far as practicable under observation, no action was taken by your Officers, as it appeared that the duty of clearing the river of these carcasses devolved upon the Thames Conservators, but as they did not agree with this view, it became necessary to dispose of one carcass by towing it to sea and letting it go on the ebb tide. The others were destroyed at the expense of the owners. RIYER WATER. The general condition of the River water during the year was good. Regular observation was kept, but at no time did the River generally become offensive, and this in spite of the fact that large quantities of impure liquid are allowed to flow into the Thames both at the outfalls of the London County Council at Barking and Crossness, and in rainy weather dilute crude sewage passes into the River from many outfalls at different places on each side of the River so as to relieve the sewers in times of heavy rainfall. The work of the removal of the accumulation of mud in the locks of the West India Docks and the Mill wall Dock has been thoroughly carried out by the respective Dock Companies, and for the first time for many years during hot weather the water in the Mill wall Dock was not offensive. During August, complaints were received of offensive smells alleged to arise in the vicinity of Limekiln Dock. The place known as Limekiln Dock is a small creek in the neighbourhood of Limehouse, and has been the subject of complaint on several occasions. The action of the winds and tides carries a certain amount of drift into the creek, which remains and ultimately settles to the bottom, forming a ridge or bar. The place was specially visited on this occasion at high and at low water, but no nuisance could be detected as arising from accumulated debris or mud. At the time of the complaint the carcasses of two dogs were stranded there, and it is probable that the offensive smell arose from that cause. These were at once buried in the river bed. 36 TABLE VIII. Original packages. Sundry quantities by weight. Loose Articles. No. Description. Tons. cwts. qrs. lbs. No. Description. MEAT— Fresh and Frozen— Beef - 353 quarters ... ... ... ... 724 pieces Mutton and Lamb 644 carcasses .. ... ... ... 252 ,, Veal, Pork and Offal 26 casks ... ... ... ... ... Preserved— Tinned 94 cases ... ... ... ... 7,636 tins Smoked and Salted 14 ” ... ... ... ... 68 loose RABBITS— Frozen- 200 crates ... ... ... ... 15,974 loose Tinned- ... ... ... ... ... ... 195 tins POULTRY and GAME— Frozen ... ... ... ... ... ... 24 sundry FISH— Wet 13 gallons ... ... ... ... ... Preserved, Tinned 284 packages 0 1 1 4 5,165 tins „ Dried 25 ” 0 2 0 0 ... FRUIT— Fresh 14,157 packages 143 19 0 21 37 loose Preserved, Dried 571 ” 1 11 4 4 304 loose ,, Tinned and Bottled 512 cases ... ... ... ... 969 tins „ Jam and Marmalade 5 ” 1 1 1 20 1,508 tins VEGETABLES— Fresh 2,159 packages 2323 16 2 0 ... Preserved, Dried 19 ” ... ... ... ... 191 tins NUTS— Cocoanuts, whole 9 bags ... 13 ... ... ... ., desiccated (Nil) ... ... ... ... ... PROVISIONS— Tea (Nil) ... ... ... ... ... Coffee ... ... 3 10 0 0 ... Cocoa ... ... 18 17 2 0 ... Butter, Cheese, Lard, Margarine 163 packages 1 3 3 17 5 tins Condensed Milk 280 cases ... ... ... ... 16 ” Prepared Foods 183 packages ... ... ... ... 217383 loose Biscuits and Confectionery 18 cases ... ... ... ... ... Sugar 14 ” ... ... ... ... ... GRAIN— Wheat, Maize, Rice, Barley, &c. 5,055 bags 733 14 0 5 21,053 sundry MEAL and FLOUR 5,230 ” ... ... ... ... ... CONDIMENTS and SPICES 5 cases ... ... ... ... 100 tins EGGS 4 cases ... ... ... ... 62,840 SUNDRIES 27 cases ... ... 3 1 5,444 Total 30,064 - 3228 11 2 16 348 8 8 8 - 37 UNSOUND FOOD. During the year there have been no large individual seizures of unsound frozen meat, the total for the year being 644 carcasses and 252 pieces of mutton and lamb, and 353 quarters and 724 pieces of beef. Of other articles the principal items have been:— In February, 13,000 eggs and 3,178 baskets dates, 6,600 bags rice and flour, 21,000 bushels and sundry bags wheat and oatmeal. In March, upwards of 11,000 eggs, 1,271 boxes dates, and 660 tons damaged flour and grain. In April, 60 tons damaged flour and grain. In May, 1,265 rabbits, 7,000 tins corned beef, 2,000 tons potatoes, 1,338 trays pears. In June, 16,800 yeast cakes, over 200,000 tins egg powder, and 2,750 rabbits. In July, 1,497 tins jam, 71 tons dates, and 11,520 eggs. In August, 1,440 eggs and 346 cases pears. In September, 4,700 rabbits. In October, 12 tons potates. In November, 11,440 eggs, 600 crates bananas, 43 tons dates, 3½ tons coffee, 2 tons onions, 121 boxes oranges. In December, 3,837 bags wheat, peas, &c., 1,000 crates bananas, 12,960 eggs, and 12 tons potatoes. This list shows only some of the principal items seized, and serves to illustrate the scale on which the inspection of food is carried out in the Docks. Further particulars are given in Table V III. On the return of the "Discovery" from the Antarctic regions, it was ascertained that the ship's stores remaining in hand were to be put up for public sale. As a certain portion was certainly unfit for food I decided to deal with the whole, which was accordingly carefully examined, and a total of 86 cases and 342 tins of various foodstuffs were found to be unsound and destroyed. On the whole, the condition of the stores was found to be fairly good. As might perhaps be expected, the tinned meats and fish yielded the largest proportion of unsound stuff, namely, about 25 per cent. The following full list of the stores destro\ed will be of .interest:— Thirty-three cases and 69 tins meat, 38 tins fish, 5 cases and 3 tins fruit, 2 cases and 11 tins marmalade, 15 cases and 31 tins vegetables, 20 cases and 5 tins butter, cheese, lard, and margarine, 1 tin prepared food, 5 cases and 2 tins vermicelli and macaroni, 3 tins barley, 4 cases eggs, 2 cases and 50 tins condiments, 1'29 tins sundries. An important prosecution in relation to the exposure for sale of polluted shellfish was undertaken by the Port Sanitary Authority during November 38 when a retailer of mussels taken from the end of Southend Pier was brought before a Magistrate at the Southend Police Court and convicted. The facts shortly are as follows:— In October the defendant sold to an Inspector of the Fishmongers' Company a quantity of mussels. It was pointed out to him at the time that mussels from this spot should not be sold for human food on account of their being contaminated with sewage from the local outfalls, which discharged into the River in the vicinity. Notwithstanding this warning, the man proceeded to Erith, and there continued selling the mussels until warned by an Inspector of the Port Sanitary Authority. On examination of the mussels, Professor Klein showed not only that they were extensively polluted with sewage, but that the organism of Enteric Fever was contained in some of the mussels. The mussels were brought to me, formally seized, and taken before a Magistrate at Southend, by whom they were condemned and ordered to be destroyed. The subsequent proceedings against the retailer were for selling mussels of the kind above described. Evidence was given by Professor Klein on behalf of the Port Sanitary Authority. The case was one of considerable public importance, bringing forcibly to the notice of hawkers of mussels that they must not collect their supplies from sources where the shellfish were likely to be contaminated with sewage effluent. HOSPITAL. TABLE IX. Number of Cases admitted, Cost of Maintenance, &c. Patients remaining in Hospital on 31st December, 1904. Admitted. Discharged. Died. Bubonic Plague 1 0 0 Suspected ditto 3 3 0 Small-pox 5 5 0 Scarlet Fever 7 5 1 Enteric Fever 33 31 0 Continued Fever 12 11 0 Measles 8 10 0 Chicken-pox 4 4 0 Totals 73 71 1 Remaining in Hospital on 1st January, 1905 7 Total number of days' treatment during the year 1,732 Average number of days' treatment for each case 22.49 The average daily cost of maintenance per head was 1s. 7d. 39 The improvements carried out with regard to the approach to the Hospital have been a great convenience, and were much appreciated during the winter months. A satisfactory road has been constructed, a good foundation was formed on the unstable ground by the use of railway sleepers. The tar paving around and between the buildings has been completed. The provision of a bathroom and furnishing of the Nurses' sitting room are comforts which are greatly appreciated by the Staff. I have, unfortunately, to report the fact that three of the Nurses fell ill with Enteric Fever; two of them apparently contracted the disease from a bad case which was being treated in the Hospital, and the other was infected by one of the sick Nurses. Two of them had the disease in a severe form, but all fortunately recovered. Changes in the Staff have arisen owing to the resignation of the late Matron and the two Assistant Nurses. Nurse Hughes was appointed in April to the vacancy of Matron, and is at present in charge, assisted by one Nurse and two Nurse Probationers. Fresh Caretakers were appointed in May. In December a patient under treatment in the Hospital for Scarlet Fever, during the temporary absence of the Nurse, absconded and proceeded to his home near Strood. He was practically convalescent, and had nearly completed the process of desquamation, but the Medical Officer of Health of the district was communicated with, and he was conveyed back to the Port Sanitary Hospital in an ambulance belonging to the Local Authority. This instance illustrates the need for Bye-laws relating to the detention of persons in Hospital. The Authority has Bye-laws for the removal of such patients from a vessel to Hospital, but there are no means of enforcing or compelling them to remain there should they wish to leave, although if they leave, legal proceedings can be taken for exposure while suffering from a dangerous infectious disorder. The Public Health (London) Act, 1891, Section 66 (3), provides for the making of Bye-laws for the detention of patients in Hospital so long as may be necessary, and I have recommended that these should be framed accordingly, and submitted to the Local Government Board for their approval. 40 STEAM LAUNCHES. The launches during the past year have not all been regularly engaged in their usual work of inspecting vessels, the "Clotho" having been laid by for extensive overhaul and repair for practically four months, and the " David Burnett" for two months ; thus the number of vessels visited by these two launches has been considerably reduced, the total number visited by the three launches amounting to 10,268, as against 11,832 for the previous year. " Clotho."—This launch has been practically rebuilt, all unsound plates in the hull renewed and bulwarks provided. The engines have been overhauled and adjusted, a new propellor provided with an increase of " pitch," with the result that her speed per hour has been increased by a knot and a quarter. The boiler was repaired and tested, and sundry alterations carried out in the after-cabin, so that the accommodation for carrying patients has been improved. The boat is faster, more seaworthy, and has been much improved in appearance. " David Burnett."—This launch, built in 1893, was surveyed by your Consulting Engineer, and, on his advice, the boiler was taken out, and the tubes renewed where necessary. The engines were overhauled, the boiler and engine-room casing repaired and replaced in such a manner that in future, should it be necessary to take out the boiler, the expense of cutting through the iron decks will be avoided. The decks have been sheathed with wood. The cost of overhauling and repairing the two launches was about 830/. CREWS' QUARTERS. To obtain as far as possible proper sanitary conditions under which persons have to live on board vessels is one of the primary duties of a Port Sanitary Authority. For this reason it is necessary to again bring forward some of the difficulties that are experienced in impressing upon those responsible for the health and comfort of seamen in their employ the importance of providing them in reason with healthy and comfortable quarters. Shipowners are governed in their relation to seamen almost entirely by the Merchant Shipping Act, an Act which contains clauses dealing with the provision of accommodation for crews, and in which certain limits are laid down as a legal minimum below which it is not lawful to go. The officials charged with the duty of seeing that these clauses of the Merchant Shipping are not infringed are those connected with the Marine Department of the Board of Trade. 41 Unfortunately, the provisions of the Merchant Shipping Act appear to accept standards with regard to cubic space, lighting, &c., which compare most unfavourably with those adopted by communities other than those concerned with life on board ship. With the framing of the Public Health Acts and the constitution of Port Sanitary Authorities, and more particularly the Port of London Sanitary Authority, it was enacted that vessels lying within the jurisdiction of the Port Sanitary Authority should be subject to that Authority in every respect as though such vessels were houses on land. Herein lies an important difficulty. It is at once apparent that the conditions under which seamen are compelled to exist while serving on board ship are deficient, to an extent much below that of any habitation on shore, in the common requirements of air space, superficial area, ventilation and lighting. It became, therefore, a question of attempting to reconcile the minimum accommodation, &c., permitted by the Merchant Shipping Act with the requirements of the individual in regard to sanitary accommodation, &c., viewed in the light of modern knowledge. In my last Annual Report I gave a Table showing the minimum amount of air space allowed for cattle in cowsheds, and for the human individual in military barracks, workrooms, lodging-houses, and seamen's quarters. Setting these side by side, it was shown that the cattle occupied the premier position, and the seamen the last. This state of things would be remarkable under any circumstances, but when it can be shown that no reason exists for thus diminishing the air space in which a seaman is compelled to live and sleep, it would appear that some active steps might be taken to remedy an evil which is little short of a public scandal. In the case of small sailing ships, where deck room is limited, and the crew are berthed below deck, it is difficult to obtain an adequate allowance either of air space or floor space, or even proper lighting and ventilation, but even on vessels of this type, the foreigner is often more advanced than the British shipowner, and will erect deck-houses wherever possible. Another point is of importance, namely, that the Merchant Shipping Act deals with and has in view the existence of seamen, but takes no notice of the equally numerous, and at the present time equally important class known as firemen. The seaman who is much exposed to all kinds of weather while on duty is, perhaps, able to counteract, for the short period he is off duty, the impure atmosphere in the quarters provided for him, but the case of the fireman is different. His work is performed in a high temperature, and is physically severe. At the end of his spell he is more or less exhausted, and on reaching his quarters he has to endure an atmosphere more vitiated than the one he has just left. 42 These things are so obvious that it is expected, in the case of new vessels especially, that some attention should be paid to them. The Board of Trade issues certain instructions to their Surveyors which, if strictly carried out, would, I have little doubt, cause some improvement, but it is not unusual, even in new vessels, to find that apparently little attention has been paid to these details. In support of these remarks, I have caused observations to be kept upon modern vessels visiting the Port, with a view to ascertaining to what extent the accommodation provided for the crews complied with the minimum requirements of the Merchant Shipping Act. With regard to lighting, the test adopted by the Board of Trade is that with one-third of the light closed it shall be possible to read the print of an ordinary newspaper in any part of the space, of course during the daytime. Inspector Romeril, your senior Sanitary Inspector, has taken much interest in the question, and the measurements, &c., given have been made by him. The following is a result of observations made on four vessels constructed in recent years:— Reference No. Registered Tonnage When Built. Situation of Crews' Quarters. Gross Cubic Contents. Nett Superficial Floor Space. Gross Area of Light Apertures. Number of Occupants. Port Side. Starboard Side. Port. Starboard. Port. Starboard. Certified for. Occupying. 1 3592 1899 Forecastle cubic ft. cubic ft. square ft. square ft. sq. inches. sq. inches. Port. Starboard. Port. Starboard. 852.7 852.7 125.4 125.4 100.5 100.5 10 10 6 6 2* 3942 1904 Forecastle 1547 1844 194 236 190.8 190.8 12 16 — — 3 3910 1902 Forecastle, 1902.8 1589.6 128 116 192.4 153.9 16 10 15 10 4 4421 1901 Forecastle 1787.4 1787.4 116 116 87.8 87.8 14 8 14 10 * Of this forecastle I append a plan, drawn approximately to a scale of ¼-inch to 1 foot, illustrating the general arrangement of the crew's quarters in this part of the vessel. This has been selected as being the newest vessel, and typical of the others. In this way it is possible to compare the amount of air space, floor space and light which is considered sufficient for seamen on modern vessels with that which is considered essential in dwellings on shore. It might be well to say here that this is not a selection of the worst cases, but is typical of cases which may be met with every day. In the case of the first vessel it will be found that if the forecastle were occupied by the number of persons for which it is certified by the Board of Trade, that the occupants would have each about 85 cubic feet of air space and 12 square feet of floor space. Sketch Plan of Forecastle NO2. described in preceding Table. 43 What this means may perhaps be better understood when it is stated that on shore anything less than 300 cubic feet of space per head would be considered overcrowding, whilst the seaman must be satisfied with about one-quarter of this allowance. With regard to the amount of light permitted in this forecastle, the total area of the lighting apertures represented 100 square inches to each division of the forecastle. Under the London Building Act, a room with the superficial floor area contained in this forecastle would require two windows each of 12 square feet area, say 4 feet by 3 feet. The amount of light permitted in this forecastle may be represented by one small pane of glass about two-thirds of a square foot in area, so that it may be realised what the conditions on this vessel were if it is imagined that 10 adult persons take their meals and sleep in a room say 10 feet by 12 feet and 7 feet high, lighted by one tiny window less than 1 foot square, situated near the ceiling, towards which the light would be directed, with a shelf 2 feet wide placed under the window, thus preventing the light from reaching the floor. The visits to the vessels were made under favourable circumstances with the sun shining brightly, but even then I saw a lamp burning in order that a man might be able to write. In the case of the second vessel the conditions will be seen to be a little better with regard to air space and floor space, but not much. Sixteen persons have to occupy a space equal to a room about 15 feet square, and the total lighting area corresponding to a window in this case equals 11/3 square feet. In the case of a house the windows of this room would have to represent no less than 24 square feet of area, or say 6 feet by 4 feet, so that the amount of light permitted in this forecastle is one-eighteenth part of that considered necessary in an ordinary living room on shore. In the case of the third vessel, there are 15 persons occupying a space of 128 square feet of floor space, and the gross area of the lighting aperture is only 192 square inches, equals 1J square feet. In the case of the fourth vessel, the lighting aperture falls as low as 87 square inches, or rather more than half a square foot, for a space occupied by 14 persons and available floor space of 116 square feet, representing a space less than 11 feet square and containing 1,787 cubic feet of air space, or 127 cubic feet per head, less than one-half the minimum amount required by persons on shore, but nearly double the amount allowed under the Merchant Shipping Act. That men should be required to live under such conditions is not right, and under the circumstances it is not surprising to find among seamen and firemen a large number of cases of Pulmonary Tuberculosis. 44 The conditions illustrated by the Table above might be considered practically ideal for the development and propagation of such a disease as Pulmonary Tuberculosis, and inasmuch as it is now recognised that the disease is infectious, it is quite time that some effective legislative measures should be adopted to secure better hygiene in crews' quarters. The fore part of a ship is not suitable for habitation. The space here is limited, and there is not scope for free movement. There are also practical difficulties in the way of efficient ventilation, more particularly in erecting ventilators. Moreover, when men come from the engine room and stokehold to the forecastle they are exposed in bad weather to the almost certainty of being thoroughly wetted by the sea. The forecastle of a vessel is, further, generally dark on account of the difficulty in providing means of lighting which will not be broken by the seas and gear. In the ideal provision of quarters for crews on board steamships, the officers should be berthed amidships and the crew aft. In this part of the vessel they are protected from weather; a skylight can be provided which will afford ample light and ventilation. An upper row of bunks should not be allowed on the side from which the light comes. Sailing ships should berth their crews in houses on deck. The crew can pass between the engine room and their quarters without getting wet, and owing to the configuration of the vessel, large and roomy quarters can be provided with mess room and wash-house. This arrangement of crews' quarters is by no means an inovation, and has already for some time been adopted by certain shipowners, with the result that a very great improvement has been effected and an example set which might with advantage be followed by all shipowners. With regard to ventilation, it is laid down by the Board of Trade that each forecastle shall be efficiently ventilated. The interpretation of this results in a cowl ventilator being placed through the deck, the lower end is placed either over or in close proximity to a bunk, the occupant thereupon stops it up, or more frequently the ventilators are removed and stored in the fore peak, whilst the opening is covered securely with canvas tied on and painted. The ventilator is usually about 8 or 9 inches in diameter, and in order to act as an uptake should be always kept back to wind; this is no one's duty, and in consequence is not done. In order that the air may be kept fairly pure 3,000 cubic feet per head of fresh air per hour should be supplied, an absolute impossibility with the means of ventilation ordinarily provided. The conditions can be much improved by fitting a ventilator which will act as an uptake only; of this there is more than one kind made; if the vitiated air is removed, fresh air will find its way in through the door or openings therein. 45 The only efficient remedy for these defects is to make it obligatory for plans of the inhabited quarters to be approved by the Local Port Sanitary Authority ; and to ensure uniformity on the point, model instructions should be issued by that Department of the Government responsible for the hygiene of the country. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1904. The London County Council introduced a General Powers Bill into Parliament last year to acquire powers with respect to sanitary and other like matters, and to confer various powers upon the London County Council and upon the Councils of Metropolitan Boroughs, and for other purposes. The Bill, as drawn up, made no mention of the Port of London Sanitary Authority, and it was ambiguous whether powers asked for could be applied at all, and if so, whether they should be applied by the Port Sanitary Authority or the Borough Councils within whose area the Docks were situated. The Bill was opposed by the Surrey Commercial Dock Company; and as a result of negotiations between Mr. Remembrancer and the London County Council, the provisions of the Bill as affecting those parts of the jurisdiction -of the Port Sanitary Authority as are situated within the Administrative County of London were, before the Bill became law, made applicable to the Corporation of the City of London as the Port of London Sanitary Authority, who alone can exercise the powers granted under this Act, within such parts of their district as previously defined. The Act received the Royal Assent during the year, and the following Sections apply to the Port Sanitary Authority as above stated. Section 19.—For the cleansing, purification or destruction of filthy, dangerous and unwholesome articles, with a view to the prevention of infectious disease, and as to the payment of compensation to the owner for any article so destroyed. Section 20.—Cleansing of houses infested with vermin, and the penalties incurred by persons failing to comply with the notice under this Section. So far as the Port Sanitary Authority is concerned, the term " house," of course, includes vessels. Section 21.—With regard to the provision of means for cleansing and purifying filthy, dangerous and unwholesome articles, and houses infested with vermin. Section 22.—With reference to sanitary conveniences, when placed or constructed as to be a nuisance or offensive to public decency, the Sanitary Authority may, by notice in writing, require the owner to remove such convenience, or otherwise reconstruct the same in such a manner and with such materials as may be required to abate the nuisances and remove the offence against public decency. 46 Section 23.—With regard to the abolition of fixed ashpits where portable ashpits are provided. Section 24.—Power of entry with regard to houses containing filthy, dangerous, and unwholesome articles, and also those infested with vermin. This is an important section, and sub-section 2 sets out as follows :— The sanitary authority of any sanitary district shall have a right to enter at all reasonable times any house, building or premises, or part thereof in that district, for the purpose of examining whether there is any contravention of the provisions of this part of this Act or any noncompliance with the requirements of any notice given thereunder respectively. Section 25.—With reference to the enforcement of this part of the Act and the provisions relating thereto. Section 26.—Definitions of the terms "sanitary authority," "sanitary district," " house," "owner," "rack rent," " ashpit," " sanitary convenience." By this Section it is enacted that— The expression " sanitary authority " means the Corporation in respect of the City, and as port sanitary authority in respect of so much of the Port of London as is established for the purposes of the laws relating to the Customs of the United Kingdom as is within the County, and as respects any metropolitan borough (except as to any portion thereof which may be within the said portion of the Port of London), the council of such borough. The expression "sanitary district" means the City or so much of the Port of London as is within the County or any Metropolitan Borough (except as to any portion thereof which may be within the said portion of the Port of London). The expression "house" includes schools and other buildings in which persons are employed and the curtilage of a house and any building or house wholly or partly erected under statutory authority, but shall not include any premises being a factory, workshop or laundry, to which the Factory and Workshop Act, 1901, applies, or any building belonging to any dock company situate within the dock premises and not used wholly or in part as a dwelling-house or stable. The expression " ashpit" means any ashpit, dustbin, ashtub, or other receptacle for the deposit of ashes or refuse matter. The expression "sanitary convenience" includes any urinal, water-closet, earth-closet or privy, and any similar convenience. 47 CANAL BOATS ACTS AND REGULATIONS. In accordance with the requirements of Section 3 of the Canal Boats Act, 1884, I herewith report upon the execution of the Canal Boats Acts, 1887 and 1884, and the Regulations made thereunder, and as to the steps taken during the year ending the 31st December, 1904, to give effect to the provisions of the said Acts and Regulations in the District within the jurisdiction of the Port Sanitary Authority of the Port of London. (1.) The present arrangements for the inspection of canal boats are the same as those which have been in force during the past. No Inspector is appointed solely for the work of inspecting canal boats, but each Port Sanitary Inspector, of whom there are seven, has a district of the Port allotted to him, as follows :— Inspector Romeril - - - 188/. 10s. per annum. Central District. West India Dock. South West India Dock. Poplar Dock. Mill wall Dock. Inspector Garland 188/. 10s. per annum. Western District. London Dock. St. Katharine's Dock. Regent's Dock. Surrey Commercial Dock. Inspector Wetjen - 162l. 10s. per annum. Eastern District. East India Dock. Royal Albert Dock. Royal Victoria Dock. Inspector Lambe - - - 136/. 10s. per annum. Gravesend District. Tilbury Dock. North Shore—from Purfleet down. South Shore—from Erith down. RIVER. Inspector Hopkins - - - 162/. 10s. per annum. Upper District. Teddington to Limehouse. Inspector Burr 162l. 10s. per annum. Middle District. Limehouse to Erith. Inspector Rolfe 136l. 10s. per annum. Lower District. Erith to seaward limits of Port of London (including part of River Medway). 48 These Inspectors visit canal boats wherever they are found in the course of their daily work, and the results are set out in the Table appended. (2) The appended Table shows that the number of boats inspected during the year 1904 was 1,022. Of this number, 905, or 88.55 per cent., were found to be conforming with the Acts and Regulations. Except in regard to the cases hereinafter mentioned, no general complaint has to be made with regard to the condition of the boats and their occupants. (3) On 117 boats there were found 146 infringements of the Acts and Regulations. In 91 cases the owners were cautioned by formal notice in writing, and in 89 cases the infringements complained of are certified to have been removed In two cases, boats have been inspected and the cabins found to be occupied by husband and wife and another person of the female sex above the age of 12 years, and in one case a cabin was found to be occupied by a man and his wife and a person of the male sex above the age of 14 years. In only one case was a boat found to be carrying an offensive cargo without the boat being provided with two bulkheads of substantial construction, as required by the Canal Boats Regulations. The matter was brought to the notice of the owners of the boat, who stated that the boat was not intended to carry offensive cargoes, and that the cargo in question, namely, bones in an offensive condition, had been taken in error. (4) Legal proceedings were recommended by your Medical Officer in the following cases :— Canal boat "Nelly," registered Brierley Hill, No. 220. This boat was inspected on September 5th, when three persons were found on board, viz., the Master, his wife, and a female aged 19 years. The Certificate stated that the after-cabin was registered for occupation by three persons. The Master's wife stated that her husband slept in the hold on the cargo, whilst the after-cabin was occupied only by herself and the girl as a sleeping place. The facts were laid before the City Solicitor, who was of opinion that the evidence as to occupation of the cabin as a sleeping place by the Master, his wife and a female above the age of 12 years wras not sufficient to obtain a conviction. The canal boat "Clyde," registered Wolverhampton, No. 741, was inspected on the 31st August, when it was found that the after-cabin—which was registered for occupation by three adults—was occupied by the Master, his wife, and their niece aged 14 years. There was no provision in the cabin for the separation of sexes. The matter was brought to the notice of the owners, and the boat being inspected at Tipton on the 4th September, it was certified that the cause of complaint was remedied. 49 On the 11th October the canal boat "Mabel," registered Brierley Hill, No. 142, was inspected, and the after-cabin found to be occupied by the Master, his wife, and another person of the male sex 20 years of age. Although the fore-cabin of this boat is registered for occupation, it was stated that the reason for not using it was that it did not contain a stove. The facts were brought to notice of the owners, and the boat was inspected at Brierley Hill on the 24th October, and the cause of complaint found to have been removed. Owing to there being no evidence of the occupation of the cabin as a sleeping place by all of the persons found on board, legal proceedings were not advised. The best evidence of such illegal occupation would be by the actual observation of the cabin so occupied during sleeping hours, but inasmuch as the legal powers of entry are between the hours of 6 a.m. and 9 p.m. only such evidence is practically impossible to obtain. (5) Canal boat " Albert," of Uxbridge, No. 220. This boat was inspected on the 22nd June, 1903, when it was found that the registration marks and numbers on both sides of the boat had been partly obliterated. This was brought to the notice of the owner, and he was called upon to have the boat lettered, marked and numbered. The boat was again inspected on the 11th May, 1904, when it was found that the lettering, marking and numbering had not been renewed, and further, that the cabin funnel was defective, the cabin top leaky, and the interior of the cabin in a dirty condition. The case was therefore placed in the hands of the City Solicitor, and as a result of his action the barge has been attended to, and the necessary repairs carried out. (6) and (7) No cases of infectious diseases have been met with on any canal boat during the year, and no boats detained for cleansing or disinfection. (8) The total number of boats registered by this Authority since 1884 is 424. Of this, 136 registrations have been cancelled, the actual number remaining on the register on the 31st December, 1904, being 288. (9) Three new boats have been registered during the year. No boats have been re-registered owing to structural alterations, but seven have been re-registered for other reasons. I am, Gentlemen, Your obedient Servant, HERBERT WILLIAMS, Medical Officer of Health, Port of London. 50 TABLE X. SUMMARY OF CANAL BOATS FOR THE YEAR ENDING 31ST DECEMBER, 1904. January. February. March. April. May. June. July. August. September. October. November. December. TOTAL. total for the year. 1899. 1900. 1901. 1902. 1903. New boats registered ... ... ... ... ... ... ... ... ... 2 1 ... 3 8 4. 1 1 3 Registration owing to structural alterations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Registration for other purposes ... ... ... ... ... 2 ... 1 ... ... 1 ... 3 7 6 14 23 11 5 Inspected 87 97 104 96 106 88 74 51 83 74 89 73 1,022 781 655 530 894 1,139 77 92 89 85 90 77 68 43 71 66 79 68 905 683 601 465 748 989 Infringements to :— Registration ... ... 1 4 1 1 2 ... 1 4 5 ... 19 14 12 12 22 21 Notification of change of master ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... ... ... Absence of certificate 1 2 ... 1 2 ... ... 1 4 1 4 ... 16 16 14 11 38 28 Certificate not identifying owner with boat 2 ... ... 3 ... 2 ... ... ... 1 ... ... 9 1 7 19 18 10 Marking, &c. 2 1 3 ... 2 ... ... 1 1 ... ... ... 10 10 6 8 24 19 Overcrowding ... ... 1 ... ... ... ... 2 1 ... ... 1 6 2 1 3 3 5 Partition separating sexes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Males over age ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... i 1 i Females over age ... ... ... ... • •• ... ... 1 1 ... ... ... 2 ... ... 1 2 4 Cleanliness ... 2 4 4 5 ... ... 1 2 1 ... 3 37 6 6 10 33 28 Painting... ... ... 1 ... ... ... ... ... ... ... ... ... 1 2 1 ... 1 1 Ventilation ... 1 1 2 1 ... ... 1 ... ... ... ... 6 8 2. 6 8 11 Dilapidation ... 2 1 4 7 ... ... 2 3 1 ... 3 38 18 17 16 47 47 Removal of bilge water ... .... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Without pump ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Refusal to admit Inspector ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No proper water vessel ... ... 1 ... 2 3 ... ... ... 1 ... ... ... 13 13 6 6 23 21 Without double bulkhead ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Notification of infectious disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Detained for cleansing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Proceedings taken ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Cautions given 7 5 11 9 15 10 3 5 12 3 6 5 91 60 54 55 138 126 ,, attended to 9 6 5 5 23 4 5 2 8 9 7 6 89 54 42 55 114 119 Total registered by Port Sanitary Authority since 1887 424 Cancelled 136 Actual number on Register, 31st December, 1904 288 Registered for 3,764 persons. Carrying 2,009 persons. PORT OF LONDON SANITARY AUTHORITY. Receipts and Expenditure under the Public Health (London) Act, 1891, for the Year ending 31st December, 1904. RECEIPTS. £ s. d- PAYMENTS. £ s. d. £ S. d. To Fees in respect of Health Certificates 88 16 0 By Salaries, Wages and Disbursements, viz. :— „ Ditto of disinfection of Vessels 123 7 6 Dr. II. Williams, Medical Officer of Health, one year 704 3 4 „ Ditto of the utilisation of Condemned Meat, &c. 161 11 6 Boarding Medical Officers' Salaries and Locum Tenens 1,267 7 0 „ Fines for Breaches of Bye-laws re Offensive Cargoes, &c. 53 0 0 Medical Officer at Gravesend Hospital, one year 109 4 0 „ Metropolitan Asylums Board, Fees under 1891 Act ... 1 0 6 W. J. Albrow, Clerk, ditto 200 0 0 ,, Rochester Port Sanitary Authority, Reimbursement of proportion of Dr. H. Williams, for Wages £3,400 0 0 Salary of Medical Officer at Gravesend, one year £100 0 0 Ditto, for Disbursements 850 0 0 ,, Ditto, for forwarding Telegrams 0 11 6 4,250 0 0 100 11 6 Guarantee Premium, re Dr. H. Williams 1 10 0 „ Compensation for Damages to Launches 30 16 7 6,532 4 4 „ Fees in respect of Canal Boat Registration 2 7 6 „ Officers' Pension Fund 182 4 3 „ Reimbursement of balance of Committee's Expenses of Inspections „ Uniforms 124 4 1 in 1903 33 17 11 „ Expenses of Launches, Hulk, &c., viz.:— „ Sundry and Miscellaneous Reimbursements 0 3 0 Insurance 121 12 7 Coal and Coke 236 17 6 Repairs and Stores 1,060 10 3 1,419 0 4 ,, Offices at Greenwich, viz. :— Rent, one year and a quarter 62 10 0 Rates and Taxes 20 8 4 Fire Insurance... 0 13 0 Telephone Rent 20 10 0 Gas 8 14 8 Water 2 10 0 Deficit defrayed out of City's Cash 8,937 1 4 Coal 2 8 0 Repairs, &c. 10 15 11 128 9 11 ,, Hospital at Denton, viz. :— Expenses of Nursing Staff 45 5 1 Rent of Causeway 2 5 0 Rates and Taxes 46 12 7 Fire and Boiler Insurance 6 8 3 Rent of Telephone 12 10 0 Coal 64 11 0 Stores and Equipment 48 8 9 External Painting Contract 78 1 4 Tarpaving, ditto 102 10 0 Repairing Causeway 71 9 4 General Repairs 59 14 7 537 15 11 „ Contract for Erection of Additional Block at Hospital, balance 50 0 0 „ Printing, Stationery and Advertisements ... 131 4 7 „ Telegrams and Maintenance of Private Wire 20 0 5 „ Expenses in relation to Condemning Unsound Food 62 6 0 „ Disinfectants 4 4 0 „ Committee's Allowance 150 0 0 „ Ditto, Inspection of River 110 0 0 260 0 0 „ Law Charges, viz. :— Mr. Comptroller 0 18 11 Mr. Solicitor 42 14 10 43 13 9 ,, Expenses of visit of Delegates to Congress at Glasgow ... 29 8 0 „ Sundries 11 3 9 Chamber of London, JOSEPH C. DIMSDALE, £9,535 19 4 £9,535 19 4. 1th March, 1905. Chamberlain. 51 52 APPENDIX A. Vessels and Premises Disinfected, from 1st January to 31st December, 1904. Month. Reason for Disinfection. Total Number of Disinfections. Chicken-pox. Continued Fever. Enteric Fever. Erysipelas. Measles. Plague. Scarlet Fever. Small-pox. Precautionary Measure. January • • • 2 2 • • • ... ... ... ... 7 n February 1 ... 2 • • • ... • • • ... 2 4 9 March ... 2 6 1 1 • • • 1 1 1 13 April ... ... 5 ... 1 • • • ... 2 4 12 May 2 ... 2 ... ... ... 2 ... 5 11 June ... ... 1 ... ... ... ... ... 4 5 July - ... ... 6 ... 1 ... ... 1 7 15 August ... ... 4 ... 1 ... ... 1 4 10 September 1 ... 3 ... 1 ... 1 ... 3 9 October ... 3 3 ... ... ... ... • • • 5 11 November 1 ... ... ... 1 1 1 • • • 3 7 December ... 2 2 ... 1 ... ... ... 3 8 Totals 5 9 36 1 7 1 5 7 50 121 53 APPENDIX B. Effects Disinfected, from 1st January to 31st December, 1904. Month. Reason for Disinfection. Hospital Bedding, &c. Total Number of Disinfections. Chicken-pox. Continued Fever. Diphtheria. Enteric Fever. Erysipelas. Measles. Plague. Scarlet Fever. Small-pox. Precautionary Measure. January ... 1 ... 3 ... ... 1 ... ... ... ... 5 February 2 1 ... 3 ... 3 ... ... 5 ... ... 14 March ... 2 ... 6 1 2 ... 1 1 ... 4 17 April ... 1 ... 3 ... 1 ... 1 2 1 2 11 May 1 ... ... 2 ... ... 1 1 ... ... 4 9 June ... ... 1 ... ... ... I •• ... 1 3 July ... ... ... 6 ... 1 1 ... 1 ... 1 10 August ... ... ... 4 ... 1 ... 1 3 ... 1 10 September 1 ... ... 3 ... 1 1 ... 1 3 10 October ... 3 ... 4 ... ... 1 ... 4 12 November 1 ... 1 ... ... ... 1 1 ... ... 4 8 December - ... 1 ... 3 ... 1 3 ... ... ... 4 12 Totals 5 9 1 38 1 10 7 8 12 2 28 121 54 APPENDIX C. Sanitary Works and Alterations in connection with Buildings, Premises, and Vessels within the Docks, &c., completed during the year :— Date completed. Works. 1904. Messrs. Baker and Co. Drain at closet at Tailors' shop, North end (close to Police Office) Tilbury Dock. Jan. 9 " 27 London and India Docks Company. Reconstruction of about 280 feet of drain at rear of A. W. Robertson and Co.'s and Lester and Perkins' premises, Royal Albert Dock. Feb. 15 Lester and Perkins. Alterations to drains of workmen's closet on South side, Royal Albert Dock, between Dry Docks and Oonnaught Road Bridge. March 7 London and India Docks Company. Construction of a lavatory at the Dock Company's Offices, East Branch Dock, near "A" Shed, Tilbury Dock. May 12 Millwall Dock Company. Drainage at new granaries in Millwall Dock. June 11 Messrs. A. Wright and Son. Proposed new branch drain in connection with extension of Messrs. Baker and Co.'s premises in Royal Albert Dock. " 20 Millwall Dock Company. Alteration to drains at Messrs. Smith and Co.'s premises, Millwall Dock. July 8 London and India Docks Company. Construction of new sewer at South Dock Railway Station. " 29 Temperance Catering Co. Alterations to drainage at Coffee and Dining Rooms, Silvertown Gate, South side, Royal Albert Dock. Aug. 24 Millwall Dock Company. Construction of a latrine at North side of " F " Warehouse. " 31 London and India Docks Company. Construction of drains at Police Inspector's House, Royal Victoria Dock. Nov. 16 Tilbury Dock. Construction of new closet and cesspit at Messrs. Miller and Son's premises. " 28 Midland Railway Company's Goods Depot, Victoria Dock. Reconstruction of drainage and closets. 55 APPENDIX D. Sanitary Works and alterations, not yet completed :— Date Plan submitted Works. 1904. Admiralty. Latrines to be erected at the Royal Naval Store Depot, West India Dock. January 5 " 9 London and India Docks Company. New drainage and water-closets at the Water Guard premises, Connaught Road, Royal Albert Dock. " 18 Surrey Commercial Dock Company. Drainage in connection with a new lavatory and w.c. to be constructed near No. 8 Warehouse, Swedish Yard. " 23 Millwall Dock Company. Construction of drains at the Central Granary Office. September 1 North London Railway. Reconstruction of drainage at Great Western Railway Company's Warehouse, Poplar Dock. " 20 Messrs. McDougall Bros. Construction of stable drain at Chemical Works. October 7 Millwall Dock Company. Proposed latrine near "T" Warehouse, Millwall Dock. " 7 Millwall Dock Company. Proposed drainage for closets, &c., at Central Granary, Millwall Dock. " 21 London and India Docks Company. Proposed alteration to drains at General Office, West India Dock. November 11 Millwall Dock Company. Construction of latrine and drainage near "Z" Warehouse, on South side of Dock. 56 APPENDIX E. Police Court Proceedings. Date. Name of Vessel. Offence. Police Court. Result. 1904. April 7 s.s. "Bergsund," of Stockholm. Failure to comply with a Statutory Notice served requiring the abatement of a smoke nuisance, and the prevention of a recurrence of same. Thames - Fined 8l.; costs and expenses 3l. 3s.—Total Hi. 3s. Prohibition order made. s.s. "Swift," of Hull, 108,526. Ditto Mansion House Fined 11. ; costs and expenses 1l.13s. Prohibition order made. May - s.s. "Avon," of Grangemouth, 90,917. Ditto Thames Prohibition order made and costs 21. 2-s. allowed. „ 20 s.s. " Essex," of Hull, 60,176. Ditto Do. Fined 10Z. and 31. 15s. costs. Prohibition order made. June 80 McDougall and Co.'s Flour Mills, Millwall Dock. Ditto Do. Fined 8I. and 61. 6s. costs. Prohibition order made. „ 30 s.s. " Colon," of Barcelona. Ditto Do. The defendant failed to appear, and the summonses were adjourned until the return of the vessel to London. July 16 s.s. ''North Sea," of London, 110,181. Ditto - Southwark Fined 31, and 1Z. 3s. costs. 17 s.s. "East Point," of Liverpool, 113,453. Ditto Thames Fined 51. and 21. 10s. costs. Prohibition order made. Sept. 23 s.s. "Earsdon," of North Shields, 84,895. Ditto Southwark Fined 21. and 21. 2s. costs. Prohibition order made. Oct. 18 Application for destruction of a unfit for human an Order for the quantity of mussels, food. Southend Order made. Nov. 4 s.s."Beethoven," of Sunderland, 114,564. Failure to report a case of infectious disease on board on arrival in the Port of London. Gravesend Fined 1/. and 61. los. 6d. costs. „ 8 David William Cundy. Selling mussels which were unwholesome and unfit for human food. Southend Fined 11. and 4s. costs. „ 24 s.s. "Irkutsk, of Windau. Failure to comply with a Statutory Notice served,requiring abatement of a smoke nuisance, and the prevention of a recurrence of same. Thames Fined 10Z. and 41. 4s. costs, and a Prohibition order made. Dec. 22 s.s. "Dundee," of London, 105,849. Ditto Westminster Fined 51. and 31. 7s. costs. „ 22 s.s. "Excelsior," of London," 105,826. Ditto Do. Do. „ 22 s.s. "Little Briton," of London, 54,676. Ditto Do. Do. LONDON: Printed by Charles Skipper & East, 49, Great Tower Street, E.C.