68. PORT OF LONDON SANITARY COMMITTEE. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, To 31st December, 1912. Presented 29th May, 1913. REPORT, For the Year ended 31st December, 1912, 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, medical inspector for purposes of the aliens act, 1905, port of london, lecturer on port hygiene, london school of tropical medicine, 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 Charlrs Skipper & East, 49, Great Tower Street, E.C. 1913. BURNETT, Mayor. A Common Council holden in the Chamber of the Guildhall of the City of London, on Thursday, the 29th day of May, 1913. 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, 1912 ; 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 Sanitary Authority of the Port of London, by the Local Government Hoard, 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, 1912, which Report contains a full and detailed account of the work carried out in the Port during that period by the Medical Officers and Inspectors. A short account of the International Sanitary Conference held in Paris during the year is given in the Report, and the subject of Plague receives special attention. It is probable that the Regulations relating to Plague, Yellow Fever and Cholera issued by the Local Government Board may be revised. The Medical Officer of Health points out that the opportunity might be taken of strengthening them in certain directions. Plague has occurred amongst the rats in the docks situated within the jurisdiction of the Port Sanitary Authority; the number of rats infected has been small, and owing to the precautions adopted there has been no serious outbreak of this disease amongst the rats. The bacteriological examination of rats has been continued at considerable expense, but your Committee consider they are justified in incurring this expense as it is of the utmost importance, not only in the interests of the public health to be able to detect the early occurrence of Plague amongst the rats so that the necessary precautions may be taken, but also in the interests of commerce the disease should be prevented from spreading, thus obviating any necessity for rigorous treatment of vessels arriving from Great Britain in foreign ports. The Medical Officer points out the necessity for making absolutely rat-proof buildings which are used for the storage of foodstuffs, and the attention of the Port of London Authority has been directed to this. The Medical Officer also considers that vessels should be fumigated with a lethal gas at intervals not exceeding six months for the destruction of rats on board. This, he points out, need not be done in this country so long as the operation, wherever performed, is done in a satisfactory manner. Several vessels arrived during the year having had cases of Small-pox on board, but it was only necessary to treat two cases in the hospital of this Authority at Denton. Cases of Diphtheria occurred at intervals on one of the training ships. The outbreak received careful attention at the hands of the Medical Officer. The type of disease was a mild one, and it is satisfactory to record that no deaths occurred amongst the boys. The recommendations made by the Medical Officer of Health were readily carried out by those in charge of the ship, and no cases have occurred since. Vessels continue to arrive with Beri-beri. No less than 38 cases have been reported during the year. This disease is considered to be due to unsuitable diet and no public danger is likely to arise therefrom. Many cases of Tuberculosis have occurred on vessels, and in each instance the necessary precautions have been taken, but it is pointed out that so long as the seamen continue to be housed under the present unsatisfactory conditions, this disease will continue to be prevalent amongst them. The sanitary condition of crews' quarters has received considerable attention. The primary duty of supervising the sanitary conditions of crews' quarters is in the hands of the Board of Trade, and several cases are reported on new vessels which fall short of the Board's minimum requirements. Certainly the conditions are such as would not be tolerated by any Sanitary Authority with respect to premises on shore. The duties of inspection of foodstuffs continue to be carried on in a satisfactory manner and entail a very large amount of work on the Officers of this Authority. Tables are given showing the large quantities which have been seized and destroyed or otherwise dealt with as unfit for human food. Some condensed milk was imported which was found on examination not to be sterile, but contained a large number of micro-organisms. This is a cheap kind of condensed milk, which is in all probability used for consumption by children, and the attention of the exporting countries was called to the necessity for sterilising the milk before exportation. The two large launches continue to work satisfactorily, but the smaller ones are getting old and should be replaced by a new one at an early date. 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 December last is appended for the information of the Court. All which we submit to the judgment of this Honourable Court. Dated this sixth day of May, 1913. George Briggs. S. Beal. J. R. Pakeman. G. R. Blades. H. Percy Monckton. Thos. Goldney. T. Robinson. Stephen H. M. Killik. Edward Hughes. H. M. Gaydon. W. Fortescue. H. Roper Barrett. A. Jerrold-Nathan. C. C. Hodges. A. C. Stanley Stone. Lewis M. Myers. OFFICES of the Port of London Satinary Authority and Medical Officer- of Dealth at 51, KING WILLIAM STREET, GREENWICH S.E. Telegraphic Address - " MEDOFF, GREEN," LONDON. Telephone No. - - - NEW CROSS 36. BOARDING STATIONS. RIVER THAMES - - Hulk " Hygeia," Gravesend. RIVER MED WAY - - Garrison Point, Sheerness. HOSPITAL FOR INFECTIOUS DISEASES at DENTON, near GRAVESEND. Telephone No. (Hospital) GRAVESEND 957. Ditto (Medical Officer in Charge) „ 86. 1912. PORT OF LONDON SANITARY COMMITTEE. Mr. John Robert Pakeman (Chairman), Cheap. ALDERMEN. Sir Walter Wilkin, K.C.M.G. Sir John Pound, Bart. Sir John Charles Bell, Bart. Sir T. Vansittart Bowater, Knt. Sir Charles Cheers Wakefield, Knt. Sir William Henry Dunn, Knt. COMMONERS. Mr. David Hatdon Aldersgate. Mr. Frederick George Mellows Aldgate. Mr. Clarence Hayden Bassishaw. Mr. Edward Ansted Billingsgate. Mr. John Sawyer Robinson Bishopsgate. Mr. Arthur Carlyon Stanley Stone Major Charles Clement Hodges Bread Street. Mr. Samuel Beal Bridge. Mr. Stephen Henry Molyneux Killik Broad Street. Mr. George Everest Ellis Candlewick. Mr. Ernest Samuel Jacob Castle Baynard. Mr. Horace Spencer Dove Coleman Street. Mr. Edward Hughes Cordwainer. Mr. Thomas Goldney Cornhill. George Bbiggs, Esq. Cripplegate Within. James Lake, Esq., Deputy Cripplegate Without. Mr. Albion Thomas Snell Dowgate. Mr. John Brear Wild N.S. Farringdon Within. Walter Fortescue, Esq., J.P. S.S. Farringdon Within. Mr. George Lavington N.S. Farringdon Without, Mr. Alfred Jerrold-Nathan S.S. Farringdon Without. Mr. Henry Martin Gaydon Langbourn. Mr. Herbert Roper Barrett Lime Street. Lewis Michael Myers, Esq., Deputy Portsoken. Mr. Edgar Edwin Bond Queenhithe. William Walter Green Esq., J.P. Tower. Col. Vickers Dunfee Vintry. Mr. H. Percy Monckton Walbrook. Corporation Representatives on the Port of London Authority and Thames Conservancy Board (ex-officio Members of the Committee) :— Mr. James William Domoney, L.C.C. Sir James Thomson Ritchie, Bart., Alderman. Spencer William Morris, Esq. 4 INDEX. PAGE Aliens Act, 1905 - 45 Anthrax - - 40 Beef 54 Beri-Beri - - 41 Boneless Meat - - 54 Canal Boats Acts - 82 Chicken-pox - - 39 Cholera - - - 12,16 Committee—List of Names 3 Compulsory Notification - 11 Condensed Milk - 60 Condiments and Spices - 59 Continued Fever - - 40 Diphtheria- - 34 Disinfection - 44 Drugs - - - 59 Eggs - - 59 Enteric Fever - - 25 Erysipelas - - 33 Fish - - 57 Food Inspection - 53 Foreign Meat Regulations - 50 Fruit - - 57 German Measles - - 33 Grain - - 59 Hospital - - - 47 Infectious Disease - - 11 Introductory - 7 Meal and Flour - - 59 Measles - - - 32 Medical Inspection - - 8 Mumps - - 40 PAGE Mutton and Lamb - - 55 Nuisances - - 72 Nuts - - 59 Offal 56 Offensive Cargoes - - 79 Pigs from China - - 55 Plague - - - 12, 18 Ditto among Rats - 20 Pork (Chinese) - - 55 Port, Extent of, &c. - 82 Poultry and Game - - 57 Provisions - - 59 Rabbits - - 57 Rat Plague - 20 Sanitary Conveniences, &c.- 74, 77 Sanitary Inspection - 71 Scarlet Fever - - 33 Small-pox - - 29 Smoke Nuisances - - 73 Smoked and Salted Meats - 57 Staff - - - 6,81 Steam Launches, &c. - 80 Sundries - - 60 Tinned Meats - - 57 Typhus Fever - - 28 Tuberculosis (Pulmonary) - 41 Unsound Food - - 48 Vegetables - - 58 Ventilation of Crew's Spaces 75 Water Closets - - 77 Yellow Fever - - 13,18 INDEX TO TABLES. table. page I. Medical Inspection—Gravesend 8 II. Ditto —Sheerness 8 III. Infectious Disease—Summary - - - 10 IV. Compulsory Notification of Infectious Disease, with number of Deaths - - - - 11 V. Cholera 18 VI. Plague - - - - - 19 VII. Rats destroyed—Return of - - - - 24 VIII. Enteric Fever - - - - - - 26 IX. Typhus Fever - - - - - 28 X. Small-pox - - 29 XI. Measles - - - - - 32 XII. German Measles - - - - - 33 XIII. Scarlatina and Scarlet Fever - - - 33 XIV. Erysipelas - - - - - 33 XV. Diphtheria ...... 34 XVI. Chicken-pox - - - - - 39 XVII. Continued Fever - - - - 40 XVIII. Mumps - - - - - - 40 XIX. Beri-Beri - - - - - - 41 XX. Pulmonary Tuberculosis - - - 42 XXI. Effects disinfected - - - - 44 XXII. Vessels and premises disinfected - - - 45 XXIII. Aliens Act, 1905 - - - - - 46 XXIV. Ditto - - - - - 46 XXV. Hospital—Admissions, Discharges and Deaths - - 47 XXVI. Unsound Food destroyed - - - - 48 XXVII. Unsound Meat—Weights of - - - - 49 XXVIII. Tuberculous Pig Carcases - - - - 50 XXIX. Foreign Meat Regulations—Notices - - - 50 XXX. Ditto ditto Certificates - - 50 XXXI. Offal - - - - - - - 56 XXXII. Sanitary Inspection—Summary - - - 70 XXXIII. Nuisances - - - - - - 72 XXXIV. Ditto 73 XXXV. Sanitary Works - - - - - 74 XXXVI. Offensive Cargoes - - - - - 78 XXXVII. Police Court Proceedings - - - - 80 XXXVIII. Canal Boats - - - - - 91 Appendix. Statement of Receipts and Expenditure - - 92 6 STAFF. List of Officers forming the Staff of the Port of London Sanitary Authority, 31st December, 1912. Office. Name of Officer. Date of Appointment. MEDICAL OFFICER OF HEALTH Herbert Williams, M.D.Lond., M.R.C.S., L.R.C.P., D.P.H. Camb. June, 1901. ASSISTANT MEDICAL OFFICERS— Gravesend SHEEKNESS W. M. Willoughby, B.A., M.D., B.C., D.P.H.Camb. May, 1901. J. S. Warrack, M.A., M.D., C.M. Aberdeen, D.P.H.Camb. April, 1903. W.D.Betenson,M.R.C.S.,L. R.C.P., Lond., D.P.H. Lond. July, 1907. A. Kidd, M.R.C.S., L.R.C.P., Lond., D.P.H. 1909. E. V. Legge, M.A., M.D., B.C., B.A.O., L.M.Dublin. 1909. GREENWICH OFFICES— Clerk W. J. Albrow March, 1890. 1st Assistant E. A. Sorrell October, 1894. 2nd ditto W. C. Barham June, 1903. Junior ditto J. G. Godden July, 1910. Ditto T. J. S. Cotterell July, 1910. FOOD INSPECTORS *H. Spadaccini, Cert.R.San.Inst. July, 1898. *W. Anderson, Cert.R.San.Inst July, 1898. *T. W. Bailey, Cert.R.San.Inst. July, 1901. SANITARY INSPECTORS *W. G. Romeril, Cert.R.San.Inst. August, 1892. *A. Garland, Cert.R.San.Inst. May, 1894. *W. G. Wetjen, Cert.R.San.Inst. - August, 1898. *W. W. Burr, Cert.R.San.Inst. - August, 1898. *H. R. Hopkins, Cert.R.San.Inst.- February, 1899. *P. R. Lambe, Cert.R.San.Inst. - January, 1900. *J. H. Rolfe, Cert.R.San.Inst. September, 1901. *W. Elward, Cert.R.San.Inst. March, 1909. #F. J. Massie, Cert.R.San.Inst. March, 1909. C. A. Shepherd, Cert.R.San.Inst. January, 1909. DENTON HOSPITAL Medical Officer W. M. Willoughby, B.A., M.D., B.C., D.P.H. Camb. November, 1908. Nurse Matron J. Jackson February, 1910. Assistant Nurse F. Hoare April, 1912. Ditto L. Harding September, 1911. Ditto F. Cork December, 1911. Cook Emma Accleton December, 1912. Maidservant Ethel Harling December, 1912. Caretakers W. J. Wragg November, 1908. M. E. Wragg November, 1908. STEAM LAUNCHES— "Lady Truscott "— Master W. Jarvis April, 1911. Engineer J. A. Hardman December, 1911. Mate C. Boyd July, 1902. Stoker-- A. E. Howard - February, 1912. " David Burnett "— Master C. Strange May, 1912. Engineer G. H. Bagshaw July, 1893. Deckhand W. Shaw June, 1910. Stoker C. Wilcox December, 1911. "Clotho"— Master C. H. Price May, 1912. Engineer J. Steen February, 1912. Deckhand A. E. Topping July, 1909. "Denton"—Relief Launch. GREENWICH MOORINGS- FUMIGATING BARGE "THOMAS"— Stoker, &c.- W. H. Buzzel February, 1912. BARGE " COLLING WOOD "— W atcbmen W. H. Buzzel February, 1912. GRAVESEND— HULK " HYGEIA "— H. A. Clarkson May, 1912. Shipkeeper I. Rogers April, 1893. Ditto- A. Salter July, 1898. OFFICE CARETAKER F. Hudgell November, 1906. These Inspectors possess the Special Certificate of the Royal Sanitary Institute for Inspectors of Food. 7 PORT OF LONDON SANITARY OFFICES, 51, KING WILLIAM STREET, GREENWICH, S.E. TO THE WORSHIPFUL THE PORT OF LONDON SANITARY COMMITTEE. Gentlemen, I have the honour to present herewith my Annual Report for the year 1912, being the eleventh of the series. The work of your officers is classified in this Report in the order into which it naturally falls, namely (a) Medical Inspection and Infectious Disease, (b) Food Inspection, and (c) Sanitary Inspection of shipping and shore premises. The total number of vessels, 9,107, arriving in London from foreign ports during the year was some 400 less than during the preceding twelve months. This diminution is probably explained by the " strike," which existed in the Port of London for two months. The number of foreign arrivals during June alone was about 300 less than in the same month in 1911. Of the total arrivals, 2,366 were medically inspected. A comparison of the numbers of vessels arriving in each year for the previous ten years and a detailed monthly statement for the year will be found in Tables I. and II. Alien Immigration is dealt with in Tables XXIII. and XXIV. Infectious Disease during the year, is set out in Tables III. to XXI., followed by details of such cases as are of general interest. The work of Food Inspection continues to increase under the Unsound Food and Foreign Meat Regulations, and a general survey of this work will be found in the Report. The work of sanitary inspection is summarised in Tables XXXII. to XXXV. This service continues to be maintained at a satisfactory standard of efficiency. The inspection of Canal Boats is dealt with in the special Annual Report on this subject, which is appended. Out of a total of 841 boats visited, 197 were found with 409 children living on board, a proportion of 2.07 children per boat, which is fairly constant. There has been no important change in the personnel of the Staff. A few general remarks will be found on page 81. 8 TABLE I. MEDICAL INSPECTION—GRAVESEND. From 1st January to 31st December, 1912. Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total. Number of foreign arrivals 781 696 779 745 738 530 655 802 826 900 823 832 9,107 Number medically inspected 232 192 211 220 195 169 143 266 189 178 185 186 2,366 Number of passengers 878 964 1,295 1,168 970 621 840 2,295 1,504 1,172 1,229 988 13,924 Number of crew 4,815 3,841 5,089 5,510 3,727 2,906 3,830 5,248 4,527 4,641 4,288 5,318 53,740 COMPARATIVE TABLE. GRAVESEND. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Mean annual number for the 10 years ending 31st December 1912. 1912. Number of foreign arrivals. 10,711 10,030 9,962 9,955 9,639 9,559 9,571 9,699 9,543 9,777.6 9,107 Number of vessels medically inspected 2,522 2,559 2,813 2,853 2,700 2,840 2,248 2,756 2,744 2,640.1 2,366 Total number medically inspected at Gravesend— From August, 1892, to December, 1911 43,046 „ 1st January to 31st December, 1912 2,366 Total 45,412 TABLE II. MEDICAL INSPECTION—SHEERNESS. From 1st January to 31st December, 1912. Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total. Number of foreign arrivals... 29 9 12 14 27 21 24 32 24 23 27 24 266 Number medically inspected 25 8 10 14 23 19 22 29 20 22 23 22 237 Number of passengers 2 3 3 11 8 2 8 13 4 — 1 — 55 Number of crew 356 104 132 177 337 248 289 450 308 299 298 334 3,332 COMPARATIVE TABLE. SHEERNESS. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Mean annual number for the 10 years ending 31st December, 1911. 1912. Number of arrivals ... 402 344 349 375 376 319 337 337 292 339.7 266 Number of vessels medically inspected ... 342 308 292 320 325 279 285 284 259 293.1 237 Total number medically inspected at Sheerness— From 1st September, 1894, to 31st December, 1911 5,067 „ 1st January to 31st December, 1912 237 Total 5,304 9 MEDICAL INSPECTION. The total number of vessels medically inspected during the year was 2,366—the average number for the preceding two years was 2,640.1. It will thus be seen that the number inspected is somewhat below the average, but it will be seen on reference to the table that the number of vessels arriving from foreign ports, namely 9,107, was lower than for many years past. Though the actual number of vessels is less, the average tonnage per vessel increases. The vessels from foreign ports which were medically inspected carried a total of 67,664 persons, of whom 13,924 were passengers. The total number of vessels entering the River Medway was 266 ; of these 237 were medically inspected by your Medical Officer stationed at Sheerness. These vessels carried 3,387 persons, of whom 55 were passengers. A case of some interest was that of the s.s. "Clan Stuart," of Glasgow, 113,911, which arrived in the port from the East Indies on the 19th June, and anchored off Southend on account of the strike. It would appear that H.M. Customs expected the arrival of the vessel off Southend, and were informed that no one would land from the vessel before the visit of a Customs Officer. On the evening of the vessel's arrival, however, a Customs Officer met two persons on the pier at Southend and ascertained that they had landed from the vessel, which had not then been admitted to " pratique." This was not done until the following morning—the 20th. It is of importance in the interests of the Public Health that persons should not land from vessels arriving, especially from "infected " or "suspected" ports, before such vessels have received a visit from the Customs Officer or Medical Officer of the Port, except, naturally, in a case of grave emergency. The Regulations of the Local Government Board, however, do not make this an offence, except, in a case where the ship has actually had a case of plague, cholera or yellow fever on board during the voyage, and I am of opinion that the Regulations might with advantage be so amended as to render it an offence for persons to leave any vessel arriving from foreign ports before the visit of an Officer of the Customs or the Medical Officer of the Port, except in the case of some grave emergency involving the safety of life or property and the like. The facts were placed before Mr. Solicitor for such faction as he might deem desirable, but in his opinion no legal action could be taken. From the total number of vessels medically inspected, 80 cases were removed to Denton Hospital for treatment. Details of these are given under the headings relating to Infectious Disease and in the sections referring to the Hospital. It is satisfactory to record that there was not during the year any epidemic within the Port of any dangerous infectious disorder. 10 TABLE III.—INFECTIOUS DISEASE. Disease. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 191 . Mean annual number for 10 years ending 31st December. 1912. 1912. (a) Cases reported: Cholera (including suspected cases) 9 4 6 3 9 5 3 5 9 5.5 2 Yellow Fever (ditto) ... ... 1 2 ... 2 ... ... ... 0.5 ... Plague (ditto) 6 6 9 9 4 1 4 6 ... 5.4 9 Small-pox 13 11 24 31 27 16 27 8 13 20.4 34 Scarlet Fever 11 11 26 82 44 23 16 21 11 25.5 10 Diphtheria 7 3 8 7 7 18 11 11 18 12.7 37 Enteric Fever 88 50 65 81 55 90 36 39 70 63.5 61 Measles 14 38 36 68 51 86 19 23 175 57.1 61 German Measles ... ... ... ... ... ... ... ... ... 0.3 3 Erysipelas ... 4 1 9 7 2 7 5 5 11 5.4 3 Typhus Fever 1 ... ... ... ... ... ... ... ... 0.2 1 Continued Fever 13 12 11 11 11 19 10 1 5 10.2 9 Relapsing Fever ... ... ... ... ... ... 1 ... 01 ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... 7.1 71 Other diseases (including Chicken- 9 17 16 35 42 41 57 25 38 32.2 42 pox). Tota 175 153 211 336 252 308 189 144 350 246.1 343 (6) Treated in Port Sanitary Hospital : Cholera (including suspected cases) ... ... ... ... I ... 1 2 ... 0.4 ... Yellow Fever (ditto) ... ... ... ... ... ... ... ... ... ... Plague (ditto) 3 4 3 1 3 1 2 ... 1.8 1 Small-pox 11 5 4 ... 8 ... 4 2 6 4.2 2 Scarlet Fever 5 7 3 28 4 6 14 ... 6 7.3 ... Diphtheria 4 ... 2 1 3 5 1 4 3 2.3 ... Enteric Fever 55 33 23 26 27 42 11 17 22 29.1 35 Measles 7 8 13 3 14 13 5 2 7 9.9 27 Erysipelas 1 ... 2 1 ... 1 1 ... ... 0.7 1 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... 13 12 9 7 10 6 10 1 4 79 7 Other diseases (includi.ng Chickenpox). Total 4 4 1 24 5 15 10 7 8 8.5 7 103 73 60 91 75 88 58 37 56 72.1 80 11 TABLE IV. Return of the Number of Cases of Infectious Disease Notified to the Local Government Board during the Year 1912, and of Deaths from the Diseases Notified : — Notified. Deaths. Small-pox 3 ... Scarlatina or Scarlet Fever 1 ... Diphtheria (including Membranous Croup) 30 ... Typhus Fever ... ... Enteric or Typhoid Fever 32 1 Continued Fever 6 ... Relapsing Fever ... ... Puerperal Fever ... ... Cholera ... ... Erysipelas 2 ... Plague (suspected) 1 ... Measles 46 1 Chicken-pox 9 ... Pulmonary Tuberculosis 16 ... Remittent Fever 1 ... 147 2 NOTIFICATIONS OF NAMES AND ADDRESSES DURING THE YEAR. Passengers 162 Crews 401 Total 563 Not traced 3 passengers. INFECTIOUS DISEASE. The total number of cases of Infectious Disease reported during the year was 343, of which 80 were treated in the Port Sanitary Hospital, the remainder going to other Institutions. The table includes for the first time Pulmonary Tuberculosis, which is now notifiable (see pp. 42-43). Of this disease, 71 cases were notified during the year. There were 61 cases of Enteric Fever, the same number of cases of Measles reported, and 34 cases of Small-pox, principally occurring on vessels during the homeward voyage from the East. There were 37 cases of Diphtheria ; 10 cases of Scarlet Fever ; while one case of that now uncommon disease—Typhus Fever— was reported. The cases of Diphtheria were principally reported from the Training Ships in the River. With regard to Small-pox, only two cases were removed on arrival ; in the other cases the patients had already been removed at some station on the homeward voyage. Table IV. shows that of the total number of cases of Infectious Disease reported, 147 were notified to the Local Government Board, and the number represents those cases which arrived or occurred in the Port, as distinct from those on vessels during the voyage. 12 During the year the names and addresses of 563 persons—passengers and crews of vessels—were notified to the various districts in which they reside. So far as I have been able to learn, only three of these addresses were not subsequently traced. This is less than one per cent., which, taken as a whole, may be considered satisfactory, but in my opinion additional powers are required similar to those conferred by the Local Government Board order relating to Plague, Yellow Fever and Cholera, which would enable Port Medical Officers to obtain the names and addresses of persons landing from vessels on which a case of Small-pox had occurred, or which had sailed, within 16 days of the arrival of the vessel, from a port where Small-pox is known to exist. An International Sanitary Conference was held at Paris and concluded its proceedings in the early part of the year. It was attended by delegates from 42 countries. The previous Conference was held in 1903, and the proceedings of that Conference were carefully examined and revised. The general provisions of the Conference are as follows:—The first recognised case of Plague, Cholera or Yellow Fever which occurs outside the limits of local areas already affected must be immediately notified, as the new local area might be hundreds of miles distant from that which was first infected. A proposal was made that all ports in direct relation with an infected area should be mentioned in the notification. The British delegates were successful in securing the rejection of this proposal, which would only tempt certain countries to treat such ports as infected and to put restrictions on shipping arriving from these ports. The local area is to be considered as no longer infected with Yellow Fever when there have been no fresh cases for 18 days after the isolation, death or recovery of the last patient. The measures taken for the prevention of the introduction of disease from infected ports on the departure of vessels are now applicable generally. Formerly they only applied to ports outside Europe, but now Yellow Fever is included as well as Plague and Cholera. The destruction of mosquitos in the case of Yellow Fever is also required as well as the destruction of rats in the case of Plague, and in relation with the latter disease the destruction of rat fleas is recognised. PLAGUE. The preponderating part played by rats and their parasites in Bubonic Plague was more fully recognised than at the previous Conference. Proposals were made to enforce a compulsory system of periodical rat destruction on all vessels and even to extend the same system to ports. It was, however, decided to recommend that ships should be subjected to periodical rat destruction, and that preferential treatment should be accorded in ports of arrival to ships that had undergone the process. Destruction of rats on suspected ships is also made compulsory. In the former Convention it was optional only. The provisions as to the prevention of destruction to merchandise and to ship's plating and engines are qualified by the words "as far as possible." CHOLERA. An important question was discussed, namely the procedure in the case of Cholera germ carriers. It is a fact that persons whilst showing no signs of this disease, nevertheless, may contain within their bodies the bacilli of Cholera which may infect other persons. Several delegates pressed for the bacteriological examination of passengers and crews from Cholera infected ports, and after much discussion, it was decided that bacteriological examination may be applied in the case of infected and suspected ships as is necessary, that is, amongst contacts or suspected persons. 13 It is provided that in "suspected" or "infected" ships, drinking water taken in at an infected port shall be thrown away after disinfection and replaced if necessary by good water, and the discharge of water ballast taken in at an infected port into a harbour may be prohibited unless previously disinfected. YELLOW FEVER. A period of six days observation or surveillance is obligatory in the case of "infected," but it is optional in the case of "suspected" ships. Mosquitos in each case are to be exterminated as far as possible on arrival of the vessel and before unloading the cargo. Infected and suspected ships are to moor when possible at least 200 metres from the shore. The expression "Observation" means isolation of travellers either on board ship or in a sanitary station. "Surveillance" means that the passengers are allowed to land, but the Authorities of the places to which they are proceeding are to be informed of their arrival. It is made clear also that the ship which has been subjected to efficient sanitary measures in one port is to be exempt from such measures in another port if in another country. A ship is not to be regarded as "suspected" if calling at a port where she has taken on board mails or passengers who have had no connection with the port or local infected area. The following measures are to be adopted at Ports and marine frontiers:— Section III.—A.—Classification of Ships. Article 21.—Ships are classified as "Infected," "Suspected" or "Healthy." (a) An infected vessel is where there has been a case of Plague, Cholera or Yellow Fever on board within seven days. (b) A suspected vessel, if there has been a case of Plague, Cholera or Yellow Fever on board at the time of departure or during the voyage, but no fresh case within seven days. (c) Healthy, if it has come from an infected port, but there has been no case on board either before departure or during the voyage. B.—Measures in Case of Plague. Article 22.—Infected ships. 1. Medical inspection. 2. The sick shall be immediately landed and isolated. 3. Contents and suspects shall be disembarked, if possible, and may be kept under observation or surveillance for a period not exceeding five days. 4. Such soiled linen, &c., belonging to passengers or crew as the Sanitary Authority may consider infected, are to be efficiently disinfected. 5. Rats on board must be destroyed. 14 Article 23.—Suspected ships shall undergo the measures specified in Sections 1, 4, 5 and 6 of Article 22. The crew and passengers may, however, be subjected to surveillance only for five days, and the crew may be prevented from leaving the ship except on duty. Article 24.—Healthy ships from infected ports shall undergo the measures specified in Section 1 and 4. Rats on board may be destroyed at the option of the Sanitary Authority. Article 25.—Healthy ships with rats on board affected with Plague, or where there has been unusual mortality amongst the rats. 1. Ships with rats on board affected with Plague. (а) Medical inspection. (b) Rats must be destroyed. (c) Infected parts of ships and articles shall be disinfected. (d) Passengers and crew kept under surveillance for a period of five days. 2. Ships with unusual mortality amongst rats. (a) Medical inspection. (b) Rats shall be examined. (c) Rats to be destroyed if considered necessary. (a) Passengers to be kept under surveillance until all suspicion shall have been removed. Article 26.—It is recommended that ships should have rats destroyed periodically at least once every six months. C.—Measures in Case of Cholera. Practically the same procedure as in the case of Plague, but no fumigation to destroy rats is required. The drinking water on board, if suspected, shall be emptied out after disinfection, and replaced if necessary by a supply of wholesome drinking water. The emptying of ballast tank in port without previous disinfection may be prohibited. D.—Measures in Case of Yellow Fever. Same as in Plague and Cholera, but vessels must be moored at least 200 metres from the shore and the mosquitoes destroyed, if possible, before unloading the cargo. The British Delegates declared that the stipulations should not be applicable to the Possessions or Protectorates of His Majesty, including the Indian Empire. The Representatives of all the Powers having taken part in the Conference signed the Convention. Article 43 recommends that there be provided in large seaports— (a) A properly organised Port Medical Service, and permanent medical vision of the health conditions of crews and of the population of the port; (b) An equipment for the transport of the sick, and suitable accommodation for their isolation and for keeping suspected persons under observation; 15 (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. It may here be desirable to give a description of the organisation provided by the Port of London Sanitary Authority for complying with the recommendations of Article 43. A.—The Staff consists of :— 1. Medical Officer of Health. 2. Five Assistant Medical Officers. 3. Thirteen Sanitary Inspectors. B.—Transport, Isolation, &c. 1. Four Steam Launches, and one ambulance boat for removing patients. 2. Isolation Hospital and Nursing Staff, Steam Disinfector, and Sulphur Di-oxide Fumigating Plant. A.—Medical and Sanitary Organisation. All vessels from foreign ports, on arrival at Gravesend or Sheerness, are visited by a 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. The Sanitary Inspectors are stationed in the various docks and are responsible for the general sanitary condition of the vessels and shore premises within their appointed districts. These will be found in detail on page 70 of this Report. B.—Transport and Isolation. 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 Medical Officer, Matron, three Nurses, and Servants. There are also a caretaker and his wife, the former removes patients from vessels to Hospital, disinfects clothing, bedding, &c., whilst his wife, with assistance, does the laundry work of the Hospital. 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 20 minutes to a temperature of 2550 Fahrenheit. The effects, after disinfection are either returned to the ship at once or stored in a waterproof shed until they can be returned. 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. 16 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 Regulations relating to those diseases. The Medical Officer at Sheerness adopts the same routine in respect to vessels entering the River Medway, which is within the jurisdiction of this Authority, and 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 patients and infected effects are brought to Denton. Disinfection of the vessel in the latter case is done at Sheerness. Cases of Infectious Disease occurring 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 Port of London Sanitary Authority is equipped with an apparatus for the generation of Sulphur Di-oxide, which can be propelled into the holds of vessels for the destruction of rats and vermin. This apparatus is carried on a specially equipped barge, towed by one of the steam launches to any part of the Port, where it may be required. C.—Bacteriology. Examinations for the final diagnosis of Plague and Cholera are carried out by Professor F. W. Andrewes, M.D., of St. Bartholomew's Hospital, on behalf of, and at the expense of the Port Sanitary Authority, whilst the initial bacteriological examination of rats is done by Dr. Newham, the Director of the London School of Tropical Medicine, in the laboratory of the School situated in the Royal Albert Dock, to whom the rats are conveyed in closed tins containing an efficient disinfecting solution. D.—Water Supply. An ample supply of drinking water of good quality is available for supply to vessels at Grave send and at all the docks in the Port. It will therefore be seen that the Port of London Sanitary Authority is well equipped and in a position to deal with any possible epidemic with absolute confidence. CHOLERA. Cholera has been prevalent in India during the past year, especially in the Bombay Presidency, where 100,000 cases have been reported, with a mortality of 50 per cent. In the Madras Presidency also about 100,000 cases occurred, with a similar mortality rate. In Bengal, and also in the French Settlements in India, Cholera was also present. This disease also broke out in the Straits Settlements, Siam, French India and China, Dutch East Indies, Japan, and China. A few cases also occurred at Tunisia and in Turkey in Asia, where the disease was probably introduced by the pilgrims returning from Mecca. The disease was also carried to Constantinople, and a severe epidemic broke out amongst the troops in Turkey in Europe. 17 There was not much Cholera in Europe during the past year. There was no recrudescence of the epidemic in Italy, but some cases occurred in the island of Sardinia, and cases were reported to have occurred in Spain at Barcelona. Subsequent to the date of closing this Report, the following Circular was issued by the Local Government Board to Port Sanitary Authorities. The precautions therein indicated are, as a matter of routine, adopted in the Port of London. CHOLERA. Circular. Port Sanitary Authorities and certain Riparian Sanitary Authorities. Local Government Board, Whitehall, S.W. 9th January, 1913. Sir, I am directed by the Local Government Board to direct your attention to the fact that Cholera is now prevalent in and around Constantinople. It is also prevalent in a number of districts and ports in Asia Minor and Syria, and is severely epidemic in Mecca and the Hedjaz, from which pilgrims are now returning to Turkey, Egypt, and Southern Europe. The Sanitary Authorities of British ports, trading with Mediterranean and Black Sea ports, should be on their guard against the importation of Cholera into their districts by vessels coming from places where the disease has appeared or is likely to appear. In this connection it is essential that the Medical Officers of' Health of such British Ports should endeavour to keep themselves informed as to the spread of the present outbreak of Cholera, and especially as to the continuance of the disease in ports and other districts where it now exists, and its appearance in other ports not yet known to be affected by it. The Statement which the Board issue weekly to the Medical Officers, of Health of Ports and Riparian Sanitary Authorities, and which contains information as to such Cholera occurrences as have come under the Board's notice, will be of assistance in this direction. I am to remind you that on September 9th, 1907, the Board issued a revised General Order relating to Cholera, Yellow Fever and Plague on ships arriving from foreign ports. The Board rely on the Port and Riparian Sanitary Authorities taking all necessary steps under that order to prevent the introduction of Cholera into this country. The Board will be glad if you will supply the Medical Officer of Health with a copy of this Circular. I am, Sir, Your obedient Servant, Secretary. To the Clerk to the Port Sanitary Authority, or The Clerk to the Riparian Sanitary Authority. 18 TABLE V. (Cholera.) Date. Name of Vessel, Port of Registry, and Official Number. Where from. No of Cases. How dealt with. 1912. Jan. 19 s.s. "Washington," of West Hartlepool, 124,342. Busreh 1 Died and body buried at Busreh. Nov. 17 s.s. " Umona," of London, 129,142 Bombay Total 1 Removed to Hospital at Middlesbrough. 2 One case of this disease was reported. It occurred on a vessel during the homeward voyage, the body being removed and buried at Busreh. A suspicious case occurred on a vessel at Middlesbrough, but this subsequently proved not to be Cholera. The following are notes of these cases:— The s.s. "Washington," of West Hartlepool, 124,342, arrived at Gravesend on the 19th January, 1912, from Busreh, when it was ascertained that a case of Cholera had occurred on board. The patient (a fireman) became ill with diarrhoea and vomiting on the 27th January. He died the same day, and was buried ashore at Busreh. The vessel and effects were fumigated at Busreh, and again on arrival at Suez. On arrival at Gravesend all were found to be well on board. The s.s. "Umona," of London, 129,142, left Bombay on the 8th October, and calling at Suez, Port Said, Malta and Portland, arrived at Middlesbrough on the 5th November. On the 14th November, a native fireman was taken ill with diarrhoea and sickness, and was removed by the Port Sanitary Authority there. The vessel left Middlesbrough on the 16th November, and arrived at Gravesend on the 17th. On medical inspection all were found well on board. The vessel was kept under daily observation while in the Port. On the 20th November, I received information from the Local Government Board that the result of the bacteriological examination in this case was " negative " as regards Cholera. YELLOW FEVER, This disease has been prevalent in South America, especially Mexico, Brazil, Chile, Columbia and Ecuador, and a few cases also occurred in the West Indies and on the West Coast of Africa. No case of Yellow Fever was reported on any vessel arriving in the Port during the year. PLAGUE. Plague has been prevalent in India but not to the same extent as in former years. Several cases occurred in the Straits Settlements and in the Federal Malay States. The disease was prevalent in China, many cases occurring at Hong Kong and Shanghai. 19 Plague has also recurred in Brazil, and in the Argentine Republic. Two cases occurred on a vessel from Rosario whilst on a voyage to Hamburg, and one case occurred after the vessel had left Hamburg for an English port. Plague also occurred in some of the West Indian Islands, e.g., Trinidad, Porto Rico, Cuba and Grenada. This disease also prevailed in Asia Minor, Egypt, British East Africa, and also in Natal and in the Island of Mauritius. TABLE VI. (Plague.) Date. Name of Vessel, Port of Registry and Official No. Where from. No. of Cases. How dealt with 1912. Feb. 7 s.s. "Den of Kelly," of Dundee, 118,750. Calcutta 1 Removed to hospital at Suez. Mar. 23 s.s. "Macedonia," of Belfast, 116,012. Sydney 1 Died and body buried at sea. June 23 s.s. " Patrician," of Liverpool, 113,459. Calcutta 6 Three removed to hospital at Point de Galle. Three died, and bodies buried at sea. Aug. 1 s.s. "Nyanza," of Greenock, 123,529. Do. 1 (suspected) Removed to Port Sanitary Hospital. . 9 Nine cases of Plague and 3uspected Plague were reported. Short notes of these cases are given below. PLAGUE (SUSPECTED). The s.s. "Den of Kelly," of Dundee, 118,750, arrived at Gravesend on the 7th February from Calcutta. On medical inspection of the persons on Board at Suez, one man was found to have enlarged glands in the groin. He had been at work all the voyage, and apparently was in good health and made no complaint. He was landed at Suez for further examination. The ship was disinfected at Suez, and again at Marseilles. All were well on arrival of the vessel at Gravesend. The s.s. "Macedonia," of Belfast, 116,012, arrived at Gravesend on the 23rd March, 1912, from Sydney and Bombay, having had a case of Plague on board during the voyage. The patient, a coal trimmer, age 22, was attacked on the 5th March, and died at 2.30 a.m. on the 6th. The quarters were disinfected at the time, and the ship was fumigated at Marseilles. No rats, dead or alive, were seen on board during the voyage. No further cases have occurred, and all on board appeared to be well. The vessel was kept under daily observation during her stay in this Port. The s.s. "Patrician," of Liverpool, 113,459, which arrived at Gravesend on the 23rd June, 1912, from Calcutta, had six cases of Plague on board during the voyage, three of which proved fatal. The persons attacked were members of the native crew, 20 three firemen and three Lascars. The cases appear to have been partly of the bubonic and partly of the pneumonic type, and were probably infected at the port of departure. No rats were reported to have been seen on board since leaving Colombo, where the vessel was fumigated, and all necessary disinfection carried out. No fresh cases occurred. On arrival at Gravesend all on board were medically inspected, and no suspicious symptoms found. The s.s. "Nyanza," of Greenock, 123,529, arrived in this Port on the 25th July, 1912, from Calcutta, all well on board. On the 27th July I received information that a lascar was suffering with a high fever and inflamed inguinal buboes. The case was considered very suspicious, and was immediately removed to Denton Hospital for observation, and all necessary disinfection of the vessel carried out. No dead rats were found, and all precautions in this relation were taken. Material from the bubo was sent to the Local Government Board for examination, and a report was received from them that the specimen was "negative" as regards Plague. RAT PLAGUE. During the past year, I regret to have to report that Plague has again occurred amongst the rats—this time on the South side of the Victoria Dock. The measures which were found successful on former occasions, have again been taken with similar results. The outbreaks of Rat Plague in the Port of London have been as follows: — 1908 1. North Quay, West India Dock. Lasting from August to September 26th. This was a serious outbreak, many rats being affected. 1909 2. No. 19 Warehouse, South West India Dock. A small localised outbreak. Seven rats only were found dead on November 11th. 1910 3. North side, Royal Albert Dock. Three rats only found affected, October 31st. 1911 4. North side, Victoria Dock. One rat only in February. Several rats were affected with Plague in a warehouse at Wapping bordering the river, but not within the district of the Port of London Sanitary Authority. 1912 5. The present outbreak has lasted from 9th February to 30th December, During the year, 1310 rats were bacteriologically examined, but only 13 were found affected with Plague. It will be seen, therefore, that Plague has occurred amongst rats in the Port of London during five years in succession. In all epidemics of Plague, the history is usually the same—outbreaks of Plague occur amongst rodent for several years, and then suddenly there may be an extension of the disease to human beings. Plague is now epidemic in so many parts of the world, with which the Port of London is in constant communication, that vessels arriving thence . . must be considered as potential means of conveying infection to this country. The following measures, in my opinion, are necessary for minimising the. risk of introduction of Plague into this country:— 1. Measures for preventing rats going on shore from vessels should be stringently carried out. 21 2. Vessels from infected ports should be subjected to periodical efficient fumigation for the destruction of rats not less than once every six months. This need not necessarily be done in this country. Wherever this is done, a certificate should be obtained describing the process adopted, and this should be taken into consideration in deciding the necessity for further fumigation. 3. Warehouses, especially those in which grain and other foodstuffs are stored, should be made absolutely rat proof. It would not be possible, of course, to prevent an occasional rat entering by a door or other temporary opening, but the warehouse doors should be closed when not in use, and especially at night. 4. The Dock Authorities should organise an efficient band of rat catchers, and should provide every means possible for destroying rats or preventing them having access to foodstuffs. All ships' refuse and garbage should be burned in a destructor. 5. A regular and routine bacteriological examination should be made of rats so that the earliest possible knowledge might be obtained of any case of Plague amongst rats in any particular district, and measures taken for dealing with the outbreak could be taken in that locality at once. Apart from the danger to the Public Health, arising from the possible introduction of Plague from rats to human beings with the attendant loss of life and health and dislocation of trade, there is to be considered the serious results that may arise, were the Port of London declared to be infected with Plague. Vessels arriving in foreign ports from London would be liable to be detained—to be fumigated before discharging the cargo—to be made to discharge the cargo away from the quayside—whilst passengers may be detained for a period of at least five days, and have all their effects disinfected before being allowed to land. The loss to the owners of ships sailing from the Port of London alone would amount to many thousands of pounds apart from the inconvenience and the interference with the regular running of their vessels. The following letter has been sent to the Port of London Authority:— 12th November, 1912. The Chief Superintendent of the Docks and Warehouses, Port of London Authority. Dear Sir, RATS. With reference to our conversation yesterday and in confirmation thereof, the following are the points to which I direct special attention:— 1. Continued efforts should be made to destroy rats in the docks, and specimens should be sent to the London School of Tropical Medicine, for bacteriological examination—this Authority bearing the cost of the examination, whilst the Port of London Authority will collect and deliver rats at the School. Difficulty has been experienced in obtaining rats from the Surrey Commercial Docks, for examination. 2. Daily search should be made for dead rats—not omitting Sunday mornings. 3. The removal of heaps of wood and other rubbish, which form an excellent place for harbouring rats. 4. A better method should be adopted for destroying refuse than that of burying it in the banks. Such refuse contains food which is acceptable to rats, and tends to attract them to the places where refuse is buried. 22 I suggest the burning of all refuse in a suitable destructor which may be in connection with boilers for the raising of steam. 5. Foodstuffs, especially grain, should be stored in buildings which are rat-proof. The present wooden sheds, viz., No. 141 South side, Victoria Dock —and also Nos. 4 and 5 Warehouses, Norway Yard, Surrey Commercial Docks—are examples of unsuitable structures. 6. The Sanitary Conveniences in the Royal Albert and Victoria Docks, especially on the North side of the Royal Albert Dock, are most unsuitable, and should be replaced with modern sanitary conveniences. Evidence of rats burrowing under these structures can be seen at most of them. This question has been brought to the notice of the Port of London Authority on several occasions. In 1910 the Port of London Authority were asked to carry out the following precautions:— 1. Destroy as many as possible of the rats in the docks ; the same to be disposed of by burning. 2. Daily search for dead rats ; utilising, if possible, the same men whose names and addresses were furnished to me, paying special attention to the warehouses, spaces between, and also the banks. 3. All accumulation of dunnage, rubbish, &c., to be collected and burnt. 4. The disposal of refuse on the banks to be discontinued and a "destructor" provided. 5. Ingress of rats to buildings should be dealt with by having the floors laid on concrete, and if the buildings are not constructed of iron, a piece of iron sheeting should be fitted round the lower part of the building quite close to the concrete and extending into the ground for at least two feet. 6. The primitive nature of the Sanitary Conveniences was again alluded to, these being undermined with rat runs. The following circular has been sent to all shipowners:— I have again to draw your attention to the possibility of the introduction of Plague into this country by means of rats suffering from that disease, which land from vessels coming from or touching at Ports where Plague exists. Should this disease be introduced into this country, it will mean not only a serious danger to the Public Health, but will almost certainly cause a serious loss to shipowners, should foreign countries deem it necessary to impose serious restrictions on vessels arriving from this country. I enclose copy of a circular which will continue to be served on the master of each vessel on arrival at Gravesend from Ports where Plague is believed to exist either amongst human beings or animals. These precautions must be adopted directly the vessel is moored, and should be continued during the whole of the time that the vessel remains in the Port of London. In addition, measures should be taken to destroy all rats on board vessels by pumping into the vessels lethal gas at intervals not exceeding six months. I shall be pleased to furnish further particulars as to this if desired. 23 Port of London Sanitary Authority. The Local Government Board have issued Regulations for the prevention of the introduction of Plague, Yellow Fever and Cholera into this country, and whereas by such Regulations it is provided, inter alia, as follows:— REGULATION 24 (2). "The master of a ship which by reason of plague is an infected ship, or a suspected ship, "or which has ceme from, or has, during a voyage, called at a port infected with plague, or in "which there are rats infected with plague, or in which there is or has been during the voyage "an unusual mortality among rats, shall, under the direction and to the satisfaction of the "Medical Officer of Health, take all such precautions or employ all such means for effectually "stopping the access of rats from the ship to the shore as in the opinion of the Medical Officer "of Health are measures reasonably necessary for the prevention of danger arising to public "health from the ship;" This is to give Notice that, in my opinion, given under the Regulation aforesaid, the following precautions are reasonably necessary for stopping the access of rats from the ship to the shore:— 1. All ropes and mooring tackle for securing the vessel either to the shore or mooring buoys, shall be fitted with metal brushes, funnels, or other effective guards, the portions of such ropes and mooring tackle leading from the vessel to a distance from the vessel's side of at least four feet shall be coated each night with fresh tar. Ropes may, if desired, be protected by a covering of canvas or yarns before tarring. 2. When not engaged in discharging cargo, one gangway only shall be permitted to afford means of communication between the ship and the shore. 3. The end of the gangway near the ship shall be whitened for a length of 10 feet, and the watchman shall keep the gangway pulled in board after sunset, or it shall be guarded in some approved manner. 4. When alongside the quay, the ports on the side of the vessel nearest the quay shall be kept closed after sunset. 5. All empty cases and barrels, especially those from the store rooms, shall be examined before being landed, to ensure that no rats are contained therein. 6. It is recommended that all possible means be adopted for catching and destroying rats, both on the voyage and during the stay of the vessel in port. Any rats so caught shall be killed, then placed in a bucket of strong disinfecting solution, and afterwards burnt in the ship's furnace. 7. No rats, alive or dead, are to be removed from the ship without my permission in writing. "If any person wilfully neglects or refuses to obey or carry out, or obstructs the "execution of this Regulation, he shall be liable to a penalty not exceeding One "Hundred Pounds, and in the case of a continuing offence, to a further penalty not "exceeding Fifty Pounds for every day during which the offence continues." HERBERT WILLIAMS, M.D., London, December 31.st, 1907. Medical Officer of Health for the Port of London. Office—51, King William Street, Greenwich, London, S.E. 24 TABLE VII. Return of Rats caught and destroyed during 1912. The entire cost of destroying these rats has been borne by the Shipowners and Dock Companies. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals. Millwall Dock— Warehouses 153 116 119 108 167 93 115 241 181 140 186 151 1,770 Vessels during voyage 102 74 — 18 42 32 — 81 32 74 117 20 592 „ while in dock 453 347 355 298 184 385 300 321 154 205 273 160 3,435 Surrey Commercial Dk.— Warehouses - - - - 20 19 1 15 12 28 12 21 128 Vessels during voyage - - - - - - - - - - 63 - 63 „ while in dock 151 54 316 69 291 218 330 103 39 107 104 41 1,823 Regent's Canal Dock— Warehouses - - - - - - - - - - - - - Vessels during voyage - - - - - - - - - - - - - „ while in dock - - - - - - - - - - - - - St. Katharine's Dock— Warehouses 46 59 79 52 56 66 64 81 57 56 82 52 750 Vessels during voyage — — — — — — — — — — — — - „ while in dock - - - - - - - - - - - - - London Dock— Warehouses 32 53 71 70 55 40 30 62 71 36 66 40 626 Vessels during voyage — — — — — — — — — — — — - „ while in dock - - - - - - - - - - - - - Albert and Victoria Dks.— - - - - - - - - - - - - - Warehouses 338 399 536 520 551 348 180 505 695 717 893 632 6,314 Vessels during voyage 15 636 493 928 85 28 928 842 62 350 474 428 5,269 „ while in dock 457 636 1,026 475 621 1,011 1,032 938 588 595 679 848 8,906 West India Dock— Warehouses 24 15 42 103 85 71 70 22 229 93 128 47 929 Vessels during voyage 20 22 186 82 82 54 20 236 58 35 110 94 999 „ while in dock 421 381 353 240 153 355 784 612 209 195 292 168 4,163 East India Dock— Warehouses 46 47 57 33 46 46 42 46 79 71 73 41 627 Vessels during voyage — - — — - - — 24 — — — — 24 „ while in dock 164 255 282 85 139 85 61 153 108 28 20 178 1,558 Tilbury Dock— W arehouses 215 202 144 181 149 298 183 276 343 294 182 66 2,533 Vessels during voyage 256 810 605 678 307 1,039 20 782 568 473 889 522 6,949 „ while in dock 287 144 224 167 134 242 244 195 206 296 253 196 2,588 River— During voyage 7 — 50 177 20 50 — — 2 — — — 306 While in river - - - - - - - - - - - - - Totals 3,187 4,250 4,938 4,284 3,187 4,480 4,404 5,535 3,743 3,792 4,896 3,705 50,352 Total from February, 1901, to 31st December, 1911 695,282 Total from 1st January to 31st December, 1912:— In Dock Warehouses - 13,677 50,352 On Vessels during voyage 14,202 On Vessels while in Dock and River - 22,473 Total 745,634 25 ENTERIC FEVER. Sixty-one cases of Enteric Fever were reported, and the list of these is given in Table VIII. 35 cases were treated in Denton Hospital, and of these, one was a member of the Nursing Staff who contracted the disease whilst attending a patient suffering from the disease. The following cases are of some general interest:— On arrival of the s.s. "Highland Pride," of London, 132,559, from Buenos Ayres, the master reported that there had been no sickness on board during the voyage. When the Medical Officer made his examination at Gravesend, he found that two cases of illness had occurred, one of which it was considered advisable to remove to Denton Hospital, as suspicious of Enteric Fever. This diagnosis was confirmed. On arrival of the s.s. "Suffolk," of London, 115,859, from Brisbane, on the 2nd April, 1912, the master reported "all well" on board. It was subsequently ascertained that the 4th Engineer was unwell with feverish symptoms, and had been ill for some days previously. He was allowed to proceed to his home in West Ham, and the Medical Officer of Health for that district was notified accordingly. On the 11th April I received information from West Ham that the man was suffering from Typhoid Fever. The s.s. "Tasmanic," of Goteborg, arrived on the 22nd April from Adelaide, and in reply to questions put to him, the master reported "all well on board," and no sickness during the voyage. It was suosequently ascertained that the steward was landed at Port Said suffering with Typhoid. An offence in each of the above cases was committed in not giving a truthful answer to the questions put on the arrival of the vessel, and the facts were placed before Mr. Solicitor, but in his opinion there was no evidence of wilful concealment of the facts, and he advised that no further action should be taken. During the five years ended 31st December last, of 100 cases of Enteric Fever admitted to Denton Hospital, all except eight were discharged cured. The total number of days treatment in hospital for the 100 cases, was 3,860, giving an average duration of 38.6 days for all cases. The cases occurred on vessels arriving from foreign ports, in the following proportion:— European Ports 28 Russia 42.8 per cent. Asiatic „ 12 India 91.6 „ African „ 12 British South Africa- 83.3 „ North American Ports 26 Canada 53.8 South American „ 21 Argentina - 100.0 „ Australian „ 1 New South Wales - 100.0 „ 100 It will be seen that the largest proportion of cases, 28, was derived from Europe, Russian ports contributing nearly half, South America next with 21, all from Argentina. From North America, Canada sent 14, and the United States 12, while 10 came from British South Africa. 26 The nationalities of the patients were as follows:— British 71 Norwegian 5 German 5 Finnish 5 Russian 4 Swedish 3 Danish 2 Belgian 2 French 1 Greek 1 Indian 1 100 TABLE VIII. Enteric F ever. Date. Name of Vessel, Port of Registry, and Official Number. Where from. No. of Cases. How dealt with. 1912. Jan. 1 s.s. "Highland Warrior," of London, 132,595. Buenos Ayres 2 Removed to Port Sanitary Hospital. 9 s.s. "Orvieto," of Belfast, 129,628 Brisbane 1 Removed to Hospital at Plymouth. Feb. 8 s.s. "Ayrshire, of Glasgow, 119,066 - Auckland 1 Removed to Port Sanitary Hospital. 17 s.s. " Oceana," of Belfast, 93,170 Bombay 2 Removed to Hospital at Port Said. 18 s.s. "Highland Loch," of London, 129,182. La Plata 1 Removed to Port Sanitary Hospital. 21 s.s. "Pollux," of Helsingfors Algiers - 4 Ditto. 27 s.s. "Buccaneer" 1 Ditto. 28 s.s. "Highland Pride, of London, 129,026. La Plata 1 Patient recovered. March 7 s.s. "Argentina," of West Hartlepool, 127,465. Bahia Blanca - 1 Removed to Hospital at Bahia Blanca. „ 15 s.s. "Highland Brae," of London, 129,153. Buenos Ayres 1 Removed to Hospital at Woolwich. 16 s.s. "Minnehaha," of Belfast, 110,520 New York 1 Removed to Hospital at Tilbury. 26 s.s. "Highland Brae," of London, 129,153. River Plate - 1 Removed to Hospital at Woolwich. 31 Port Sanitary Hospital, Denton Near Gravesend 1 Treated in Port Sanitary Hospital. April 12 s.s. "Suffolk," of London, 115,859 Brisbane 1 Removed to Hospital at West Ham. 13 s.s. "Persia," of Greenock, 109,258 Bombay 1 Removed to Hospital at Port Said. 27 Date. Name of Vessel, Port of Registry, and Official Number. Where from. No. of Cases. How dealt with. 1912. April 12 s.s. "Anchoria," of Glasgow, 129,598- Calcutta 1 Removed to Port Sanitary Hospital. „ 17 s.s." Carmarthenshire,"of Southampton, 98,863. Yokohama 1 Removed to Hospital at Colombo. „ 17 s.s. "Highland Piper," of London, 132,559. Buenos Ayres 1 Removed to Port Sanitary Hospital. „ 19 s.s. "Aldersgate," of London, 123,695 Bahia Blanca - 3 One removed to hospital at Bahia Blanca. Two died and bodies buried at sea. 23 s.s. "Tasmanic," of Gothenburg Adelaide 1 Removed to Hospital at Port Said. May 3 s.s. "Georgic," of Liverpool, 105,326 - Sydney 2 Removed to Hospital at Durban. „ 10 s.s. '' Mantua," of Greenock, 127,544 - Bombay 1 Removed to Port Sanitary Hospital. June 2 s.s. " Montreal," of Liverpool, 113,373 Montreal 1 Ditto. 2 s.s. " Athenic," of Liverpool, 115,239 - Wellington 1 Ditto. 7 s.s. "Eastry," of West Hartlepool, 98,526. Alexandria 1 Removed to Hospital at Alexandria. 16 s.s. "Malwa," of Glasgow," 127,543 Sydney - 1 Removed to Port Sanitary Hospital. „ 25 s.s. "Slawentzitz," of Hamburg " Buenos Ayres 1 Ditto. 26 s.s. "Vectis," of Greenock, 81,820 Norway - 1 Ditto. 28 s.s. " Mount Temple," of Liverpool, 113,496. Montreal 1 Ditto. July 4 s.s. "Orama," of Glasgow, 132,989 Brisbane 1 Developed the disease after leaving vessel. 9 s.s. "Rimutaka," of Plymouth, 111,355 Auckland 1 Died, and body buried at sea. 15 s.s. "Katherine Park," of Glasgow, 115,780. Bahia Blanca - 2 Removed to Hospital at Bahia Blanca. 23 s.s." Wiltshire," of Brisbane, 132,675 Brisbane 1 Removed to Port Sanitary Hospital. Aug. 8 s.s. " Corinthian," of Glasgow, 111,257 Montreal 1 Ditto. 14 s.s. "Ascania," of Liverpool, 131,342 Ditto 1 Ditto, 26 s.s. " Mantua," of Greenock, 127,544 - St. Petersburg 1 Ditto. Sept. 1 s.s. ''Umvolosi," of London, 115,857 - Bombay 1 /Ditto. 13 s.s. " Vesuvio," of London, 79,155 Naples - 1 Ditto. 25 s.s. " King John," of Stockton, 124,272 Karachi 1 Removed to Hospital at Malta. 26 s.s. ''Bagdale," of Whitby, 118,853 - Cyprus - 1 Removed to Port Sanitary Hospital. Oct. 16 s.s. " Minnewaska," of Belfast, 124,674 New York 1 Removed to Hospital at New York. 26 s.s. "Egypt," of Greenock, 105,581 - Bombay 1 Removed to Hospital at Marseilles. 28 Date. Name of Vessel, Port of Registry, and Official Number. Where from. No. of Cases. How dealt with. 1912. Nov. 8 s.s. "Atsuta Maru " (Japanese) - Yokohama 1 Removed to Port Sanitary Hospital. Dec. 4 "Erne," of Plymouth Davis Straits 1 Removed to Hospital at Peterhead. 6 Port Sanitary Hospital, Denton - 1 Removed to Port Sanitary Hospital. 16 s.s. "Minnewaska," of Belfast, 124,674 New York 1 Ditto. 18 s.s. "Aeneas," of Liverpool, 131,305 Brisbane 1 Ditto. 23 s.s. " Moravian," of Aberdeen, 108,662 Ditto 1 Ditto. 24 s.s. "Galeka," of London, 110,265 East London 4 Ditto. 61 TYPHUS FEVER. On the 10th April, 1912, I received information that one of the passengers per the s.s. "Perm," from Libau, which arrived in London on the 2nd April, had been admitted to the City Hospital, Liverpool, on the 4th April ailing with an illness which was subsequently diagnosed as Typhus Fever. I made enquiries and ascertained that, with the exception of a family of nine persons, all the other passengers (transmigrants) had left the country. The Medical Officer of Health of the districts to which the passengers proceeded were informed of the facts, and the owners of the ships conveying the transmigrants were also communicated with. The patient was incubating the disease on arrival of the vessel, but it had not developed, and so could not be recognised. This was the first case of Typhus Fever reported in the Port since the year 1903. TABLE IX. (Typhus Fever.) Date. Name of Vessel, Port of Registry and Official Number. Where from. No. of Cases. How dealt with. 1912. April 10 s.s. "Perm," of Copenhagen Libau 1 Removed to Hospital at Liverpool. 29 TABLE X. (Small-pox.) Date. Name of Vessel, Port of Registry and Official Number. Where from. No. of Cases. How dealt with. 1912. Jan. 13 s.s. "Delhi," of Greenock, 117,398. Wrecked off Morocco 1 Removed to Hospital at Woolwich. 20 s.s. "Maloja," of Belfast, 132,012. Bombay 1 Removed to Hospital at Marseilles. Feb. 10 s.s. " Mooltan," of Greenock, 117,397. Auckland 3 Two removed to Hospital at Suez, and one to Port Sanitary Hospital. March 21 s.s. "Ajax," of Liverpool, 113,395. Yokohama 11 Removed to Hospital at Penang. „ 27 s.s. "Colaba," of Glasgow, 121,287. Calcutta 1 Removed to Metropolitan Asylums Board's, South Wharf Shelter. April 1 s.s. "Fiona," of Leith, 118,709 Leith 1 Ditto. 2 s.s. "Thecius," of Liverpool, 127,933. Yokohama - 7 Removed to Hospital at Penang and Singapore. 9 s.s. " Princess Clementine" (Belgian). Naples 1 Removed to Hospital at Palermo. May 3 s.s. "Clan Sutherland," of Glasgow, 106,037. Marmagoa - 1 Isolated on board. June 25 s.s. "Culna," of Glasgow, 124,164. Bombay 4 One removed to Hospital at Suez, one at Antwerp, and two at Middlesbrough. Oct. 28 s.s. "Lesseps " (Norwegian) - Almeria 1 Removed to Port Sanitary Hospital. Nov. 8 s.s. " Kirkcaldy,"of Kirkcaldy, 117,571. Kirkcaldy - 1 Removed to Hospital at Kirkcaldy. Dec. 23 s.s. "Medina," of Greenock, 131,849. Bombay 1 Removed to Hospital at Port Said. Total 34 • SMALL-POX. Thirty four-cases of Small-pox were reported, and I give below notes o£ each case. The s.s. " Delhi," of Greenock, 117,398 (belonging to the Peninsular and Oriental Steam Navigation Company), was wrecked on the Northern coast of Morocco on the 13th December, 1911. The Lascar crew were landed and taken to Gibraltar, and there put on board the s.s. "Egypt," on which they were brought to London, and remained on board during the whole of their stay, and finally went back in that vessel to India. During the whole of the time they were kept under the observation of one of the company's medical officers. The European crew remained salving portions of the cargo, and one member, a winchman, who, it is stated, stayed a night or so in Tangiers, sailed for London with the European members of the crew on the s.s. "Arabia" on the 1st January, 1912. The winchman proceeded to his home in Woolwich, where he was subsequently found to be ill, and later he was diagnosed as suffering with confluent Small-pox, from which he subsequently died in hospital. The Medical Officer of Health for Woolwich telephoned the facts to me, and as it was possible that the other members of the crew may have been exposed to the risk of infection, the names and addresses of all the members of the "Delhi" crew coming to 30 London were notified to the Medical Officers of Health of the respective districts in which they were to reside, so that they could be visited if deemed desirable and the fact ascertained that they were in good health. So far as I know, no other cases occurred. The s.s. "Maloja," of Belfast, 132,012, arrived at Gravesend on the 28th January, 1912, from Bombay, having landed a case suspicious of Small-pox at Marseilles on the 13th January. On arrival of the vessel at Gravesend all names and addresses of passengers and crew were taken and notified to the respective Medical Officers of Health. The vessel and effects were thoroughly disinfected by this Authority. No further cases occurred. The s.s. "Mooltan," of Greenock, 117,397, arrived at Gravesend on the 10th February from Auckland, having landed two cases of Small-pox at Suez. The vessel and effects were disinfected at Suez. On the 12th February one of the crew (a fireman) was taken ill and found to be suffering with Small-pox. He was admitted to the Port Sanitary Hospital at Denton. All necessary disinfection was carried out by this Authority, and all persons on board kept under daily observation during the vessel's stay in the Port. The names and addresses of the passengers and crew leaving the vessel were notified to the respective Medical Officers of Health. The s.s. "Ajax," of Liverpool, 113,395, arrived on the 21st March from Yokohama, having had 11 cases of Small-pox (one death) on board. These were landed at Penang. All necessary disinfection was carried out at Singapore and Penang. Among the cargo were the effects of a person who had died from Small-pox in Bangkok. There was no evidence that they had been disinfected, so they were removed to Denton Hospital for disinfection as a precautionary measure before handing them over to the friends of the deceased. With reference to the s.s. "Mooltan," of Greenock, 117,397, which arrived on the 10th February, having landed two cases of Small-pox at Suez (see above), I received information on the 27th February that a native on this vessel, lying in Tilbury Dock, was ill. On an examination, the disease was found to be very suspicious, and the patient was removed to Denton Hospital, where he was subsequently found to be suffering from Small-pox. The crew's quarters on this vessel were thoroughly fumigated, and afterwards painted. No further cases occurred. The vessel sailed for Bombay on March 1st. The s.s. "Colaba," of Glasgow, 121,287, arrived at Gravesend on the 23rd March, 1912, from Calcutta. One of the crew (a Native servant) was admitted to the Seamen's Hocpital, Greenwich, on the 25th March suffering with "Syphilis," and subsequently removed thence to the Metropolitan Asylums Board's hospital, where the disease was diagnosed as Small-pox. All necessary disinfection was carried out by this Authority, and the addresses of the persons leaving the ship were notified to the respective Medical Officers of Health. On the 1st April, however, I received information that the case ultimately turned out to be not Small-pox. On the 29th March, 1912, I received information that a man returned from Santander to Glasgow in the s.s. "Saxone," travelled to Leith by train, and then proceeded in the s.s. "Fiona" to London. On arrival in London he proceeded to a 31 lodging-house in Poplar, and not feeling well, went to a dispensary there. The doctor who saw him decided that the case was Small-pox. The man was removed to the South Wharf Shelter of the Metropolitan Asylums Board. Meanwhile the vessel had sailed for Leith to undergo general overhaul. The owners of the vessel, and Medical Officer of Health for Leith, were communicated with as to precautionary measures of disinfection. The s.s. "Princess Clementine"(Belgian) arrived on the 7th April, 1912, from Naples, having landed a case of Small-pox at Palermo. All necessary disinfection was carried out. Every person on board was well on arrival, and no further cases have occurred. The s.s. "Theseus,"of Liverpool, 127,933, arrived at Gravesend on the 1st April, 1912, from Yokohama. On the 27th February, a distressed British seaman from Hong Kong, consulted the surgeon, complaining of "prickly heat."A diagnosis of probable Small-pox was made, which was confirmed by the Port Medical Officer at Singapore. The patient was removed there. The quarters were disinfected at Singapore, and all the Chinese crew and steerage passengers were re-vaccinated. Six other cases occurred. On arrival at Gravesend all on board appeared to be in good health. The s.s. "Clan Sutherland,"of Glasgow, 106,037, arrived on the 30th April, 1912, from Marmagoa. On the 3rd April a Native quartermaster was taken ill with pains in the head, and a rash, accompanied with fever. On the 10th April he Avas seen by the Port Medical Officer at Aden, who thought the case was suspicious of Small-pox. The patient was isolated on board, and on the 13th April was able to resume duty. The bunk and effects were thoroughly disinfected, and all persons were found well on arrival. The s.s. "Culna,"of Glasgow, 124,164, arrived at Gravesend on the 23rd June, 1912, from Bombay, having had four cases of Small-pox on board during the voyage. All necessary disinfection was carried out, and no fresh cases have occurred. The names and addresses of all persons leaving the vessel in London were taken and notified. On arrival at Gravesend all were medically inspected, and no suspicious symptoms found. On the 31st October, 1912, I received information that a child named Peter Philp, whose father is employed on the s.s. "Kirkcaldy,"had died at Kirkcaldy, and that the disease was reported to be Small-pox. The vessel was kept under strict observation while in this Port, and unsuccessful efforts were made to vaccinate the father before the vessel returned to Kirkcaldy. The Norwegian s.s. "Lesseps"arrived at Gravesend on the 28th October, 1912, when a case of Small-pox was removed therefrom to Denton Hospital. The contacts, together with all effects, were removed to Denton Hospital for disinfection. All the crew were vaccinated, and the ship was thoroughly disinfected. The vessel was kept under daily observation during its stay in the Port, and no further cases had occurred when the vessel sailed for Hamburg on the 29th October. The names and addresses of all those leaving the vessel, including the Pilot, were notified. The s.s. "Medina,"of Greenock, 131,849 arrived on the 21st December from Bombay, having landed a case of Small-pox at Port Said on the 9th. The cabin was thoroughly disinfected, and all infected bedding, &c., destroyed. Immediate contacts were vaccinated. No further cases occurred and all were found well on arrival in London. The names and addresses of all the passengers and crew were nbtified. 32 MEASLES. Sixty-one cases of Measles were reported, of which 27 were admitted to Denton Hospital. This disease is fairly common on homeward bound passenger ships. Small-pox in an early stage may be mistaken for Measles, so it is important that every case of Measles should be reported and seen by the Boarding Medical Officer so that the diagnosis may be confirmed. Where the patients on landing have either nowhere to go, except an hotel, or might go to a house where children lived, and so would be a public danger, they are landed at Denton Hospital and kept until free from infection. TABLE XI. (Measles.) Date. Name of Vessel, Port of Registry and Official Number. Where from. No. of Cases. How dealt with. 1912 January 3 s.s. "Sheerness,"of Glasgow, 115,776 Glasgow 1 Removed to Port Sanitary Hospital. February 3 s.s. "Osterley,"of Glasgow, 128,287 Brisbane 1 Died and body buried at sea. „ 15 s.s. "Kitano Maru,"of Tokio Yokohama - Removed to Hospital at Marseilles. March 22 s.s. "City of Karachi,"of Liverpool, 120,846. Calcutta 1 Removed to Port Sanitary Hospital. April 20 s.s. "India,"of Greenock, 105,572 - Shanghai - 1 Removed to Military Hospital in London. May 16 s.s. "German,"of Southampton, 109,290. East London Removed to Hospital at Southampton. „ 28 s.s. "Minnewaska,"of Belfast, 124,674. New York - 1 Allowed to proceed to home. June 4 s.s. "Mongolia,"of Greenock, 117,385. Auckland - 1 Removed to Hospital at Sydney. „ 13 s.s. "Galway Castle,"of London, 132,616. Capetown - 1 Removed to Hospital at Southampton. July 9 s.s. "Dimboola,"of Melbourne, 133,505. Newcastle - 1 Removed to Port Sanitary Hospital. „ 21 s.s. "Ausonia,"of Liverpool, 129,735 Montreal 1 Ditto. „ 24 s.s. "Lake Michigan,"of Liverpool, 115,252. Ditto 1 Ditto. „ 28 s.s. "Highland Warrior,"of London, 132,595. Buenos Ayres 1 Patient recovered. August 19 s.s. Dunluce Castle,"of London, 118,490. Delagoa Bay 15 14 removed to Port Sanitary Hospital, and one at Southampton. „ 29 s.s. "City of Vienna,"of Glasgow, 97,652. Bergen 1 Treated on board. „ 29 s.s. "Intaba,"of Aberdeen, 129,345 Port Natal - 1 Patient recovered. „ 31 s.s. "Otway,"of Glasgow, 128,282 Brisbane Ditto. September 8 s.s. "Maloja,"of Belfast, 132,012 - Sydney 1 Removed to Hospital at Colombo. „ 16 s.s. "Kasan,"of Copenhagen - Libau 7. Removed to Port Sanitary Hospital. „ 26 s.s. "Runic,"of Liverpool, 113,441 Sydney 1 Removed to Hospital at Durban. October 14 s.s. "Orama,"of Glasgow, 132,989 Brisbane 1 Patient isolated on board the vessel. „ 31 s.s. "Sardinia,"of Glasgow, 115,696 Yokohama - One removed to Port Sanitary Hospital, one at Marseilles, and one recovered. November 11 s.s. "Atanta Maru " - 1 Removed to Port Sanitary Hospital. „ 26 s.s. "Medic,"of Liverpool, 110,573 Sydney 14 Convalescent on arrival of vessel in London. „ 30 s.s. "Morea,"of Glasgow, 128,235 Ditto 1 Removed to Hospital at Colombo. December 4 Training Ship "Arethusa" Lying off Greenliithe 1 Removed to Ship's Hospital on shore. „ 12 s.s. "Orvieto,"of Belfast, 129,628 Brisbane 3 Removed to Hospital at Plymouth. „ 24 s.s. "Galeka,"of London, 110,265 - East London 5 Convalescent on arrival in London. 76 33 TABLE XII. (German Measles.) Date. Name of Vessel, Port of Registry, and Official Number. Where from. Number of cases. How dealth with. 1912. March 13 s.s. "Mantua,"of Greenock, 127,544 - Auckland - 1 Removal to Hospital at Plymouth. April 13 s.s. "Persia,"of Greenock, 109,258. Bombay - 1 Ditto. „ 17 s.s. "Minnehaha,"of Belfast, 110,520 New York 1 Removal to Hospital at Tilbury. Total 3 SCARLET FEVER. Ten cases were reported, and of these six were removed before the arrival of the vessel at Gravesend. TABLE XIII. (Scarlet Fever.) Date. Name of Vessel, Port of Registry, and Official Number. Where from. Number of Cases. How dealt with. 1912. January 13 s.s. "Moldavia,"of Greenock, 117,382 Auckland - 1 Removed to Hospital at Adelaide. April 20 s.s. "Galway Castle,"of London, 132,616. Cape Town 1 Removed to Seamen's Hospital Greenwich. August 21 s.s. "Johannesburg,"of North Shields, 104,829. Do. 2 Removed to Hospital at Plymouth. „ 31 s.s. "Otway,"of Glasgow, 128,282 - Brisbane - 2 Removed to Hospital at Melbourne. Sept. 14 s.s. "Otranto,"of Belfast, 124,675 Sydney 1 Ditto. „ 23 s.s. "Otway,"of Glasgow, 128,282 Brisbane - 2 Removed to Hospital at Tilbury Brook. Nov. 7 s.s. "Fernandina,"of West Hartlepool, 127,430. Savannah - 1 Removed to Hospital of Metropolitan Asylum Board. Total 10 ERYSIPELAS. This disease is not often met with nowadays on board vessels arriving. Three cases only were reported, and one of these was treated in the Port Sanitary Hospital. After a few days the patient developed delirium tremens, and became so violent that it was necessary to remove him to Strood. Workhouse. TABLE XIV. (Erysipelas.) Date. Name of Vessel, Port of Registry, and Official Number. Where from. No. of Cases. How dealt with. 1912. April 26 Barge "Brian Boru,"of London, Deptford - 1 Removed to Seamen's Hospital, 123,705. Greenwich. Sept 11 s.s. "Themistocles,"of Aberdeen, London - 1 Removed to Port Sanitary 129,349. Hospital. Dec. 23 s.s. "Medina,"of Greenock, 131,849 - Bombay - 1 3 Patient isolated on board. 34 DIPHTHERIA. Of this disease 37 cases were reported, principally from the Training Ship "Warspite,"lying off Greenhithe. TABLE XV. (Diphtheria.) Date. Name ofVessel, Port of Registry, and Official Number. Where from. No. of Cases. How dealt with. 1912. Jan. 6 Pier Head Cottages, Millwall Dock 2 Removed to Brook Hospital. „ Feb. 1 Training Ship, "Warspite,"lying off Greenhithe 1 Removed to Ship's Hospital on shore. „ 26 s.s. "Malwa,"of Greenock, 127,543 - Sydney - 2 Removed to Hospital at Fremantle. March 1 Training Ship "Warspite,"lying off Greenhithe 1 Removed to Ship's Hospital on shore. „ 4 Ditto "Arethusa,"Ditto Ditto 1 Ditto. „ 6 Ditto "Warspite,'' Ditto Ditto 1 Ditto. „ 20 Ditto Ditto 1 Ditto. „ 20 s.s. "Nyanza,"of Greenock, 123,529 - Yokohama 1 Removed to Hospital at Singapore. „ 29 Training Ship "Warspite,"lying off Greenhithe 1 Removed to Ship's Hospital on shore. April 18 Ditto Ditto 1 Ditto. t „ 25 Ditto Ditto 1 Ditto. May 18 Ditto Ditto 1 Ditto. „ 19 s.s. "Rangatira,"of Southampton, 124,523. Port Chalmers 1 Isolated on board the vessel. „ 29 Training Ship "Warspite,"lying off Greenhithe 1 Removed to Ship's Hospital on shore. June 7 Ditto Ditto 1 Ditto. „ 18 Ditto Ditto 1 Ditto. „ 20 Ditto Ditto 1 Ditto. „ 28 Ditto Ditto 7 Ditto. to Sept. 9 Sept. 23 to Oct. 25 Ditto Ditto Ditto. Oct. 26 Training Ship "Arethusa,"lying, off Ditto 1 Ditto. „ 30 Ditto Ditto 1 Ditto. „ 28 Training Ship "Warspite, lying off Ditto 1 Ditto. Nov. 8 Ditto Ditto 1 Ditto. Dec. 6 Ditto Ditto 1 Ditto. 37 DIPHTHERIA on Training Ship "WARSPITE." During the year, several cases of Diphtheria occurred on the Training Ship "Warspite"at irregular intervals, twenty-seven cases having been notified between 28th January and 1st December. This vessel was moored at Charlton until 1901, when on account of repeated outbreaks of Diphtheria on board, it was considered desirable to remove her to Greenhithe. 35 The vessel has been inspected regularly, is well found and managed; when full, 230 boys can be accommodated and six of resident staff. There are three training ships moored at Greenhithe near the right bank of the river, and at no great distance from each other, in the following order proceeding down the river:— "Warspite,""Arethusa"and "Worcester." Boys join every fortnight and new boys are kept in a Mess by themselves for 14 days. The number of boys on the ship on the last day of each month was as follows :— January 201 July 213 February 223 August 211 March 223 September 207 April 228 October 215 May 230 November 224 June 222 December 228 This shows an average of 218 boys on board, and only in the month of May was the full accommodation of 230 occupied. The following table indicates the number of cases notified in each year since 1900. It will be seen that sporadic cases occurred after the removal to Greenhithe, but that with the exception of the year 1908, when 10 cases were notified, there was no outbreak until 1912. Year. Number of cases. Year. Number of cases ''Warspite.' "Arethusa." "Worcester." "Warspite." "Arethusa." "Worcester." 1900 13 2 Nil 1907 Nil Nil Nil 1901 26 Nil 1 1908 10 1 „ 1902 17 3 Nil 1909 3 2 „ 1903 1 Nil „ 1910 Nil 4 „ 1904 Nil „ „ 1911 2 2 „ 1905 „ 2 „ 1912 27 2 „ 1906 1 2 „ The decks on the training ship "Warspite"are four in number, as follows:— 1. Upper deck. This deck is used for drill and recreation. Right forward are situated the boys' water closets. 2. Main deck. Used for messing. The Officers' water closets are situated on this deck. 3. Lower deck. Used for instructional purposes by day, and at night for sleeping quarters. 4. Orlop deck and hold. Lavatory, Schoolroom and Gymnasium. The bovs on the "Warspite"are grouped in "messes,"with an average of about 14 boys in each "mess." They sleep in hammocks, which are numbered from the fore part of the ship, the even numbers being on the port side, and the odd numbers on the starboard side. 36 The drinking water is brought to the vessel in a barge, and is syphoned thence into tanks stowed in the lower part of the vessel. These tanks are cleaned out and lime washed annually in the month of July. The supply of water for daily use is pumped from these tanks by means of a large pump, which can be used at will either for pumping river water for fire purposes, or fire drill, or for drinking water. The practice of using this pump for river water has been discontinued since July in this year, and the pipes communicating from the pump to the drinking water supply are furnished with taps, which are closed and locked. Only condensed milk is used by the boys, no fresh milk being bought. There has been no epidemic of Diphtheria on shore, and the boys only go on shore to the playing fields. There is, however a "tuck "shop in the village, which the boys frequent, and where ice cream may be purchased, but no connection has been found between the boys affected and those eating ice cream from this shop. The following table shows the dates of notification, the number of hammock slinging, and the number of mess:— TRAINING SHIP "WARSPITE."Diphtheria. Date of Notification. Onset of Disease. Mess. Initials of Patient. Hammock Slinging. 1912. 1912. 28th J anuary 26th January 1 A. R. F. 19 29th February 27th February 7 W. S. H. 121 4th March 1st March 9 L. S. T. 151 20th March 10th March 1 J. V. F. 3 27th March 25th March 11 C. A. W. 183 15th April 12th April 8 C. F. 124 25th April 22nd April 3 H. B. 47 10th May 8th May 7 P. W. 129 29th May 26th May 4 J. S. L. 58 5th June 3rd June 3 E. G. C. 39 11th June 8th June 14 L. H. 204 19th June 18th June 1 F. B. 15 27th June 23rd June 15 A. W. 235 22nd July 18th July 2 E. A. 6 16th August 14th August 14 J. W. 224 16th August 25th August 14 R. W. 198 28th August 28th August 3 T. G. L. 57 2nd September 1st September 10 W. P. 148 6th September 4th September 14 S. N. 212 22nd September 19 th September 1 A. C. 13 24th September 22nd September 13 A. Y. 205 14th October 12th October New boys W. R. H. 115 19th October 17th October 7 T. R. 99 22nd October 20th October New boys H. J. E. 79 26th October 25th October 6 W. F. G. 90 5th November 3rd November 16 L. J. T. 226 1st December 29th November New boys F. W. L. 106 37 I visited the ship in company with Dr. Sells, the Medical Officer of the ship, on 26th September, and made a thorough inspection of the ship, and enquired carefully into all matters likely to throw any light on the source of infection. On examination of the Table on page 36, it will be seen that the cases occur irrespective of the number of the mess or contiguity of the hammock slinging. The mess traps, knives and forks, &c., are carefully washed in hot water every day, and when a case of Diphtheria has occurred in any member of the mess, all traps belonging to that mess are boiled. Each deck is sprayed with Izal once a week, and during the vacation, from 26th June to 10th July, the whole ship was fumigated with Formalin. There was a serious leak in the side of the vessel during the present year, and this allowed water to enter the bilges, which were consequently always wet. This leak was stopped in July, and at the time of my inspection the bilges were found practically dry. The boys sleep on the lower deck, slung in hammocks. There is a urinal on each side, which is kept closed during the day and used only at night in cases of emergency. One urinal is situated opposite sling 109 on starboard side, and 110 on port side, and it will be noted that no case has occurred in the occupants of the hammocks slung in the vicinity of the urinal. Dr. Sells, Medical Officer of the ship, has no doubt that the cases were Diphtheria from the clinical symptoms, &c., and from bacteriological examination. Every boy who complained was at once sent ashore, and isolated, and kept under observation. A swab from the throat was sent to the Clinical Research Institute, and only those cases were notified as Diphtheria, which were reported as "positive"after bacteriological examination, and, in addition, presented the usual clinical signs of Diphtheria. Several cases of Tonsillitis also occurred which were isolated and dealt with in the same manner. Swabs from these throats were sent for examination and were reported as "negative." The nature of the disease was mild, and each boy was kept four weeks in hospital, and given two weeks' leave—returning to the vessel at the expiration of six weeks from the onset of the disease. No paralysis was observed in either of the cases, as a complication following the disease, and no death occurred. The vessel is situated as the upper one of the three and receives the first force of the ebb tide, containing the effluent from Barking and Crossness, several miles away, but no smells or any offensive condition of the water have been observed. River water was formerly used for washing down the lower decks, but this practice has been discontinued and only fresh water pumped from the tanks is now used for that purpose. Enquiry was made as to the use of slates on board, as these might have been a source of infection from the practice of some boys cleaning their slates after spitting on them; but none are used. Penholders are used in common. These might become infected by a boy, when in an early stage of the disease, putting them into his mouth. 38 Each boy has his own towel, which is marked with his number, also his own tooth brush, and has to clean his teeth each day under the supervision of an instructor. Sanitary conveniences are situated in the fore part of the ship and are kept always in a clean condition ; the excreta pass direct into the river. Ventilation is sufficient; the ports are kept open and there is through ventilation in all quarters. The boys' friends visit the ship once a week and may possibly introduce infection. Boys who had been ill with Diphtheria returned to the ship after an absence of only six weeks; convalescents have been known to be infectious for some considerable time after apparent recovery. The outbreak was not a severe one, and consisted of 27 cases spread over a period of 10 months, affecting one out of three ships moored in the same locality, and which are occupied by boys of similar age, and two of them by boys drawn from the same station in life, and who go on shore in the same village. If there had been any general cause, it would be natural to suppose that each ship would have been affected, and therefore, whatever the source of infection might have been, it had solely to do with the "Warspite." The drinking water, milk and sanitary conveniences were considered, but if the disease was communicated by either of these means, a number of boys would have been taken ill in the first instance at about the same time. Case 22 occurred in a boy who had only been on board five days, and he might possibly have been infected before joining the ship. I made the following recommendations:— (a) No boy should be allowed to return to the ship after suffering with Diphtheria, until three swabs had been taken from the nose and throat on three successive days, and had been found free from the organism of Diphtheria. (b) Slate pencils and pens were to be cleansed daily with boiling water. (c) Tooth brushes should be sterilized. (d) Should cases continue to occur, swabs should be taken from each boy on board as well as the instructors and attendants to ascertain if there was a "carrier"on board—that is, a person harbouring the bacilli of Diphtheria in their persons although well and showing no signs of the disease. (e) To consider the administration of anti-diphtheritic serum to each person on board as a prophylactic. (†) That the pump in connection with the drinking water tank should never be used for pumping water from the river. 39 It is not possible to say with any degree of certainty what was the cause of the continuance of this disease on board this vessel, but it is evident that it Avas due to some small local cause, and my impression is that it was not unconnected with the penholders and possibly with a boy returning after being ill and still harbouring in his mouth the organisms of the disease. It is also possible that, in spite of the early isolation of each boy as he ailed, that he might have been in an infectious condition for a few hours previous to complaining, and so might have communicated the disease during that period. The boys went on a month's leave on December 17th. Three cases of Diphtheria are reported to have occurred in the homes of boys on leave, but one of the cases occurred 14 days and, in two instances, three weeks after the boys had gone home, so that the probability is that the infection in these cases was not connected with the "Warspite." My suggestions were readily adopted, and I much appreciate the help and cordial co-operation which I received from Dr. Sells, the Medical Officer of the ship. TABLE XVI. (Chicken-Pox.) Date. Name of Vessel, Port of Registry, and Official Number. Where from. Number of Cases. How dealt with. 1912. Jan. 20 s.s. "Otranto,"of Belfast, 124,675 Brisbane 2 Removed to Hospital at To Ion 21 s.s. "Jelunga,"of Glasgow, 98,596 Middlesbrough. 1 Isolated on board. Feb. 3 s.s. "Osterley,"of Glasgow, 128,287 Brisbane 2 Removed to Hospital at Plymouth. 7 s.s. "Galeka,"of Southampton, 110,265 Cape Town 1 Removed to Hospital at Southampton. — 27 s.s. "Mooltan "- 1 Removed to Port Sanitary Hospital. April 13 s.s. "Persia,"of Greenock, 109,258 - Bombay 1 Removed to Hospital at Marseilles. „ 27 s.s. "Otway,"of Glasgow, 128,282 Brisbane 1 Removed to Hospital at Plymouth. May 5 s.s. "Galeka,"of Southampton, 110,265 East London. 1 Allowed to proceed to home. 18 s.s. "City of Vienna,"of Glasgow, 97,652. Calcutta Remained on board the vessel. 18 s.s. "Maloja,"of Belfast, 132,012 Sydney 1 Removed to Hospital at Marseilles. 21 s.s. "Dunluce Castle,"of London, 118,490. Cape Town 1 Isolated on board the vessel. June 8 s.s. "Guildford Castle,"of London, 132,611. Do. 1 Ditto. 11 s.s. "Orama,"of Glasgow, 132,989 Brisbane - 2 Patients recovered. 11 s.s. "Highland Rover,"of London, 129,067. Buenos Ayres. 2 Patients isolated on board the vessel. 23 s.s. "Orontes,"of Glasgow, 115,707 Sydney 2 Removed to Hospital at Plymouth. 28 Training ship, "Warspite,"lying off . Greenhithe 1 Removed to Ship's Hospital on shore. Aug. 3 s.s. "Rose,"of London, 112,843 Ferry boat at Tilbury 6 Removed to Port Sanitary Hospital. 31 s.s. "Otway,"of Glasgow, 128,282 Brisbane 1 Patient recovered. Sept. 14 s.s. "Otranto,"of Belfast, 124,675 Sydney 1 Removed to Hospital at Melbourne. Dec. 12 s.s. "Garth Castle,"of London, 129,078. Cape Town 1 Convalescent on arrival in London. Total 31 40 TABLE XVII. (Continued Fever.) Date. Name of Vessel, Port of Registry, and Official Number. Where from. No. of Cases. How dealt with. 1912. Jan. 6 s.s. "Arabia,"of Greenock, 105,587 Bombay 1 Removed to Port Sanitary Hospital. Feb. 27 s.s. "Buccaneer,"of London, 91,871 Roscoff 1 Ditto. April 10 s.s. "Ellenia,"of Trieste Alexandria 1 Ditto. June 1 s.s. "Highland Laddie,"of London, 129,082. La Plata 1 Ditto. Aug. 12 s.s. "Vectis,"of Greenock, 81,820 Trondhjem 1 Patient recovered. Oct. 17 s.s. "Cesarevitsch Alexei,"of Riga St. Petersburg 1 Removed to Port Sanitary Hospital. Nov. 9 s.s. "Persia,"of Greenock, 109,258 - Bombay 1 Ditto. Dec. 28 s.s. "Nyanza,"of Greenock, 123,529 - Yokohama 1 Removed to Hospital at Port Said. 30 s.s. "Sarnui,"of Copenhagen Bangkok 1 Removed to Port Sanitary Hospital. 9 TABLE XVIII. (Mumps.) Date. Name of Vessel, Port of Registry, and Official Number. Where from. No. of Cases. How dealt with. 1912. March 22 s.s. "Pembrokeshire,"of Southampton, Vladivostock 1 Isolated on board the vessel. 98,870. April 10 s.s. "Garth Castle,"of London East 3 Removed to Hospital at London ampton. „ 13 s.s. "Orvieto,"of Belfast, 129,628 Sydney 3 Allowed to leave vessel. May 19 s.s. "Rangatira,"of Southampton, Port 4 Isolated on board the vessel. 124,523. Chalmers 11 ANTHRAX. On the 2nd December, I received information that a man had been admitted to Poplar Hospital on the 26th November, and died on the 1st December of Anthrax. On making enquiries, it was ascertained that the man had been working in Tilbury Docks for some time, and up to the 26th November he was working cargo from the s.s. "China,"and assisted in removing 91 bales of goat skins. 41 TABLE XIX. (Beri-Beri.) I herewith give a record of the cases of this disease met with. Ten vessels have reported 38 cases during the voyage:— Date of Arrival. Name of Vessel. Where from. N umber of Cases. 1912. January 11 "Marga,"of Drammen Chili 8 „ 15 s.s. "Namur,"of Greenock, 123,528 Yokohama 6 „ 28 s.8. "Trocas,"of London, 101,972 Singapore 3 „ 28 s.s. "Ping Suey,"of Liverpool, 110,143 Yokohama 1 February 6 "Ganges,'' of Tvedestrand Callao 6 „ 7 s.s. "Den of Kelly,"of Dundee, 118,750 Calcutta 1 „ 11 s.s. "Sicilia,"of Glasgow, 113,933 Antwerp 8 June 14 s.s. "Namur,"of Greenock, 123,528 Yokohama 1 „ 29 s.s. "Sardinia,"of Glasgow, 115,696 Colombo 3 October 19 s.s. "Nubia,"of Greenock, 102,394 Yokohama 1 38 TUBERCULOSIS. The Public Health (Tuberculosis) Regulations, 1908. The Public Health (Tuberculosis in Hospitals) Regulations and the Public Health (Tuberculosis) Regulations, 1912, have been revoked, but will continue in force until January 31st, 1913. During the year 1 notification has been received from a Medical Practitioner and 70 cases have been reported on incoming ships. In each case the quarters occupied by the patient have been disinfected, and where the person has not left the vessel, he has been isolated wherever practicable. I described in my last Annual Report, the prevalence of Pulmonary Tuberculosis amongst seamen, and gave some statistics showing its extent. I must again repeat that the conditions under which seamen live on board vessels are extremely favourable to the spread of infection and the development of this disease. The occupants of the seamen's quarters on board many ships may be described as "troglodytes "for indeed many of these places are verily similar to caves, constructed of air tight materials, dark, overcrowded in a hygienic sense, and ventilated (?) by an iron pipe which is generally blocked up, thus only allowing the fresh air to enter by the door. The following example, which was met with during the year, will indicate the possible danger which may arise from persons on board suffering from Pulmonary Tuberculosis. 42 J. A., the chief baker on a steamer carrying a number of passengers, was working on board the ship from April 29th, 1912, until November 2nd, 1912, when he was found to be suffering from Pulmonary Tuberculosis and was put off duty. Further comment on this case is needless—the objection, if not the danger, must be realised by everyone. Table XX. gives a list of the cases, from which it will be seen that they arrive from all parts of the world. In every case the quarters on the vessel occupied by the person infected were subsequently disinfected by your officers. TABLE XX. (Pulmonary Tuberculosis.) Date. Name of Vessel, Port of Registry and Official Number. Where from. No. of Cases. How dealt with. 1912. Jan. 9 s.s. "Karamea,"of Southampton, 110,264. Adelaide 1 Patient proceeded to his home. „ 12 s.s. "Malta,"of Greenock, 102,398 Antwerp 1 Removed to Seamen's Hospital, Greenwich. „ 18 s.s. "Namur,"of Greenock, 123,528 - Yokohama 1 Died, and body buried at Penang. „ 19 s.s. "Bellerophon,"of Liverpool, 120,915 Tacoma 1 Died, and body buried at sea. „ 25 s.s. "Ping Suey,"of Liverpool, 110,143 Yokohama 1 Ditto. „ 31 s.s. "Palawan,"of Greenock, 102,400 Ditto 1 Ditto. Feb. 1 s.s. "Amatonga,"of North Shields, 115,957. Busreh 1 Removed to Hospital at Perim. „ 12 s.s. "Cyclops,"of Liverpool, 123,998 Vancouver 1 Died, and body buried at Hong Kong. „ 26 s.s. "Malwa,"of Greenock, 127,543 - Sydney 1 Died, and body buried at sea. March 10 s.s. "Antilochus,"of Liverpool, 123,984 Victoria, B.C. 1 Removed to Hospital at Hong Kong. „ 20 s.s. "Sunda,"of Greenock, 102,399 Calcutta 1 Returned to Bombay in vessel. April 1 s.s. "Dover Castle,"of London, 118,409 Cape Town Removed to Hospital at Southampton. „ 10 s.s. "Anna Dorette Boog,"of Rostock - Bougie 1 Removed to Seamen's Hospital, Greenwich. „ 12 s.s. "Persic,"of Liverpool, 110,620 - Sydney 1 Died,and body buried at sea. „ 13 s.s. "Orvieto,"of Belfast, 129,628 Ditto 1 Allowed to leave vessel in London. „ 16 s.s. "Miltiades,"of Aberdeen, 118,179 Ditto 1 Ditto. „ 23 s.s. "Geelong,"of London, 118,426 Ditto 1 Isolated on board the vessel. May 5 s.s. "Highland Loch,"of London, 129,182. Buenos Ayres 1 Removed to Seamen's Hospital, Greenwich. „ 5 s.s. "Galeka,"of Southampton, 110,265 East London - 1 Removed to Hospital at Southampton. „ 17 s.s. "Demosthenes,"of Aberdeen, 129,362. Brisbane 1 Died, and body buried at sea. June 1 s.s. "Corinthian,"of Glasgow, 111,257 Montreal 1 Patient proceeded to his home in Greece. June 13 s.s. "Lake Erie,"of Liverpool, 110,631 Ditto 1 Removed to Hospital at Brixham. „ 21 s.s. "Inanda,"of Aberdeen, 118,187 Natal 1 Removed to Hospital at Las Palmas. „ 28 s.s. "Garth Castle,"of London, 129,171 Cape Town 1 Removed to Hospital at Southampton. „ 30 s.s. "China,"of Belfast, 104,467 Sydney 1 Removed to Hospital at Aden. July 3 s.s. "Sardinia,"of Belfast, 115,696 - Calcutta 1 Removed to Branch Seamen's Hospital. Forward 28 43 Date. Name of Vessel, Port of Registry and Official Number. Where from. No. of Cases. How dealt with. 1912. Brought forward 28 July 8 s.s. "Highland Corrie,"of London, 129,117. Buenos Ayres 1 Patient proceeded to home. „ 11 s.s. "Ascania," of Liverpool, 131,342 Montreal 1 Isolated on board the vessel. „ 20 s.s. "Wiltshire," of 132,675. Brisbane 1 Died and body buried at sea. „ 23 s.s. "Grantully Castle," of London, 129,058. Cape Town 13 Removed to Hospital at Southampton. Aug. 10 s.s. "German,"of Southampton, 109,290. Ditto 2 Ditto „ 28 s.s. "Galician," of Southampton, 113,834. East London 1 Patient proceeded to home. „ 25 s.s. "Highland Glen," of London, 120,139. Buenos Ayres 1 Ditto Sept. 1 s.s. "Bellerophon," of Liverpool, 120,915. Vancouver 1 Landed at Hong Kong. „ 3 s.s. "Commonwealth," of London, 115,903. Sydney 1 Landed in London. „ 16 s.s, "Belgic," of Liverpool, 131,383 Ditto 1 Ditto „ 22 s.s. "Mongolia," of Greenock, 117,383 Ditto 1 Died and body buried at sea. „ 22 s.s. "Highland Loch," of London, 129,182. Buenos Ayres 1 Landed at Gravesend. „ 24 s.s. ''Simla," of Greenock, 102,393 Yokohama 1 Patient remained on board the vessel. „ 26 s.s. "City of Glasgow," of Glasgow, 121,304. Calcutta 1 Removed to Hospital at Suez. „ 26 s.s. "Cyclops," of Liverpool, 123,978 Vancouver 1 Patient isolated on board the vessel. October 8 "Siam," of Grimstad Galeta Buena 1 Patient isolated on board the vessel. „ 17 s.s. "Inanda,"of Aberdeen, 118,187 Durban 1 Patient proceeded to home. „ 18 s.s. "Grantully Castle," of London, 129,058. Cape Town 1 Removed to Hospital at Southampton. „ 19 s.s. "Malwa," of Greenock, 127,543 - Sydney 1 Removed to Hospital at Colombo. „ 21 s.s. "Goorkha," of Southampton, 106,917. Durban 1 Removed to Hospital at Marseilles. „ 22 s.s. "Demosthenes," of Aberdeen, 129,362. Brisbane 1 Patient isolated on board the vessel. „ 28 s.s. "Orestes," of Glasgow, 115,707 - Ditto 1 Removed to Hospital at Tilbury. Nov. 2 s.s. 'Athenic," of Liverpool, 115,239- Wellington - 1 One died and body buried at sea, one left vessel in London. „ 4 s.s. "Clan Buchanan," of Glasgow, 124,232. Chittagong 1 Removed to Hospital at Malta. „ 6 s.s. "Borneo," of Newcastle, 104,287 - Calcutta 1 Patient left vessel in London. „ 8 s.s. "Dunluce Castle," of London, 118,490. Cape Town 1 Removed to Hospital at Southampton. „ 25 s.s. "Montfort," of Liverpool, 110,568 Montreal 1 Patient left vessel in London. „ 26 s.s. "Medic," of Liverpool, 110,573 - Sydney 1 Patient remained on board the vessel. 30 s.s. "Morea," of Glasgow, 128,235 Ditto None. Left vessel at Tilbury. Dec. 9 s.s. "Arabia," of Greenock, 105,587 Bombay 1 Plymouth. 11 s.s. "Umvolosi," of London, 115,857 Natal 1 None. Left vessel at Tilbury. 18 s.s. "Aeneas," of Liverpool, 131,305 Brisbane 1 Ditto 20 s.s. "Gloucester Castle," of London, 132,592. Durban 1 Southampton. 23 s.s. "Moravian," of Aberdeen, 108,662 Brisbane 1 Durban. 24 s.s. "Galeka," of London, 110,265 East London None. Left vessel in London. 28 s.s. "Begonia," of North Shields, 109,908. Busreh 1 Marseilles. 71 44 DISINFECTIONS OF EFFECTS, BEDDING, ETC. This disinfection is carried out at Denton Hospital by means of a WashingtonLyons apparatus, and from Table XXI. it will be seen that the apparatus was in use on 46 occasions for this purpose. A total of 70 vessels were disinfected by your officers on account of infectious disease. (See Table XXII.) TABLE XXL Number of Disinfections of Effects, Bedding, &c., from 1st January to 31st December, 1912. Month. Reason for Disinfection. Hospital Bedding, &c. Total Effects. Number of times Steam Disinfeotor was used. Disinfected by Fumigation. Cholera. Chicken-pox. Continued Fever. Diphtheria. Enteric Fever. Erysipelas. Measles. Pulmonary Tuberculosis. Suspected Plague. Remittent Fever. Scarlet Fever. Small-pox. Precautionary measure. January ... 1 1 ... 1 ... 1 ... ... ... 1 1 ... 1 7 6 ... February ... 1 1 ... 5 ... ... ... ... ... ... 1 ... ... 8 4 ... March ... ... ... ... ... ... 1 ... ... ... ... 2 ... 2 5 4 ... April ... ... 1 ... 2 ... ... ... ... ... ... ... ... 3 6 4 ... May ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... 3 3 ... June ... ... 1 ... 6 ... ... ... ... ... ... ... ... ... 7 3 ... July ... ... ... ... 1 ... 3 1 ... ... ... ... ... ... 5 3 ... August ... ... ... ... 2 ... 1 ... ... 1 ... ... ... ... 4 5 ... September ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 3 ... October ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 2 4 ... November ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 3 3 ... December ... 1 1 ... 3 ... 1 ... ... ... ... ... ... ... 6 4 ... Totals ... 3 6 ... 23 ... 11 1 ... 1 1 5 ... 6 57 46 ... 45 TABLE XXII. Vessels and Premises Disinfected, from 1st January to 31st December, 1912. Month. Reason for Disinfection. Total Number of Disinfections. Cerebro-Spinal Meningitis. Chicken-pox. Cholera. Continued Fever. Diphtheria. Enteric Fever. Erysipelas. Beri-Beri. Measles. Mumps. Plague (Suspected). Remittent Fever. Scarlet Fever. Small-pox. Pulmonary Tuberculosis. Precautionary Measure. Whooping Cough. January ... ... ... 1 ... 1 ... 1 1 ... ... ... ... 1 ... 4 ... 9 February ... ... ... 1 ... 4 ... ... ... ... ... ... ... 2 ... 3 ... 11 March ... ... ... ... ... 2 ... ... 1 1 ... ... ... 1 ... 1 ... 6 April ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... 3 May ... ... ... ... ... 1 ... ... 2 ... ... ... ... ... 1 ... ... 4 June ... ... ... 1 ... 6 ... ... ... ... ... ... ... ... ... ... ... 7 July ... ... ... ... ... 1 ... ... 3 ... ... ... ... ... 1 ... ... 5 August ... 1 ... ... ... 2 ... ... 1 ... ... 1 ... ... ... ... ... 5 September ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... 1 ... ... 4 October ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 2 ... ... 4 November ... ... ... 1 ... 1 ... ... 1 ... ... ... 1 ... 1 ... 1 6 December ... ... ... 1 ... 4 ... ... 1 ... ... ... ... ... ... ... ... 6 Totals ... 2 ... 6 ... 25 1 1 12 1 ... 1 1 5 6 8 1 70 ALIENS ACT, 1905. I have set out in Tables XXIII. and XXIV. the particulars of the numbers of Aliens arriving in this port on immigrant and non-immigrant ships, from which it will be seen that the total of such arrivals in the Port of London during the year was 41,601 ; that of this number 18,645 were cabin passengers, 7,764 were exempted second class, and 7,057 were transmigrants. Deducting these, there remain 8,135. Of these, 1,315 were proceeding to destinations outside the United Kingdom, 516 had returning holiday tickets, 1,320 were Alien seamen, and 1,154 were alien residents in this country returning hither. Deducting these, a balance of 3,830 aliens remains. Of these 104 were refused leave to land, and the remainder 3,726 is the estimated total of alien immigrants into London, via the Port, during the year, and who probably settled in this country. These figures, however, are not absolute, the completed official returns not having yet been published. Of those refused leave to land, 19 were rejected by your Medical Officer, as Medical Inspector under the Act. 46 ALIENS ACT, 1905. The following figures are extracted from the quarterly Parliamentary returns, and are subject to correction when the complete returns are published:— TABLE XXIII ALIEN PASSENGERS. LONDON. Total. Cabin. Exempt 2nd Class Passengers. Transmigrants. Other alien passengers. Proceeding to destinations outside the United Kingdom. Holiday return tickets. Seamen. Refused leave to land. Residents returning. Balance. Totals. January 2,403 933 495 553 422 44 16 66 4 70 222 422 February 2,531 852 327 795 557 24 21 116 4 53 339 557 March 2,612 911 444 679 578 58 20 109 8 58 325 578 April 3,170 1,489 641 545 495 50 28 134 6 64 213 495 May 3,515 1,797 608 456 654 94 47 83 10 78 342 654 June 3,344 1,794 701 395 454 76 46 80 — 85 167 454 July 4,989 2,634 1,100 348 907 250 110 96 17 115 319 907 August 5,664 2,875 1,151 507 1,131 345 88 88 14 237 359 1,131 September 4,403 2,088 813 538 964 104 56 194 9 183 418 964 October 3,557 1,485 620 727 725 116 40 149 15 90 315 725 November 2,932 964 470 818 680 86 12 136 13 54 379 680 December 2,481 823 394 696 568 68 32 69 4 67 328 568 41,601 18,645 7,764 7,057 8,135 1,315 516 1,320 104 1,154 3,726 8135 All Ports. 12 months 472,534 197,196 104,588 113,442 57,308 7,361 9,212 11,217 1,147 8,541 19,820 TABLE XXIV. Arrivals in the Port of London. Ships. Alien Passengers on Non Immigrant. Immigrant Total. NonImmigrant Ships. Immigrant Ships. Total. January 140 10 150 1,705 698 2,403 February 110 13 123 1,512 1,019 2,531 March 142 14 156 1,669 943 2,612 April 145 20 165 1,818 1,352 3,170 May 128 31 159 1,858 1,657 3,515 June 108 24 132 1,596 1,748 3,344 July 137 48 185 1,558 3,431 4,989 August 158 59 217 1,398 4,266 5,664 September 161 46 207 1,485 2,918 4,403 October 159 26 185 1,997 1,560 3,557 November 143 15 158 1,844 1,088 2,932 December 135 14 149 1,568 913 2,481 1,666 320 1,986 20,008 21,593 41,601 Other Ports 7,638 3,628 11,266 128,857 302,076 430,933 Total 9,304 3,948 13,252 148,865 323,669 472,534 London. Percentage of Total 1912 17.90 8.10 14.98 13.44 6.67 8.80 Do. 1911 2023 8.39 1696 1756 661 1025 47 TABLE XXV. HOSPITAL. Number of Cases Admitted, Cost of Maintenance, &c. Patients remaining in Hospital on 31st December, 1911 4 Admitted. Discharged, Died. Remaining under treatment Cholera 0 0 0 0 Cholera (suspected) 0 0 0 0 Bubonic Plague 0 0 0 0 Ditto (suspected) 1 1 0 0 Small-pox 2 2 0 0 Scarlet Fever 0 0 0 0 Enteric Fever 35 30 0 8 Continued Fever 7 7 0 0 Diphtheria 0 0 0 0 Measles 27 27 1 0 Erysipelas 1 1 0 0 Chicken-pox 7 7 0 0 Other Diseases 0 0 0 0 Totals 80 75 1 8 Remaining in Hospital on 31st December, 1912 8 Total number of days treatment during the year 1,349 Average number of days treatment for each case 16.86 Average daily number of patients in Hospital 4.56 Average daily cost of maintenance per patient 1s. 8.6d. Average total cost of maintenance per patient £1 7s. 8d. The total number of cases under treatment in the Hospital during the year was 84. Of theee, 80 were admitted during the year. Of the total number, 75 were discharged convalescent and one died in hospital, while eight remained under treatment at the end of the year. It will be seen in Table XXV., that the average number of days treatment for each case was 16.86, while the average daily cost of maintenance of each patient was Is. 8½d., and the average total cost of maintenance of each patient was 1l. 7s. 8d. 48 TABLE XXVI. Quantity and Description of Unsound Food Seized and Destroyed for the Year ending 31st December, 1912. Original packages. Sundry quantities by weight. Loose Articles. Approximate Total weight of Goods destroyed. No. Description. Tons. cwts. qrs. lbs. No. Description. Tons. cwts. qrs. lbs. MEAT— Fresh and Frozen— Beef 564 quarters ... ... ... ... 613 pieces 58 3 0 3 Mutton and Lamb 634 carcasses ... ... ... ... 252 „ 14 3 2 3 Veal, Pork and Offal 1,576 various ... ... ... ... 1,866 various 27 4 2 23 Preserved— Tinned 108 cases ... ... ... ... 1,804 tins, &c. 5 17 3 17 Smoked and Salted 15 „ ... ... ... ... 6 hams 2 16 2 8 Sundry 8 various ... ... ... ... ... ... 0 6 0 8 RABBITS— Frozen 134 crates ... ... ... ... 2 loose 2 17 0 0 Tinned ... ... ... ... ... ... ... ... ... ... ... ... POULTRY and GAME— Frozen 3 casts ... ... ... ... 10 loose 0 2 0 14 FISH— Preserved, Dried 11 casks,&c. ... ... ... ... ... ... 1 1 2 0 „ Tinned and Bottled 136 cases ... ... ... ... 9,806 tins, &c. 5 7 2 19 „ Frozen ... ... ... ... ... ... ... ... ... ... ... ... FRUIT— Fresh 4,495 various 3 18 2 0 ... ... 135 0 2 16 Preserved, Dried 3,385 ... ... ... ... ... ... ... 134 16 1 13 „ Tinned and Bottled 89 cases 35 0 0 0 2,029 tins, &c. 43 10 0 12 „ Jam and Marmalade 4 casks,&c. ... ... ... ... ... ... 0 12 1 21 VEGETABLES— Fresh 2,619 bags ... 7 2 0 ... ... 106 6 2 0 Preserved, Dried 1 cask ... ... ... ... 287 tins 107 12 3 18 NUTS Whole 406 bags ... ... ... ... ... ... 17 8 0 0 Sundry 33 cases ... ... ... ... ... ... 2 0 0 0 PROVISIONS— Tea 8 ... ... ... ... ... ... ... 0 3 2 8 Coffee ... ... ... ... ... ... ... ... ... ... ... ... Cocoa 31 cases 1 18 2 24 ... ... 4 5 2 24 Butter, Cheese, Lard, Margarine ... ... 5 4 1 24 10 tins 5 5 0 20 Condensed Milk 924 cases ... ... ... ... ... ... 23 2 2 0 Prepared Foods 8 ... ... ... ... ... 144 tins 0 15 1 8 Biscuits and Confectionery ... ... ... ... ... ... 545 tins 0 5 1 11 Sugar ... ... ... ... ... ... ... ... ... ... ... ... GRAIN— Wheat, Maize, Barley, Rice, &c. ... ... 2880 1 0 17 ... ... 2,880 1 0 17 MEAL and FLOUR 3,968 bags 2 1 1 13 ... ... 178 6 1 4 CONDIMENTS and SPICES 9 various ... ... ... ... ... ... 0 4 1 3 EGGS 4 cases ... ... ... ... ... ... 0 2 1 20 DRUGS 3 ... ... ... ... ... ... ... 0 4 0 0 SUNDRIES ... ... ... 4 1 20 ... ... 0 4 1 20 Total 19,176 various | packages 2928 16 0 14 17,368 various 3,758 7 I 2 Approximate Total weight of Goods destroyed during the year 1909 - - - 1,415 7 0 22 „ „ 1910 - - - 2,483 6 2 13 „ „ „ 1911 - - - 1,408 4 3 1½ „ „ „ 1912 - - - 3,758 7 1 2 49 TABLE XXVII. Description of Meat Destroyed. Year. Beef. Mutton. Veal, Pork, Offal. Tinned. Smoked and Salted, &c. Total. Tons cwts. qrs. lbs. Ton. cwts qrs lbs. Ton s cwt qrs. lbs. Tons cwts. qrs. lbs. Tons acts. qrs. lbs. Tons cwts. qrs. lbs. 1905 335 16 0 27 361 14 1 5 8 17 3 24 2 0 0 12 0 4 1 4 708 12 3 16 1906 136 5 3 24 94 15 0 8 22 7 0 10 9 0 0 26 0 0 3 14 262 0 0 26 1907 47 5 2 16 63 6 2 24 8 11 1 6 2 14 4 5 63 8 0 22 185 6 3 17 1908 47 14 2 6 22 12 2 10 1 3 0 8 3 12 2 8 2 19 1 13 78 2 0 17 1909 19 11 3 7 21 3 1 17 Pork and Veal— 2 10 2 19 0 2 3 22 113 9 1 19 4 14 7 23 Offal— 65 4 2 15 1910 1,100 0 0 27 50 8 1 13 Pork and Veal— 3 2 2 2 32 13 1 6 1,234 1 3 24 3 5 0 13 Offal— 44 12 1 19 1911 341 6 3 18 25 9 1 6 Pork and Veal— 6 8 2 5 3 18 2 0 462 11 0 0 4 8 1 19 Offal— 80 19 1 8 1912 58 3 0 3 14 3 2 3 Pork and Veal— 5 17 3 17 3 2 2 16 108 11 3 6 7 14 2 13 Offal— 19 10 0 10 Total for eight years 2,086 4 1 16 653 13 1 2 271 10 0 0 35 7 2 10 106 10 0 13 3,153 5 1 13 50 TABLE XXVIII. The following is a list of pig-carcases found during the year to be affected with tuberculosis. They were seized as unfit for food and destroyed :— Date. Name of Vessel. Where from. Where lying. Number of Carcases. 1912. Jan. 8 " Dorset " Australia Victoria Dock *2 Feb. 8 " Ayrshire " Ditto Tilbury Dock *1 15 " Afric " Ditto Ditto *3 March 6 " Shropshire " Ditto Ditto *4 6 " Wakool" Ditto RoyalAlbert Dock *1 21 " Ballaarat" Ditto Ditto *1 April 16 " Carmarthenshire " China Victoria Dock 7 and 1 side. * These carcases had attached the official certificate o£ the Commonwealth of Australia. The facts were reported to the High Commissioner for the Commonwealth of Australia and to the Local Government Board. TABLE XXIX. PUBLIC HEALTH (FOREIGN MEAT) REGULATIONS, 1908. During the year Notices were served under Article III. (5) and VI. of the above-mentioned Regulations, requiring the exportation of the following meat :— Date of Arrival. Name of Vessel. Where from. Where lying. Description and quantity of foreign meat in respect of which Notices were served. 1912. April 16 s.s. " Carmarthenshire," of Southampton, 98,863. China Royal Victoria Dock. 56 packages pigs. Oct. 21 Ditto Ditto RoyalAlbert Dock *88 packages, each containing 2 sides of pork. Nov. 10 s.s. " Highland Piper," of Liverpool, 132,599. Buenos Ayres Ditto †40 boxes stripped loins. * These goods were found to be putrid, and were destroyed. † Referred to the Local Government Board under Article 17 of the Public Health (Foreign Meat) Regulations, 1908, and notices subsequently withdrawn. TABLE XXX. PUBLIC HEALTH (FOREIGN MEAT) REGULATIONS, 1908. During the year Certificates were issued under Article III. (5) of the above-mentioned Regulations in respect of the undermentioned meat : — Date. Name of Vessel. Where from. Where lying. Description and quantity of foreign meat in respect of which Certificates were issued. 1912. Jan. 3 s.s. " Thoraten " Gothenburg Millwall Dock 6 packages beef. „ 4 s.s. "Highland Warrior" Buenos Ayres Royal Albert Dock. 442 cases ox cheeks. „ 5 s.s. "Durham" Australia Victoria Dock 47 pig carcasses. „ 5 s.s. "Runic" Ditto Ditto 12 pig carcasses. 51 Date. Name of Vessel. Where from. Where lying. Description and quantity of foreign meat in respect of which Certificates were issued. 1912. Jan. 10 s.s. " Elstree Grange " Argentina Victoria Dock 305 bags ox cheeks. „ 10 s.s. " Higliland Laddie" Ditto Royal Albert Dock. 325 cases ox cheeks. „ 13 s.s. "Dorset" Australia Victoria Dock 90 pig carcasses. „ 15 s.s. "Rubis" Ostend Tilbury Dock 2 bales bacon. „ 18 s.s. " Beacon Grange " Argentina Victoria Dock 265 bags ox cheeks. 19 s.s. " Highland Rover " Ditto Royal Albert Dock. 151 crates ox cheeks. 22 s.s* "Medic" Australia Victoria Dock 14 pig carcasses. „ 25 s.s. " Highland Glen " Argentina Royal Albert Dock. 384 cases ox cheeks. „ 31 s.s. " Highland Corrie" Ditto Ditto 328 cases ox cheeks. „ 31 s.s. " Saphir " Ostend Tilbury Dock 3 bales bacon. Feb. 2 s.s. " Aeneas " Australia Royal Albert Dock. 106 pig carcasses. ,, 3 s.s. "Kent" Ditto Victoria Dock 83 pig carcasses. „ 7 s.s. " Niwaru " Ditto Ditto 122 pig carcasses. „ 7 s.s. " Highland Piper " Argentina Royal Albert Dock. 75 crates ox cheeks. „ 8 s.s. "Marathon" Australia Ditto 24 pig carcasses. „ 13 s.s. " Ayrshire" Ditto Victoria Dock 346 pig carcasses. „ 14 s.s. "Rubis" Ostend Tilbury Dock 2 packages bacon. „ 15 s.s. " Highland Scott" Argentina Royal Albert Dock. 129 crates ox cheeks. „ 20 s.s. " Afric " Australia Tilbury Dock 243 pig carcass's. „ 22 s.s. " Highland Loch " Argentina Royal Albert Dock. 362 crates ox cheeks. „ 22 s.s. " Thule " Gothenburg Millwall Dock 10 pig carcasses, 8 sides beef. Mar. 1 s.s. " Highland Pride Argentina Royal Albert Dock. 2 crates ox cheeks. „ 2 s.s. " Whakatane " New Zealand Victoria Dock 10 crates ox cheeks. „ 6 s.s. " Rubis " Ostend Tilbury Dock 3 bales bacon. „ 11 s.s. " Highland Brae " Argentina Royal Albert Dock. 173 crates ox cheeks. „ 11 s.s. "Highland Warrior" Ditto Ditto 210 cases ox cheeks. „ 12 s.s. "Shropshire" Australia Victoria Dock 238 pig carcasses. „ 12 s.s. "Wakool" Ditto Royal Albert Dock. 180 pig carcasses. „ 18 s.s. "Tropic" Ditto Victoria Dock 69 pig carcasses. „ 18 s.s. " Suevic " Ditto Ditto 240 pig carcasses. „ 22 s.s. " Highland Laddie" Argentina Royal Albert 1 IAPIT 131 crates ox cheeks. „ 23 s.s. " Opawa " New Zealand UULh. Victoria Dock 16 pig carcasses. „ 28 s.s. " Ascanius " Australia Royal Albert Dock. 19 pig carcasses. „ 28 s.s. " Highland Rover" Argentina Ditto 268 crates ox cheeks. „ 29 s.s. " Ballaarat" Australia Ditto 61 pig carcasses. „ 29 s.s. " Ruapehu " New Zealand Victoria Dock 25 crates ox cheeks. April 3 s.s. " Highland Glen " Argentina Royal Albert Dock. 228 crates ox cheeks. „4 s.s. "Topaze " Ostend Tilbury Dock 4 packages sheep plucks. 52 Date. Name of Vessel. Where from. Where lying. Description and quantity of foreign meat in respect of which Certificates were issued. 1912. April 11 s.s. " Suffolk " Australia Victoria Dock 19 pig carcasses. „ 18 s.s. "Persic" Ditto Ditto 22 pig carcasses. „ 18 s.s. "Highland Piper" Argentina Royal Albert Dock. 250 cases ox cheeks. „ 18 s.s. " Persic" Australia Victoria Dock 22 pig carcasses. ,, 24 s.s. " Highland Scot" Argentina Royal Albert Dock. 282 crates ox cheeks. „ 24 s.s. " Rubis " Ostend Tilbury Dock 2 packages bacon. „ 25 s.s. " Indralema " New Zealand Royal Albert Dock. 37 pig carcasses. „ 30 s.s. " Geelong " Australia Ditto 18 pig carcasses. May 1 s.s. " Highland Corrie" Argentina ... 335 crates ox cheeks. „ 3 s.s. " Carmarthenshire" China Victoria Dock 37 pig carcasses. 5 s.s. " Ivaipara " New Zealand Ditto 24 crates ox cheeks „ 9 s.s. "Highland Loch" Argentina Royal Albert Dock. 397 crates ox cheeks. „ 10 s.s. " Saphir " Ostend Tilbury Dock 1 cask " guts." „ 15 s.s. "Rubis" ... ... 2 bales bacon. „ 16 s.s. " Runic " Australia Victoria Dock 55 pig carcasses. „ 23 s.s. "Mimiro" Ditto Ditto 285 pig carcasses. „ 31 s.s. " Highland Brae" Argentina Royal Albert Dock. 381 crates ox cheeks. June 20 s.s. "Highland Glen" Ditto Ditto 400 crates ox cheeks. „ 20 s.s. " Highland Piper" Ditto Ditto 406 crates ox cheeks. July 10 s.s. " Topaze " Ostend Tilbury Dock 2 bales bacon. „ 13 s.s. " Highland Corrie " Argentina Royal Albert Dock. 380 crates ox cheeks. „ 20 s.s. " Hurunui" New Zealand Victoria Dock 45 packages ox cheeks. „ 30 s.s. " Durham " Ditto Ditto 142 bags ox cheeks. Aug. 2 s.s. "Highland Warrior'' Argentina Royal Albert Dock. 400 crates ox cheeks. 2 s.s. "Rimutaka " New Zealand Victoria Dock 26 crates ox cheeks. 9 s.s. "Highland Brae" Argentina Royal Albert Dock. 269 crates ox cheeks. „ 15 s.s. " Highland Laddie" Ditto Ditto 12 crates ox cheeks. „ 20 s.s. " Wiltshire" Australia Victoria Dock 100 bags ox cheeks. „ 22 s.s. " Zephyrus " Argentina London Dock 150 packages offal, 382 bags tripe, 109 stag-briskets, 408 ox briskets, 109 buttocks. „ 28 s.s. "Saphir" Ostend Tilbury Dock 1 bale bacon. „ 29 S.s. "Orari" New Zealand Victoria Dock 58 crates ox cheeks. „ 29 s.s. " Ayrshire " Australia Ditto 108 bags ox cheeks. Sept. 5 s.s. "Saphir" Ostend Tilbury Dock 2 bales bacon. „ 11 s.s. "Topaze" Ditto Ditto 2 bales bacon. „ IB s.s. " Rotorua " New Zealand Victoria Dock 10 crates ox cheeks. „ 18 s.s. " Highland Corrie" Argentina Royal Albert Dock. 400 crates ox cheeks. „ 25 s.s. " Norfolk " Australia Victoria Dock 480 crates ox cheeks. 53 Date. Name of Vessel. Where from. Where lying. Description and quantity of foreign meat in respect of which Certificates were issued. 1912. Sept. 25 s.s. " HighlandiLoch " Argentina Royal Albert Dock. 100 crates ox cheeks. Oct. 1 s.s. "Buteshire " Australia Victoria Dock 217 bags ox cheeks. 2 s.s. " Highland Pride " Argentina Royal Albert Dock. 459 crates ox cheeks. 2 s.s. "Topaze " Ostend Tilbury Dock 1 package bacon. „ 9 s.s. "Highland Warrior" Argentina Royal Albert Dock. 150 crates ox cheeks. 9 s.s. "Rubis" Ostend Tilbury Dock 3 bales bacon. „ 16 s.s. " Rubis " Ditto Ditto 3 bales bacon. „ 22 s.s. "Highland Laddie" Argentina Royal Albert Dock. 75 crates and 10 bags ox cheeks. „ 23 s.s." Saphir " Ostend Tilbury Dock 2 bales bacon. „ 23 s.s. " Anglian " Boston Royal Albert Dock. 100 pig carcasses. „ 31 s.s. " Highland Rover" Argentina Ditto 100 crates ox cheeks. Nov. 4 s.s. " Kelvindale " Ditto Victoria Dock 100 bags ox cheeks. 4 s.s. "Highland Glen" Ditto Royal Albert Dock. 285 packages ox cheeks. „ 12 s.s. " Highland Piper " Ditto Ditto 190 bags ox cheeks. 19 s.s. " Highland Scot " Ditto Ditto 100 crates ox cheeks. „ 20 s.s. " Topaze " Ostend Tilbury Dock 2 bales bacon. „ 25 s.s. " Lancastrian " Boston Boyal Albert Dock. 200 pig carcasses. 26 s.s. " Parana " Argentina Victoria Dock 185 bags ox cheeks. „ 28 s.s. " Highland Corrie " Ditto Ditto 200 crates ox cheeks. Dec. 8 s.s. " Rubis " Ostend Tilbury Dock 1 bale bacon. 4 s.s. " Anglian " Boston Royal Albert Dock. 200 pig carcasses. 5 s.s. " Highland Loch " Argentina Ditto 200 cases and 60 bags ox cheeks. „ 11 s.s. " Topaze " Ostend Tilbury Dock 2 bales bacon. „ 14 s.s. " Highland Pride" Argentina Royal Albert Dock. 200 bags and 150 cases ox cheeks. „ 20 s.s. "Highland Warrior" Ditto Ditto 219 bags and 250 crates ox cheeks. „ 27 s.s. " Highland Brae " Ditto Ditto 200 bags and 250 cases ox cheeks. ,, 30 s.s. "Silvia" Hamburg Tilbury Dock 1 tin sterilized milk. FOOD INSPECTION. The Regulations issued by the Local Government Board, under the Public Health (Regulations as to Food) Act, 1907, have been carried out strictly in the Port of London and resulted in the seizure of 3,758 tons 7 cwts. 1 qr. 2 lbs. of Unsound Food by your officers, which were destroyed or disposed of in such a manner as to prevent its being used for human consumption. This is the largest quantity of food-stuffs seized and dealt with hitherto in the Port of London. A summary of the Unsound Food seized is shown by Table XXVI. In only one instance was it necessary to apply for a magistrate's order for the destruction of Unsound Food seized by your officers. Reference to the case is made under the heading of Fruit (tinned and bottled). 54 BEEF. The importations of Frozen and Chilled beef from Australia, New Zealand and South America, into the Port of London daring the year were 200,694 quarters in excess of the previous year and totalled 2,028,479 quarters, or 41.24 per cent of the total quantity imported into the United Kingdom. 58 tons 3 cwts. 0 qrs. 3 lbs. were seized as unfit for human food, and comprised 564 quarters, 594 pieces, 17 packages and sundry pieces. This shows that, on the whole, the beef arrived in good condition. The largest quantity seized on any ship was 12 tons 1 cwt. 1 qr. 19 lbs., as compared with 90 tons in the previous year. AUSTRALIAN BEEF AFFECTED WITH "WORM" (ONCHOCERCA). In only one instance was beef from Australia found to be effected with "worm " (onchocerca). The consignment arrived in the Port of London on the 30th November and consisted of one package containing four briskets and flanks. "Worm" nests were found in each, and the meat was, therefore, seized and destroyed. The Official Certificate of the Commonwealth of Australia, as approved by the Local Government Board, was not found on the package or meat. The practice of cutting off the flanks and briskets from the fore-quarters has continued, whilst the examination of the hind-quarters has been more thoroughly and efficiently done by the inspectors in Australia, and accounts for the absence of "worm" in the beef examined in this Port. BONELESS MEAT. The s.s. "Highland Piper," from Buenos Ayres, arrived in the Royal Albert Dock on the 9th December, having on board 40 boxes of meat described as "Stripped loins." This was boneless meat, and was dealt with as Foreign Meat of Class 1 and Notices were served upon the Importers, under Articles III. (5) and VI of the Public Health (Foreign Meat) Regulations, 1908, forbidding the removal of the meat for any purpose other than exportation. There being a difference of opinion between the Importers and your Medical Officer of Health as to whether the meat capae within the definition of Foreign Meat of Class 1, and should be exported, the matter was referred to the Local Government Board for determination, in accordance with the provisions of Article 17 of the Regulations. Dr. Mac Fadden, the Chief Food Inspector of the Local Government Board, attended at the Victoria Dock and examined a portion of the consignment, and having heard the opinion of the Importers and your Medical Officer of Health, he decided that the meat was not Foreign Meat of Class 1, and in accordance with his decision the Notices served upon the Importers were withdrawn and the meat released. 55 MUTTON AND LAMB. 7,690,737 carcases of frozen mutton and lamb from Australia, New Zealand and South America were discharged from vessels in the Port of London during the year, being 279,595 carcases less than the previous year's total. With few exceptions the meat was in good condition and only 14 tons 3 cwts. 2 qrs. 3 lbs. comprising 634 carcases and 252 pieces, were seized as unfit for human food. The largest quantity seized on any vessel was about 5 tons. PORK. The pork seized and destroyed comprised 25 carcases, 3 pieces and 88 packages each containing 2 sides, the total weight being 7 tons 14 cwts. 2 qrs. 13 lbs. Nineteen of the carcases and one piece were found to be effected with Tuberculosis, and a list of these will be found in Table XXVIII. The remainder was unsound. PIG-CARCASES FROM CHINA. The s.s. "Brodmore," from Hankow, arrived on the 8th January with 3,814 Chinese pig-carcases on board. The carcases were not consigned to London and, therefore, were not examined by your Inspectors. The vessel sailed from London for Liverpool with the carcases on board on the 18th January, and the facts were reported to the Medical Officer of Health for that Port. The s.s. "Carmarthenshire" arrived on the 16th April. Amongst the cargo were 50 pig-carcases from Shanghai and 40 from Harbin. These were examined and it was found that 4 of those from Shanghai and 3 from Harbin were effected with Tuberculosis, and they were accordingly seized and destroyed, the remainder being passed. There were also 56 packages from Manchuria, which, on examination, were found to contain portions of the carcases of pigs, namely, the sides. This meat clearly came within the description of Foreign Meat, Class 1, as defined by the Public Health (Foreign Meat) Regulations, 1908, Article 1, (i) (C) inasmuch as "the expression Foreign Meat, Class 1, means Foreign Meat in the form of severed " parts of the carcase of a pig, or of other edible parts of a pig, which have not, before " importation, been salted, cured, pickled, dried, or smoked, or otherwise prepared as "bacon or ham, and which are not contained in a box, case, receptacle, or package vvirh " an official certificate impressed thereon, or affixed or attached thereto." No official certificate has been recognised in regard to China as yet. As the importation of Foreign Meat of Class 1 is prohibited, a Notice was served (under Article V of the Foreign Meat Regulations) upon the importers, forbidding the removal of the pork for any purpose other than exportation. In the course of a preliminary examination of the meat, one side was inspected and found to be diseased and was accordingly seized and destroyed, the remainder being exported. 56 The same vessel, from Yokohama, arrived in the Port of London again on the 21st October, having on board 88 packages of pork which had been shipped at Shanghai. An examination of the packages revealed the fact that each contained two sides of pork. This was also Foreign Meat of Class 1, and a Notice was served upon the consignees forbidding the removal of the meat for any purpose other than exportation. At the request of the consignees, permission was given for the meat to be put into cold store in the dock, pending arrangements being made for its exportation, but it was found to be unsound and stinking, and the Port of London Authority refused to receive it in their store. It was, therefore, seized by one of your Food Inspectors and, with the consent of the consignees, destroyed in the usual way. OFFAL. The Offal seized and destroyed amounted to 19 tons 10 cwts. 0 qrs. 10 lbs. which was made up as follows :— Tons. Cwts. Qrs. Lbs. Ox-livers— 11 crates, 2 boxes, 30 bags, 1,010 loose 6 10 1 3 Sheep-livers— 41 boxes, 682 loose 0 18 1 16½ Pig-livers— 30 loose 0 0 2 14 Kidneys— 27 cases, 132 crates, 21 bags, 1,138 boxes 10 6 0 13 Sweetbreads— 8 crates, 5 loose 0 6 3 21 Hearts— 15 bags, 6 crates, 20 loose 0 15 0 13 Plucks— 78 loose 0 2 3 0 Lungs— 16 loose 0 0 1 3 Tongues—1 0 0 0 3 Ox-cheeks— 30 bags 0 9 2 8 Total weight 19 tons 10 cwts. 0 qrs. 10 lbs. There was a very noticeable decrease in the quantity of Ox-livers discharged in the Port of London during the year, especially in the case of those coming from Argentina. The following table shows the result of the examination of certain consignments of Livers. TABLE XXXI. Date. Name of Vessel. Where from. Where lying. No. of diseased or unsound livers seized. Percentage of whole consignment 1912. Jan. 3 s.s. ''Highland Brae" Argentina Royal Albert Dock 94 57.89 16 s.s. '' Highland Warrior " Ditto Ditto 172 33.13 April 18 s.s. "Tongariro" New Zealand Royal Victoria Dock 27 33 Oct. 10 s.s. " Buteshire" Australia Ditto 110 65.47 The condition in which Kidneys arrived showed much improvement. 57 TINNED MEATS. The tinned meats seized and destroyed amounted to 5 tons 17 cwts. 3 qrs. 17 lbs., and included:— Beef— 37 cases and 1,580 loose tins. Mutton— 221 loose tins. Sundry— 50 cases and 3 loose tins. Brawn— 1 cask. SMOKED AND SALTED MEATS. Only 2 tons 16 cwts. 2 qrs. 8 lbs. of this class of meat was destroyed as unsound, and comprised:— Bacon— 3 cases. Hams— 12 boxes and 6 loose. RABBITS (Frozen). 134 crates and 2 loose rabbits, weighing 2 tons 17 cwts., were seized and destroyed. POULTRY AND GAME. Only 3 cases of poultry and game and 10 loose fowls were seized. FISH. The following is a list of the Fish seized and destroyed:— Tons. Cwts. Qrs. Lbs. Dried— 2 cases 0 0 2 10 Salted Eels— 9 casks 1 0 3 18 Tinned Anchovies— 3 cases, 53 tins 0 10 1 0 „ Crab— 35 cases, 455 tins 0 14 0 15 „ Lobster— 1,436 tins 0 12 0 0 „ Salmon— 75 cases, 91 tins 1 13 0 5 „ Sardines— 100 tins 0 0 1 22 „ Fish Paste and Sundries— 54 cases, 7,776 jars 1 17 1 5 Total weight 6 tons 9 cwts 0 qrs 19 lbs. FRUIT. The fruit destroyed as unfit for food was as follows:— Apples— 160 boxes, 85 barrels, a quantity Tons. Cwts. Qrs. Lbs. loose 10 14 0 24 Bananas— 2,577 crates 79 13 1 0 Grapes— 8 cases 0 2 2 26 Lemons— 24 boxes 1 4 0 0 Mangoes— 7 cases 0 1 3 0 Oranges— 268 boxes, 1 barrel. 2 tons loose 19 0 1 17 Passion fruit— 7 cases 0 3 2 0 Peaches— 1 case 0 0 1 0 Pears— 1,241 cases, 33 barrels 21 11 3 25 Prickly pears— 8 cases 0 1 4 0 Plums— 66 cases 7 0 1 20 Tomatoes— 7 crates, 2 cases 0 5 4 16 Total weight 135 tons 0 cwt. 2 qrs. 16 lbs. 58 DRIED FRUIT. Tons. Cwts. Qrs. Lbs. Figs— 168 bags, 10 cases, 186 taps 5 7 2 20 Currants— 2 boxes 0 0 2 24 Dates— 372 bags, 1,355 boxes, 826 cases, 200 mats 111 11 3 12 Peaches— 246 bags 17 12 2 25 Prunes— 5 boxes 0 0 2 27 Raisins— 15 boxes 0 2 2 17 Total weight 134 tons 16 cwts 1 qr. 13 lbs TINNED AND BOTTLED FRUITS. 43 tons 10 cwts. 0 qrs. 1 lb. of tinned and bottled fruits were seized and destroyed. On the 24th October, 22 cases of tinned cherries (weighing about 33 cwts.), lying at Millwall Dock, ex s.s. "Afghanistan," from Leghorn, were seized by one of your Officers, as the tins were badly blown. The consignees were communicated with and given an opportunity of sorting the goods, with a view to saving any that might be found fit for human food. They, however, contended that the goods were sound and wholesome, and expressed their readiness to take delivery of the goods. At their request permission was given them to draw samples of the goods for analysis. The consignees admitted the goods were fermented and not merchantable, yet they insisted that they were not unwholesome, and that they could be treated and used for confectionery purposes, cake making, &c. The consignees declined to consent to the destruction of the goods, and they were taken before a Magistrate at the Thames Police Court and an order of condemnation applied for. In evidence the owners admitted that the cherries were fermented and unsound, but argued that they could be treated in such a way as would render them " merchantable." The magistrate, after hearing the evidence and inspecting the cherries, agreed that they were unsound and unfit for human food; he condemned them and ordered them to be destroyed. Fresh. These consisted of 2,619 bags and 7½ cwts. of loose onions, total weight being 106 tons 6 cwts. 2 qrs. 0 lbs. Preserved comprised Tons. Cwts. Qrs. Lbs. Cauliflower— 1 cask 0 2 0 0 Gherkins— 40 tins 1 0 0 0 Onions— 58 tins 0 1 0 4 Parsnips— 162 tins 0 2 3 16 Turnips— 27 tins 0 0 1 26 Sundries— 24 tins 0 0 2 0 Total 1 ton 6 cwts 3 qrs. 18 lbs. PRESERVED (Jam and Marmalade). Three casks and one case of jam, weighing 12 cwts. 1 qr. 21 lbs. No unsound marmalade came under the notice of your Inspectors. VEGETABLES. 59 NUTS. The only goods under this heading, destroyed during the year were 406 bags of chestnuts, weighing 17 tons 8 cwts. and 33 cases of desiccated cocoanut, weighing 2 tons. There were, however, still under seizure at the close of the year a further 11,323 bags of chestnuts which had not then been dealt with, but the greater part was subsequently destroyed. PROVISIONS. The provisions seized and destroyed were as follows:— Tons. Cwts. Qrs. Lbs. Tea— 8 cases 0 3 2 8 Cocoa— 31 cases and a quantity loose 4 5 2 24 Butter— 10 tins 0 0 2 24 Cheese— Trimmings 5 4 1 24 Condensed Milk— 924 cases 23 2 2 0 Prepared Foods— 8 cases and 144 tins 0 15 1 8 Biscuits and Confectionery— 545 tins 0 5 1 11 Total weight 33 tons 17 cwts 2 qrs. 15 lbs. GRAIN. The greater portion of the grain seized as unfit for human food was subsequently released under a guarantee for poultry or animal food, and a notification sent to the Medical Officer of Health of the district to which it was being taken. The total quantity dealt with during the year was:— Tons. Cwts. Qrs. Lbs. Wheat 2,859 0 1 19 Maize 11 9 3 2 Barley 6 0 0 0 Rice 0 15 3 12 Oats 2 15 0 12 Total weight 2,880 tons 1cwt. 0qrs. 17 lbs. MEAL AND FLOUR. The quantity seized was 178 tons 6 cwts. 1 qr. 4 lbs., and this was dealt with in the same way as the grain. CONDIMENTS AND SPICES. These were limited to nine packages of sauce in bottles, the weight being 4 cwts. 1 qr. 3 lbs. EGGS. Four cases of eggs were destroyed as unfit for human food, the weight being 2 cwts. 1 qr. 20 lbs. DRUGS. Three cases of medicines, weighing 4 cwts., were destroyed. 60 SUNDRIES. The only goods coming under this heading are 4 cwts. 1 qr. 20 lbs. of various foodstuffs. On the 20th July I received a report from the Board of Trade Chief Inspector of Ships' Provisions, that when inspecting the provisions on the s.s. " Uganda," of Glasgow, Official Number 121,258, lying in the South West India Dock, he found one tierce of salt beef (surplus stores) which, in his opinion, was unfit for human consumption. The meat was accordingly examined by one of your Food Inspectors, who seized it as unfit for human food. The fact that the meat was unsound and unfit for human food was brought to the notice of the owners, who were asked to consent to its destruction. They, however, replied asking to be allowed to remove the meat, and stating that they had a market for surplus beef on the West Coast of Africa. This request was refused, and they were informed that unless they consented to the destruction of the meat it would be taken before a magistrate with a view to obtaining an order for its destruction. Thereupon they gave their consent to its destruction, which was carried out in the usual way. CONDENSED MILK. On the 31st October about 850 cases of condensed milk were seized in the Millwall Dock as being unfit for human food. I submitted samples to Dr. F. W. Andrewes for examination, and he reported that he found numerous cells in the milk which were indistinguishable from pus cells, together with a large number of micro-organisms. It was evident that the cells and micro-organisms must have been present in the milk when it was canned, and I therefore took samples of the same brand of milk from a fresh consignment, which had just arrived, and submitted them to Dr. Andrewes. His examination revealed the presence of the same cells and the same organisms. I deemed it desirable to make further investigations, and accordingly various shipments of machine skimmed milk were sampled and examined by Dr. Andrewes. He has submitted to me a lengthy report, which is appended herewith. His conclusions are as follows :— 1. In normal healthy milk, cells are present which are identical with those of pus. In none of the condensed milks examined did I find these cells in greater number than might be expected for the natural cellular content of the milk. The suggestion that such milks contain pus has therefore no warrant. 2. The bacterial content of a large number of the samples examined seems unnecessarily high. That it is unnecessary is shown by the fact that in some samples of machine skimmed condensed milk the number of bacteria is small and their character unobjectionable. It would sppear that the process of Pasteurisation is in the latter case adequately, and in the former case inadequately, carried out. To set up any numerical standard in this respect might prove difficult if it were shown that bacteria multiply in condensed milk, because the number would vary with the age of the sample. 61 3. The presence in a condensed milk of staphylococcus pyogenes aureus in any considerable number appears to me objectionable, but, again, for the reason just stated, it is difficult to suggest any numerical standard. Speaking purely as a pathologist, and leaving it to those concerned to decide whether the suggestion is practicable, I should be disposed to condemn a condensed milk the sediment of which yields a culture of staphylococcus in which staphylococcus pyogenes aureus formed a noticeable element. With adequate Pasteurisation the absence of this coccus could, I believe, be secured. This machine skimmed milk is placed in tins of varying sizes, which are sold principally to the poorer classes, and there is no doubt that much of it is consumed by children and infants, although the labels on the tins are marked distinctly that the milk should not be used by infants. There is considerable evidence that the mortality of infants and children fed on condensed milk is much greater than those fed on ordinary milk. I have addressed letters to the Commissioners for Denmark and Holland, which are the countries chiefly concerned in importing this class of milk, making the following suggestions:— (a) That careful supervision should be made of cows on the dairy farms to ensure that no milk from cows with any inflammatory condition of the udder is sent to the factory for condensation. (b) That the milk should be exposed to a sufficiently high temperature, after condensation, to ensure that all micro-organisms are killed. Some good condensed milks contain very few organisms, so it is evident that many of those which have been examined have not been submitted to a sufficiently high temperature. I have received letters from them as follows :— Harald Faber, F.C.S., 7 and 8, Idol Lane, Commissioner to the Danish Government. London, E.C., oth December, 1912. Dr. Herbert Williams, Medical Officer of Health, Port of London, Greenwich. Dear Sir, In reply to your letter of the 3rd instant, for which I am much obliged, I have noticed the points in Dr. Andrewes' report which you mention, and I am to-day writing to the factory to point out what you say and to recommend the supervision of cows and the heating of the milk after condensation. An examination at the laboratory in Copenhagen has fully confirmed Dr. Andrewes' opinion of the samples. This refers to the samples taken before my visit to you. Yours faithfully, (Signed) HARALD FABER. 62 Dr. J. L. Van Ryn, Rijkslandbouwconsulent der Nederlanden Netherland Agricultural Commissioner Voor Groot-Britannie en Ireland, for Great Britain and Ireland. 50, Mount Park Road, Ealing, London. The Medical Officer of Health, 5th December, 1912. Port of London, Greenwich. Sir, I beg to acknowledge the receipt of your letter of the 3rd instant, and note with great pleasure that the difficulties with regard to condensed milk are now removed. I may add that I fully agree with the recommendations made by you, and that I will take the necessary steps to give effect to them. Our only desire is to supply this market with foodstuffs to which no reasonable objections can be raised, and you can rest assured that I shall always be pleased to co-operate with you to obtain that result. I am, Sir, Your obedient Servant, (Signed) J. J. L. VAN RYN, Agricultural Commissioner to the Netherlands Government. The position is one of some difficulty. There is, on the one hand, the protection of the public, especially the infant life, and on the other there is the interference with a large trade, but there is no doubt that the milk should be sterilised before being canned, which would lessen any risk to the health of infants. The following is Dr. Andrewes' report in full detail :— REPORT ON CONDENSED MILKS. On 31st October, 1912, I received from Dr. Williams a tin of condensed milk. He stated that he had reason to suspect its quality. I found the sediment of this milk to consist largely of polynuclear leucocytes with large numbers of staphylococci and hardly any other microbes. The appearance of the stained film so strongly suggested pus that I felt no hesitation in condemning the sample. During the following few days Dr. Williams sent me further samples of machine skimmed condensed milks. I found them all to contain an abundance of polynuclear leucocytes and staphylococci, and they seemed equally worthy of condemnation. It appeared later that all the milks emanated from the same factory under different names. Shortly afterwards I received further samples of similar milks. These also were found to present much the same characters, though the abundance of polynuclear leucocytes and staphylococci was not quite so marked as in the former brands, so that, though with some misgiving, I did not feel justified in condemning them off-hand as I had condemned the other samples. 63 There exists no cytological or bacteriological standard in this country by which an authoritative judgment upon a condensed milk can be given. Much attention has been paid to the cells and bacteria in fresh milk, but I am aware of comparatively few observations on the bacteria, and none on the cellular, contents of condensed milk. In consultation with Dr. Williams it was decided that I should examine a number of different samples, good as well as doubtful, in order, if possible, to arrive at some standard. Dr. Williams has furnished me with specimens of all or most of the brands arriving in the Port during the past few weeks, and I have studied altogether 57 samples. This has been sufficient for me to arrive at certain conclusions, which I shall state in the following report :— The Nature of Condensed Milks. These fall into two main classes :— I. The higher class of preserved milks contain the full fat contents of the original milk, and are for the most part unsweetened or either uncondensed, or but little condensed, so that they are quite liquid. Such milks are necessarily sterilised, because otherwise they would not keep, for they are eminently favourable media for bacterial growth. Other milks, while containing the full cream, are condensed and slightly sweetened. They are sometimes sold as sterilised, but they keep well even if they are not, because the physical and chemical properties of the mixture are unfavourable to bacterial growth. II. The lower class condensed milks are prepared from machine skimmed milk, and the fat content is so small that their food value is very low. Sugar is added and the mixture is evaporated at a comparatively low temperature under diminished atmospheric pressure. These milks are not sold as sterilised, nor, in my experience, are they ever sterile, though the more easily killed bacteria of fresh milk are destroyed, and those that remain grow with difficulty in the dense and syrupy product. The condensed milks which have fallen under suspicion belong to the last class. Such a product must be judged bacteriologically by the potential harmfulness of the bacterial content, and this content may be very unlike that of the fresh milk from which it was prepared. Methods of Examination. My practice has been to cleanse the outside of the tin with sterile water, and to open it with a tin-opener freshly boiled for each tin. With a freshly boiled teaspoon I then transfer three teaspoonfuls of the milk, well stirred up from the bottom of the tin, to about half a pint of recently boiled and cooled normal saline solution, in a sterile beaker. The mixture is stirred until thoroughly dissolved, and then placed in a sterile conical glass, covered with a sterile glass plate. Here it stands overnight, and the sediment is examined in the morning. No judgment can be formed from the apparent volume of the sediment, because this may largely consist of crystalline material which does not go into solution. Indeed, the crystalline matter diminishes, by dilution, the apparent number of cells present of rough microscopic examination. 64 For this microscopic examination I proceed as follows:— The milk is poured away as far as possible, leaving only the sediment. I then take up into a sterile capillary pipette a little of the sediment from the extreme apex of the conical glass. One very small drop is placed on a sloped agar culture tube and distributed over the surface; the tube is then incubated at 37° C. for 24 hours, and afterwards at 20° C. A. second small drop is placed on a slide and spread into an even film; this is fixed, when dry, in absolute alcohol and methylene blue. A third drop is placed on a slide, covered with a cover glass, and examined unstained for crystals, cells, &c. By this routine, carried out in exactly the same way in every case, a fair, if rough, comparison can be made between different samples. But no exact quantitative comparison is thus possible, and for determining the cellular content of selected samples I have employed more refined methods. For the estimation of the number of cells in condensed skimmed milk it suffices to take a measured amount and dilute it four or five times with 1 per cent, caustic potash. The cells can then be counted with a haemocytometer and the number per cubic millimetre easily estimated. In milks containing the full cream this is not possible. Here I take a measured amount into a centrifruge tube, dilute with weak caustic potash, centrifugalise for 10 or 15 minutes, pipette off the supernatant fluid, fill up again with normal saline, and again centrifugalise. The fluid is again pipetted off and Joison's fluid is added up to the original amount of condensed milk. The mixture is now well stirred and the cells estimated by the hsemocytometer. The nature of the cells present is determined by a differential count on films stained with methylene blue. In a condensed milk the cells have suffered such changes that more refined methods of staining are almost useless. I have tried Leishman's stain and Ehrlich's triacid stain, but they give but vague representations compared with the fresh cell. Such differential counts are not easy; certain cells are clearly recognisable as mononuclear and others as polynuclear, while others are plainly squamous epithelium, but there are many cells which cannot be assigned with certainty to any category. I have carried out differential counts of the cells in 14 cases, but I have contented myself with estimating the percentage number of cells which in my judgment were certainly polymorphonuclear leucocytes. In a few cases I have resorted to animal experiment. In six consecutive samples of condensed milks, early in the series, I injected the sediment from three teaspoonfuls of the milk subcutaneously into guineapigs. These were samples of machine skimmed milk which I was disposed to condemn. The Cellular and Bacterial Content of Normal Fresh Milk. This has been amply studied, and the following facts are generally accepted:— Fresh milk from normal cows contains from 50 to 100 up to more than 1,000 cells per cubic millimetre. Of these some are squamous epithelium from the teats, some are epithelial cells from the mammary gland and ducts, and some are mononuclear cells resembling lymphocytes. But a large proportion are cells with a lobed and twisted nucleus resembling ordinary polynuclear leucocytes. Some observers have considered these to be derived from mammary epithelium, but they cannot be distinguished histologically from leucocytes, and my own opinion is that they are leucocytes. The important point is that these cells, whatever their nature, are present in considerable numbers in milk from selected normal cows 65 presenting no evidence whatever of disease in the mammary gland. Polynuclear leucocytes are the cells especially characteristic of acute inflammation, and are the essential ingredients of pus. But in view of the above facts it is clear that no milk should be accused of containing pus unless such cells are present in immoderate and disproportionate numbers. The bacterial content of fresh milk is of various nature. It is unavoidable'that it should contain certain microbes from the skin of the cow and the milker, and amongst these are staphylococci, sometimes staphylococcus pyogenes aureus. The chief source of bacterial milk pollution is cow dung, so abundantly present on the hind quarters and belly of the animal and even on the udder. Unless the most exceptional care is taken, some admixture of cow dung with milk is the rule. The main organisms in milk are thus of excremental origin, and include streptococci, bacillus coli, and bacillus enteritides sporogenes. In fresh milk, as sold in shops, these organisms are invariably found in numbers proportional to the original pollution of the milk and to the temperature at which it has been kept during the interval since milking. Thus it is common to find 1,000 or more B. coli and 1,000 or even 10,000 streptococci per c.c. of milk, for these organisms multiply rapidly unless the milk is kept very cool. But staphylococci are not usually found in such large numbers. The Cellular and Bacterial Content of Preserved Milk. Here, as I have already said, our knowledge is much more scanty. As regards the cellular content I have had to make my own observations. I have taken as a standard the best whole milk imported uncondensed in tins and sterile on culture. These have furnished the following results :— Sample 1—Total cells 2,200 per c. mm.—60 per cent, polynuclears. „ 2 „ 830 „ 62 „ „ o „ 3o0 „ 57 „ y ,, 4 ,, 660 ,, 57 ,, ,, n ^ n a 66 ,, ,, „ 6 „ 480 „ 67 „ „ a 7 a 2,100 „ 73*5 „ ,, (The last sample was not quite sterile on culture.) It will be apparent from these figures that the high-class preserved milks have a cellular content much the same as normal fresh milk, as might have been anticipated. But if they are diluted and allowed to stand in a conical glass, a sediment is obtained, which in a stained film presents a colourable imitation of pus, so far as its cytological aspect goes, though it differs in the absence of pyogenic microbes. In examining stained films of the sediments from the seven high-class unsweetened milks just menrioned, I found one group of ill staining and probably dead staphylococci in each of two samples ; otherwise not a single microbe was seen. The Cellular Content of Condensed Machine Skimmed Milk. Stained films from the sediments from these may show no greater apparent abundance of cells than a high class milk. In other cases, and these the more frequent, the cells appear more frequent in films, sometimes very much more numerous. Nevertheless, actual counts of the number of cells per c. mm. are no higher than in good milk. (The highest count I have obtained is 1,800 per c. mm. of the undiluted 66 fluid.) "This sparseness of cells ,in a condensed milk is probably due to the fact that they are in part got rid of in the sediment which is carried down during centrifugalisation and adheres to the vessel. Moreover, differential counts on films from machine skimmed brands, even when these are swarming with staphylococci, present no deviation from those seen in good milks. Thus in seven samples the percentage of polynuclears was 57, 62, 74.5, 64, 60, 60 and 68. It might be expected that the presence of actual pus in the milk, or even the admixture of milk suffering from non-suppurative mastitis, would raise the percentage of the polynuclears. Experience has, however, shown in the case of fresh milks that too much reliance must not be placed on this, because in a herd the milk of one or two affected cows mingled with a hundred or more normal milks scarcely affects the cellular content of the whole. Conclusions as regards the Cells in Condensed Milk. I have to admit that the studies of condensed milks which I have outlined above have considerably modified my first opinions as to the nature of the cellular contents of condensed milk. I no longer think that one should apply the term "pus" to a sediment merely because it is rich in polynuclear cells, without a count of the actual number of such cells per cubic millimetre of the milk and a careful consideration of the associated microbes, and even here there may be fallacies which I shall consider below. That the presence of such cells in very large numbers may indicate pus no one will dispute, but it is not a matter to be settled without careful consideration. The Bacteriology of Condensed Milks. I have said that unsweetened and little condensed milks are necessarily sterilised ; they have no bacteriology. One cannot find bacteria in them microscopically, since the dead bodies of the original bacteria in the fresh milk appear to become disintegrated and invisible. At most one may find a few badly stained ghosts. In the case of sweetened condensed milks the case is very different. In the course of these investigations I have examined 44 tins of such milk by ordinary bacteriological methods, though in no case quantitatively. That is to say, I have made agar cultures from a minute quantity of the sediment from each milk, about the same amount in each case, being a very small drop from the end of a capillary pipette. The results are roughly comparable, but only roughly. In a preliminary investigation of this kind I deemed it unnecessary to attempt quantitative estimations, though it may clearly be necessary to do so if any arbitrary standard is to be set up. In no single one of the 44 tins examined were living bacteria absent, and they were usually present in considerable numbers. In the process of preparation the condensed milk seems to be subjected to a temperature sufficient to destroy the bulk of the contained bacteria, and when prepared the chemical nature of the product seems to render it unfit for the life, or at least for the growth of most surviving bacteria. All observers are agreed that the bacterial contents of condensed milk is greatly less than that of fresh milk, and that even when the tin is opened its contents undergo decomposition slowly. We have therefore to consider the survival chances of the 67 bacteria in milk which is being condensed. Streptococci, which are the most abundant organisms in ordinary milk, are the most easily destroyed, and although I have found them present in certain samples, they are an inconspicuous feature of condensed milk. Bacillus coli and its allies are also largely destroyed. Some observers have failed to detect bacilli of this group in samples examined, but I have noticed them in seven or eight specimens, and if I had employed differential culture media, I should probably have found them more frequently present. Bacillus proteus is also occasionally found. Staphylococci, on the other hand, are commonly very abundant, in many cases only staphylococcus albus, but often typical staphylococcus aureus, rapidly liquefying gelatin and fermenting mannite. Certain samples yield pure cultures of staphylococcus aureus and albus. Bacterial spores escape destruction, and colonies of Bacillus mesentericus and its allies are often seen in cultures, but they are rarely numerous, probably because they are sparse and accidental air contaminations of the original milk, and cannot multiply in condensed milk. I have not devoted special attention to the spores of anaerobic bacilli in condensed milks, but I know that they may be present. So far as my present observations go, the only microbes which demand more detailed consideration are the staphylococci in condensed milk. No one who is acquainted with the methods of preparation of this product, which is not sold as sterile, and with the bacteriology of fresh milk, could condemn it because it contained the bacteria of fresh milk in greatly diminished numbers, or such harmless air contaminations as Bacillus mesentericus. But when a condensed milk yields pure and abundant cultures of Staphylococcus pyogenes albus and aureus the question of its wholesomeness demands very careful consideration. When a film from the sediment of condensed milk is crowded with polynuclear leucocytes and swarming with staphylococci, and when a cultivation yields a pure growth of staphylococcus pyogenes aureus and albus, the inference that pus is present in the milk is at first sight irresistible. From the examination of this series of machine skimmed milks a general impression is left on my mind that an apparent abundance of polynuclear cells as often associated with large numbers of staphylococci. But I must admit that this rule is not invariable. In some cases I have found an abundance of polynuclears with few staphylococci, and in others crowds of staphylococci with relatively few polynuclears. Moreover, in none of these cases have I found the percentage of polynuclears increased above that in good preserved milks. I have therefore considered very carefully whether any alternative explanation of the phenomenon is possible, and the following one seems to me at least conceivable. The polynuclear cells do not, so far as I can determine, exceed in absolute numbers what might be expected from the content in normal milk of such cells. No special explanation is needed for their presence. As regards the staphylococci, it is known that these organisms, indistinguishable from the ordinary pyogenic staphylococci aureus and albus, occur in the skin of cows, and their presence in milk is well known. Amongst non-sporing bacteria staphylococci are remarkably resistant to heat, and would be likely to survive better than most other bacteria the processes involved in condensing a milk. If, now, they were able to grow in the condensed milk, an explanation of the phenomenon I am considering would be forthcoming, for we should find a pure culture of staphylococci intermingled with the cells characteristic of pus. From the grouping of the staphylococci in large clumps in the milk sediments, and from their active and well stained appearance, I think it probable that they do grow in condensed milk, though I have not at present carried out experiments to prove this. 68 I put forward this suggestion in a tentative way as possibly explaining certain of the cases in which the appearance of pus has been presented. In other cases it may well be that the suggestion of inflammation is a true one, for amongst the immense herds of cows furnishing the factory milk there must be some unrecognised cases of mastitis. Cultural Results from Sediments of Machine Skimmed Milks. I here tabulate the results of cultures from 42 tins:— 1. Staphylococci, pure, or in overwhelming predominance - 30 tins. 2. Staphylococci and Bacillus colt in roughly equal abundance - 5 „ 3. Mixture of various Bacilli, &c., Staphylococci relatively few- 7 „ It will be seen from these figures that pure cultures of staphylococci are by no means always found, and, indeed, the large proportion of samples in which I obtained them is probably due to the fact that 28 out of the 42 tins thus examined were from a certain factory, the product of which was under suspicion. All but one of these 28 tins yielded almost pure growths of staphylococci. That this need not be so is seen by the seven tins in the third group, which yielded a relatively scanty crop of various bacteria, with only occasional colonies of staphylococci, and to which no bacteriologist could raise any objection. A difficult question remains for consideration, namely, the wholesomeness of a condensed milk containing an abundance of staphylococcus pyogenes aureus and albus. I am not able to offer a decisive opinion on this point. On the one hand it is certain that these microbes are the cause of inflammatory suppurative affections in man, when they gain access to the tissues, and the resistance of the patient is sufficiently low. On the other hand, we bear these organisms on our skins and mucous membranes, where they live as saprophytes without impairing health so long as our resistance is normal. I cannot adduce evidence that the swallowing of such a dose of staphylococci as would be contained in the amount of a condensed milk consumed in a single meal would produce any prejudicial effect. But it must be remembered that we are here dealing with a product which may be kept for months before it is used, and if, as I think possible, the staphylococci multiply in the tins, the content of the milk in staphylococcal endotoxin, from dissolution of many of the cocci, may become considerable. I dare not therefore affirm that such milks are harmless. In the six instances in which I injected the sediment from condensed milks, all of which contained abundant staphylococci, into guineapigs, no acute suppuration was produced, though in four cases a local inflammatory swelling occurred, subsiding after a few days. The guineapig is not as a rule susceptible to infection with staphylococci unless these are of high virulence, so that too much stress must not be laid on this negative result. My own opinion is that the presence of staphylococcus pyogenes aureus in large numbers in a condensed milk is objectionable. I cannot prove that it is dangerous, though I suspect it. The presence of living and perhaps multiplying pathogenic organisms in a preserved food cannot be regarded with indifference, even though such organisms are normally present on the skin and mucous membrane. 69 Less stress should probably be laid on those staphylococci yielding a white growth. There is, it is true, a staphylococcus pyogenes albus which is a mere variety of staphylococcus pyogenes aureus, and seems identical with it in pathogenic powers, but there are also other comparatively harmless white staphylococci, common on skin surfaces, and distinguishable from the actively pyogenic form only by more or less elaborate tests. The Results of Animal Experiment. I have already alluded to these so far as concerns the absence of any immediate production of suppuration when sediments from certain of the milks were inoculated into guineapigs. It is too early to determine whether any of the animals will become tuberculous ; the object of the inoculations would be frustrated by killing them at this stage, and the result must be related in a few weeks' time in an addendum to this report. General Conclusions. (1) In normal healthy milk, cells are present which are identical with those of pus. In none of the condensed milks examined did I find these cells in greater number than might be expected from the natural cellular content of the milk. The suggestion that such milks contain pus has therefore no warrant. (2) The bacterial content of a large number of the samples examined seems unnecessarily high. That it is unnecessary is shown by the fact that in some samples of machine skimmed condensed milk the number of bacteria is small and their character unobjectionable. It would appear that the process of Pasteurisation is in the latter case adequately, and in the former case inadequately carried out. To set up any numerical standard in this respect might prove difficult if it were shown that bacteria multiply in condensed milk, because the number would vary with the age of the sample. (3) The presence in a condensed milk of staphylococcus pyogenes aureus in any considerable number appears to me objectionable, but again, for the reason just stated, it is difficult to suggest any numerical standard. Speaking purely as a pathologist (and leaving it to those concerned to decide whether the suggestion is practicable), T should be disposed to condemn a condensed milk the sediment of which yielded a culture of staphylococci in which staphylococcus pyogenes aureus formed a noticeable element. With adequate Pasteurisation the absence of this coccus could, I believe, be secured. F. W. ANDREWES, M.D., F.R.C.P., D.P.H. St. Bartholomew's Hospital, December 5th, 1912. 70 TABLE XXXII. General Summary, and Analysis, of the Sanitary Inspections of Vessels, &c., in the Port of London, for the year ended 31st December, 1912. 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. 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. To be Cleaned. Inspected. Defective. To be Cleaned. Inspected. Defective. To be Cleaned. No. in District in good condition, 31 at December, 1912. New Barges Condemned. Use Discontinued. No. In District Slat december, 1913. 13908 171 1616 1270 8 153 3170 29 233 1248 17 85 897 11 49 14044 233 447 3543 3 328 841 95 27 4292 64 509 - 18 - - - 18 Total Inspections to 31st December, 1911 980,678 Docks and River. No. Nationality. Arrived from Foreign Ports. No. of inspections. Arrivals Per cent. of Total. Total Inspections from 1st January to 31st December, 1912- St. Katharine's 1,101 American - — — London 2,152 Argentine 5 11 .05 Austrian 24 44 .26 "Foreign" 15,177 Regent's Canal 682 Belgian 322 356 3.54 "Coastwise" 4,418 Millwall 2,678 Brazilian - — - "Inland Navigation" 19,325 British† 5,302 9,168 56.31 West India 1,748 Danish 253 466 2.78 Premises on shore 4,292 Poplar 89 Dutch 601 770 6.60 Finnish 21 71 .23 206 43,212 East India 833 French 122 1.34 Total 1,023,890 German 857 1,240 9.31 Cleansing of Crew's Quarters, &c. :— Victoria 3,085 Greek 6 27 .05 Royal Albert 2,860 Italian 9 34 .09 Japanese 56 96 .61 Total to 31st December, 1911 64,588 Commercial 2,734 Roumanian — — — Total No. of Vessels from 1st January to 31st December, 1912 2,954 Tilbury 1,965 Russian 147 305 1.61 Siamese 1 3 .01 Gravesend District 2,887 Spanish 57 84 .62 Total 67,542 River—*Upper District 6,155 Swedish & 1,311 2,295 14.41 Norwegian Number of vessels inspected :— In the Launohes— *Middle 5 871 Mexican 1 1 .01 *Lower „ 4,080 Portuguese — — — "Lady Truscott" 3,255 Uruguayan — - — Medway Nil. Chilian 1 — .01 "David Burnett" 3,619 "Clotho" 3,454 Total vessels 38,920 Total vessels † Coastwise and Inland navigation 9,096 15,177 23,743 "Denton" 3,603 Shore premises 4,292 Shore premises 4,292 Total 43,212 Total 43,212 97.85 Total 13,931 In the Docks, &c. 24,989 *Upper District extends from Limehouse to Teddington. *Middle „ „ „ Limehouse to Erith. *Lower „ „ „ Erith to outer limits of Port of London. Total 38,920 COMPARATIVE TABLE. Total number of Inspections of vessels from— 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Yearly average for the 10 years ending 31st December, 1912 "Foreign" "Coastwise," "Inland 15,989 15,685 14,279 13,013 17,971 15,258 14,887 13,710 14,015 15,177 14,998.4 Navigation," and other Inspections 19,496 19,700 19,975 22,335 19,414 20,014 25,469 24,857 24,009 28,035 22,330.4 Total 35,485 35,385 34,254 35,348 37,385 35,272 40,356 38,567 38,024 43,212 37,328.8 71 SANITARY INSPECTION. In Table XXXII. is given a summary of the work of sanitary inspection as carried out by the Inspectors throughout the Port. From this Table it will be seen that the total number of visits of inspection throughout the year was 43,212. Of this number 15,177 were to vessels from foreign ports; 5,418 were to "coastwise" vessels; 19,325 to barges and other craft engaged in traffic within the Port, while 4,292 inspections were of workplaces, sanitary conveniences and other premises on shore. Of the total number of vessels inspected 2,938 required cleansing as regards crew's quarters, while nuisances generally, including the above, to the total of 4,648, were discovered and dealt with during the year. These are dealt with in greater detail in Tables XXXIII-IV., relating to Nuisances. From the list of Nationalities (Table XXXII.), it will be seen that the greater number of vessels inspected were, as usual, British. Of foreign nationalities, the majority were Swedish and Norwegian with 14.41 per cent., Germany being second with 9.31 percent., other nationalities being in lesser proportion. Of the total number of vessels inspected, 13,931 were visited in the steam launches, while 24,989 inspections were made in the docks. NUISANCES. The total number of Nuisances reported during the year was 4,684—see Tables XXXIII-IV. Of these 4,061 were on vessels, 585 related to premises on shore, while 2 were in relation to the river itself. Of the nuisances on ships, by far the larger number, 2,954, were from the dirty condition of the crew's quarters. This is a constantly recurring offence, and it will not be, of course, satisfactorily remedied until there is some radical alteration in the habits of firemen and seamen. Foul bilges and forepeaks accounted for 223, and defective ventilation, lighting and heating for 349. Leaky decks, hawsepipes, etc., 116, and 14 arose from the condensation on bare iron bulkheads and floors. Complaints of the insanitary condition of closets and similar conveniences numbered 26. Smoke nuisances from vessels totalled 240. This class of nuisance is coming under control and in practically all cases an intimation is sufficient to produce an immediate abatement. It will be noticed that only one case of recurrence was reported. With regard to shore premises, the number of Smoke Nuisances reported was 30 and no case of recurrence was reported. The total number of nuisances in respect of shore premises was 585, and of this number 509 related to premises in generally dirty and insanitary condition, not necessitating any Structural Alterations. The Sanitary Works and Alterations, Table XXXV., were all carried out under the immediate supervision of your officers, plans being submitted to your Committee in practically every case. No serious difficulty has arisen in connection with any of this work, but I am still of opinion that the powers of the Authority in this direction need strengthening, and that the existing conditions relative to sanitary conveniences and the disposal of refuse in the docks are far from satisfactory. The docks employ a considerable working population, most of whom spend the entire hours of labour within the dock gates, and it is, therefore, important that there should be no lack of conveniences for all classes, and that these should be in accordance with the public health standards of the neighbouring districts for people of a similar class. 72 TABLE XXXIII. NUMBER OF NUISANCES ON VESSELS REPORTED AND DEALT WITH during the year ending 31st December, 1912. Description of Nuisances. January. February. March. April. May. June. July. August. September. October. November. December. Totals. Smoke Nuisances:— Number of complaints received 26 8 5 ... 21 8 41 16 43 30 21 21 240 Number of recurrences reported ... ... ... ... ... ... ... ... ... ... 1 ... 1 Offensive Cargoes (Bye-laws):— Number of Infringements reported 1 1 3 2 7 12 2 4 ... 4 4 3 43 Structural and other Defects:— Ventilation 5 5 5 23 3 4 24 10 6 5 10 8 108 Lighting 14 21 20 33 10 5 13 9 9 10 11 8 163 Heating 9 6 10 20 2 ... 1 3 5 7 7 8 78 Bare iron in crew's quarters 3 3 1 ... ... ... 3 ... ... ... 1 3 14 Leaky decks, hawse-pipes, cable casings, &c. 16 6 20 22 5 6 4 5 10 8 7 7 116 Defective bulkheads and floors 3 2 5 4 2 ... 1 ... 3 3 2 2 27 Sanitary conveniences ... 2 1 2 7 1 ... 5 1 1 1 5 26 Ship's gear or stores stowed in crew's quarters ... 1 6 8 ... ... 1 ... ... ... ... 2 18 Foul bilges and peaks 4 8 29 31 17 5 15 20 19 28 22 25 223 Storage of drinking water (dirty or defective tanks) ... 2 4 4 ... 2 ... ... ... 1 2 1 16 Dirty quarters 250 239 252 242 274 200 230 219 245 285 267 251 2,954 Accumulation of offensive matter 1 ... ... ... 2 ... ... 1 ... ... •• 1 5 Miscellaneous Nuisances ... 3 7 2 2 1 4 ... 2 ... 6 2 29 Totals 332 307 368 393 352 244 339 292 343 382 362 347 4,061 Total number of vessels on which structural alterations were ordered 36 41 57 89 26 14 39 29 31 27 32 33 454 Total number of vessels on which structural alterations were reported as carried out 18 50 19 27 50 63 7 26 14 49 14 44 381 NUMBER OF NUISANCES IN THE RIVER REPORTED AND DEALT WITH during the year ending 31st December, 1912. From discharge of foul liquid, sewage, 4c., into the River ... ... ... ... ... 1 ... 1 ... ... ... ... 2 Offensive condition of River water ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ... ... ... ... ... 1 ... 1 ... ... ... ... 2 73 TABLE XXXIV. NUMBER OF NUISANCES ON SHORE PREMISES REPORTED AND DEALT WITH during the year ending 31st December, 1912. Description of Nuisances. January. February. March. April. May. June. July. August. (September. October. November. December. Totals. Smoke Nuisances:— Number of complaints received ... 5 ... ... ... 4 ... 1 4 8 5 3 30 Number of recurrences reported ... ... ... ... ... ... ... ... ... ... ... ... ... Structural and other Defects:— Ventilation ... ... ... ... ... ... ... ... ... ... 1 ... 1 Lighting ... ... ... ... ... ... ... . . . ... ... ... ... ... Heating ... ... ... ... ... ... ... ... ... ... ... ... ... Dilapidations ... 1 ... ... ... ... ... ... ... ... ... ... 1 Sanitary conveniences 1 2 2 ... 1 4 ... 2 2 ... 2 1 17 Water supply ... ... ... ... 1 ... ... 1 ... ... ... ... 2 Dirty premises 38 38 32 29 72 33 94 29 34 37 44 29 509 Accumulation of offensive matter 1 ... ... ... 1 ... ... ... ... 3 1 ... 6 Drainage ... ... ... ... ... ... ... 1 ... ... ... ... 1 Foul cesspits, latrines, &c. 1 3 1 ... ... 2 ... ... ... ... ... ... 7 Miscellaneous nuisances 1 2 3 1 ... 1 1 ... ... 1 ... 1 11 Totals 42 51 38 30 75 44 95 34 40 49 53 34 585 Number of shore premises on which structural alterations were ordered 2 2 2 ... 1 3 2 2 2 ... 2 1 19 Number of shore premises on which structural alterations were reported as carried out 1 1 2 ... 1 1 3 2 2 ... 3 3 19 SUMMARY. Smoke. Structural. Offensive Cargoes. Drainage, Sewage, &c. Miscellaneous Totals. Number of Nuisances reported— (a) On vessels 240 548 43 ... 3,230 4,061 (b) On shore 30 21 ... 1 533 585 (c) On the River ... ... ... 2 ... 2 Totals 270 569 43 3 3,763 4,648 Number of written Intimations— (a) On vessels 113 375 20 ... 240 748 (b) On shore 2 7 ... ... 17 26 (c) On the River ... ... ... ... ... ... Totals 115 382 20 ... 257 774 Number of Statutory Notices— (а) On vessels 6 2 2 ... ... 10 (b) On shore ... ... ... ... 2 2 (c) On the River ... ... ... ... ... ... Totals 6 2 2 ... 2 12 74 TABLE XXXV. Part I. Date completed. Works. 1912. Jan. 13 Tilbury Dock— Alterations to closets and drains at Western Office. March 22 London Dock— Construction of sanitary conveniences at Ambulance Station. April 11 East India Dock— *Erection of water closet accommodation for Messrs. Johnson and Jorgenson's new premises at Nos. 12 and 13 Warehouses. „ 18 Royal Victoria Dock— Construction of drainage at Messrs. Rank's premises. May 6 Millwall Dock— Drainage at Canadian Pacific Railway Co.'s new premises. „ 25 West India Dock— †Construction of drains for new office (warehouse-keeper's) at No. 6 Remote, North Quay. Aug. 12 St. Katherine's Dock— Erection of sanitary conveniences at " B " warehouse. „ 13 Tilbury Dock— Construction of new closets, urinals and drainage thereto, at "E" shed. „ 19 Milwall Dock Railway Extension— Erection of two new urinals and one water closet near No. 1 Railway Bridge. Oct. 24 West India Dock— New drainage for General Offices, Import Quay. Nov. 13 Tilbury Dock— Erection of closet and drain at the Clerk of Work's Office, Tilbury Main Dock Extension Works. „ 23 London Dock— Erection of urinal at the Strong Spirit Store, South Quay. „ 25 Tilbury Dock— Connection of drainage with public sewer (Contractor's yard). Dec. 1 Surrey Commercial Dock— Erection of urinal at Steel Yard. 1 Surrey Commercial Dock— New drainage for Motor Ambulance Garage. „ 4 St. Katherine's Dock— Erection of new two-stall urinals near No. 5a Gate, " C " warehouse. „ 17 Millwall Dock— Provision of drainage at Fruit Office. „ 24 Surrey Commercial Dock— Erection of sanitary conveniences at Norway Yard. „ 24 Surrey Commercial Dock— Erection of dry closet and urinal at Russia Yard North. „ 30 Surrey Commercial Dock— Construction of sanitary conveniences and drainage for same at Commercial Yard. „ 30 Surrey Commercial Dock— Erection of sanitary conveniences at Brunswick Yard. * Structure and type of trough closet (men's closet) is not approved by your Officers, and therefore was not passed as satisfactory. † Old brick drain not abolished. Part II. Sanitary Works and alterations, not yet reported as completed :— Date Plan submitted. Works. 1912. Jan. 2 Millwall Dock— Proposed new urinal, North side. „ 24 London Dock— Proposed re-drainage, General Office. Feb. 3 London Dock— Proposed construction of new urinal at No. 11 warehouse. „ 15 Royal Albert Dock— Proposed erection of sanitary conveniences at new Impounding Station. March 15 West India Dock— Proposed drains for Motor Ambulance Station. „ 19 St. Katherine's Dock— Proposed alteration in drainage at Messrs. Travers' premises. April 16 London Dock— Proposed new drainage at North Quay. „ 25 Surrey Commercial Dock— Proposed erection of a two stall urinal, Upper Quebec Yard. May 3 London Dock— Proposed construction of new drainage at North Quay, Western Dock. July 3 Regent's Canal Dock— Proposed closet accommodation for new warehouse at South Quay. „ 4 London Dock— Proposed re-construction of drainage at Oil Vault, Western. Dec. 7 St. Katherine's Dock— Proposed water closets, &c., on top floor "C" Warehouse. „ 24 Royal Albert Dock— Proposed erection of two Moule's Patent Earth Closets at Messrs. Scrutton's premises. 75 VENTILATION OF CREW SPACES. "The proper ventilation of every space on a vessel appropriated to the officers and crew is perhaps the most important point a Surveyor has to consider and decide upon in connection with crew space inspection." These words are taken from the Instructions issued by the Board of Trade as to the Survey of Master's and Crew Spaces, which also provide that "there should not be less than two ventilators, one serving as an inlet for the admission of fresh air and the other as an outlet for the escape of impure air, whether the accommodation consists of forecastle, poop, round house, side house, or cabins." "Wherever practicable, all cabins should have an efficient ventilator fitted in the deck above them." In the majority of cases this is not considered practicable, and so many cabins are not provided with ventilators. "Where a forecastle or deck-house is divided by a fore and aft bulkhead or close partition, care must be taken that the ventilation of each space is complete in itself." The forecastles of ships are generally divided into two spaces for the accommodation of seamen and firemen respectively, but it is quite the exception to find that the ventilation of each space is complete in itself. The practice is to put one ventilator in each space and to leave a few small openings at the top of the partition, which is considered technically to make the crew's quarters into one space. "Skylights made to open cannot be relied upon as efficient ventilators available under all conditions of the weather, and they should not be accepted in the place of the ventilators ordinarily required." I have selected some instances met with of defective ventilation and give below notes of the same. The s.s. "-," was inspected on the 29th December, 1904. The ventilators in the sailors and firemen's quarters were being used for the passage of stove funnels. This was brought to the notice of the owners, and of the Board of Trade. An inspection was made by the Surveyor of the Board, and I received a communication from them as follows:— "10th January, 1908. "With reference to your letter of the 6th ultimo, I am now informed by the Board that after inspection of this vessel's crew spaces at a port in the North, they are satisfied with the ventilation as to amount, and the arrangement for stove funnels. The bulkhead in the middle line being open to a certain extent, the spaces are considered for ventilation as one." The vessel subsequently arrived in this Port on the 27th June, 1912, and was personally inspected by me. I found in the crew's quarters forward, each space ventilated by one ventilator which passed through a mooring bitt, and there was evidence of this having been used for the passage of the stove funnel. The other ventilator was permanently closed with wood painted over, and the internal opening was situated immediately over a bunk, whilst the small "certain" extent of opening in the bulkhead referred to in the letter, was found closed with wood. 76 The facts were again reported to the Board of Trade, who communicated with me as follows:— "2nd August, 1912. "With reference to your letter of the 3rd ultimo, respecting the ventilator of the crew's quarters on board the s.s.-, official number —, I am now advised by the Board of Trade that there are two ventilators of 6-inch diameter fitted to the after end of the forecastle in addition to the two mentioned in your letter. "Also the stove pipes, which are only 34-inch diameter, are so fitted as to leave annular ventilating spaces which are good upcasts in the winter time when the stoves are in use. "I may mention, however, that the cowls require repairing, but the surveyor at North Shields has taken the necessary steps to have this done. The Board, after considering the full circumstances of the case, do not consider additional ventilation necessary." This example illustrates the difficulty of dealing with these cases. At the time of sailing, the vessel was fitted with the necessary ventilation. Beyond the fact that one was fitted over a bunk, no objection can be raised ; but when the vessel is at sea in bad weather, the ventilator will be securely stopped, the other ventilator will be used in winter for the passage of the funnel, so that there will be no ventilation otherwise than that provided by the stove and the small annular space between the stove funnel and the ventilator. The following short notes of instances of defective ventilation refer to vessels met with during the past year. Built 1912. The only provision for the ventilation of the officer's cabins was by a butterfly inlet over a door which opened into an alleyway. It was argued that the port hole was an efficient means of ventilation, but having regard to the expressions of the Board of Trade, respecting scuttles and skylights, it is obvious that the porthole should not be accepted as an efficient ventilator available under all conditions of weather. Built 1908. The crew's quarters of this vessel were in the forecastle. One ventilator was found fixed in a position forward of a bulkhead with an opening on one side only. There was no ventilator at all in the actual crew space. Built 1912. There was no ventilation of the crew's quarters through the deck. Side ports and openings in the bulkhead only. Built 1911. No overhead ventilation of officer's quarters— apertures in door side only. Sailing vessel.- Built 1873. Forecastle not ventilated. A flange fitted for stove funnel and this was stopped up. Built 1912. Crew's quarters in the forecastle divided by a fore and aft bulkhead— one ventilator on one side only of the divisional bulkhead. This was a lower forecastle. The solitary ventilator, of the "cowl" variety, was fixed right in the nose of the vessel. The result in bad weather may be imagined. 77 Built 1912. Officers' quarters without overhead ventilation. Apertures in door side only. Built 1911. This forecastle was divided by a fore and aft bulkhead. In this case, the bulkhead was carried up close to the deck overhead. There was one ventilator only in each compartment. Built 1900. The crew's quarters in this case were in the lower forecastle. No ventilation to the open air. The cases quoted are merely a selection of the more obvious divergencies not only from ordinary sanitary standards, but from the definite and precise instructions of the Board of Trade itself, and are certainly evidence of the complaint which has been brought forward in the Annual Reports of your Medical Officer for many years, that the ventilation of crew's quarters, as at present tolerated under the Merchant Shipping Act, is unsatisfactory to a degree which is, in the light of our present knowledge and desire to improve the lot of the seaman, to say the least, extremely regrettable. WATER CLOSETS. With the exception of the travelling section of the public, few persons are aware of the degree of present day efficiency reached by appliances of this type on board ships, but closets for the use of crews are still in most cases limited to the type known as the "trough" closet contained in a structure usually dark and unventilated, except by the door. The term is sufficiently descriptive, and one must imagine a trough usually of cylindrical section and of a length sufficient for the number of seats to be provided. This trough is often found without any means of flushing other than by hand ; it therefore is usually "furred" with decomposing excreta, and the kind of nuisance which has to be dealt with in that case can be readily comprehended. It is no exaggeration to state that these closets are frequently found in a condition absolutely revolting to approach even by sanitary inspectors. Appliances of a modern pattern and pedestal type can now be obtained of requisite durability and efficiency, at a reasonable cost, and there is no practical difficulty in supplying them with efficient flushing apparatus on any vessel of even moderate dimensions. The abominable and unapproachable kind of closet first referred to should not be permitted on a ship any more than it would be tolerated in a house on shore. 78 TABLE XXXVI. OFFENSIVE CARGOES. Forty-four cases of infringement of the above-mentioned bye-laws were reported during the year. In each case written notice was sent to the owrners of the barges concerned:— Date. Name of Vessel. Infringement. 1912. Jan. 20 Barge "Jess" Laden with a cargo of offensive refuse matter which was entirely uncovered, and loaded above the coamings. Feb. 14 Lighter " Ruth " Ditto Ditto. Marcli 6 Dumb Barge " Mary " Laden with a cargo of refuse matter which was entirely uncovered, and loaded above the coamings. „ 12 Dumb Barge " Jess " Ditto Ditto. „ 18 Dumb Barge "Amaryllis " Laden with a cargo of refuse matter which was not properly and securely covered so as to prevent any nuisance arising therefrom April 13 Dumb Barge "Olympus" Ditto Ditto. „ 29 Dumb Barge "Humber" • Laden with a cargo of refuse matter which was not properly and securely covered so as to prevent any nuisance arising therefrom, and was also loaded above the coamings. May 16 Lighter "Gallant" Laden with a cargo of refuse matter which was not properly and securely covered so as to prevent any nuisance arising therefrom. „ 17 Lighter "Roger Leigh" Ditto Ditto. „ 17 Lighter "Elizabeth" Ditto Ditto. „ 22, 23 & 25 Lighter "Emma" Ditto Ditto. „ 23 Lighter "Wasp" Laden with a cargo of blood and meat which was not properly and securely covered so as to prevent any nuisance arising therefrom. „ 31 *Lighter "Tay" Laden with a cargo of refuse matter which was not properly and securely covered so as to prevent any nuisance arising therefrom. „ 31 & June 3, 4 & 5 *Lighter "Cannon" Ditto Ditto. 3 *Lighter "Passion Flower" Ditto Ditto. 3 *Lighter "Lobelia" Ditto Ditto. „ 4 & 5 Lighter "Stormberg" Ditto Ditto. „ 5 & 6 Lighter "Myrtle" Ditto Ditto. „ 5 & 6 *Lighter "Orchid" Ditto Ditto. „ 6 Lighter "Jasmine" Ditto Ditto. „ 6 *Lighter "Freesia" Ditto Ditto. „ 7, 8 & 10 *Lighter "Lupine" Ditto Ditto. „ 7, 8 & 10 *Lighter "Cowslip" Ditto Ditto. „ 8 & 10 *Lighter "Dahlia" Ditto Ditto. „ 11 Lighter "Bramble" Ditto Ditto. 20 Lighter "Cairo" Ditto Ditto. * Also loaded above the coamings. 79 Offensive Cargoes— continued. Date. Name of Vessel. Infringement. July 15 Lighter "Cambridge" Laden with a cargo of fish in a decomposing condition, which was not properly and securely covered so as to prevent any nuisance arising therefrom. „ 15 Lighter "Ann" Ditto Ditto. Aug. 14 Lighter "May" Laden with a cargo of refuse matter which was not properly and securely cevered so as to prevent any nuisance arising therefrom. „ 16 Lighter "Mary Ann" Laden with a cargo of fish offal, which was not properly and securely covered so as to prevent any nuisance arising therefrom. 16 Lighter "Faith" Ditto Ditto. „ 27 Lighter " Victor " Laden with a cargo of dung, &c., which was not properly and securely covered so as to prevent any nuisance arising therefrom. Oct. 19 Lighter "Ruth" Laden with a cargo of house refuse which was not properly and securely covered so as to prevent any nuisance arising therefrom, and was also loaded above the coamings. „ 22 Lighter "Tiger" Ditto Ditto. „ 24 Lighter "Salford" Ditto Ditto. „ 24 Lighter "Mulatto" Ditto Ditto. „ 28 Lighter "Robert" Laden with a cargo of fish offal which was not properly and securely covered so as to prevent any nuisance arising therefrom. „ 29 Lighter "Cambridge" Ditto Ditto. „ 30 Lighter "Walter" Laden with a cargo of refuse matter which was not properly and securely covered so as to prevent any nuisance arising therefrom. Nov. 18 Lighter "Wandsworth" Ditto ditto. „ 18 Lighter "Baby" Ditto Ditto, and also loaded above the coamings. „ 19 Lighter Heather" Ditto Ditto. „ 25 Lighter "Ann" Laden with a cargo of fish offal, which was not properly and securely covered so as to prevent any nuisance arising therefrom. Dec. 7 Lighter "Militant" Loaded with a cargo of road sweepings, &c., which was not properly and securely covered so as to prevent any nuisance arising therefrom. „ 7 Lighter "Roger Leigh" Ditto Ditto. „ 12 Lighter "Robert" Laden with a cargo of fish offal which was not properly and securely covered so as to prevent any nuisance arising therefrom. OFFENSIVE CARGO BYE-LAWS. The infringements against the Bye-laws in respect of the Carriage of Offensive Cargoes continue to be committed from time to time, the principal offenders being the craft employed by contractors in the removal of refuse matter from the Metropolis to the Rubbish shoots in the lower reaches of the river. In the year under review, many of these cases occurred daring the periods of suspension of labour in the Port when it became difficult not only to remove the barges but to get them properly covered. 80 No legal proceedings were taken in any of these cases, as it was considered that the suspension of labour might be held to be a "reasonable excuse" for the non-removal of the refuse within the terms of the bye-laws, moreover it was the lesser evil for the refuse to be in barges on the Thames than to allow it to remain in the vicinity of dwellinir-houses. During the labour troubles previously referred to, a larsje number of " free labourers "employed in the Port of London were housed on vessels and in various sheds within the docks. The accommodation was carefully inspected, and representations made to the responsible authorities as to the necessity of every case of illness being seen by a medical man, so that no case of infectious disease should be undetected. The health of the "free labourers" was exceedingly good, and no case even suspicious of infectious disease occurred. The President of the Local Government Board was asked two questions in the House of Commons on this subject, and was able to give satisfactory answers. TABLE XXXVII. POLICE COURT PROCEEDINGS. January. February. March. April. May. June. July. August. September. October. November. December. Total. Total number of cases in which legal proceedings were recommended ... ... ... 2 ... 1 1 ... ... ... ... 1 5 Total number of cases in which legal proceedings were taken ... ... ... ... . .. ... ... ... ... ... ... 1 1 The one case, in which Police Court proceedings were taken as above, was an application for an order for the destruction of a quantity of tinned cherries, particulars of which are given in the section relating to food inspection. STEAM LAUNCHES. With reference to the average cost of working the steam launches, the general result is satisfactory. There has been little variation on the daily cost on any of the launches except in the case of the "Denton," where the cost of repairs in the engine room during the year was exceptionally heavy. The Lady Truscott" has been at work through the year at the ordinary routine of inspections, and it is satisfactory to note that the daily cost of running this launch is not much greater than was the case with the " David Burnett" when on the Gravesend station. The "David Burnett" was transferred to the Greenwich station, where, with a junior crew in charge, the cost of working is not so heavy. 81 The "Clotho" has given little trouble during the past year, while the "Denton" has been used principally as a relief launch. The moorings of the launches at Greenwich were removed in April from Union Wharf to a position higher up and situated off the Trafalgar Hotel. This position is nearer the office and more convenient in every way, especially as the launches are afloat at every state of the tide. HULK "HYGEIA." In August, it was found that the Hulk was making more water than usual and required daily pumping. As the leak increased it became obvious that the vessel was in danger of sinking at her moorings, and on being placed into dry dock, the leak was found to be caused by a rotten plank in the bottom of the vessel. This was accordingly thoroughly repaired, since when no further trouble has arisen. STAFF. Medical Officers.— In November, Dr. Legge at Sheerness became ill, and it became necessary to appoint Dr. Waugh temporarily to carry out his duties. At the time of closing this Report, though making satisfactory progress, Dr. Legge is not able to resume duty. Office Staff. — This remains as in the preceding year, and has proved equal to dealing with the increase of clerical work, naturally consequent to the progressive additions made to the powers of the Authority, the outdoor staff and equipment. Food and Sanitary Inspectors.— There are no changes to record with regard to the Staff of Inspectors. Steam Launches.— An alteration in the arrangement of the crews was brought about by the resignation, in June, of J. G. True, C. H. Price being appointed master. The vacancy for an engineer at the end of last year was filled by promoting J. Steen, fireman on the "Lady Truscott," and appointing another fireman in his place. Hospital.— On the 26th November, Nurse Cork fell ill with Enteric Fever, contracted in the course of her duties. She has made a good recovery and resumed her duties. Domestic Staff.— Emma Accleton was appointed temporarily as cook in December, in the place of Eva Mary Dack, at a wage of 20l, per annum. Ethel Harling was appointed temporary housemaid in December, in the place of Emily Harvey, at wages of 17l. per annum. 82 CANAL BOATS ACTS. In accordance with Section 3 of the Canal Boats Act, 1884, I beg to present herewith my Annual Report on the working of the Canal Boats Acts and Regulations within the district of the Port of London Sanitary Authority, during the year ending 31st December, 1912. The Acts and Regulations apply within the whole of the district under the jurisdiction of the Port of London Sanitary Authority, including the river and docks —as a "canal," for the purposes of the Act, includes any river, inland navigation, lake, or water being within the body of a county, whether it is or is not within the ebb or flow of the tide. The navigation in addition to the enclosed docks, includes the following navigable tributary waters and creeks of the River Thames :— On the right bank from Teddington downwards :— Part of the Grand Surrey Canal within the Surrey Commercial Docks. Hay's Dock. St. Saviour's Dock. Deadman's Dock. River Ravensbourne (Deptford Creek). Rivers Cray and Darenth (Dartford Creek). The entrance to the Gravesend Canal. Cliffe Creek. Yantlet and Coalmouth Creeks. Part of the river Medway, and of the Swale. On theSleft bank from Teddington downwards :— The entrance to the River Brent. Chelsea Dock. Grosvenor Dock. Limekiln Creek. Part of the River Lea. Barking Creek. Rainham Creek. Mucking Creek. Thames Haven. Hole Haven. Potton and Rushley Creeks. River Roach as far up as Rochford. The whole of this area is divided into three districts, known as the Upper, Middle and Lower, each district being in charge of an Inspector, as follows :— RIVER. Upper District. Teddington to Limehouse. Inspector Romeril 208l. per annum. 83 Middle District. Limehouse to Erith. Inspector Burr 208l. per annum. Lower District. Erith to seaward limits of the Port of London (including part of River Medway). Inspector Shepherd 143l. per annum. The Docks are divided into four districts, known as the Central, Eastern, Western and the Gravesend district. It has been found advisable to sub-divide these districts, and instead of one Inspector to each, two have been appointed to the Western, and two to the Eastern district, as follows :— Central District. West India Dock. South West India Dock. Poplar Dock. Millwall Dock. Inspector Lam be 195l. per annum. Eastern District. Royal Victoria Dock. East India Dock. Inspector Garland 208l. per annum. Royal Albert Dock. Inspector Wetjen 208l. per annum. Western District. London Dock. St. Katherine's Dock. Regent's Dock. Inspector Hopkins 208l. per annum. Surrey Commercial Dock. Inspector El ward 169l. per annum. Gravesend District. Tilbury Dock. Left Shore, from Purfleet down. Right Shore, from Erith down. Inspector Rolfe 195l. per annum. (2) The total number of inspections for the year was 817, representing a net number of 323 boats. The remainder, 494, represents repeated visits by Inspectors of this Authority. The number of the boats found not conforming to the Acts and Regulations was 125, or 15.29 per cent, of the total, the percentage for the previous five years being 7.33 per cent. 84 In addition to the above, 24 boats were at the time of visit found with the cabin doors locked, there being no person on board. Inspection was therefore impossible, therefore these visits are not included in the number of boats inspected. The total number of boats inspected shows a decrease on the previous year, this being accounted for by the suspension of labour in the Docks during the months of May and June, during which period there was little movement of vessels in the Port. (3) With reference to the various infringements of the Act: — (a) Unregistered Boats. The following boats were found, on inspection, to be unregistered within the meaning of the Act,:— Date. Name of Boat. Registration Authority. Reason for Registration or Re-registration. 1912. March 21 "Editha " Port of London Structural alteration. May 15 *"Glendower" Ditto New Boat. June 3 *"Mary Ann" Ditto Ditto. July 1 "Rose Mary" Towcester Ditto. Nov. 5 "Sandford" - Ditto. Dec. 4 "James" - Ditto. „ 23 "Aldershot" Port of London Ditto. Those marked * have been registered with this Authority. The "Editha" awaits re-measurement, and has not since been seen in the Port. The "Sandford" and "James" being owned at Brentford, will probably be registered with the Registration Authority there. The "Aldershot" has not yet received the formal sanction of the Registration Authority of the Port of London. (b) Notification of Change of Master. None. (c) Certificates. Absence of certificate was found in the following cases, a complaint being sent to the owners. In the case of the boats marked * information was received that the Certificates were subsequently placed on board :— 1912. Jan. 14 *"Weaver" registered Uxbridge, No. 226. „ 17 * " Rhodes " ,, Port of London, No. 320. March 4 * "Perseverance " „ Ware, No. 51. „ 19 * "The Solar" „ Uxbridge, No. 444. „ 26 "Britannia " „ Port of London, No. 408. „ 27 * "Perseverance " „ Ware, No. 51. „ 28 " Dauntless " „ Berkhamsted, No. 443. May 22 * " Eric " „ Brierley Hill, No. 231. „ 28 "Four Sisters " „ „ No. 264. „ 28 "Catherine " „ „ „ No. 232. * Remedied. 85 1912. June 26 * "Twaddell" registered Brentford, No. 227. July 1 * " Eric" „ Brierley Hill, No. 231. „ 10 * " Providence " „ Port of London, No. 292. „ 10 "Grett" „ Birmingham, No. 1,762. „ 13 "Gravesend" „ No. 1,261. „ 24 * "Despatch" „ Port of London, No. 396. „ 24 * "William" „ Bishop's Stortford, No. 28. „ 30 * "Perseverance" „ Uxbridge, No. 173. „ 30 "Eliza Sophia" „ Towcester, No. 82. Aug. 14 "Blue Jacket" „ Berkhamsted, No. 478. „ 16 "Edith" ,, Brentford, No. 229. „ 20 "Jessie" „ Port of London, No. 242. Sept. 12 * "Eric" ,, Brierley Hill, No. 231. „ 13 * "Lilian" „ Ware, No. 20. „ 19 "Beresford" ,, Birmingham, No. 1,279. „ 19 * "Henry" „ Uxbridge, No. 458. „ 21 * "Vic " „ Brierley Hill, No. 153. „ 21 * "Franklin" „ Berkhamsted, No. 338. Oct. 1 *"Percy" „ Ware, No. 64. „ 8 "Mary Ann" „ Port of London, No. 458, Nov. 1 * "Franklin" „ Berkhamsted, No. 338. „ 5 *"Chess" No. 437. „ 7 "Northfleet" ,, Brentford, No. 298 (registration subsequently cancelled). Dec. 9 "Friendship" „ Brierley Hill, No. 240. In the following cases, the Certificates produced did not identify the owner with the boat:— 1912. March 30 * "Eric" registered Brierley Hill, No. 231. Aug. 27 † "Dauntless " „ Port of London, No. 345. „ 27 †"Frank" „ „ No. 431. „ 27 †"Hope" „ Reading, No. 8. Sept. 14 * "Good Intent" „ Daventry, No. 207. * Remedied. † Re-registered at Reading. (d) Marking. The following boats were found infringing in this respect : — 1912. Feb. 23 "Henley" registered Uxbridge, No. 458. March 20 *"Chess " „ Berkhamsted, No. 437. April 1 *"Cordite" „ Stepney, No. 1. „ 2 *"Bourne" „ Berkhamsted, No. 442. „ 9 "Rhodes" „ Port of London, No. 320. July 4 "May" „ Coventry, No. 373. „ 17 "Mary" „ Brierley Hill, No. 244. „ 18 *"Muriel" „ Port of London, No. 397. „ 23 "Nellie" „ Brierley Hill, No. 220. „ 25 "Victoria" „ Uxbridge, No. 189. Aug. 8 *"May" „ Coventry, No. 373. * Remedied. 86 (e) Overcrowding. This was found in the case of three boats, as follows :— The canal boat "Maud," registered Berkhamsted, No. 410, was inspected on the 29th February, 1912. The fore cabin, which is registered for one adult, was filled up with spare gear, &c. The after cabin, registered for four adults, was occupied by two adults and five children. A complaint was sent to the owner on the 1st March. The boat was again met with on the 18th March and found to be in the same condition. On the 3rd July the boat was again inspected, when the infringement was found to have been remedied. The canal boat "Isleworth," registered Uxbridge, No. 466, for three adults aft, was inspected on the 15th May, 1912. The after cabin was found to be occupied by two adults and three children. A complaint was sent to the owners on the 16th May 1912. The boat was again inspected on the 15th June and found to be in the same condition. A further communication was sent to the owners, and on the 8th July I received information that the infringement had been remedied. The canal boat "Nantwich," registered Berkhamsted, No. 440, was inspected on the 16th September, 1912. The fore cabin was registered for one adult, and the after cabin for three adults. The after cabin was admitted to be occupied for sleeping purposes by two adults and four children, it being stated by the person in charge that the children were too young to occupy the fore cabin alone. A complaint was sent to the owners in respect of the infringement, and on the 19th November I received information that the infringement had been remedied. (f) Separation of the Sexes. The following boats were found unlawfully occupied by persons of the opposite sex, not being man and wife :— The canal boat "Islington," registered Uxbridge, No. 465, was inspected on the 15th May, 1912, when the after cabin was found to occupied by a man and his wife, and a male person above the age of 14 years. A complaint was sent to the owners on the 15th May, and on the 8th July I received information that the infringement had been remedied. The canal boat "Weaver," registered Brentford, No. 316, was inspected on the 7th November, 1912, when the after cabin was found to be occupied by a man and his wife, and a male person above the age of 14 years. A complaint was sent to the owner on the 8th November in respect of the infringement, and again on the 21st December, 1912, but no reply has been received, and the boat has not since been seen in the Port. (q) Cleanliness. The following boats were found to require cleansing, and those on which the necessary improvement was made are marked accordingly*:— 1912. Jan. 21 " Reliance " registered Berkhamsted, No. 441. Feb. 29 *" Maud " No. 410. March 6 *"Hilda" „ Wolverhampton, No. 945. „ 8 *"Sarah" „ Brentford, No. 85. 87 1912. March 21 "Editha" unregistered. April 3 "Kestrel" registered Berkhamsted, No. 222. „ 9 "Carnation" „ Port of London, No. 255. „ 9 "Rhodes" „ No. 320. „ 11 "Jane" „ Berkhamsted, No. 277. May 1 "Providence" „ Port of London, No. 292. „ 3 "Duke of Elgin" „ Rochester, No. 275. „ 28 *"Eliza" „ Wolverhampton, No. 934. June 5 "Rebecca" „ Brentford, No. 66. July 4 *"Holland" „ Birmingham, No. 1163. Aug. 27 *"Hope" „ Reading, No. 8. Sept. 3 *"Robin" „ No. 12. „ 20 "Colne " „ Berkhampsted, No. 333. Oct. 4 "Trent" „ Uxbridge, No. 392. „ 16 "Stanley" „ Port of London, No. 271. Nov. 7 "Northfleet" „ Brentford, No. 298 (registration subsequently cancelled). „ 14 *"York" „ Wolverhampton, No. 941. Dec. 13 "Walter" „ Berkhamsted, No. 345. „ 17 "Humber" „ „ No. 433. (A) Ventilation. The following boats were found to require better ventilation, or some repair Those in which the alterations have been made, are noted*:— 1912. Jan. 2 *"James" registered Brentford, No. 58. „ 18 "Stanley" „ Port of London, No. 271. Feb. 12 *"Stone" „ Wolverhampton, No. 948. „ 19 *"Cicero" „ Reading, No. 21. „ 19 *"Lansdowne" „ Uxbridge, No. 443. „ 26 "Medway" „ Brentford, No. 311. „ 28 *"Brimo" „ Reading, No. 20. „ 28 *"Togo" „ Berkhamsted, No. 385. March 5 *"Milner" „ „ No. 354. „ 6 *"Hilda" „ Wolverhampton, No. 945. „ 8 *"Sarah" „ Brentford, No. 85. „ 8 "Walter" „ Berkhamsted, No. 345. „ 13 *"Hilda" „ Wolverhampton, No. 945. „ 16 "Jubilee" „ Port of London, No. 275. „ 19 *"the Solar" ,, Uxbridge, No. 444. „ 21 "Editha" unregistered. „ 25 *"Lark" registered Berkhamsted, No. 483. „ 27 "Perseverance" „ Ware, No. 51. „ 28 *"Dorothy" „ Wolverhampton, No. 929. „ 30 "Perseverance" ,. Ware, No. 51, „ 30 *"Albert" „ Berkhamsted, No. 314. April 1 *"Cordite" „ Stepney, No. 1. „ 2 *"Eliza" „ Berkhamsted, No. 279. „ 9 "Carnation" „ Port of London, No. 255. „ 9 "Rhodes" „ „ „ No. 320. „ 11 *"Jane" „ Berkhamsted, No. 277. May 1 "Providence" „ Port of London, No. 292. „ 2 "George and Jane" „ Brentford, No. 42. „ 8 *"Bersham" ,, Wolverhampton, No. 975. „ 15 *"Glendower" unregistered— subsequently registered Port of London, No. 457 „ 28 *"Eliza " registered Wolverhampton, No. 934. 88 1912. June 5 "Rebecca" registered Brentford, No. 66. July 10 *"Bee" „ Port of London, No. 235. „ 11 *"Warwick" „ Wolverhampton, No. 917. „ 11 *"Gayton" „ „ No. 906. „ 17 "Mary" „ Brierley Hill, No. 244. „ 18 *"Miller" „ Daventry, No. 181. „ 18 *"Thames" No. 170. „ 22 *"George and Jane" „ Brentford, No. 42. „ 24 "Joseph" „ Berkhamsted, No. 363. August 1 *"Braunston" „ Uxbridge, No. 453. „ 24 "Oak" „ „ No. 346. „ 24 "Evelyn Maud" „ Brentford, No. 203. „ 27 *"Maud" „ Berkhamsted, No. 410. „ 27 "Dauntless" „ Port of London, No. 345. Sept. 3 *"Robin" „ Reading, No. 12. „ 20 "Colne" „ Berkhamsted, No. 333. „ 23 *"Dufferin" No. 347. „ 24 "Wandle" „ „ No. 327. „ 30 *"Penkridge" „ Birmingham, No. 999. Oct. 1 *"Percy" „ Ware, No. 64. „ 3 "Oak" „ Uxbridge, No. 346. „ 15 "Oak" „ „ „ „ 15 "Providence" „ Port of London, No. 292. „ 16 *"Stanley" No. 271. „ 18 "Sarah" „ Brentford, No. 85. „ 30 "Robin" „ Reading, No. 12. „ 31 "Carnation" „ Port of London, No. 255. Nov. 1 "Rhodes" „ „ No. 320. „ 1 *"Franklin" „ Berkhamsted, No. 338. „ 5 "Sandford" unregistered „ 7 "Northfleet" registered Brentford, No. 298 (registration subsequently cancelled.) „ 14 *"York" Wolverhampton, No. 941. „ 21 "Hope" registered Port of London, No. 240. Dec. 10 "Hope" „ „ „ „ 13 "Walter" „ Berkhamsted, No. 345. „ 17 "Humber" „ „ No. 433. „ 19 "Stanley" „ Port of London, No. 271. (i) Painting. Seventeen boats were found to require painting with regard to the interior of the cabin— which was done in the cases marked *. 1912. Feb. 26 "Royal Oak" registered Berkhampsted, No. 373. March 8 *"Sarah" „ Brentford, No. 85. April 1 *"Cordite" „ Stepney, No. 1. „ 2 *"Eliza" „ Berkhamsted, No. 279. „ 9 "Carnation" ,, Port of London, No. 255. „ 9 "Rhodes" „ „ No. 320. May 3 "Duke of Elgin" „ Rochester, No. 275. July 17 "Mary" „ Brierley Hill, No. 244. „ 18 *"Miller" „ Daventry, No. 181. „ 18 *"Thames" No. 170. „ 22 *"George and Jane" „ Brentford, No. 42. „ 24 "Joseph" „ Berkhamsted, No. 363. 89 1912. Aug. 27 *"Maud" registered Berkhamsted, No. 410. Oct. 16 *"Stanley" „ Port o£ London, No. 271. „ 18 "Sarah" „ Brentford, No. 85. „ 31 "Carnation" „ Port of London, No. 255. Dec. 13 "Walter" „ Berkhamsted, No. 345. (j) Provision of Water Cask. The following boats were not provided with proper vessel for containing water for drinking. In only two cases have I received information that this has been done:— 1912. March 25 *"Lark" registered Berkhamsted, No. 483. April 9 "Rhodes" „ Port of London, No. 320. Aug. 27 "Dauntless" No. 345. „ 27 "Hope" „ Reading, No. 8. Oct. 11 *"Jane" „ Berkhamsted, No. 277. Nov, 5 "Sandford" unregistered. „ 7 "Northfleet" registered Brentford, No. 298 (registration subsequently cancelled). Dec. 4 "James" unregistered. „ 17 "Humber" registered Berkhamsted, No. 433. (k) Removal of Bilge Water. In the following 3 cases, the bilges were found to be in a filthy condition:— 1912. July 22 *"George and Jane" registered Brentford, No. 42. Sept. 21 *"Jessie" „ Ware, No. 59. Dec. 13 "Walter" „Berkhamsted, No. 345. * Reported to be remedied. (I) Notification of Infectious Disease. No case of infectious disease was notified to me during the year, on board any canal boat. (m) Admittance of Inspector. No difficulty has been experienced in regard to the visits of the Inspector of this Authority. (4) No legal proceedings were necessary during the year. (5) The total number of infringements found was 196 on 125 boats. Formal notice of each infringement was at once given to the owners, and in many cases were remedied without further complaint. The number of such notices was 97, and the number which has been certified as attended to was 74. Of the complaints issued in the year now under review, 68'04 per cent, were remedied. (6) No case of infectious disease has been reported on any canal boat in the Port of London during the year. 90 Double Bulkheads— There were no infringements with regard to the provision of these. (7) No boats have been detained for cleansing. (8) On December 31st, 1912, there were 258 boats on the Register. (9) Two boats were registered in 1912. These were new boats. I have the honour to be, Gentlemen, Your obedient Servant, Herbet. williams Medical Officer of Health, Port of London. 91 TABLE XXXVIII. SUMMARY OF CANAL BOATS FOR THE YEAR ENDING 31st DECEMBER, 1912. January. February. March. April. May. June. July. August. September. October. November. December. TOTAL. 1907. total 1908. for the 1909. year 1910. 1911 New boats rsgistered ... ... ... ... ... ... ... ... ... 2 ... ... 2 ... ... ... 2 6 Registration owing to structural alterations ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Registration for other purposes ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 1 1 ... Inspected 52 42 79 73 85 58 123 56 70 79 54 46 817 1,294 3,110 1,379 878 889 Conforming to Acts and Regulations 46 32 59 67 74 55 104 44 57 68 47 39 692 1,188 1,066 1,289 807 800 Infringements in respect to:— Registration ... ... 1 1 1 1 1 1 ... ... 1 2 9 6 2 ... 4 8 Notification of change of master ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 Absence of certificate 2 ... 5 ... 3 1 8 4 6 2 2 1 34 24 22 9 20 44 Certificate not identifying owner with boat ... ... 1 ... ... ... ... 3 1 ... ... ... 5 3 13 5 ... 2 Marking, &c. ... 1 1 3 ... ... ... 1 ... ... ... ... 11 18 14 20 9 18 Overcrowding ... 1 1 ... 1 1 ... ... 1 ... ... ... 5 8 5 3 2 5 Partition separating sexes ... ... ... ... 1 ... ... ... ... ... 1 ... 2 ... ... ... 1 ... Males over age ... ... ... ... 1 ... ... ... ... ... 1 ... 2 ... ... ... ... ... Females over age ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cleanliness 1 1 3 4 3 1 1 1 2 2 2 2 23 35 30 20 14 12 Painting ... 1 1 4 1 ... 5 1 ... 3 ... 1 17 2 2 ... 9 19 Ventilation ... 1 ... 2 2 ... 1 ... ... 1 ... 1 8 4 1 2 3 5 Dilapidation 2 6 13 5 5 1 8 5 5 8 6 4 68 29 31 46 27 33 Removal of bilge water ... ... ... ... ... ... 1 ... 1 ... ... 1 3 ... ... ... ... 1 Without pump ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Refusal to admit Inspector ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No proper water vessel ... ... 1 1 ... ... ... 2 ... 1 2 2 9 5 10 6 5 9 Without double bulkhead ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Notification of infectious disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Detained for cleansing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Proceedings taken ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Cautions given 3 6 12 6 7 3 16 9 13 9 7 6 97 82 76 80 33 70 „ attended to 2 3 7 10 4 3 5 6 5 6 11 12 74 85 71 80 46 49 Total registered by Port Sanitary Authority since 1887 458 Registered for 2,916 persons. Carrying 1,832 persons. Cancelled 200 Actual number on the Register, 31st December, 1912 258 92 ADMINISTRATION OF THE PORT OF LONDON (PUBLIC HEALTH ACT, 1891). Dr. REVENUE ACCOUNT for the Year ended 31st December, 1912. Cr. £ s. d. £ s. d. £ s. d. £ s. d. To Salaries, viz.:— By Proceeds of Sale of Unsound Food 813 5 8 Dr. H. Williams, Medical Officer of Health 904 5 0 Less Amount paid to Consignees of Ditto 681 11 9 Assistant Medical Officers :— 131 13 11 Dr. W. M. Willoughby £400 0 0 „ Sundry Fees, viz. :— ,, J. S. Warrack 400 0 0 Health Certificates 4 14 6 „ W. M. Willoughby 109 4 0 Metropolitan Asylums Board, under 1891 Act 0 8 0 „ W. D. Betenson 385 0 0 Canal Boat Registration 1 5 0 „ E. V. Legge 350 0 0 Inspection of Export Meat 23 12 6 „ A. Kidd 350 0 0 30 0 0 Locum Tenens 108 17 6 ,, Grant from Home Office in respect of Medical Officer under the Aliens Act, 1905 750 0 0 2,103 1 6 W. J. Albrow, Clerk 285 0 0 „ Refund of proportion of Medical Officer's Salary, &c., by Rochester 3,292 6 6 Port Sanitary Authority 100 0 0 „ Uniforms 136 8 0 ,, Ditto, forwarding Telegrams 0 7 6 „ Fidelity Guarantees 1 16 0 100 7 6 „ National Health Insurance 8 16 9 „ Sundry Reimbursements 2 10 0 „ Wages, per Dr. Williams, viz.:— Offices 453 10 0 1,014 11 5 Inspectors 2,770 13 4 „ Excess of Expenditure over Income 11,172 5 7 Launch Crews 1,362 5 11 Hospital Staff 273 13 5 4,860 2 8 ,, Workmen's Compensation 23 9 9 „ Contributions to Officers' Pension Fund No. 1 £92 14 6 „ Ditto No. 2 208 15 8 301 10 2 ,, Contributions to Officers' Pension Fund re Pensions 169 8 8 „ Pensions 52 0 0 522 18 10 „ Disbursement per Dr Williams viz Petty Cash Expenses, Inspectors and others 354 15 1 Postage Stamps 54 0 0 Sundry Office Expenses 36 5 8 445 0 9 „ Offices at Greenwich, viz. :— Rent 55 0 0 Rates and Taxes 18 3 4 Fire and Boiler Insurance 1 0 2 Telephone Rent 22 18 10 Gas 7 3 7 Repairs 0 11 6 Coal 3 4 6 Water 2 6 0 110 7 11 „ Expenses of Steam Launches, Hulk, &c., viz.:— Insurance 154 7 2 Coal and Coke 446 11 9 Repairs. S428 16 10 Less Reimbursements for Damage 12 4 11 416 11 11 Stores 250 0 10 New Rail " Lady Truscott" 92 7 9 1,359 19 5 ,, Hospital at Denton, viz. :— Expenses of extra Nurses 181 8 3 Rent of Causeway, &c. 6 5 0 Rates and Taxes 71 5 3 Fire and Boiler Insurance 11 8 6 Telephone Rent 13 5 0 Gas 62 5 2 Coal 26 7 8 Stores 79 0 2 General Repairs 130 10 1 Maintenance of Patients 118 16 0 700 11 1 „ Printing and Stationery 69 4 11 „ Telegrams and Maintenance of Private Wire 14 10 10 ,, Examination of Rats, &c. 227 8 O „ Disinfectants 13 19 0 „ Subscriptions 22 8 0 „ Advertisements 5 15 1 „ Medical Examinations re new Appointments 2 12 6 „ Miscellaneous 7 8 0 „ Law Charges, viz. :— Mr. Comptroller 3 6 3 Mr. Solicitor 31 2 11 34 9 2 „ Mr. Hallkeeper, Disbursements 4 11 6 „ Delegation Expenses 25 10 6 „ Committee's Allowance 150 0 0 „ Ditto re Inspection of River 147 1 10 297 1 10 £12,186 17 0 £12,186 17 0 Chamber of London, ADRIAN POLLOCK, 27th March, 1913. Chamberlain.