STMARY 5 THE SANITARY CHRONICLES of St. Marylebone; being the ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, FOR THE YEAR 1900. by ALEXANDER WYNTER BLYTH, Medical Officer of Health, and Analyst of Food and Drugs for the Parish of St. Marylebone; Barrister-at-Law of Lincoln's Inn; Fellow of the Institute of Chemistry, &c., &c. VOL. XX. London: Printed by George Pulman & Sons, Ltd., 24-26, Thayer Street, Manchester Square, W. PREFACE. The following Report is a brief summary of disease, mortality, and sanitary administration in the Parish of St. Marylebone during 1900. The arrangement is the same as that of previous Annual Statements. The Town Hall, St. Marylebone, January, 1901. A REPORT of the METEOROLOGY, MORTALITY, AND SICKNESS of ST. MARYLEBONE FOR THE YEAR 1900. By A. Wynter Blyth. METEOROLOGICAL SUMMARY. march quarter. January was mild, wet, and gloomy. There was little frost and no snow. The mean temperature was 40.30. Winds, westerly. Rain fell on 20 days, amounting to 2.16 inches. Sunshine generally was deficient. The weather of February was bad and uncomfortable beyond precedent; 13 out of the 28 days were rainy. On two days fog prevailed, and on five days there were heavy snowstorms. The total rainfall was 3.2 inches. The minimum temperature was 200, the mean 37.70; the winds N.E. The weather of March was of the normal character—dry, with cold north and north-east winds. On seven days rain fell equalling 0.85 inch. The mean temperature was 42.1°. june quarter. Summer weather prevailed during the two latter weeks of April, a higher temperature being reached than for the corresponding period during half a century. The month was generally fine. The maximum temperature was 770, the mean 43.5°. On eight days rain fell (0.59 inch). 4 May was a fine and fairly bright month. Rain fell on seven days—0.75 inch. The sunshine registered ranged from 17 per cent. to 41 per cent. of the possible. Winds, westerly. Mean temperature 54o. June was characterised by warm summer weather, with occasional thunderstorms. The temperature reached 88.6°, the mean was 62.7o. The sunshine varied from 32 to 46 per cent. There were 12 rainy days, the total rainfall being 1.57 inch Winds mostly S.W. september quarter. Most of July was a month of tropical heat, the minimum temperature being 40.3o, the maximum 94°, the mean 64.9°. The mean temperature of the weeks ending July 14th and 21st was above 65o, and hotter by 3o and 9o respectively than the average temperature for the corresponding week for 50 years. During the month there were seven rainy days, the rainfall being 1.62 inch. From 20 per cent. to 74 per cent. of the possible sunshine was received. Three out of four weeks of August were fine and warm; one week very wet. The rainfall for the month was 1.88 inch, rain falling on 11 days. The maximum temperature attained was 82.1°, the mean being 61.5° September was a dry, fine month. Rain fell on only three days—0.72 inch. The mean temperature was 61.2°, the extremes ranging between 41o and 75°. The sunshine received in Regent's Park varied from 23 per cent. to nearly 50 per cent. december quarter. October was a month of fine autumnal weather, with but nine rainy days—0.96 inch. The sunshine received varied from 17 per cent. to 46 per cent. November was overcast and wet. On 15 days rain fell, the rainfall being 1.91 inch. The sunshine ranged from 7 per cent. to 22.5 per cent. The mean temperature was 48.5°, the maximum 63°. December was gloomy and mild. 1.10 inch of rain fell in 11 days. The lowest temperature was a degree above freezingpoint; the highest 57.5o and the mean 47.4o. The sunshine varied from 4 per cent. to 15 per cent. 5 BIRTHS AND DEATHS. The number of births registered during the 52 weeks ending December 22nd, 1900, when all essential corrections have been made, was 3,125. The number of deaths (corrected) of parishioners was 2,700. This gives a birth-rate of 21.9; a death-rate of 18.9 per thousand. The birth- and death-rates for 1900 of the sub-districts were as follows: — All Souls birth-rate 17.0 Death-rate 15.6 Rectory birth-rate 20.2 Death-rate 20.7 St. Mary birth-rate 23.8 Death-rate 17.8 Christchurch birth-rate 23.7 Death-rate 19.8 St. John birth-rate 25.17 Death-rate 21.9 The following is a statement of the average death-rates of St. Marylebone and its sub-divisions for five years—from 1895 to 1900: — All Souls birth-rate 17.0 Death-rate 15.2 Rectory birth-rate 23.2 Death-rate 22.5 St. Mary birth-rate 23.7 Death-rate 19.9 Christchurch birth-rate 24.1 Death-rate 20.7 St. John birth-rate 26.4 Death-rate 21.9 The whole district birth-rate 22.9 Death-rate 20.3 The following table gives the distribution of the deaths of parishioners dying in various extra-parochial institutions, all of which are included in the mortality statistics :— St. Marylebone Infirmary, Notting Hill 524 North-Western Fever Hospital 29 Eastern Fever Hospital 4 Western Fever Hospital 9 South-Western Fever Hospital 3 Hospital Ship "Atlas" 1 St. Mary's Hospital 70 Children's Hospital, Paddington 9 Children's Hospital, Gt. Ormonde Street 7 Westminster Hospital 4 King's College Hospital 2 University College Hospital 14 St. George's Hospital 12 St. Bartholomew's Hospital 1 St. Thomas's Hospital 5 Charing Cross Hospital 7 London Hospital 2 Carried forward 703 6 Brought forward 703 Guy's Hospital 2 West London Hospital 1 Royal Free Hospital 1 St. Saviour's Hospital 2 St. Mark's Hospital 1 St. Peter's Hospital 2 Hospital for Women, Euston Road 3 Homoeopathic Hospital, Euston Boad 1 Lying-in Hospital, Endell Street 1 London Temperance Hospital 5 National Hospital, Queen Square 2 Abbey Road Hospital 1 Bolingbroke Hospital 1 North London Consumption Hospital 1 Cancer Hospital 3 Brompton Hospital 6 French Hospital 7 Italian Hospital 1 German Hospital 2 Italian Hospital 1 Great Northern Central Hospital 1 Central London Sick Asylum 2 Caterham Asylum 2 Banstead Asylum 5 Cane Hill Asylum 1 Colney Hatch Asylum 19 Ilford Asylum 12 Leavesden Asylum 20 Hanwell Asylum 24 City of London Asylum 1 Camberwell Asylum 1 Hoxton House Asylum 1 London County Asylum 2 Middlesex Asylum 3 Licensed Victuallers' Asylum 1 City of London Chest Hospital 1 Royal Hospital for Incurables 2 Friedenheim 6 St. Pelagias' Creche 4 Infants' Incubator, Earl's Court 5 St. Pancras Infirmary 5 Paddington Infirmary 2 St. George's Infirmary 1 Kensington Infirmary 1 St. Luke's Home 3 Butchers' Alms-houses, Fulham 1 Salvation Army Home, Hackney 1 Otherwise 13 887 7 SMALLPOX. Smallpox was imported into the district in April from a P. & O. steamship (see "Sanitary Chronicles," April and May). Four cases were notified. By means of prompt removal to hospital, retention in the shelter of persons who had been in contact with the patients, revaccination, and disinfection, there was no spread. SCARLET FEVER. Scarlet fever (as shown by the curve, opposite page 16) was generally below the average up to the end of October. In that month there occurred a localized outbreak in the St. Marylebone Charity School for Girls; the effect of this outbreak is clearly seen in the rise of the curve in the 43 rd week. The seasonal maximum, which usually takes place in the first week of October, was displaced to the last week of October. The outbreak and the measures which were so successful in controlling it have been detailed briefly in the " Sanitary Chronicles" for October, 1900. From a medical point of view the illness of the children possessed some unusual features. With a few cases of undoubted ordinary genuine scarlet fever, there were several others in which a diagnosis was difficult, the more especially if they were considered alone and without reference to the true cases. The safe course, however, was taken, so far as isolation and other preventive measures were concerned, of considering all the patients suffering from a mild attack of an infectious fever. The total number of cases of scarlet fever notified in the whole district during 1900 was 358; of these 18, or 5 per cent., terminated fatally. This is equal to a mortality per million living of 125. Partly owing to a change of type in the disease, partly to early isolation, and improved methods of medical treatment, scarlet fever has altered its character. Formerly a malignant malady, leaving in a large percentage of cases that recovered, deafness, or more or less permanent injury to the kidneys, or both, at the present time a vast number of cases produce scarcely as much disturbance as a common cold. MEASLES. Measles was twice as fatal as scarlet fever, 36 deaths being registered from that cause—equal to a death-rate per million of 254. There is neither notification of measles nor 8 facilities for isolating such cases in hospital. The writer fails to see the logic of taking precautions against the less fatal and allowing the more fatal malady to run its course. Even although it must be allowed that the spread of infection may not be materially influenced by early isolation of cases of measles, yet without doubt the removal of children when ill of so serious an infantile disorder from unsuitable surroundings and placing the patients in institutions where they would obtain skilled nursing with the requisite medical attention, would reduce the mortality. DIPHTHERIA. Diphtheria was generally above the average until December, when it declined. There were three decided rises above the mean (see curve), viz., in the third week of May, the last week of July, and the second week of November. The number of cases notified amounted to 199; of these 36 died, giving a case mortality of about 18 per cent.—a deathrate per million living, of 254. During the year 43 specimens from suspected diphtheritic throats were examined bacteriologically at the Jenner Institute, and 22, or about 51 per cent., were pronounced to contain the true diphtheria bacillus. ENTERIC OR TYPHOID FEVER. Typhoid was under the average until December, when the cases rose to their maximum. The maximum number of cases usually occurs in the autumn. Indeed, one of the old names for typhoid is "autumnal fever." Hence so far as this district is concerned, there is a displacement in the period of maximum. The Medical Officer of Health for St. George's has noticed the same thing, and since typhoid is a water-borne disease, suggests, with some confidence, that the abnormal rise is caused by impurities in the water-supply derived from the Thames. The winter rains surcharge the river with filth, the filters get overtaxed, imperfectly filtered water is drunk, some of which contains the specific germs. This suggestion is ingenious, and may be true, since the winter service of water is slightly more impure than the summer. There is, however, another explanation of a similar character. As it is well known and acknowledged that during the heavy winter rains, estuaries, rivers, and 9 so forth are more impure than in the summer, it follows that shellfish are more likely to be contaminated during those seasons, and the increase may point to typhoid from shellfish rather than to water direct. Seventy-five cases of typhoid were notified; of these 13 were fatal, giving a case mortality of 17 per cent., or about 92, per million living. This rate in itself is not high. The last annual return of the Registrar-General's Return (1898) gives rates for all England varying in 25 years from 137 to 231. PROSECUTIONS UNDER THE PUBLIC HEALTH (LONDON) ACT. A recurring nuisance in the summer months is the nonremoval of stable manure. The Borough, owing to the extension of the suburban districts, is continually being, as it were, removed farther and farther from the country districts, where the manure is required. The railway rates for such an article as stable manure are prohibitory, and at certain seasons it is only possible to get manure removed by paying a relatively high price. It may, however, be stated generally that the stable manure was better and more regularly removed in 1900 than in any previous year. In two instances it was necessary to summon offenders for breaches of the byelaws. The occupiers of John's Yard and the occupiers of Boston Mews were brought before the magistrate in respect to offences connected with manure, and orders for abatement obtained. The owners of certain houses in Linhope Street, Melina Place, Harrow Street, Lisson Grove, Shouldham Street, Burne Street, Boston Place, Abbey Gardens, and Upper Dorset Street were summoned for disobedience of the notices of the Local Authority to reconstruct drains or to abate serious nuisances. Magistrate's orders were obtained; in a few cases the defendants were fined. THE SHELTER. The St. Marylebone Shelter, established for the purpose of receiving for short periods families temporarily turned out of their homes during the operation of disinfection, has been used 10 times, and has afforded accommodation for 17 adults 10 and two children. During the year 1899 it was used 11 times and accommodated 49 persons. The following is the complete return: — 1900. Days or Hours of Occupation. Disease. No. of Persons. April 14 4 days Smallpox 1 adult „ 18 8 „ „ 1 „ „ 20 2 „ „ 1 „ „ 24 4 „ „ 1 „ „ 27 1 day „ 2 adults „ 27 1 „ „ 1 adult May 7 4 days „ 5 adults „ 8 1 day „ 1 adult Aug. 13 1 „ „ 2 adults, 2 children Dec. 12 1 „ Scarlet Fever 2 adults DISINFECTION. In January, 1900, an additional steam disinfector was erected adjacent to the Baths, established under the Cleansing of Persons Act, for the purpose of disinfecting the extremely filthy clothing of the persons cleansed in these baths. In other words, the ordinary disinfection after cases of infectious disease was henceforward separated from the disinfection for vermin and for dirt. No district in the Metropolis has a more complete installation than St. Marylebone. The disinfection by superheated steam was established in 1899, and the apparatus, with but few intermissions for repair, has been working since that year. The list of articles disinfected in 1900 is as follows: — Beds 335 Mattresses 732 Bolsters 516 Pillows 1,295 Sheets 916 Blankets 2,399 The disinfecting vans have been used 580 times. 11 CLEANSING OF PERSONS ACT There is now accommodation in the shape of hot baths and simultaneous disinfection of clothing for both sexes. The extension of the bath accommodation for women was completed in 1900. Steps were taken to notify the fact to various institutions and common lodging-houses frequented by women of the class likely to take advantage of the Act. A much smaller number of females have used the baths than expected. There are, however, signs of a gradual increase. During 1900, 3,352 males and 28 females underwent the cleansing process and had their clothing disinfected. A considerable number of these poor persons were most offensive, swarming with parasites, and generally in a deplorable state—so much so that they would have infected any public seat or public vehicle that they made use of. The great majority of the applicants come from the Salvation Army Home in Burne Street, the remainder from common lodging-houses. SANITARY LEGISLATION, 1900. The only Act, passed in 1900, bearing directly on sanitary matters (with the exception of the Census Act) is an amendment to the Housing of the Working Classes Act, 1890. The amended Act (63 & 64 Vict., c. 59) gives power to this Borough, in common with other Boroughs, to establish and acquire "lodging-houses" for the working classes, under Part III. of the Act, outside the district. In other words, the Council may, if they choose, establish in Willesden, Hampstead, Hendon, or elsewhere "lodging - houses." What "lodging-houses" exactly means can only be gathered by inference. They may evidently be structures like Lord Rowton's lodging-houses—that is, places furnished and provided with appliances for cooking, and so forth, or they may be unfurnished dwellings, or they may be even single cottages with land attached not exceeding half an acre. « The expenses incurred under the Act are to be defrayed as part of the ordinary expenses of the Council. Ample borrowing powers under easy terms are provided. 12 Section 5 of the amended Act provides that the Local Authority may lease any land acquired to a lessee under the condition that the lessee will carry the Act out. The Local Authority "shall insert in any lease provisions binding the lessee to build on the land as in the lease prescribed, and to maintain and repair the buildings," so as to secure the buildings being used exclusively as lodging-houses within the meaning of the Act. The amended Act is of some considerable interest just now, the Improvement and Housing Committee having its provisions under consideration. CLERICAL WORK OF THE SANITARY DEPARTMENT. Mr. J. Curtis, assisted by Mr. W. J. Howe, continues to perform the clerical duties of the department, which include the preparation and despatch of the many notices and letters arising from the employment of the inspectorial staff and out of Committee meetings, the keeping of the registers of nuisances, of infectious disease notifications, and of registered houses, the preparation for Committee meetings and reports to the Council, enquiries by the public, and numerous smaller matters. Among the latter may be mentioned acting as a telephonic exchange for the whole establishment, this necessitates many and constant interruptions. It must be added that this clerical work— comprising all the above details and the drafting of important letters and reports—has to be performed in an office used by seven Sanitary Inspectors, two Disinfectors, the Dust Contractors' Foremen, and the general public; circumstances which make the duties of the Clerks less easy of execution than if the surroundings were quieter. Mr. Curtis' exceptional abilities have received somewhat tardy recognition by his appointment as Clerk to the Public Health Committee at a slightly increased salary. The duties of such a post, owing to the transfer of all questions of sanitary detail from the Council to the Committee, entail longer office hours, more responsibility, and work generally. PRACTICAL SANITARY WORK, 1900. A tabular statement is given of the work of each of the seven Inspectors at page 29. 1,218 complaints of sanitary defects were received and promptly attended to. The number of inspections of all kinds amounted to nearly 15,000. The 13 majority of these conditions were remedied by simply calling the attention of the proper person to the nature of the nuisance by a written communication, in only 244 cases formal notice of the Local Authority was issued. No small portion of the work of the Inspector was taken up in the supervision of new drainage works. 385 houses have been entirely or partly drained under the supervision of the Sanitary Inspectors. Each of these houses will have been visited several times, the smaller schemes about three times, but the larger schemes of drainage' require the drains to be tested in sections, and as many as 20 visits are often required. Two of the Inspectors (Mr. Richard Phillips and Miss O'Kell) have special duties, and the writer has asked them to furnish Reports as follows : To the Medical Officer of Health. Sir, I beg to present to you a Report of my work during the year 1900. FACTORY AND WORKSHOP ACTS. At the beginning of the year considerable attention was given to the compilation of a new Register and the proper division of work between myself and Miss O'Kell. The number of workrooms (occupied exclusively by men) at present on the register is 179, representing 139 employers, mostly tailors and outfitters. These establishments have been regularly visited, cleansing orders have been issued where necessary, and many sanitary defects have been detected and remedied. The new workrooms have been measured and registered in the usual way. I have also been able to render some assistance to Miss O'Kell in the measurement of some of the large workrooms under her care. BAKEHOUSES. The number of bakehouses at present in use in the Borough is 92 ; in addition there are 11 bakehouses registered, but not in use. Two bakehouses have been pulled down in Wells Street and Market Place and rebuilt as private houses. 14 SMOKE NUISANCES. The number of complaints of smoke nuisance have considerably increased during the year 1900. Many cases of nuisance have been satisfactorily and permanently abated, and others are still under strict observation. TRADE NUISANCES, ETC. During the year several complaints of trade nuisances have been received. These have each been exhaustively dealt with. Smells alleged to come from the Regent's Canal were complained of from various sources, and the necessary investigations covered a period of some weeks. Appended is a statement of that part of my work which admits of tabulation. Workshops, Tailors, &c. No. of Visits 139 Bakehouses ,, 184 Smoke Nuisance „ 231 I am, Sir, Your obedient Servant, RICHARD PHILLIPS. January 1st, 1901. To the Medical Officer of Health for the Borough Council of St. Marylebone. Sir, I beg to submit to you a Report of my work daring the year 1900. WORKSHOPS AND LAUNDRIES IN WHICH WOMEN AND GIRLS ARE EMPLOYED. Number of Workrooms on Register, December 31st, 1899 876 Number of Workrooms added to Register during year ending December 31st, 1900 564 1,440 Number of Workrooms removed from Register during year ending December 31st, 1900 122 1,318 15 It will be seen from the above statement that there are at present on the Register 1,318 workrooms. These represent 681 businesses, of which 31 are laundries and the remainder principally dressmaking, millinery, and tailoring businesses, with a few miscellaneous trades. During the year I have paid 460 first visits and 1,662 visits of re-inspection to workshops and laundry workshops. I have also paid about 300 calls on miscellaneous business (leaving workroom cards, making enquiries, etc.). In the course of these visits I found several workshops which had not previously been visited by any Inspector. The cubic measurement of each new workshop has been taken, and ventilation and sanitary conditions investigated before placing on the Register. In measuring the larger workrooms, I have had the help of Mr. Phillips, whom I would take this opportunity of thanking for the ready assistance he has always rendered me, both in this part of the work and in some of my initial difficulties. I have served 124 written intimations of nuisances and three statutory notices for the abatement of nuisances. Workroom cards showing the number of persons permitted in each room have been distributed. Each new workshop where women or girls are employed has been duly notified to H.M. Inspector of Factories, as required by the Factories and Workshop Act of 1891. WORKS CARRIED ON UNDER SUPERVISION. (a) Cleansing, Limewashing, etc.— 144 rooms found to be dirty have been cleansed. In many cases (particularly in laundries) staircases, passages, yards, etc., leading to or adjoining workplaces have been cleansed. (b) Sanitary Conveniences.— Further accommodation was required and has been provided in 20 workplaces. In three others new waterclosets have been substituted for old and insanitary ones, while 18 waterclosets found to be defective in water-supply were renovated. In many cases it has been necessary to draw the attention of the employers to the general dirty state of the waterclosets and lavatories. (c) Ventilation, Lighting, and Heating.— Improvement in ventilation has been effected in 12 workrooms; three have been discontinued as unsuitable; 10 gas stoves used for heating irons have been removed from the workrooms or provided with means for carrying off the fumes generated. In three wash- 16 houses a ventilating-hood with a pipe conducting the steam into the outer air has been-fixed over the copper. Of the 1,318 workrooms on the Register, 1,004 are lighted by gas, 204 by electricity, and 110 by lamps. The more general adoption of electric lighting for workrooms is hindered by the fact that gas has warming powers which electric lights have not. I refer to the very harmful practice, so much in vogue, of warming the rooms by burning gas. I think that, in the interests of the workers, there should be a definite regulation that, should gas be used for warming purposes, it should only be through the medium of properly ventilated stcges. OVERCROWDING. Twenty-one cases of overcrowding have been detected during the course of the year's work. In every instance the nuisance was at once abated; and after closely watching these places, I have only to report a second offence in one case. COMPLAINTS. Sixty-four Complaints relating to workshops have been received and carefully investigated. Those regarding overtime have been forwarded to H.M. Inspector of Factories. Several anonymous letters have been received, alleging overcrowding 111 the bedrooms provided for the use of the employees in drapery establishments, etc., but in each case the statements made have proved, on investigation, to be incorrect. • OUTWORKERS. There are on the Register 184 outworkers 'iving in the Borough. These have each been visited at least once during the year, and my visits have resulted in the detection of a large number of nuisances, some of which I have been able to deal with myself, and others which I have reported to the District Sanitary Inspectors. The names and addresses of 204 outworkers non-resident in the Borough have been forwarded to the Medical Officers of Health of the Districts in which they reside. CURVE SHOWING THE NUMBER OF CASES NOTIFIED WEEK BY WEEK OF SCARLET FEVER, DIPHTHERIA, AND TYPHOID FEVER DURING 1900, AS COMPARED WITH A FIVE YEARS' AVERAGE. 17 I am happy to be able to state that, speaking generally, I find employers perfectly willing to conform to the regulations imposed upon them. When I have to call attention to any breach or omission, I frequently receive a ready promise of immediate attention, which renders formal notice unnecessary. In evidence of this, I would call attention to the large number of nuisances abated in excess of the written notices served. PUBLIC CONVENIENCES. In obedience to your instructions, I have, during the year, inspected twice or thrice weekly each of the Women's Public Conveniences. I have invariably found these places clean and well kept by the attendants. I have been able to suggest a few trifling alterations, which were in each case sanctioned by the late Vestry. I beg to remain, Sir, Your obedient Servant, L. MARGUERITE O'KELL, Sanitary Inspector. SALE OF FOOD AND DRUGS ACTS. A full list of substances analysed under the Sale of Food and Drugs Acts is given in table II. It will be seen by that table that out of 639 samples only eight were reported against. Of the eight, five samples were milk, the samples being either diluted with water or deprived of cream, or both. In November the attention of the whole country was directed to possible poisonous contamination of beer. 15 samples, taken by the various Inspectors from different parts of the Parish, were analysed, but found to contain no arsenic. A large number of samples of beer have been examined since, and although the results belong to the present year (1901), it may be well to state that no arsenic as yet has been found. In a work published in 1879*, the writer distinctly pointed out the possibility of beer becoming contaminated by arsenic *A Manual of Practical Chemistry, "The Analysis of Foods and the Detection of Poisons," p. 169, by A. Wynter Blyth, Lond., 1879. The subsequent editions of this work appeared in two volumes, the one devoted to foods, the other to poisons. In the article on "Beer" the statement relative to arsenical glucose was repeated in each edition. 18 by the use of glucose, and gave determinations of the amount of arsenic actually found in certain glucoses by a French chemist (T. Clouet, "Du Glucose Arsenical." Ann. d'Hygiene Publique, XLIX., January, 1878). The possibility of its occurrence has therefore been known to the scientific world from the date of T. Clouet's research in 1878, and the chief facts accessible in the English language since 1879. It was not, however, until midsummer, 1900, that the attention of the medical profession in the Manchester district was directed to a considerable number of cases of skin and nervous affections, generally connected with the result of inflammatory action of the ends and trunks of the nerves—hence the scientific name of "peripheral neuritis." These cases continued to increase, and were generally ascribed to the action of alcohol, but Dr. Reynolds, by a process of inductive reasoning, came to the conclusion in November that they were due to probably arsenic in beer. Within a very short time of the announcement of the nature of the poison, Dr. Kelynak and Mr. Kirby, of Manchester, had localised the main source of the poison, and immediate measures for its detection and for arresting, as far as practicable, the consumption of arsenical beer had been taken. A strict investigation has conclusively proved that the injury has been by no means confined to persons drinking beer to excess. In one case a young woman suffered from very characteristic symptoms after partaking of a pint of stout daily, a quantity she had been accustomed to for years. Examination of the stout showed it to contain 1/25 of a grain of arsenious acid per gallon. Presuming that this was the usual amount of contamination of the stout drunk, it shows that so small a quantity as of a grain of arsenious acid taken daily may cause serious illness. The poisoned beer appears confined to the Manchester district and the Midlands. Up to the date of preparing this Report an enormous number of samples of beer have been tested in the Metropolitan District—a district containing a population, it must be remembered, of several millions—but no arsenic has been found. Nor does there appear to have been a sufficient number of cases of neuritis treated in the hospitals in this district or in the neighbouring district to justify suspicion of poisoning. The writer believes that the beer in the district at present is free from metallic contamination, and the brewers whose trade has already been affected by the arsenic scare may be depended upon in the future to take especial precautions. 19 On the other hand, in golden syrup, and in various kinds of confectionery, glucose is from time to time used. Golden syrup, or treacle, should be the product of the sugar-cane and should contain no starch glucose syrup. This is a more probable source of poisoning now than beer, because the glucose syrup, if added at all, is usually added in considerable amount. Glucose syrup does not necessarily contain arsenic. It has never been found, for example, in American glucose made by the action of hydrochloric acid on starches; and in the English system of making starch-glucose by acting on the starch with some 3 or 4 per cent. of sulphuric acid, if the acid is free from arsenic, the glucose also will be free from arsenic. Attention is now being directed to all products in which glucose may enter as a proper or improper addition, and such articles are carefully tested for arsenic. 20 REPORT OF MORTUARY KEEPER FOB THE YEAR 1900. TABLE I. Number of bodies received from January 1st to December 31st, 1900. Males. Females. Males. Females. Brought forwd. 148 126 January 29 23 July 32 24 February 21 23 August 24 16 March 25 21 September 18 21 April 24 22 October 10 16 May 26 22 November 21 16 June 23 15 December 21 18 Forward 148 126 Total 511 274 237 Number of Inquests from January 1st to December 31st, 1900. Brought forward 118 January 20 July 29 February 22 August 15 March 23 September 15 April 22 October 6 May 16 November 18 June 15 December 17 Forward 118 Total 218 INFECTIOUS CASES RECEIVED. Diphtheria 11 Scarlet Fever 1 Smallpox 1 Typhoid Fever 1 Enteric Fever 3 Total 17 21 TABLE II.—Sale of Food and Drugs Acts.—Total number of Sample analysed during the year ending December 31st, 1900. Genuine. Adulterated. Total. Dairy Products: Milk 148 5 153 Butter 60 .. 60 Margarine 17 .. 17 Cream 3 .. 3 Cheese 1 .. 1 Condiments: Mustard 18 .. 18 Pepper 14 .. 17 Curry Powder 1 .. 1 Vinegar 5 .. 5 Spirits: Gin 32 .. 32 Whisky 55 .. 55 Brandy 19 .. 19 Rum 13 .. 13 Beverages: Beer 15 .. 15 Port Wine 5 .. 5 Tea 10 .. 10 Coffee 15 .. 15 Cocoa 3 .. 3 Starchy and Sacharine Substances: Flour 6 .. 6 Bice, Sago, Peaflour 4 .. 4 Honey 10 .. 10 Treacle 12 .. 12 Jam 35 .. 35 Sweets 7 .. 7 Sugar 2 .. 2 Drugs: Seidlitz Powder 1 .. 1 Jalap 1 .. 1 Quinine 1 .. 1 Laudanum 4 .. 4 Limewater 1 .. 1 Tartaric Acid 1 .. 1 Bicarbonate of Soda 1 .. 1 Soda Water 1 .. 1 Miscellaneous: Lard 9 .. 9 Olive Oil 3 .. 3 Cocoa Butter 2 .. 2 Apple Green 1 .. 1 Lemonade 1 .. 1 Lemon Quash 3 .. 3 Mincemeat 1 .. 1 Sauce 5 .. 5 Tinned and Bottled Foods 85 .. 85 Total 631 8 639 • 22 TABLE III.—TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, in the Sanitary District of ST. MARYLEBONE, during 1900; classified according to Diseases, Ages, and Localities. (a) All Souls Rectory St. Mary Christ Church St. John Totals Population at all Ages. (b) Census 1896 36,495 19,798 19,637 32,547 32,611 141,188 (c) Registered Births 638 409 459 794 825 3125 (d) Aged under 5 or over 5. Under 5 5 upwards , Under 5 5 upwards Under 5 5 upwards Under 5 5 upwards Under 5 5 upwards Under 5 5 upwards New Casks of Sickness in bach Locality coming to the knowledge of the medical Officer of Health. 1. Smallpox .. .. .. .. .. .. .. 1 .. 4 .. 5 2. Scarlatina 26 92 13 25 6 23 13 56 40 64 98 260 3. Diphtheria 8 22 5 10 1 12 30 36 31 44 75 124 4. Membranous Croup .. .. .. .. .. .. .. 1 .. 1 .. 2 Fevers. 5. Typhus .. .. .. .. .. .. .. .. .. .. .. .. 6. Enteric or Typhoid 1 21 13 2 15 1 11 2 9 6 69 7. Continued .. .. .. .. .. .. .. .. .. .. .. .. 8. Relapsing .. .. .. .. .. .. .. .. .. .. .. .. 9. Puerperal .. 3 .. .. .. .. .. 1 .. 2 .. 6 10. Cholera .. .. .. .. .. .. .. .. .. .. .. .. 11. Erysipelas 1 29 1 63 22 8 55 4 29 14 188 Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospitals. 1 Smallpox .. .. .. .. .. .. .. 1 .. 4 .. 5 2. Scarlatina 21 73 2 19 5 16 20 49 25 41 80 198 3. Diphtheria 5 20 3 6 2 8 24 22 22 35 56 91 4. Membranous Croup .. .. .. .. .. .. .. .. .. .. .. .. Fevers. 5. Typhus .. .. .. .. .. .. .. .. .. .. .. .. 6. Enteric or Typhoid 1 11 .. 10 1 9 .. 7 1 4 3 41 7. Continued .. .. .. .. .. .. .. .. .. .. .. .. 8. Relapsing .. .. .. .. .. .. .. .. .. .. .. .. 9. Puerperal .. .. .. .. .. .. .. 1 .. .. .. 1 10. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .11. Erysipelas 1 7 .. 35 .. 5 1 10 .. 7 2 64 23 TABLE IV. Names of Localities. ALL SOULS. RECTORY. S. MARY. CHRIST CHURCH. S. JOHN. year. Population estimated to middle of each Year. Births registered. Deaths at. all Ages. Deaths under 1 year. Population estimated to middle i of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. a b c d a b c d a b e d a b e d a b c d 1895 36,595 725 591 126 19,798 526 446 84 19,637 486 411 92 32,547 908 777 191 32,611 890 629 166 1896 „ 779 588 143 „ 526 461 80 „ 423 365 75 „ 892 788 198 „ 833 673 166 1897 „ 696 522 118 „ 445 424 67 „ 448 346 74 „ 806 632 163 „ 867 651 184 1898 „ 662 559 128 „ 436 454 70 „ 478 381 81 „ 800 637 162 „ 823 572 140 1899 „ 545 506 102 „ 423 494 65 „ 450 412 80 „ 766 608 148 „ 822 556 136 Averages of Years 1895 to 1899. 36,595 681 555 103 19,798 471 456 73 19,637 457 383 80 32,547 802 688 172 32,611 847 616 138 1900 36,595 642 575 114 19,798 409 420 59 19,637 459 342 68 32,547 790 659 154 32,611 825 704 174 24 TABLE V.—Giving the death-rate per thousand of population of the five Registration Districts for certain classes of Disease, 1900. The whole District. All Souls. Rectory. St. Mary. Christ Church. St. John. Zymotic Diseases 2.64 2.17 2.57 2.49 2.34 3.61 Pulmonary, other than Phthisis 4.31 2.86 4.44 3.58 5.62 5.02 Tubercular 2.01 2.15 1.78 1.66 2.16 2.05 25 TABLE VI.—Giving the Causes of Deaths during the 52 Weeks ending December 22nd, 1900, at the Middlesex Hospital, Queen Charlotte's Lying-in Hospital, Samaritan Hospital, the Workhouse, and the Marylebone Infirmary, Notting Hill. W. Middlesex Hospital. Queen Charlotte's Hospital. Samaritan Hospital. Workhouse. Notting Hill Infirmary. Influenza .. .. .. .. .. Scarlet Fever .. .. .. .. Diphtheria 3 .. .. .. 1 Typhoid Fever 5 .. .. .. 3 Diarrhœa 4 1 .. 3 10 Erysipelas 1 .. .. .. 3 Pneumonia and Pleurisy 26 2 1 5 20 Pyaemia 1 .. 2 .. 3 Syphilis 1 .. .. .. 4 Cancer 137 .. 1 .. 44 Phthisis and Tuberculosis 40 1 .. .. 131 Rheumatism 2 .. .. .. 6 Apoplexy 9 3 .. 3 12 Paralysis 2 .. .. .. 16 Bronchitis 15 .. .. 9 96 Asthma .. .. .. 2 .. Peritonitis 8 1 2 .. 2 Disease of Brain 2 .. .. 5 1 ,, Heart 30 2 .. 4 34 Kidney 17 .. .. .. 5 ,. Liver 7 .. .. .. 8 ,, Uterus 2 .. 7 .. .. „ Ovary 2 2 4 .. .. Parturition .. 1 .. .. .. Diabetes .. .. .. .. .. Fractures and Injuries 20 .. .. 2 17 Old Age .. .. .. 2 34 Low Vitality, Infants .. 2 .. 5 .. Premature Birth 1 13 .. 3 .. Other causes 74 11 3 9 74 Total *309 †39 ‡20 52 524 * Of the 309 deaths in the Middlesex Hospital, 226 were those of non-parishioners. †37 of the 39 deaths in Queen Charlotte's Hospital were those of non-parishioners. ‡ 17 of the 20 deaths in the Samaritan Hospital were non-parishioners. 26 TABLE VII.—Causes of, and Ages at, Death during 1900, in the Borough of St. Marylebone.* CAUSES OF DEATH. Deaths in whole District at subjoined Ages. Deaths in Localities (at all Ages.) All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. j All Souls. Rectory. St. Mary. Christ Church. St. John. Smallpox 2 ... ... ... 1 1 ... ... ... ... ... 2 Measles 39 13 21 5 ... ... 2 6 6 12 13 Scarlet Fever 22 5 9 8 ... ... ... 4 2 5 6 5 Whooping Cough 48 30 16 2 ... ... ... 11 9 2 8 18 Diphtheria and Membranous Croup 29 4 13 12 ... ... ... 5 1 2 8 13 Croup 3 1 2 ... ... ... ... 2 ... 1 ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... Enteric 15 ... 1 3 ... 11 7 2 1 3 Other continued ... ... ... ... ... ... ... ... ... ... ... ... Epidemic influenza 75 4 1 3 3 40 24 20 14 13 5 23 Cholera ... ... ... ... ... ... ... ......... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 137 101 19 1 1 5 10 29 17 17 36 38 Enteritis ... ... ......... ... ... ... ... ... ... ... ... ... Puerperal fever 2 ... ... ... ... 2 ... ... 1 1 ... ... Erysipelas 4 ... ... ... ... 4 ... 2 ... ... 1 1 Other Septic Diseases 22 ... 1 ... 6 10 5 ... 3 4 13 2 Phthisis 275 14 10 15 52 161 20 80 34 30 68 63 Other Tubercular Diseases 12 10 2 ... ... ... ... ...1 2 2 4 3 Cancer, Malignant Disease 137 1 1 3 85 47 47 27 20 15 28 Bronchitis 355 63 25 4 5 121 137 62 55 39 102 97 Pneumonia 216 57 41 9 5 84 20 36 27 23 73 57 Pleurisy 3 1 ... ... ... 1 1 1 ... ... 1 1 Other Diseases of Respiratory Organs 41 2 4 ... 2 20 13 ... 8 7 11 6 Alcoholism Cirrhosis of Liver 4 ... ... ... ... 4 ... ... 1 1 1 1 Venereal Diseases 9 7 ... ... ... 2 ... ... 3 2 4 ... Premature Birth 70 70 ... ... ... ... ... 22 3 6 15 24 Diseases and Accidents of Parturition 1 ... ... ... ... 1 ... ... 1 ... ... ... Heart Diseases 228 2 1 10 11 119 85 41 41 30 59 57 Accidents 83 26 8 6 5 25 13 16 9 9 30 19 Suicides 11 ... ... ... 1 9 1 1 1 5 4 All other causes 857 158 58 22 376 243 177 163 121 180 226 All causes 2700 569 232 101 95 108-4 619 575 420 342 659 704 "The deaths include deaths in the Public Institutions, enumerated in Table VI., with the exception of deaths of non-residents in the district. 27 REGISTER OF SANITARY WORK, Year ending 31st December, 1900. SANITARY DEPARTMENT. Mr. J. Hodges, No. 1 District. Mr. A. Perry, No. 2 District. Mr. T. Gorniot, No. 3 District. Mr. D. J. Andrews No. 4 District. Mr. W. Yeo, No. 5 District. Mr. R. Phillips, Special Duties. Miss L. M. O'Kell . Number of Complaints received ... 163 232 299 278 50 62 1218 Inspections. Of Dwelling Houses 385 347 289 433 296 193 8 1951 „ Kitchens (separately occupied) 56 ... 36 241 149 ... 4 486 ,, Schools 11 18 9 10 10 ... ... 58 ., Houses registered under PublicHealth(London) Act, 1891 275 ... 183 228 287 ... ... 973 ,, Dairies and Cow-houses 24 12 11 3 5 ... ... 55 ., Bakehouses 2 ... ... ... ... 509 ... 511 „ Slaughterhouses 24 15 7 4 7 ... ... 57 „ Miscellaneous Inspections 1841 1948 1989 1923 1672 1838 3496 14707 Notices issued for Abatement of Nuisances 44 25 67 31 72 3 2 244 Letters written relating to Abatement of Nuisances* 233 218 211 344 229 19 124 1378 Proceedings taken before Magistrates under Sanitary Acts. 4 ... 16 5 ... ... ... 25 Reports made to Medical Officer of Health 361 404 451 360 596 254 90 2516 Infectious Patients removed to Hospital 156 74 86 89 158 ... 5 568 Rooms Disinfected after Infectious Disease 252 164 151 142 304 ... 25 1038 New Pipe Drains (feet) 12658 15646 9880 9480 17126 136 64926 Houses where defects in Drainage have been detected and remedied 69 79 60 109 64 3 ... 385 Unwholesome Food—Number of Seizures made 1 ... ... 2 2 ... ... 5 Food Adulteration. Samples collected for Analysis 124 115 122 130 120 25 3 639 Proceedings taken before Magistrates 1 ... 2 ... ... ... ... 3 Removal of Bodie3 to Mortuary 9 2 1 3 2 ... ... 17 INDEX TO MONTHLY REPORTS, 1900. A page Abbey Gardens, Prosecution relative to . 32 All Souls, Birth and Death-Rate— January 2 February 20 March 31 April 46 May 56 June 69 July 84 August 95 September 95 October 114 November 124 Arsenic in Beer 126 B Bennett v. Harding 70 Bethell, Pitt, and Longman, Prosecution relative to Manure, Boston Mews . . 4 Birth and Death-Rates— January 2 February 20 March 31 April 46 May 56 June 69 July 84 August 95 September 95 October 114 November 124 Births and Deaths— January 2, Table II. 12 February 20, „ IV. 24 March 30, Table V. 37, „ VI. 37 April 46, ,, IV. 51 May 56, „ IV. 63 June 68, Table IV. 75, ,, V. 75 July 84, „ IV. 89 August 94, ,, IV. 89 August 94. ,, VII. 104 September 94, Table VIII. 104, ,, IX. 105 October 94, „ IV. 119 November 124, V. 132 Boston Mews, Prosecution of Occupiers relative to Manure 4 Boston Place, No. 58, Prosecution of Owner relative to Manure 70 Burne Street, No. 37, Prosecution of Owner. 70 Burne Street Area, Representation under Housing of Working Classes Act of . 86 Burne Street, No. 37, Prosecution of Owner of 70 C Callow Park Milk Co., Prosecution of, for Milk Adulteration 71 Chard, James, Prosecution of, for Milk Adulteration 71 page Christ Church Birth and Death-Rate— January 2 February 20 March 31 April 46 May 56 June 69 July 84 August 95 September 95 October 114 November 124 Cleansing of Persons Act 32 D Deaths, causes of— January Table V. 15 February „ VI. 25 March ,, VII. 38 April „V. 52 May ,, V. 64 June „ VIII. 78 July „V. 90 August ,, X. 106 September „ XI. 107 September Quarter „ XII. 108 October „ V. 120 November ,, IV. 131 F Finchley Road, Smell in 72 G Golden Syrup, Adulteration of 33 H Harrow Street, No. 31, Prosecution of owner of under Public Health Act 3 Harrow Street, No. 14, Prosecution of owner of under Public Health Act 70 Health of District during March Quarter 32 Hot Weather and Health 85 House Refuse, collection of 126 Housing of the Working Classes Act (Burne Street Scheme) 86 I Infant Mortality from Convulsive and Wasting Diseases— January 3 February 21 March 31 April 47 May 57 June 69 July 85 August and September 95 October 115 November 126 ii. INDEX TO THE MONTHLY RE PORTS—continued. page Infectious Diseases notified in— January Table III. 13 February „ II. 22 March „ II. 34 April ,,II. 49 May ,, II. 61 June Quarter ,, III. 74 July „ II. 87,101 August ,, IV. 102 September ,, V. 102 October ,, III. 118 November „ III. 130 Influenza, Deaths from, February, 1900 . 21 J January, 1900, exceptional Mortality of 4 John's Yard, Prosecution of Occupants for Non-Removal of Manure 32 L Linhope Street, No. 10, No. 50, Prosecution of Owners under Public Health Act 4 70 Lisson Grove, No. 127, Prosecution of Owners under Public Health Act 21, 48, 70 Logsdon v. Booth 10,12 M Margarine 33 Marshall, Arthur, Prosecution of, for Milk Adulteration 71 Meteorology— January 1 February 19 March 29 April 45 May 55 June 67 July 83 August 93 September 93 October 113 November 123 Middlesex Hospital, Causes of Death in, January Table IV. 14 February „ III. 23 March „ IV. 36 April „ III. 50 May ,, III. 62 June „ VI. 76 July ,, III. 88 August „ IV. 101 September ,, V. 102 October ,, III. 118 November ,, II. 129 N Notting Hill Infirmary, Causes of Death in— January Table IV. 14 February ,, III. 23 March ,, IV. 36 April „ III. 50 May ,, III. 62 June „ VI. 76 July ,, III. 88 August ,, IV. 101 September . Table V. 102, „ VI. 103 October ,, III. 118 November „ II. 129 P page Peas, Coppered 33 Phthisis (see Tubercular Diseases). Pulmonary Diseases, Death Rates from, in— January 3 February 21 March 31 April 47 May 57 June 69 July 85 August 95 September 95 October 115 November 125 Q Queen Charlotte's Lying-in Hospital, Causes of Death in— January Table IV. 14 February „ III. 23 March „ IV. 36 April ,, III. 50 May „ III. 62 June „ VI. 76 July „ III. 88 August ,, IV. 101 September „ V. 102 October ,, III. 103 November „ I. 129 R Rectory—Birth- and Death-Rate— January 2 February 20 March 31 April 46 May 56 June 69 July 84 August 95 September 95 October 114 November 124 S St. John—Birth- and Death-Rate— January 2 February 20 March 31 April 46 May 56 June 69 July 84 August 95 September 95 October 114 November 124 St. Mary—Birth- and Death-Rate— January 2 February 20 March 31 April 46 May 56 June 69 July 84 August 95 September 95 October 114 November 124 St. Marylebone Charity Schools, Outbreak of Scarlet Fever in 115, 126 INDEX TO THE MONTHLY REPORTS—continued. iii. page Sale of Food and Drugs Act 33, 40, 71, 79, 98, 99 Salvation Army Shelter 10-12 Samaritan Hospital, Causes of Death in— January 14 February 23 March 36 April 50 May 62 June 76 July 88 August 101 September 102 October 118 November 129 Sanitary, Practical Work of Inspectors- January 17 February 27 March 42,43 April 54 May 66 June 81,82 July 91 August 109 September 110, 111 October 121 November 133 Scarlet Fever Outbreak 115 Shouldham Street, No. 14, Prosecution of Owner under Public Health Act 21 Smallpox 48, 58 T Tubercular Diseases Death Rate, from— January 3 February 21 March 31 April 47 May 57 June 69 July 86 August 95 September 95 October 115 November 125 U . page Underground Rooms, Illegal Occupation of 5, 5, 10 Upper Dorset Street, No. 12, Prosecution of owner of 48 W Water, Analysis of 16,26, 41,53 Workhouse, Causes of Deaths in. January 14 February 23 March 36 April 50 May 62 June 76 July 88 August 101 September 102,103 October 118 November 129 Workplace under Factory Act 70 Z Zymotic Diseases, Death-Rate from, January 3 February 31 March 31 April 47 May 57 June 69 July 85 August 95 September 95 October 115 November 125 INDEX TO ANNUAL REPORT. A PAGE All Souls, Births and Deaths in. Table IV. 25 Birth- and Death-Kates of .7 Infectious Sickness in. Table III. 24 Causes of Death in. Table VII. 27 Andrews, D. J., Register of Work during the year 29 Arsenic in Beer 19 B Births and Deaths 7 Boston Mews, Prosecutions of Occupants relative to Non-Removal of Manure . . 11 C Christ Church, Births and Deaths in. Table IV. 25 Birth- and Dearh-Rate of 7 Causes of Death in. TableVII. 27 Infectious Sickness in. Table VII. 27 Cleansing of Persons Act 13 Cleansing of Workshops 17 Clerical Work of Sanitary Department 14 Curtis, J., Work of 14 D Diphtheria 10 Disinfection 12 F Factory and Workshop Acts, administration of 15 G Glucose in Syrups 21 Gorniot, T., Register of Work during the year 29 H Hodges, J., Register of Work during the year 29 Housing of the Working Classes Act Amendment Act 13 Howe, W. J., Work of 14 I Infectious Sickness Table III. 24 J John's Yard, Prosecution of Occupants for Non-Removal of Manure 11 M Measles 9 Meteorology 5, 6 Middlesex Hospital, Causes of Death in. Table VI. 27 Mortuary Keepers Report 22 N Notting Hill Infirmary, Causes of Death in. Table VI. 27 O PAGE O'Kell's, Miss, Report 19 „ ,, Register of Sanitary Work during the year 29 Outworkers 18 Overcrowding in Workshops 18 P Perry, A., Register of Sanitary Work during the year 29 Phillips. Richard, Report 15 ,, Register of Sanitary Work during the year 29 Practical Sanitary Work 14 Prosecutions under the Public Health (London) Act 11 Public Conveniences 19 Public Institutions, Deaths in 7, 8 Pulmonary Diseases, Death-Rate from, Table V. 26 Q Queen Charlotte's Hospital, Causes of Death in Table VI. 27 R Rectory, Births and Deaths . Table IV. 25 ,, Birth-Rate and Death-Rate of 7 ,, Causes of Death in . Table VII. 27 ,, Infectious Sickness in. Table III. 24 S St. John, Births and Deaths in . Table IV 25 ,, Birth and Death-Rates of ,, Causes of Death in Table VII. 27 St. Mary, Births and Deaths in Table IV. 25 ,, Birth- and Death-Rates of 7 ,, Infectious Sickness in Table III. 24 St. Marylebone, Causes of Death in. Table VII. 28 St. Marylebone Charity School for Girls, Scarlet Fever Outbreak 9 Sale of Food and Drugs Acts, 19. Table II. 23 Samaritan Hospital, Causes of Death in. Table VI. 27 Sanitary Legislation 13, 14 Scarlet Fever 6 Shelter, Occupation of, during 1900 19 Smallpox 9 Smoke Nuisances 16 T Trade Nuisances 16 V Ventilation, Lighting, and Heating of Workshops 17 W Workhouse, Causes of Death in. Table VI. 27 Workshops and Laundries 12 Y Yeo, W., Register of Work during the Year . 29 Z Zymotic Diseases, Death-Rate from . Table IV. 26