STMARY 13 Metropolitan Borough of St. Marylebone. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1907. MEREDITH YOUNG, M.D., D.P.H. Of Lincoln's Inn, Barrister-at-Law WITH AN APPENDIX Containing the Report of the Public Analyst, ALEXANDER WYNTER BLYTH, [Barrister-at-Law, of Lincoln's Inn ; Fellow of the Institute of Chemistry, etc., etc.) London: Geo. Pui.man & Sons, Ltd., Printers. 1908. London: George Pulman & Sons, Ltd., Printers, London and Wealdstone. Public Health Office, 20th February, 1908. To the Worshipful The Mayor, the Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor and Gentlemen, I have the honour to present to you a Report on the health and sanitary condition of the Borough for the year 1907. Your late Medical Officer of Health, Mr. Wynter Blyth, had, at the date of my arrival, already prepared and tabulated most of the figures, so that my own share of the task has been but a light one. The statistical curves in the frontispiece are the work of Mr. Wynter Blyth. My knowledge of the district is not yet sufficient to enable me to comment, except in the briefest and most tentative manner, on the various items in the Report. The arrangement of the Report has been varied slightly and it is hoped that the present form will be found more convenient. I am, Mr. Mayor and Gentlemen, Your obedient Servant, Meredith Young, Medical Officer of Health. INDEX TO ANNUAL REPORT A PAGE Alcoholism, deaths from 7 All Souls, birth and death-rate of 7 „ births and deaths in 17, 19 B Bacteriological examinations 14 Baker, Miss, report of 38, 39, 40 „ summary of work done by... 25 Bakehouses, inspection of 23, 27 Baths, cleansing 41 „ for School children 1, 43 Birth and death-rates 7, 15 Births and deaths 7, 15 Births, visitation of 40 c Christ Church, birth and death-rate 7 „ births and deaths, Table 17, 19 Cleansing of Persons Act, 1897 39, 41, 42, 43 Coffee shops, pastrycooks and tea rooms 23 „ inspection of 38 Consumption (Phthisis) 9, 40 Cowhouses 23, 44 Croup, membranous 13 Customs &. Inland Revenue Act 48 D Day Nurseries 41 Deaths, causes of 17 Deaths in extra parochial institutions 18, 19 Deaths, infantile 11 Diphtheria 12, 13, 14 Disinfection 46 District births and deaths 19 Drainage (new) 27 Dust collection 45, 46 E Elementary schools, inspection of 40 Enteric fever 2, 13 Erysipelas 12, 13 F Factories and workshops 33,34, 35, 36, 37, 38,39 Fines recovered under Sale of Food and Drugs Acts 29 H Hospital of St. John, causes of death in... 16 Hotel kitchens, inspection of 38 House drainage 27 House refuse removal 45, 46 Houses let in lodgings 23 I Ice cream premises 23 Infantile mortality 9, 10, 11 Infectious bodies received in mortuary 47 Infectious disease notifications 12, 13 Influenza 8 Inquests 47 Inspections 24, 25 L Licensed cowhouses, list of 44 Licensed slaughter houses, list of 44 London County Council (General Powers) Act, 1904 [Sec. 20 (1)] 46 M Membranous croup ??? .Middlesex Hospital, causes of death in Milk, adulteration of 28.29,3??? Milk premises ??? Mortuary Keeper, report of ??? N Notifications of infectious disease Nuisances ??? o Offensive trades ??? Outlying institutions, deaths in ??? Outworkers ??? P Population ??? Phthisis (Consumption) ??? Phthisis, bacteriological examinations respect of ??? Phthisis, death-rate ??? Prosecutions 2??? Public urinals ??? Q Queen Charlotte's Hospital, causes death in ??? R Register of sanitary work ??? Restaurant and dining room kitcher inspection of ??? Revenue Act, certificates granted . s St. John, birth and death-rate of J „ births and deaths in ??? St. Marylebone, birth and death-rate ??? ,, births and deaths in St. Marylebone Infirmary, causes ??? death in ??? St. Mary, birth and death-rate ??? „ births and deaths in ??? Sale of Food and Drugs Acts 28, 29, ??? Samaritan Hospital, causes of death in Sanitary inspections ??? Scarlet fever ??? School children, cleansing of ??? Shelter ??? Slaughterhouses ??? Smoke observations ??? T Trade nuisances ??? Typhoid fever ??? „ bacteriological examini ??? tions in respect of ??? Tenement houses ??? u Underground conveniences ??? v Verminous rooms ??? Vital statistics ??? w Workhouse, causes of death in ??? Workshops ??? z Zymotic diseases, death-rate ??? 1907. CURVE SHOWING NUMBER OF CASES OF SCARLET FEVER, DIPHTHERIA. AND TYPHOID FEVER NOTIFIED WEEK BY WEEK DURING 1907, Part I. STATISTICAL 7 POPULATION. The Registrar-General gives the population of St. Marylebone, estimated to mid-year, 1907, as 127,718. At the census of 1901 the enumerated population was 133,301, so that there has been an estimated decrease during the six years since then of 5,583. Owing to the want of more frequent enumerations, this estimate has perforce to be accepted, and statistics can only be given on the assumption that it approaches precision. It is hoped that, at an early date, definite means of checking this estimate will be available. BIRTHS. During the year 1907 there were 2,583 births registered, namely, 1,349 of males, and 1,234 of females, a number equal to a rate of 2o-2 per 1,000 of the estimated population. In the several Registration Sub-districts, the birth-rates were as under:— All Souls 15.9 St. Mary 16.9 Christ Church 26.9 St. John 19.2 The average rate for the previous ten years is 22.3 per thousand. In England and Wales, taken as a whole, the birth-rate during 1907 was 26.3, and in the 76 great towns it was 27 0. DEATHS. The total number of deaths to be debited to the Borough is 1931, equal to a death-rate of 15.1 per thousand. This figure has been corrected by the inclusion of persons who, though normally residents in the Borough, died in institutions outside, and by the exclusion of persons who, though they died within the Borough boundaries, were normally residents of other districts. The average death-rate for the preceding 10 years is 17.6 and it may be noted that the rate for 1907 is, curiously enough, exactly the same as that for the preceding year. The death-rates in the several registration Sub-Districts during 1907 were as under:— All Souls 12.3 St. Mary13.7 Christ Church 18.3 St. John 16.0 8 The death-rate for England and Wales as a whole during 1907 was 15.0 while in the 76 great towns it was 15.4. However favourable the general death-rate may be it is always advisable to dissect it into its component parts as far as possible, for it is only by so doing that one can ascertain in what direction to move with a view to its further reduction. The three main divisions which have been previously recorded are those in Table I, given herewith, in which some very slight alterations have been made. The zymotic death-rate, which includes the deaths from certain selected preventible diseases, is at once seen to be distinctly favourable (0 94 per thousand), for the death-rate in England and Wales during 1907, due to the same group of diseases, is given as 1.26 and the corresponding rate for the 76 large towns is 1.54. The zymotic death-rate has been the result principally of whooping-cough and autumnal diarrhoea. Influenza was responsible for 27 deaths, and more than half of these were those of persons of advanced age—65 years and upwards. phthisis claimed a toll of 179 deaths, more than threequarters of these occurring at that period of life which is most valuable alike to the individual and the State. The deaths from Alcoholism are of course very much understated. Alcohol induces death more or less immediately in scores of cases where its effects are not recognised, let alone formally recorded. If truth were allowed to stand out naked and alone, alcoholism as a cause of death would displace many so-called deaths from bronchitis, heart disease, kidney disease and the like ; whilst if its contribution to the fatality of other diseases (and particularly the acute and exhausting diseases of the pneumonic and enteric fever types) could be properly apportioned it would be found to be quite an appreciable one. The low tubercular death rate (1.79 per thousand), and that from diseases of the respiratory organs (2'02 per thousand) are both matters for congratulation. Cancer and other malignant diseases, however, have been responsible for no fewer than 146 deaths. Of this total 84 have occurred, as indeed is usual, at ages from 25 to 65 years—the working period of life—while 61 were in persons over the age of 65 years. Heart diseases have been the cause of 190 deaths, and here again almost the whole of the mortality has occurred at late age period. No other item in the death account appears to call for special comment. 9 The death rates in some of the immediately adjoining districts are as under:— Corrected general death-rate. Phthisis. Zymotic Diseases. Islington 15.2 1.26 1.24 Hampstead 9.0 0.67 0.45 Holborn 16.6 2.28 1.24 Kensington 14.8 0.96 1.00 Paddington 13.46 1.05 0.97 St. Pancras 15.0 1.59 1.18 TABLE I. Showing the comparative mortality during the fifty-two weeks ending 28th December, 1907, from certain classes of diseases :— Total deaths 52 weeks ending 28th Dec. 1907. Rate per 1,000 of the population. I. Deaths from Zymotic Diseases 118 0.94 2. Deaths from Phthisis and other Tubercular Diseases 229 1.79 3. Deaths from Respiratory Diseases ... 386 2.02 NOTES. 1. Includes Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria and Membranous Croup, Typhus, Enteric and other continued Fevers, Diarrhœa and Enteritis. 2. Includes deaths from Pulmonary Phthisis, Tubercular Meningitis, General Tuberculosis, Tabes Mesenterica and other forms of Tuberculosis. 3. Includes Bronchitis, Pneumonia, Pleurisy, and other diseases of the Respiratory Organs. INFANTILE MORTALITY. Principally owing to the cold and wet summer of 1907, the death rate of infants under the age of twelve months was a very low one, viz., 1.02 per thousand registered births. This figure is, it is believed, considerably lower than any on record. It is probable, however, that the infantile death rate in many of the poorer and more crowded districts, could it be separately recorded, would not be one for congratulation. It may be possible in future years to group the statistical returns under this heading in such a manner as to distinguish the lights and shades of the picture. 10 The table appended gives, in the form designed by the Local Government Board, the various causes of death at different age periods, and from this it may be seen that several causes of death loom large e.g. premature birth, atrophy, debility and marasmus, bronchitis and pneumonia. The deaths during the first month of life amounted to 98 or more than one-third of the total, showing at once the great need for such measures as the Notification of Births Acts will shortly enable us to out into more effective operation. The infantile death rates in some of the adjoining districts are as under:— Islington 117 Hampstead 73 Holborn 131 Kensington 126 St. Pancras 11 TABLE 11.—Infantile Mortality during the Year 1907. Deaths from stated Causes in Weeks and Months under One Tear of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 1 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Mont hs. 10-11 Months. 11-12 Months. Total Deaths under One Year. i.. Common Infectious Diseases. Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 2 Scarlet Fever .. .. •• .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria : Croup. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 Whooping Cough .. .. .. .. .. 4 .. .. 1 2 2 1 .. 1 .. .. 11 ii. Diarrhœl Diseases. Diarrhoea, all forms .. 1 2 .. 3 2 1 2 .. 1 4 .. .. 1 .. .. 14 Enteritis, Muco-enteritis Gastro-enteritis 1 .. 1 .. 2 .. 1 2 .. .. .. .. .. 1 .. .. 6 Gastritis, Gastrointestinal Catarrh 1 .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 2 iii. Wasting Diseases. Premature Birth 22 4 4 1 31 4 .. .. .. .. .. .. .. .. .. .. 37 Congenital Defects . 8 .. .. .. 8 2 1 .. 2 1 .. .. 1 .. .. .. 15 Injury at Birth 2 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 Want of Breast-milk Starvation .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Atrophy, Debility, Marasmus 9 4 4 4 21 4 2 1 .. 2 2 .. .. .. .. .. 32 iv. Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. 1 .. 1 1 .. .. 1 1 2 .. .. 7 Tuberculous Peritonitis : Tabes Mesenterica .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. 2 . Other Tuberculous Diseases .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. 2 v. Other Causes. Erysipelas .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Syphilis 1 .. .. .. 1 .. 2 .. .. 1 .. .. .. 1 .. .. 7 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. 2 .. 2 .. 1 .. 1 .. 9 Convulsions 1 2 1 .. 4 2 2 .. 1 .. .. .. 2 .. .. .. 11 Bronchitis .. 2 .. 1 3 7 5 1 3 5 1 .. .. 1 2 1 29 Laryngitis .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 2 Pneumonia 1 .. .. .. 3 2 5 3 3 3 3 1 .. 1 6 2 32 Suffocation, overlying 1 .. 1 1 3 2 .. 2 1 .. 2 .. 1 .. .. .. 11 Other Causes 8 4 .. 1 13 3 3 2 1 2 1 1 1 .. .. .. 27 55 19 14 10 98 37 26 14 17 17 17 5 8 12 10 3 264 Population. Estimated to middle of 1907—127,718. Births in the year 2,583. Deaths in the year of legitimate infants, 252 , illegitimate infants, 12. Deaths from all causes at all ages, 1,931. Death rate per thousand of registered births, 102.026. Average death rate per thousand of registered births for 5 years ending 1906, 137.98. 12 INFECTIOUS DISEASES. There have been 695 notifications of infectious disease received during the year. Scarlet fever has been somewhat more prevalent than in past years, there having been 416 cases reported. There has been slightly less diphtheria than in 1906, whilst Typhoid fever has been markedly reduced as compared with the previous year. Of the cases reported a very considerable number were removed to hospital for treatment, viz:— Scarlet fever 389 or 90.38 per cent. of the cases notified. Diphtheria 108 „ 86.0 „ „ „ Enteric fever 17 „ 68.0 „ „ „ Erysipelas 30 „ 24.0 „ „ „ The notification-rate or proportion to population of cases of infectious disease notified during the year is 5.44 per thousand. The St. John's District appears to have suffered but little from any infectious disease with the exception of scarlet fever, of which it had a fair share. The curve prepared by the late Medical Officer of Health shows in bold lines the seasonal variation in the incidence of Scarlet Fever, Diphtheria, and Typhoid Fever as compared with the average for the preceding ten years (faint dotted lines). In the case of Scarlet Fever, the departures from the average have been somewhat frequent and in the second half of the year rather pronounced. The Diphtheria curve has on several occasions followed that of Scarlet Fever, a coincidence reminding one of the now prevalent theory that the two diseases are near relations. Typhoid fever has moved but very little from the abscissa or base-line, and —probably owing to the prolonged cold and wet weather which took the place of summer in 1907—there is no indication of a rise in the curve during late autumn and early winter. 13 TABLE III.-TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coining to the knowledge of the Medical Officer of Health, in the Sanitary District of ST. MARYLEBONE, during the year ending 28th December, 1907; classified according to Diseases, Ages, and Localities. All Souls St. Mary * Christ Church* St. John Totals * Population AT ALL AGKS. Census 1901 36,391 37,948 39,636 20,426 133,301 Registered Births 537 629 1029 388 2583 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 upward- New Cases of Sickness in each locality coming to the knowledge of the medical Offices op Health. 1. Smallpox .. .. .. .. 1 .. .. .. 1 .. 2. Scarlatina 25 78 40 98 36 76 14 49 115 301 8. Diphtheria 12 17 11 27 18 23 6 9 47 76 4. Membranous Croup .. .. .. .. .. .. .. .. .. .. Fevers. 5. Typhus .. .. .. .. .. .. .. .. .. .. 6. Enteric or Typhoid .. 10 .. 8 .. 3 .. 4 .. 25 7. Continued .. .. .. .. .. .. .. .. .. .. 8. Relapsing .. .. .. .. .. .. .. .. .. .. 9. Puerperal .. 4 .. 1 .. .. .. .. .. 5 10. Cholera .. •• .. .. .. .. .. .. .. .. 11. Erysipelas 1 12 1 42 8 49 .. 12 11 115 Number of such Cases Removed from there. Homes in the several Localities for Treatment in Isolation Hospitals. 1. Smallpox .. .. .. .. 1 .. .. .. 1 .. 2. Scarlatina 23 73 39 90 34 73 14 43 110 279 3. Diphtheria 11 15 11 20 16 23 5 7 43 65 4. Membranous Croup .. .. .. .. .. .. .. .. .. .. Fevers. 5. Typhus .. .. .. .. .. .. .. .. .. .. 6. Enteric or Typhoid .. 7 .. 6 .. 3 .. 2 .. 17 7. Continued .. .. .. .. .. .. .. .. .. .. 8. Relapsing .. .. .. .. .. .. .. .. .. .. 9. Puerperal .. 1 .. .. .. .. .. .. .. .. 10. Cholera .. .. .. .. .. .. .. .. .. .. 11. Erysipelas 1 1 .. 16 .. 11 .. 1 1 29 *St. Mary and Rectory sub-districts are now united into one under the name of St. Mary. 14 BACTERIOLOGICAL EXAMINATIONS. These examinations are conducted by Dr. Eastes, at the Laboratory of Pathology and Public Health, 38, New Cavendish Street, in doubtful cases of Typhoid Fever, Diphtheria and Phthisis, and the following table gives particulars of the number of cases and the result there of:— Positive. Negative. Total. Typhoid Fever 3 10 13 Diphtheria 13 25 38 Phthisis 29 53 82 Totals 45 88 133 It cannot be too frequently pointed out that a single negative result in the case of any of the above diseases is of but little value. In any case where a negative result is obtained it is strongly advisable to take a second and even a third specimen for examination—this whether the clinical signs clear up or not. It is to the interest alike of the public and the patient that this should be done. A single negative result gives one often a false sense of security, and if a medical man relying upon such a result allowed a diphtheritic patient, for example, to mix freely with others, a disastrous spread of infection might follow. In the same way typhoid and tubercle infection might be caused to spread, whilst, in all three diseases, the dangers to the patient of non-recognition of his illness are all too serious. 15 APPENDIX I. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEB0NE DURING 1907 AND THE TEN PREVIOUS YEARS. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. No. Rate. Under 1 Year of Age. At all Ages. No. Rate per 1,000 Births registered No. Rate. No. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1897 137,780 3,262 23.7 606 189.9 2,107 15.3 972 325 793 2,575 18.7 1898 136,720 3,199 23.4 581 181.6 2,080 15.2 907 281 804 2,603 19.0 1899 135,660 3,106 22.9 530 191.5 2,079 15.3 1,001 339 836 2,576 19.0 1900 134,600 3,125 23.2 589 183.0 2,098 15.6 944 285 887 2,700 20.1 1901 133,301 3,042 22.8 449 147.6 1,742 13.0 941 328 797 2,211 16.6 1902 132,010 2,960 22.4 434 146.6 1,961 14.9 1,118 395 892 2,458 18.6 1903 130,900 2,818 21.5 402 142.6 1,683 12.9 1,070 356 853 2,180 16.6 1904 129,970 2,791 21.5 393 139.9 1,716 13.2 1,062 369 825 2,172 16.7 1905 128,960 2,618 20.3 358 138.5 1,625 12.5 895 400 801 2,026 15.7 1906 127,960 2,648 20.7 322 121.6 1,506 11.8 1,240 334 759 1,931 15.1 Averages for years 18971906 132,786 2,956 22.3 466 157.3 1,859 14.0 1,016 341 824 2,343 17.6 1907 127,718 2,583 20.2 264 102.2 1,574 12.3 1,229 433 790 1,931 15.1 Area of District in acres, 1,427.8 acres. Total population at all ages 133,301, at Census of 1901. Number of inhabited houses,13,636 „ Average number of persona per house, 10.6 ,, 16 A.PPENDIX II. TABLE giving the Causes of Deaths during 1907, at Middlesex Hospital, Queen Charlotte's Lying-in Hospital, the Samaritan Hospital, the Workhouse, the Hospital of St. John and Elizabeth, and the Marylebone Infirmary, Notting Hill, W. Middlesex Hospital. Queen Charlotte's Hospital. Samaritan Hospital. Workhouse. Notting Hill Infirm'ry Hospital of St. John & Elizabeth, Grove Road. Smallpox .. .. .. .. .. .. Influenza .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. Diphtheria 2 .. .. .. .. .. Typhoid Fever 1 .. .. .. 2 .. Diarrhoea 4 .. .. .. 4 .. Erysipelas 2 .. .. .. 5 .. Pneumonia and Pleurisy 23 6 .. .. 18 .. Pyaemia 2 .. .. .. 1 .. Syphilis 2 1 4 .. 2 .. Cancer 130 1 .. .. 55 3 Phthisis & Tuberculosis 37 .. .. .. 92 9 Rheumatism .. .. .. .. 5 .. Apoplexy .. .. .. .. 15 1 Paralysis .. .. .. .. 7 .. Bronchitis 17 .. .. .. 99 1 Asthma .. .. .. .. .. .. Peritonitis .. .. .. .. 3 .. Disease of Brain .. .. .. .. .. .. „ Heart 28 .. .. .. 25 3 „ Kidney 3 .. .. .. 5 .. ,. Liver 10 .. .. .. 5 2 „ Uterus .. .. .. .. .. .. „ Ovary .. .. .. .. .. .. Parturition .. 5 .. .. .. .. Diabetes .. .. .. .. .. .. Fractures and Injuries 17 .. .. .. 4 1 Old Age .. .. .. .. 27 .. Low Vitality, Infants .. .. .. .. 13 .. Premature Birth .. 15 .. .. .. .. Other causes 140 23 5 25 116 4 Total *418 †51 **11 44 503 ***25 *Of the 418 deaths in the Middlesex Hospital, 358 were those of non-parishioners, †Of the 51 deaths in Queen Charlotte's Hospital, 44 were those of non-parishioners. **The 11 deaths in the Samaritan Hospital were those of non-parishioners. ***20 of the 25 deaths in the Hospital of St. John were those of non-parishioners. 17 APPENDIX III. Table showing deaths from certain specified diseases for the year ending 28th December, 1907. CAUSES OF DEATH. Deaths in whole District at subjoined Ages. Deaths in Localities (at all Ages.) Deaths in Public Institutions. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. All Souls. St. Mary. Christ Church. St. John. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Measles 13 2 5 5 ... 1 ... 6 2 5 ... 3 Scarlet Fever 19 ... 9 7 ... 3 ... 1 6 9 3 11 Whooping Cough 38 11 26 1 ... ... ... 9 6 18 5 5 Diphtheria and Membranous Croup 13 2 8 2 ... 1 ... 3 1 7 2 11 Croup ... ... ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... Enteric 2 ... ... ... ... 2 ... ... ... 2 ... 1 Other continued ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 27 ... 2 2 1 8 14 7 4 9 7 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 25 14 7 ... ... 2 2 4 4 16 1 13 Enteritis 8 6 1 1 ... ... ... 1 ... 6 1 2 Puerperal Fever 4 ... ... ... ... 4 ... 1 1 2 ... 2 Erysipelas 7 1 ... ... ... 6 ... 2 1 4 ... 8 Other Septic Diseases 18 2 ... ... 2 9 5 8 2 5 3 11 Phthisis 179 1 5 6 9 140 18 42 16 64 27 125 Other Tubercular Diseases 50 10 13 3 5 17 2 7 14 22 7 48 Cancer, Malignant Disease 146 ... ... 1 ... 84 61 41 13 32 30 192 Bronchitis 237 29 17 2 ... 73 116 53 60 89 35 111 Pneumonia 143 32 33 4 1 54 19 32 39 58 14 69 Pleurisy 2 ... ... ... ... 2 ... 1 ... 1 ... 1 Other Diseases of Respiratory Organs 4 ... 1 ... ... 1 2 2 ... 2 ... ... Alcoholism Cirrhosis of Liver 41 ... ... ... 2 38 1 13 14 8 6 33 Venereal Diseases 9 7 1 ... ... 1 ... 2 1 6 ... 8 Premature Birth 37 37 ... ... ... ... ... 6 10 15 6 17 Diseases and Accidents of Parturition 4 ... ... ... ... 4 ... ... 3 1 ... 6 Heart Diseases 190 1 ... 4 4 108 73 41 57 62 30 81 Accidents 46 11 3 3 4 13 12 11 13 15 7 33 Suicides 10 ... ... ... ... 9 1 2 2 3 3 2 All other causes 659 98 29 6 16 228 282 120 181 222 136 446 All causes 1,931 264 160 47 44 808 608 415 510 683 323 1240 18 APPENDIX IV. The following statement shows the number of deaths in outlying institutions of persons normally resident in Marylebone. St. Marylebone Infirmary, Notting Hill 503 St. Mary's Hospital 53 North-Western Fever Hospital 13 Western Fever Hospital 16 Northern Fever Hospital 1 South Wharf (Metropolitan Asylums Board) 1 London Fever Hospital 1 University College Hospital 23 St. Bartholomew's 3 St. Thomas' 1 Great Northern Hospital 1 King's College Hospital 2 St. George's Hospital 4 London Hospital 1 Westminster Hospital 1 Royal Free Hospital 1 Children's Hospital, Paddington 17 Children's Hospital, Great Ormond Street 8 French Hospital 5 German Hospital 3 Italian Hospital 1 Cheyne Hospital 1 Cancer Hospital, Chelsea 3 Home Hospital, Fitzroy Square 1 Royal Hospital, Waterloo Road 2 St. Luke's Hospital 5 Bethnal House Asylum 1 Claybury Asylum 9 Camberwell Asylum 2 Cane Hill Asylum 3 Leavesden Asylum 7 Long Grove Asylum 1 Hanwell Asylum 19 Middlesex Asylum, Tooting 1 Banstead Asylum 9 Belmont Asylum 1 Colney Hatch 12 Hoxton 4 Darenth 4 Tooting Bec 3 Dartford Heath 1 Caterham 1 749 19 Brought forward 749 Peckham House Asylum 1 London Temperance Hospital 3 Victoria Hospital, Chelsea 1 Royal Hospital for Incurables 1 St. Peter's Home, Kensington 3 St. Joseph's Home 7 St. Anne's Home, Stoke Newington 1 Hampstead Workhouse 1 Holborn Workhouse 2 Holborn Infirmary 1 St. Pancras Infirmary 2 Paddington Workhouse 1 Paddington Infirmary 1 Friedenheim 1 Homeoepathic Hospital 2 Clapham Maternity 1 Central Sick Asylum 1 Camberwell Workhouse 1 Other addresses 10 790 APPENDIX V. District births and deaths for the fifty-two weeks ending 28th December, 1907. Sub District. Population in 1901. Births. Deaths. Males. Females. Males. Females. All Souls 35,391 271 266 215 200 St. Mary 37,948 342 287 252 258 Christ Church 39,536 545 484 374 309 St. John 20,426 191 197 153 170 Total 133,301 1,349 1,234 994 937 Note.— In the above table the births and deaths have all been properly corrected, strangers have been eliminated, and extra-parochial deaths and others have been allotted to their proper Sub-district. *The Rectory Sub-district is now amalgamated with St. Mary. Part II. DEPARTMENTAL. 23 SANITARY INSPECTION. The following special premises requiring constant supervision exist in the Borough:— Milk Premises 343 Cowshouses 6 Slaughterhouses 10 Offensive Trades 2 Ice Cream Premises 84 Bakehouses 78 Restaurants and Dining Rooms (Kitchens) 68 Hotel Kitchens 27 Coffee Shops, Pastry Cooks, and Tea Rooms 145 Houses let in Lodgings 758 Workshops 2,831 In addition to these there are many places such as Mews, Butchers, Fishmongers' and Greengrocers' Shops, Outworkers, etc., which must, year after year, be frequently and continuously inspected. A record of inspectorial work is contained in the following table, so far as such work is capable of being expressed within the four corners of such a statement. 24 REGISTER OF SANITARY WORK Year ending 31st December, 1907. PUBLIC HEALTH DEPARTMENT. District Inspectors. Mr.E. Lumley, Dust Inspector. Total. Mr. J. Hodges, No. 1 District. Mr. A. Perry, No. 2 District. Mr. D. J. Andrews, No. 3 District. Mr. T. Gorniot, No. 4 District. Mr. G. Smith, No. 5 District. Public Health (London) Act. Inspections. Dwelling Houses, &c 484 ... 408 ... 386 ... 1278 Tenements 488 ... 397 ... 425 ... 1310 Underground Dwellings 124 ... 161 ... 132 ... 417 Dairies, Milk Shops, Cow Houses 227 ... 173 ... 176 ... 576 Slaughter Houses 65 ... 2 ... 9 ... 76 Yards, Stables, and Mews 486 ... 512 ... 471 ... 1469 Smoke Shafts 74 15 94 ... 207 106 496 Offensive Trades and Effluvia Businesses ... ... 2 ... 8 ... 10 Refuse Receptacles 98 ... 90 ... 76 218 482 Enquiries re removal of refuse 170 ... 225 ... ... 2466 2861 Removal of Bodies to Mortuary 2 ... 5 ... 2 ... 9 Visits to Works in progress 912 3187 999 3044 949 ... 9091 . Miscellaneous Inspections 764 978 552 1666 536 68 4564 UNWHOLESOME FOOD Number of seizures made ... ... 1 1 ... ... 2 INFECTIOUS DISEASE:— Cases Isolated 16 ... 18 ... 8 ... 42 Cases Removed to Hospital 161 ... 198 ... 217 ... 576 Rooms Disinfected 239 ... 240 ... 305 ... 784 NEW DRAINAGE Number of Plans Passed ... 168 ... 190 3 ... 361 New Pipe Drains (feet) 12 18295 ... 16457 47 ... 34811 Houses where defects in existing Drainage have been detected and remedied 94 14 67 7 74 ... 256 Food and Drugs Act. ADULTERATION. Samples collected for Analysis 292 ... 310 ... 379 ... 981 Correspondence, Legal Procedure, & c. Complaints received 284 ... 453 ... 287 *347 1371 Letters and Intimations relating to Abatement of Nuisances 494 ... 588 ... 470 210 1762 Statutory Notices Served 71 ... 107 ... 62 ... 240 Proceedings taken before Magistrates 5 ... 15 ... 12 ... 32 Reports made to Medical Officer of Health 538 528 667 598 558 319 3208 *Includes complaints and letters respecting removal of House Refuse. 25 REGISTER OF SANITARY WORK Year ending 31st December, 1907. PUBLIC HEALTH DEPARTMENT. Miss F. A. Baker. Miss S. W. Limont. (6 Months). Mr. R. Phillips. Miss M. Johnson. (6 Months). Total. Factory and Workshop Act. Enquiries as to Occupation 83 ... 301 ... 384 Factories 3 ... 26 ... 29 Workshops 644 ... 455 ... 1099 Domestic Workshops 4 ... 9 ... 13 Outworkers' Premises 147 ... 25 ... 172 Restaurants, &c. ... ... 445 ... 445 Bakehouses ... ... 411 ... 411 Public Health (London) Act ... ... 18 ... 18 Smoke Shafts ... ... 157 ... 157 Offensive Trades ... ... 4 ... 4 Enquiries re non-removal of Dust ... ... ... ... ... Visits to works in progress 83 ... 212 ... 295 Miscellaneous Inspections 955 83 556 137 1731 Complaints received 65 5 72 1 143 Letters and Intimations 47 5 1 1 54 Statutory Notices, &c. 1 ... ... ... 1 Proceedings taken before Magistrate ... ... ... ... ... Reports made to M.O.H. 81 20 245 3 349 Elementary Schools 1 29 ... 16 46 Phthisis cases 172 209 ... 29 410 Birth Returns 615 747 ... 764 2126 26 NUISANCES. 1,165 complaints were received during the year. The majority of the Nuisances were abated by verbal notice or intimation. In 231 cases the usual Statutory Notice was issued. In the following cases the Notices had to be enforced by Legal proceedings :— Offence. Failure to provide efficient ventilation to the w.c. at No. 15a, Baker Street. Failure to redrain the premises No. 87, Crawford Street. Failure to remove the accumulation of manure from No. 8, John's Yard. Refusal to allow dustman to remove house refuse from receptacle in yard at rear of premises through basement room. Ditto, by way of front passage. Obstructing men during relaying drains at No. 122, Marylebone Road. Allowing fowls to stray in the carriageway at the east end of Barrett Street, so as to be a nuisance. Refusing to allow dustman egress to remove the offensive accumulation of house refuse from the back yard. Walls of front and back areas dirty, premises without properly covered dust receptacle. Failure to provide a proper receptacle for the storage of manure. Result. Summons was not applied for, work complete 23rd January, 1907. Premises closed. Lease expired 31st March, 1907, 3/- costs. Solicitors recovered the cost of removal of manure, 6/-. Magistrate refused to grant warrant as the defendants would grant access, but not egress, the P.H. (L.) Act not applying to the case 5th April, 1907. Order made for men to be admitted 6th March, 1907. Workmen admitted and work complete. Magistrate took no evidence and dismissed the case. Summons withdrawn, dust having been removed and old brick receptacle demolished. Summons was withdrawn as work was executed, 6th September, 1907. Summons withdrawn, receptacle provided, 19th September, 1907. SMOKE OBSERVATIONS. Altogether 653 very brief observations were taken at various times by the staff of Male Inspectors of the chimney shafts 27 etc., throughout the Borough in connection with smoke consumption, this number including several observations of engines taken in the siding of the Great Central Railway, Marylebone Station. During the year 22 complaints were made in respect of nuisances from smoke. Five of these were in respect of chimneys from private houses and the remaining 17 were immediately abated on the Inspector calling with reference thereto. In one case (3 and 4, Barrett Street) an Intimation of Nuisance was served with the result that the chimney was reconstructed and the nuisance ceased. In another case (17, Nutford Place) two Notices were served in respect of an alleged nuisance from smoke from a chimney in the back addition of a private house entering the windows of adjoining premises, which included an elementary school classroom. The matter was referred to the Solicitors for proceedings to be taken, but at the close of the year the matter was still in abeyance, the alleged nuisance having for the time ceased. At the time of writing this Report part of the nuisance arising from a defective flue has been abated. The remaining nuisance is not one coming within the purview of the Public Health Acts and the complainants have therefore been advised to deal with it as a private or common law nuisance. As this kind of complaint is frequently referred to the Public Health Department it may be shortly stated here that the Public Health (London) Act, 1891, to all intents and purposes, only allows the Department to deal with black smoke issuing in such quantities as tc be a nuisance from the chimney of premises which are not private dwellings. HOUSE DRAINAGE, 1907. During the year 313 plans of new drainage, representing 34,811 feet of pipes have been dealt with. Proceedings were taken during 1907 in the following cases to enforce compliance with the By-laws of the London County Council, as to giving Notice, depositing plans, etc. Offence. Executing sanitary work at 17, Park Road, without notice or depositing plans. Executing certain sanitary work at No. 31, York-terrace, without depositing plans and constructing such works contrary to the Bye-laws of the London County Council. Result. Fine 5/- and 2/- costs. Fined 10/- on each of four summonses, in all £2 and 8/costs. 28 Even a very short experience has shown me that in this branch of sanitary work particularly, it is necessary to hold the reins with a very firm hand, and it is therefore my fixed intention to do so. In the matter of drainage we know definitely now what is wrong and what is right, so that we have every reason for rejecting the first and insisting on the second. Sanitation is like war, and must admit no half-hearted measures of reform. PROCEEDINGS UNDER THE SALE OF FOOD AND DRUGS ACTS. In the accompanying statement the results of proceedings under the Sale of Food and Drugs Acts are set out. The Report of the Public Analyst is appended, so that it is only necessary to call attention to a few prominent matters. Milk has been the subject of prosecution in 22 out of a total of 28 prosecutions, and Butter in five cases. In several cases the fines were scarcely such as to act as a deterrent. From the Annual Report of the Board of Agriculture and Fisheries just issued it would appear that milk, being still the article most easy to adulterate with impunity, is therefore most frequently the subject of tampering. Taking England and Wales as a whole, about one sample in every ten was detected as adulterated ; the actual amount of adulteration would probably be in excess of this to a considerable extent. Butter is apparently not so much adulterated, but in my opinion this proportion would not be maintained if the number of samples were increased. Butter is probably more adulterated now than any other single article of diet, and will continue to be so until some absolutely Draconian method be adopted for its prevention. The Butter Act of 1907 will go some little way towards this end, but in my opinion the sale of Margarine as Butter will probably not be stopped unless Margarine be put under practically the same regulations of sale as Horseflesh, i e., allowed to be sold only in certain shops definitely labelled to the world as Margarine Shops. Public health officials, analysts, and the public are daily being duped by clever fakers, but the very poor section of the public are probably swindled most. It is sincerely hoped that local authorities throughout the kingdom will devote more attention to the vendor of butter than has hitherto been given, and that magistrates will penalize any impositions on the public to the full extent allowed by law. The following table is of present interest in this connection : 29 TABLE, SHOWING SAMPLES OF MILK, BUTTER AND CHEESE, taken in England and Wales during 1904-5-6 and the number found adulterated. [Taken from Annual Report of Board of Agriculture and Fisheries (Intelligence Division) for year, 1906.] Year. Examined. Adulterated. Percentage Adulterated. Milk 1904 36,413 4,031 1l.l 1905 38,920 3,759 9.7 1906 42,132 4,678 11.1 Butter 1904 15,124 867 5.7 1905 16,152 1,100 6.8 1906 17,002 1,219 7.1 Cheese 1904 2,176 20 0.9 1905 2,226 52 2.3 1906 2,044 27 1.3 List of cases in which proceedings were taken by the Borough Council during 1907 :— Name. Offence. Result. Remarks. G.M' D. Milk diluted with water to the extent of at least 3.6 per cent. - Adulteration small, Solicitors cautioned Vendor T.W. Milk deficient in fat to the extent of 13.4 per cent. Fine 10/Costs 12/6 - P.L. Milk deficient in fat to the extent of 33 per cent., and diluted with at least 23.9 per cent. of water. Fine 40/Costs 12/6 - G.L. Milk deficient in fat -to the extent of 247 per cent., and diluted with at least 28 per cent. of water. Fine 40/Costs 12/6 - J.H. Milk deficient in fat to the extent of 6.7 per cent., and diluted with at least 29.9 per cent. of water. Fine £5 Costs 12/6 30 Name. Offence. Result. Remarks. J.H. Adulteration of coffee. Sample contained at least 35 per cent. of its weight of chicory. Fine £5 Costs 12/6 - A.B.C. Milk deficient in fat to the extent of at least 9 per cent. Committee decided not to proceed, see Public Health Minutes, 1/3/07 W.E.B. Adulteration of butter. Sample contained 10 per cent. butter fat, the remainder being fat other than that of butter fat. Fine 10/- Costs 12/6 - C.S. Adulteration of butter. Sample only contains 10 per cent. butter fat, the remainder being fat other than that of butter fat. Fine 40/Costs 12/6 - J.M.H. Adulteration of milk. Sample diluted with at least 10 per cent. of water. Costs 12/6 Public Health Committee decided 15 th March, 1907, not to proceed, Mr. Hunt having given up selling milkand agreed to pay costs. W.S. Adulteration of skim milk. Milk diluted with at least 16 per cent. of water. Fine 2/6 Costs 12/6 - T.R.J. Adulteration of milk. Sample adulterated by dilution with water to the extent of 157 per cent., and deficient in milk fat to the extent of 18 per cent. - Case dismissed. Date which sample was taken incorrectly given. Sample taken i4/2/'07 ; summons stated 13/2/'07. J.T. Milk deficient in fat to the extent of 167 per cent. and diluted with water 12 per cent. Fine 20/Costs 12/6 - 31 Name. Offence. Result. Remarks. P.T.C. Milk deficient in fat to the extent of 6.67 per cent. and diluted with 107 per cent. water. Fine 10/- Costs 12/6 - H.E.H. Milk deficient in fat to the extent of 6.67 per cent. - Defendant pleaded warranty defence. Case dismissed. W.S. Milk deficient in fat to the extent of 24.7 per cent. and is diluted with 23'6 per cent, water. Fine 20/Costs 12/6 - A. P. Milk diluted with water to the extent of at least 8.8 per cent. Fine 5/Costs 12/6 A.Y. Milk deficient in fat to the extent of at least 36.7 per cent. Fine £10 Costs 12/6 W.T.J. Milk diluted with water to the extent of at least 20 per cent. Fine 10/Costs 12/6 E.J.C. Milk deficient in fat to the extent of at least 10.7 per cent. and diluted with water to the extent of at least 8 per cent. Fine 40/Costs 12/6 A.K. Milk deficient in fat to the extent of at least 16 per cent. and added water at least 11.7 per cent. Fine 20/Costs 12/6 E.W. Selling margarine as butter. Selling margarine in a wrapper without the word " margarine " printed thereon. Fine 20/Costs 12/6 W.C. Milk deprived of milk fat to the extent of at least 86 per cent. Fine £10 Costs 12/6 Fine and costs not recovered, W. C. having absconded. E.T. Milk deficient in milk fat at least 20 per cent. Fine 20/Costs 12/6 32 Name. Offence. Result. Remarks. M.W. Selling milk deficient in fat to the extent of 18 per cent. Warranty proved. Case dismissed. H.T.B. Selling milk deficient in fat to the extent of 6.7 per cent. Fine 40/Costs 12/6 D.C.D. Selling margarine without a wrapper with the word " margarine " inscribed thereon Fine 40/Costs 12/6 J.N. Selling margarine without a wrapper with the word " margarine " inscribed thereon Fine 10/Costs 2/- TENEMENT HOUSES. There are, approximately, 750 of these premises in your Borough, and even from the little I have seen of them up to the present, I judge that they demand most constant and systematic surveillance. Wherever one has a collection of individuals using common property and conveniences the responsibility for good sanitary conduct is necessarily sub-divided. This sub-division of responsibility will act like dry-rot on the hygienic morals of the community concerned, unless pretty drastic measures are employed. It is alike to the interest of the property owner and the tenant that very frequent inspection should be carried out. The London County Council (General Powers) Act, 1907, Section 78, contains a long-needed provision as to water supply of tenement houses. The wording is somewhat involved, but it is taken to mean that there must be a proper and sufficient supply of water on every floor of a tenement house on which there are rooms separately occupied. At the time of writing this report, an instance has come to hand where a poor crippled old woman has had to carry all the water required up seven flights of stairs ! This usually means that all waste water has to be carried down the same length of stairs. Cleanliness is seriously discouraged by such conditions as these. The Section referred to above is quoted in extenso:— " For the purpose of section 48 (Provisions as to house without proper water supply) of the Public Health (London) Act, 1891, a tenement house shall be deemed to be a house without a proper and sufficient supply of water, unless there shall be provided on the storey or one of the storeys in which the rooms or lodgings in the separate occupation of each family occupying such house are situate a sufficient provision for the supply of water for domestic purposes : 33 Provided that with respect to any building existing and in use as a tenement house at the passing of this Act this section shall not (a) come into operation until the first day of January one thousand nine hundred and eight, or (b) apply where the only storey or storeys on which a proper and sufficient supply of water is not provided is or are a storey or storeys (i) constructed at a height exceeding that to which the Metropolitan Water Board may for the time being be required to furnish a supply of water for domestic purposes and (II) to which a supply of water for such purposes is not at the passing of this Act being furnished by the said board by agreement: Provided also that this section shall not apply to any tenement house in respect of which it can be shown that any such provision for the supply of water as aforesaid is not reasonably necessary." FACTORY & WORKSHOPS ACTS. In the following tabular statement, which may be supplemented by a reference to the reports of Miss Baker, Miss Limont, Miss Johnson, and Mr. Phillips, certain details required by the Home Secretary are given. The workplaces inspected have all practically been the kitchens of Hotels, Restaurants, Coffee-shops, etc. Factories and workshops have, speaking generally, only been inspected on the receipt of intimations from the Home Office relating to conditions requiring the intervention of the Health Department. The Outworkers in this Borough are very numerous, and it is quite impossible with the present staff to inspect their workrooms even once a year. The same remark applies to the workshops which number over three thousand. It is hoped in a short time, however, to considerably improve upon this. Roughly speaking two-thirds of the Registered Workshops have been visited during the year, and one-third of the outworkers. That is to say at present the department is only visiting and inspecting the workshops at the rate of once every eighteen months, and the outworkers (who are the frailest section of the working community) at the rate of once every three years. This is surely in want of radical improvement. 34 I.—INSPECTION. Premises. Number. Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 24 — — - Workshops (Including Workshop Laundries.) 1,926 37 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 898 17 — Total 2,848 54 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances wider the Public Health Acts:— Want of cleanliness 62 62 — — Want of ventilation 2 2 — — Overcrowding 1 1 — — Want of drainage of floors — — — — Other nuisances 15 15 — — Sanitary accommodation insufficient — — — — unsuitable or defective 8 8 — — not separate for sexes 3 3 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) — — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100). — — — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 91 91 — — 35 3.—HOME WORK. nature of work. OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' premises. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Number of Addresses of Outworkers received from other Councils. Number of Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. † Outworkers † Lists. Outworkers (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (10) (12) (13) (14) (15) (16) Wearing Apparel— Making, etc 133 1682 64 790 1502 1236 ... ... 322 11 11 ... ... ... ... Lace, Lace Curtains and Nets ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Furniture and Upholstery 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas 2 12 1 6 2 12 Paper Bags and Boxes ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Total 138 1695 66 796 1504 1248 ... ... 324 11 11 ... ... ... ... 36 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Dressmaking, Tailoring, Millinery, Laundries, &c. 2,831 Bakehouses 78 Restaurants and Coffee Shops 235 Total number of workshops on Register 3,144 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 41 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5.) Notified by H.M. Inspector 47 Reports (of action taken) sent to H.M. Inspector 37 Other 2 Underground Bakehouses (s. 101):— Certificates granted during the year - In use at the end of the year 70 37 3, Upper Gloucester Place, Marylebone Road, N.W. January 1st, 1908 To the Medical Officer of Health. Sir, I beg to submit the following report of work done during the year ending 1907. Factories and Workshops. There are in the Borough 178 registered workshops which are occupied exclusively by men, chiefly in the trades of tailoring. The trades represented by the workshops occupied by men only are as follows :— Tailors and Outfitters 86 Bootmakers 10 Upholsterers 5 Cabinet Makers 8 Silversmiths 8 These workshops have been periodically inspected, and any defects in sanitation have been remedied. Any notification of occupation of new workrooms has received attention. Notice has been received from 60 occupiers of new workshops, the trades included being tailoring, upholstery, bridle cutting, turnery, cabinet making, joinery, trunk making, perfumery-case making, cleaning, silversmiths, leather-case making and hat making. Bakehouses. During the year 4 of the underground bakehouses have been closed or used for other purposes, leaving a total of 78 bakehouses in the Borough, 8 of which are on ground level. These have all been inspected at various times, and cleansing of premises ordered where required. Smoke Nuisances and Trade Nuisances. Reports of these have been made periodically to the Public Health Committee. During the year 24 complaints were made, which received immediate attention, and where necessary Intimation Notices were served. Trade Nuisances.—Complaints were made of these in three instances. Two tripe-boilers' premises were inspected and cleansing ordered to be done, and complaint was made of bacon-curing premises in Edgware Road, in which case I had the flues of the ventilating shaft repaired and put in working order. 38 Underground Conveniences and Public Urinals. The work of the attendants has been supervised by me, and I am able to report well on the way in which their duties have been carried out. Any alterations or repairs necessary at any of the 5 men's Conveniences have been done. The public urinals also have been regularly inspected, and the work of the flushers found to be satisfactorily done. The Shelter, Baths, and Large Disinfector. I have frequently inspected these premises, and have supervised all necessary repairs. Hotels, Restaurants, Coffee Shops, etc. I have made inspections of 235 premises, giving careful attention to the kitchens and to all places where food is stored. Inspections made of Workshops during 1907 1531 „ „ Bakehouses 393 ,, ,, Hotels, Restaurants, etc. 415 ,, ., Conveniences and Public Urinals Daily Smoke observations taken 147 I am, Sir, Your obedient Servant, Richard Phillips, Inspector. 3, Upper Gloucester Place, 1st January, 1908. To the Medical Officer of Health. SIR, I beg to present my report for the year 1907. FACTORY AND WORKSHOP ACT. Owing to the increased amount of immediate work necessitated by receiving the Registrar's birth returns weekly, the workshops have not been much attended to. All complaints received have had immediate attention. Workshops on register at end of year 1906 2,521 Number added during the year 1907 294 Number of removals known 162 Number of re-inspections made 395 Total number on register at end of year 1907 2,653 39 The number of lists of Outworkers received from all quarters has greatly increased this past year ; this, of course, entails an increase of clerical work, but a true return of those resident in the Borough cannot be given, as comparatively few visits have been made. Number of outworkers on register at end of year 1906 991 Number of removals known 12 Number of inspections made during 1907 322 Number of addresses forwarded to other Boroughs 1,248 Number received from other Boroughs 1,502 Infant Life. Since the month of June last, in addition to the Midwives' returns formerly sent, a weekly return of births has been received from the Registrar-General, thus increasing the average number of births to be visited per week from 14 to 56. The mother and child have been visited within the week of notification, and, where necessary, friendly advice given on the treatment and cleanliness of the child. A very large per cent. of infants in this Borough start life on breast feeding ; indeed, save for the necessity there often is for the mother to assist in earning bread for the family, the number of infants not breast fed is comparatively small, and then it is seldom an act of negligence. Unfortunately the development of the child is not able to be kept well under observation as the number of revisits possible is few ; so that at the time when advice may be most essential it cannot be given. Phthisis. Since the month of August the number of visits to phthisical patients has been 178 ; in the case of removal to hospital or death, the premises have been disinfected with few exceptions ; although it is not always an easy matter to educate those concerned up to the importance of disinfection. Cleansing of School Children. The Nurse appointed by the London County Council reports to me most of the worst cases of verminous children and those having skin diseases attending schools in this Borough; on visiting them it is possible to persuade them to attend the Baths regularly and also to induce cleaner habits in the home. In the 48 cases visited during this year a marked improvement in the child has been reported. The public conveniences for Women have been regularly 40 inspected, and by order of the Committee, since the month of October daily inspections have been made. I can report very satisfactorily on the cleanliness of the conveniences, and on the general discharge of their duties by the attendants. I am, Sir, Your obedient servant, Francis A. Baker, Inspector. 3, Upper Gloucester Place, January 1st, 1908. To the Medical Officer of Health. Sir, I beg to present a repo.rt of my work from August 6th to December 31st, 1907. Registered Births. The number of visits and revisits made from the Midwives' Returns by my predecessor, Miss Limont, was 747. I have visited 594 cases and given advice as to the cleanliness both of the mother and the baby, urging the necessity of breastfeeding whenever possible. Generally speaking, the lying-in room (sometimes the only room in which the family lived) was tolerably clean but badly ventilated and often untidy, but in most cases I found both the mother and infant clean. I find that the majority of the mothers breast-feed, unless circumstances, such as the father being out of work, necessitate their going out to work. I have been able to make only 24 revisits, these being to urgent cases of improper feeding or of illness. Elementary Schools. Miss Limont paid 29 visits to these, and I have inspected all those in the Borough, and have found them in good order and cleanly kept. Phthisis. During the first seven months of the year 237 visits were made, and, including those attended to by my predecessor ; disinfection was done in 61 instances. In a few cases disinfection has been refused, owing to the fact that at present some families do not realise the necessity for same. Women's Conveniences. In accordance with the order of the Committee on October 15th, the conveniences have been visited. On all occasions I have found the attendants' duties carried out satisfactorily. 41 Day Nurseries. Out of the six nurseries in the Borough, I have visited five and have found them all well managed. I am, Sir, Your obedient Servant, Monica Johnson. CLEANSING OF PERSONS ACTS, 1897. The Baths provided under the above Act have been in constant use during the past year ; the following tabular statement shows the accommodation provided and the number of persons who have availed themselves of a cleansing bath and have had their clothes disinfected, since the establishment was instituted under the above adoptive Act. accommodation, 1907. Men. Women. Baths for adults 4 2 Boys. Girls. Baths for Children 2 3 NUMBER OF PERSONS USING THE BATHS SINCE OPENING. Year. Adults. Total. Children. Total. Males. Females. Males. Females. *1898 3,301 5 3,306 ... ... ... 1899 4,340 ... 4,340 ... ... ... 1900 3,401 31 3,432 ... ... ... 1901 4,140 142 4,282 ... ... ... 1902 4,250 272 4,522 ... ... ... 1903 5,515 655 6,170 ... ... ... 1904 7,089 1,376 8,465 ... ... ... 1905 7,981 1,431 9,412 †107 353 460 1906 6,891 1,974 8,865 1,873 3,311 5,184 1907 6,785 1,807 8,592 2,367 3,404 5,771 Totals 53,693 7,693 61,386 4,347 7,068 11,4I5 *Opened 2nd March, 1898. † Opened June, 1905. 42 The London County Council (General Powers) Act of 1907, S. 36, gives statutory power to the County Medical Officer or any other person authorised by him to examine the person and clothing of any child attending any School provided or maintained by the Council, in order to ascertain whether the person or clothing is infested with vermin or is in a foul or filthy condition, and further proceeds to require the parent or person in charge to cleanse the person or clothing of the child within 24 hours of a notice to that effect. In default of compliance the Medical Officer is empowered to remove the child from the School and have it and its clothing properly cleansed in suitable premises and with suitable appliances, power of detention until this has been effected being given. The next section of the same Act enables lodging-house inmates to be dealt with in a similar manner. The premises at Grove Road will be immediately available for any cases of this description, for not only can men and women be dealt with separately, but children can readily be kept away from undesirable adults. If it be the intention of the County Council to apply these sections to a verminous condition of the hair it may reasonably be anticipated that a considerable amount of work and responsibility will be imposed upon those Borough Councils which afford facilities to the County in the enforcement of the provision, for such conditions, in most cases, require several consecutive days attention and not infrequently the ruthless employment of scissors. Whether the words " properly cleansed " would justify the removal of hair in the absence of parental consent is open to considerable doubt. Work of a similar nature to that proposed has been carried out in this Borough for some time. It is hoped that the action of the County Council will have the effect of causing other Borough Councils to provide facilities for cleansing, and thus relieve Marylebone of the necessity of doing the work gratuitously for them, as is bound to be the case to some extent at present. 27, Grove Road, N.W. January, 1908. To the Medical Officer of Health. Sir, I beg to submit the following Report of works for the year ending December 31st, 1907 :— The Shelter. The shelter was used 17 days, accommodating for various periods 17 adults and 10 children. 43 The following is a detailed statement of the occupation :— 1907. No. of hours occupied, Reason of occupation. No. of persons. Jan. 7th 3 Puerperal Fever 2 Adults Feb. 16th, 17th, 18th 36 Diphtheria 2 Adults, 1 Child March 10th 10 Scarlet Fever 2 Adults, 3 Children March 22nd 4 Puerperal Fever 1 Adult April 2nd, 3rd 14* Small Pox 2 Adults, 1 Child August 3rd, 4th 24 Scarlet Fever 2 Adults, 2 Children Aug. 10th, 11th, 12th 36 Diphtheria 2 Adults, 2 Children August 28th, 29th 14 Scarlet Fever 2 Adults, 1 Child Sept. 6th, 7th 24 Scarlet Fever 2 Adults * Case returned not Small Pox. Baths. (Cleansing of Persons Act, 1897.) The addresses of the applicants were as follows :— Males giving the address of Salvation Army Shelter and Lodging Houses in the Borough 6,785 Females giving the address Shaftesbury Institute, and those with no addresses 1,807 Totals 8,592 Special Baths for School Children. From January 1st to December 30th, 1907. Boys 2,367 Girls 3,404 Totals 5,771 Owing to rules made by the London County Council Education Committee, time is not allowed during school hours for children to avail themselves of the Baths. After I had interviews, a concession was granted, so that the children are now sent in charge of the senior in class, who leaves them here about 4 or 4.30 p.m. They are at liberty to go home after bathing. The attendants under my charge were satisfactory. I am, Sir, Your obedient servant, Lillie Kilgallin, Matron. 44 SLAUGHTER HOUSES. Notices of intention to apply to the London County Council for the renewal of Slaughter-house Licences were received by the Public Health Department in respect of the following premises:— Premises. Conditions. 75, Abbey Road — 6a, Bolsover Street (rear of) — 178, Edgware Road — 4, Henry Street, St. John's Wood Small cattle only 50, Henry Street, St. John's Wood Ditto 134, High Street, St. John's Wood This Licence is granted on the clear and distinct under standing that the room over the slaughterhouse is not used as a living-room 31, Little Church Street Small cattle only 32A, Union Street, Middlesex Hospital — No opposition was raised by the Sanitary Authority to the foregoing applications, and the Licences were duly granted for one year ending 31st October, 1908, by the Public Health Committee of the London County Council, at their meeting at the Clerkenwell Sessions House on the 21st October, 1907. The number of inspections of slaughter-houses made during the year was 76, and in no instance was a nuisance found to exist or the cleanliness of the premises called into question. COW HOUSES. Notices of intention to apply to the London County Council for the renewal of Cow house Licences were also received in respect of the following premises :— Premises. No. of Cows. 58, Acacia Road (sheds Nos. 1, 2 & 3) 44 56, Bell Street 15 *42A, Clipstone Street 10 26, John Street 14 15, Little Church Street (rear of) 12 3, Malthouse Mews 22 117 * This Licence is granted on the undertaking of the Licensee not to keep more than 10 cows on the premises. 45 These cow-houses have been frequently inspected during the year, and have been found in good condition. No complaints have been received as to nuisances on these several premises No opposition was raised by the Sanitary Authority to the renewal of the Licences which were granted by the London County Council on the 21st October, 1907, with the one condition set out above, for one year ending 31st October, 1908. REMOVAL OF HOUSE REFUSE. This work is carried out by contract. In the district south of Marylebone Road the house refuse was removed by Mr. Thomas Hobbs for the first quarter of the year, Messrs. William Mead & Co., Ltd., securing the contract for three years, commencing 1st April, 1907. In the North District, north of Marylebone Road, the contractors are Messrs. E. H. Jackson & Co., Ltd., who hold the contract for three years, commencing 1st April, 1906. All complaints with reference to non-removal, letters respecting removal and refusals by householders to have the house refuse removed, have been at once investigated by the Dust Inspector and fully considered by the Dust Sub-Committee at their fortnightly meetings. In one case during the year the Committee considered that the terms of the Contract had been so violated as to render it necessary to put the penal clauses into operation, and Messrs. E. H. Jackson & Co., Ltd., were fined £50. The Dust Inspector made 2,466 enquiries in respect of the removal of house refuse, and in addition thereto 395 enquiries were made by the District Inspectors. Letters and intimations were issued in 210 cases to abate nuisances, but in one case only was it found necessary to have recourse to legal proceedings in connection with removal. In many instances old brick receptacles have been abolished and the more sanitary properly covered moveable metal receptacles substituted. The following tabular statement gives the number of complaints, letters and refusals in respect of the removal of house refuse received, and the fines levied and recovered for contravention of the terms of the contracts during the last four years :— NORTH DISTRICT. Year. Complaints. Letters. Refusals. . 1904 49 52 28 — 1905 53 66 227 Mead, £20 and £26 5s. 1906 49 61 51 Mead, £15 ; Jackson, £5 1907 46 54 83 Jackson, £50. 46 SOUTH DISTRICT. Year. Complaints. Letters. Refusals. Fines. 1904 194 184 63 Hobbs, £20. 1905 72 170 366 —— 1906 69 157 556 Hobbs, £15, £1 is. and £50. 1907 106 173 471 — DISINFECTION. The following is a statement of the articles steam-disinfected during the year 1907 and the previous year. No complaint of damage has been received by the Department :— 1907. 1906. Beds 285 329 Mattresses 579 515 Bolsters 660 678 Pillows 1,188 1,285 Sheets 1,030 1,246 Blankets 1,665 1,555 Sundries 4,619 4,872 10,026 10,480 The vans were used 476 times in 1907 ; 451 times in 1906. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1904. (Section 20 (1). During the year 1907 11 Statutory Notices were served on the owners of premises, representing 43 rooms, in respect of which the Medical Officer of Health certified that the house or part thereof was infested with vermin. In each case the Notices to remove the wall paper from the walls and take such steps as were necessary to remove the vermin were promptly complied with. 47 REPORT OF MORTUARY KEEPER, MARYLEBONE, FOR THE YEAR 1907. Number of bodies received from 1st January to 31st December, 1907. Males. Females. Males. Females Brought forward 133 104 January 22 18 July 12 6 February 28 22 August 12 11 March 20 18 September 13 13 April 21 13 October 14 11 May 26 19 November 20 10 June 16 14 December 19 16 133 104 223 171 Grand total 394 Number of bodies received from 1st January to 31st December, 1906.—432. Number of Inquests held from 1st January to 3lst December, 1907. Brought forward 93 January 16 July 12 February 22 August 8 March 13 September 11 April 17 October 12 May 15 November 15 June 10 December 13 93 71 Grand total 164 Number of Inquests held from 1st January to 31st December, 1906—172. Number of Infectious Cases received from 1st January to 31st December, 1907. Scarlet Fever 2 Diphtheria 1 Total 3 Number of bodies received from 1st January, 1889, to 31st December, 1907. Total .. .. 8,584, 48 REVENUE ACT, 1903. Nine certificates were granted by the Medical Officer of Health during the year for exemption or reduction of Inhabited House Duty in accordance with the Revenue Act, 1903, in respect of the premises mentioned below. Seventy-two tenements were covered in these certificates, and in no case was the certificate refused or withheld. In some cases the application was held over until certain sanitary alterations had been carried out. Premises. No. of Tenements. Abercorn Mansions 6 Howard House, 167-171, Cleveland Street 30 45, New Cavendish Street 6 1, High Street, St. John's Wood 2 39 & 40, Foley Street 10 Cumberland Mansions 3 9, Cavendish Square 1 31 & 32, Saville Street 11 Spanish Place Mansions 3 72 REPORT OF PUBLIC ANALYST BY ALEXANDER WYNTER BLYTH, M.R.C.S., F.I.C., F.C.S. ETC., ETC. Barrister-at-Law, of Lincoln's Inn. PUBLIC ANALYSTS REPORT. . The Laboratory. Sale of Food and Drugs Acts. (See Table below.) Nearly 1,000 samples of all kinds were analysed, but the greatest proportion of the samples were those coming under the general denomination of "dairy produce." Milk. Out of 452 samples of milk, 38 were returned as adulterated, which is in the proportion of a little more than 4 per cent. The adulteration was mainly diluting beyond the standard and abstracting fat. In one case the fat was abstracted so perfectly as to justify a certificate of 86 per cent. abstraction. The defendant was fined £10 and costs. Up to the present the fine has not been recovered, the defendant having disappeared. It is interesting to observe that most of the London milks are artificially coloured with aniline dyes. On the other hand it is rare to find coloured milk in certain counties such for instance as the County of Devon. The writer is of opinion that all colouring matter added to milk should be prohibited. Butter. Of 134 samples of butter, 4 were certified to be adulterated; the offences were mainly the selling of margarine in the place of butter, most of the butters contained no borax, a few contained borax, but the amount was small, under 20 grains. Alcoholic Liquids. Eighty-four samples of spirits were examined, and of these six were found to be diluted below the standard strength. The whiskies were blends of various qualities. It was not thought desirable to certify to blends as adulterated simply because they contained silent spirit until the question has been finally disposed of as to whether, under the term, whisky is included a spirit with most of the higher alcohols removed by the patent still. It is interesting to observe that a certain number of medical men ascribe high medicinal powers to the furfural and to the higher alcohols. I doubt much whether these opinions are sound; hitherto all research has shown that the higher the alcohol the more poisonous. A man who has so far forgotten himself as to get very drunk on whisky is far more likely to 52 suffer from a head in the morning from a high-class whisky containing large quantities of fusel oil, and so forth, than from what would be considered a low-class whisky containing mostly a pure grain spirit. Among the alcoholic liquids examined were home-made wines, a few of these had been doctored with salicylic acid to prevent fermentation: a wholly unnecessary addition. Miscellaneous examples. The rest of the table scarcely calls for comment. A sample of American ketchup had a considerable quantity of benzoic acid: some writers consider benzoic less harmless than salicylic; in any case such additions should be declared. A. WYNTER BLYTH. 53 SALE OF FOOD AND DRUGS ACTS. Samples Analysed during the Year 1907. Genuine. Adulterated. Total. DAIRY PRODUCTS— Milk 414 38 452 Butter 130 4 134 Cheese 4 — 4 Cream 3 — 3 Margarine 23 — 23 ALCOHOLIC LIQUIDS— Brandy 5 - 5 Whisky 55 3 58 Rum 6 2 8 Gin 12 1 13 Beer 3 — 3 Champagne 1 — 1 Port Wine 3 — 3 Claret 1 — 1 Sherry 1 — 1 Orange Wine 3 — 3 Ginger Wine 5 2 7 Raisin Wine 3 3 6 Black Currant Wine — 1 1 Elder Wine 1 — 1 Red Currant Wine 1 — 1 NON-ALCOHOLIC BEVERAGES— Tea 4 - 4 Coffee 26 1 27 Coffee and Chicory 3 — 3 Cocoa 18 — 18 CARBO-HYDRATES— Sugar 10 - 10 Jam 9 - 9 Sweets 6 - 6 Honey 1 — 1 Golden Syrup 2 — 2 Corn Flour 1 — 1 Pea Flour 1 — 1 TINNED GOODS— Various Canned or Tinned Goods 85 1 86 CONDIMENTS— Pepper 20 - 20 Mustard 14 1 15 Vinegar 2 — 2 Pickles 1 — 1 Sauce 10 — 10 Ketchup 5 1 6 Tomato Relish 1 — 1 Chutney 1 — 1 DRUGS— Citrate of Magnesia 1 - 1 Tartaric Acid 11 - 11 Cream of Tartar 3 - 3 MISCELLANEOUS— Fish Oil 2 - 2 Lard 8 - 8 Ice Cream 9 — 9 Lemon Squash 1 — 1 Chocolate Powder 1 - 1 Custard Powder 1 — 1 Liquorice Powder 3 — 3 Dripping 1 — 1 935 58 993 metropolitan Borough of St. fOar^Iebone. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1908. MEREDITH YOUNG, M.D., D P H. Barrister-at-Law, of Lincoln's Inn. WITH AN APPENDIX Containing- the Report of the Public Analyst, ALEXANDER WYNTER BLYTH, Barrister-at-Law, of Lincoln's Inn; Fellow of the Institute of Chemistry, etc., etc. London: Geo. Pulman & Sons, Ltd., Printers. 1909. London . George Pulman & Sons, Ltd., printers, london and wealdstone. Public Health Office, May 3rd, 1909. To the Worshipful The Mayor, the Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor and Gentlemen, I have the honour to present to you my Report on the health and sanitary circumstances of your Borough for the year 1908. I beg to commend to your special notice those sections of the Report dealing with the following matters, which are of distinctive interest in this portion of London— the Public Food Supply, the Control of Phthisis, Underground and Tenement Dwellings, and the Removal of House Refuse. It would be at best useless repetition to summarise here, as appears to be the fashion in such Reports, the chief points of interest under those headings, and I would hope that the members of your Council will have leisure to peruse and carefully consider the Report, at any rate these particular sections, with a view to the adoption of a policy which will result in the amelioration of the conditions described. I desire to place on record my high appreciation of the devotion to the work of the Department shown by the Chairman of the Public Health Committee, the Rev. J. A. Beaumont, and of the encouragement and assistance which he has so unstintedly given in that capacity. Councillor Lea-Smith has continued, as Chairman of the Dust Sub-Committee, to devote a very considerable amount of personal and detailed attention to the important question of the Removal of House Refuse— a matter which calls for constant and thorough supervision— and the Department is deeply indebted to him in this .matter. I wish also to acknowledge the kindness and cordiality with which any recommendations of mine have been invariably received by the members of the Public Health Committee as well as by your Council. The Staff of the Department have worked loyally at all times, and have grudged neither time nor pains to make their work, which is often trying and disagreeable, a round success. I am, Mr. Mayor and Gentlemen, Your obedient Servant, MEREDITH YOUNG, Medical Officer of Health. INDEX TO ANNUAL REPORT. A I All Souls, Sub-District, birth rate 11 Infantile mortality 24, 25,26,27 „ „ births and deaths 17,19 Infectious disease 28 29,85 „ „ death rate 16 Insanitary houses 48 Inspection, sanitary 46,47, 48, 49 B Institutions, lists of 22 Bacon report on analysis of 54-62 L Bacteriological examinations 30 Legitimate birth rate table 14 Bacteriological examination of food 70-74 London County Council (General Powers) Bakehouses 17,79,87 Act, 1904. Sec. 20 (1) 106 Baker, Miss F. A., report of 80 Birth Rates since 1880 11 M ,, ,, in various countries 13,14 Marriages 10 ,, ,, in other boroughs 23 Measles 32 Birth returns 84 Meat inspection 78 Births 10, 11,84, 86 Milk, bottled 72, 73 Births Registered since 1880 11 „ Pasteurised 73 Boracic acid in food 53-62 ,, pus in 70-72 Bottled milk 72-3 M ilkshops and dairies 74,75,76 Bread 79 Mortuary 47,97-103 Buildings, Nuisance from demolition of 51, 52 N C New buildings, &c., population 7,8,9, 10 Cerebro Spinal Meningitis 28, 29, 31 Notification of Births Act, 1907 15 Chemical examination of food 53 Nuisances, general 9 Childrens' eyes and how to care for them 25 „ Irom demolition ol buildings 51, 52 Christ Church, Sub-District birth rate 11 O „ „ death rate 16 Overcrowding 48 ,, ,, births and deaths 17,19 Cleansing of Persons Act, 1897 ... 47, 85, 95, 96 P Condensed Milk 73 Petroleum, discharge of into sewers 81 Consumption 28, 29, 30, 32, 33, 34, 35 36,37, 38, 39, 84 Phthisis 28, 29, 30, 32, 33, 34, 35, 36,37, 38, 39, 84 Continued fever 30 Population, new buildings, &c. ... 7,8,9,10 Coveniences, Public Sanitary 109 Population, estimated from 1880 11 Cowhouses 77 Prosecutions, Public Health (London) Act, 1891 50,51 D Prosecutions Sale of Food and Drugs Act, Dairies and Milkshops 74, 75,76 1875-99 63-69 Day Nurseries, inspection of 86 Public Analyst's report I., II., III. Death certification 39, 40 Public house urinals, report on 104, 105 Death Rates in St. Marylebone 16 Public sanitary conveniences 108 in other Boroughs 23 Puerperal fever 28, 29 Deaths 15 R Deaths and Death Rates from stated causes 18 „ under 1 year of age 19 Revenue Act, 1903 49,106 ,, causes of 20 S ,, in extra parochial Institutions 22 Sale of Food and Drugs Acts, lists of samples 63-69 Departmental report 40-108 Sanitary inspection 46,47,48,49 Diphtheria 28, 30 Scarlet fever 28,29 bread 79 Schools, inspection of 86 Disinfection 47,107,108 Sewers, discharge of petroleum into 81 Drainage, house 80 shelter 49,97 Slaughterhouses, list of 70, 77 E Smoke observations 87 Enteric fever 28,29 St. John, Sub-district, birth rate 11 Erysipelas 28,29 „ „ death rate 16 Eyes, how to care for children's 25, 26 ,, ,, births and deaths 17,19 St. Mary, ,, birthrate 11 F „ „ births and deaths 17,19 Factories and workshops 83,84,87, 88,89,90 _ , death rate 16 Food inspection 47 Statistical report 1-40 , bacteriological examination of ... 70-74 Summer diarrhoea 24 „ boracic acid in 53-62 T „Chemical examination of 53 Typhoid fever 28,29,30 G Underground public conveniences 85, 86, 87, 109 General administration 43-46 Underground rooms 48,91,92 Glanders, London Notification Order 1907 30 Urinals attached to public houses, report on 104, 105 „ „ „ Proceedings under 31 V Verminous persons, baths for 47, 85, 95, 96 House drainage 80 Vital statistics (Tables) 17,18,19,20,21 House refuse, removal of 48, 92, 93, 94 W House to house inspections 48 Water supply 48,104 Houses let in lodgings 92 Workshops and factories 83, 84, 85, 87, 88, 89, 90 CURVE SHOWING THE NUMBER OF CASES OF SCARLET FEVER, DIPHTHERIA AND TYPHOID FEVER NOTIFIED WEEK BY WEEK DURING THE YEAR 1908. * iTi ft ^ Part I. STATISTICAL. *• 7 POPULATION, NEW BUILDINGS, ETC. The estimated population of St. Marylebone to mid-year, 1908, is given by the Registrar-General as 126,867. This figure shows a decrease on the census population of 1901 of 6,434; in other words, the Registrar-General is of opinion that the population is decreasing at the rate of nearly 1,000 per annum. I think this figure should be accepted with some reserve, for although a considerable number of dwelling houses are being converted into business premises, thus decreasing the population actually living in St. Marylebone, one must reckon with the fact that during recent years a considerable number of small business premises and small dwelling-houses have been demolished to give place to large blocks of flats, artizans dwelling and more commodious ordinary dwelling-houses. Information is being accumulated as to the character of new buildings which are being erected in the district, with a view of checking this estimate of population. For some years, of course, this information will not be sufficiently complete for deductions to be made from it. Through the courtesy of the Town Clerk I am able to quote the figures relating to the number of assessments in St. Marylebone from 1891 to the present date. I reproduce also the letter accompanying this statement as it throws light on some causes of the variations. Town Hall, Marylebone Lane, W. 11th March, 1908. Dear Sir, I have now had extracted from the Rate Books the number of assessments in the Borough for each year from 1891 to 1907 inclusive in conformity with the request contained in yours of the 3rd instant. You will notice that there is an upward tendency until the year 1901, when a drop occurs of 736 assessments, this being attributable to the demolition of property consequent upon the advent in the Borough of the Great Central Railway. In 1907 the building known as Scott Ellis Gardens was erected, which accounts for an increase of about 500 assessments. I append hereto the number of assessments. Yours faithfully, J. WILSON, Town Clerk. 8 Corrected Number of Estimated No. Persons Population Year. Assessments. Population. each Assess. (Death Rates). 1891 18,251 142,381 7.8 1892 18,276 1893 18,366 1894 18,558 1895 18,596 142,000 7.6 142,700 1896 18,737 141,188 7.5 141,625 1897 19,294 137,780 7.1 138,440 1898 19,325 137,720 7.1 139,197 1899 19,502 135,660 6.9 143,111 1900 19,558 134,600 6.8 135000 1901 18,746 133,301 7.1 134,000 1902 18,822 132,069 7.0 132,150 1903 19,115 131,234 6.9 131,337 1904 19,206 130,337 6.7 130,843 1905 19,268 129,453 6.77 129,871 1906 19,582 128,580 6.5 128,733 1907 20,107 127,718 6.3 127,880 Through the courtesy of Mr. Arthur Ashbridge, F.R.I.B.A., District Surveyor, I am able to give a list of New Buildings which have been completed in this Borough between 1st January, 1907, and the present date. NEW BUILDINGS ERECTED IN ST. MARYLEBONE FROM 1ST JANUARY, 1907 TO 31 ST MARCH, 1909. Address. Nature of Building. 3, 4 & 4a, Little Portland Street Workrooms Marble Arch Tube Station Private Hotel over 23, Newman Street Shop and showrooms 5, Wimpole Mews Motor Garage 308-310, Oxford Street Shop and showrooms 8, 9, 10, 11, 12 & 12a, Margaret Block of flats Street, and 12, Great Titchfield Street 91, Wigmore Street Shop and showrooms 55 to 58, Wells Street Blocks of workshops 75, Newman Street Shop, showrooms and Fine Art School 62, Montagu Square Motor Garage in rear 9, Wimpole Street Dwelling house Clarence Gate Mansions (Block K) Block of flats 11, Gray's Buildings Workshop High Street, N.W. (next to 3 shops Four shops with dwellings at angle of Henry Street) over 9 Address. Nature of Building 26-30, Lisson Street and 28-30, Block of dwellings Mitcham Street 22, Oxford Street Shop and showrooms 386, do. do. 78, Marylebone Lane Shop and dwelling 53, Bryanston Street Block of offices ra, Upper Wimpole Street Dwelling house Harrow Street and Union Street Home for Women 39, Devonshire Place, Portland Place Motor Garage Great Portland Street, etc. Concert Hall (formerly the site of St. Paul's Church) 18, Welbeck Street and 59, Queen Dwelling houses Anne Street 3, 4 and 5, Cosway Street Nurses Home extension 19, St. John's Wood Road Chapel and Sunday schools 12 to 16, Great Portland Street and Shop and showrooms 1, Great Castle Street 11, Gee's Court Workrooms 19 to 21, Great Portland Street Shop and showrooms 20, Harley Mews South Stable 1 and 1 a, Chapel Place Shop and showrooms Harewood Avenue Rifle range 47, Margaret Street Shop and dwelling Welbeck House, Welbeck Street and Block of flats with Hotel, Wigmore Street Restaurant and shops 41, Harley Street Dwelling house 101-103, Great Portland Street Hotel 13, Devonshire Mews Motor Garage 10 and 11, Molyneux Street Block of flats High Street, St. John's Wood (south Four shops with dwellings of Messrs. Williamson's premises) over 40, Welbeck Street Dwelling house 26, Devonshire Place Mews Motor Garage 66, Wigmore Street Warehouse 120, Edgware Road Shop and dwelling 71, Berners Street Shop and showrooms North Gate Mansions, Albert Road Block of flats (Block 2) North Gate Mansions, Albert Road Do. (Block 3) Bute House, Townshend Road Motor Garage Harcourt House, Cavendish Square Block of flats (South Block) Harcourt House, Cavendish Square Do. (North Block) IO Address. Nature of Building. 22, Newman Street Block of offices 158, 160, and 162, Oxford Street Shop and showrooms, etc. (Messrs. Mappin & Webb's premises) 122, Great Titchfield Street Shop with dwelling over 71, Berners Street Shop and showrooms 47, Margaret Street Shop with dwelling over Newman Street and Castle Street Hotel Messrs. Osier's premises, Newman Warehouse Mews 1, Berners Steeet Do. 8, Marylebone Passage Workshop 118, Edgware Road Shop and showrooms, etc. 34 and 35, Horace Street Workmen's dwellings 31, Avenue Road Dwelling house -2 to 10a, Homer Row and 15, John Motor Garage Street 6, Devonshire Mews North Do. 39, Queen Anne Street Dwelling house 48, New Cavendish Street Shop with dwelling over 20, Great Portland Street and Shop and showrooms 2, Margaret Court Foley Street and Union Street Schools 12, Gee's Court Workrooms 12B, Portland Place Residential flats 40, James Street Shop with dwelling over 36, Cavendish Square Dwelling house 14, Little Portland Street Workrooms 28, Margaret Street Shop and showrooms 23, New Cavendish Street Dwelling house 53, Bryanston Street Addition to Church Army premises 11 to 21, James Street, Barrett Street Warehouse and Bird Street 20, Old Cavendish Street Shop and offices MARRIAGES. There have been 1,259 marriages celebrated in your Borough during 1909, a number equivalent to a marriage rate of 19.84 per thousand of the estimated population. During the first quarter of the year there were 218 marriages, during the second 322, during the third 394 and during the fourth 325. BIRTHS. During the year 1908 there were registered 2,559 births, viz.: 1,285 of males, and 1,274 of females= 20.2 per 1,000 of the estimated population. 11 In the several Registration Sub-Districts, the birth rates were as under:— 1907. 1908. All Souls' 15.9 13.6 St. Mary 16.9 16.3 Christ Church 26.9 29.4 St. John 19.2 20.7 The average rate for the previous ten years is 218 per thousand. In England and Wales, taken as a whole, the birth rate during 1908 was 26.5, and in the 76 great towns it was 27.0. The rate for St. Marylebone is an exceedingly low one, and if, as I imagine, the population should not be so low as stated by the Registrar-General, the rate would, of course, be considerably lower. Many writers have directed attention to the decline in the birth rate which has taken place for some time throughout all civilised countries. I give in the accompanying table the rate for St. Marylebone as far back as statistics can be obtained, and a glance at this will reveal a fairly steady and continuous decline. Table showing the population, births registered, and the birth rate from the year 1880 to 1908:— Year. Population. Births Registered. Birth Rate. 1880 l6l,680 5,012 31.5 1881 161,680 4,979 29.0 1882 155,004 4,831 27.8 1883 154,910 4,395 28.4 1884 I54,910 4,162 26.8 1885 156,290 4,014 25.0 1886 156,290 4,004 25.6 1887 156,290 4,044 25.9 1888 156,290 3,806 24.3 1889 157,790 3,744 23.8 1890 157790 3,669 23.2 1891 142,381 3,758 25.9 1892 141,871 3,617 25.5 1893 142,404 3,552 24.9 1894 142,404 3,483 24.4 1895 142,000 3,535 24.9 1896 141,188 3,353 24.9 1897 137,780 3,262 23.7 1898 136,720 3,199 23.4 1899 135,660 3,106 22.9 1900 134,600 3,125 23.2 1901 133,301 3,042 22.8 12 Year. Population. Births Registered. Birth Rate. 1902 132,010 2,960 22.4 1903 130,900 2,818 21.5 1904 129,970 2,791 21.5 1905 128,960 2,618 20.3 1906 127,960 2,648 20.7 1907 127,718 2,583 20.2 1908 126,867 2,559 20.2 The fact is of no small moment, not only to St. Marylebone, but to every part of Britain and her colonies. The opinions of those who are competent to decide on the causes of this decline in the birth rate, are briefly to the following effect:— 1.— Variation in the Marriage Rate. 2.— The later age at which women marry. 3.— Variation in the proportion of women at child-bearing age in the population. 4.— The deliberate restriction of child-bearing on the part of parents. There is no lack of educated opinion that the last-named cause may pretty safely be assumed to be that which is operating with greatest detriment to the increase of the population. The matter is not one which is easy to discuss in a public report; but, at the same time, one must risk the giving of offence by speaking out quite plainly. The statement made above is almost invariably countered by the argument of over-population. As a comment on this one may adduce a statement made by Dr. Farr, one of the greatest statisticians that we have ever had, and recorded by him so far back as 1842. Dr. Farr then said that the rate of progression of population since the first census 1801, was such, that if it should continue the population would have doubled in 1850. He proceeds "Double the number of "families will exist, and must be supplied with subsistence "in England, but there will also be double the number of men "to create subsistence and capital for her families, to man her "fleets, to defend her inviolate hearths, to work mines and "manufactures, to open new regions of colonisation, and double "the number of minds to discover new truths, to confer the "benefits and to enjoy the felicity of which human nature is "susceptible." These words, written nearly seventy years ago, have proved those of a true prophet, and there can surely be no reason to think that they will not, under proper social conditions, be still true in another hundred years. Scientific advances, quicker 13 inter-communication between countries far apart, and the universal advance of civilisation, should surely lead us to be more optimistic than to talk about over-population. The birth-rate in St. Marylebone during 1908 is lower than the lowest rate of any civilised country. The question is, however, of much more than merely local importance. I give a table showing the average birth-rate in various countries for the 25 years 1881 to 1905, and for the years 1906 and 1907:— ANNUAL BIRTH RATES PER 1,000 PERSONS LIVING, 1881—1907. Countries. (Arranged in Order of Rates in 1901-5). Quinquennial Periods. Years. Rate in 1901-5 compared with that in 1881-5 taken as 100. 1881 to 1885 1886 to 1890 1891 to 1895 1896 to 1900 1901 to 1905 1906 1907 Russia (European) 49.1 48.2 48.2 49.3 - - - - Bulgaria 37.0 36.2 37.7 41.3 41.0 44.3 - 111 Roumania 41.8 40.9 41.0 40.2 39.4 40.5 41.7 94 Jamaica — 36.8 38.6 38.9 39.0 38.1 35.0 - Ceylon - 30.3 31.7 37.2 38.8 35.7 32.8 - Servia 46.3 43.7 43.3 40.1 38.7 41.3 - 84 Hungary 44.4 43.5 41.7 39.4 37.2 36.0 36.0 84 Chili 39.1 35.5 37.0 35.0 36.1 — - 92 Austria 38.2 37.8 37.4 37.3 35.0 34.8 - 93 Spain 36.4 36.0 35.3 34.3 35.0 33.4 32.9 96 Prussia 37.4 37.3 37.0 36.5 34.8 33.7 33.0 93 German Empire 37.0 36.5 36.3 36.0 34.2 33.1 - 92 Italy 38.0 37.5 36.0 34.0 32.6 31.9 31.4 86 Japan — 28.5 28.6 31.1 31.7 - - - The Netherlands 34.8 33.6 32.9 32.1 31.5 30.4 30.0 91 Finland 35.5 34.5 31.8 32.6 31.3 31.4 - 88 Western Australia 34.7 36.9 30.7 28.3 30.3 30.0 29.2 87 Denmark 32.4 31.4 30.4 30.0 29.0 28.5 28.3 90 Tasmania 35.0 34.1 32.7 28.2 29.0 29.5 29.6 83 Scotland 33.3 31.4 30.5 30.0 28.9 27.9 27.0 87 Norway 31.2 30.8 30.2 30.1 28.6 26.7 26.3 92 ENGLAND & WALES 33.5 31.4 30.5 29.3 28.1 27.1 26.3 84 Switzerland 28.6 27.5 27.7 28.5 28.1 27.4 - 98 Belgium 30.7 29.3 28.9 28.9 27.7 25.7 - 90 New South Wales 37. 7 36.4 32.9 28.0 26.7 27.0 27.1 71 Queensland 36.5 37.4 34.1 29.1 26.7 26.3 26.9 73 New Zealand 36.3 31.2 27.7 25.7 26.0 27.1 27.3 73 Sweden 29.4 28.8 27.4 26.9 26.1 25.7 25.5 89 Victoria 30.8 32.7 30.9 26.2 25.0 25.1 25.2 81 South Australia 38.5 34.7 32.0 27.0 24.5 23.7 23.9 64 Ireland 23.9 22.8 23.0 23.3 23.2 23.6 23.2 97 Ontario, Province of 22.4 22.0 19.9 20.1 21.8 23.3 - 97 France 24.7 23.1 22.3 21.9 21.2 20.6 19.7 86 14 The position of England and Wales shown in this report is by no means an enviable one. The Registrar.General in searching for the reason of such wide discrepancies among the crude birth-rates in the various countries enumerated, states that they are due to some extent to variations in the civil condition, and the sex and age constitution of the several populations. He indicates, however, one of the most important reasons of this decline in the table which he has constructed from certain countries from which the requisite data were obtainable and from which again the invidious position of England and Wales is clearly apparent. Coupled with this we have in both tables the very alarming fact that the decline in the crude birth-rate and the decrease in fertility of married women is even more strikingly noticeable in the most important British Colony— the Australian Commonwealth. LEGITIMATE BIRTH RATES. Countries. (Arranged in order of rates in 1900—02.) Proportion of Legitimate Births per 1,000 wives aged 15—45 years Increase ( + ) or Decrease (—) per cent in Fertility during 20 years. Approximate periods. 1880—82 1800—92 1900—02 European Countries. The Netherlands 347.5 338.8 315.3 - 9.3 Norway 314.5 306.8 302.8 — 3.7 Prussia 312.6 307.6 290.4 — 7.1 Ireland 282.9 287.6 289.4 + 2.3 German Empire 310.2 300.9 284.2 — 8.4 Austria 281.4 292.4 283.7 + 0.8 Scotland 311.5 296.4 271.8 — 12.7 Italy 276.2 ? 269.4 - 2.5 Sweden 293.0 280.0 269.0 — 8.2 Switzerland 284.1 274.0 265.9 — 6.4 Denmark 287.1 278.1 259.1 — 9.8 Spain 257.7 263.9 258.7 + 0.4 Belgium 312.7 285.1 250.7 - 19.8 ENGLAND & WALES 286.0 263. 8 235.5 - 17.7 France 196.2 173.5 157.5 — 19.7 Australian Commonwealth. Tasmania ? 311.0 256.4 - ? Queensland 329.0 320.6 252.8 — 23.2 Western Australia* 323.9 338.8 246.4 — 23.9 South Australia 326.5 307.5 235.0 - 28.0 New South Wales 337.8 298.5 234.3 - 30.6 Victoria 299.2 297.8 226.8 — 24.2 New Zealand 322.1 277.5 243.2 - 24.5 *The legitimate births in Western Australia are not precisely known, but are estimated to be 95 per cent. of the total births. IS The Registrar-General's sole comment on these figures is contained in the following sentence, which reflects an opinion I have been forced to for a number of years:— "It is probable that there is a common cause operating "throughout these countries to account for the phenomenon "of a general decline in human fertility, and apart from any "decrease due to changes in the age constitution of the married women of conceptive ages, there is strong ground "for the assumption that, in varying degree, that cause is "the deliberate restriction of child-bearing on the part of "the people themselves." NOTIFICATION OF BIRTHS ACT, 1907. Towards the end of 1907 your Public Health Committee had under consideration the adoption or otherwise of the above Act, and resolved that it should be put into force within the Borough. It was hoped that the Act might have come into force at the commencement of the calendar year. However, it was not until the 5th June, 1908, that a letter was received from the Local Government Board, consenting to the adoption of the Act, and fixing the 15th June as the date on which the Council's resolution of adoption would come into operation. Fortunately, in anticipation of the receipt of this communication, some of the clerical work (which in a Borough such as this is of an exceptionally heavy character, owing to the fact that there are 1,246 registered medical practitioners resident therein) had already been put in hand. The usual circular letter, drawing the attention of all medical practitioners and midwives practising in the Borough to the provisions of the Act, was at once sent out. During the first month or two of the operation of the Act, the number of notifications received tallied very fairly with the number of births registered. During recent months, however, the notifications of births have been falling off, and it will probably be necessary before very long to take legal action to impress the fact of the existence of the Act on those responsible for compliance with its provisions. DEATHS. The total number of deaths to be debited to the Borough is 1,845, equal to a death-rate of 15.4 per thousand This figure has been corrected by the inclusion of persons who, though normally residents in the Borough, died in institutions outside, and by the exclusion of persons who, though they died within the Borough boundaries, were normally residents of other districts. 16 The average death-rate for the preceding 10 years is 172. The death-rates in the several Registration Sub-Districts were as under:— 1907. 1908. All Souls 12.3 13.2 St. Mary 13.7 14.9 Christ Church 18.3 19.0 St. Johns 16.0 13.4 The death-rates for 1908 have been corrected by multiplying the net figures by the Registrar-Generals factor for correction for St. Marylebone, viz.: 10652. This factor is one which it is necessary to apply in order that a fair comparison may be made between the death-rates of towns where certain conditions vary. These conditions have no direct reference to the size of population or the social or industrial conditions of the inhabitants, but the correction is intended to abolish those discrepancies which would otherwise exist in connection with what is called the "age and sex distribution" of the population. Towns, for example, having a large population of people of middle age when death is infrequent, cannot fairly be compared with those which have a large population of the very young or the very old, in whom death, of course, is much more frequent. Furthermore, it is known that the death-rate amongst women is smaller than the death-rate among men, speaking, of course, quite generally. By applying the correction to which allusion has been made, these two discrepancies are virtually eliminated, and a fair comparison is thus possible. The corrected deathrate for England and Wales, as a whole, during 1908, was 147 and in the 76 great towns of England and Wales it was 15.8. The figures for the other Metropolitan Boroughs are given in a comparative table appended hereto. (See page 23). On inquiring into the more prominent causes of death, one finds that zymotic diseases have been responsible for 112 out of a total of 1,845 deaths. Infantile diarrhoea, the fatal effects of which are virtually confined to the first year of life, has been the cause of 45 deaths, 32 of these being in infants under 1 year of of age. Measles has caused the death of 24 children, and being a disease of later life, its effects are manifest in the age-period 1 to 5 years. Scarlet fever comes next in order with a record of 13 deaths, and Whooping Cough and Diphtheria follow closely with 12 deaths from each cause. Tubercular diseases have been responsible for 203 deaths, of which no fewer than 125 have been at the most useful period of life, viz., 17 between the ages of 25 and 65. Epidemic Influenza has claimed 34 victims, most of these being at advanced age periods. Cancerous diseases present a somewhat similar record, there having been 158 deaths at all ages, 92 of these at ages from 25 to 65 years, and 63 in persons aged over 65 years. Chest diseases always bulk large in the annual death roll, and during 1908 caused 298 deaths under only four specific headings, no inconsiderable number of deaths due to other unspecified respiratory diseases going to swell the large column headed " All other causes." Deaths by accident or negligence have numbered 57, and those by suicide 18. It is highly satisfactory to be able to state that only three deaths have had to be classified in the column "ill-defined causes." Finally, in this very general review, one may allude to the somewhat unusual fact that two deaths are ascribed to chicken pox. The principal causes of death are tabulated in several ways in the following tables with a view of bringing certain details, which will be apparent at a glance, into greater prominence. TABLE I. District Births and Deaths for the fifty-three weeks ended 2nd January, 1909. Sub District. Population estimated to middle of year 1908. Births. Deaths. Males. Females. Total. Males. Females. Total. All Souls 33,683 238 222 460 212 207 419 St. Mary 36,117 303 285 588 243 263 506 Christ Church 37,628 533 574 1,107 344 331 675 St. John 19,439 211 193 404 118 127 245 Totals 126,867 1,285 1,274 2,559 917 928 1,845 Note.— In the above table the births and deaths have all been properly corrected, strangers have been eliminated, and extra-parochial deaths and others have been allotted to their proper Sub-district. i8 TABLE II. Showing the comparative mortality during the fifty-three weeks ended the 2nd January, 1909, from certain classes of diseases:— Total deaths 53 weeks ended 2nd Jan. 1909. Rate per 1,000 of the population. 1. Deaths from Zymotic Diseases 112 0.94 2. Deaths from Phthisis and other Tubercular Diseases 203 1.70 3. Deaths from Respiratory Diseases 298 2.50 NOTES. 1. Includes Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria and Membranous Croup, Typhus, Enteric and other continued Fevers, Diarrhoea and Enteritis. 2. Includes deaths from Pulmonary Phthisis, Tubercular Meningitis, General Tuberculosis, Tabes Mesenterica and other forms of Tuberculosis. 3. Includes Bronchitis, Pneumonia, Pleurisy, and other diseases of the Respiratory Organs. 19 TABLE III. Vital Statistics of Separate Localities in 1908 and the ten Previous Years. Names of Localities. The Whole Borough. All Souls. St. Mary. Christ Church. St. John. 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. Death at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under1 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. c. d. a. b. c. d. a. b. c. d. 1898 138,200 3,199 2,003 581 35,818 602 559 128 38,602 914 835 151 31,859 800 637 162 31,921 823 572 140 1899 130,900 3,106 2,570 530 35,485 545 506 102 38,239 873 906 145 31,561 766 608 148 31,615 822 556 136 1900 135,350 3,125 2,700 509 35,082 642 575 114 37,805 868 702 127 31,201 790 659 154 31,202 825 704 174 1901 133,301 3,042 2,211 449 35,388 583 514 92 37,903 854 607 90 39,527 1178 704 202 20,423 427 386 65 1902 132,650 2,960 2,458 434 35,219 570 503 74 37,763 777 721 113 39,342 1182 775 182 20,326 431 459 66 1903 131,700 2,818 2,180 402 34,966 607 479 73 37,493 802 591 114 39,061 1003 746 172 20,180 406 364 43 1904 131,000 2,791 2,172 393 34,781 598 512 79 37,293 740 560 106 38,853 1058 753 168 20,073 395 347 40 1905 129,453 2,618 2,026 358 34,370 527 438 81 36,853 696 530 81 38,394 1053 723 154 19,836 352 335 42 1906* 127,960 2,648 1,931 322 33,974 520 408 64 36,428 627 556 72 37,951 1088 652 141 19,607 313 315 45 1907 127,718 2,583 1,931 264 33,908 537 415 47 36,358 629 510 51 37,881 1027 683 131 19,571 388 323 35 Averages of Years 1898 to 1907 132,423 2,889 2,279 430 34,899 579 491 85 37,479 778 658 105 36,563 994 694 161 23,481 518 436 78 1908 126,867 2,559 1,845 267 33,683 460 419 55 36,117 588 506 77 37,628 1107 675 105 19,439 404 245 26 *The Rectory and St. Mary's Registration Sub-Districts were amalgamated this year. 20 TABLE IV.— Showing deaths from certain specified diseases during the fifty-three weeks, to 2nd January, 1909. Registered Births and Deaths. Corrected Births and Deaths. Births. Deaths. Births. Deaths. M. F. M. F. M. F. M. F. 2111. 2035. 842. 861. 1285. 1274. 917. 928. 4146. 1703. 2559. 1845. No CAUSES OF DEATH. Deaths in whole district at subjoined ages. Deaths in localities at all ages. Deaths in Public Institutions. All Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. All Souls. St. Mary. Christ Church. St. John. 1 Small-pox - - - - - - - - - - - - 2 Measles 24 5 18 1 — - - - 9 15 — 1 3 Scarlet Fever 13 - 6 5 1 1 - 3 3 5 2 - 4 Whooping-Cough 12 7 5 — — — — 3 3 6 — - 5 Diphtheria, Membranous Croup 12 1 6 5 — — — — l 10 1 — 6 Enteric and Continued Fever 6 - — 1 — 4 1 2 l 2 1 1 7 Typhus Fever — - — — — - — — — — - - 8 Diarrhœa, Dysentry 41 30 5 — 1 2 3 9 16 15 1 6 9 Epidemic or Zymotic Enteritis 4 2 1 — — - 1 — - 2 2 1 10 Enteritis 10 3 5 - - 2 - 3 3 2 2 4 11 Asiatic Cholera - - - — - - — — — — — - 12 Erysipelas 5 — — — 1 4 — 2 2 1 — — 13 Puerperal Fever 3 — — — 1 2 — — 1 2 — 2 14 Other Septic Diseases 17 4 2 3 1 6 1 4 3 5 5 7 15 Epidemic Influenza 34 1 — 1 — 14 18 4 20 8 2 4 16 Intermittent Fever and Malarial Cachexia 1 — — — - 1 - 1 - - — — 17 Tuberculosis of Lungs 154 1 2 1 23 114 13 35 33 61 25 34 18 Tuberculosis of Meninges 20 7 6 4 1 2 — 3 7 8 2 8 19 Other forms of Tuberculosis 29 4 7 3 — 9 6 7 3 16 3 17 20 Alcoholism and Cirrhosis of Liver 35 - - — — 32 3 10 9 4 12 11 21 Cancer 158 - 1 1 1 92 63 35 38 60 25 210 22 Premature Birth 53 53 — - — — — 14 10 24 5 28 23 Developmental Diseases 63 56 7 — — — — 11 14 28 10 22 24 Old Age 99 — — — — — 99 20 32 31 16 1 25 Meningitis 14 3 6 — 1 3 1 2 6 5 1 8 26 Inflammation and Softening of the Brain 2 — — — 1 — 1 — - 1 1 1 27 Organic Diseases of the Heart 67 — - 1 — 42 24 24 l 5 18 10 39 28 Croup (Spasmodic) 1 1 - - - - - - l — — — 29 Acute Bronchitis 49 16 9 1 - 13 10 6 14 25 4 2 30 Chronic Bronchitis 157 - 1 - — 59 97 45 42 58 12 25 31 Lobar (Croupous) Pneumonia 31 2 — — 2 16 11 6 6 15 4 12 32 Lobular (Broncho-) Pneumonia 61 24 16 1 - 14 6 17 14 20 10 17 33 Diseases of the Stomach 8 1 - - - 4 3 3 1 3 1 15 34 Obstructions of the Intestines 12 1 — - — 7 4 3 1 6 2 19 35 Nephritis and Bright's Disease 78 — 1 1 — 51 22 16 -23 27 12 30 36 Tumours and other affections of Female Genital Organs 10 1 — — - 7 2 3 5 2 - 20 37 Accidents and Diseases of Parturition 7 — — — 2 4 1 1 2 3 1 7 38 Deaths by Accident or Negligence 57 11 5 7 9 18 7 24 16 13 4 36 39 Deaths by Suicide 18 — — — 2 14 2 4 5 8 1 9 40 Deaths from ill-defined causes 3 — — — 1 — 2 — 1 2 — — ! 41 All other causes 475 32 15 16 19 224 169 99 146 162 68 197 42 Chicken-pox 2 1 1 — — — — — — 2 - - Totals 1845 267 125 52 67 764 570 419 506 675 245 794 21 TABLE V. VITAL STATISTICS OF THE BOROUGH OF ST. MARYLEBONE DURING 1908 AND THE TEN PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of residents registered in Public Institutions beyond the District. Nett Deaths at all ages belonging to the District. No. Rate. Under 1 Year of Age. At all Ages. No. Rate per 1,000 Births registered No. Rate. No. Rate. 1 2 3 4 5 6 7 8 8 10 11 12 13 1898 130,720 3,199 23.4 581 181.6 2,080 15.2 907 281 804 2,603 19.0 1899 135,660 3,106 22.9 530 191.5 2,079 15.3 1,001 339 836 2,576 19.0 1900 134,600 3,125 23.2 589 183.0 2,098 15.6 944 285 887 2,700 20.1 1901 133,301 3,042 22.8 449 147.6 1,742 13.0 941 328 797 2,211 16.6 1902 132,010 2,960 22 4 434 146.6 1,961 14.9 1,118 395 892 2,458 18.6 1903 130,900 2,818 21.5 402 142.6 1,683 12.9 1,070 356 853 2,180 16.6 1904 129,970 2,791 21.5 393 139.9 1,716 13.2 1,062 369 825 2,172 16.7 1905 128,960 2,618 20.3 358 138.5 1,625 12.5 895 400 801 2,026 15.7 1906 127,960 2,648 20.7 322 121.6 1,506 11.8 1,240 334 759 1,931 15.1 1907 127,718 2,583 20.2 264 102.2 1,574 12.3 1,229 433 790 1,931 16.1 Averages for years 1898 to 1907 131,779 2,889 21.8 432 149.5 1,806 13.67 1,040 352 824 2,278 17.2 1908 126,867 559 20.2 267 104.3 1,703 14.3* 794 652 794 1,845 15.4* Total population at all ages 133,301, at Census of 1901. Area of District in acres, 1,427*8 acres. Number of inhabited houses, 13,636 „ Average number of persons per house, 10*5 ,, * The death rates in columns 8 and 13 have been corrected by multiplying the figures by the Registrar-General's factor 1*0652. 22 TABLE VI. Institutions within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. At the following Nursing and Surgical Homes within the District, deaths of residents and non-residents have been certified. Christian Union Almshouses Banstead Asylum 57, Beaumont Street Cane Hill Asylum 55, do. Hospital for Paralysis, Maida Vale Camberwell House Asylum 3, do. Children's Hospital, Paddington Green 53, do. Hospital of St. John and St. Elizabeth 22, do. Cancer Hospital, Chelsea 20, do. Hospital for Invalid Gentlewomen, 90, Harley St. London Throat Hospital, 204, Great Portland St. Middlesex Hospital Colney Hatch Asylum 25, do. Children's Home, Bonner Road, Bethnel Green 36, do. 14, do. Claybury Asylum 33, do. Charing Cross Hospital 50, do. Queen Charlotte s Hospital Children's Hospital, Great ormond Street 52, do. Samaritan Free Hospital 49, do. St. Peter's Harbour, 10, Greville Place West End Hospital, 73, Welbeck Street Caterham Asylum 13, Bulstrode Street Dartford Heath Asylum 14, do. Darenth Asylum 33, Bentinck Street French Hospital, Shaftesbury Avenue 12, Duchess Street 36, Devonshire St., Portland Place Freidenheim Hospital, Hampstead 22a, do. Guy's Hospital 29, do. Home Hospital, 16,Fitzroy Square 12, do. 23, do. Home for the Blind, Stanley Road, Islington 45. do. 30, do. Hammersmith Infirmary 90, Harley Street Horton Asylum 15, Hanrietta Street Homoeopathic Hospital 15a, do. 12, Holies Street Hostel of God King's College Hospital 52, Hallam Street Leavesden Asylum 7, Mandeville Place Lambeth Infirmary 9, do. London Hospital 3, do. Long Grove Asylum 59, Mortimer Street Manor Asylum, Epsom 19, Manchester Street North-Western Fever Hospital 3, Nottingham Place 11, do. National Hospital, Queen's Square 25, New Cavendish Street. 7, Queen Anne Street 7, Osnaburgh Terrace 4, Upper Wimpole Street Peckham House Asylum 14 a, do. Royal Free Hospital 1a, do. St. Bartholomews Hospital 59, Weymouth Street St. Mary's Hospital 50, do. St. Marylebone Infirmary 29, Wimpole Street St. Luke's Home, Kensington 51, Welbeck Street 55, do. Sick Asylum, Hendon 15, do. St. Joseph's Home, Portobello Road 56, do. St. Pancras Infirmary St. George's Hospital St. Peter's Home, Kensington St. Joseph's Hospice, Mare Street, E. 23 Institutions within the District receiving sick and infirm persons From outside the District. Institutions outside the District receiving sick and infirm persons from the District. At the following Nursing and Surgical Homes within the District, deaths of residents and non-residents have been certified. St. Thomas' Hospital Tooting Bee Asylum Throat Hospital, Soho University College Hospital 131, Upper Richmond Rd. Victoria Hospital, Chelsea Westminster Hospital Westminster Union Workhouse Western Fever Hospital Warrington Lodge, Warrington Crescent By the courtesy of the Metropolitan Medical Officers of Health, I am able to give your Council the statistics for the whole of the other London Boroughs for purposes of comparison. Such comparison, however, must be made with full cognisance of the fact that this Borough is in many respects a favoured one. Borough. Birth Rate. Corrected Death Rate. Death Rates from Infant Mortality per 1,ooo Registered Births. Seven chief Zymotic Diseases. Phthisis. Pulmonalis. Battersea 25.1 13.3 1.23 1.19 107 Bermonsdey 32.1 18.8 2.31 1.85 146 Bethnal Green 32.6 17.1 2.4S 1.62 133 Camberwell 25.1 13.1 0.09 1.12 107 Chelsea 20.2 14.5 1.38 1.27 108 Deptford 262 14.6 1.37 1.30 123 Finsbury 30.3 19.0 2.4 2.3 115 Fulham 28.5 13.3 1.67 1.21 117 Greenwich 23.3. 12'9 1.16 1.14 120 Hackney 24.3 13.9 1.48 1.50 117 Hampstead 15.1 8.7 0.41 0.79 69 Holborn 27'8 15.7 1.02 1.89 76 Islington 24.3 13.6 1.01 1.21 103 Kensington 19.0 140 0.92 1.00 122 Lambeth 27.7 13.5 1.2 1.7 93 Lewisham 22.8 11.0 1.14 0.85 87 London (City) 14.4 12.6 0.15 1.24 65 Paddington 21.4 12.3 0.89 0.97 105 Poplar 31.9 16.3 2.18 1.49 123 St. Marylebone 20.2 15.4 0 94 1.70 104 St. Pancras 23.4 15.0 1.07 1.53 115 Shoreditch 32.2 18.3 1.9 1.9 138 Southwark 28.1 16.3 1.76 1.88 136 Stepney 32.5 16.6 2.56 1.5 130 Stoke Newington 19.1 12.7 0.86 1.04 98 Wandsworth 22.2 10.2 0.82 0.83 98 Westminster 16.5 12.3 – 1.18 100 Woolwich 24.1 11.6 0.92 1.23 95 24 INFANTILE MORTALITY. There is little need to allude to the splendid work constantly being done by your Lady Sanitary Inspectors— if the Council does not know and appreciate it very many others do—and it is a fact that seldom does a day pass by without some request being received by the Department that their help and advice would be welcomed by some person or other. Praises as to their work are just as frequently being received. Assisted by the earnest and kindly voluntary workers of the St. Marylebone Health Society, there is no doubt that they save many infant lives annually. The lessons they impress upon parents and others as to cleanliness, the proper storage of milk and other foods, the correct method of feeding and managing infants, the prevention of blindness and so forth, will, I feel confident, leave a permanent mark on the health of this Borough. Two leaflets, which are explained by your Lady Sanitary Inspectors and the workers of the St. Marylebone Health Society, and left at homes where they will be appreciated, have been issued or reissued during the year 1908; and as requests for copies of them are so numerous as to shew clearly that they are valued by others engaged in similar work, I reproduce them. Assistance was most kindly given in the preparation of that on Infantile Diarrhoea by Miss Christine Murrell, M.D., and Dr. Eric Pritchard, whilst the one dealing with Ophthalmia was most kindly revised by the staff of the Western Ophthalmic Hospital and by Dr. Sydney Stephenson, whose help I desire to acknowledge most fully and most gratefully. SUMMER DIARRHCEA. Diarrhoea is one of the most fatal diseases of young children. It may be prevented by taking particular care of the child, and the cleanliness of its food and surroundings. (1). During the hot weather cow's milk should be boiled before being used, and if kept should be covered with a clean damp cloth to prevent dust getting into it. (2). Infants should not be weaned during the hot months of the year. (3). If babies have to be fed by hand, follow directions given in leaflet on "Infant Feeding," copy of this can be had on application as below. Breast-fed babies hardly ever suffer from Diarrhoea. 25 (4). No tainted food or sour milk should be bought or used and all food should be protected from dust and flies. (5). Children's bodies and clothing should be kept clean. Soiled napkins and other clothes should not be allowed to lie about, but should at once be put into water to soak, and washed as soon as possible. (6). Extra care should be taken to keep the house and back yard clean. (7). Keep the dust-bin closely covered, as far from the house as possible, and see that it is regularly emptied. Burn kitchen refuse on the fire. (8). Sinks, gulleys, and closets should be kept clean and flushed daily. (9). If an infant has severe diarrhoea and sickness a doctor should at once be consulted, and meanwhile only egg water or plain water should be given. Egg water is made by well beating up the white of an egg and adding a little water thereto. Inform the landlord if drains are stopped up, if water supply is deficient, or if other defects exist. If not promptly attended to, write to the Medical Officer of Health, 24, Somerset Street, W. CHILDREN'S EYES AND HOW TO CARE FOR THEM. Inflammation in the eyes of the new-born child is a very dangerous and infectious illness, and if prompt measures are not taken may entirely destroy the sight. (1). When a child is born, it is wise to thoroughly wash out its eyes with water. The baby's eyes should be examined daily for a week after birth, and if there is the slightest discharge send for the doctor at once. (2). Remember that this disease is very catching if the discharge should get into the eye of another person. (3). In every case of injury to the eye, however slight, get a doctor's advice at once, and do not trust such a serious matter to a chemist, who, through ignorance, may use measures which might result in permanent blindness. 26 (4). If you are nursing your child through Measles, Scarlet Fever, etc., be very careful to follow your doctor's instructions even after your child is better, as the sight may be greatly injured in this kind of illness. (5). Never allow your children to read, write or sew in a bad light, or they may permanently damage their eyesight. (6). Never allow your child to wear glasses until the doctor has examined the eyes and ordered them. You are warned against the advertisements of so-called "Eye Specialists," chemists posing as " Opticians," " Sight Testers," and the like. (7). If you notice that your child has to bend closely over books or work, or screws up his eyes when looking at things at a distance, or holds his head crookedly under the same circumstances, or suffers from pains in the head, there is probably something wrong with the eyes, and he should be promptly taken to a doctor or to the Eye Hospital for treatment. All children over a year old who squint should be taken to the doctor or the Eye Hospital at once. The principal causes of infantile mortality in St. Marylebone, as will be seen from Table VII. appended, are prematurity of birth, developmental diseases (such as dentition, want of breast milk and marasmus), and diarrhceal diseases. There were 267 infant lives lost in St. Marylebone during 1908, the infantile death rate being equivalent to 104 per thousand registered births, as compared with 102, the rate for 1907. These rates are not high as compared with those of most other districts in London. The infantile death 'rate is higher than it should be in Christ Church Sub-District (which embraces Lisson Grove), no fewer than 105 of the deaths recorded having taken place in that district, as compared with 77 in St. Mary's District (the area bounded by Marylebone Road, Edgware Road, Oxford Street, and High Street), 59 in All Souls' District (the area east of High Street, Marylebone), and 29 in the St. John's Wood District. The deaths of infants were greater in number during the first week of life than during any other single period, no fewer than 71 out of the total of 267 occurring at that time. This fact alone justifies the adoption of the Notification of Births Act, shewing, as it does, the need for early notification and early visitation, with a view to the administration of advice and assistance in the management of this dangerous period. 27 BLE VII. Infantile Mortality during the Year 1908. Deaths from stated Causes in Weeks and Months and in Sub-Districts under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 1 10-11 Months. 11-12 Months. Total Deaths under 1 Year. All Souls. St. Mary. Christ Church. St. John. Totals. smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. chicken-pox .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 measles .. .. .. .. .. 1 .. .. .. .. .. 2 2 .. .. 1 6 .. 1 5 .. 6 scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. diphtheria: (including Membranous Croup) .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. 2 .. 1 1 .. 2 whooping Cough .. .. .. .. .. 1 .. .. 1 .. .. 2 1 I .. .. 6 3 .. 3 .. 6 diarrha, all forms .. .. 1 .. 1 6 3 .. 4 .. .. 1 1 1 2 .. 19 4 8 6 1 19 Enteritis, Muco-en- teritis Gastro-enteritis .. 1 1 .. 2 2 1 2 3 1 .. 1 1 1 14 5 4 4 1 14 gastritis, Gastro- intestinal Catarrh .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 2 .. .. 1 1 2 premature Birth 45 1 3 .. 50 2 1 .. 1 .. .. .. .. .. .. .. 54 14 14 21 5 54 congenital Defects 12 .. 3 .. 17 5 1 .. 3 1 2 1 .. .. .. .. 30 3 9 15 3 30 injury at Birth 2 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 1 .. 2 want of Breast-milk Starvation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. atrophy, Debility, Marasmus 1 1 2 2 9 8 5 1 1 .. .. .. .. 1 1 2 28 8 8 8 4 28 Tuberculous Meningitis .. .. .. .. .. .. .. 1 .. 1 1 1 1 1 1 .. 7 2 2 1 2 7 tuberculous Perito- nitis: Tabes Mesenterical .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. other Tuberculous Diseases .. .. .. .. .. .. 1 1 .. 1 1 .. .. .. .. .. 4 .. .. 4 .. 4 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. syphilis .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. 2 1 .. 1 .. 2 rickets .. .. .. .. .. .. 3 .. .. .. 1 .. 1 .. .. 2 7 2 1 2 2 7 meningitis (not Tuberculous) .. .. .. 1 1 .. .. .. .. .. .. .. .. 2 .. .. 3 .. .. 2 1 3 convulsions 1 1 .. .. 2 .. .. .. .. .. 1 .. .. .. 2 .. 5 1 1 2 1 5 bronchitis 1 .. .. 1 2 2 1 1 2 2 3 .. 2 2 1 19 2 8 7 2 19 laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 .. .. 1 pneumonia .. 2 .. 1 4 3 1 4 3 1 2 .. 2 3 6 1 30 8 10 10 2 30 suffocation,overlying 3 .. .. 1 5 3 3 .. .. 1 .. .. .. .. .. .. 12 4 3 5 .. 12 other Causes 4 3 .. .. 7 1 2 2 .. .. .. .. .. .. 1 13 2 5 5 1 13 71 11 13 8 103 36 25 12 17 8 10 11 9 13 16 7 267 59 77 105 26 267 Population. Estimated to middle of 1908—126,867. births in the year, legitimate, 2,441; illegitimate, 118. deaths in the year of legitimate infants, 227; illegitimate infants, 40. deaths from all causes at all ages, 1,845. 28 INFECTIOUS DISEASES. Including phthisis (176 cases) there have been 873 notifications of infectious disease received during the year. Of the cases reported a very considerable number were removed to hospital for treatment, viz., Diphtheria 108 or 90.1 per cent, of the cases notified- Erysipelas 42 or 33.6 „ „ Scarlet Fever 393 or 96.0 „ „ Enteric Fever 25 or 73-5 „ „ Puerperal Fever 4 or 500 „ „ Cerebro-Spinal Fever or 50.0 „ „ Phthisis 111 or 63.0 ,, „ The notification rate or proportion to population of cases of infectious disease, including phthisis, notified during the year is 6'8 per thousand. The persistent heavy incidence of scarlet fever in children of school-age justifies the demand made by one of the neighbouring Borough Councils that an exhaustive inquiry should be held into the etiology of this ever-present disease. With the exception of the St. John's District, which is usually a favoured one in these matters, the disease has not been more life in one part of the Borough than another. The other infectious diseases have shown no particular rise or fall during 1908. 29 TABLE VIII. Cases of Infectious Disease Notified during the Year ending 2nd January, 1909. Notifiable Disease. Cases notified in whole District. Total cases notified in each locality. Number of cases removed to Hospital from each locality. Cases isolated at home At ages—years. All Souls St. Mary Christ Church St. Jonn Totals. All Souls St. Mary Christ Church St. John Totals At all ages. Under 1 1 to 5 5 to 15 15 to65 25 to 65 65 and upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, including Membranous Croup 118 5 43 47 13 10 ... 20 28 55 15 118 20 27 53 8 108 10 Erysipelas 125 2 5 2 17 77 18 18 39 57 11 125 4 25 12 1 42 83 Scarlet Fever 409 5 111 235 41 17 ... 119 103 131 56 409 116 ... 126 54 393 16 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 34 ... 1 4 11 18 ... 10 7 13 4 34 7 8 11 2 25 9 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 1 ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... 1 Puerperal Fever 8 ... ... ... 2 6 ... 1 2 4 1 8 ... 2 1 1 4 4 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 2 ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... 1 1 Phthisis 176 ... 1 4 20 146 5 27 43 98 8 176 16 35 55 5 111 65 Totals 873 12 165 294 104 274 24 196 223 359 95 873 163 191 259 71 684 189 The Workhouse is situated in the Sub-district of St. Mary. 30 BACTERIOLOGICAL EXAMINATIONS. These examinations are conducted by Dr. Eastes, at the Laboratory of Pathology and Public Health, 38, New Cavendish Street, in doubtful cases of Typhoid Fever, Diphtheria and Phthisis, and the following table gives particulars of the number of cases and the result there of:— Positive. Negative. Total. Typhoid Fever 3 7 10 Diphtheria 12 33 45 Phthisis 21 50 71 "Continued " Fever 1 – 1 Totals 37 90 127 The utility of these examinations to the Medical Practitioner and the Public Health Department is so great that they are now an absolutely essential part of the work of the Department. LONDON (NOTIFICATION OF GLANDERS) ORDER, 1907. Under the London (Notification of Glanders) Order, 1907, Article 2 (5), it is laid down that on and from the 1st of January, 1908, "an Inspector of the Local Authority who receives "information of the existence or suspected existence of "disease, shall forthwith report the fact to the Local "Authority, and also to the Medical Officer of Health of the "Sanitary District in which the animal died or was "slaughtered, or in which the carcase was at the time of the " notice." Local Authority for the purposes of this Order means the London County Council. Inspector for the purposes of this Order means the Veterinary Inspector of the London County Council. During the year notifications were forwarded by the Inspector as outbreaks occurred, and all the steps in connection with the slaughter of diseased animals and the cleansing and disinfection of infected premises were carried out by and under the supervision of the London County Council Inspector, in accordance with the Glanders and Farcy Order of 1907, and the London County Council's Regulations made thereunder. The disease was notified as occurring at the following premises in the Borough. 31 In all cases reported the sanitary condition of the living rooms at the premises was inspected, and they were found to be in a cleanly state. Defects in drainage were discovered at three of the premises, and in one case a proper receptacle for the storage of manure was requisitioned and provided. 1908. Premises. Condition of Living Rooms, Drainage, Etc. 1st Jan. In Boston Mews Clean. Notice served to provide a proper receptacle for the storage of manure. 17th Jan. 2, Boston Place Clean. 10th Feb. 11, Fairlop Place Clean. Notice served to redrain the premises. Work completed 18th March, 1908 3rd Dec. Phoenix Yard Clean. Drains found to be defective. Order served to re-construct. 15th Dec. 54, Weymouth Street Clean. Drains found to be defective. Order served to re-construct. One case of human glanders was notified on the 6th November, 1908, as occurring at 80, Lisson Grove. The patient was removed to the Infirmary, and died on the 19th November, 1908. In spite of exhaustive inquiry it could not be ascertained either from the deceased or from his relatives where he had been in the habit of working, hence the source of infection could not be ascertained. The only facts his relatives could supply were that he had no regular employment, but did odd work as a coachman. CEREBRO-SPINAL FEVER. This disease is now notifiable throughout London, and the London County Council forward reports of all cases occurring in any Metropolitan Borough to all the other Boroughs. Your Medical Officer of Health had some experience of the cases which occurred in Glasgow a couple of years ago, and can assure your Council that they may think themselves exceedingly fortunate in not having had to face an outbreak in their district. The disease is one of the most hopeless with which to deal clinically—your Medical Officer, accustomed as he is to most phases of pain and suffering, will never forget the feeling of horror aroused by the contemplation of the Glasgow Fever 32 Hospital Wards filled with groaning, shrieking, contorted children actually held in the pangs of the disease, and with whom nothing could be done but to narcotise the horrible pain, whilst even those who had evaded death were poor, pale, pinched, shrunken, paralysed, blind or deaf creatures. Not only this but the causation of the disease was, and still is, baffling all known sanitary measures. There are quarters in St. Marylebone where, if this disease should ever gain a footing, it would simply revel. Your Council know full well to what localities I allude. Measures to improve these places should never be relaxed, despite the conflict with vested interests which will always result. The tenement houses in Burne Street, Rathbone Place, Gresse Street, Capland Street, Upper Charlton Street, Virgil Place, and Nightingale Street, are some of which, during my term of office, I have learned the conditions, and I ask you as a Council, when dealing with insanitary conditions in these and similar localities, to remember that misplaced leniency will be like sowing a wind the whirlwind of which in the form, not merely of lessened general health, especially of the young generation, but in the form of phthisis, cerebro-spinal meningitis, and other destroyers of vitality, will very shortly be reaped. MEASLES. A considerable number of cases of measles have been reported during the year from the various schools. In only two cases, however, has the number of infected children been a serious one. In these two cases your Medical Officer of Health paid a visit to the school concerned and made enquiries into the circumstances attending the outbreak. With the co-operation of the County Council (Education) Medical Officer, measures were devised, such as the exclusion of unprotected children, the prevention of the assembling of children together in the early morning, and for such lessons as singing, etc., by which it was found possible to avert any such harsh measures as the closure of the school or any department thereof. PHTHISIS. 1 here were 154 deaths recorded from pulmonary phthisis during 1908, a number equivalent to the deaths of 1.21 persons out of every thousand persons in the district. Taking the deaths from other tubercular diseases into account, the total is thereby raised to 203, equal to a death rate of 1.70 per thousand of the estimated population. The sad thing about these deaths from phthisis is that the disease does its fell work chiefly during the period of early 33 manhood and womanhood, when men should, in the fulness of their strength, be advancing the work of the home and of the nation, and when women should be strong to bear and rear healthy children. Yet a mere glance at the world's record of those celebrated in science, art, literature, and the like, suffices to show how those who have cut their niches highest in the rock of fame have succumbed at an untimely hour to this still potent and still omnipresent death-dealing agency. Schiller, Keats, Chopin, Laurence Sterne, Robert Louis Stevenson, Moreau, Spinoza, Weber— these are some of the world's luminaries who have been claimed as victims by phthisis at the noontide of their fame. What of the tens of thousands of obscure honest workers who merely swelled the ranks of those engaged in keeping the everyday world going and who have gone under from the same cause ? These are facts as true to-day as they have always been. The man in the street knows these facts. The specific cause of the disease and the main avenues of infection are known ; the influences both pre-natal and post-natal affecting its development have been demonstrated; the fundamental principles, at all events, on which prevention and cure are to be based, are agreed upon by all whose word is of any weight; yet our hands are still in our pockets and our coats upon our backs. Localised and fitful attempts are being made—praise be to their originators—to deal with this, probably the largest problem to which public health has ever set its hands, but in the absence of State aid, these will probably die of inanition before long. Small urban and rural districts, local authorities cramped by expenditure which would in many cases have been better left to private enterprise, cannot afford, forsooth, to spend money on the prevention and cure of phthisis ! What seems to be required is the establishment of a special tuberculosis department of the Local Government Board on the lines of similar departments now existing in some of our large cities, and closely co-ordinated with what we shall before long know as the Public Assistance Authority. Such a department might be empowered to put into force regulations such as those authorised by Section 134 of the Public Health Act, 1875, which outlines the action to be taken whenever any part of England is threatened with or affected by any "formidable infectious disease." Regulations under this Section may be made for house-to-house visitation, the provision of medical aid and accommodation, the promotion of cleansing, ventilation and disinfection, and, generally, for guarding against the spread of disease. These powers have only been rescued from oblivion on the occurrence of an outbreak of cholera; their operation has certainly been the occasion for the free spending of money, but their effect has been the prompt stamping out of the disease. 34 Has not the time arrived when a similar organisation against phthisis is possible? International co-operation—as in the case of cholera—is obviously necessary, and the interests concerned are, of course, enormously large. But the evil is world-wide and deeply rooted, and no half-hearted reform will ever have a chance of success. "Medical science cannot cope alone and unaided with this difficult and prodigious world problem; many forces—economic, legislative, sociological, humanitarian—must be enlisted." (J. B. Huber.) Sir John Moore has proposed the following excellent scheme of administrative control of phthisis :— "(a) (1) Compulsory notification; (2) verification of diagnosis by bacteriological examination of sputum; (3) removal of patients to hospitals ; (4) periodic inspection and disinfection of the homes of the tuberculous. (b) The provision of hospital accommodation (isolation hospitals, sanatoria, consumption wards, etc.) for (1) early cases; (2) advanced cases, to provide comfort for the dying and to secure safety for the living. (c) The vigorous and absolute segregation of tuberculosis cases in workhouses, asylums, and other public institutions. (d) Education of the public concerning the prevention and management of tuberculosis. (e) Improvement of the housing of the working classes and of the very poor, especially in towns." This is a big programme and means the free spending of money. But in England and Wales during the year, 1907, 11,299 males and 8,069 females died from tuberculous phthisis of the lungs, whilst 31,166 males and 24,935 females died during the same period from various kinds of tuberculosis including the pulmonary form. The number of sufferers and crippled workers is probably three times as large as the figures given. The battle is thus worth fighting and we have Pasteur's dictum to encourage us—'C'est dans lepouvoir humain de faire disparditre du monde tous les maladies parasitaires.' So far as home treatment is concerned, the necessary fresh air and sunlight are only obtainable in undiluted form in small towns and country places. For such cases the advice given by 35 Osier is, apart from the confidence of the patient and the discreet and stern management of the physician-— "(1) Persistence—benefit is usually a matter of months, complete arrest a matter of years, absolute cure a matter of many years. (2) Sunshine by day; fresh air by night. (3) Rest while there is fever. (4) Bread-stuffs and milk, meat and eggs." The voluntary notification of this disease has been in force now for about two and a half years. The notifications received have had reference very largely to occupants of the Workhouse or various Common Lodging Houses in the Borough. The total number of notifications received has been during 1908—172, as compared with 291 during 1907. The deaths from phthisis during 1908 numbered 154, so that it is pretty clear that the notifications do not cover, by a very considerable margin, the number of actual cases existing in the Borough. A very considerable number of cases have been forwarded to the Infirmary for treatment. By the courtesy of Dr. J. R. Lunn, the Medical Superintendent of the St. Marylebone Infirmary, I am able to inform your Council that there are in that Infirmary 32 beds set apart for consumptive females, and 62 for consumptive males. Dr. Lunn adds that cases are seldom if ever received for treatment in the early stages of phthisis. The cases which come into the Infirmary are advanced cases, and, unfortunately, they come in and go out pretty much as they choose. This bare statement forges another link in the chain of evidence which goes to show that no amount of voluntary submission to treatment is likely to be of any avail in the ultimate stamping out of this disease. In the cases reported to the Department, visits are paid both by your Lady Sanitary Inspectors and by the voluntary workers of the St. Marylebone Health Society. A card (reproduced below) is explained to those interested, and is left at the house. It is printed on cloth backed paper, so that it may be referred to from time to time. Disinfection of premises is carried out in a considerable number of cases—always after the death of the patient, and fairly frequently at periodical intervals during the continuation of the illness, so as to prevent, as far as possible, re-infection of the patient himself, and infection of those around him. 36 METROPOLITAN BOROUGH OF ST. MARYLEBONE Public Health Department. PRECAUTIONS AGAINST CONSUMPTION. Consumption is an infectious disease. It is caused by a microbe or germ, which grows in the lungs of the patient. The sputum (spit) coughed up by the patient contains a great many of these germs. When this sputum is allowed to dry it may become powdered into a fine dust and get into the air. Persons breathing this air may then take the germs into their lungs, and after a time become consumptive. This is how consumption is spread from one person to another. A consumptive patient should on no account spit on the floor of any room, workshop, theatre, or other place where people assemble; or on the floor of any railway carriage, tram-car, or other public conveyance; or on a street pavement. Nor should the patient spit into an ordinary pocket handkerchief. The sputum soon dries in the pocket, and when the handkerchief is next used a cloud of infective dust may be scattered around the patient. A consumptive patient who does not take care to destroy his sputum before it becomes dry is a source of danger to other people and to himself, for he may, when almost cured, start the disease afresh by breathing his own dried sputum. At home the patient should spit into a piece of paper or clean rag, which should be at once burnt on the fire. If there is no fire the patient should spit into a jar, pocket spittoon, or other vessel containing water or some fluid disinfectant, to keep the sputum moist. The vessel should be emptied twice a day down the water-closet, and then thoroughly cleansed with boiling water before being again used. Outside the house the patient should spit into a pocket spittoon, which should contain a little water or fluid disinfectant, and should be kept perfectly clean. Or the patient may carry a number of pieces of soft paper, or clean rags to spit into. These should never be carried loose in the pocket after being used, but should be put into a tobacco pouch, sponge bag, or other waterproof receptacle. On returning home the paper or rags should be burnt, and the pouch or bag well washed with disinfectant All persons who have a chronic cough should carry out the above precautions. 37 The knives, forks, spoons, plates, cup, &c., used by a consumptive patient should be put into boiling water immediately after use, and should never be used by another person. The patient's night-clothes, sheets, pillowslips, &c., should not be mixed with the general washing of the family, nor sent to a public laundry, but should be boiled and then washed by themselves at home. A consumptive patient should, if possible, occupy a separate bedroom, or at least a separate bed. The rooms should have plenty of sunlight and be kept well ventilated and well lighted. The windows should always be open. Fresh air and sunlight will not only help the patient to recover, but will also help to prevent the other members of the family from becoming consumptive. Carpets, curtains and upholstery should not be used in a consumptive's room. If already in use they should be removed and disinfected. If the patient's clothes, pillows or bedclothes become soiled with sputum they should be at once disinfected by steam or washed with boiling water. The floor of a consumptive's room should be thoroughly washed with soap and water at least once a week and should always be kept free from dust. The floor should not be swept unless tealeaves moistened with disinfectant have first been scattered over it to prevent the dust from rising. The best way to remove the dust is to wipe the floor with a wet cloth. The articles of furniture, &c., in the room should be dusted with a damp duster. Dry dusting and sweeping may scatter infectious dust about the room and thus be a source of danger to the patient and to other persons. Every three months the walls should be rubbed down with dough which should then be burnt. Consumptives should not kiss on the lips. A male consumptive should not wear a beard or moustache, but should be clean shaved. When it has been decided that anyone is suffering from consumption the house should be thoroughly disinfected. On a request made in writing to the health department disinfection will be carried out free of charge. Consumption was formerly thought to be an incurable disease. This is a great mistake. Recovery from consumption is not at all uncommon. It depends largely upon the careful observance of the rules on this card. Other important points are:— Plenty of nourishing food. Abstinence from alcohol unless it is ordered by a doctor. 38 What is good for the cure of consumption is good for the prevention of consumption. People who keep their windows open and their houses and bodies scrupulously clean, and abstain from the excessive use of beer, wine, or spirits are doing a good deal to keep away consumption. Any one of the following disinfectants will be found reliable. Carbolic Acid, i tablespoonful pure acid well mixed with § pint water. Izal table spoonful, mixed with 3 pints water Cyllin „ „ 3 „ Kerol „ „ 3 „ Lysol „ „ 1½ „ Meredith Young, M.D. Medical Officer of Health. Public Health Department, 24, Somerset Street, Portman Square, W. During the year 1908 the Brompton Hospital for Consumption and Diseases of the Chest have had under consideration by their Committee a scheme for the voluntary notification of cases of Pulmonary Tuberculosis, and the detection of contact cases in the early stage of the disease. The system is, briefly, that upon the patient giving his consent the case will be notified' to the Medical Officer of Health for the district in which the patient resides. Facilities are very kindly afforded by the Hospital Committee to the Medical Officer of Health to send any suspected case of phthisis occurring among inmates in the patient's home to the Hospital where he will be examined, and receive advice on hygienic or medicinal measures. The scheme was naturally warmly welcomed by your Medical Officer of Health, and a number of certificates have accordingly been received and dealt with by the Public Health Department. An endeavour has been made, on the suggestion of a member of the St. Marylebone Health Society, to have this system extended to the various other Hospitals in London at which Pulmonary Phthisis is treated. It is believed that the Medical Officer of Health for the County is using his best endeavours at the present time to secure the operation of this extended system. 39 TABLE IX. DEATHS FROM PHTHISIS. Population. Year. All Ages. Sub-Districts. All Souls. St. Mary. Christ Church. S. John. 126,867 1908 154 35 33 61 25 127,718 1907 179 42 46 64 27 127,960 1906 197 36 64 73 24 129,453 1905 195 37 56 69 33 131,000 1904 214 43 57 82 32 131,700 1903 241 71 56 78 36 132,650 1902 225 59 59 71 36 133,301 1901 223 71 60 56 36 135,350 1900 275 80 64 68 63 DEATHS FROM PHTHISIS AND OTHER TUBERCULAR DISEASES. Year. No. of Cases. Population. Rate per 1ooo of Population. 1908 203 126,867 1.70 1907 229 127,718 1.79 1906 244 127,960 1.90 1905 248 129,463 1.92 172 cases of Phthisis were notified during 1908. 291 Do. do. do. 1907. DEATH CERTIFICATION. It is really a matter of serious moment that the certification of causes of death is in such an unsatisfactory condition. Certification by medical men is, on the whole, quite satisfactory, and if the Medical Officer of Health were given a proper locus standi so that he would be enabled, not merely as a matter of courtesy, but as a matter of right, to inquire into cases where vague nomenclature had been employed, and where primary causes were ineffectually distinguished from secondary causes, probably nothing more would be requisite. To this end little more is required but the transference of the supervision of Registrars of Births and Deaths to the local Sanitary Authority, with power to make regulations for the guidance of these officers. 40 In the case of deaths not certified by medical practitioners a more drastic change is needed. The coroner's jury may have its good uses, but its seven hundred years of hoary antiquity must probably stand as one of the best excuses for its existence. A fairly extensive experience of such bodies compels me to say that, whilst innate commonsense and shrewdness often constitutes their salvation from totally fallacious findings, they are exceedingly apt to be swayed more by irrelevant items of evidence than by those which are both relevant and admissible. Not infrequently their verdicts are arrived at without medical guidance, and are couched in terms which display a want of appreciation of the real meaning of the words they have heard and even of those which they have themselves used. The law has in view, in the holding of coroner's inquests, the highly important duty of inquiring into cases of homicide or sudden death with the object of separating out those deaths due to criminal intent. State medicine has in view an object no less important, for correct death certification depends upon correct medical nomenclature; upon the latter public health statistics are entirely based, and upon the last legislative measures for the betterment of public health are very largely founded. There is a distinct necessity, in my opinion, for the regular co-operation of medical with legal knowledge in all inquiries into sudden and unknown causes of death. Every coroner possessed of legal qualifications alone, should have as an adviser a medical man of extensive pathological experience, and post-mortem examination should be the necessary preliminary to every inquest. Until these essentials are carried out the findings of coroners' juries must be accepted with very considerable reserve. I give some verdicts recorded in this district during 1908 to show the curious wording sometimes adopted by juries:— "Suffocation—want of fresh air, caused by collapse of houses." "Bursting of abscess in abdomen and inflammation of lungs accelerated by fractured patella and injury to the side caused by a fall on ground when alighting from a tramcar in motion." "Disease of heart and other organs caused by alcoholism, otherwise natural." "Disease of heart and liver at a time when he was under chloroform for the purpose of an operation." Part II. DEPARTMENTAL. ■ 43 GENERALA ADMANISTRATION The first few months of my tenure of office were, at the request of the Public Health Committee, devoted to an exhaustive enquiry into the administration of the Department, with a view to its better equipment with staff and the modernisation of its methods. This was a somewhat exceptional task to undertake, and proved rather more formidable than I had anticipated. At the same time certain alterations were imperative, and had my predecessor been remaining in office, there is little doubt but what he would have effected many of these himself. The Public Health Department of St. Marylebone has gradually acquired duties and responsibilities in excess of those obtaining in most other Metropolitan Boroughs, notably the supervision and control of the public underground conveniences and verminous persons baths, the removal of dust, and the drainage of new as well as of old buildings. With the exception of the first, I feel bound to state that it is only proper that they should be under the control of the Public Health Department. At the same time the worknecessarily inseparable from the adequate supervision of these matters subtracts a good deal of time from that which is available for one's daily work, and by so doing limits to a some what undesirable degree the time which one would like to give to problems for which a Medical Officer of Health has had more ad hoc training. At the request of the Chairman of the Public Health Committee, your Medical Officer of Health prepared a report early in the year, dealing with the whole of the administration of the Department. In this report attention was drawn to the fact that the staff of the department was inadequate to deal with the work which ought to be carried out. After a very full consideration of the recommendations contained in this report, in which your Chairman, the Rev. J. A. Beaumont, M.A., and the Members of the special Sub-Committee appointed to deal with it (Councillors Helsdon, Lea-Smith, Colonel Maude and Dr. Swanton) took a keen personal interest, and spent a very considerable amount of time, a scheme for the re-apportionment of duties and for an increase of staff was carried through the Council. A very considerable amount of the re-organization of the Department consisted in mere re-arrangement of duties, so that officers who once took up a matter should carry it through to completion, without having the opportunity of divesting themselves of responsibility at an uncertain stage. Roughly speaking, so 44 far as the clerical staff is concerned, the chief clerk is now responsible for work in connection with committee meetings, accounts and petty cash, orders and requisitions, convenience registers and records, vital statistics, statutory notices, and general interviews. The assistant clerk is responsible for infectious disease notifications, forms and registers, complaints and the "follow-up" book connected therewith, drainage records and plans, and office stock. The junior clerk is responsible for the correspondence, which has increased to more than double the amount during the past year, the outworkers' lists which are exceedingly numerous and are becoming more so every year, and the indexing of various books, etc. An office boy has been added to the staff to do some of the more elementary clerical work. The card system, which had been invading the department in a manner such as to virtually displace every other system, has been checked in its growth, on account of certain obvious disadvantages which are inseparable from it. It may be worth while mentioning here that in cases involving departmental, or it may even be legal, interference, entries in a register, for example, of certain special premises subject to licensing should be made in a certain and definite order as regards time, so that interpolation of additional facts can only be made in a manner which is obvious at a glance. By far the most important alteration effected in the routine work of the department has been the establishment of a followup book, and more recently of follow-up cards, so that the progress in connection with any particular complaint can be at once checked. It has, one fears, been far too common a thing in the past for a complaint, owing to the difficulty in enforcing the remedy, to gradually fall into the list of forgotten papers, and never to get remedied at all. At present, however, any complaint which is made is at once recorded on a card and in a register under a numerical heading, and until it is actually written off in that register as having been completed to the satisfaction of the Inspector or your Medical Officer of Health, it is never allowed to go out of sight. This is purely a business procedure and is analogous to the system adopted by most business houses of keeping in touch with their customers by repeated letters and advertisements until they have attained their object or obviously failed to make any impression. It was found that the inspectorial staff was quite inadequate to carry out the work which has to be done in this important Metropolitan Borough, and a re-arrangement and certain additions to it were recommended. An Outdoor Superintendent has been appointed whose duties, inter alia, are that he shall inspect the various properties of the Committee, the conveniences, public urinals, 45 public mortuary, shelter baths, large disinfector, and the various attendants employed at them; to supervise all repairs in connection with them, to keep a watch on the consumption of gas, coal, water and electricity, and so forth. So far as the women's conveniences are concerned, Miss Raker and Miss Johnson take it in turn to visit these, Miss Baker doing the larger part of the work, and anything which requires repairing or renewing, etc., is reported to your Medical Officer of Health for the attention of the Outdoor Superintendent. The staff of District Inspectors was found to be insufficient to thoroughly carry out the important works of inspection of tenement houses and underground rooms, infectious disease control, and house-to-house inspection. Their districts were therefore re-arranged and an additional Inspector was appointed. Further, it was deemed advisable, in view of the great importance of the subject, to appoint a special Food Inspector to carry out the duties under the Sale of Food and Drugs Act, the inspection of bakehouses, coffee shops, restaurants, hotel kitchens, slaughterhouses, cowhouses, dairies and milkshops, street meat markets, etc., etc. The principle was recognised in planning out the duties of the Inspectors that Inspectors should be Inspectors and Clerks Clerks, and as a necessary corollary to this the further principle that an Inspector's first duty lies in his district and not in the office. Special rules were therefore framed for everyone in the department, the object being in framing those rules to make everyone do certain things at certain times, to make them account for every part of their day as far as possible, and last, but not least, to establish a system which would enable your Medical Officer of Health to follow the Inspectors in their work and see that it was honestly carried out. A large number of minor matters in connection with the control of infectious disease, the supervision of drainage works, the inspection of food and of tenement dwellings and underground rooms, the checking of smoke nuisances, the inspection of factories, workshops, workplaces, and outworkers' premises, the issue of water certificates for new houses, the taking of legal proceedings, etc., etc., were also dealt with. The work of your Lady Sanitary Inspectors is increasing both in amount and in responsibility. During 1908 it was found necessary to employ a temporary Inspector to assist them during four months of the year. At the time of writing this report it has been decided to appoint a temporary Inspector to assist them during three months at least of this year. It will be necessary in a short time to make a permanent addition to this part of the staff. It may also be necessary to provide additional help in the office work. The mere fact that the postage account increased from £13 17s. Id. in 1907, to £30 17s. o½d. in 1908, 46 i.e., was considerably more than doubled, is perhaps sufficient argument in favour of this change. In addition, however, one may draw attention to the fact that the larger staff of Inspectors and the re-arrangement of their duties so that more actual work per man will be the result, is bound to considerably increase the clerical work in the department. Finally, your Committee decided to appoint Dr. J. R. Prior, Medical Officer of Health and Medical Officer to the Education Committee, Finchley Urban District Council, as Deputy Medical Officer of Health, to take charge of the Department during the absence of your Medical Officer of Health. I wish here to record my appreciation of the thorough and efficient manner in which Dr. Prior has discharged those duties. SANITARY INSPECTION. The following special premises requiring constant supervision exist in the Borough :— Milk Premises 343 Cowhouses 5 Slaughterhouses 10 Offensive Trades 2 Ice Cream Premises 84 Bakehouses 78 Restaurants and Dining Room (Kitchens) 68 Hotel Kitchens 27 Coffee Shops, Pastrycooks, and Tea Rooms 145 Houses let in Lodgings 758 Workshops 2,984 In addition to these there are many places such as Mews, Butchers', Fishmongers' and Greengrocers' Shops, Outworkers, etc., which must, year after year, be frequently and continuously inspected. A record of inspectorial work with special reference to these premises is contained in the following table, so far as such work is capable of being expressed within the four corners of such a statement. 47 Table Premises. NUMBER OF PLACES:— On Register at end of 1907. Added in 1908. Removed in 1908. On Register at end of 1908. Number of Inspections, 1908. Number of Notices, 1908. Number of Prosecutions, 1908. Milk Premises 253 33 39 247 317 17 ... Cowsheds 6 ... 1 5 58 1 ... Slaughterhouses 8 ... ... 8 62 2 ... Offensive Trade Premises 2 ... ... 2 30 1 ... Ice Cream Premises 84 10 14 80 90 14 ... Registered Houses let in Lodgings 758 ... ... 758 1224 739 ... Mortuary. Mortuary Keeper's Return. Removed by Inspectors. Number of bodies received 414 1 Number of infectious bodies received 5 5 Disinfection. Number of rooms disinfected 764 Number of articles disinfected 11,784 Cleansing of Persons Act, 1897. Adults. Children. Total Males. Females. Males. Females. Number of persons cleansed 8,741 2,563 2,198 3,046 16,549 Bakehouses. Number on Register at end of 1908 78 Number above ground 70 Number underground 8 Number of inspections 156 Number of prosecutions - Places where Food is Prepared for Sale. Number on Register at end of 1908 240 Number of inspections 220 Number of notices . - 48 House to House Inspections (136). Number of defects discovered 640 Number of notices 88 House Refuse. Number of inspections 3,986 Number of old brick receptacles abolished 23 Number of new metal receptacles provided 163 Number of complaints of non-removal received 98 Number of letters received re removal of 244 Number of refusals to have house refuse removed 423 Number of Statutory Notices served 7 Number of Prosecutions 1 Water Supply. [London County Council (General Powers) Act, 1907, Sec. 78]. Number of premises where water supply has been provided to upper storeys 21 Number of Prosecutions 1 Overcrowding. Number of dwelling rooms overcrowded 154 Number remedied 154 Number of prosecutions - Underground Rooms. Illegal occupations dealt with 127 Number of rooms closed or let with rooms on other floor 127 Number of prosecutions 1 Insanitary Houses. Number closed under Public Health (London) Act, 1891 1 Number closed under Housing of the Working Classes Act - Number of premises cleansed under Section 20 of the London County Council (General Powers) Act, 1904 53 49 Shelter Provided under Sec. 60 (4) of the Public Health (London) Act, 1891. Number of persons accommodated during the year 9 adults 5 children Revenue Acts. Number of houses for which applications were received 16 Number of tenements comprised therein 102 Number of tenements for which certi- (a) granted 69 ficates were (b)refused 33 (c) deferred — NUISANCES. The increased activity of the Public Health Department cannot perhaps be better illustrated than by the figures relative to the receipt of complaints and the service of statutory notices. During 1908 there were 1,768 complaints received as compared with 1,165 in 1907 an increase of 603. During 1908 there were 280 statutory notices served, as compared with 231 in 1907, an increase of 49. In addition, there were 21 notices served on owners to provide proper and sufficient water supply to the upper storeys of tenement houses under the Act which came into force on 1st January, 1908. In the large majority of cases the grounds of complaint were removed without anything further than the issue of the preliminary intimation. No fewer than 1,488 complaints succumbed to this simple preliminary measure, plus perhaps a reminder by the inspector in the course of a visit, or a letter from the Department. In 17 cases, however, the requisite work was not executed even after the issue of a statutory notice followed by what is known as a "final notice" warning the responsible person that legal proceedings would be entered upon unless the notice received immediate compliance. In several of these cases when the summons came on for hearing, it was found that the work had been completed, and all that was asked for in such cases was that the costs to which the department had been put should be paid. A closing order was obtained in one instance owing to the existence of a seriously defective drain. In only two cases was it necessary to press the proceedings to the infliction of a fine. The nature of the offences and of the proceedings is set out in the following statement:— 50 Offence. Result. Continually letting an illegal under- Magistrate ordered ground room (left-hand front kitchen to be vacated kitchen) at No. 12, Gresse Street, within a week, and as a separate dwelling. fined Defendant £1 and £130 costs. Walls and ceilings of room on ground Summons withdrawn, floor at No. 24, John Street, very Defendant agreeing to dirty. Room used for preparation pay costs. 11/6. Work and cooking of food. complete 2nd April, 1908. The premises, No. 12, Hereford Summons heard 16th Street, dirty and verminous ; closets April, 1908. Work filthy, and walls of yard dirty. complete 16th April, 1908. Costs 2/-. The premises, No. 10, Hereford Summons heard 16th Street, dirty and verminous ; fresh April, 1908. Abateair inlet defective, and yard dirty. ment order made for work to be done in 7 days. Costs 2/-. The premises, No. 9, Hereford Street, Summons heard 16th dirty and verminous ; area and April, 1908. Abateyard dirty; paving of yard ment order made for defective. work to be done in 7 days. Costs£1 3 0. Offensive refuse removed from No. Summons withdrawn, 44, Devonshire Street, Lisson Defendant having paid Grove, by Contractor at cost of cost of removal of 7/6, the Owner having failed to refuse, 7/6. Costs remove the refuse after notice. £130. Dirty condition of basement and yard Summons withdrawn, of premises, No. 44, Devonshire Work completed. Street, Lisson Grove ; accumulation Costs £1 3 o. of refuse ; surface drain untrapped. A defective drain at No. 15, Great Closing order granted. Quebec Street. Premises empty 22nd May, 1908. Costs 6/-. Defective receptacle for storage of Case not proceeded with, house refuse at No. 74, Salisbury Dustbin provided 21st Street. May, 1908. A defective drain at No. 2, Venables Order made to do work Street. within 21 days, 29th May, 1908. Costs 6/-. 51 Offence. Result. Defective drains at No. 2, Ryder's Terrace. Order made to do work in 14 days. Work pleted 8th November, 1908. Costs 6/-. Basement of No. 39, Baker Street dirty and infested with rats. Order made to do work in 14 days, 28th August, 1908. Work complete 15 th September, 1908. Costs 6/- Sink waste pipes at Buckingham House, Cleveland Street, not trapped. Summons withdrawn. Work complete 1st December, 1908. Defective rainwater pipe and waste pipe at No. 1, Gresse Street; no water supply to upper storeys, accumulation of refuse. Order made for work to be done within 7 days and 4th December, 1908. Costs 2/-. Dirty condition of the premises, No. Order made for work to 12, Gresse Street; defective sink be done within 7 days, waste pipe. 4th December, 1908. Costs 2/-. Defective closets and flushing apparatus at the premises, No. 115,Crawford Street; closet stopped and offensive ; basement walls and ceilings and area dirty. Summons withdrawn, 15th January, 1908. Work having been done. Receptacle for house refuse neither Defendant fined £2 and put on kerb nor in such a position £1 3s. od. 3rd Decon premises, No. 424-426, Edgware ember, 1908. Road, as to be easily accessible to dustmen. NUISANCE FROM DEMOLITION OF BUILDINGS. In a district such as this, where the demolition of old buildings is a matter of pretty frequent occurrence, it is becoming increasingly important that some measures should be taken to prevent nuisances from the dense clouds of dust which are at present raised during the carrying out of this work. A letter was addressed by your Medical Officer of Health to the County Medical Officer of Health asking whether there was any power to prevent this unpleasant and possibly dangerous nuisance, but a reply has been received that there is no power at present in existence which would enable either the County council or the 52 Borough Council to deal with the matter. Apart from the nuisance occasioned by the dissemination of dust in this manner, there is also the possibility of infection to be considered. The seriousness of the matter was recognised in Paris, it is believed, some ten or eleven years ago, and a by-law is in existence there compelling housebreakers to water the part of the building which they are pulling down, in such a manner as to prevent dust arising from it. It is to be hoped that some such power may be obtained in the Metropolis before very long. THE PUBLIC FOOD SUPPLY. The safeguarding of the public food supply is one of the most important duties of a Sanitary Authority, and demands a well-planned, vigorous and unceasing system of inspection. Your Council has now appointed an Inspector to give undivided attention to this matter, and his duties are probably more onerous and demand more keenness and attention to detail than those of any other Inspector. His business is to ferret out and bring to justice those who often make a business, and certainly never lose a chance, of cheating the public, and cheating them in a way which directly concerns their health. If an absolutely pure public food supply could be by any means secured, there is no doubt that a considerable number of known diseases, to say nothing of many, the origin of which at present is sometimes not even suspected, would disappear from our midst. It is certainly wisdom in this connection to aim at as high an ideal as possible. The public food supply in this Borough is safeguarded by the inspection of premises used for the storage, preparation and sale of food, and as far as practicable of all articles and utensils connected with the same, The inspection of persons connected with food supply is limited at present to the prevention of certain scheduled infectious diseases, and no account is taken of personal cleanliness, and the presence of diseases such as skin diseases, tuberculosis and vermin for example. This inspection is supplemented by the chemical examination of articles of food and drugs for the detection of adulteration. Recently, with the sanction of your Committee, I commenced bacteriological examination of such thing's as milk, condensed milk, ice cream, and certain tinned and bottled foodstuffs. The results obtained indicate that this last line of work must be continued and augmented if the food supply is to be properly protected. The only drawback to its practical utility is the absence of reasonably effective legal procedure to be put into operation on the discovery of impurity. Doubtless before long the Sale of Food and Drugs Act will be amended to include bacteriological as 53 well as merely chemical adulteration. Still, much has been accomplished already in this Borough by what one may term purely administrative action, backed, as it always can be, by the threat of publicity. CHEMICAL EXAMINATION OF FOODS. From the table submitted it will be seen that the samples taken have been numerous and varied. Samples are taken at frequent intervals on Saturday afternoon and evenings, Sundays and general holidays. The number and nature of the samples are regulated according to season, and, as far as one is able to do so, by a reference to trade journals and other sources of information, according to the state of the market. During a prevalence of influenza, to give a simple example, it is usually wise to devote some attention to such articles as ammoniated tincture of quinine, spirits of camphor, quinine wine, etc. ; in the early spring to citrate of magnesia, cream of tartar, sulphur tablets and the like, and during the prevalence of cold weather to sweet spirits of nitre, camphorated oil, ipecacuanha wine, saffron, etc. During the summer months one naturally increases the samples of such articles as cream, milk, lime juice, lime water, jams, and tinned and bottled foods. Agents are frequently employed and frequently changed. Test samples (unofficial and undivided) are regularly taken. The habits of the poorer section of the public in the matter of purchases arc imitated as closely as possible, e.g., an agent is sent in to buy a quarter of a pound of butter, an ounce or two of tea, and a pennyworth of milk. Your inspectors have on several occasions taken their seats in Oxford Street and Regent Street tea shops for the purpose of obtaining samples. It is in fact only by the adoption of such methods that the cunning displayed by dishonest vendors and the carelessness and ignorance of others can be met. The prosecutions undertaken by the Department under this heading have met with considerable success as the Table shows. But the result of this work is not all apparent in the fines and costs obtained. We are gradually making it felt that the sale of adulterated food is attended with very considerable risk both to pocket and reputation, and one can only hope that the spread of this wholesome feeling will be greatly augmented by the continued operations of the Department. We are, I think, carrying the matter even further back than this and making the manufacturer feel that he is not going always to be the one who escapes whilst the small retailer bears the brunt of the charge. In more than a few cases during 1908 we succeeded in bringing very considerable pressure to bear upon the manufacturer or wholesaler and with some tangible result. This is undoubtedly 54 the thing at which to aim. In several cases it has been deemed policy to sacrifice one's chances of success in a petty prosecution, and in place of that to seek to enlist the co-operation of the manufacturer or wholesale dealer with a view to improvement on a much wider basis. This was done early in March, 1908, in the case of some samples of American and Canadian Bacon which were certified by your Analyst to contain considerable quantities of boric acid. This particular question is of great interest in view of the report issued shortly after the taking of these samples by Dr. A. W. F. McFadden, of the Local Government Board Foods Department. The firms concerned were interviewed by your Public Health Committee, and promised their earnest co-operation to secure a smaller percentage of boric acid. I can do no better in connection with these cases than reproduce a statement kindly furnished to me by one of the firms. He writes under date April 2nd 1908 :— " For more than 25 years a large and increasing business in Canadian bacon has been carried on with this country. The bacon is cured with salt and saltpetre only (no Boracic Acid being ever used in the cure); it is then lightly sprinkled with Borax powder, and packed in boxes for shipment. " Our shippers inform us they use 4 lbs. of borax in packing a box of bacon containing 650/750 lbs. weight. We have since cabled them to reduce the quantity to -2 lbs. per box, and we may find this amount sufficient for the purpose. " Canadian bacon is cured mildly for immediate consumption, and there is no object in using any more borax than absolutely necessary. Besides, the borax is not used with bacon in the ordinary sense of a preservative, the meat is already preserved by the cure. Borax is simply used to keep the meat dry, and prevent slime during transit. " When the product comes to this country it is manipulated by wholesale merchants, who wash the borax off in hot water, and if properly done little if any trace of it should remain ; then they put it into smokehouses and dry it out for the consumer. Further, after all this washing and smoking the bacon has to be cooked, a good deal of it being boiled, especially by the poor classes. " This process is carried on with all product packed with borax, and it has never been altered even to this day. The system which has passed muster for so many years has given the greatest satisfaction to the traders and consumers, because it has given them a mild, delicate, palatable, and wholesome article. 55 "The consumers of this country will not have salt bacon, and there is no other known method of bringing mild cured product from Canada and the United States of America than the one at present in use. The business from Canada and the United States of America cannot be done on any other lines ; we have tried many others, including refrigeration without borax packing, but all results were unsatisfactory. "To show you the magnitude of the trade, we may state that during the past three years the imports of Canadian product alone have amounted to— 1905. 1,483,560 cwts. value £3,450,177 1906. 1,445,019 „ „ 3,809,860 1907. 1,489,350 „ „ 4,016,583 4,417,929 „ „ £11,276,620 and from the United States of America they have been. 3,778,088 cwts. value £8,238,385 1906. 3,821,637 ,, „ 9,667,884 1907. 3,112,686 „ „ 8,427,979 10,712,411 „ ,. £26,334,248 as given in the Trade and Navigation accounts for 1907. "The whole of this product is sent over to this country sprinkled lightly with borax, and nothing else. "We append analysis by Dr. Rideal of a piece of Canadian bacon taken just as it lands from the ship ; also a piece of Canadian smoked bacon bought in a shop. The latter piece has been analysed for Boracic Acid, firstly as it is sold over the counter, secondly after being fried, and thirdly after being boiled. Copy analysis by Dr. Rideal of piece of green bacon in the condition that it arrives in London. The box that this piece was taken from contained 672 lbs. of bacon, and 4 lbs. of borax powder has been used in packing. " I have examined a sample of green bacon received from you, March 23rd, which then weighed 4 lbs. 5 ozs. This sample showed on its surface that borax had been used for packing. I therefore washed the joint in three litres of warm water to remove the crystals of borax adhering thereto as far as possible. 56 "The wash water contained 27 grammes of crystallized boric acid, so that out of 4 lbs. of borax used in packing a box of green sides—say 650 lbs.—only 14 borax adheres to the surface of the bacon. "I then removed the bone and rind from the bacon, which left 3 lbs. 3 ozs. available for examination. This was divided into two portions to determine the actual amount of boric acid in the lean meat and fat respectively. The fat weighed 26 ozs., and lean 25 ozs., and the quantity of boric acid in these was as follows :— fat. lean. grains boric acid per lb. grains boric acid per lb. 0.5 3.3 giving an average quantity of boric acid in the edible portions equal to 1.9 gr." Copy Analysis by Dr. Rideal on piece of smoked bacon bought at a shop. (The sample referred to in this report was washed in cold water.) "I have to report that I have made an examination of the piece of smoked bacon received from you March 27th, with a view to ascertaining the quantity of boric acid present therein, and after subjecting the sample to the usual cooking processes of boiling and frying. "The sample weighed 4 lbs. 15.25 ozs., and after removing the bone and rind 3 lbs. 14.5 ozs. After removing the two surface rashers, which might possibly have contained some boric acid from the packing, I took three separate portions for analysis. " One rasher cut through the whole joint, weighing 6 ozs., was tested for boric acid and contained 1.47 grains per lb. The second rasher, which weighed 4.5 ozs., was then fried, and after frying, weighed two ounces. On analysis it yielded 9.1 grains boric acid per lb., which, calculated on the weight before frying equals 3 9 grains per lb. " The last portion, weighing 2 lbs. 13 oz., was boiled for 1½ hours in two litres of water and after boiling had diminished in weight to 2 lbs. 2¼ ozs., whilst the volume of the water after boiling was 1880 c.c., and the quantity of boric acid in these two were separately determined. In the boiled bacon it amounted to o.67 grains per lb. calculated on the weight after cooking, whilst 17 grains had been dissolved in the water. The total quantity of boric acid calculated from these two determinations in this portion of the unboiled bacon amounted therefore to 6.0 grains per lb. 57 "It will be seen, therefore, that the boric acid is very unevenly distributed throughout the joint, but that in no case is the amount of any significance. "It is interesting to note that the rasher selected for frying was cut from the joint between that of the sample used for the first test, and that which was taken for boiling, and it contains a quantity of boric acid intermediate between these two." Copy of further Report from Dr. Ridcal. "1 send you herewith report on the examination of the sample of bacon received from you March 31st from which it will be seen that the boric acid is unevenly distributed throughout the joint as was also the case in the former sample received from you March 27th, and the quantity in such bacon both before and after cooking is very small. " Summarising the two results we have as follows :— Boric acid, in grains per lb., in smoked bacon which has been packed in borax. March 27th Washed in cold water. March 31st Washed in hot water. Mean. Uncooked 1.47 1.19 1.33 Calculated from fried portion 3.9 1.26 2.58 Calculated from boiled portion 6.0 3.15 4.57 Amount present in Cooked Meat. Fried 9.1 1.8 5.45 Boiled 0.67 0.56 0.61 "On comparing the two sets of experiments it will be seen that in both cases, as might be expected, the process of frying the bacon increases the amount of borax present, whilst the process of boiling reduced the quantity of borax considerably. As to the actual amount present in the bacon it is obvious that it is unevenly distributed, and that therefore in order to get a reliable estimate of the actual quantity present per lb. it is necessary to take some large samples for examination, and 1 believe that the figures obtained by calculation from the boiled sample arc the most reliable for this reason. " It is also evident that when a single rasher is taken, the ratio of fat to lean must on each occasion vary, and give different results, as the borax is chiefly present in the lean portions of the meat which are near the surface. This is well shown in the fried portions of March 27th, which gave the highest result 9.1, when a very large quantity of the fat was fried away." 58 COPY OF FURTHER REPORT RECEIVED FROM DR. RIDEAL. "I have to report that I have made an examination of the piece of smoked bacon received from you March 31st, with a view to ascertaining the quantity of boric acid present therein, and after subjecting the sample to the usual cooking processes of boiling and frying. "The sample weighed 5 lbs. 6½ ozs., and after removing the bone and rind, 4 lbs. 12½ ozs. This was done by your representative in my presence. "Three separate portions were taken for examination. One rasher weighing 1 lb. 1 oz. was tested for boric acid and was found to contain 1.19 grains per lb. The second rasher used for frying weighed 7½ ozs. before frying, and after frying 5¼ ozs. On analysis it yielded r82 grains per lb., calculated on the fried meat, and 1.26 grains per lb. calculated on the uncooked meat. The last portion, weighing 3 lbs. 3¾ ozs., was boiled in two litres of water and after boiling weighed 2 lbs. 6£ ozs. The volume of water was reduced to 1650 c.c., and the quantity of boric acid in the water and meat was separately determined. The boiled bacon contained 0.56 grains per lb., calculated on the weight after cooking, whilst 8'8 grains had been dissolved in the water. The total amount of boric acid calculated on these two portions was 3.15 grains per,lb." This firm took steps to have the chemical analysis verified by another authority and also to have a bacteriological examination made by Dr. Klein. I am very courteously allowed to reproduce the reports of these two experts. It is pointed out by the firm in a letter dated May 11th, 1908, that "this was a special analysis, as we allowed the bacon to remain in the borax in which it is packed a fortnight after it arrived, our object being to see how much of the borax actually penetrated into the meat during that time. Canadian bacon is very rarely carried for a fortnight before being used; the bulk of it is handled within a week of arrival. You have now got all the information that we have been able to gather on this question from the most reliable sources, and as far as we can see there is not sufficent borax used in our packing to beat all dangerous to health." BACTERIOLOGICAL REPORT by Dr. Klein, of St. Bartholomew's Hospital and College, on three pieces of bacon which had been kept under his observation between March 23rd and April 6th. 59 Sample No. 1 was a piece of green bacon landed March 23rd. Sample No. 2 was a piece of green bacon landed March 6th, and unboraxed. Sample No. 3 was a piece of smoked bacon, date of landing unknown. "The three pieces of bacon delivered here on March 23rd, viz., one piece of bacon boraxed, No. 1, one piece of bacon not boraxed, No. 2, and one piece of bacon, boraxed and then smoked, No. 3 (delivered here on March 24th), were kept under observation until April 6th; the temperature was as follows :— March 23rd in the morning 55 F. 24th 50 25th 55 26th 50 27th 46 28th 54 30th 54 31 st 48 April 1st 54 2nd 52 3rd 53 4th 50 6th 53 "On April 6th all three pieces of bacon were removed from the box and inspected— "Piece No. 1 looked the same as when put into the box, no smell, very little mould on sides. "Piece No. 2 had stale smell, in many parts slimy matter, good deal of mould on sides. " Piece No. 3, same as No. 1. "The bacteriological analysis was carried out in the following manner: of each sample 5 to 6 grammes of meat and fat from the depth were finely minced and distributed and well shaken in 10 c.c. of sterile salt solution ; each cubic centimetre of the turbid emulsion corresponded therefore to about ½ gramme of material. The cultures were made in various media in order to ascertain (a) the presence of undesirable microbes and (b) the general character of the microbes present. The results were as follows (a) None of the samples contained any bacillus coli. (b) All three samples contained abundance of cocci ; these in culture yielded white colonies ; they were quite harmless and their culture had no smell at all. (c) Sample No. 2 (not boraxed) had in addition abundance of short streptococci, and, what I consider of great importance 6o abundance of small mobile sporing bacilli which caused in the cultures a pronounced smell like that of ammoniacal (decomposed) urine. From this it follows that the unboraxed bacon contained unquestionably abundance of microbes which had caused ammoniacal decomposition, the other two samples, viz., No. i and No. 3, were free of any such microbes." Copy Report of Analysis for Borax by Dr. Hurtley, Analyst to St. Bartholomew's Hospital and College, of the same two pieces of bacon as reported on by Dr. Klein. Sample No. 1, piece of green bacon landed March 23rd, analysed 6th April. Sample No. 3, piece of smoked bacon, date of landing unknown. " The samples were examined for the quantity of boric acid contained in them in accordance with the instructions furnished to me by Dr. Klein, except in one particular. The boiled piece was not weighed after boiling, as no constant weight could be obtained, and moreover the weight varied too much according to the time it was left to drain. In this case therefore the amount of boric acid found in the boiled piece is calculated on the weight of the piece before it was boiled. " All the results are expressed in terms of boric acid H3BO3, If it is desired they can be converted into borax by multiplying by 1.54, since 1 part of boric acid if made borax would give 1.54 parts of borax. " Every care has been taken in the analysis to avoid loss, and some of them have been made by two methods to serve as a check. Sample No. 1, boraxed, nnsmoked. "A. The whole piece weighed 6 lbs. 14.71 ozs. It was washed with distilled water having a temperature of 40°C or 104°F ; it was not brushed, but rubbed well all over with the fingers. The washings were brownish in colour, turbid, alkaline to litmus and filtered badly. The filtered washings were analysed and gave 2.2047 grammes of boric acid. This corresponds to 4. 917 grains of boric acid to 1 lb. of bacon. B. Ozs. Boric acid in grains per lb. of meat. Weight of whole 15.20 6.526 piece Weight less rind 12.31 8.061 & rib 61 Ozs. Boric acid in grains per lb. of meat. Weight of streaky 571 11.047 per lb. of streaky. (a) fat 1.180 per lb. of streaky. (b) lean 9.867 per lb. of streaky. Weight of back 6 60 5.476 per lb. of back. (a) fat 0.464 per lb. of back. (b) lean 5.012 per lb. of back. (Frying) C. Weight of rasher 7.04 4.956 less rind, etc. Weight after frying 3.40 10.257 (Boiling) D. Weight of piece 23.28 7.64 less rind, etc. 3.59 boric acid in water. 4.05 boric acid in piece boiled. Sample No. 3. Boraxed. Smoked. B. Weight of whole 17.00 4.32 piece Weight less rind 13.96 5.26 & rib Weight of streaky 7.08 5.131 per lb. of streaky. Fat 0.750 per lb. of streaky. Lean 4.38i per lb. of streaky. Weight of Back 6.88 5.395 per lb. of back. Fat 0.233 per lb. of back. Lean 5.162 per lb. of back. (Frying) C. Weight of rasher 6.06 5.015 less rind, etc. Weight after frying 2.33 13.056 (Boiling) D. Weight of piece less rind, etc. 20.10 5.26 4.88 in water in which it was boiled. 0.38 in boiled piece. 62 "Remarks.—Sample No, 1. Analysis C. In this case it is clear that the rasher was not cut evenly. Doubtless I cut the fat thicker than the lean so that the boric acid works out low. Sample No. 3. Analysis C. This was fried too much. Analysis D. This was boiled too much. Also the piece was so small that practically ail the boric acid was boiled out. It will be observed that the unsmoked sample contains always more boric acid than the smoked. "The unsmoked streaky contains 11 grains per lb. When that piece was washed it was not dried but placed on a flat surface back downwards. In such a position I am sure there would be a tendency for the boric acid to drain down from the back to the streaky part. "In no case is the amount of boric acid at all likely to be injurious—even in she fried specimen (No. 3 C), which was certainly fried too mnch; there is not 0.2 per cent of boric acid ". "Sample No. 1 is piece of the same side analysed for borax by Dr. Rideal, and the comparison is interesting, but bear in mind that Dr. Rideal's analysis was made the same day as the bacon landed, whereas the analysis by Dr. Hurtley was made after the bacon had lain in the borax with which it was packed for two weeks. Also Dr. Rideal trimmed the face of the meat before making his analysis, and thereby reduced the amount of borax. Dr. Rideal's was meant for a fighting analysis, and Dr Hurtleys was for our own information, as to what the worst could be like." This firm in particular was eager to demonstrate their desire to have some standard fixed as regards the amount of boric acid to be allowed in imported bacon, and approached both the English and American Governments. Both firms alluded to gave their trade experience in the matter freely, and it is believed were quite earnest in their desire to have the question settled on a proper basis. It is perhaps too early yet to hope for active interference by Government, but your Public Health Committee will be well advised to keep the question of the purity of this almost universal article of diet well to the front. 63 SALE OF FOOD AND DRUGS ACTS, 1875-1899. Report of the Public Analyst appointed for the Metropolitan Borough of St. Marylebone upon the Articles analysed by him under the above Act during the year 1908 :— Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority, under Section 13 of Act, and, if so the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated, and if Adulterated, what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. FIRST QUARTER ENDING 31st MARCH , 1908. 49 milks Sanitary Inspector Genuine. £500 per ann. for 700 samples. Over that number 7/6 per sample. 2 do Do. Adulterated. One (762) 8 per cent. deficient in fat, the other 8.8 per cent. of added water (822). (762) Warranty defence case dismissed. Costs against Council 37 butters Do. Genuine, 12 contained no preservative, the rest boric acid up to 20 grains per lb. (822) Fine £10, Costs £6/6/-. 4 do. Do. Adulterated, 1 with 28 grains boric acid per lb., another with 35 grains boric acid per lb., a third 50 per cent. fats other than butter fat, and the fourth sold as "butter mixture" was margarine. 1. Cautionary letter sent to Vendor; 2. Cautionary letter sent to Vendor: 3. (775) Fined £10, Costs 12/6; 4. (772) Fined £4, Costs 23/-. 2 margarine Do. Genuine. 2 cheese Do. Do. 5 lard Do. Do. 4 cream Do. Do. 5 whishy Do. Do. 3 brandy Do. Do. 1 do. Do. Adulterated, 26.7 degrees under proof. (590) Test sample. 1 rum Do. Genuine. 6 gin Do. Do. 5 coffee Do. Do. 4 cocoa Do. Do. 1 do. Do. Adulterated, containing a red sand, increasing the normal mineral matter about double. (732) Fined £1, Costs 23/-. 2 pepper Do. Genuine 8 mustard Do. Do. 6 vinegar Do. Do. 64 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations 3 sugar Sanitary Inspector Genuine. 4 sal volatile Do. Do. 2 Gregory powder Do. Do. 2 milk of sulphur. Do. Do. 2 cream of tartar. Do. Do. 8 ammoniated tinct. of quinine Do. Do. 7 condensed milk Do. Do. 2 pork sausages Do. Do. 2 bacon Sanitary Inspector Genuine. No preservatives. 1 American bacon Do. Adulterated 53 grains of boric acid per lb. (663) Summons withdrawn. Defendants paid Council's costs. 1 Canadian bacon Do. Adulterated, boric acid, up to 38 grains per lb- (828) Summons withdrawn 1 Beef dripping . Do. Genuine. 3 macaroni Do. Genuine, but one contained an excess of acid (lactic) Test sample. 12 sweet spirits of nitre Do. Genuine, but many rather low in nitric oxide. 1 do. Do. Adulterated. Contained only a trace of nitric oxide. (578) Fine 10s Costs 12s. 6d. 4 glycerine Do. Genuine. 2 brawn Do. Do. 1 orange and quinine wine Do. Do. 2 preserved peas Do. Do. 1 preserved cherries Do. Do. 1 German sausage Do. Do. 1 barley wine Do. Do. 4 olive oil. Do. Do. 2 lunch tongue Do. Do. 1 sulphur ointment Do. Do. 3 camphorated oil Do. Do. SECOND QUARTER ENDING 30th JUNE, 1908. 37 milks Sanitary Inspector Genuine. 5 do. Do. Adulterated. (908) 16.7 per cent. fat deficient. (852) 18.2 percent. fat deficient, and 28.9 per cent. of added water. (854) 36 percent. fat deficient. (873) (test sample) 33 per cent. fat deficient. (877) separated milk 3 per cent. added water (908) Fine £2, no costs. (852) Fine £5, costs 14/8. («54) Fine £5, costs 14/6. (877) Cautionary letter sent to Vendor. 17 butters Do. Genuine. 10 contained boracic acid up to 0.36 per cent. 65 Articles submitted for Analysis State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority, under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 1 butter Sanitary Inspector Adulterated. (920) Margargarine 90 per cent. of fat other than that of butter fat. (920) Fine £2, costs 14/6 2 creams . Do. Genuine. Both contained boracic acid 0.099 per cent. and 0.248 per cen. ly. 4 margarines Do. Do. 2 whiskies Do. Do. 1 gin Do. Do. 1 rum Do. Do. 1 quinine wine Do. Do. 1 orange wine Do. Do. 1 lime juice cordial Do. Do. 4 coffees Do. Do. 1 cocoa Do. Do. 1 bread Do. Do. 2 do Private Purchaser Adulterated. One contained a trace of alum. The other a small admixture of flour other than that of wheat. 1 flour Sanitary Inspector Genuine. 1 jam Do. Do. 1 honey Do. Do. 1 custard powder Do. Do. 3 sugars Do. Do. 1 tinned milk Do. Do. I tinned salmon Do. Do. 1 tinned peas Do. Do. 1 tinned beef Do. Do. 1 tinned spinach . Do. Do. 1 vinegar. Do. Do. 1 mustard Do. Do. 1 white pepper . Do. Do. 1 caraway Do. Do. 1 nutmeg Do. Do. 1 beef dripping Do. Adulterated with 5 per cent mutton fat. Cautionary letter sent to Vendor. 1 beef sausages Do. Adulterated, containing 0 42 per cent boric acid. Cautionary letter sent to Vendor and to all shopkeepers in the Borough against using boracic acid as a preservative in food 1 lime juice Do. Genuine. 1 lard Do. Do. 1 mercury ointment Do. Do. 66 Articles submitted for Analysis State whether the sample was sub- rnitted to the Analyst by an Officer acting under the direction of a Local Authority J under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated. and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. vations 2 castor oil Sanitary Inspector Genuine. 1 camphorated oil Do. Do. 1 liquorice powder Do. Do. 1 sedleitz powder Do. Do. 1 glycerine Do. Do. 1 lung syrup Do. (Test sample.) Contained a ! bitter substance giving alkaloidal reactions, but the quantity submitted was too small to identify the same. 4 prescriptions ... Do. Genuine. 1 citrate of magnesia Do. Do. 3 cream of tartar Do. Do. But traces of lead 25, .5, and 5 lead in 100,000 parts was found. THIRD QUARTER ENDING 30TH SEPTEMBER, 1908. 39 milks Sanitary Inspector Genuine. 6 do. Do. Adulterated. No. 1053, 16.46 percent. water. No. 1055, 3 per cent water. No. 1222, (6.23 per cent water. No. 1225, 19.8 per cent. water. No. 1702. 10 per cent. deficient fat. No. 1528, 6 46 per cent. water. (1053) Fined 5/-, Costs 12/6. (1055) Proceedings not taken in view of error of Inspector in dealing with sample. (1222) Proceedings not taken. Sample burst. (1225) Fined £2, Costs 12/6. (1702) Fined £2, Costs 12/6. (1528) Fined 10/-, Costs 2/-. 8 butters Do. Genuine. Most contained borax, one up to 22 grains per lb. boric acid. 3 do Do. Adulterated. Nos. 1110, 1503 and 1522 all margarines containing over 80 per cent. of fats other than butter fat. (1110) Fined £2, Costs 12/6. (1503) Fined 10/-. Costs 12 (1522) Fined £3. Costs 14/6. 5 creams Do. Genuine. Three contained boric acid up to 0.198 per cent. 2 cheeses Do. Genuine. 2 rums Do. Do. 1 whisky Do. Do. 6 7 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under the direction of a local Authority, under Section 13 of Act, and, if so, the name of such Authority. Result of Analysts ; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 1 brandy Sanitary Inspector Genuine. 1 gin Do. Do. 2 cyders Do. Do. No trace of lead. 4 cocoas Do. Do. 5 coffees Do. Do. 1 chocolate powder Do. Do. 3 vinegars Do. Do. 1 mushroom ketchup Do. Do. I sweets Do. Do. 3 chocolates Do. Do. 1 jam Do. Do. 2 condensed milks Do. Do. 1 prawns (canned) Do. Do. 1 salmon and shrimp paste Do. Do. 1 lobster (canned) Do. Do. 2 apricots do. Do. Do. 1 pears do. Do. Do. 1 salmon do. Do. Do. 1 extract of beef Do. Do. 1 ice cream Do. Do. Free from dirt. 1 beef sausages Do. Do. 1 German sausage Do. Do. 1 orange and quinine wine Do. Do. 1 quinine wine Do. Do. 2 ammoniated tinct of quinine Do. Do. 3 spirits of camphor Do. Do. 1 camphorated oil Do. Do. 1 glycerine Do. Do. 1 sal volatile Do. Do. 1 arrowroot Do. Do. 3 limewaters Do. Do. 1 oil of juniper Do. Do. 2 cream of tartar Do. Do. 1 citric acid Do. Do. 1 tartaric acid Do. Do. 1 fluid magnesia Do. Do. 2 saffrons Do. Do. 1 Gregory's powder Do. Do. 1 white beeswax Do. Do. FO URTH QUARTER ENDING 31ST DECEMBER, 1908. 95 milks Sanitary Inspector Genuine. All the genuine milks free from preservatives, but 11 were arti ficially coloured. 68 Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority, under Section 13 of Act, and, if so, the name of such Authority Result of Analysis ; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 2 milks Sanitary Inspector Adulterated. No. 1293, 3.75 per cent., and No. 1299, 10.59 per cent. water. (1293) Fined £1, Costs 12/6. (1299) Warranty defence. Case dismissed with costs against the 1 Do Private Purchaser A trace of formalin. Council. 42 butters Sanitary Inspector Genuine. 16 butters contained boric acid up to 29 grains 1 Do Do. (Test sample.) Adulterated margarine. per lb. 1 bread and butter Do. Genuine. 1 Do Do. The butter adulterated 80 per cent. foreign fats. Proceedings pending. 3 creams Do. Genuine. 4 cheeses Do. Do. 3 margarines Do. Do. 1 lard Do. Do. 2 whiskies Do. Do. 2 rums Do. Do. 1 gin Do. Do. 1 stout Do. Do. 1 lager beer Do. Do. 1 Harvest Burgundy Do. Do. 1 Tarragona Port Do. Do. 5 coffees Do. Do. 1 Do Do. Adulterated—half chicory. Solicitor advised no proceedings as sample was wrapped in a paper with the words "Mixture of Coffee and Chicory." 2 chocolates Do. Genuine. 5 cocoas Do. Do. 1 mustard Do. Do. 3 vinegars Do. Do. 1 shrimp paste Do. Do. 2 chicken paste Do. Do. 1 Do. Do. Do. Small quantity of borax. 1 tinned apricots Do. Do. 1 tinned peas Do. Do. 1 tinned pears Do. Do. 1 calf's foot jelly Do. Do. 1 potted meat (beef) Do. Do. 1 baked haricot Do. Do. beans 6g Articles submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under the direction of a Local Authority, under Section 13 of Act, and, if so, the name of such Authority. Result of Analysis ; showing whether the sample was Genuine or Adulterated, and if Adulterated what were the nature and extent of the Adulteration. The sum paid in respect of the Analysis. Observations. 1 tinned peaches Sanitary Inspector Genuine 2 corned beef Do. Do. 1 extract of meat Do. Do. 1 Oxo Do. Do. 1 Danish roll bacon Do. Do. 1 American do. Do. Adulterated, 14.8 gr. boric acid per lb. Cautionary letter sent to Vendor. 2 sausages Do. Genuine. 1 saveloy Do. Adulterated, 10.43 gr. boric acid per lb. Cautionary letter sent to Vendor. 5 aerated waters Do. Genuine. 1 camphor water Do. Do. 2 spirits of camphor Do. Do. 2 camphorated oil Do. Do. 1 castor oil Do. Do. 1 olive oil Do. Do. 1 sal volatile Do. Do. 1 zinc ointment Do. Do. 1 sulphur do. Do. Do. 1 precipitated sulphur Do. Do. 1 mercurial plaster Do. Do. 1 Seidlitz powder Do. Do. 1 sweet spirits of nitre Do. Do. 1 fluid magnesia Do. Do. 1 Gregory's powder Do. Adulterated 26.6 percent. Mg. 0 instead of 66.6 per cent. Fined 5/-, 12/6 costs. 2 tincture of quinine (amm.) Do. Genuine. 1 ipecacuanha wine Do. Do. 2 tartaric acid Do. Do. 2 cream of tartar Do. Do. 2 black draughts Do. Do. 1 custard powder Do. Do. 1 belladonna plaster Do. Do. 5 jams Do. Do. 3 sugars Do. Do. ■ 1 arrowroot Do. Do. SUMMARY. Total number of Samples Analysed. Number Adulterated. 1st Quarter 220 11 2nd ,, Il8 10 3rd 126 9 4th 24I 10 705 40 70 BACTERIOLOGICAL EXAMINATION OF FOODS. During the year 17 samples of milk, 3 samples of condensed milk, 2 of sardines, 2 of salmon, 14 of ice cream and one of tinned tongue were taken for microscopical and bacteriological examination. Reports have already been presented to your Committee on the subject. Fourteen of the milks were examined microscopically, and in three a special search was made for tubercle bacillus. The reports cannot be said to be at all satisfactory. There was in almost all of them a trace of pus and blood, and a pretty high bacterial content, whilst in quite a number of the samples streptococci were present. A copy of the report of the Bacteriologist was sent in all cases to the vendor, or in cases were Companies were concerned, to the Managing Director or Secretary, and they were invited to offer any explanation of the conditions found. A few specimens of the reports received are given herewith :— Sample No. 1510. "The deposit from this specimen is fairly large, of a "brownish colour, and has a trace of pus, and very little blood. "The bacteria are very numerous, amongst which are a few "streptococci." Sample No. 1920. "This sample contains a distinct trace of pus, with an "occasional red blood disc and numerous streptococci. There "is only a minimal trace of extraneous matter which includes "vegetable debris and microscopic grit. The number of "bacteria, apart from the streptococci, is quite low. Evidently " one cow has streptococcal mastitis and should be excluded " before the milk is marketed." Sample No. 1921. "This sample contains a distinct trace of pus, a small "number of red blood discs, and a few streptococci. There is "hardly any extraneous matter, and the total bacterial "content is unusually low, but the milk is not fit for human " consumption." Sample No. 1923. "The deposit from this specimen contains a trace of pus, "and a very small number of tubercle bacilli of the bovine " type. Other bacteria are scarce." Sample No. 1927. • "This sample is rather rich in cellular elements, but as they "consist of colostrum corpuscles and lymphocytes, this is due "to physiological causes. There are no pus or red blood "discs, and no streptococci were seen. There are, however, a "little vegetable debris and fine grit, which have imported "rather more bacteria than a first class milk should contain." 71 In the case of Sample No. 1923, the County Council were at once communicated with, and informed of the address of the vendor, who in this instance happened to be a cowkeeper within the Borough. At the same time word was sent to this vendor, informing him of the condition found, and asking him to have his cattle examined and exclude any with a suspected udder from the milk supply until he heard further. A couple of days later we heard that the County Council's Veterinary Inspector had found the cow suffering from tubercular mastitis, and the animal was at once taken away and killed. I gathered from the cowkeeper that this particular animal had a few weeks prior to the taking of the sample shown signs of failing health and lung trouble, and that he had really only been waiting for a visit from the County Council's Veterinary Inspector in order that he might have her condemned and get compensation. In the other instances the milk vendors concerned responded most loyally and had examinations made of their cattle by medical men, bacteriologists, and veterinary surgeons. In a few instances exception was taken to the findings of the Council's Bacteriologist in the cases where pus was stated to be present in the samples. Your Bacteriologist relies entirely on the results of a differential count of leucocytes which he states is based on accurate physiological and pathological data. To quote from a letter received from him :— ". . . . Milk produced from a perfectly healthy and "normal udder may contain at different periods very widely "different numbers of cells. These cells in health are "colustrum corpuscles and lymphocytes, with an occasional "polymorphonuclear leucocyte. "Leaving aside the colostrum corpuscles present in health, "the ratio of lymphocytes to polymorphonuclear leucocytes "is about 20-1. As soon as any inflammatory lesion arises, "either in the ducts or in the acini of the gland, the number "of the polymorphonuclear leucocytes steadily increases, the number of the lymphocytes remaining constant. By the "time the inflammatory process is fully established the pus "cells are in excess, and it is absolutely certain that if in any "given specimen of milk the deposit contains polymorpho"nuclear leucocytes in the proportion of 20 or more to each "lymphocyte, the milk is coming from an inflamed or "partially inflamed udder." "All the published statistics dealing with the cellular con"tents of milk have overlooked this very important feature. "My own paper on the subject, published in the year 1899, "drew attention to this principle, but I had not at that time "fully worked it out, as I had not discovered a process for "making it readily evident, but during the last few years 72 "stains have been invented which render differential enumer"ations perfectly simply and easy, and the whole method, "which depends upon the ratio, is infinitely more accurate " than one that depends upon bulk enumerations" The difference between your Bacteriologist and those employed by others is, after all, not a very great one, and in my opinion it might easily be adjusted by a conference between them. The first difference of opinion is as to the value of a differential count of leucocytes in cases where the total number of leucocytes present is a small one. Your Bacteriologist, I believe, applies his ratio to all cases, whereas those who differ from him admit its justification, if at all, only in cases where the leucocytes are relatively large in number. The other point of difference lies in the fact that some bacteriologists estimate the total number of cells as so many per cubic millimetre, and rely entirely upon an enumeration of the total cells for evidence of pus, disregarding altogether the differentiation between the various kinds of cells. The action instituted last year should, in my opinion, be persevered with ; for there is no doubt that whilst the large milk companies spend a great deal of money in securing skilled medical, bacteriological, chemical and veterinary supervision of their cows, cowsheds and everything which has to do with the production, storage and distribution of milk, competition is so keen that unless some independent authority also tests the efficiency of that supervision from time to time, it may be allowed to slacken. I may remark before passing away from the question of the supervision of milk, it is obviously a thing which may be either well or badly carried out. Further than this, all the precautions taken by the farmer and by the Dairy Company's advisers may be upset by the carelessness of the distributor or the general public. It is not unknown, for example, for milkmen to take a dirty bottle from the house of a customer, and to fill it up in the road amongst all the dust and dirt, with milk from a churn or can, and deliver it perhaps a street further off as genuine bottled milk —bottled under strict regulations. It is instances of this kind which I believe to be very rare, which have damaged the sale of bottled milk. A short time ago, I had handed to me a circular pointing out many so-called dangers from bottled milk. These dangers are based principally upon the possibility of the bottles being improperly cleansed. It is pointed out, for example, in the circular referred to, that owing to the heat required for sterilisation of the glass bottles, and owing to the fact that in sterilising them a number are broken, sterilisation is apt to be done imperfectly, and the milk contained in the bottles is therefore liable to contain a number of putrefactive bacteria. 73 That this is the case every now and again naturally cannot be denied. At the same time it is no uncommon thing to see dirty milk cans and dirty milk churns due to imperfect cleansing and sterilisation. The delivery of milk in bottles is, in my view, one which should be extended, but it should always be subject to conditions such as the following :— (1) A guarantee should be given that the bottles have not only been washed, but also sterilised. (2) The stoppers for the bottles should be also sterilised, and should be, if of the removable type, kept in a clean metal or earthenware receptacle provided for this purpose alone. (3) The filling of the bottles should be done under the strictest supervision in a room specially devoted to this purpose, by people who are clean in their clothing and person, and the bottles should be invariably closed immediately after they are filled. It is a fact that a good deal of the milk sold at present as "Pasteurised milk-" has not been Pasteurised in the whole of its bulk. It is possible to detect this by means of chemical tests, and I think samples should be taken for this purpose from time to time. The Public Analyst has been asked to make an examination of milks for dirt as well as for the ordinary chemical adulteration (addition of water, removal of fat, and addition of preservatives), but no cases have come to my knowledge where official action was called for. Three samples of condensed milk were submitted to bacteriological examination, and one of them was passed as harmless. In the case of one other, it was certified that " from O.OI c.c. of this milk a rich growth of a streptococcus was obtained, and in larger quantities in addition to the streptococcus, the bacillus subtilis and a micrococcus was found." The milk was certified to be quite unfit for human consumption. The matter was immediately referred to the wholesale dealers in this condensed milk, and it was suggested that they take measures to prohibit the sale of any more of it until the question could be more fully investigated. They consented to take this action, and recalled the milk from the whole of their branches. Some little dispute arose between their Bacteriologist and the Council's Bacteriologist as to the significance of the micrococcus, and as to the endeavour on the part of this Council to establish a bacterial standard for condensed milk. Condensed milk, of course, is not sold as sterilised, but at the same time if properly prepared, and especially if properly canned immediately after condensation, it ought to conform to a pretty high standard of bacterial purity. Your Council is endeavouring to have a standard of this description fixed by the Local Govern- 74 merit Board. In view of this, further action as regards condensed milk will probably be suspended for a little time. In the remaining sample, which was reported upon in similar terms to the previous one, the same line of action was pursued. Of the other samples of food, one of tinned salmon was certified to be unfit for human consumption on account of the presence, in large numbers, of a streptococcus. The sardines were perfectly free from organisms capable of growth at 37° C. and the other samples were passed as sound. On the general question of bacteriological examination of food I wish to impress, if indeed it needs impressing, upon your Council the desirability of persevering with the line of action which has been taken up. It will probably be rare for your Council to have to undertake a prosecution in a case of this kind, for personally I have always found that a private interview with the Managing Director or Secretary of the firm concerned has led to much better results than could possibly have been obtained by any petty prosecution. It is, in my view, unfair to drag a firm of repute through the Police Court with the fact ever in view that no matter what the result may be, a slur has been cast upon their reputation. There is always in such cases bound to be a conflict of expert evidence, and this involves the expenditure of a considerable amount of money. That money would be far better spent in the securing of greater supervision of the production of the food product concerned, and in the carrying out of experiments with plant, etc., to improve the mode of production, as well as in the carrying out of experiments in order to arrive at a standard which should be reasonable both from the public health and the manufacturer's point of view. I have met with considerable success in carrying out this policy, and I commend a continuation of it to the consideration of your Council. DAIRIES AND MILKSHOPS. Considerable activity has been shown by the Public Health Department during the whole of 1908 in the supervision of these important places. The fact that registration is necessary has been advertised, and a considerable number of applications were received and dealt with. A few were advised to discontinue the sale of milk, it being a very subsidiary part of the trade in certain cases. In other cases registration was held over pending the carrying out of structural alterations. Every milkshop in the Borough has been inspected at least once during the year, and many of them several times. The following card of inquirywas drawn up by your Medical Officer of Health to guide the Inspector, and to ensure that no point which might affect the purity of the milk sold should be overlooked. 75 Metropolitan Borough of St. Marylebone Consecutive Number M. O. H. M I LKSHOPS. Occupier's Name Occupier's Address Covering and cleanliness of walls ceiling What is floor covered with? Is it smooth and free from cracks, Slc. ? How often is floor swept ? Scrubbed ? When scrubbed last? Condition How milk or milk vessels protected during sweeping? How often is counter (table) scrubbed ? When scrubbed last? Condition Any signs of milk spilt on counter or floor ? Cleanliness of person in charge of shop, clothing ? Hands? Cleanliness of fixtures (tables, counter) ? Milk Utensils. Number Nature How cleansed ? What are they covered with ? If a cloth cover, how often is cover changed ? Dipper or measure made of? Cleanliness? Where kept when not in use ? Is any strainer used? Where kept? What is done with milk left over at end of day ? For what other purposes is milk used? Name specially anything likely to give rise to effluvia? Is milkshop in aerial communication with (a) any sleeping apartment or (6) any place from which impure air can gain access to milk (drains, gullies, urinal, closets, dust receptacles, manure, overcrowded room, dirty room, paraffin, rags, pig swill, etc., etc.)? Any infectious disease in these premises recently ? Has Occupier a copy of the Dairies, Cowsheds, and Milkshops Regulations? Inspector s Initials Date 76 The following suggestions contained in a memorandum drawn up by the Society of Medical Officers of Health are adhered to as far as circumstances admit, and the circumstances must be very special to cause a departure from the main lines of these suggestions:— No premises are registered for the sale or storage of milk unless the following structural conditions are complied with:— The lighting and ventilation are sufficient ; No room which is used as a sleeping room must communicate directly with the room or shop in which the milk is sold or stored. The premises must be so constructed that every part of the interior is capable of being maintained in a satisfactory state of cleanliness. There must be no inlet to any drain in the room in which the milk is sold or stored. Efficient means of cleansing the milk vessels, either by steam or hot water, must be available. A plentiful supply of water must be provided, and where a storage cistern is necessary such cistern must be properly covered and ventilated, and so placed as to be readily accessible. No premises are registered where it is possible that milk may be stored in close proximity to any article capable of contaminating such milk, as for instance, paraffin, fish, coal, vegetables, etc. No premises are registered if there is a manure pit or other offensive accumulation in close proximity. Efficient means for the storage and removal of house or other refuse must be provided. Several special reports have been presented to your Public Health Committee on the lesults of bacteriological examinations of milk taken from the dairies of the principal companies trading in the Borough. It is unnecessary to recapitulate these. Suffice it to say that enough has already been done to demonstrate to these companies that, excellent as are the precautions carried out by most of them to secure the purity of their milk, these are still imperfect in some details, and that your Public Health Committee—if not the slumbering public—demand an even better degree of hygienic supervision. SLAUGHTER HOUSES. Notices of intention to apply to the London County Council for the renewal of slaughter-house licenses were, received by 77 the Public Health Department in respect of the following premises:— Premises. Conditions. 75, Abbey Road — 6a, Bolsover Street (rear of) — 178, Edgware Road — 4, Henry Street, St. John's Wood Small cattle only 50, Henry Street, St. John's Wood Ditto 134, High Street, St. John's Wood This Licence is granted on the clear and distinct understanding that the room over the slaughterhouse is not used as a living-room 31, Little Church Street Small cattle only 32A, Union Street, Middlesex Hospital — No opposition was raised by the Sanitary Authority to the foregoing applications, and the licenses were duly granted for one year ending 31st October, 1909, by the Public Health Committee of the London County Council at their meeting at the Clerkenwell Sessions House on the 26th October, 1908. The number of inspections of slaughter-houses made during the year was 62, particular attention being given to the maintenance of strict cleanliness therein. COW HOUSES. Notices of intention to apply to the London County Council for the renewal of Cow-house Licenses were also received in respect of the following premises:— Premises. No of Cows. 58, Acacia Road (sheds Nos. 1, 2 & 3) 44 56. Bell Street *42A, Clipstone Street 10 26, John Street 14 † 15, Little Church Street (rear of) 12 3, Malthouse Mews 22 117 * This License is granted on the undertaking of the Licensee not to keep more than 10 cows on the premises. † These premises ceased to be used as a Cow-house in December, 1908. 78 The number of inspections of Cow-houses made during the year was 58. Several minor defects were discovered and remedied, and in the case of the Cow-house at No. 15, Little Church Street, certain structural alterations were found to be necessary. The licence for these premises was not opposed, but alter in the year the owner decided not to execute the work, and to cease using the premises as a Cow-house. MEAT INSPECTION. It should be publicly known that your Council have now appointed a special Eood Inspector whose qualifications and experience enable him to keep under skilled supervision the various shops and stalls where meat is exposed for sale. Particular attention is being given to the shops and stalls in those localities where meat of indifferent quality is marketed. He is ably assisted by Inspector Smith, who is also qualified as a Meat I nspcctor. A fair number of seizures were made during the year in question by the last-named Inspector, and substantial fines obtained. There cannot be too much attention devoted to this branch of inspectorial work, for there is reason to believe that certain parts of this Borough have gradually come to be regarded by those who traffic in it as a very convenient outlet for this third-rate stuff. Offence. Result. Exposing for sale unsound Defendant fined.£20 and £$ 8s meat:— costs. 2 pieces of beef. 1 piece of mutton. Exposing for sale unsound Defendant fined£io and £2 4s. food:— costs. 9 tins pineapple. 2 „ beans. 1 „ condensed milk. Exposing for sale unsound food:— Defendant fined£o and £3 3s. 12 tins salmon. costs. In one Fried Fish shop which I had occasion to visit several times because of a serious nuisance from fumes occasioned to some workrooms overhead, I was once met with a most offensive smell which at first I could not locate. After a search, however, I found a dirty iron tin about the size of a small dustbin which contained fish-guts. These had been kept for close upon a week 79 in the room where fish was cleaned and cooked and immediately below a room in which many people sat to eat the finished product. The assistants informed me that these guts were their perquisites and brought them in 5/- a week, being sold for the purpose of fining wine. BAKEHOUSES. There are 78 bakehouses in the Borough, and these have been fairly regularly inspected, and a number of minor alterations and repairs carried out. Inspector Phillips made 220 inspections of hotel kitchens, restaurants, coffee-shops, and the like. The experience of the Department in respect of these places is that even the very best of them require persistent supervision. DIRTY Bread.— I have in other Annual Reports alluded to the very casual manner in which bread is protected from extraneous dirt. It is a matter which may be verified in the streets of any town on any occasion, that bread by being carried about in baskets in which it is openly exposed to all the dust which is blowing about the roads, by being not infrequently dropped in the roads, and hastily wiped on the hand or clothes of the carrier, and so forth, is as regards the cleanliness of the crust bound to be a matter of public concern. I have communicated with the largest bread companies in London, and those who have taken the trouble to reply have admitted the importance of delivering bread to the public in a cleanly state, but beyond seeing that their vans and baskets arc kept clean, they take no precaution to ensure its arrival at the table in a clean condition. It is stated that bread cannot be put into a wrapper while warm ; again in large businesses, as soon as it is cool, it must be loaded into vans for quick delivery. It is further stated that it would require a large staff and entail very great extra expense to wrap each loaf individually in paper, and, finally, that the public would probably not be prepared to pay any additional cost for bread so protected. Of the truth of some of these assertions I have very serious doubts. Some firms, whose output it is true may not be very large, do deliver bread to the public wrapped in non-absorbent paper. A man in the business, who has been engaged in it for 33 years, tells me that every loaf which leaves his shop (and the shop, I know, is one where a by no means small trade is done in bread) is wrapped in clean paper and tied up with string, the paper being stamped with a small rubber stamp. The cost of paper and string for this is about fourpence per hundred 2 lb. loaves. This gentleman tells me that he has very frequently seen—what I suppose everyone else has seen—children and errand boys 8o carrying bread hugged tightly against their clothes, the cleanliness of which is open to question, and frequently allowing it to drop in the streets. One cannot help thinking that this simple measure of protection could be carried out without the very serious trouble or expense which it is alleged it would involve. HOUSE DRAINAGE. This class of work continues to demand the constant and vigilant attention of the department. That the work is increasing is shown by the fact that 480 plans of new drainage were received and dealt with during 1908, as compared with 313 in 1907, an increase of 167. The number of inspections carried out was 4,371, namely, 2,292 in the district North of the Marylebone Road, and 2,079 in the South district. In only two instances has it been necessary to enter upon legal proceedings against builders for contravention of the London County Council By-laws. The particulars of these cases are as below. Offence. Constructing a W.C. at No. 72, Wells Street, in contravention of the London County Council's By-laws. Executing sanitary work at No. 23A, George Street, Portman Square, without giving notice. Executing such work in contravention of the London County Council's By-laws. I think it would be advisable at an early date to distribute in certain of the poorer localities a notice cautioning the inhabitants against the wilful damage which is pretty frequently done to water-closets and their fittings. Sections 15 and 41 (d) of the Public Health (London) Act, 1891, cover cases of this description. If such a measure resulted in a lessening of the numerous complaints which come to the knowledge of the Department of improper usage of water-closets, sinks, gullies, traps, pipes, etc., not only will nuisances dangerous to the public health be lessened, but property owners will receive a measure of protection to which they are justly entitled. The noticc could be distributed in suitable localities by your District Inspectors as occasion offers. Result. Defendant fined £2. Summons withdrawn on Solicitor's advice, builder having meantime apologised and complied with the requirements of the Department. 81 A good deal of overlapping of work and division of responsibility in connection with drainage alterations has, it is believed, been eliminated. The rule of the Department now is that whenever any complaint is received in regard to drainage, the District Inspector makes a surface examination and the preliminary inspection, using possibly chemical tests, smoke tests, and the like. If he finds that there is a merely trifling defect he carries the remedy through to completion. If, on the other hand, this preliminary examination discloses a more serious state of affairs, he makes a suggestion in his Journal that the drains be opened up for examination. After approval by your Medical Officer of Health the usual request to the Works Department is issued, and the case is thereupon handed over at once to the special drainage Inspector concerned, who visits the drains when they are opened up, issues the necessary Intimation and Statutory Notice, and supervises the whole of the re-constrnction. In this district, where speculation in lease-values appears to be very freely indulged in, one is constantly being asked to allow departures from the strict requirements of Statutory Notices and Intimations. Each case of this kind has to be dealt with on its merits, but the general rule is that leaselife is not accepted as an excuse for modification of requirements which would otherwise be necessary. In order to have a more complete record of drainage work, the form used in depositing plans has been slightly amended, and a lengthy form of specification has been drafted which we now require the builders to fill in in detail. The use of this form has the double advantage that the Department gets all the information it requires, and that the architects and builders are shown precisely the nature of the specification which is required from them. Notices of approval of plans are now sent out direct from the Public Health Department, the duplicate being returned to the person depositing the plans. DISCHARGE OF PETROLEUM INTO SEWERS. In consequence of a somewhat severe accident to one of the Council's workmen—an accident which might easily have proved fatal—the attention of the Works and Public Health Departments was drawn to the important question of the admission of petroleum into the public sewers. Communication with the London County Council brought to light the fact that, although everything possible was being done to ensure the provision of petroleum interceptors in an indirect fashion by requiring applicants for licences under the Petroleum Act to provide such interceptor as a condition of the granting or renewal of the licence, no direct power existed. 82 At private motor garages, however, the petroleum is kept by motor car owners under the Regulations of the Secretary of State as to petroleum which is being used in light locomotives, such premises rarely coming under the purview of the London County Council. It is obvious that in a district such as this, where there are very many private motor garages, the total quantity of petroleum spirit discharged into the sewers is likely to be a serious matter. Accordingly, in all cases where plans have come before this Department for the drainage or re-drainage of premises containing a motor garage, the suggestions of the Public Control Committee of the London County Council have been as far as possible enforced. On the matter coming prominently before the Public Health Committee, as a result of the accident alluded to above, a resolution was passed that a circular letter should be sent to the whole of the known motor garages in the Borough, asking them to take means to prevent the discharge of waste petrol into the sewers. Your Medical Officer of Health, however, thought it was not quite a thorough method of procedure to leave it to each individual owner to work out his own salvation in this difficult matter, and accordingly enquiries were made in a number of likely quarters, with a view to discovering some practicable method. Obviously the provision of any reasonable number of intercepting chambers will not meet the case, for it is perfectly possible that in course of time these will become entirely filled with petrol, and the excess of petrol will be washed over into the sewers. Means must be adopted for the- frequent and regular skimming of the petrol contained in these interceptors, and for its disposal otherwise than by discharge into the sewers. The difficulty was eventually solved, one of my correspondents making a reasonably practical suggestion, and a circular letter showing the method of procedure which was strongly recommended, has been sent to all motor garages in the Borough. A copy is given herewith. Gentlemen, Discharge oe Petrol into Sewers. The Council of this Borough have recently had their attention drawn to the great danger to life caused by the discharge into the public sewers of petroleum, or of some residue from petroleum or other liquid liable to give off inflammable vapour. Explosions have occurred in sewers in which men were working, and as a result one man employed by this Council was most seriously injured. 83 It is suggested that the oils retained in petroleum interceptors should be baled up and put into a barrel for return to the oil refiners. A convenient method to adopt for separating the oils from the water, with which they are unavoidably mixed in the trap, is to pour the oils scooped up out of the interceptor into a fairly large barrel standing on end, and fitted with two taps, one near the bottom of the barrel, and the other about a quarter of the way up. After sufficient time has been allowed for settlement, the water may be run off from the lower tap and the oils drawn from the higher one. I am directed to ask you to give this matter your serious attention, and to urge you to give such instructions and to make such arrangements as will prevent the escape from your premises into drains or sewers of matter or liquid of a dangerous nature. By section 10 of the London County Council (General Powers) Act, 1894, any person convicted of discharging petrol into public sewers is liable to be fined £20, with an additional fine of ,£5 for every day on which the offence continues. I am Yours faithfully, James Wilson. Town Clerk. FACTORIES AND WORKSHOPS. To speak perfectly candidly these have not received the amount of supervision during 1908 they should have had. The late Inspector Phillips, whose duty it was to inspect workshops used by males and male outworkers' premises, was so over-burdened with other duties that it was not possible for him to do more than he actually did. Much the same remark applies to your two lady Sanitary Inspectors—indeed it was necessary early in the year to appoint a temporary assistant to help them in their work. The work of the department has now been reorganized in such a manner, that the workrecently done by Inspector Phillips under this heading, can well be carried out in a proper manner by the four district Inspectors. In the case of the work done under this heading by Miss Baker and Miss Johnson, it has again, after an interval of less than a year, been found necessary to appoint a temporary assistant. It will probably be found necessary—in my opinion it is necessary now—to make this appointment a permanent one. The work done in this connection may be readily gathered from the reports of the three Inspectors concerned, and from the tabular statement appended. 84 To the Medical Officer of Health SIR, I beg to submit the following report of my work for the year 1908. Factory and Workshop Act. With reference to this part of my work, very little has been done, owing to pressure of other duties. 153 new workshops have been registered, and 88 re-inspections have been made. All complaints received have been immediately attended to, and, where substantiated, remedied. Only five outworkers' premises were inspected during the year. Birth Returns. These returns have been received weekly from the Registrar, and since the adoption of the Early Notification of Births Act, in June, they have been forwarded weekly from the maternity hospitals of the district, and daily from those in attendance on the births taking place in the home. The percentage of early notifications over the registered births received was 82.8 per cent. The South district has been under my care, and during the year 1,009 visits have been paid to the mothers, enquiries made respecting the general health of the infant and of the family, and, where needed, advice given as to feeding, etc. Most of the infants are breast fed, the only exceptions being due to physical weakness or domestic circumstances. Owing to the varied nature of my work it has been seldom possible to find time to re-visit, hence the good results of this special work must scarcely be reckoned, whereas by steadily watching the development of at least special cases, much good in the future health, or even in the life-protection of the child, might be looked for. For this reason the three months' work done by Miss Wienholt was of great use, as she was able to devote her time to the care of those cases visited by her in the Borough. Phthisis. 169 cases have been reported during the year; of these 54 were from common lodging houses or the workhouse. I have made 226 visits, but as so many of the patients do not acknowledge the complaint from which they are suffering, much care is needed in dealing with them. Where it is found that other members of the home have their health endangered, or 85 that the means are insufficient for the care of the patient, he is always urged to enter the infirmary, and, with few exceptions, disinfection of the room after removal is allowed, as also after any death from this disease. Cleansing of Persons Act. About sixty families have at various times been reported to me by the London County County nurse as being verminous or having scabies; The homes have been visited and the children advised to attend the Cleansing Baths ; and in many cases improvement has been noted. Infectious Diseases. This work is mostly amongst school children, whose mothers often show great carelessness in dealing with various members of the family who may be suffering from measles, whooping cough, etc. Women's Conveniences. These have been inspected daily, and reported thereon to the Committee. The work of the Attendants has been satisfactory, and all repairs have been done as needed. The following table gives a tabulation, where tabulation is possible, of my work:— Workshops re-inspected 88 New workshops registered and measured 153 Visits respecting birth returns 1009 Visits „ phthisis 226 Visits ,, verminous school children 77 Visits „ infectious diseases 43 Complaints received and investigated 63 Works in progress visited 25 Miscellaneous visits and inspections 249 I am, Sir, Your obedient Servant, FRANCES A. BAKER, Inspector. January 1st, 1909. 86 To the Medical Officer of Health. Sir, Registered Births. With reference to the above I have paid 1,867 visits and have been much impressed with the anxiety of the mothers to breast feed their infants, a lack of power to do so arising chiefly from want of proper food during the later months of pregnancy, or from the necessity that the mother should go out to work. In cases where it was needed advice has been given on the feeding of the infant, and on the general cleanliness and health of the home and family. Owing to the large number of births registered re-visits have been absolutely impossible, but cases requiring special observation have been referred to the Health Society Consultations. Elementary Schools. Forty visits have been paid to these, and on all occasions the sanitary arrangements have been found in good order and cleanly kept. Day Nurseries. All the Day Nurseries have been visited periodically ; they appear to be well managed, and by the care given to the children who attend, there is no doubt that they supply a great need to the mothers of the district who are obliged to go out to work. Women's Conveniences. According to your order the Conveniences have been inspected three times weekly in the months from January to June, and twice a week since that time. The following is a tabulated statement of my work for the year:— Outworkers' premises inspected 65 Phthisis cases visited 16 Elementary Schools inspected 40 Registered Births 1,867 Miscellaneous visits and inspections 488 I am, Sir, Your obedient Servant, Monica Johnson. 87 To the Medical Officer of Health SIR, I beg to submit the following report of work done during the year 1908. Factories and Workshops. The workshops on the register occupied by men only represent the following trades:— Tailors and Outfitters 96 Bootmakers Upholsterers Cabinet Makers Silver Smiths 12 6 8 7 These have been periodically inspected, and any defects in sanitation have been remedied. General. The 78 Bakehouses have been inspected from time to time and cleansing ordered as required. 340 observations have been taken on Smoke Nuisances; also the premises of two tripe boilers, the only offensive trades in the district, inspected. I have made 220 inspections of Hotel kitchens, Restaurants and Coffee Shops, special attention being given to the kitchens and to all places where food is stored. The Shelter, Baths and Disinfector have been visited frequently and all necessary repairs attended to. The Men's Underground Conveniences have been inspected daily, and I have found the work of the Attendants satisfactorily done. Inspections made during the year— Bakehouses 156 Hotels, Restaurants and Coffee-shops 220 Smoke observations 340 Conveniences and Public Urinals Daily, I am, Sir, Your obedient servant, Richard Phillips, Inspector. 88 Report on the administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Workplaces and Home work. I.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. (i ) (2) (3) (4) Factories 2 - - (Including Factory Laundries.) Workshops 374 30 — (Including Workshop Laundries.) Workplaces (Other than Outworkers' premises included 378 29 — in Part 3 of this Report.) Total 754 59 — 2.—DEFECTS FOUND. Particulars. Number of Defects. N umber of Prosecutions. Found. Remedied. Kef erred to H.M. inspector. (1) (2) (8) (4) (5) Nuisances under the Public Health Acts-.— Want of cleanliness 34 33 - - Want of ventilation — — — — Overcrowding 5 5 — — Want of drainage of floors — - — — Other nuisances 6 6 - — Sanitary accommodation insufficient — - — unsuitable or 4 4 - — defective not separate for 5 5 — — sexes Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) — — - — Breach of special sanitary requirements for bakehouses (ss. 97 to 100). 4 4 - - Other offences — — - — (Excluding offences relating to work which are included in Part 3 of this Report.) Total 58 57 - - 89 3.—HOME WORK. NATURE OP WORK. OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' premises. OUTWORK INUNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Number of Addresses of Outworkers received from other Councils. Number of Addressesof Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Failing to keep or Permit inspection of lists. Failing to send lists. TWice in the year. Once in the year. Lists. † Outworkers † Lists. Outworkers (1) (2) (3) (i) (5) (6) (7) (8) 0) (10) (ii) (12) (13) (14) (15) 16) Wealing Apparel— (1) Making, etc 140 1824 ... ... 1254 12 83 ... ... 161 ... ... ... ... ... ... (2) Cleaning and washing 1 8 ... ... ... 8 ... ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets 4 29 ... ... 7 25 ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... 9 ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 2 4 ... ... 20 2 ... ... ... ... ... ... ... ... ... Fur pulling 1 3 ... ... 1 2 ... ... ... ... ... ... ... ... ... Umbrellas, etc. 9 30 ... ... 6 27 ... ... ... ... ... ... ... ... ... Paper Bags and Boxes ... ... 3 ... ... ... 2 ... ... ... ... ... ... Basket making ... ... 1 ... ... ... 1 ... ... ... ... ... ... Brush making ... ... 9 ... ... ... ... ... ... ... ... ... ... Electro-plate ... ... 3 ... ... ... ... ... ... ... ... ... ... Total 150 1898 ... ... 1299 1347 ... ... 164 ... ... ... ... ... ... 90 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Dressmaking, Tailoring, Millinery, Laundries, &c 2,984 Bakehouses 78 Coffee Shops, Restaurants and Hotels 240 Total number of workshops on Register 3,302 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5.) Notified by H.M. Inspector 44 Reports (of action taken) sent to H.M. Inspector 18 Other — Underground Bakehouses (s. 101):- Certificates granted during the year — In use at the end of the year 70 91 UNDERGROUND ROOMS. A considerable number of these have been inspected, and the results recorded on special forms drafted by your Medical Officer of Health, much on the lines adopted by several other Metropolitan Boroughs. It is not too much to say, judging from the results of these special inquiries and from a considerable number of personal inspections, that the large majority of the underground rooms in this Borough are occupied illegally, i.e. in contravention of the provisions of the Public Health (London) Act, 1891. It is utterly useless to attempt to deal with these on the strict lines of this Act for, even supposing that the staff of inspectors were sufficient to discover all those illegally occupied, the enforcement of notices to quit or occupy them only in conjunction with a room on an upper floor, would involve the displacement of hundreds of families who literally cannot find accommodation such as they require at a rent that they can afford. At the same time the occupation of most underground rooms is hygienically most undersirable, particularly for children. Medical practitioners of long experience in this locality tell me • that rheumatism is exceedingly common amongst the children inhabiting underground rooms, and rickets only slightly less prevalent. The consequences of rheumatism are manifested in heart-trouble before very long and this incapacitates sufferers from most forms of heavy physical work, which is usually the only kind of employment open to persons of this class. The question is thus an exceedingly serious one and will probably call for legislative interference shortly. If a discussion of the subject at a Conference of Metropolitan Borough Councils could be arranged, it would be possible, I feel sure, to arrive at a standard of habitability for these dwellings, which, without pressing too harshly on owners, would nevertheless secure in the first place a greater degree of protection for those who are compelled to occupy these rooms, and in the second place, greater uniformity of action on the part of Borough Councils. Every case reported to your Medical Officer of Health has been individually considered and only those rooms which have been found to be considerably below the standard prescribed by the Public Health Act have been dealt with so as to prohibit their occupation. Most of the rooms have been reported to have no damp-proof course : the width of the open areas abutting on them has in the majority of cases been too little—thus preventing the proper access of sunlight and fresh air: the space below the floor is usually unventilated : the average height of the rooms is only about seven feet; the height of the ceiling above the adjoining 92 ground is usually less than that prescribed by statute ; the available air space is generally the minimum allowable—and this is an exceedingly low figure. On the other hand one occasionally finds underground rooms which, whilst not strictly conforming to the requirements of law, are nevertheless quite useful dwellings especially for those who are out at work all day and practically only use them for purposes of sleeping. On the whole an unusual degree of discretion will have to be exercised by your responsible officer in dealing with these dwellings until such time as a revision of Sections 96, 97 and 98 of the Public Health (London) Act, 1891, has been accomplished. HOUSES LET IN LODGINGS. The By-laws which came into force on the 29th June, 1907, had, unfortunately, to be left more or less in abeyance owing to the insufficiency of the sanitary staff, until late in the year. The Council's Solicitors gave it as their opinion that all premises which came under the operation of these By-laws must be re-registered. It was obviously little use doing this as a merely clerical piece of work, and accordingly the plan decided upon has been to request each District Inspector to report half a dozen houses of a kind such as to require sanitary supervision for each fortnightly meeting of the Public Health Committee. These houses are then formally placed on the Register and are inspected, any sanitary alterations being made the subject of intimation, and, if necessary, statutory notice on the owner. The work is bound to be a somewhat tedious one, for very few houses up to the present, at all events, have been discovered which do not require a considerable amount of alteration from a public health point of view. There are approximately 1,000 of these houses let in lodgings in the Borough. From my personal knowledge of them, I am able to assert that they will require very constant .supervision. The principal items which require attention are dirt, vermin, insufficient water supply and overcrowding. In spite of the immense amount of work which this inspection will of necessity entail, it must on no account be relaxed if a proper standard of health is to be maintained in the occupants of these for the most part wretched dwellings. REMOVAL OF HOUSE REFUSE. The removal of house refuse is still done by contract. The Contract for the North District entered into on the 1st March, 1905, for three years, by Messrs. E. H. Jackson & Co., Ltd., of 93 56, Durham Road, Finsbury Park, N., was on and from the Ist April, 1908, transferred by agreement to Mr. J. Abrahams, of Wedmore Street, Holloway, N. This Contract expired on the 3Ist March, 1909, and Messrs. VV. Mead & Co., Ltd., having secured the Contract for two years commenced the removal in this district on the Ist April, 1909. The South District Contract is still being carried on by Messrs. W. Mead & Co., Ltd., of The Wharves, Paddington, W., and will expire on the 3Ist March, 1910. The following tabular statement gives the number of complaints, letters, and refusals in respect of the removal of house refuse received, and the fines levied and recovered for contravention of the terms of the Contract during the last five years:— NORTH DISTRICT. Year. Complaints Letters. Refusals. Fines. 1904 49 52 28 — 1905 53 66 227 W. Mead & Co., Ltd., £20 and £26 5s. 1906 49 61 W. Mead & Co., Ltd., £15 and E. H. Jackson & Co., Ltd., ,£5 1907 46 54 83 E. H. Jackson & Co., Ltd., £50 1908 26 63 114 — SOUTH DISTRICT. Year. Complaints. Letters. Refusals. Fines. 1904 194 184 63 T. Hobbs, £20 1905 72 170 366 - 1906 69 157 556 T. Hobbs, £15, £ 1 Is., and £50 1907 106 173 471 — 1908 63 159 228 W. Mead & Co., Ltd.,£I and £2 The supervision of the Dust Contract is divided between your special Dust Inspector and the Out-door Superintendent, the latter taking a certain small specified area, which will be changed fairly frequently, so as to ensure that every eighteen months or two years the whole of the district will have come under the independent inspection of two officers. 94 In the special report which I presented to your SubCommittee, on the re-organisation of the Department, I used the following words:— "I am distinctly of opinion that the daily kerb collection of refuse ought to be extended to cover a much larger area of the Borough. It is nothing less than a standing disgrace to the civilisation of the Metropolis that dust collection with its most disagreeable accompaniments and possibilities of danger to health, should be going on in good residential and business localities at all hours of the day. I hope St. Marylebone will lead the way in the abolition of this insanitary procedure. The extension of the early removal could be done at an increased cost which I feel sure would be cheerfully borne by, at any rate, the large majority of the ratepayers." Figures were given to the Sub-Committee showing that in Westminster it had been found possible to arrange for a very considerable extension of the daily removal at an increased cost which was surprising in its smallness. After a slightly longer experience I see no reason whatever to alter the opinion expressed in that report to the extent of even one word, and I sincerely trust that your Committee will take the matter up in an earnest and business-like manner at the time of the renewal of the Contracts. The complaints which have been received as to the time of clearance of dust has somewhat increased, but it is obviously impossible to arrange for clearance at a time which will be satisfactory to everybody. Your contractors have shown a commendable desire to please in all cases where the request has been a reasonable one. Requests for more frequent clearance have also been received in fair numbers, and are always specially investigated, and the request granted if it is a fair one. The increasing use of gas stoves is doubtless responsible for many of these requests —the absence or temporary abandonment of use of the oldfashioned kitchener, especially during the summer months, rendering it difficult to dispose of animal and vegetable refuse in the proper manner, and resulting in its deposit in the dustbin, where, in a short time, it gives rise to offensive smells. No fewer than 44 fixed dustbins have been abolished during the year as the result of notice from the Department—movable metal covered receptacles taking their place. Many abominable dust-shoots have also been cleared away 95 VERMINOUS PERSONS BATHS. Miss Kilgallin, the Matron who superintends the work at these Baths, has reported that 11,304 adults and 5,244 children made use of the baths during the year 1908. The comparative tables submitted showing the numbers during each month of 1907 and 1908, prepared by Miss Kilgallin, indicates a very marked increase in the work done during the last year. Of the male adults 7,183 gave as their address on the night previous to their coming to the baths, the Salvation Army Shelter, and 1,558 gave as their address various Lodging Houses in the Borough. Of the female adults 327 hailed from the Shaftesbury Institute, and 2,236 gave no address whatever. There is at present no means of verifying these addresses, and it might be advisable, as a check upon this, to give a number of printed tickets to the Salvation Army Shelter, Church Army, Shaftesbury Institute, and the various Common Lodging I louses in the Borough, to be given up by the recipient on presenting himself at the Baths for treatment. It would soon become common knowledge among those frequenting Lodging Houses,etc., that the possession of a ticket was a necessary preliminary to the securing of a bath, whilst it might always be left to the discretion of your Matron and the Attendants to treat any bona-fde cases hailing from other quarters. Your Matron devotes very special attention to the many cases of neglected children which come to the baths, and is to be greatly commended for what one may term the ' aftercure ' she bestows upon them. In a very considerable number of cases she visits the homes and sometimes also the schools, in order to find out whose fault it is that the children are verminous In addition to this, of course, the School Nurse receives a list of children who come to the Baths every week. This co-ordination of work is bound to exert a very salutary influence on both the children and their parents. It will be noted that there is a slight decrease in the children bathed during 1908, as compared with those in 1907. This decrease is partly due to the fact that the baths were closed during two weeks in June for painting, and also to the fact that the new Schools in Capland Street have a bath provided. Miss Kilgallin reports that the attendants under her charge have given every satisfaction in the performance of their work. As this is the last opportunity I shall have, I desire to put on record my high appreciation of the manner in which Miss Kilgallin discharges her difficult and at times very unpleasant duties. VO Q\ CLEANSING OF PERSONS ACT. BATHS—BOROUGH OF ST. MARYLEBONE, 27, GROVE ROAD. ADULTS. 1907. ADULTS. 1908. 1907. Males. Fmls. Total. I Remarks. 1908. Males. Fmls. Total. Increase over 1907. Remarks. January 599 136 735 January 649 171 820 85 February 511 111 622 657 137 794 172 March 499 115 614 Easter Holidays. March 672 152 824 210 April 525 128 653 April 580 143 723 70 Easter Holidays. May 541 161 702 May 581 172 753 51 2½ days closed for boiler inspection. June 392 73 465 lune 721 190 917 452 I day closed, painting. July 560 144 701 July 813 249 1,002 358 August September 745 051 163 189 908 840 August September 878 811 273 274 1,151 1,085 243 245 1½ days closed, sweeping flues. October 646 215 861 October 921 310 1,237 376 November 515 194 709 November 756 258 1,014 3C5 1½days closed, sweeping flues. December 601 178 779 December 701 222 923 144 Totals 6,785 1,807 8,592 Totals 8,741 2,563 11,304 654 Increase over 1907 1,956 756 2,712 2,712 CHILDREN. CHILDREN. Over Inc. 1908. Dec. January 176 321 l 497 January 178 386 504 07 — February 215 370 585 February 300 307 607 22 - March 260 415 675 March 343 446 789 114 — April 180 306 494 April 202 301 50'i 9 — Easter Holidays. May 256 3.-59 595 May 232 308 540 — 55 2\ days closed as above. June 151 205 356 June 126 189 315 — 41 2 weeks closed, painting. July 163 154 317 July 155 190 345 28 - August 40 22 68 August 16 42 58 — 10 September 249 197 446 September 109 208 317 — 129 October 246 349 595 October 176 212 387 — 208 November 203 451 654 November 170 233 403 — 251 days closed, sweeping flues. December 216 273 489 December 192 224 416 — 73 Totals 2,36 V 3,404 , 5,771 Totals 2,198 3,040 5,245 526 Decreases in returns for 1907 169 358 520 526 97 SHELTER. The Shelter, which is also under the charge of Miss Kilgallin, has only been used on six occasions as set out in the statement below. The District Inspectors have from time to time been reminded that it is their duty to enquire particularly into the manner in which those displaced from their homes during disinfection of premises intend to dispose of themselves during that time, and if they are not satisfied that they will be able to obtain lodgment without danger to the public health, they are to very strongly urge upon the people concerned the use of the Shelter. It is feared that this instruction has not been as faith fully carried out as it might have been. The matter is, therefore, one which will require further and continued supervision. 1908 No of hours occupied Reason of occupation. No. of persons. April 28th, 29th 24 Scarlet Fever 2 Adults, 1 Child May ist 4 Scarlet Fever 1 Adult, 1 Child Oct. 7th. 3 Scarlct Fever 1 Adult, 3 Children Oct. 26tl) I Private 2 Adults Oct. 26th, 27th I4 Scarlet Fever 1 Adult Oct. 27th I Private 2 Adults PUBLIC MORTUARY. Early in the year Mr. Ellis, who had been Mortuary Keeper for a great many years, found it necessary to resign his position on account of failing health. Your Committee suitably recognised the good work which Mr. Ellis had for so long carried out. On the appointment of Mr. G. Coombes as successor to Mr. Ellis, it was deemed advisable to reconsider the duties of the Mortuary Keeper, and incidentally certain old regulations which were not quite up to modern requirements were also revised. I desire to acknowledge many valuable suggestions received in connection with this work from Dr. J. H. Swanton, a member of the Mortuary Sub-Committee. In matters of this kind due regard has always to be had for public sentiment. I feel confident that, judiciously administered, the duties of the Mortuary Keeper as framed by the Public Health Committee and the Bye-laws which have, at the date of writing this report, been finally approved by the Local Government Board, will ensure a proper measure of protection to the public health without any unnecessary friction, and without any undue trespass on the somewhat vague field of public sentiment. 98 By-Laws made by the Mayor. Aldermen and Councillors of the Metropolitan Borough of St. Marylebone with respect to the Management of a Mortuary, and charges for the use of the same in the Metropolitan Borough of St. Marylebone. Interpretation. 1. Throughout these by-laws the expression "the Council" means the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. 2. Every person who, in pursuance of permission obtained from the Council, has caused the body of one who has died of an infectious disease to be deposited in the Mortuary shall cause the body to be enclosed with all reasonable despatch in an air-tight coffin and fastened down, and to be removed from the Mortuary for the purpose of interment within a period of three days from the date of death. Provided that if an inquest is about to be held or is being held on the body, such person shall not cause the body to be removed except with the authority or on the certificate of the Coroner, but such person shall cause the body to be removed within twenty-four hours after the issue of such authority or certificate. 3. Every person who, in pursuance of permission obtained from the Council, has caused the body of one who has died of a non-infectious disease to be deposited in the Mortuary shall cause the body to be removed therefrom for the purpose of interment within a period of four days from the date of death. Provided that if an inquest is about to be held or is being held on the body, such person shall not cause the body to be removed except with the authority or on the certificate of the Coroner, but such person shall cause the body to be removed within twenty-four hours after the issue of such authority or certificate. Provided further, that if before the expiration of the above period the body is in such a state of decomposition as to cause a nuisance, he shall on receiving a notice from the Borough Council or the Medical Officer of Health that it is in such a state, cause the body with all reasonable despatch to be removed from the Mortuary for the purpose of interment, or to be placed in an air-tight coffin and fastened down. 4. Every person for the time being employed in depositing a body in the Mortuary or in removing a body therefrom, shall, while so employed, conduct himself in all respects with decency and propriety. 5. Every person, who, being a friend or relative of one whose body has been deposited in the Mortuary, has been admitted to view the body, shall, while on the premises, conduct himself in all respects with decency and propriety. 99 6. Every person who, for the purpose of depositing a body in the Mortuary, uses a shell which has not been provided by the Council shall, in every case where the body is transferred from the shell before being carried from the premises to the place of burial, cause the shell, as soon as conveniently may be after the transfer of the body therefrom, and in any case within forty-eight hours of such transfer, to be removed from the premises. 7. Every person who shall deposit a body in the Mortuary shall, so far as practicable, furnish the Mortuary Keeper with information relating to the following particulars :— (a) Name in full of the deceased. (b) Sex. (c) Age. (d) Cause of death. (e) Purpose for which the body is brought, whether for inquest, post-mortem, or simple custody. (f) Number of house and name of street or description of place from which the body has been removed. (g) Name and address of person by whose order it has been brought to the Mortuary. (h) Date on which it is proposed to remove the body for burial. 8. No person shall, without the consent in writing of the Medical Officer of Health or Coroner, open a coffin deposited in the Mortuary and containing a body which is likely to be in an offensive condition owing to decomposition or dangerous owing to infection. 9. Every person who shall have deposited a body at the mortuary in a shell or coffin which is in a defective condition shall within a reasonable time of receiving notice from the Medical Officer of Health furnish a proper or substantial shell or coffin. 10. No person shall remove any body deposited at the Mortuary from a coffin in which it shall have been enclosed except by permission in writing of the Medical Officcr of Health or the Coroner. 11. Every person who shall offend against any of the foregoing by-laws shall be liable for every such offence to a penalty of Five Pounds, and in the case of a continuing offence to a further penalty of Ten Shillings for each day after written notice 100 of the offence from the Council; provided, nevertheless, that the Justices or Court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think fit, adjudge the payment, as a penalty, of any sum less than the full amount of the penalty imposed by this by-law. 12. Every person using the Mortuary for the purposes of embalming, injecting or otherwise treating any body with the object of preventing or delaying putrefactive changes, shall pay to the Council a charge of Twenty Shillings in respect of each body so treated. The Seal of the Council of the Metropolitan Borough of St. Marylebone was hereunto affixed on the 14th day of January, 1909. By order, J. WILSON, Town Clerk. Allowed by the Local Government Board this 20th day of March, 1909, S. B. PROVIS, Secretary. Acting on behalf of the said Board under the authority of their General Order, dated the twenty-sixth day of May, 1877. DUTIES OF MORTUARY KEEPER. 1. He shall carry out the By-laws and Regulations of the Public Health Committee relating to the Mortuary and postmortem room and the instructions of the Medical Officer of Health, and shall be at their service at any hour of the day or night. 2. He shall keep the whole of the premises and all articles therein in a clean and tidy condition, and shall be responsible for the washing of all sheets, covers, towels, etc., and for the cleaning of windows, gullies, lamps, eaves gutters, etc., and shall execute all minor repairs to the premises and the various fittings. 101 3. He shall keep such books as the Committee or the Medical Officer of Health from time to time prescribe, and in particular shall fill in the books relating to the deposit of bodies. He shall produce all books for examination by the Committee or the Medical Officer when and where required to, and shall submit a return of the work done at the Mortuary, when, and in the form required by the Medical Officer of Health. 4. He shall report at once to the Medical Officer of Health any loss of or any damage to the property of the Committee, or any breach of the Committee's Bye-laws or Regulations. 5. He shall not be entitled to receive gratuities from persons visiting the Mortuary to see the body of their friend or relative. 6. He is prohibited from recommending any undertaker to the relatives or friends of deceased persons. 7. In the event of his finding any property on any body taken to the Mortuary, he shall fill in on the printed list the articles found, and shall deliver such articles :— (1) If an inquest be held—to the Coroner's Officer or Police Constable in charge of the case. (2) If no inquest be held—to the immediate relatives of the deceased. (3) If the body be not claimed—to the Relieving Officer, to be dealt with according to law. 8. He shall take charge of the clothing if it be not required by the Coroner or the Police, and shall deliver it to the relatives or the Relieving Officer as the case may be, seeing that in all cases the person to whom the property or clothing is given signs the form of receipt for same. 9. He shall pay particular care to the affixing of a distinctive label to every coffin. 10. He shall see that all persons visiting the Mortuary conduct themselves with decency and propriety. 11. He shall give notice forthwith to the Medical Officer of Health of the reception of any body dead of infectious disease, or any body in an offensive condition. 102 12. He shall obtain the consent in writing of the Medical Officer of Health before destroying any shell as provided in the By-laws. 13. He shall in matters not specifically covered by these rules obey the directions of the Medical Officer of Health. Your Medical Officer of Health received a deputation from the London Branch of the British Embalmers Society on the subject of these By-laws when it was explained that although such By-laws had of necessity to be framed in a manner which appeared rigorous and possibly formidable their administration was always a matter with which tact, judgment and consideration for the difficulties and sentiments inseparable from such matters were always blended by those who had to see to their due enforcement. The Society were advised to place their objections formally before the Local Government Board and did so, but the Board confirmed the By-laws as presented by your Council. The Society regarded the last By-law of the series— one imposing a change for the use of the mortuary for purposes of the embalming and injecting bodies as one which would put a bar in the way of what, in their opinion, had proved a very useful measure of sanitation. It was their desire that no charge should be made in cases where a simple injection of the cavities with formalin or similar antiseptic might have to be carried out, However, this still remains as a mode of treatment for which, if done in your Council's Mortuary a small charge may be made. During the year it was found necessary to investigate the condition of the drainage at the Mortuary. Whilst this investigation was proceeding, it was discovered that the north-east corner of the central building was to some extent giving way. The advice of an architect was obtained, and he recommended that this corner should be shored up and underpinned. This was done at a cost of approximately £89 10s. On the completion of this work the whole of the drainage system was re-laid throughout at a cost of £56 10s. The whole of the outside of the buildings has been repainted at a cost of £45 is. 103 REPORT OF MORTUARY KEEPER, ST. MARYLEBONE, FOR THE YEAR 1908. Number of bodies deposited from 1st January to 31st December, 1908. Males. Females. Brought forward Males. Females 117 99 January 21 22 July 16 14 February 14 16 August 18 14 March 17 20 September 16 18 April 27 19 October 18 19 May 20 14 November 15 18 June 18 8 December 19 13 117 99 219 195 Grand total 414 Number of bodies received from 1st January to 31st December, 1907.—394. Number of Inquests held from 1st January to 31st December, 1908. Brought forward 89 January 17 J uly 11 February 16 August 14 March 14 September 16 April 21 October 18 May 11 November 14 June 10 December 16 89 178 Number of Inquests held from 1st January to 31st December, 1907—164. Number of Infectious Cases received from 1st January to 31st December, 1908 -5 Number of bodies received from 1st January, 1889, to 31st December, 1908. Total 8,998, 104 WATER SUPPLY TO NEW DWELLING HOUSES. The provisions of Section 48 of the Public Health (London) Act, 1891, have, in the past, probably been more honoured in the breach than in the observance. It is very necessary, however, that they should be carried out rigorously. Accordingly, in the middle of the year a notice was inserted in the local papers drawing attention to the fact that no house which had been newly erected or pulled down to or below the ground floor and re-built, could legally be occupied as a dwelling house until the Sanitary Authority had certified that it had a proper and sufficient supply of water. Attention was drawn to the penalty contained in the Act for a breach of these provisions. A number of certificates have already been granted, and through the notices which are received by the Department as to drainage of new buildings, and also through the lists which are kindly supplied by the District Surveyor, it is hoped that in the future the proper enforcement of this section will be much facilitated. WATER SUPPLY TO TENEMENT HOUSES. A fair number of intimations have been served during the year, under the London County Council (General Powers) Act, 1907, Sec. 78. All of these received ready compliance, with one exception, and here it was found necessary to apply for a summons, but the case did not come on for hearing inasmuch as the water was provided to the upper storeys of the premises before the summons was returnable. Public House Urinals. Some few years ago a return was prepared showing inter alia the character of the urinal accommodation at the 215 public houses in the Borough. No action appearing to have been taken by the Public Health Department in that matter I deemed it advisable to have a further inspection made and a schedule of inquiries was prepared for your District Inspectors under the following headings :— I.—General Sanitary Condition (a) Paving. (b) Water Supply. (c) Flushing and Cleansing. 1.—How done ? 2—By whom done ? 3.—How often done ? (d) Drainage. (e) Limewashing, Tarring, etc. 105 II.—Decency (a) Approached from ? (b) Overlooked ? (c) Proximity to w.c. or other premises used by females. (d) Screening. III.—Lighting Summarised the results of this special inspection disclosed the following :— 1. Public Houses discontinued as such since previous Report 2 2. Public Houses having urinals in a satisfactory condition 99 3. Public houses reported to General Purposes mittee as having no urinals attached 51 4. Urinals defective in sanitary condition by reason of— (a) Paving defective 2 (b) No water supply 13 (c) Water supply defective 3 (d) Drainage defective 4 (e) Limewashing, Tarring, etc., required 55 5. Urinals "offensive to public decency" (L.C.C. General Powers Act, 1904, S. 22) (a) By reason of approach thereto 0 (b) By reason of being overlooked 2 (c) By reason of proximity to w.c. or other premises used by females 1 (d) By reason of insufficient or no screening 12 (e) By reason of insufficient or no lighting 34 Intimations were duly served in respect of the conditions found and the work of remedying these was followed up by the Department until it could be written off as complete. In the case of 15 out of the 51 houses mentioned above as having no urinals attached the customers were allowed to use the w.c. attached to the house, and in a number of others there was a public urinal within a reasonable distance. The results of inspection were such as to indicate the necessity of periodical attention being given to these places. REVENUE ACT, 1903. Eight certificates were granted by your Medical Officer of Health during the year for exemption or reduction of Inhabited House duty, in accordance with the Revenue Act, 1903, in respect of the premises mentioned below, after amendments had 106 in some cases been made to the sanitary fittings. Sixty-nine tenements were covered in these certificates. Two applications for certificates in respect of premises covering 33 tenements were refused, the owners of a large block of flats in one case refusing to comply with the requirements to provide anti-syphonage pipes to the w.c.'s, and in the other case, in consequence of the owner not complying with a requisition to amend the sink waste pipes. Premises. No. of Tenements. Culworth House, Henry Street 16 6, 7, 8, 10, 11, 12, 14, Cosway Street 15 la, 2b, 6a, 7b, 7m, Hyde Park Mansions 5 45 and 46, Newman Street 4 Berners Street Mansions 10 69, Great Titchfield Street 4 Dean House, 114 and 116 Great Titchfield Street 12 13 and 15, Mortimer Street 3 69 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1904 (SECTION 20 (1). Statement showing the number of Statutory Notices served in respect of which the Medical Officer of Health certified that the house or part thereof was infested with vermin, compared with the same period of the previous year. In each case the notices to remove the wall paper from the walls and take such steps as were necessary to remove the vermin, were promptly complied with :— 1907. 1908. Statutory Notices served 11 22 Rooms 43 53 DISINFECTION. The following is a statement of the articles steam disinfected during the year 1908 and the previous year. No complaint of damage has been received by the Department:— 1907 1908. Beds 285 388 Mattresses 579 503 Bolsters 660 693 Pillows 1188 1354 Sheets 1030 1118 Blankets 1665 1941 Sundries 4619 5787 Totals 10,026 11,784 107 The number of rooms disinfected during 1908 was 764, compared with 784 the previous year. Number of journeys made by the disinfecting vans during the year, January to December, 1908. January 64 journeys. February 34 ,, March 39 April 48 May 57 June 53 July and August 63 ,, September 60 ,, October 46 ,, November 46 „ December 39 ,, 549 The vans were used 476 times in 1907. A few minor amendments have been made in the procedure in connection with this important branch of administration. Short and simple instructions as to the precautions to be observed by those in charge of infectious cases have been prepared for all the important infectious diseases dealt with by the Department. The instructions to the Inspectors are that these shall not only be delivered to the persons responsible, but shall also be explained verbally by them. Enquiries into cases of Puerperal Fever have been transferred entirely to the Lady Inspectors. Cases notified from the Metropolitan Asylums Board as having been discharged with a doubtful infectious lesion arc made the subject of repeated visits in order to discover whether any recurrence or aggravation of the symptoms has taken place, and also to discover whether any illness of a mild character has resulted from exposure of other members of the family to these complications of infectious illness. In a good many instances I have been asked by medical practitioners to visit doubtful cases of infectious illness with them and express an opinion as to the nature of that illness. I have felt it a part of my official duty to place the experience I have had in the diagnosis of doubtful cases at the disposal of local practitioners. So far there has been no need to make this branch of work known in any general manner to the practitioners in the Borough, as one usually finds that it gradually filters through into the proper quarters. Early in the year a claim was received of damage alleged to have been done by the use of liquefied sulphur dioxide and it was deemed expedient to settle this claim without 108 resort to legal proceedings. A system of disinfection by formaldehyde gas has been almost universally adopted in place of that by sulphur dioxide, though the latter is still used for a limited number of cases where there is no likelihood of damage resulting to expensive decorations and the like. The Inspectors now carry tickets entitling people to a certain supply of liquid disinfectant to be distributed from the Public Health Office, and these are given to people who are too poor or too ignorant to buy disinfectant of a reliable character. Your Committee adopted my recommendation to have a clock indicator fixed on the Large Disinfector which will show for every day on which the Disinfector is used the time at which any disinfection has been carried out, the pressure reached in the chamber, and the time during which this pressure was maintained. The recording card is fixed on the apparatus early in the morning by your Outdoor Superintendent, and the indicating apparatus is then padlocked. The cards are removed daily and submitted to your Medical Officer of Health for examination. PUBLIC SANITARY CONVENIENCES. These have been inspected daily throughout the year by Inspector Phillips, Miss Baker and Miss Johnson, and the numberless details involved in their maintenance and management have received due attention. Your Surveyor has on many occasions most kindly given the department the benefit of his advice and assistance in connection with alterations and repairs. The ventilation of the Men's Lavatory at Oxford Circus, has been materially improved at a small cost. The pavementlights at the Marylebone Road Convenience have been entirely overhauled and the prism-lights, which experience shews to be distinctly dangerous, by reason of large pieces of glass chipping off, have been removed. The old stalls at Portland Road Men's Convenience, have been taken out and new white glazed earthenware stalls, without metal gratings, fixed in their place—an alteration which has already effected a great improvement in the atmosphere of this place. Efforts have been made to trace a leakage of water or other liquid, into the St. John's Wood Road Convenience, but without result. This effort should be renewed, as considerable damage to the ceiling and walls, and possibly also to electric light fittings may ensue. The money takings are reported regularly to your Public Health Committee and to the Council. All that can be said of them is that they fluctuate in amount, in a manner and to an extent which admits of no general explanation, but there are indications that time spent on the supervision of this matter is time very well spent. i. APPENDIX CONTAINING THE REPORT OF THE PUBLIC ANALYST, A. Wynter Blyth, Barrister-at-Law, Fellow of the Institute of Chemistry, etc., etc. REPORT OF THE PUBLIC ANALYST. During 1908 705 samples were analysed under the Sale of Food and Drugs Act. Of these 40 were certified to be adulterated, that is about 5.6 per cent. No conclusion can however be drawn from a crude percentage of this kind. Dairy produce being by far the most liable to fraudulent manipulation, it follows that if all the samples had been milk and butter, the percentage would have been higher. On the other hand, the articles least liable to be tampered with are tea and loaf sugar, the one being examined by the Customs and the other a crystalline substance difficult to supplant by a cheaper material; if these articles had formed the greater part of the samples, then the amount of adulteration would have been practically a negative quantity. On the other hand the percentage of adulteration in any single article, such as milk, affords a rough sort of guide to the prevalence or not in the district of adulteration of that particular article; there are, however, fallacies here, for it depends much as to the manner in which the samples are obtained whether the offenders are caught or not. Dairy Produce. Of 236 samples of milk 16, or just under 7 per cent., were certified as adulterated. In 6 out of the 16 milk fat was deficient in varying quantities from 8 up to 36 per cent.; in others the offence was watering from a minimum of 3 per cent. ii. up to a maximum of nearly 29 per cent. 103 of all the milks were more or less artificially coloured, mostly with a mixture of annatto and an aniline dye. The colouring is added to give a faint tinge of yellow to white milk, so that the customer may imagine he is being supplied with a fine rich milk coloured with the natural lacto chrome from the cow. It is highly desirable that this addition should be prohibited as unnecessary and deceptive. Very few milks had any preservatives added : the raid against preservatives in milk has had an excellent effect. Butter. 113 butters were examined; of these 7 were margarines and therefore adulterated. Fifty-four of the butters contained boric acid, the quantities varying from a few grains up to 35 grains per lb. Here again the various convictions throughout the country of vendors putting large quantities of preservatives such as 40 to 50 grains of boric acid to the lb., has done good. It is rare now to find a heavily boraxed butter. Cream. Fourteen samples of cream were analysed; five contained small quantities of boric acid. Spirits. Thirty samples of spirits were analysed, viz., ten of whisky, five of brandy, six of rum, and nine of gin; as a rule the spirits were not only genuine but of good quality. One brandy was found to be below the legal strength. Drugs. More articles coming under the British Pharmacopoeia were analysed than in former years. Although the analysis of drugs is not easy, especially of certain complicated compound medicines, yet the analyst has the great advantage of usually having some sort of standard to work by. 111 drugs were analysed, and in one case only—a sample of Gregory's powder—was a certificate of adulteration given. The powder had been carelessly compounded, the magnesia being 26 6 per cent, instead of 66.6 per cent. iii. Miscellaneous. It may be noted that a conviction was obtained for a cocoa in which the weight had been increased by an admixture with a red sand. Of six samples of bacon, three contained boric acid, 38 and 43 grains to the pound ; a beef sausage contained 29.4 grains of boric acid to the pound ; and a saveloy 10.4 grains to the pound. What with the common occurrence of boric acid in cream, butter, sausages and bacon—all ordinary breakfast articles, although but little may be in each, yet, considering the aggregate, many of us get well disinfected below the belt before commencing the day's work. The writer prefers to trust to his own fluids to keep down inimical microbes. A. Wynter blyth. R 1/67