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The death-rate in the Borough was only 18 - 3 per 1,000 ; the next lowest death-rate having been
20-0 per 1,000 in 1901, and 20-4 in each of the years, 1894 and 1897. The zymotic death-rate was
only 1"21 per 1,000 in comparison with 2-29 for the preceding year.
The sanitary and hygienic lessons to be learned from these records are the great importance of
making use of all means that will ensure increased purity of the air we breathe such as can be obtained
by the following measures. Good flushing of streets, gullies and drains; securing as much bright
sunshine as possible, and reducing obstructions to the movement of the air in our large towns by the
abatement of smoke nuisances, the demolition of narrow courts and allies, provision of parks and
other open-air spaces, and securing as much ventilation and through ventilation as possible in dwellings
and work-places.
During the year changes have taken place in the staff of the Public Health Department, due
to the resignations of Inspectors Freeman and Gregory, which took effect from the 30th September,
1903. The Public Health Committee and the Council agreed to my recommendation to appoint a
female Inspector, and Miss F. N. F. Lovibond was appointed and began her duties on December 28th,
1903. The other vacancy was not then filled up for the following reasons: —At the time of the
changes under the London Government Act, Inspector Freeman was engaged in the eastern part of
the area of the Holborn District Board of Works, a large portion of which was then transferred to the
Borough of Finsbury, and the Commissioners under the Act decided that Inspector Freeman should
be transferred to this Borough. A large demolition of premises has taken place, or is about to take
place, that has fortunately cleared away, or will shortly clear away, some of the most insanitary
premises in the Borough.
The prevention of consumption on various occasions during the year received the careful
attention of the Council and of the Public Health Committee, and on the 9th December, the Council
agreed that, during a period of twelve months to be computed from the Ist day of January next, any
medical practitioner attending on or called in to visit any patient in the Borough who is suffering
from consumption should be invited to send to the Medical Officer of Health a certificate in the same
form as that prescribed by the Local Government Board for the notification of infectious diseases, and
that in consideration of his doing so the Council should pay to him a similar fee to that to which he
would have been entitled had he been notifying a case of infectious disease.
In connection with the subject of Small-pox and the great importance and value of successful
Vaccination and Re-vaccination and the necessity for a Re-vaccination Act, I have given extracts
from the valuable report by Dr. R. Bruce Low, of the Local Government Board, on the arrangements
made in Germany for dealing with Small-pox, in which he shows that compulsory Yaccination and
Re-vaccination (and not isolation, as has been alleged) were Germany's great protectors against
Small-pox.
In his report he gives the number of recorded deaths from Small-pox in Germany and in
England and Wales during the twelve years 1891-1902 inclusive, and from these statistics I have
estimated that the Small-pox mortality in England and Wales was twenty times more than in
Germany during that period.
Under the heading Scarlet Fever I dealt with the question of the reduction of the stay of
patients in hospital, and gave extracts from a paper of mine published in "Public Health,"
February, 1903, showing that there had been an average reduction of more than a week in the
period of detention at the Metropolitan Asylums Board Hospitals which had been accomplished
without any corresponding increase in " return" cases. I also emphasised the importance of every
infectious hospital being well supplied with small isolation rooms or wards, and that ordinary wards for
Scarlet Fever, Diphtheria, and Measles should, if possible, be small rather than large, so as to lessen
the risk of spreading other infectious diseases accidentally introduced, and that patients at different
ages should be equally distributed as far as possible through the wards. In fact, fever hospitals
should be constructed so as to secure strict isolation as far as possible. This ideal system of
hospital construction exists at the Pasteur Hospital, Paris, which is in connection with the Pasteur
Institute. Some of the wards of the existing hospitals could with advantage and small outlay be converted
into the cubicle system. In this way the stay of patients in hospital might be still further