CHE 3 ANNUAL REPORT For 1895, OF THE Medical Officer of Health. LOUIS C. PARKES, M.D.; D.P.H. Lond. Univ.; M.R.C.S. Eng. fellow of the sanitary institute and member of the board of examiners; fellow of the society of medical officers of health; member of council of the epidemiological society; lecturer on hygiene and public health at st. george's hospital medical school. TOWN HALL, KING'S ROAD, CHELSEA. 1896. ANNUAL REPORT For 1895, OF THE Medical Officer of Health. LOUIS C. PARKES, M.D.; D.P.H. Lond. Univ.; M.E.C.S. Eng. fellow of the sanitary institute and member of the board of examiners; fellow of the society of medical officers of health; member of council of the epidemiological society; lecturer on hygiene and public health at st. george's hospital medical school. TOWN HALL, KING'S ROAD, CHELSEA. 1896. TABLE OF CONTENTS. SEC. I.—STATISTICAL page. Population of Chelsea 3 Births and Birth-rate 3 Deaths and Death-rate 3 Table of Deaths (Local Government Board Form) 8 Table of New Cases of Infectious Sickness (do.) 9 SEC. II.:— The Notification of Infectious Diseases— Small-pox 10 Scarlet Fever, Diphtheria, and Enteric Fever 10 The Case Mortality 12 Removal of Patients to Hospital 13 Vital Statistics of Kensal Town in the five years, 1891-5 13 The Water Supply of Chelsea 15 Special Reports 15 SEC. III.:— Work of the Public Health Department— Summary of Nuisances and other matters reported on 17 Magisterial proceedings during 1895 19 List of Bake-houses, Cow-houses, and Slaughter-houses 22 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, For 1893. Section I.-STATISTICAL. POPULATION OF CHELSEA. The estimated population of Chelsea to the middle of the year 1895 is 99,929. The estimated population of each sub-district is as follows:— Chelsea North 41,200 Chelsea South 33,921 Kensal Town 24,808 BIRTHS AND BIRTH-RATE FOR 1895. Table I. gives the births and birth-rate per 1,000 per annum in each district of Chelsea, in the whole parish, and in London. Table I. Number of Births. Birth-rate per 1,000. Chelsea North 1,188 28.93 Chelsea South 840 24.85 Kensal Town 695 28.11 Whole Parish 2,723 27.34 London 133,715 30.55 In 1891 the birth-rate of Chelsea was 29.1; in 1892 it was 28.7; in 1893 it was 29.2; and in 1894 it was 27.4. DEATHS AND DEATH-RATE FOR 1895. The total number of deaths registered in the parish was 2,002. Of this total 323 were deaths, within the district, of non-parishioners— chiefly occurring in the hospitals in the parish; and 241 deaths of parishioners of Chelsea occurred outside the district in various public institutions. There were, therefore, 1,920 deaths of parishioners of Chelsea. These 1,920 deaths are equivalent to a death-rate for the year of 19.28 per 1,000. The death-rate of all London for the year was 19.86. 4 The following Table II. gives the death-rates of Chelsea and of London during the past 12 years:— Table II. Year. Chelsea. London. Death-rate per 1,000. Death-rate per 1,000. 1884 21.4 20.8 1885 22.7 20.3 1886 21.6 20.5 1887 22.0 20.3 1888 19.6 19.3 1889 18.6 18.3 1890 20.4 21.5 1891 21.0 21.4 1892 20.8 20.4 1893 20.0 21.3 1894 16.4 17.8 1895 19.3 19.9 The larger mortality in 1895 over that which characterised 1894, is in part attributable to the return of influenza in the early part of the past year, with its concomitant increase in deaths from diseases of the respiratory organs, and to the warmth of the summer season, when diarrhoeal diseases were unusually prevalent and fatal. The corrected death-rate of Kensal Town for 1895 was 14.6 per 1,000, as against 12.5 per 1,000 in 1894. The corrected death-rate of the home district (Chelsea, north and south) was 20.8 per 1,000, as against 17.6 per 1,000 in 1894. Zymotic death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 2.66 per 1,000 in 1895, the corresponding rate for London generally being 2.64 per 1,000. In 1891, the zymotic death-rate in Chelsea was 2.0 per 1,000; in 1892 it was 3.1 per 1,000; in 1893 it was 3.0 per 1,000; and in 1894 it was 2.5 per 1,000. Table III.—For the Year 1895. Birth-rate per 1,000. Death-rate per 1,000. Zymotic death-rate. Influenza death-rate. Phthisis death-rate. Other tubercular diseases death-rate. Respiratory diseases death-rate. Deaths under 1 year to 1,000 births. Percentage of deaths under 5 to total deaths. Chelsea 27.3 19.3 2.66 0.68 1.91 0.34 4.54 170 36.7 London 30.5 19.9 2.64 0.49 1.82 0.80 4.22 166 40.4 5 Only 11 deaths were attributed to Measles in 1895, as against 69 in 1894. The mortality from Whooping-cough was nearly identical with that of 1894, there being 35 deaths in 1895, as against 38 in 1894. The mortality from Enteric Fever (14 deaths) was equal to the average of the past 12 years. Diphtheria.—57 deaths were due to this disease, as against 49 deaths in 1894, the average of the 11 years, 1884-1894, being 32 deaths annually. Chelsea's figure for the past year is now in excess of Chelsea's proportion of the total diphtheria deaths in London (see Table V.). It is noteworthy that whilst diphtheria as a cause of death has been steadily increasing since 1891, croup has been decreasing. In 1895, no deaths were registered as being due to croup. This is probably due to the fact that illness, which would formerly have been certified as croup by the medical attendant, is now returned as diphtheria. The following (Table IV.) shows the annual mortality in Chelsea from diphtheria and croup during the 12 years, 1884-95, and whilst it is very suggestive of the fact that the preventive measures which are now taken to control the spread of this disease have had little or no effect in diminishing its mortality, yet it also shows that throat disease of a fatal character was as prevalent in 1884-5 as it has been in 1893-4-5. Table IV.—Fatal Throat Disease in Chelsea in 12 Years. Year. Diphtheria. Croup. Diphtheria and Croup. 1884 31 30 61 1885 33 21 54 1886 28 10 38 1887 19 7 26 1888 14 9 23 1889 23 9 32 1890 56 8 64 1891 16 14 30 1892 34 13 47 1893 48 9 57 1894 49 5 54 1895 57 — 57 Scarlet Fever.—This disease was again very prevalent in 1895, and is credited with the causation of 25 deaths. During the last quarter oi the year the Metropolitan Asylums Board Fever Hospitals were unable to admit all the patients applying for admission, and, in consequence numerous cases in Chelsea experienced a delay of one or more days in removal, whilst others were treated in their own homes during the entire period of illness. 6 Table V.—Zymotic Disease Mortality in Chekea in 1895. Actual number of Deaths in Chelsea. Chelsea's proportion of total London Deaths according to its population. Small Pox 1 1 Measles 11 60 Scarlet Fever 25 19 Diphtheria 57 53 Whooping Cough 35 34 Enteric Fever 14 14 Diarrhœa 123 82 Influenza 68 49 The Diarrhœa mortality was more than double that which occurred in 1894. The heat and drought of the summer season of 1895 were in marked contrast with the temperature and rainfall prevailing in 1894, and, as usually occurs, there was a notable prevalence of infantile diarrhoea in the hot, dry season. Table VI.—Zymotic Mortality in Chelsea. Deaths in 1895. Average number of Yearly Deaths in 1884-94. Measles 11 62 Scarlet Fever 25 17 Diphtheria 57 32 Enteric Fever 14 14 Whooping Cough 35 60 Influenza.—The number of deaths referred to influenza, as a primary or secondary cause of death, amounted to 68 in 1895, as against 28 in 1894, 33 in 1893, 84 in 1892, 90 in 1891, and 18 in 1890. In London, deaths have been recorded from influenza in every week in the year, amounting to a total of 2,156. But of this total no fewer than 1,570 deaths, or 72.8 per cent, of the total, occurred in the 6 weeks ending March 30th. Respiratory Diseases.—The death-rate from diseases of the respiratory organs was 4.54 per 1,000, or 1.54 per l,000higher than in 1894, which was the lowest recorded rate of the 10 years preceding. The increased rate of mortality in 1895 is in greater part attributable to the prevalence of influenza, of which disease pneumonia is at the same time a common and very serious complication, and in less part to the long period of excessive cold in the early part of the year. 7 Table VII.—Respiratory Diseases. Death-rate per 1,000 per Annum. Years. Chelsea. London. 1884-89 (inclusive) 4.3 4.2 1890 (1st Influenza Epidemic) 4.4 5.0 1891 (2nd „ „ ) 5.5 5.3 1892 (3rd „ „ ) 4.8 4.6 1893 (4th „ „ ) 4.3 4.6 1894 3.0 3.4 1895 (5th „ „ ) 4.5 4.2 Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1895 was 2.25 per 1,000, as against 2.62 in London generally. The average death-rate from these diseases in Chelsea during the 11 years 1884-94 was 3.04 per 1,000. Cancer.—Malignant cancerous diseases caused 75 deaths amongst Chelsea parishioners. This is equal to the average of the 11 years 1884-94. Chelsea's proportion of the total London deaths from cancer in 1895 is 82. Deaths in Public Institutions.—In 1895, 28.8 per cent, of the total deaths of parishioners of Chelsea occurred in public institutions, the average for the 4 years 1891-2-3-4 being 31.6 per cent. In 1895, 14.1 per cent, of the total deaths of parishioners occurred in the Chelsea Workhouse and Infirmary, the average of the 4 years 1891-2-3-4 being 15.1 per cent. 8 TABLE OF DEATHS during the Year 1895, in the Metropolitan Sanitary District of Chelsea; classified according to Diseases, Ages, and Localities. Nambs of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Mortality from all causbs, at subjoined ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age.. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Small-pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Chelsea North, exclusive of Public Institutions 566 158 64 17 13 187 127 Under 5 ... ... 6 ... ... ... ... ... ... ... 1 4 9 46 ... ... 65 ... 7 8 76 222 5 upwds. ... 1 3 ... ... 3 ... ... 2 ... 1 ... 1 2 1 50 81 28 29 6 136 344 Chelsea South, exclusive of Public Institutions 466 140 64 22 16 140 84 Under 5 ... 3 7 ... ... ... ... ... ... ... 2 5 4 30 ... ... 63 1 ... 3 86 204 5 upwds. ... 2 3 ... ... 2 ... ... ... ... 1 ... ... 1 2 34 69 24 17 14 93 262 Kensal Town 288 117 48 13 9 62 39 Under 5 ... 2 1 ... ... 1 ... ... ... ... ... 1 14 28 ... ... 39 ... 3 3 73 165 5 upwds. ... 1 1 ... ... 1 ... ... ... ... ... ... 1 3 ... 21 30 14 10 1 40 123 Workhouse and Infirmary 280 25 11 2 13 136 93 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 4 4 ... ... 6 1 ... ... 21 36 5 upwds. ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 1 54 63 22 2 1 98 244 Brompton Hospital 105 ... 2 1 31 71 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 5 upwds. ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 88 2 6 ... ... 6 103 Cancer Hospital 87 ... ... ... 2 73 12 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 2 ... 82 87 Hospital for Women 11 ... ... ... ... 11 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 10 11 Royal Hospital for InPensioners 47 ... ... ... 1 16 30 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 15 12 ... ... 18 47 Victoria Hospital for Children 137 55 54 28 ... ... ... Under 5 ... ... 1 ... ... 1 ... ... ... ... ... ... 2 19 ... 4 30 2 ... 2 48 109 5 upwds. ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 4 2 3 ... 2 14 28 Cheyne Hospital St. Camillo's Hospital Lying-in House of St. John 15 5 ... 6 1 2 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 9 10 Totals 2002 500 243 89 86 698 386 Under 5 ... 5 15 ... ... 2 ... ... ... ... 3 10 33 127 ... 6 203 4 10 16 309 743 5 upwds. 4 11 ... ... 7 ... ... 2 ... 3 ... 2 7 4 256 263 110 60 24 506 1259 The subjoined numbers have also to be taken into account in judging of the above Records of Mortality. Deaths occurring outside the district among persons belonging thereto 241 14 44 26 23 114 20 Under 5 1 12 20 ... ... ... ... ... ... ... ... 1 2 5 ... ... 3 ... ... 3 11 58 5 upwds. ... 4 13 ... ... 6 ... ... 1 ... ... ... ... ... ... 26 14 18 1 17 83 183 Deaths occurring within the district among persons not belonging thereto 323 50 46 26 34 155 12 Under 5 ... ... 1 ... ... 1 ... ... ... ... ... ... 2 16 ... 6 25 2 ... 2 41 96 5 upwds. ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 92 6 10 3 1 113 227 9 TABLE OF POPULATION, BIRTHS, AND OP NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge op the Medical Officer of Health during the Year 1895, in the Metropolitan Sanitary District of Chelsea; classified according to diseases, ages, and localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Population at all ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the medical officer of health. Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospital. Census, 1891. Estimated to middle of 1895. Small-pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Small-pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerpereal. (a) (b) (c) (d) (e) 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 IO 11 12 13 Chelsea Home District 74,485 75,121 2028 Under 5 ... 96 104 ... ... 1 ... ... ... ... 9 ... ... ... 60 66 ... ... 1 ... ... ... ... ... ... ... 5 upwds. 1 260 185 2 ... 63 1 ... 5 ... 68 ... ... 1 109 112 ... ... 33 ... ... 1 ... ... ... ... Public Institutions:— Chelsea Infirmary ... ... ... Under 5 ... 16 2 ... ... ... ... ... ... ... ... ... ... ... 16 2 ... ... ... ... ... ... ... ... ... ... 5 upwds. 2 13 2 ... ... 1 ... ... 1 ... 3 ... ... 2 13 2 ... ... 1 ... ... ... ... ... ... ... Chelsea Workhouse ... ... ... Under 5 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 8 ... ... ... ... ... ... ... ... 2 ... ... ... 8 ... ... ... ... ... ... ... ... ... ... ... St. George's Infirmary ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Victoria Hospital ... ... ... Under 5 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 3 3 ... ... ... ... ... ... ... ... ... ... ... 3 3 ... ... ... ... ... ... ... ... ... ... Duke of York's Schools ... ... ... Under 5 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 55 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Consumption Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chelsea Barracks ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Kensal Town 21,787 24,808 695 Under 5 ... 36 8 ... ... 1 ... ... ... ... 1 ... ... ... 20 3 ... ... ... ... ... ... ... ... ... ... 5 upwds. 1 93 24 ... ... 9 ... ... 2 ... 19 ... ... ... 49 11 ... ... 4 ... ... 1 ... 1 ... ... Totals 96,272 99,929 2723 Under 5 ... 154 117 ... ... 2 ... ... ... ... 10 ... ... ... 100 74 ... ... 1 ... ... ... ... ... ... ... 5 upwds. 4 469 215 2 ... 74 1 ... 8 ... 93 ... ... 3 244 131 ... ... 38 ... ... 2 ... 1 ... ... 10 Section II. THE NOTIFICATION OF INFECTIOUS DISEASES. Small-Pox.—In Chelsea 4 cases of this disease were notified in 1895, as occurring amongst Chelsea parishioners. Three of these cases occurred in the home district, and one in Kensal Town. In 1894 there were 12 cases of small-pox in Chelsea; in 1893 there were 29 cases; and in 1892 four cases. In London, during 1895, 1,076 cases of smallpox were notified, as against 1,391 cases in 1894, 2,933 cases in 1893, and 436 cases in 1892. There was very little small-pox—only 46 cases— in 1895, in the 8 parishes which form the western district of London. SCARLET FEVER, DIPHTHERIA, AND ENTERIC FEVER. Table VIII. shows the comparative prevalence of these diseases in London, and in the western districts of London, during 1894 and 1895. Table VIII.—Notifications in 1894 and 1895 per 10,000 of Population (1891 census). Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. *London 1894 1895 1894 1895 1894 1895 1894 1895 3.30 2.55 45.0 49.0 26.4 27.1 8.41 8.81 Chelsea 1.25 0.42 32.8 64.7 25.2 34.5 9.87 7.90 Kensington 1.08 0.48 23.4 31.6 16.1 21.9 5.41 5.95 * Fulham 5.02 0.22 59.7 38.5 36.3 42.4 4.58 7.09 * Hammersmith 0.82 0.82 34.7 40.2 19.1 21.0 5.86 6.07 * Paddington 2.55 1.10 25.6 37.4 33.4 20.9 6.36 6.19 * St. George's, Hanover Square 1.53 0.51 3.43 41.7 14.8 14.5 9.44 5.23 * Westminster 0.18 1.08 2.66 33.6 14.6 20.1 8.46 5.03 * St. James's 1.60 0.40 26.0 37.6 15.2 19.6 .10.00 5.60 *Uncorrected for dual notification. The most noticeable feature of the past year is the greatly increased prevalence of scarlet fever in Chelsea, as compared with 1894. The amount of scarlet fever in Chelsea in 1895 was even in excess of that which prevailed in 1893, when the notifications of this disease in London generally were double the number of those received in the past year. It will also be seen from Table VIII. that Chelsea was the only western district which suffered in 1895 from an excess of scarlet fever. All the other seven west-end parishes, without an exception, show a figure considerably below that of the Metropolis, whereas Chelsea's figure is over 30 per cent, in excess of that characterising London generally. 11 Out of the total of 623 cases, 57 occurred in the Duke of York's Royal Military School, and 41 in the Chelsea Workhouse and Infirmary. The Hospitals of the Metropolitan Asylums Board became very full in the last quarter of the year, and not only was there delay in the removal of cases to the Hospitals, but many cases were kept at home which would have been tranferred to Hospital had there been accommodation for them. Second, third, and even fourth cases of scarlet fever have occurred within short periods of each other in a house invaded by the disease, and the majority of these secondary cases have arisen in houses where there was either a delay in removing the initial case, or where the initial case was kept at home during the whole period of the disease. The inability of the Metropolitan Asylums Board Fever Hospitals to receive scarlet fever cases does not explain the exceptional incidence of the disease upon Chelsea, as the surrounding parishes laboured under a similar disadvantage. Removal to hospital was effected in 55.2 per cent, of the Chelsea cases, or excluding the 57 cases at the Duke of York's School, which were isolated in the school infirmary forming part of the school buildings, 60.8 per cent, of the cases were removed to hospital, as compared with 71 per cent, in 1894. Out of the total 623 cases, 129, or 20.7 per cent., belonged to Kensal Town, which shows that the disease was not quite so prevalent in Kensal Town as in the home district, the population of Kensal Town, according to the 1891 census, forming 22.63 per cent, of the population of the whole parish of Chelsea, or, if we take the estimate for 1895, forming 24.8 per cent, of the population of the whole parish. Out of the total 494 cases of scarlet fever occurring in the home district in 1895, 250, or 50.6 per cent, were notified in the last four months of the year. This aggravated prevalence in the autumn months is a usual feature, not only in scarlet fever, but also in diphtheria and in enteric fever, and has caused in the past autumn a large increase of work to the officers of the Public Health Department. Diphtheria was considerably more prevalent in Chelsea in 1895 than in 1894, and Chelsea's figures for 1895 will be seen from Table VIII. to be in excess of the figure characterising the metropolis as a whole. There is only one western parish, namely Fulham, which has a higher incidence rate for diphtheria in 1895 than Chelsea. If we exclude Kensal Town, and take the home district alone, the incidence rate of diphtheria in 1895 per 10,000 of the home district population is 39.9, or but very little below the figure of Fulham (42.4). Like scarlet fever, the prevalence of diphtheria was at its maximum in October, November, and December, when the Metropolitan Asylums Board Fever Hospitals were crowded with patients, but there was very much less difficulty and delay in effecting the removal of diphtheria cases than of scarlet fever. Removal to hospital was effected in 61.7 per cent, of the diphtheria cases as compared with 58 per cent, in 1894. The excessive prevalence of diphtheria was practically confined to the home district, the number of cases occurring in Kensal Town in the year under review being only 32, or 9.6 per cent, of the total cases, whereas in proportion to its census 12 population, Kensal Town should have taken 23 per cent, of the total cases, or in proportion to its 1895 estimated popoulation 24.8 per cent, of the total cases, that is to say 82 cases of this disease instead of only 32. Out of the total 300 cases of diphtheria occurring in the home district in 1895, 147, or 49 per cent., were notified in the last four months of the year. Enteric Fever showed a slight decrease in 1895, as compared with 1894. As usual, the greatest prevalence was in the last four months of the year, 45 out of the total of 66 cases in the home district, or 68.2 per cent., having been notified in these months. It it probable that a considerable percentage of these cases contracted the infection outside Chelsea. The number of cases of enteric fever occurring in Kensal Town in 1895 was only 10, or 13.2 per cent, of the total 76 cases in the parish. In proportion to its 1895 estimated population, Kensal Town should have had 24.8 per cent, of the total, that is to say 19 cases. The following Table IX. shows the case mortality, or percentage of deaths to notifications, of scarlet fever, diphtheria, and enteric fever in Chelsea and in London in each of the six years 1890-5. Table IX.—Case Mortality in Chelsea and in London, 1890-5. Scarlet Fever. Diphtheria. Enteric Fever. Chelsea. London. Chelsea. London. Chelsea. London. 1890 7.0 5.7 20.1 24.1 17.4 23.0 1891 3.6 5.1 9.6 22.5 17.4 15.6 1892 5.3 4.3 22.2 23.9 13.6 17.2 1893 5.3 4.3 20.8 24.5 22.1 18.4 1894 5.1 5.1 20.2 24.0 14.7 17.9 1895 4.0 4.0 17.2 20.3 18.4 16.5 This Table shows that, as regards scarlet fever, the type of the disease prevailing in Chelsea, judging from the tendency to a fatal termination, corresponds very closely with that common to the metropolis as a whole. Diphtheria, excluding from consideration the year 1891, which was exceptional, appears to be in Chelsea somewhat less fatal than the same disease in London generally, and this apparent mildness of type is exhibited to nearly the same extent in each of the years under review. The small number of cases of enteric fever occurring in any one year in Chelsea are insufficient to exclude purely accidental fluctuations in the case mortality. Table X. exhibits the removals of patients suffering from scarlet fever, diphtheria, and enteric fever from their homes to hospitals, in each of the six years 1890-5, expressed as percentages of the total number of cases notified. 13 Table X.—Percentage Removals to Hospitals. Scarlet Fever. Diphtheria. Enteric Fever. Per cent. Per cent. Per cent. 1890 37 20 29 1891 40 15 22 1892 48 27 32 1893 50 41 38 1894 71 58 63 1895 55 62 51 VITAL STATISTICS OF KENSAL TOWN IN THE FIVE YEARS 1891-5. It is of some interest to compare the mortality and infectious disease figures of Kensal Town with those of the home district. The population of Kensal Town being comparatively a small one, it is necessary to take the figures of a period of some years in duration in order to avoid the errors inseparable from paucity of data, and to arrive at conclusions to which some weight can be attached for the purposes of comparison. The average annual birth-rate of Kensal Town during the 5 years 1891-5 is 30.2 per 1,000. The average annual birth-rate during the same period for the home district is 27.6 per 1,000. The average annual death-rate of Kensal Town for the 5 years is 15.34 per 1,000, the corresponding rate for the home district being 20.76 per 1,000. Some small part of this difference of 5.42 per 1,000 in the death-rate may be accounted for by the age-distribution of the Kensal Town population being more favourable to a low death-rate than the age-constitution of the home district population, but there are no published figures available for making the necessary correction. Judging from the death-rate it must be concluded that the average population of Kensal Town is either healthier than the average of the home district, or that the people at Kensal Town are less exposed to risks and dangers inimical to health and life than those of Chelsea proper. As regards deaths from the seven principal zymotic diseases, there is not much difference between Kensal Town and the home district. The average annual zymotic death-rate for the 5 years 1891-5 is for Kensal Town 2.6 per 1,000, and for the home district 2.7 per 1,000. As regards the particular diseases forming this class there are some differences in Kensal Town and the home district which will be best shown as in Table XI., by expressing the mortality from each disease of Kensal Town parishioners in the 5 years as a percentage of the total mortality of the parish. 14 Table XI.—Kensal Town Mortality expressed as a Percentage of the Total Mortality of the Parish (1891-5). Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Measles. Whooping Cough. Diarrhoea. Phthisis. Respiratory Diseases. 25∙9 22∙4 15∙2 17∙0 33∙9 20∙5 17∙3 16∙8 Small-pox, one of the zymotic diseases, has been omitted from the group, as the mortality from it in the past five years has been inconsiderable, whilst phthisis and respiratory diseases have been included. The average population of Kensal Town for the five years 1891-5 formed 23∙8 per cent, of the average population of the whole parish, so that in comparison with its population, Kensal Town has suffered considerably more from whooping cough, and slightly more from scarlet fever in the five years than the home district, but as regards all the other diseases mentioned in Table XI. its death-rate has been lower than that of the home district. The compulsory notification of infectious diseases has been in force since the beginning of 1890, so that there are figures available for comparison for a period of 6 years. During this period the number of cases of scarlet fever notified amongst Kensal Town parishioners has been 21∙9 per cent, of the total scarlet fever cases notified in the parish; the number of cases of diphtheria and membranous croup in Kensal Town has been 21∙8 per cent, of the total; and the number of cases of enteric fever only 130 per cent, of the total. There has, therefore, on the average of 6 years, 1890-5, been a somewhat less prevalence of scarlet fever and diphtheria in Kensal Town than in the home district, and very much less prevalence of enteric fever. As regards diphtheria and membranous croup, it is worthy of remark that if the figures of the year 1890—the first year of compulsory notification—are excluded, Kensal Town stands in a very much better position. In this year (1890) the Kensal Town cases formed no less than 43∙3 per cent, of the total cases notified in the parish, whilst the average of the 5 years, 1891-5, is only 16 per cent. There was certainly an exceptional prevalence of diphtheria in Kensal Town in this year (1890), as the mortality corresponded to the notifications, the Kensal Town deaths from diphtheria forming 43 per cent, of the total diphtheria deaths in the parish. In Kensal Town during the period under review there were 159 deaths of infants under one year to 1000 births, the corresponding number in the home district being 154. The deaths of children under 5 years of age in Kensal Town formed 48∙4 per cent, of the total 15 Kensal Town mortality, whilst the deaths under 5 years of age in the home district formed only 33∙1 per cent, of the total home district mortality. On the whole, it may be concluded that the average standard of public health in Kensal Town is superior to that of the home district, for the general death-rate is lower, and there is a smaller prevalence of, and mortality from, preventable zymotic disease. It is true that there is a larger infantile mortality in Kensal Town than in the home district, but this is accompanied by a higher birth-rate in the former district. There can be no question that the natural increase of population in Kensal Town by excess of births over deaths is very much greater in Kensal Town than in the home district. According to the census of 1891, the population of Kensal Town formed 22∙63 per cent. of the population of all Chelsea. The natural increase in the 5 years that have elapsed since the census is 2,745, which would give a population in April, 1896, of 24,532, forming 24∙3 per cent, of the population of the entire parish. The estimated population for April, 1896, which assumes that the rate of increase between 1881 and 1891 has remained constant up to the present time, is even higher, being 26,215 or 26 per cent, of the population of the entire parish. It is probable that the census shortly to be taken will disclose a figure for Kensal Town somewhere between the two estimates above given. THE WATER SUPPLY OF CHELSEA. The quality of the water supplied to Chelsea in 1895 was up to the average standard. The examinations of the Official Analyst for the Local Government Board show that about 98∙7 per cent, of the bacteria present in the unfiltered Thames water at Hampton are removed by the processes of subsidence and filtration carried out by the Chelsea Water Works. The largest number of microbes present in a cubic centimetre of the Chelsea water was 232 (in February), and the smallest number 4 (in October), the average for the year being 56, which falls below Professor Koch's dictum that portable water should not contain more than 100 microbes per cubic centimetre. Constant Supply.—The percentage of house supplies on the constant system in the Chelsea Company's district was 73 at the end of the year 1895, as against 63 at the end of the year 1894. The whole of the parish (home district) should now be receiving a constant supply of water. SPECIAL REPORTS. During the past year I have had the honour to present special reports on the under-mentioned subjects for the consideration of the Yestry:— January 22nd.—Receptacles for dung at 225 and 257, Pavilion-road. February 5th.— Eemoval of fish offal: the frost and frozen waterpipes: Cadogan Lodge, Pavilion-road: Public Health (London) Act, section 60, sub-section 4 (thelprovision of shelters): Metropolitan Asylums Board ambulance service. 16 February 19th.—No. 294, Kensal-road : combined drainage. April 2nd.—The excessive mortality during the 7 weeks ended March 23rd. June 11th.--Amendment of the definition of the words "sewer" and drain. July 9th.—Public Health (London) Act, section 55, and the School Board for London. July 23rd.—The public mortuaries : No. 232, Kilburn-lane. July 30th.—The Vestry v. Marshall (owner of 117, Walton-street). September 24th.—Small-pox in Chelsea : nuisance on unoccupied land in Kensal Town. October 8th.—Removal of cow-dung manure through the streets: sunken dung-pits. November 5th.—The drainage of Little Orford-street: nuisance on unoccupied land at Turks-row. November 26th.—Paradise-walk : infectious disease in the Marlborough-road district. WORK OF THE PUBLIC HEALTH DEPARTMENT. Appended are tabular statements, which give full information as to the detailed work of the department during the year 1895. I am, my Lord and Gentlemen, Your obedient Servant, LOUIS C. PARKES, Medical Officer of Health. 17 Section III. PUBLIC HEALTH DEPARTMENT. Summary of Nuisances and other matters reported on and Work done during the Year 1895. Houses and Premises :— Home District. Kensal Town. Total. * Reported on respecting nuisances complained of 925 264 1189 Reported on with reference to infectious cases 661 195 856 Cleansed, whitewashed and repaired 120 129 249 Defective roofs repaired 73 9 82 Disinfected after zymotic diseases 543 120 663 Cases of overcrowding abated 22 4 26 Dust-bins, new, provided 161 22 183 ,, repaired 28 25 53 Underground rooms reported as occupied contrary to Act 18 18 Houses closed as unfit for human habitation 10 - 10 Drainage :— Drains opened, cleansed and made sound 200 95 295 „ trapped with stoneware gullies Water-closets cleansed and repaired 106 22 128 ,, new pans and traps provided 186 28 214 Spout drains cleansed, repaired or renewed 96 73 169 Sink, bath, and lavatory waste pipes disconnected 109 16 125 Soil pipes ventilated or repaired 60 10 70 „ new, provided 50 — 50 New drains laid, in accordance with Vestry's regulations 78 3 81 Cesspools abolished 3 — 3 Water Supply:— For domestic purposes, provided where cut off by Water Company 73 11 84 For water closets, or check cisterns provided 234 58 292 Main cisterns cleansed or repaired 29 21 50 „ new, provided 10 2 12 Water butts abolished 8 — 8 Nuisances abated arising from— Keeping of animals 11 2 13 Accumulations of manure and other filth 33 17 50 Yards cleansed, paved, or drained 153 97 250 Smoke 2 1 3 Dung pits repaired, drained, &c., or cages, &c., provided 3 — 3 * This does not include re-visits to premises to ascertain works in progress, or premises visited where no nuisances were found to exist, which, if added, would at least treble the number of visits made. 18 Miscellaneous:— Home District. Kensal Town. Total. Dead bodies removed to public mortuary for sanitary reasons 4 3 7 Goods disinfected after infectious cases at station 2955 93 3048 Goods destroyed after infectious cases 32 — 32 Number of samples taken for analysis (Food and Drugs Act) 97 42 139 Unsound food. Number of boxes of fish, &c., condemned and destroyed 31 — 31 Proceedings taken:— Notices issued for sanitary works, &c., including infectious diseases notices 1213 271 1484 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 32 - 32 Legal proceedings in respect of food adulteration 6 2 8 Correspondence:— Number of letters written in connection with sanitary matters, including those of Medical Officer of Health 617 237 854 Daily returns of infectious cases sent to Metropolitan Asylums Board 273 - 273 Notification of infectious cases sent to School authorities 398 175 573 Entries in Inspectors' Report Books 876 195 1071 ,, Inhabitants' Complaint Book 73 — 73 Certificates of Disinfection given 489 40 529 The cow-houses and slaughter-houses were inspected by a SubCommittee of the Works and General Purposes Committee and Medical Officer of Health prior to licenses being renewed in October last, and a list of the retail bakehouses under inspection in Chelsea forms a separate Appendix. Sanitary Inspectors, ALEXANDER GRANT,} Home WILLIAM CHAS. LIGHTFOOT,} District. JAMES JOHN MACKAY, Kensal Town. 19 HOME DISTRICT. MAGISTERIAL PROCEEDINGS DURING 1895, UNDER SALE OF FOOD AND DRUGS ACT. Streets where purchased. Article. Extent of Adulteration. Date of Hearing. Result. College-street Milk 32% fat abstracted Jan. 29th Fine, £20. Costs, 16s. 6d. Stadium-street „ 33% added water April 23rd Fine, £3. Costs, 16s. 6d. Camera-square Butter 60% foreign fat May 7th Fine, 5s. Costs, 11s. 6d. Seaton-street „ 75 % „ „ 21st Fine, £1. Costs, 11s. 6d. Lawrence-street „ 40 % „ „ „ Fine, £1. Costs, 11s. 6d. Marlborough-road Coffee 60% chicory June 25th Fine, 10s. Costs, 10s. 6d. KENSAL TOWN. Kensal-road Butter 40% foreign fat July 20th Fine, 10s. Costs, 12s. 6d. Church-place Milk 12% added water Dec. 13th Fine, 7s. Costs, 12s. 6d. Total Fines, £26 12s. Costs, £5 3s. HOME DISTRICT. MAGISTERIAL PROCEEDINGS UNDER PUBLIC HEALTH (LONDON) ACT, 1891. Address of Premises. Nature of Nuisance or Complaint. Date of Hearing. Result. 6, Davis-place Dirty and dilapidated state of premises, defective w.c., defective yard surface 1895. April 2nd Premises closed, as unfit for human habitation. 24, Riley-street Foul and defective w.c., defective drain inlets, dust bin, rain-water gutters and pipes, dirty and dilapidated state of premises „ 2nd " " " " 29, Worlds Endpassage Want of a proper w.c., defective gutters and pipes „ 2nd " " " " 118 & 119, Cheyne walk Accumulation of filth, defective yard surface ,, 2nd Order for work to be done in 7 days. May 5th Line £2 14s., costs 2s. For non-compliance with order June 4th „ £2 14s., distress, or 14 davs Pipe Factory, Davisplace Want of a w.c. for use of workpeople, filthy and dilapidated state of premises April 2nd Adjourned sine die. 1, D'Oyley-street Foul and defective w.c., foul and defective drains, defective dust bin „ 9th Work done at day of hearing. Summons withdrawn. Eatley-buildings Foul and defective w.c.'s, defective dust bins „ 23rd Order for work to be done in 7 days— 2s. costs. Oxford House, Dartrey-road Foul and obstructed drains, defective dust bins, filthy and dilapidated state of premises ,, 23rd Cranley House, Vicat-street Foul and defective w.c.'s, foul and untrapped sink waste pipes, obstructed drain, filthy and dilapidated state of premises These 3 summonses were heard together, and adjourned to the 30th, when orders, for the work to be done in 7 days, were made, with £2 2s. costs. Craigside House Foul and defective w.c.'s, foul and untrapped sink wastes, dirty and dilapidated state of premises 45, Langton-street No water to premises May 7th Closing order made. Fine £2, costs 12s. „ 21st Line £3 10s., costs 10s. For non-compliance with closing order. June 11th ,, £1 10, Shawfield-street Foul and defective drain, foul and defective w.c.'s, foul and defective sink wastes, defective soil pipe May 28th Adjourned to June 11th and withdrawn on payment of 1s. costs. Work done. 38, Margarettaterrace Foul and obstructed drains, foul and defective w.c.'s, defective soil pipe June 4th Order for work to be done in 7 days— 1s. costs. 34, First-street Foul and obstructed drains, defective traps, rain-water pipes and gutters, w.c., dust bin, &c. „ 11th „ „ „ „ 1s. costs. 117, Walton-street Defective drains July 30th Order for 14 days. Defendant appealed to Quarter Sessions and order was quashed November 11th. Vestry's appeal still pending in Queen's Bench Division. 6, East-street Foul and defective drains Aug. 6th Order for work in 14 days. 31, Edith-grove Want of water to premises „ 23rd Closing order—23s. costs. Crooked Usuage Non-removal of manure Sept. 2nd Penalty £2, distress or 14 days. North-street Removing offal during prohibited hours (H. Dredge) Aug. 8th Fined £2, costs 23s. King's road ... ... „ „ „ (J. Bacon) „ 23rd „ 10s., „ 23s. Flood-street „ „ „ (J- Bacon) Sept. 18th „ £2, „ 23s. King's road „ „ „ (J. Phillips) Oct. 1st „ 10s., „ 5s. 6d. Sydney Street „ hog wash „ (F. Strudwick) „ 1st „ 10s., „ 2s. 6d. King's-road „ offal „ „ (J. T. Phillips) „ 8th... „ 20s., „ 5s. Blantyre Stables Defective drain inlets, w.c., yard surface, &c., filthy premises, &c. „ 8th Closing order made. Leader-street Removing offal during prohibited hours (J. Page) „ 8th Fined £1, costs 5s. „ „ „ „ „ (H. Dredge) „ 15th „ £2, „ 5s. Dartrey-terrace „ „ „ (Wm. Stannard) „ 15th ,, £1, „ 5s. Cale-street „ „ „ (J. Page) ,, 22nd Dismissed for want of eorroborative evidence. Albert-place „ „ „ „ (J. Pond) „ 22nd „ „ „ „ Orme-yard, Pondterrace Defective paving in yard, open drain, and defective dung pit ,, 29th Order for 14 days £2 2s. costs. 16, Wellingtonsquare Defective roofs Nov. 19th Order for 7 days—£2 2s. costs. Dec. 10th Penalty £1 6s., costs £2 2s. for noncompliance with Magistrate's order. 2, Edith-grove Want of water to premises „ 17th Water on, on date of hearing. Summons withdrawn. Thomas Bingham Using abusive language to the Inspector in the public streets June 19th Bound over to keep the peace for 6 months, himself in £20 and 2 Sureties in £10 each, or to go to prison for 1 month. 22 BAKEHOUSES IN USE ON JANUARY 1st, 1896. Street. Occupier. Above Ground. Below Ground. 74, Arthur-street Solomon Keppler. ...... Below. 93, Beaufort-street A. Coventry ...... „ 26, Blantyre-street Fox ...... „ 55, Burnaby-street W. Snelling ..... „ 1, Cadogan-street Summers ...... „ 2, Cale-street Judkins Above. 77, Cheyne-walk Spells ...... Below. 20, Church-street Bauer ...... „ 60, College-street E. A. Stead ...... „ 17, Coulson-street Brust ...... „ 3, Dartrey-terrace Knee ...... „ 67, Flood-street J. Venner ...... „ 95, „ Gass ...... „ 153, Fulham-road C. M. Nash ...... „ 187, „ S. Young ...... „ 323, „ Burge ...... „ 395, „ Nunnee ...... „ 15, Green-street Bott ...... „ 53, Godfrey-street Becker ...... „ 102, Keppel-street Haynes ...... „ 83, King's-road J. Humphry ...... „ 47, „ Pennycuick ...... „ 88, „ Akast ...... „ 134, „ Buckea ...... „ 145, „ J. Humphry ...... „ 302, Musgrove ...... „ 351, „ Mardon ...... „ 399, „ Dohna ...... „ 414, „ Korle ...... „ 488, „ Matthews ...... „ 502, „ Batchelor ...... „ 23 Street. Occupier. Above Ground. Below Ground. 517, King'sroad Mackay ...... Below. 1, Leader-street H. Southey Above. ....... 48, Lots-road West ...... Below. 83, Lower Sloane-street Mills Above. ...... 43, Manor-street Essling ...... Below. 62, Marlborough-road Koumiss ...... „ 100, „ „ Reitze Above. ...... 110, „ „ Wordley „ ...... 23, Queen's-road Hilton ...... Below. 58, Eawlings-street Hannah ...... „ 14, Riley-street Bashford ...... „ 150, Sloane-street Penny cuick ...... „ 43, Stay ton-street Salzmann Above. ...... 117, Sydney-street J. Humphry ...... Below. 25, Walton-street Burrows ...... „ 46, „ Small ...... „ KENSAL TOWN DISTRICT. 551, Harrow-road J. Cumming Above. Below. 597, „ John Davey ...... „ 608, „ W. Y. Menzler Above. ...... 690, „ Heinrich Geissler „ ...... 62, Herries-street Fredk. Spohr ...... Below. 83, ,, A. Royston ...... „ 193, Kensal-road A. Webb ...... „ 300, „ Francis Frost Above. ...... 226, Kilburn-lane James Guscott „ ...... 12, Mozart-street Henry Geo. Taylor. „ 24 SLAUGHTER HOUSES. Street. Occupier. Crooked Usage Cridlan, P. and J. W. 169, Fulham-road Philp, J. 341, „ Foyer, W. 52, King's-road Cobb, G. A. 54, „ „ 413, „ Rowland, Mrs. 2, Little Smith-street Clayton, F. 82, Marlborough-road Iggulden, F. 90, „ „ 128, „ Cowlin, F. 273, Kensal-road Miles, A. COW-HOUSES. 54, Arthur-street (rear of) Jennings, J. Church-street Emerton, J. 406, King's-road Jordan, G. 3a, Leverett-street Robinson, F. 10, Stay ton-street Hughes, R.