Thelsea Hestry. ANNUAL REPORT For 1897, 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. 1898. 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. :— Infectious Diseases— Small-pox 10 Scarlet Fever 10 Diphtheria 10 Enteric Fever 11 The Case Mortality 12 Removal of Patients to Hospital 12 Prevalence of Diphtheria and Scarlet Fever in the Parishes of West London from 1890 to 1897 12 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 1897 19 List of Bake-houses, Cow-houses, and Slaughter-houses 22 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For 1897. Section I.-STATISTICAL. POPULATION OF CHELSEA. The estimated population of Chelsea for the year 1897 is 96,745. The estimated population of each sub-district is as follows : — Chelsea North 42,163 Chelsea South 33,217 }5880 Kensal Town 21,365 BIRTHS AND BIRTH-RATE FOR 1897. Table I. gives the births and birth-rate per 1,000 per annum in the home district and in Kensal Town, in the whole parish, and in London. Table I. Number of Births. Birth-rate per 1,000. Home District 1,902 25.3 Kensal Town 647 30.4 Whole Parish 2,549 26.4 London 133,618 30.0 In 1896 the birthrate of the home district was 26.2, and of Kensal Town 29.9, the birth-rate of the whole parish being 27.0. DEATHS AND DEATH-RATE FOR 1897. The total number of deaths registered in the pariah was 1,777. Of this total 298 were deaths, within the district, of non-parishioner s— chiefly occurring in the hospitals of the parish ; and 230 deaths of parishioners of Chelsea occurred outside the district in various public institutions. There were, therefore, 1,709 deaths of parishioners of Chelsea. These 1709 deaths are equivalent to a death-rate for the year of 17.73 per 1,000, as against a death-rate of 18.83 per 1,000 in 1896. 4 The following Table II. gives the death-rate of Chelsea and its constituent districts, and of London, during the past seven years :— Table II. Year. Home District. Kensal Town. Chelsea. London. Death-rate. Death-rate. Death-rate. Death-rate. 21.4 17.5 22.1 21.0 1891 21.9 17.8 21.0 20.7 1892 16.3 1893 21.6 20.4 21.4 1894 17.6 16.8 17.8 14.1 1895 20.8 16.8 19.9 19.9 19.0 18.2 18.8 18.6 1896 17.9 17.1 17.7 18.2 1897 The lessened mortality in Chelsea in 1897, as compared with 1896, is attributable to a lesser prevalence in 1897 of diphtheria and measles, which diseases caused a large number of deaths amongst children in 1896. The high death-rates of the years 1891, 1892, 1893, and 1895, were largely due to the prevalence of epidemic influenza in those years. The general death-rate of Chelsea in 1897 would have been lower had it not been for the excessive prevalence of infantile diarrhœa in July and August. The deaths of parishioners of Kensal Town numbered 365, equivalent to a death-rate of 17.1 per 1,000; the death-rate of the home district (1,344 deaths) being 17.9 per 1,000. Zymotic death-rate. —The death-rato in Chelsea from the seven principal zymotic diseases was 3.11 per 1,000 in 1897, the corresponding rate for London generally being also 3.11 per 1,000. In 1896 the zymotic death-rate in Chelsea was 4.31 per 1,000, this high rate due to excessive mortalities from diphtheria, measles, and diarrhœa. Table III.—For the year 1897. Zymotic death-rate. Influenza death-rate. Diarrhœa 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 Home District 2.8 .. 1.34 1.96 0.52 3.39 151 32.1 Kensal Town 4.3 .. 2.49 1.41 0.56 2.72 190 46.0 Chelsea 3.1 0.20 1.60 1.84 0.53 3.25 161 35.1 London 3.1 0.15 1.45 1.77 0.70 3.14 159 39.8 There were no deaths from small-pox in 1897; and, as in 1896, not a single case of the disease oocurred in the parish. 5 Measles. —This disease caused 18 deaths in 1897, as compared with 109 deaths in 1896. Only one death from measles occurred in Kensal Town. Out of the 18 deaths no fewer than 10 occurred in the three last weeks of the year, when measles was again assuming an epidemic form in the home district. In 1896 the epidemic commenced in February and continued until the middle of June. Scarlet Fever. —This disease caused 17 deaths in 1897, as compared with 28 deaths in 1896. Out of the 17 deaths, five belonged to Kensal Town. From the middle of September until the end of November the Fever Hospitals of the Metropolitan Asylums Board were unable to admit all the patients suffering from this disease, and also those suffering from diphtheria, who applied for admission, but there was much less difficulty and delay in securing the admission of patients than in 1896. Diphtheria. —This disease was much less prevalent than in 1896, but was credited with the causation of 53 deaths, 10 of which belonged to Kensal Town. In addition there were 3 deaths from membranous croup. In 1896 there were in Chelsea 108 deaths from diphtheria and four from membranous croup. Of the 56 deaths from fatal throat disease in Chelsea in 1897, 42 were under five years of age, and 14 were over five ; 40 deaths occurred in hospitals and 16 at the patients' own homes. Table IV. — Zymotic Disease Mortality in Chelsea in 1897. Actual number of Deaths in Chelsea. Chelsea's proportion of total London Deaths according to its population. Measles 18 42 Scarlet Fever 17 17 53 Diphtheria 49 41 Whooping Cough 40 Enteric Fever 14 13 Diarrhœa 154 139 Table V.— Zymotic Disease Mortality in Kensal Town in 1897. Actual number of Deaths in Kensal Town. 1 Measles 5 Scarlet Fever 10 Diphtheria Whooping Cough 16 4 Enteric Fever 53 Diarrhœa Kensal Town's proportion of total Chelsea Deaths according to its population. 4 4 12 9 3 34 6 Table VI. — Zymotic Mortality in Chelsea in 1897. Deaths in 1897. Average number of Annual Deaths in 1884-96. 62 18 Measles 17 Scarlet Fever 19 Diphtheria and Croup 56 49 Enteric Fever 14 14 Whooping Cough 41 58 91 (1891—6). Diarrhœa 154 Enteric Fever. —The mortality from enteric fever (14 deaths) was equal to the average of the past 13 years. Of the 14 deaths, four belonged to Kensal Town. Diarrhaa.— The deaths in Chelsea in 1897 from diarrhœal diseases (diarrhoea, cholera, gastro-enteritis, and enteritis) were 154 in number, and far exceeded the mortality of any recent year. All but 10 of the 154 deaths were of children under five years of age, the great majority of these being infants under one year. Of these 154 deaths, 53 were deaths of Kensal Town residents, Kensal Town's proportion of the total in accordance with its population being only 34 deaths. The excessive prevalence of diarrhœa commenced in the third week in July, when the weather was very hot, and reached its maximum about the middle of August, when a decline set in with the onset of cooler weather. In the eight weeks ending the fourth September, 114 out of the total of 154 deaths were registered. In London generally there was a similar excessive incidence of diarrhœal diseases, the death-rate during the past year from these diseases being the highest recorded since 1868, when a summer of very exceptional heat was experienced. Table VII.— Mortality from Diarrhæal Diseases. Year. Chelsea. London. Death-rate per Million. Death-rato per Million. 792 774 1891 1892 864 801 1134 1084 1893 1894 541 617 1895 1278 1182 1896 1069 1112 1897 1597 1446 7 Influenza. —The number of deaths referred to Influenza, as a primary or secondary cause of death, amounted to 19, as against 13 in 1896, and 68 in 1895, which was the last year in which Influenza was epidemic in London. Of the 19 deaths, 3 belonged to Kensal Town. In London generally there was no epidemic in 1897, but deaths have been recorded from this disease in every week of the year, amounting to a total of 671, as compared with 496 in 1896. Table Vlll.— Respiratory Diseases. Death-rate per 1,000 per annum. Years. Chelsea. London. 4.3 4.2 1884-89 (inclusive) 4.4 1890 (1st Influenza Epidemic) 5.0 5.5 1891 (2nd „ „ ) 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 1896 3.6 3.3 1897 3.2 3.1 The death-rate from respiratory diseases in Chelsea in 1897 was low owing to the comparative absence of influenza, and the mildness of the winter and spring season. Tubercular Diseases. —The death-rate from phthisis and other tubercular diseases in Chelsea in 1897 was 2.37 per 1,000, as against 247 in London generally. The Kensal Town rate was 1.97 per 1,000. The average death-rate from these diseases in Chelsea during the 13 years, 1884-96, was 2.93 per 1,000. Cancer. —Malignant cancerous diseases caused 83 deaths amongst Chelsea parishioners, of which number 15 belonged to Kensal Town. The annual average of the 13 years, 1884-96, is 76 deaths. Chelsea's proportion of the total London deaths from cancer in 1897 is 85. Deaths in Public Institutions. —ln 1897, 32.1 per cent, of the total deaths of parishioners of Chelsea occurred in public institutions, the average for the six years, 1891-96, being 31 per cent. Of the home district residents, 35.2 per cent, of the deaths occurred in public institutions, and of Kensal Town residents, 20.5 per cent. In 1897, 14.5 per cent, of the total deaths of parishioners occurred in the Chelsea Workhouse and Infirmury, the average of the six years, 1891-96, being 14.7 per cent. Of the home district residents, 18.4 per cent, of the deaths occurred in the Workhouse and Infirmary, and of Kensal Town residents, only 8.8 per cent. TABLE OF DEATHS during the Year 1897, in the Chelsea Metropolitan Sanitary District; classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. (a) Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. (i) Small-pox. 1 Scarlatina. 2 Diphtheria. 3 Membranous Croup. 4 Fevers. Cholera. 10 Erysipelas. 11 Measles. 12 Whooping Cough. 13 Diarrhæa and Dysen tery. 14 Rheumatic Fever. 15 Phthisis. 16 Bronchitis, Pneumonia, and Pleurisy. 17 Heart Disease. 18 Influenza. 19 Injuries. 20 All other Diseases. 21 Total. 22 At all ages. (b) Under 1 year. (c) 1 and under 5. (d) 5 and under 15. (e) 15 and under 25. (f) 25 and under 65. (g) 25 and upwards. (h) Typhus. 5 Enteric or Typhoid. 6 Continued. 7 Malarial. 8 Puerperal. 9 460 145 45 9 21 161 79 3 ... ... ... 8 11 48 ... ... 47 3 ... 5 Chelsea North, exclusive of Public Institutions Under 5 ... ... ... 65 190 ... ... ... ... 1 2 5 1 ... 1 3 1 39 54 35 10 9 108 270 5 upwds. ... ... ... ... 1 ... ... Chelsea South, exclusive of Public Institutions 359 105 37 5 14 126 72 ... 5 2 6 8 33 34 1 2 50 Under 5 ... 1 ... ... ... ... ... ... ... ... ... 142 ... 1 .. 1 ... 2 28 34 29 3 13 104 217 5 upwds. ... .. ... ... 2 ... ... ... 290 118 37 12 7 68 48 1 ... ... 1 15 50 28 1 155 Kensal Town Under 5 ... 4 2 ... .. ... ... ... ... .. .. ... ... 53 ... 1 ... ... 1 3 3 18 22 19 3 135 5 upwds. ... 2 ... ... ... .. 6 57 293 15 13 1 9 116 ... ... 3 4 1 6 ... 14 28 Workhouse and Infirmary ... 139 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 1 1 58 57 25 7 111 265 5 upwds. ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Brompton Hospital 93 ... ... 4 36 53 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 77 2 11 93 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... 2 95 ... 1 1 3 72 18 ... ... ... ... ... 1 1 Cancer Hospital Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 94 5 upwds. ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... 15 ... ... 1 ... 14 ... ... ... ... Hospital for Women Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... 15 15 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Hospital for In- Pensioners ... 60 ... ... ... ... 14 46 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... 1 13 23 23 60 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Victoria Hospital for Children 3 ... ... 1 22 3 12 2 36 80 93 44 36 13 ... ... ... Under 5 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 1 3 1 6 13 5 upwds. .. ... ... ... ... ... ... ... ... ... ... ... ... ... Cheyne Hospital St. Camillo's Hospital Lying-in House of St. John 19 2 1 8 2 5 1 Under 5 ... ... ... ... .. ... ... ... ... ... 3 3 ... ... ... ... ... ... ... ... ... ... ... 3 2 1 1 9 16 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Under 5 12 ... ... ... 157 ... 127 4 1 9 222 Totals 1777 429 170 54 92 652 380 ... ... ... ... 3 16 37 4 599 3 4 1 5 2 9 6 223 183 146 17 36 524 1178 5 upwds. ... 1 ... ... 11 ... ... 5 ... The subjoined numbers have also to be taken into account in judging the above Records of Mortality. Deaths occurring outsider the district among persons belonging thereto 18 49 30 15 108 Under 5 ... 29 ... ... ... ... 2 ... 6 ... 2 12 65 230 15 9 ... 2 ... 3 2 ... ... ... 5 upwds. ... 3 11 ... ... 1 2 1 1 ... 27 11 21 1 16 70 165 ... ... ... ... ... 298 37 ... 7 Deaths occurring within the district among persons not belonging thereto 37 29 27 24 Under 5 ... ... 2 ... ... ... ... 1 ... 16 ... 9 36 66 147 ... 2 ... ... ... ... ... 1 5 5 upwds. ... 1 1 ... 1 ... 77 12 ... 127 232 ... ... ... ... ... ... ... ... TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health during the Year 1897, in the Chelsea Metropolitan Sanitary District; classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. (a) Population at all Ages. Registered Births. (d) Aged under 5 or over 5. (e) New Cases of Sickness in each Locality, coming to the knowledge of the medical officer of health. I Number of such Cases Removed from their Homes in the several localities for treatment in isolation Hospital. Small-pox. 1 Scarlatina. 2 Diphtheria. 3 Membranous Croup. 4 Fevers. Cholera. 10 Erysipelas. 11 12 13 Small-pox. 1 Scarlatina. 2 Diphtheria. 3 Membranous Croup. 4 Fevers. Cholera. 10 Erysipelas. 11 12 13 Last Census. (b) Estimated to middle of 1897. (c) Typhus. 5 Enteric of Typhoid. 6 Continued. 7 Relapsing. 8 Enteric or Typhoid. 6 Continued. 7 Relapsing. 8 Puerperal. 9 Puerperal. 9 Typhus. 5 75,196 75,380 1902 Chelsea Home District Under 5 5 upwds. ... 105 93 2 ... 3 ... ... ... ... 6 ... ... 84 78 ... ... ... ... ... ... ... ... ... 1 143 ... ... 197 ... 39 1 4 ... 62 150 90 ... 21 1 3 ... ... ... ... ... ... ... ... ... ... ... Public Institutions: — Chelsea Infirmary 2 ... ... ... .. ... ... ... ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 3 1 ... ... ... ... 7 ... ... 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chelsea Workhouse ... Under 5 5 upwds. 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 5 upwds. ... ... Victoria Hospital ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... 2 1 ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 5 upwds. 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Hospital ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 647 ... Kensal Town 21,450 21,365 Under 5 5 upwds. 52 17 3 ... ... ... ... ... 4 ... ... ... 39 11 ... ... ... ... ... ... ... ... ... ... ... 124 51 ... 10 ... ... 18 ... ... ... 88 30 ... 6 ... ... 2 ... ... ... ... ... ... ... ... ... ... 96,745 2549 ... 10 ... 89 ... ... ... Totals 96,646 Under 5 5 upwds. ... 161 112 5 3 ... ... ... ... ... 126 ... 1 ... ... ... ... ... 196 90 122 ... 3 ... ... 327 ... ... 49 1 ... 4 ... ... ... ... 244 ... ... 27 ... ... ... ... 10 Section II. INFECTIOUS DISEASES. Small-pox. — There were no cases of this disease in Chelsea in 1897. In 1896, there were no cases; in 1895, there were 4 cases; in 1894, 12 cases; in 1893, 29 cases; and in 1892, 4 cases. In London, during 1897, 105 cases of small-pox were notified, as against 260 cases in 1896, 1,076 cases in 1895, 1,391 cases in 1894, 2,933 cases in 1893, and 436 cases in 1892. In the 8 parishes forming the western district of London (population 773,760) only 5 cases of small-pox were notified in 1897, as against 35 in 1896. Scarlet Fever. —This disease was less prevalent in 1897 than in 1896, the case-rate per 10,000 of population being 50.4 in 1897, as against 58.6 in 1896. The case-rate for all London was 51.3 per 10,000. The disease was somewhat more prevalent in Kensal Town than in the home district, 176 out of the total of 488 eases belonging to Kensal Town, whereas Kensal Town's share of the cases in proportion to its population would have been only 108 cases. In 1897, the incidence rate of scarlet fever in Chelsea was exceeded only by that of Fulham, but the home district rate (41.4 per 10,000) was exceeded by both Kensington and Fulham. As usual the prevalence of the disease was greatest in November (46 cases), and declined very greatly in December (23 cases) ; otherwise the course of the disease was somewhat erratic, there being fewer cases in October than in either of the three preceeding months. The percentage of cases of school age (3 to 13 years) was 72.1 per cent, in Chelsea, 67.9 per cent, in the home district, and 79.5 per cent, in Kensal Town. The fall in notified cases following the closure of the schools (Board Schools on the 22nd July) was very small in the past year. In Kensal Town, where scarlet fever was most prevalent at this time, the number of notified cases in the 4 weeks succeeding the closure of the schools was 22, all but 2 being of school age, as against 17 cases (all but 1 of school age) in the preceeding 4 weeks. In the 4 weeks following the re-opening of the schools only 9 cases were notified in Kensal Town. Diphtheria. —There was a great diminution in the prevalence of this disease in 1897, as compared with 1896, the case-rate per 10,000 of the population in Chelsea being only 32.4, as against 48.3 in 1896. It will be remembered that it was the home district which has specially suffered from diphtheria of recent years, so that the decline in the diphtheria case-rate in the home district from 57.1 per 10,000 in 1896, to 32.1 in 1897, is especially satisfactory. The prevalence of diphtheria in the home district of Chelsea during the yast 8 years averages higher than that of any other of the parishes constituting Western London, as will be seen by referring to the table on page 13. The London 11 diphtheria case-rate for 1897 is 29.6 per 10,000. Out of the total of 313 cases of diphtheria and membranous croup notified in Chelsea, 71 belonged to Kensal Town, the share of the latter district in proportion to its population being 69 cases. Chelsea's diphtheria case-rate in 1897 was slightly exceeded by only one parish, that of Fulham, in West London, all the other parishes having case-rates below that of Chelsea. In the home district the cases were fairly equally divided amongst the several mouths, but 129 cases occurred in the first six months and only 111 in the last half of the year, contrary to what usually occurs in the behaviour of diphtheria, which has a marked seasonal preference for the autumn months. This is, no doubt, to be attributed to the influence of the epidemio in the latter half of 1896. In Kensal Town 10 cases occurred in the first quarter of the year, 21 cases in the second quarter, 10 cases in the third quarter, and 32 cases in the fourth quarter. The percentage of cases of school age (3 to 13 years) was 61.7 per cent, in Chelsea, 57.0 per cent, in the home district, and 77.5 per cent, in Kensal Town. The fall in notified cases following the closure of the schools was not at all marked until the thirty-third week of the year, some three weeks after school closure, but from the thirty-third to the thirty-fifth week only three cases at school age were notified, as against 11 in the proceeding three weeks. The diminution of diphtheria notifications in London usually commences iu the thirty-third week and continues to the thirty-sixth, and is, no doubt, dependent on antecedent school closure in the thirtieth week. In 1897 the board schools closed on July 22nd, which is about a week earlier than usual. Enteric Fever. —The number of cases of enteric fever in 1897 (including one notified as continued fever, which was subsequently ascertained to be enteric) was 53. The cases annually notified since 1890 are as follows:—1890, 63 cases; 1891, 46 cases; 1892, 44 cases; 1893, 77 cases; 1894, 95 cases; 1895, 76 cases; 1896, 68 cases; 1897, 53 cases. The number of cases in Kensal Town in 1897 was 10, Kensal Town's proportion of the total 53 cases being 12. The number of cases notified in the first quarter of the year in Chelsea was 17; in the second quarter, 5 ; in the third quarter, 17; in the fourth quarter, 14. There were no cases attributable to the Maidstone epidemic, but in one case the infection was probably acquired whilst the patient was in residence at King's Lynn. In three other cases the infection was probably acquired outside the parish, whilst in three cases the patients were inmates of Nursing Homes in the pariah, and were infected outside the parish. This leaves 46 cases in which the infection was probably acquired in the parish. The following Table IX. shows the case mortality, or percentage of deaths to notifications of scarlet fever, diphtheria (including membranous croup), and enteric fever in Chelsea, and in London, in each of the eight years, 1890-97. 12 Table IX.— Case Mortality in Chelsea, and in London, 1890-97. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Chelsea. London. Chelsea. London. Chelsea. London. 17.4 1890 1891 1892 1893 1894 1895 1896 1897 7.0 5.7 17.6 24.1 23.0 3.6 5.1 15.4 22.5 17.4 15.6 5.3 4.3 22.9 23.9 13.6 17.2 5.3 23.4 4.3 24.5 22.1 18.4 5.1 5.2 21.7 23.6 14.7 18.1 4.0 4.2 18.7 18.4 17.0 20.4 3.7 22.9 19.3 14.7 17.7 4.9 3.4 17.9 18.8 3.5 17.1 26.4 It will be noticed that both in Chelsea and in London last year the case mortalities of scarlet fever and diphtheria were lower than in 1896, indicating that in both of these diseases the type was milder in character than in 1896. In enteric fever, on the other hand, the case mortality in Chelsea was unusually high, but the number of eases being small accidental fluctuations are especially prone to occur. Table X. exhibits the removals of patients suffering from scarlet fever, diphtheria, and enteric fever, from their homes to hospitals, in each of the eight years, 1890-97, expressed as percentages of the total number of cases notified. Table X.— Percentage Removals to Hospitals. Scarlet Fever. Diphtheria. Enteric Fever. 1890 37 20 29 1891 40 15 22 1892 48 27 32 50 41 1893 38 71 1894 58 63 1895 55 62 51 1896 61 56 56 76 67 54 1897 Prevalence of Diphtheria and Scarlet Fever in the various districts of Western London from 1890 to 1897. The following Tables XI. and XII. are based upon the notified cases of diphtheria and membranous croup, and of scarlet fever respectively, in each of the eight parishes constituting Western London, in CASE-RATE PER 10,000 OF POPULATION 13 each of the eight years since notification commenced, and the rates are calculated upon the estimated population of each district for each year according to the censuses of 1891 and 1896. The home district of Chelsea without Kensal Town has been taken, as the inclusion of Kensal Town tends to obscure the topographical relations which the tables indicate. Contrasting the two tables as regards the behaviour of scarlet fever and diphtheria amongst a large population, it will be seen that whilst there are great fluctuations in prevalence of scarlet fever from year to year in West London, the fluctuations in prevalence of dip htheria are comparatively limited. There was a steady rise of diphtheria prevalence from 1891 (15.1 per 10,000) to 1896 (25.5 per 10,000), but the fall has already commenced. Again it will be seen that in years when scarlet fever prevalence was above the average, nearly all the parishes suffered in a corresponding degree, and vice versa when there was but little prevalence. There are, however, some exceptions to this rule, as for instance: Fulham in 1894, Chelsea in 1895, and Fulham again in 1897 ; these exceptions being probably dependent upon some locally acting cause, possibly special school influences. In diphtheria, however, this rule does not apply to nearly the same extent; and the table shows that of two contiguous parishes one may have for a succession of years a diphtheria incidence-rate twice or even three times as great as that of its neighbour. It is evident that the infection of diphtheria is not so rapidly diffusible or explosive as that of scarlet fever. As a set-off against this, however, the table shows that the infection of diphtheria is much more persistent in a district, where it has once strongly taken root, than is the scarlet fever contagion. The diphtheria rate tends to remain permanently high in a district for two, three, four, or more years. This is specially noticeable in the cases of Fulham, Hammersmith, and Chelsea. Table XI. — Notifications of Diphtheria and Membranous Croup per 10,000 of Population from 1890 to 1897. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1890-7. 23.1 21.8 26.7 36.4 57.1 32.1 30.8 27.6 Chelsea (Home District) 21.7 22.2 16.5 21.8 17.5 Kensington 14.0 12.1 11.2 22.4 19.4 11.3 25.0 32.8 31.3 23.7 Fulham 10.9 9.4 35.9 32.8 32.2 20.9 14.7 Hammersmith 23.3 29.6 27.9 18.6 19.9 23.4 31.4 19.8 Paddington 19.4 15.4 14.4 24.0 19.3 25.8 21.2 St. George's, Hanover Sq. 9.6 10.7 15.5 15.6 13.4 12.1 15.5 15.0 13.4 7.6 8.8 25.5 13.4 19.4 20.3 20.9 16.4 Westminster 15.1 St. James's 5.9 11.4 17.6 16.1 22.1 14.8 8.4 19.0 18.3 23.2 20.8 15.1 17.4 22.6 25.5 West London 16.8 22.2 23.3 25.8 25.7 24.3 London 15.4 15.2 19.6 31.9 31.3 29.6 14 Table XII.— Notifications of Scarlet Fever per 10,000 of Population from 1890 to 1897. 1890. 1897. 1890-7. 1891. 1892. 1893. 1894. 1895. 1896. Chelsea (Home District) 33.1 50.4 65.0 31.6 65.8 45.5 20.4 56.7 41.4 18.8 22.8 31.4 37.4 Kensington 23.4 43.5 56.1 59.8 43.7 Fulham 13.4 54.6 70.3 51.0 31.5 55.2 64.4 46.8 33.9 23.1 66.5 32.5 36.9 51.1 Hammersmith 36.3 46.5 37.5 41.3 18.4 22.0 64.6 23.6 33.9 38.8 Paddington 45.4 63.9 38.9 18.2 17.2 St. George's, Hanover Sq. 42.6 74.8 32.4 38.0 42.8 22.0 36.0 Westminster 23.1 20.4 53.3 76.5 26.1 33.1 41.8 34.1 38.5 26.0 St. James's 20.1 28.0 46.7 24.8 35.0 32.5 57.8 33.9 West London 54.6 58.1 37.1 45.2 25.6 47.3 64.6 40.4 30.8 20.1 43.5 42.6 London 36.7 63.7 86.0 51.3 51.3 27.1 And, indeed, it almost appears as if the abnormal prevalence of the disease, after nearly exhausting itself in Hammersmith, thence spread eastwards to Fulham, and theuce slowly still passed eastwards into Chelsea, taking a period of some five years in its extension. The maximum intensity of this expanding wave of diffusion appears to have been reached in Chelsea in 1896, when the case-rate reached the high figure of 57 per 10,000, and the death-rate was no less than 1.28 per 1,000. In Kensington a sustained high case-rate from 1893 is seen in a lesser degree, broken, however, by a fall in the rate in 1894. In Paddington a high case-rate is seen for only two years in succession, whilst in St. George's, Hanover Square, there has been but little fluctuation from year to year in diphtheria prevalence. The parishes of Westminster and St. James's, having smaller populations, are, perhaps, more liable to be capriciously affected, but the figures show a greater prevalence of diphtheria at the end of the period under review than at its commencement. The diphtheria death-rates of the various districts correspond fairly with the case-rates, the parishes having the highest case-rates in any year, having also the highest death-rates, and vice vend. An extra prevalence of diphtheria is certainly not compensated for by any greater mildness in type of the disease, as is sometimes seen in the case of scarlet fever. On the contrary, the experience of Chelsea shows that great prevalence of the disease is accompanied by increased severity of type and a high mortality in proportion to cases. The conclusions that may be drawn from these tables are not necessarily discouraging for the future, for they appear to indicate that whilst a wave of high diphtheria prevalence has taken possession of London since 1892, this wave is probably now on the downward grade. The tables are also suggestive of the fact that diphtheria is one of those diseases of which the infection has a partiality for and tends to cling to 18 certain districts. It is, therefore, more allied to enteric fever, which is a very preventable disease, than to diseases of the class in which the infection is very diffusible, such as influenza, measles, whooping cough, and, in a lesser degree, scarlet fever; such diseases being but little amenable to sanitary control. What the precise factors are that favour the persistency of diphtheria in a district are not exactly known, but it would appear probable that in London, at any rate, these are as much concerned with social conditions (poverty and overcrowding) as with strictly sanitary conditions. THE WATER SUPPLY OF CHELSEA. The quality of the water supplied to Chelsea in 1897 was up to the average standard. The examinations of the Official Analyst for the Local Government Board show that about 99'2 per cent, of the bacteria present in the unfiltered water of the Thames at Hampton, whi.h grow at ordinary temperatures of the air, are removed by the processes of subsidence and filtration oarried out by the Chelsea Water Works. The largest Dumber of microbes present in a cubio centimetre of the Chelsea water at the general filter well was 441) on the sth April, and the smallest number 6 on the 13th April, and again on the 26th October, the average for the year, excluding the sth April, being 23. Constant Supply. — The percentage of house supplies on the constant system in the Chelsea Company's district was 90 at the end of 1897, as against 82 at the end of 1896. SPECIAL REPORTS. During the past year I have had the honour to present special reports on the undermentioned subjects for the consideration of the Vestry : — March 2nd.--Combined drainage in Chelsea sanctioned by the Metropolitan Commissioners of Sewers. March 30th.—The drainage of No. 5, Orford-street, and No. 1, Leverett-street. April 13th.—(1) The drainage of Nos. 397—415, Fulham-road (odd Nos.). (2) The drainage of No. 340, King's-road. April 27th.—(1) Combined drainage of Nos. 5, 7, 9, 11, Denyerstreet. (2) The Chelsea Electricity Supply Company's Works. May 25th.—(1) The sale of margarine as butter. (2) Nos. 397—415, Fulham-road. June 15th.—The Thames foreshore near Cremorne Tap. July 6th.—(1) The Thames foreshore near Cremorne Tap. (2) Analysis of drugs. July 20th.—The Hans Crescent hotel. July 27th.—Little Orford-street. 16 September 28th.-(1) The removal of a scarlet fever patient through the streets. (2) Alleged smoke nuisance at East-row, Kensal Town. (3) Cowhouse at 3A, Leverett-street. (4) Wilkinson's sword factory. November 9th.—The reception of typhoid and diphtheria patients in general hospitals. December 21st.—(1) Amendment of section 36 of the Public Health (London) Act. (2) Charitable shelters. 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 1897. I am, my Lord and Gentleman, Tour 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 1897. Houses and Premises:— Home District. Kensal Town. Total. Reported on respecting nuisances complained of 962 272 1234 Reported on with reference to infectious cases 678 279 957 254 Cleansed, whitewashed, and repaired 227 481 Defective roofs repaired 59 7 66 Disinfected after zymotic diseases 563 239 802 Cases of overcrowding abated 24 3 27 18 Dust-bins, new, provided 94 112 35 24 „ repaired 11 Underground rooms reported as occupied contrary to Act 3 3 - Houses closed as unfit for human habitation. 18 18 - Workshops inspected 357 357 - Drainage:— Drains opened, cleansed, and made sound „ trapped with stoneware gullies 189 112 301 Water-closets cleansed and repaired 92 42 134 „ new pans and traps provided 385 31 416 Spout drains cleansed, repaired, or renewed 193 79 272 Sink, bath, and lavatory waste pipes disconnected 125 25 150 Soil pipes ventilated or repaired 230 11 241 „ new, provided 183 3 186 New drains laid, in accordance with Vestry's regulations 262 9 271 - Cesspools abolished 1 1 Additional w.c. accommodation provided 2 5 7 Water Supply:— For domestic purposes, provided where cut off by Water Company 24 7 31 For water-closets, or check cisterns provided 184 61 245 Main cisterns cleansed or repaired 17 19 36 „ new, provided 2 4 6 Nuisances abated arising from:— Keeping of animals 15 1 16 Accumulations of manure and other filth 45 21 66 Yards cleansed, paved or drained 266 150 416 Smoke 3 6 3 Dung pits repaired, drained, &c.,or cages, &c., provided 6 6 Dust shoots abolished 6 6 - - 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 14 2 16 Goods disinfected after infectious cases at station 3928 3928 - Goods destroyed after infectious cases 28 28 - Number of samples taken for analysis (Food and Drugs Act) 139 46 185 Unsound Food. Number of boxes of fruit, &c., condemned and destroyed 120 80 200 Proceedings taken: — Notices issued for sanitary works, &c., including infectious diseases notices 1170 304 1474 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 28 2 30 Legal proceedings in respect of food adulteration 9 1 10 Correspondence:— Number of letters written in connection with sanitary matters, including those of Medical Officer of Health 840 258 1098 Daily returns of infectious cases sent to Metropolitan Asylums Board 281 281 - Notification of infectious cases sent to School Authorities 460 233 693 Entries in Inspectors' Report Books 962 207 1169 „ Inhabitants' Complaint Book 68 68 - Certificates of Disinfection given 496 103 599 „ Infectious diseases for removal cases 214 214 - The cow-houses and slaughter-houses were inspected by a Sub- Committee 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, WILLIAM CHAS. LIGHTFOOT, FREDERICK F. FLINN, Home District. JAMES JOHN MACKAY, Kensal Town. MAGISTERIAL PROCEEDIGNS DURING 1897, UNDER THE SALE OF FOOD AND DRUGS ACT. Streets where purchased. Article purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Denyer-street 72% foreign fat Fine, £1. Costs, 10s. 6d. Butter Mar. 2nd Cocoa Mar. 2nd College-street 60% foreign substances Dismissed on account of label being on wrapper, stating it was a mixture. Milk April 27th 60% fat abstracted Bramerton-street Dismissed on account of label on can. Milk 25% added water June 1st Trafalgar-square Fine, £1. Costs, 10s. 19 Drugs 42% below strength in B.P.. Fine, £2. Sloane-street June 15th Drugs Blantyre-street 80% below strength in B.P. June 15th Fine, £1. Drugs June 15th Blantyre-street 16% below strength in B.P. Fine, £1. 80% below strength in B.P. June 15th King's-road Drugs Fine, £1. 15% below strength in B.P. June 15th King's-road Drugs Fine, £1. Total, £8 Fines, and £1 Os. 6d. Costs. MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT. Situation of Premises. Nature of Nuisance or Complaint. Date of Hearing. Result. King's-road Removing offal during prohibited hours. Jas Lake Fined £1 and 5s. costs. Jan. 5th Fined £5 and 2s. costs. 498, King's-road Exposing unsound rabbits for sale. Owner Jan. 13th Jan. 13th Fined— and 2s. costs. „ „ Manager „ „ Sloane-street Removing offal during prohibited hours. Mark Levy Feb. 2nd Fined 40s. and 5s. costs. 1, Gunter-grove Feb. 16th Want of water to premises Premises closed. 302, King's-road Failing to give notice of intention to provide new w.c, &c. Feb. 16th Fined 1s. Mar. 16th Premises closed. Want of water to premises 131, Church-street. April 6th Defective w.c, rain-water pipe and drain inlet Adjourned to 13th, for work to be done. 57, College-street April 13th Withdrawn; 1s. costs. Work being completed. „ „ „ „ Want of a proper receptacle for manure April 13th Stables at rear of 16, Wellingtonsquare Fined 5s. Want of water to premises Premises closed. June 1st 74, Cheyne-walk 15, Little Orfordstreet Yard surface to be repaired, premises cleaned, &c. July 6th Order for work to be done in 14 days. 19, Little Orfordstreet Yard surface to be repaired, premises cleaned, &c. July 6th Order for work to be done in 14 days. July 6th „ „ „ „ „ 23, Little Orfordstreet July 20th Fined 10s. and 5s. costs. Removing offal during prohibited hours. Wm. James Dartrey-terrace July 20th Fined 10s. and 2s. 6d. costs. „ Wm. Atkins The Embankment Premises closed, 23s. costs. Aug. 17th 71, Burnaby-street Want of water to premises Oct. 12th Order for work to be done in 14 days. Defective drain, drain inlets, rain-water pipe, w.c., &c 51, Cale-stret Oct. 12th Fined £1 and costs £1 1s. Tite-street Exposing scarlet fever patient in public street Oct. 19th Adjourned to 26th inst. 10, Brewer-street Keeping dogs so as to be a nuisance „ „ „ Oct. 26th Order for abatement in 14 days. £2 2s. costs. „ „ Oct. 19th Want of water to stables Order for water to be put on in 7 days. Stables at rear of 337, King's-road Nov. 23rd Adjourned. Defective drains, dust bin and w.c. 64, Walton-street Withdrawn. Work done. „ „ Dec. 21st „ „ Nov. 23rd „ Water on, on day of hearing. Want of water to premises 12, Wellingtonsquare Removing offensive matter in an improper vehicle James Smith Dec. 21st Fined 20s. and 5s. costs. Walton-street Dec. 21st Fined 1s. Ditto during prohibited hours C. Smith „ Dec. 21st Order for work to be done in 7 days, 10s. costs. 62, Park-walk Defective drains, w.c., &c. Total: £11 7s. Fines, and £6 3s. 6d. Costs. 22 BAKEHOUSES IN USE ON JANUARY 1st, 1898. Occupier. Above Ground. Below Ground. Street. Solomon Keppler ...... 74, Arthur-street Below. A. Coventry 93, Beaufort-street ...... „ Schuck 26, Blantyre-street ...... „ Loe 55, Burnaby-street ...... „ Summers 1, Cadogan-street ...... „ Above. Judkins 2, Cale-street ...... 77, Cheyne-walk Spells ...... Below. ...... Bauer „ 20, Church-street E. A. Stead ...... 60, College-street „ Dietericks ...... 17, Coulson-street „ ...... 3, Dartrey-terrace Knee „ J.Venner 67, Flood-street ...... „ ...... „ 95, „ Gass C. M. Nash ...... „ 153, Fulham-road A. Bailey ...... 187, „ „ Burge ...... 323, „ „ ...... 395, „ Gilder „ ...... 15, Green-street Bott „ Becker 53, Godfrey-street ...... „ Weedon ...... 102, Keppel-street „ ...... 47, King's-road Pennycuick „ ...... 83, „ J. Humphry „ 88, „ ...... Akast „ 134, „ ...... Buckea „ J. Humphry ...... 145, „ „ ...... 302, „ Musgrove „ Mardon ...... 351, „ „ Dohna ...... „ 399, „ ...... Korle „ 414, „ 488, „ ...... Matthiae „ Batchelor 502, „ ...... „ 23 Above Ground. Street. Occupier. Below Ground. McKay ...... Below. 517, King's-road 1, Leader-street H. Southey Above. ...... 48, Lots-road West ...... Below. 83, Lower Sloane-street Miles Above. ...... 43, Manor-street Essling ...... Below. Kremers 62, Marlborough-road ...... „ 100, „ „ Reitze ...... „ Above. 110, „ „ Wordley ...... ...... 23, Queen's-road Hilton Below. 58, Rawlings-street Hannah ...... „ 14, Riley-street Bashford ...... „ 150, Sloane-street Pennycuick ...... „ Salzmann 43, Stay ton-street Above. ...... J. Humphry 117, Sydney-street ...... Below. 25, Walton-street Burrows ...... „ Small ...... 46, „ „ KENSAL TOWN DISTEICT. 551, Harrow-road J. Cumming Above. Below. ...... „ 597, John Davey W. Y. Menzler Above. 608, „ ...... Heinrich Geissler 690, „ ...... „ 62, Herries-street Below. Fredk. Spohr ...... 83, „ A. Royston „ ...... ...... 193, Kensal-road A. Webb „ Francis Frost Above. 300, „ ...... James Guscott 226, Kilburn-lane ...... „ Henry Geo. Taylor 12, Mozart-street „ ...... 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. Crooked-usage Jennings, J. Church-street Emerton, J. Jordan, G. 406, King's-road 3a, Leverett-street Robinson, F. Hughes, R. 10, Stayton-street