CHE6 Chelsea Gestry. ANNUAL REPORT For 1898, OF THE Medical Officer of Health. LOUIS C. PARKES, M.D.; D.P.H. Lond. Univ.; M.B.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. 1899. TABLE OF CONTENTS. SEC. I.—STATISTICAL page. Population of Chelsea 3 Births and Birth-rate 3 Deaths and Death-rate 4 Table of Deaths (Local Government Board Form) 9 Table of New Cases of Infectious Sickness (do.) 10 SEC. D. Infectious Diseases— Small-pox 11 Scarlet Fever 11 Diphtheria 11 Prevalence of Scarlet Fever and Diphtheria in the Parishes of Western London 12 Enteric Fever 13 The Case Mortality 14 Removal of Patients to Hospital 15 Special Reports 15 SEC. III. Work of the Public Health Department— Summary of Nuisances and other matters reported on 17 Magisterial proceedings during 1898 19 List of Bake-houses, Cow-houses, and Slaughter-houses 22 ANNUAL, REPORT of the MEDICAL OFFICER OF HEALTH For 1898. Section I.-STATISTICAL. POPULATION OF CHELSEA. The estimated population of Chelsea for the year 1898 is 96,826. The estimated population of each sub-district is as follows :— Chelsea North 42,247 75,526 Chelsea South 33,279 Kensal Town 21,300 BIRTHS AND BIRTH-RATE FOR 1898. Table I. gives the births and birth-rate per 1,000 per annum in the homo district and in Kensal Town, in the whole parish, and in London. Table I. Number of Births. Birth-rate per 1,000. Home District 1,761 23.4 Kensal Town 571 26.9 Whole Parish 2,332 24.2 London 132,432 29.5 In 1897 the birth-rate of the home district was 25.3, and of Kensal Town 30.4, the birth-rate of the whole parish being 26.4. The progressive lowering of the birth-rate of recent years, both in the home district and in Kensal Town, is shown in the next Table. 4 Table II.—Birth-rate per 1,000. Year. Home District. Kensal Town. London. 1891 28.3 32.6 31.8 1892 27.7 33.5 31.0 1893 28.5 33.7 31.0 1894 27.2 31.3 30.2 1895 27.1 32.4 30.5 1896 26.2 29 9 30.2 1897 25.3 30.4 30.0 1898 23.4 26.9 29.5 The diminished birth.rate in the home district is, no doubt, largely due to the changes that have been in progress of recent years affecting the social conditions of the population, many poor and crowded neighboui hoods having been swept away to make room for the inhabitants of highly.rated houses and flats. In Kensal Town, however, with its essentially working class population, the tendency towards a steadily declining birth.rate is also noticeable, and is probably not attributable to any falling off in the marriage-rate. In London generally the birth-rate also shows a progressive decline during the past eight years. DEATHS AND DEATH-KATE EOE 1899. The total number of deaths registered in the parish was 1,827. Of this total 300 were deaths, within the district, of non-parishioners— chiefly occurring in the hospitals of the parish; and 231 deaths of parishioners of Chelsea occurred outside the distriot in various public institutions. There were, therefore, 1,758 deaths of parishioners of Chelsea. These 1,758 deaths are equivalent to a death-rate for the year of 18*2 per 1,000, as against a death-rate of 17'7 per 1,000 in 1897. Table III. gives the death-rate of Chelsea and its constituent districts, and of London, during the past eight years :— Table III. Year. Home District. Kensal Town. Chelsea. London. Death-rate. Death-rate. Death-rate. Death-rate. 1891 22.1 175 21.0 21.4 1892 21.9 17.8 210 20.7 1893 21.6 16.3 20.4 21.4 1894 17.6 14.1 16.8 17.8 1895 20.8 16.8 199 19.9 1896 19.0 18.2 18.8 18.6 1897 17.9 17.1 17.7 18.2 1898 18.1 18.7 18.2 18.7 5 The slightly higher mortality in Chelsea in 1898, as compared with 1897, is attributable to a greater prevalence of measles in the past year. As in 1897, there was an excessive prevalence of infantile diarrhoea in the summer (August and September), which raised the general death-rate. The past year is the first year on record in which the general death-rate of the home district has been below that of Kensal Town. All the diseases of the zymotic class appear to have been more prevalent in Kensal Town than in the home district, but especially diphtheria, measles, and summer diarrhoea. The high death-rates in Chelsea of the years 1891, 1892, 1893, and 1895, wero largely duo to the prevalence of epidemic influenza in those years. Zymotic death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 3*39 per 1,000 in 1898, the corresponding rate for London beiug 2-8 per 1,000. In 1897 the zymotic doath-rato in Chelsea was 3*11 per 1,000. Table IY.—For the year 1898. Zymotic death-rate. Diarrhoea 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. Ilome District 2.87 1.26 1.91 0 53 3.44 161 34.0 Kensal Town 5.23 2.12 1.37 0.80 3.10 222 52.5 Chelsea 3.39 1.45 1.79 0 59 3.38 176 38.2 London 2.80 1.56 1.78 0.71 3.28 167 40.8 The above Table shows that during the past year there has been an exceptional prevalence of fatal infantile diseases in Kensal Town, as shown by the high zymotic and diarrhoea death.rates, the excessive mortality of infants under one year of age in proportion to births, and the high percentage of deaths under five years of age to total deaths. In 1897 also, Kensal Town suffered severely from summer diarrhoea, the zymotic death.rate being 4.3 per 1,000, the diarrhoea death.rate 2"49 per 1,000, there being 190 deaths of infants under one year to every 1,000 births, and 46 per cent, of tho total deaths being of children under five years of age. Small.pox.—Thero were no deaths from small.pox in 1898; and as in 1896 and 1897, not a single case of the disease occurred in the parish r _ Measles.—This disease caused 92 deaths in 1898, as compared with 18 deaths in 1897, and 109 deaths in 1896. Sixty.four of the deaths 6 occurred in the home district, and 28 in Kensal Town. In the homo district the epidemic commenced early in December, 1897, and continued until the middle of June, 1898; in Kensal Town no deaths from measles wore registered until the middle of March, 1898, and the epidemic ceased about the end of June, 1898. In 1896 the epidemic commenced in the homo district in February, and in Kensal Town in March, and came to an end in both districts in July. Scarlet Fever.—This disease caused 14 deaths in 1898, as compared with 17 deaths in 1897, and 28 deaths in 1896. Out of the 14 deaths, 5 belonged to Kensal Town. Diphtheria.—This disease caused 40 deaths, and in addition there was one death from membranous croup. Out of the 41 deaths, 19 belonged to Kensal Town, leaving only 22 for the home district. Of the 41 deaths from fatal throat disease in Chelsea in 1898, 32 were under five years of age, and 9 were over five ; 32 deaths occurred in hospitals, and 9 at the patients' own homes. Table V. Deaths from Diphtheria and Membranous Croup. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1898. Home District 32 20 32 43 41 52 96 45 22 Kensal Town 21 10 14 13 13 5 16 11 19 This Table shows the great reduction in diphtheria mortality in the home district in 1898 as compared with the previous six years (1892-7). Table YI.—Zymotic Disease Mortality in Chelsea in 1898. Actual number of Deaths in Chelsea. Chelsea's proportion of total London Deaths according to its population. Measles 92 66 Scarlet Fever 14 13 Diphtheria 40 38 Whooping Cough 26 46 Enteric Fever 14 13 Diarrhoea 140 150 7 Table yii.—Zymotic Disease Mortality in Kensal Town in 1898. Actual number of Deaths in Kensal Town. Kensal Town's proportion of total Chelsea Deaths according to its population. Measles 28 20 Scarlet Fever 5 3 Diphtheria 19 9 Whooping Cough 10 6 Enteric Fever 4 3 Diarrhoea 45 30 Table VIII.— Zymotic Mortality in Chelsea in 1898. Deaths in 1898. Average Number of Deaths Annually in 1884—07. Measles 92 59 Scarlet Fever 14 19 Diphtheria and Membranous Croup 41 50 Enteric Fever 14 14 Whooping Cough 26 57 Diarrhoea 140 100 Enteric Fever.—The mortality from enteric fever (14 deaths) was equal to the average of the past 14 years. Of the 14 deaths, 4 belonged to Ken sal Town. Diarrhoea.—The deaths in Chelsea in 1898 from diarrhceal diseases (diarrhoea, cholera, gastro-enteritis, and enteritis) were 140 in number, and far exceeded the mortality of any recent year, except 1897. All but 9 of the 140 deaths were of children under five years of age, the great majority of these being infants under one year. Of these 140 deaths, 45 were deaths of Kensal Town residents, Kensal Town's proportion of the total in accordance with its population being only 30 deaths. The excessive prevalence of diarrhoea commenced early in August, reached its maximum about the middle of the month, and was sustained at a high level quite up to the end of September. In the nine weeks ending the first of October, 98 out of the total of 140 deaths were registered. In Loudon generally there was a similar excessive incidence of diarrhceal diseases, the death rate during the past year being the highest recorded since 1868. 8 Table IX.—Mortality from Diarrhceal Diseases. Year. Chelsea. London. Death-rate per Million. Death-rate per Million. 1891 792 774 1892 864 801 1893 1134 1084 1894 541 617 1895 1278 1182 1896 1069 1112 1897 1597 1446 1898 1451 1556 Influenza.—The number of deaths referred to influenza, as a primary or secondary cause of death, amounted to 35, as against 19 in 1897, 13 in 1896, and 68 in 1895, the last year in which influenza was widely epidemic in London. Of the 35 deaths, 9 belonged to Kensal Town. Twenty-five of the total occurred in the first three months of the year. In London generally there was no widespread epidemic in 1898, but deaths have been recorded from this disease in every week of the year, amounting to a total of 1,283, 857 of which occurred in the first quarter. In 1897, 671 deaths were registered in London as due to influenza. The death-rate from respiratory diseases in Chelsea in 1898 (3.38 per 1,000) 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 1898 was 2.38 per 1,000, as against 2.49 in London generally. The Kensal Town rate was 2.17 per 1,000, that of the home district being 2.44 per 1,000. The average death-rate from these diseases in Chelsea during the 14 years, 1884-97, was 2*89 per 1,000. Cancer.—Malignant cancerous diseases caused 101 deaths amongst Chelsea parishioners, of which number 10 belonged to Kensal Town. The annual average of the 14 years, 1884-97, is 77 deaths. Chelsea's proportion of the total London deaths from cancer in 1898 is 88. Deaths in Public Institutions.—In 1898, 31.1 per cent. of the total deaths of parishioners of Chelsea occurred in public institutions, tho average for the seven years, 1891.7, being 31.2 per cent. of the home district residents, 341 per cent. of the deaths occurred in public institutions, and of Kensal Town residents 20.8 per cent. In 1898, 15-2 per cent, of the total deaths of parishioners occurred in the Chelsea Workhouse and Infirmary, the average of the seven years, 1891-97, being 14 7 per cent. Of the home district residents, 17.3 per cent. of the deaths occurred in the Workhouse and Infirmary, and of Kensal Town residents, only 8.0 per cent. 9 TABLE OF DEATHS during the Yeak 1898, in the Chelsea Metbopolitan Sanitary District; 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 causes, 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. L5 and under 25. 55 and under 65. 65 and upwards. (i) 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) 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 444 122 68 12 6 137 99 Under 5 ... ... 2 1 ... ... ... ... ... ... 30 6 40 ... ... 37 2 6 66 190 5 upwds. ... ... 2 ... ... 2 ... ... ... ... ... ... 1 4 1 44 55 36 12 7 i)0 254 Chelsea South, exclusive of Public Institutions 1 390 118 55 11 16 125 65 Under 5 ... ... 1 ... ... ... ... ... ... 1 24 2 35 1 32 1 9 07 173 5 upwds. ... ... 1 ... ... 2 ... ... ... ... ... 2 1 4 1 33 42 22 10 6 91 217 Kensal Town 315 121 61 17 15 74 27 Under 5 ... ... 2 ... ... ... ... ... ... ... ... 23 8 43 ... ... 36 1 1 5 63 182 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 10 8 1 b8 133 Workhouse and Infirmary 280 23 19 ... 5 132 101 Under 5 ... ... 1 ... ... ... ... ... ... ... ... 8 1 8 ... 1 3 1 ... ... 13 42 5 upwds ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... 49 56 20 1 4 99 238 Brorapton Hospital 1 96 ... ... 4 28 63 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 73 3 12 ... ... 8 26 Cancer Hospital 94 ... ... 2 5 75 12 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 1 ... ... ... 89 94 Hospital for Women 13 1 ... ... 1 11 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 12 Royal Hospital for InPensioners 69 3 ... ... ... 19 47 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... 3 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 18 15 ... ... 29 66 Victoria Hospital for Childrcn 117 43 58 16 ... ... ... Under 5 ... ... 5 ... ... ... ... ... ... ... 1 5 1 7 ... 3 23 2 ... 9 45 101 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 ... 1 10 16 Cheyne Hospital and St. Camillo's Hospital 9 ... ... 5 2 ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 9 Totals 1927 431 261 67 78 636 354 J ' Under 5 ... ... 11 1 ... ... ... ... ... ... 2 90 24 134 ... 5 133 4 4 29 255 092 5 upwds ... ... 3 ... ... 6 ... ... 4 ... 4 6 2 9 3 226 196 131 31 19 495 1135 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 231 18 47 19 16 1115 16 s Under ... 7 23 ... ... ... ... ... ... ... ... ... ... 4 ... ... 12 1 ... 1 4 14 65 5 upwds ... 7 6 ... ... 8 ... ... ... ... ... ... ... ... ... 18 10 15 ... 23 76 166 Deaths occurring within the district among persons not belonging theretc 300 39 46 20 36 140 19 | ... ... 3 ... ... ... ... ... ... ... 1 4 ... ... ... 3 19 ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 73 6 17 ... I 3 114 215 10 TABLE OF POPULATION, BIRTHS, AND OP NEW CASES OP INFECTIOUS SICKNESS, coming to the knowledge op the Medical Officer op Health during the Year 1898, 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. Population at all ACbS. Registered Births. Aged under 5 or over 5. New Casks of Sickness in each Locality, coming to the knowledge of the medical officer of health. Number of such Cases Removkd from their Homes in the several localities for treatment in isolation Hospital. Small-pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Smoll-pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Last Census. Estimated to middle of 1898. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Knteric or Typhoid. Continued. Relapsing. Puerperal. (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 0 10 11 12 13 Chelsea Home District 75,196 75,526 1761 Under 5 5 upwds. ... 65 47 1 1 1 ... ... ... 4 ... ... ... 43 39 ... ... 1 ... ... ... ... ... ... ... ... 193 96 39 ... 2 53 143 58 21 ... ... ... ... ... ... ... Public Institutions :— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chelsea Infirmary ... ... ... Under 5 5 upwds. ... 3 ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 12 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Duke of York's School ... ... ... Under 5 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Victoria Hospital ... ... ... Under 5 5 upwds. ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chelsea Barracks ... ... ... Under 5 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. George's Hospital ... ... ... L'nder 5 5 upwds. ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... Kensal Town 21,450 21,800 571 Under 5 5 upwds. ... 20 42 ... ... ... ... ... ... ... 3 ... ... ... 17 37 ... ... ... ... ... ... ... 2 ... ... ... 49 76 ... ... 16 ... ... 2 ... 20 ... ... ... 42 66 ... ... 8 ... ... ... ... 3 ... ... Totals 96,646 96,826 2332 Under 5 o upwds. ... 88 94 2 ... 1 1 ... ... ... 8 ... ... ... 62 78 ... ... 1 ... ... ... ... 9 ... ... ... 248 177 ... ... 55 ... ... 5 ... 85 ... ... ... 187 125 ... ... 29 ... ... ... ... 3 11 Section II. INFECTIOUS DISEASES. Small-pox.—As in the two previous years, 1896 and 1897, thero were no cases of this disease in Chelsea in 1898. In 1895, there wero 4 cases; in 1894, 12 cases; in 1893, 29 cases; and in 1892, 4 cases. In London, during 1898, 35 cases of small-pox were notified, as against 105 cases in 1897, 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 781,395) only 3 cases of smail-pox were notified in 1898, as against 5 in 1897, and 35 in 1896. Scarlet Fcrer.—This disease was less prevalent in 1898 than in 1897, the case-rate per 10,000 of the population being 34.7 in 1898, as against 50.4 in 1897. The case-rate for West London was 35.1 per 10,000, and for London generally 37.6 per 10,000. The disease was prevalent to about the same extent in the home district and in Kensal Town, 69 out of the total of 336 cases belonging to Kensal Town, Kensal Town's share of the cases in proportion to its population being 72 cases. During the past year the incidence-rate of scarlet fever in Chelsea was exceeded by Fulham (66 per 10,000), and by Hammersmith (43.3 per 10,000), the remaining parishes of West London having rates below that of Chelsea. The autumnal exacerbation in prevalence of scarlet fever in 1898 was only slightly marked, but there was a steady decline in prevalence towards the end of November. The fall in notified cases following the closure of the schools (Board Schools on tho 21st July) was well marked, especially in the last three weeks of August. The percentage of cases of school age (3 to 13 years) was 67 per cent, in Chelsea, 66 per cent, in the home district, and 72 per cent, in Kensal Town. Diphtheria.—There was a slight diminution in the prevalence of this disease in Chelsea in 1898, as compared with 1897, the case-rate per 10,000 of the population in Chelsea being 28.2, as against 32.4 in 1897. In the home district the diminished prevalence of diphtheria was considerable, the case-rate for 1898 being only 20.3 per 10,000, as against 32.1 per 10,000 in 1897. In Kensal Town, however, there was more diphtheria in 1898 than in any year since 1890, when diphtheria last assumed an epidemic form there. 12 Table X. -Ca.scs of, and Deaths from Diphtheria and Membranous Croup in the home district, and in Kensal Town. CASES. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1898. Homo District 172 162 163 200 207 273 429 242 153 Kensal Town 129 33 38 39 42 32 60 71 119 DEATHS. Home District 32 20 32 43 41 52 96 45 22 Kensal Town 21 10 14 13 13 5 16 11 19 Out of the total of 273 cases of diphtheria and membranous croup notified in Chelsea in 1898, 119 cases belonged to Kensal Town, the share of the latter district in proportion to its population being only 59 cases. The greatest prevalence of the disease in Kensal Town was in May, when 29 cases were notified. In June there were 13 notifications, in July 14, and in August 18. After this date the disease rapidly subsided, only 17 cases being notified in the last four months of the year. In the home district the largest number of cases notified in any one month was in January (21 notifications). In February there were 11 notifications, in March 10, in April 12, in May 12, in June 10, in July 14, in August 7, in September 13, in October 7, in November 10, and in December 14. In the first six months of tho j'ear 82 cases wero notified, and in tho last six months 71 cases, contrary to what usually occurs, diphtheria being a disease usually showing a tendency to prevail most in the autumn months. The percentage of cases of school age (3 to 13 years) was 662 per cent. in Chelsea, 59.5 per cent. in tho homo district, and 74.8 per cent. in Kensal Town. The fall in notified cases following the closuro of the schools at midsummer was well marked in tho homo district; but in Kensal Town 11 cases of school age were notified during tho four weeks following the closure of the schools as against 7 in tho preceding four weeks. The decline in Kensal Town set in with tho thirty-third week of the year, some three weeks after school closure (July 21st), only 2 cases of school age being notified from the thirty-third to the thirtysixth weeks, as against 11 cases in the four weeks preceding the thirty-third week. A similar decline of diphtheria (school age) cases in Chelsea at the same period was noticed in 1897. Prevalence of Scarlet Fever and Diphtheria in TVest London. Tho following Table XI. is based upon the notified cases of diphtheria and membranous croup, and of scarlet fever respectively in 13 each of the eight parishes constituting Western London, the rates being calculated upon the estimated population of each district. Taule XI.—Notifications of Scarlet Fecer, and of Diphtheria and Membranous Croup per 10,000 of population. Scarlet Fever. Diphtheria and Membranous Croup. 1897. 1890-7. 1898. 1897. 18907. 1893. Chelsea (Home District) 41.4 45.5 35.4 32.1 30.8 20.3 Kensington 43.7 37.4 27.5 19.4 17.5 12.9 Fulham 64.4 46.8 66.0 32.8 23.7 38.8 Hammersmith 37.5 41.3 43.3 14.7 23.4 15.3 Paddington 38.9 33.8 23.9 25.8 21.2 20.5 St. George's, Hanover Square 22.0 36.0 27.4 15.0 13.4 13.8 Westminster 34.1 38.5 18.8 20.9 16.4 24.1 St. James's 57.8 33.9 13.9 22.1 14.8 19.3 West London 43.5 40.4 35.1 23.2 20.8 21.4 London 51.3 51.3 37.6 29.6 24.3 26.4 The above Table shows that in West London, as a whole, there was less scarlet fever in 1898 than in 1897. In Fulliam, however scarlot fever maintained itself at the same high rate as in 1897, whilst in Hammersmith and in St. George's, Hanover Square, there was a slightly increased incidence of the disease as compared with 1897. As regards diphtheria, there was also a diminution of cases in West London the decrease being most marked in the home district of Chelsea. In Fulham there was a considerable increase in prevalence of the disease also an increase to a less extent in Westminster and Hammersmith. In all the other districts there was a decrease. In regard to Fulham it may be observed that the past year is the sixth in succession in which the diphtheria case.rate has maintained itself at a high figure. It will be noticed also that, during the past nine years, the prevalence of both scarlet fever and diphtheria has been less proportionally to population iu West London than in London as a whole. Enteric Fever.—The number of cases of enteric fever in 1898 was .06. The cases annually notified since 1890 are as follows:—1890, 63 cases $1891, 4G cases; 1892, 44 cases; 1893, 77 cases; 1894, 95 cases; 1895, 76 cases; 1896, 68 cases; 1897, 53 cases; 1898, 56 cases. The number of cases in Kensal Town in 1898 was 15, Kensal Town's 14 proportion of the total being 12 cases. The number of cases notified in the first quarter of the year in Chelsea was 12 ; in the second quarter, 4; in the third quarter, 10 ; and in the fourth quarter, 30 (19 in the homo district, and 11 in Kensal Town). In 8 cases the infection of the disease may have been, and probably was acquired, outside the parish, whilst in another case the patient was received into a Nursing Home in the parish from outside. This leaves 47 cases in which the infection was probably acquired in the parish, as compared with 46 in 1897. It is somewhat remarkable that out of the 14 cases notified in Kensal Town from the 1st October to the end of the year, 9 were of children under 12 years of age, this extreme incidence on children being somewhat unusual. The following Table XII. 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 nine years, 1890-98. Table XII.—Case Mortality in Chelsea, and in London, 1890-98. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Chelsea. London. Chelsea. London. Chelsea. London. 1890 7.0 5.7 17.6 24.1 17.4 23.0 1891 3.6 5.1 15.4 22.5 17.4 15.6 1892 5.3 4.3 22.9 23.9 13.6 17.2 1893 5.3 4.3 23.4 24.5 22.1 18.4 1894 5.1 5.2 21.7 23.6 14.7 18.1 1895 4.0 4.2 18.7 20.4 18.4 17.0 1896 4.9 3.7 22.9 19.3 14.7 17.7 1897 3.5 3.4 17.9 17.1 26.4 18.8 1898 4.2 3.4 15.1 25.0 19.3 As in 1897 the case mortality of enteric fever in Chelsea was somewhat high, as compared with previous years. The lowered fatality of diphtheria in recent years is probably to be attributed to the gradually extending use of the antitoxin treatment in this disease. Table XIII. exhibits the removals of patients suffering from scarlet fever, diphtheria, and enteric fever, from their homes to hospitals, in each of the nine years, 1890.98, expressed as percentages of the total number of cases notified. 15 Table XIII.—Percentage Removals to Hospitals. Scarlet Fever. Diphtheria. Enteric Fever. 1890 37 20 29 1891 40 15 22 1892 48 27 32 1893 50 41 38 1894 71 58 63 1895 55 62 51 1896 61 56 56 1897 76 67 54 1898 74 74 54 About three-quarters of all the scarlet fever and diphtheria patients, in 1898, were removed from their homes to the Fever Hospitals, and rather more than half of the enteric fever patients. SPECIAL REPORTS. During the past year I have had the honour of presenting special reports on the undermentioned subjects for the consideration of the Ycstry:— January 18th.—Proceedings at Petty Sessions; Authorisation of Medical Officer of Health to appear on behalf of the Vestry. February 15th.—Wilkinson's Sword Factory. March 15th.—The Vestry's liability for combined drainage at No3. 5 and 6, Stewart's-grove. Smoke nuisance at the Royal Chelsea Brewery. March 29th.—Tho Vestry's liability for the combined drainage of six houses at Eign's-cottages, Milmau's-street. April 19th.—Eigu's-cottage's, Milnian's-street. May 3rd.—Eigu's-cottages, Milman's-street. Measles epidemics. June 7th.—Tho removal of stable manure. Smoke consumption. Diphtheria in Kensal Town. The removal of infectious cases to hospital. June 21st.—Smoke nuisances. Combined drainage on the Cadogan estate. July 19th.—Diphtheria in Kensal Town. The appointment of a sanitary inspector for Kensal Town. July 26th.—Appointment of sanitary inspectors. September 27th.—No. 6, Marlborough-street. No. 39, Manor-street. October 11th.—Failure to notify cases of scarlet fever. November 22nd.—Nuisance on unoccupied land at Kensal Town. 16 December 6th.—Report on the examination of the water supplied by the Chelsea Water Works from November, 1897, to November, 1898, with some observations on the suitability of the Thames as a source of supply for London : by the Medical Officer of Health, and S. Rideal, D.Sc., F.I.C. 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 1898. I am, my Lord and Gentlemen, Your obedient servant, LOUIS C. PARKES, Medical Officer of Health. 17 Section III. PUBLIC HEALTH DEPAETMENT. Summary of Nuisances and other matters reported on and Work done during the Year 1898. Houses and Pbemises :— Home District. Kensal Town. Total. *Reported on respecting nuisances complained of 876 355 1231 Reported on with reference to infectious cases 601 219 620 Cleansed, whitewashed, and repaired 246 231 477 Defective roofs repaired 88 16 104 Disinfected after zymotic diseases 419 184 603 Cases of overcrowding abated 27 4 31 Dust-bins, new, provided 83 20 103 ,, repaired 11 14 25 Underground rooms reported as occupied contrary to Act 11 — 11 Houses closed as unfit for human habitation 15 7 22 Drainage :— Drains opened, cleansed, and made sound „ trapped with stoneware gullies 380 105 485 Water-closets cleansed and repaired 92 30 122 ,, new pans and traps provided 226 44 270 Spout drains cleansed, repaired, or renewed 117 152 269 Sink, bath, and lavatory waste pipes disconnected 76 15 91 Soil pipes ventilated or repaired 93 57 150 „ new, provided 103 9 112 New drains laid, in accordance with Vestry's regulations (including 13 systems of combined drainage) 165 14 179 Additional w.c. accommodation provided 3 15 18 Water Supply :— For domestic purposes, provided where cut off by Water Company 22 — 22 For water-closets, or check cisterns provided 68 21 89 Main cisterns cleansed or repaired 8 8 16 „ new, provided 1 — 1 Nuisances abated arising from :— Keeping of animals 6 5 11 Accumulations of manure and other filth 19 8 27 Yards cleansed, paved or drained 107 168 275 Smoke 8 — 8 Dung pits repaired, drained, &c., or cages, &c., provided 1 8 9 * 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 :— Homo District. Kcnsal Town. Total. Dead bodies removed to public mortuary for sanitary reasons 8 3 11 Goods disinfected after infectious cases at station 1551 23 1574 Goods destroyed after infectious cases 63 — 63 Number of samples taken for analysis (Food and Drugs Act) Unsound Food. Number of boxes of fruit, 112 44 156 &c., condemned and destroyed 125 — 125 Pboceedings taken :— Notices issued for sanitary works, &c., including infectious diseases notices 1229 385 1614 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 10 11 21 Legal proceedings in respect of food adulteration 8 2 10 cokkesl'ondence :— Number of letters written in connection with sanitary matters, including those of Medical Officer of Health 517 324 841 Daily returns of infectious cases sent to Metropolitan Asylums Board 246 — 246 Notification of infectious cases sent to School Authorities 363 145 508 Entries in Inspectors' Report Books 896 336 1232 „ Inhabitants' Complaint Book 42 — 42 Certificates of Disinfection given 420 94 514 Certificates of Infectious diseases for removal cases 352 78 430 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, WILLIAM CHAS. LIGHTFOOT (Resigned), FREDERICK F. FLINN (Resigned), GEO. R. METZLER, Home District. J. W. KING, JAMES JOHN MACKAY, Kensal Town. 19 MAGISTERIAL PROCEEDINGS DURING 1898, UNDER THE SALE OP FOOD AND DRUGS ACT. Streets where purchased. Article purchased. Extent of Adulteration or Abstraction. Date of Hearing. Besult. Leader-street Milk 10% added water Feb. 8th Fine, £1. Costs, 10s. 6d. Sloane-street Drugs 25% below B.P. strength „ 15th „ 5s. „ 10s. 6d. Cadogan-street „ „ 321 „ „ „ 5s. „ 10s. 6d. ft ft „ 38 % „ „ „ 10s. „ 10s. 6d. Marlborough-road „ 59 % „ „ „ 15s. „ 10s. 6d. ,, ,, „ 12 % „ „ „ 5s. „ 10s. 6d. Dartrey-road Milk 20% added water April 19th „ £2. „ 10s. 6d. Edith-grove „ 0%„ „ „ „ £1- ,, 10s. 6d. Kensal Town „ 10% June 10 th „ £2. ,, 2s. „ „ „ 27% Nov. 29th „ £2. „ 10s. 6d. Total: £9. 10s. Fines, and £4. 16s. 6d. Costs. 20 21 MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Date of Hearing. Result. 29, Royal-avenue Want of water to premises June 14th Closing order made. Failing to comply with magistrate's order „ 28th Fined £3, or one month's imprisonment. 1, Eign's-cottages Wilfully obstructing a drain „ 21st Fined £1. King's-road Removing offal during prohibited hours. W. James July 5th Fined £2, and 5s. costs. Lower Sloane-street „ „ „ A.Stannard „ „ Fined £1, and 2s. costs. 5, Stayton-street Unfit for human habitation „ 19th Closing order made. 143, Marlboro'-road Defective drains, w.c., and roof „ 26th Order for works in 14 days. 6, Marlboro'-street . Defective drains, dustbin, and roof; want of w.e.c., dirty and dilapidated state of the premises ; Oct. 4th . Closing order made. „ „ Failing to comply with magistrate's order . Nov. 1st . Fined £3 10s., or one month's imprisonment. 39, Manor-street Continuing to let a cellar dwelling after due notice e Oct. 4th . Fined 10s. 31, Laugton-street Failure to notify case of infectious disease by medical practitioner ,, 25th . Fined £2. KENSAL TOWN 1, 2, 3 and 4, Pike'scottages, and 1, 2 and 3, Elizabethplace Unfit for human habitation Nov. 8th . Closing orders made. 3, 4 and 5, Wedlake street Defective drains and dilapidated premises „ 22nd . Order for works in 14 days. 48, Beethoven-stree Defective drains Dec. 6th . Adjourned (works in progress.) Total: £13 Fines, and 7s. Costs. 22 BAKEHOUSES IN USE ON JANUARY 1st, 1899. Street. Occupier. Above Ground. BelowGround. 74, Arthur-street Solomon Kepp ...... Below. 93, Beaufort-street A. Coventry ...... „ 26, Blantyre-street Schuck ...... „ 55, Burnaby-street Loe ...... „ 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 Gerres ...... „ 3, Dartrey-terrace Knee ...... „ 67, Flood-street J. Venner ...... „ 95, Gass ...... „ 153, Fulham-road C. M. Nash ...... „ 187, A. Bailey ...... „ 323, Burge ...... „ 15, Green-street Bott ...... „ 53, Godfrey-street Becker ...... „ 102, Keppel-street Steel ...... „ 47, King's-road Pennycuick ...... „ 83, „ J. Humphry ...... „ 88, „ Akast ...... „ 134, „ Buckea ...... „ 145, „ J. Humphry ...... „ 302, „ Musgrove ...... it 351, „ Mardon ...... „ 399, „ Dohna ...... „ 414, „ Korle ...... „ 488, „ Matthiae ...... „ 23 Street. Occupier. Above Ground. BelowGround. 502, King's-road Bitter ...... Below. 517, McKay ...... „ 1, Leader-street H. Southey Above. ...... 48, Lots-road West ...... Below. 83, Lower Sloane-street Miles Above. „ 43, Manor-street Lorenz ...... Below. 62, Marlborough-road Kremers ...... „ 100, „ „ Eeitze ...... „ no, „ „ Wordley Above. „ 23, Queen's-road Hilton ...... Below. 58, Bawling's-street Hannah ...... „ 150, Sloane-street Pennycuick ...... „ 43, Stayton-street Salzniann Above. „ 117, Sydney-street J. Humphry ...... Below. 25, Walton-street Burrows ...... „ 46, Channon ...... „ KENSAL TOWN DISTRICT. 551, Harrow-road A. Hudson Above. Below. 608, „ W. Y. Menzler „ „ 690, „ Heinrich Geissler „ „ 62, Herries-street Fredk. Spohr ...... Below. 83, „ A. Eoyston ...... „ 193, Kensal-road Francis Frost ...... „ 300, „ „ 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. 82, Marlborough-road Iggulden, F. 90, „ „ 128, „ Little, G. 273, Kensal-road Miles, A. COW HOUSES. Crooked-usage Jennings, J. Church-street Emerton, J. 406, King's-road Jordan, G. 3a, Leverett-street Robinson, F. 10, Stayton-street Thomas, J.