Chelsea Nestry. ANNUAL REPORT For 1899, 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. 1900. 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 Prevalence of Scarlet Fever and Diphtheria in the Parishes of Western London .... .... .... .... 11 Enteric Fever .... .... ... .... 12 The Case Mortality .... .... .... .... '13 Removal of Patients to Hospitals .... .... .... 14 Measles .... .... .... .... .... 14 Bacterioscopic Diagnosis .... .... .... .... 15 SEC. III.:— The Sanitary Condition of the Parish— Combined Drainage .... .... .... ... 17 Drainage, W.C.'s, Yards, Dust-bins .. .... .... 18 Dung receptacles .... .... .... .... 18 Unsound Food .... .... .... ... 18 Disinfection .... .... .... 19 Water Supply .... .... .... .... 19 Reports to the Vestry .. .... .... .... 20 SEC. IV.:— Work of the Public Health Department— Summary of Nuisances and other matters reported on .... 21 Magisterial proceedings during 1899.. .... .... 23 List of Bake-houses, Cow-houses, and Slaughter-houses .... 26 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For 1899. Section I—STATISTICAL. POPULATION OF CHELSEA. The estimated population of Chelsea for the year 1899 is 96,908. The estimated population of each sub-district is as follows: — Chelsea North 42,332 75,674 Chelsea South 33,342 Kensal Town 21,234 BIRTHS AND BIRTH-RATE FOR 1899. 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 1,772 23.5 Kensal Town 609 28.8 Whole Parish 2,381 24.7 London 133,120 29.4 In 1898 the birth-rate of the home district was 23 4, and of Kensal Town 26.9, the birth-rate of the whole Parish being 24.2. The slight rise of 0 - 5 per 1,000 in the birth-rate of the parish in 1899, appears to indicate that the rate, which had been steadily declining since 1891, has now reached a point at which it will remain fairly constant for some time. DEATHS AND DEATH-RATE FOR 1899. The total number of deaths registered in the parish was 1927. Of this total 252 were deaths, within the district, of non-parishioners— chiefly occurring in the hospitals of the parish; and 225 deaths of parishioners of Chelsea occurred outside the district in various public institutions. There were, therefore, 1,900 deaths of parishioners of Chelsea. These 1,900 deaths are equivalent to a death-rate for the year of 19.7 per 1,000, as against a death-rate of 18.2 per 1,000 in 1898. Table II. gives the death-rates of Chelsea and its constituent districts, and of London, during the past nine years: — Table II. Home District. Kensal Town. Chelsea. London. Year. Death-rate. Death-rate. Death-rate. Death-rate. 1891 22.1 17.5 21.0 21.4 17.8 21.0 20.7 1892 21.9 21.4 1893 21.6 16.3 20.4 1894 17.6 14.1 16.8 17.8 1895 20.8 16.8 19.9 19.9 1896 19.0 18.2 18.8 18.6 1897 17.9 17.1 17.7 18.2 18.7 1898 18.1 18.7 18.2 1899 20.0 18.7 19.7 19.8 The higher mortality in Chelsea home district in 1899, as compared with 1898, viz., 1.9 per 1,000, is attributable to a greater prevalence of whooping cough and influenza, with a corresponding increase in deaths from respiratory diseases. There was also an increase in the number of deaths of adults, and of old people over 65 years, in 1899, as compared with 1898. Zymotic death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 2.88 per 1,000 in 1899, the corresponding rate for London being 3.20 per 1,000. In 1898 the zymotic death-rate in Chelsea was 3.39 per 1,000. The decrease in 1899 is due to a diminished prevalence of scarlet fever, diphtheria, and more especially of measles, whooping-cough being the only disease showing a large increase. Table III.—For the year 1899. Diarrhœa death-rate. Other tubercular diseases death-rate. Percentage of deaths under 5 to total deaths Zymotic death-rate. Phthisis death-rate. Respiratory diseases death-rate. Deaths under 1 year to 1,000 births. Cancer death-rate. Home District 2.67 1.29 1.96 4.39 1.08 156 28.4 0.49 Kensal Town 3.64 2.03 1.80 0.71 3.69 0.71 187 38.8 Chelsea 2.88 1.45 1.93 0.54 4.23 0.99 164 30.5 London 3.20 1.66 1.88 0.64 3.89 0.93 167 36.9 Kensal Town again suffered severely from summer diarrhoea in 1899, but less heavily than in 1898 and in 1897, in the latter year the diarrhoea death-rate being 2.49 per 1,000. The mortality from measles 4 and diphtheria in Kensal Town in 1899 was also considerably lower than in the previous year, when the zymotic death-rate reached the high figure of 5.23 per 1,000. Small-pox.—There were no deaths from small-pox in 1899 ; and, as in the three preceding years, not a single case of the disease occurred in the parish. Measles.—This disease caused 18 deaths in 1899, as compared with 92 deaths in 1898, 18 in 1897, and 109 in 1896. Fourteen of the deaths occurred in the home district, and four in Kensal Town. Measles now tends to become epidemic in London every other year. Scarlet Fever. —This disease caused only 8 deaths in 1899, as compared with 14 in 1898, 17 in 1897, and 28 in 1896. Out of the 8 deaths, one only belonged to Kensal Town. This is probably the lowest mortality from scarlet fever that has ever been recorded in Chelsea, the annual average of the 15 years, 1884-98, being 19 deaths. Diphtheria.—This disease caused 25 deaths, of which number 13 occurred in the home district and 12 in Kensal Town. Of the 25 deaths, 11 were under 5 years of age, and 14 were over 5; 16 deaths occurred in hospitals, and 9 at the patients' own homes. Table IV. Deaths from Diphtheria and Membranous Croup. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 Home District 32 20 32 43 41 52 96 45 22 13 Kensal Town 21 10 14 13 13 5 16 11 19 12 The above table shows the immense reduction in diphtheria mortality in the home district in 1899, following the epidemic of 1896. As for scarlet fever, this is probably the lowest mortality that has ever been recorded in the home district of Chelsea, the annual average of the 15 years, 1884-98, being 49 deaths for the whole of Chelsea, of which number about 35 would be deaths of residents in the home district. Table V. —Zymotic Disease Mortality in Chelsea in 1899. Actual number of deaths in Chelsea. Chelsea's proportion of total London Deaths according to its population. Average number of deaths annually in 1884-98. Measles 18 46 61 Scarlet Fever 8 8 19 Diphtheria 25 42 49 Whooping Cough 71 37 55 Enteric Fever 18 17 14 Diarrhœa 140 161 103 5 Whooping Cough.—Of the 71 deaths from whooping cough, 60 were of home district residents, and 11 of Kensal Town residents. In the home district the disease assumed an epidemic form in the first quarter of the year, the number of deaths registered in this quarter (43) being higher than in any previous quarter during the past ten years. Enteric Fever. —The mortality from enteric fever (18 deaths) was slightly higher than the average of the past 15 years. Of the 18 deaths, 6 belonged to Kensal Town. Diarrhoea.—The deaths in Chelsea in 1899 from diarrhæal diseases (diarrhæa, dysentery, cholera, gastro-enteritis, and enteritis) were 140 in number, exactly equal to the mortality of 1898. This is the third year in succession of unusually severe diarrhæa mortality, the great heat and drought of the summer being again favourable to the onslaughts of this disease. All but 11 of the 140 deaths were of children under 5 years of age, the great majority of these being infants under one year. Of these 140 deaths, 43 were of Kensal Town residents, and as usual in this disease, Kensal Town suffered more severely than the home district. Table VI. —Mortality from Diarrhæal Diseases. Chelsea. London. Year. 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 1556 1898 1451 1899 1450 1663 The excessive prevalence of diarrhæa commenced in the last week of July, attained its maximum in the second week of August, and then rather rapidly declined. In the ten weeks ending the 16th September, 116 out of the total of 140 deaths for the year were registered. In London generally there was a similar excessive incidence of diarrhæal diseases, the death-rate for the year being in excess of those recorded in 1897 and in 1898, and being, in fact, the highest recorded rate since the year 1868. Influenza. —The number of deaths referred to influenza, as a primary or secondary cause of death, amounted to 53, as against 35 in 1898, 19 in 1897, 13 in 1896, and 68 in 1895, the last year in which influenza was widely epidemic in London. Of the 53 deaths, 10 belonged to Kensal Town. Thirty-four deaths out of the total 53 occurred in the first quarter of the year. In London generally there was no very widespread epidemic until towards the latter end of December, 342 deaths in this month being attributed to influenza as a primary cause of death. The total number recorded for the year is 1818, 857 of which oocurred in the first quarter. In 1898, in London, 1,283 deaths were ascribed to influenza, but there was no widespread epidemic. Respiratory Diseases.—The death-rate from these diseases in Chelsea was 4'23 per 1,000, which is considerably higher than the rate of 1898—338 per 1,000. The two last weeks of December were made memorable by a largely increased mortality from these diseases, due to the prevalence of influenza, and of very unfavourable atmospheric conditions. Tubercular Diseases. —The death-rate from phthisis and other tubercular diseases in Chelsea in 1899 was 2 - 47 per 1,000, as against 2*52 in London generally. The Kensal Town rate was 2'51per 1,000, that of the home district1. being 2'45. The average death-rate from these diseases in Chelsea during the fifteen years, 1884-98, is 2'86per 1,000. Cancer.—Malignant cancerous diseases caused 96 deaths amongst Chelsea parishioners, of which number 15 belonged to Kensal Town. The annual average of the 15 years, 1884-98, is 79 deaths. The cancer death-rates are shown in Table 111. Deaths in Public Institutions.—ln 1899 29'6per cent, of the total deaths of parishioners of Chelsea occurred in public institutions, the average for the eight years, 1891-8, being 31'2 per cent. Of the home district residents, 31.2 per cent, of the deaths occurred in public institutions, and of Kensal Town residents, 23'5per cent. In London generally, 29'9 per cent, of the total deaths occurred in public institutions. In 1899, 16'4 per cent, of the total deaths of parishioners occurred in the Chelsea Workhouse and Infirmary, the average of the eight years, 1891-8, being 14'8 per cent. Of the home district residents, 17'2per cent, of the deaths occurred in the Workhouse and Infirmary, and of Kensal Town residents, 13'4 per cent. Of the 283 deaths over 25 years of age in the Infirmary, 7 were stated to have been accelerated by chronic alcoholism, and 3 were due to cirrhosis of the liver, presumably the effects of long continued alcoholic excess. 7 TABLE OF DEATHS during the Year 1899, in the Chelsea Metropolitan Sanitary District; classified according to Diseases, Ages, and Localities. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. (f) 15 and under 25. (g) 25 and under 65. 18 Heart Disease. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. (a) (c) Under 1 year. (d) 1 and under 5. (e) 5 and under 15. (h) 65 and upwards. 4 Membranous Croup. Fevers. 14 Diarrhœa and Dysentery. 17 Bronchitis, Pneumonia, and Pleurisy. 1 Small-pox. 3 Diphtheria. (b) At all ages. 2 Scarlatina. 11 Erysipelas. 13 Whooping Cough. 15 Rheumatic Fever. 19 Influenza. 20 Injuries. 21 All other Diseases. 7 Continued. 10 Cholera. 12 Measles. 16 Phthisis. 6 Enteric or Typhoid. 8 Malarial. 9 Puerperal. 5 Typhus. (i) Under 5 Chelsea, North, exclusive of Public Institutions 129 ... 3 30 35 49 4 4 46 491 111 60 13 9 169 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 4 3 1 1 1 1 5 1 43 85 38 23 7 107 ... ... ... ... ... ... ... Chelsea, South, exclusive of Public Institutions 121 Under 5 ... 3 10 25 42 51 4 53 473 131 57 13 11 140 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 2 2 1 ... 4 2 28 72 38 13 15 108 ... ... ... ... ... ... ... .. ... 50 Under 5 4 11 39 28 1 1 52 Kensal Town 302 107 29 12 11 93 ... ... ... ... ... . ... ... ... ... .. ... ... ... 5 upwds. 2 1 1 1 1 23 38 19 9 9 62 ... ... ... ... ... ... ... ... ... ... 136 Under 5 3 13 4 14 Workhouse and Infirmary 327 25 9 3 7 147 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 ... ... ... 5 upwds. 1 1 1 1 70 25 2 6 141 ... ... ... ... ... ... ... ... ... ... ... 1 Under 5 Brompton Hospital 113 3 26 83 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 1 89 3 9 1 10 ... . ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Under 5 ... Cancer Hospital 101 2 1 87 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... 2 1 98 ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... Under 5 Hospital for Women 11 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Hospital for In- Pensioners 42 Under 5 68 ... 26 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 2 13 25 3 25 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Victoria Hospital for Children ... Under 5 1 6 1 2 15 32 8 17 7 ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 1 1 5 ... .. .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cheyne Hospital and St. Camillo's Hospital Under 5 1 9 7 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 1 2 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 491 ... 3 ... ... 17 69 129 ... 1 138 1 5 11 180 Totals 1927 382 172 60 65 757 ... ... ... ... ... ... ... 5 upwds. ... 6 8 2 4 4 1 11 3 258 257 155 49 42 573 ... ... ... ... ... ... The subjoined numbers have also to be taken into account in judging the above Records of Mortality. Under 5 5 upwds. ... Deaths occurring outsider the district among persons belonging thereto 7 8 2 5 1 6 6 13 225 17 31 17 18 119 23 ... ... ... ... ... ... ... ... ... ... ... ... 8 1 16 17 1 26 ... 1 ... ... 11 ... ... ... ... ... ... ... ... 13 83 Deaths occurring within the district among persons not belonging thereto 1 3 1 2 15 255 8 14 15 26 173 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 5 upwds. 1 86 5 12 2 6 121 ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, COMING TO THE KNOWLEDGE OF THE Medical Officer Of Health during the Year 1899, in the Chelsea Metropolitan Sanitary District ; classified ACCORDING TO Diseases, Ages, AND Localities. Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospital. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. (d) Registered Births. Population at All Ages. (e) Aged under 5 or over 5. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. (a) Fevers. Fevers. 1 Small-pox. 2 Scarlatina. 3 Diphtheria. 4 Membranous Croup. 4 Membranous Croup. 11 Erysipelas. 1 Small-pox. 2 Scarlatina. 3 Diphtheria. 11 Erysipelas. 10 Cholera. 10 Cholera. Estimated to middle of 1898. (c) 6 Enteric or Typhoid. 7 Continued. 8 Relapsing. 9 Puerperal. 6 Enteric or Typhoid. 7 Continued. 8 Relapsing. 9 Puerperal. 5 Typhus. 5 Typhus. Last Census. (b) 12 13 12 13 Under 5 1772 60 29 ... 42 21 ... Chelsea, Home District 75,196 75,674 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 160 90 33 3 8 1 44 116 62 24 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Public Institutions:— II I I II I I I I I I I I I I I I I I m I I I I I I I I I I I I I I I I I I I I I m I I I I I I I I I ... Under 5 1 1 ... Chelsea Infirmary ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 1 3 7 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ... ... Duke of York's School ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Victoria Hospital Under 5 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 7 ... 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chelsea Barracks Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 St. George's Hospital ... 3 ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 2 3 7 ... 3 2 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Kensal Town Under 5 30 609 12 37 ... ... ... 12 ... 21,450 21,234 ... ... ... 20 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 45 63 1 1 29 43 54 15 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 96,908 2381 Under 5 83 55 Totals 96,646 73 70 ... ... 54 ... ... ... 165 ... 63 ... ... 4 ... ... 1 ... ... ... 162 ... ... ... ... ... ... ... ... 5 upwds. 210 ... 9 1 125 44 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Section 11. INFECTIOUS DISEASES. Small-pox.—As in the three previous years, 1896, 1897, and 1898, there were no cases of this disease in Chelsea in 1899. In London during 1899, 29 cases of small-pox were notified, as against 35 in 1898. In the eight parishes forming the western district of London (population 789,230), only one case of small-pox was notified in 1899, as against 3 in 1898. Scarlet Fever.—This disease was less prevalent in 1899 than in 1898, the case-rate per 10,000 of the population being 29* 1 in 1899, as against 34"7 in 1898. The case-rate for West London was 36 0 per 10,000, and for London generally 39'9 per 10,000. The disease was prevalent to a slightly less extent in Kensal Town than in the home district, 56 out of the total of 282 cases belonging to Kensal Town, Kensal Town's share of the cases in proportion to its population being 62 cases. During the past year, the incidence-rate of scarlet fever in Chelsea was exceeded by Fulham (65.5 per 10,000), by Hammersmith (40.6 per 10,000), by Westminster (38.3 per 10,000), and by Paddington (29.8 per 10,000), the remaining three parishes of West Loudon having rates below that of Chelsea. The autumnal exacerbation in prevalence of scarlet fever in Chelsea in 1899 was only slightly marked, but the decline did not set in until the third week in December. The fall in notified cases following the closure of the schools (Board Schools on the 27th July) was well marked, especially in the last two 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 70 per cent, in Kensal Town. The unusually small fatality from scarlet fever in Chelsea in 1899 has been already alluded to. Diphtheria.—There was again a diminution in the prevalence of this disease in Chelsea in 1899, as compared with 1898, the case-rate per 10,000 of the population being 24.4, as against 28.2 in 1898. In the home district, the diphtheria case-rate in 1899 was only 18*0 per 10,000, as against 20.3 in 1898, and 32.l in 1897. In Kensal Town, however, the diphtheria prevalence was again above the average, although not quite so high as in 1898. 10 Table VII. —Cases 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 1899 Home District 172 162 163 200 207 273 429 242 153 136 Kensal Town 129 33 38 39 42 32 60 71 119 100 Deaths. Home District 32 20 32 43 41 52 96 45 22 13 Kensal Town 21 10 14 13 13 5 16 11 19 12 Out of the total of 236 cases of diphtheria and membranous croup notified in Chelsea in 1899, 100 cases belonged to Kensal Town, the share of the latter district in proportion to its population being only 52 cases. The greatest prevalence of the disease in Kersal Town was in January (22 cases), February (16 cases), and June (12 cases). In April there were no cases, but in all the other months cases were notified. In the home district, the largest number of cases notified in any one month was in July (24 notifications). The cases were fairly evenly distributed throughout the other months of the year, October (7 cases) and December (4 cases) coming off, however, very lightly. In the whole of the last quarter of the year, there were only 20 cases notified, as against 31 in the first quarter, 38 in the second quarter, and 47 in the third quarter. The percentage of cases of school age (3 to 13 years) was 60 per cent, in Chelsea, 57 per cent, in the home district, and 64 per cent, in Kensal Town. The fall in notified cases following the closure of the schools at midsummer was noticeable in the home district, but irregular in character. The first two weeks in August were characterised by a slight fall, whilst in the third week of that month no cases at all were notified. There was no renewal of prevalence after the schools had re-opened. In Kensal Town the effect of school closure is barely traceable in the weekly returns. Prevalence of Scarlet Fever, Diphtheria, and Enteric Fever in West London. The following table VIII. is based upon the notified cases of scarlet fever, diphtheria and membranous croup, and enteric fever, respectively, in each of the eight parishes constituting West London, the rates being calculated upon the estimated population of each district. 11 Table VIII.—Notifications per 10,000 of Population. Enteric Fever. Diphtheria and Membranous Croup. Scarlet Fever. 1898 1890-8 1899 1898 1890-8 1899 1899. Chelsea (Home District) 35.4 44.4 29.9 20.3 29.6 18.0 5.7 27.5 36.3 25.6 12.9 17.0 14.9 6.2 Kensington 66.0 48.9 65.5 38.8 25.4 40.8 8.6 Fulham 43.3 40.6 15.3 17.6 Hammersmith 41.5 21.4 10.6 Paddington 23.9 37.1 29.8 20.5 21.1 15.9 7.6 St. George's, Hanover Square 27.4 35.0 24.5 13.8 13.4 11.3 5.7 Westminster 18.8 36.3 38.3 24.1 17.3 19.5 8.7 13.9 31.7 22.3 19.3 15.3 16.9 15.5 St. James' 39.8 36.0 21.4 20.9 West London 35.1 20.9 7.9 London 37.6 49.8 39.9 26.4 24.5 30.2 9.8 The above table shows that in West London, as a whole, there was about the same amount of scarlet fever in 1899 as in 1898. In Fulham, scarlet fever maintained itself at the same high rate as in the two previous years, 1897 and 1898. In Westminster, there was nearly twice as much scarlet fever in 1899 as in 1898, whilst in Hammersmith, although the rate was a high one (40 - 6 per 10,000), it was slightly less than in 1898. As regards diphtheria, there was a slight diminution of cases in West London, five parishes, including Chelsea, showing a small decrease, and three parishes a small increase. In Fulham, the prevalence of this disease increased slightly over the high prevalence obtaining in 1898, the past year (1899) being the seventh in succession in which the diphtheria case-rate in this parish has maintained itself at a high figure, being in fact more than double the case-rate of any other of the West London parishes. Both as regards scarlet fever and diphtheria, Fulham has been singularly unfortunate of recent years. It will be noticed from the table, that during the past ten years, when compulsory notification has been in force, West London has suffered less, proportionally to its population, from scarlet fever and diphtheria, than has London as a whole. Enteric Fever. —The number of cases of enteric fever notified in Chelsea in 1899 were 64. 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 oases; 1898, 56 cases; 1899, 64 cases. In 1899, the Chelsea home 12 district enteric fever case-rate per 10,000 was equal to that of St. George's, Hanover Square, the wealthiest of the West London parishes, and was lower than that of any other West London parish. The case-rate for the entire parish of Chelsea was 6'6 per 10,000, and is exceeded by all the West London parishes, except St. George's, Hanover Square, and Kensington. The number of cases in Kensal Town in 1899 was 21, Kensal Town's share proportionally of the total being 14 cases. The number of cases notified in the first quarter of the year in Chelsea was 11; in the second quarter, 6; in the third quarter, 18 (9 in the home district, and 9 in Kensal Town); and in the fourth quarter, 29 (23 in the home district, and 6 in Kensal Town). Out of the 43 cases occurring in the home district in the past year, in 12 the infection of the disease was probably acquired outside the parish; whilst out of the 21 cases occurring in Kensal Town, in 9 the infection was probably acquired outside of the parish—in 4 of these cases the infection being contracted during August at Falmouth, where enteric fever was very prevalent at that time. This leaves 43 eases in which the infection was probably acquired in the parish, as compared with 47 cases in 1898, and 46 in 1897. Case Mortality.—The following table 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 10 years, 1890-99. Table IX.— Case Mortality in Chelsea, and in London, 1890-99. Diphtheria and Membranous Croup. Scarlet Fever. 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 23.9 13.6 5.3 4.3 22.9 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 3.5 179 17.1 26.4 18.8 3.4 1898 14.8 4.2 3.4 15.1 25.0 19.3 1899 2.8 2.2 10.6 28.1 18.0 - The low case mortality of scarlet fever in 1899, both in Chelsea and in London, is remarkable. The prevalence of the disease remains much what it has always been, but the mortality caused by it continues steadily to diminish. The lowered fatality of diphtheria in recent years 13 is almost certainly attributable to the more extended use of the antitoxin treatment in this disease. A case mortality so low as 10.6 per cent, is certainly novel in the history of this disease in London. The high case mortality of enteric fever in Chelsea is probably due to the importation into the parish of unusually severe cases from outside its boundaries. Removals to Hospitals.—Table X. exhibits the removals of patients suffering from scarlet fever, diphtheria, and enteric fever, from their homes to hospitals, in each of the ten years, 1890-99, 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 22 1891 40 15 1892 48 27 32 1893 50 41 38 1894 71 58 63 1895 55 62 51 61 56 56 1896 1897 76 67 54 1898 74 74 54 1899 77 76 69 The percentage of removals of cases of all three diseases is in advance of any previous year, showing that hospital treatment continues to advance in favour amongst all classes of the community. Measles.—There was no epidemic of measles in 1899, but the expected visitation, now regularly recurring every other year, is already making itself felt in the home district at the moment of writing. It is a matter for regret that the London County Council has not seen its way to apply by order the "prevention" sections of the Public Health (London) Act (Sections 58—74) to measles, so that the same precautions may be rendered compulsory by the public with regard to this disease, as are required for the far less fatal malady, scarlet fever. This Vestry urged the desirability of so doing upon the Council, and it was the Council's own suggestion that it should be done; but, so far as I am aware, no action has been taken. I have recently addressed a letter to all school teachers in the home district, urging the importance, during the progress of an epidemic of measles, of excluding all children from school, who show any traces of nasal and faucial catarrh, which are often the early and very infectious stages in the development of attacks of measles. 14 Bacterioscopic Diagnosis of Diphtheria and Enteric Fever.—ln all cases which are brought by medical practitioners to my notice, and in which I think such a course desirable, I am now empowered by the Public Health Committee of the Vestry to forward to the Jenner Institute material for examination free of charge to the patient or his friends. The exact significance qûa infectiveness, of the Klebs-Læffler Diphtheria Bacillus is still unsettled, so far as regards its presence in throats of normal appearance, or not presenting clinical signs of diphtheria, so that I am still of opinion that notification should be based rather upon clinical evidence of diphtheria, than upon bacterioscopic examination of removed secretion. Evidence is accumulating that the Klebs-Læffler bacillus is more widely spread amongst the general child population than was formerly anticipated, but the exact significance of this fact in its relation to localised occurrences, or epidemic outbursts, has still to be determined. In my opinion, swab examinations, as a part of municipal administration, are only called for where clinical symptoms or surrounding circumstances point to the presence of diphtheria in its generally recognised forms. The Widal Serum reaction for enteric fever might with advantage be more generally employed in cases of doubtful nature, than has hitherto been the case. In one case, at least, it has proved of great use in this parish ; and its earlier adoption would tend greatly to the advantage of the patient in the crowded homes of the poor, by securing removal to hospital at a time when treatment and nursing are of the greatest value, and by removing a source of danger to others in the house at the earliest possible moment. In the tenement homes of the poor, the nursing at home of a case of enteric fever, involves a considerable amount of risk of infection to the healthy inmates. 15 Section III THE SANITARY CONDITION OF THE PARISH. There has been a steady and continuous improvement in the sanitary condition of the parish during the past nine years The tabular statements prepared by the Sanitary Inspectors show that in the home district 1,470 separate premises were inspected by them during 1899, of which number 891 were house-to-house inspections carried out in those parts of the district where the lower wage-earning classes reside. In Kensal Town, where, since February, 1899, Mr. Metzler has been carrying out the duties of Sanitary Inspector in succession to Mr. Mackay, 640 premises have been inspected, the greater number of these being house-to-house inspections. It has only been necessary to take proceedings in a few instances (see appended statement), to enforce the due carrying out of the Vestry's notices; and I am glad to be able to report that each year less difficulty is encountered in the carrying out of works of necessary sanitation. There appears to be greater willingness on the part of property owners to recognise their responsibilities in these directions, and the high rents now almost universally obtainable for working class accommodation, not only render improved sanitation possible, but also make it remunerative. In some of the more central parts of the home district, the leases of many of the houses will expire within the course of a few years. The Public Health Committee of the Vestry has been, and is at present, engaged in considering the aspects of this question in so far as it relates to the housing or re-housing of the working class population that will be displaced. In the meantime, the structural conditions of many of the older houses are not very satisfactory, and it is found that constantly recurring inspections are necessary to maintain these premises in anything like a satisfactory condition of tenantable repair. In the early part of the year, 1899, under the direction of the Public Health Committee, notices under the Lodging House Regulations, made under the Sanitary Act of 1866, were served upon the owners of numerous houses in certain of the poorest streets in the more crowded central and western parts of the home district, such houses having been previously registered with the Vestry prior to my accession to office in 1891. The Vestry having recorded its opinion that it was inadvisable in carrying out these regulations to make distinctions between the different classes of houses let in lodgings, or occupied by members of more than one family, the Public Health Committee again took the matter into consideration, with the result that it resolved to restrict the application of the regulations to such houses as appeared upon my recommendation to the Committee to be in need of regulation for various sanitary or other reasons. 16 Combined Drainage.—During the past few years some difficulty has been experienced with regard to the combined drainage of premises. Prior to 1893, when the case of Travis v. Uttley re-opened the whole question, it had been generally held and acquiesced in by owners of property, that combined drains situate on private land were private drains for which the owners were responsible. It now, on the contrary, appears to be the opinion of the general public that all combined drains are sewers for which the Vestry is responsible. This, of course, is not so; only those combined drains being sewers which have never been authorised by the Vestry or the Metropolitan Commissioners of Sewers (prior to 1855). Fortunately in Chelsea the majority of the combined drains existing have either been authorised by the Vestry or by the Metropolitan Commissioners of Sewers. In the former case the orders and plans are recorded in the books kept by the Vestry's Surveyor, whilst in the latter the records are kept by the London County Council, and are easily accessible. In respect of these latter a copy has been made, for the use of the Vestry, of the applications to drain, with all proper references to plans deposited in the Commissioners Books, which has been found exceedingly useful. In a majority of instances these combined drains are carried through the back yards at a distance from the houses, and do not run under the houses except at certain points. Although very far from being equal to modern constructions, they serve their purpose still fairly well, and are not, as a rule, productive of any nuisance. In some instances improvements have been carried out in these systems, either by reconstruction, where they were altogether defective or inefficient, or by the insertion of inspection manholes or improving the gradients, where such improvements were called for. In certain other cases, where no authorisation could be found, the Vestry has been called upon by the owners of property, to reconstruct combined systems of drainage, which were sewers, and a list of these works and the cost of each is appended to this report. In all these cases, the ground landlord (where he could be found) has been informed of the fact of the reconstruction of the sewer by the Vestry, and his attention directed to the Sections of the Metropolis Local Management Acts, which prohibit any interference with or building over the Vestry's sewers. Combined Drainage Works executed by the Vestry, and their Cost. £ s. d. 1896—February. Nos. 11, 13, 15, 17, 19, 21, 23, 25 and 27, Little Orford Street 67 1 8 April. Nos. 375 and 377, King's Road 0 0 20 1897 —January. Sun Court, and 68 and 69, Cheyne Walk 10 0 0 „ April. Nos. 5, 7, 9 and 11, Denyer Street 14 12 0 „ November. Nos. 50 and 51, Blenheim Street, and No. 19, Cale Street 6 17 6 1898—March. Nos. 5 and 6, Stewart's Grove 13 0 0 „ April. Eign's Cottages (6 houses on North side), Milman's Street 67 10 0 17 £ s. d. 1899—January. Eign's Cottages (Nos. 5, 6 and 7) 28 0 0 April. Nos. 25 and 27, Denyer Street 13 4 0 „ June. Nos. 29, 31, 33 and 35, College Street 29 14 0 „ December. Nob. 45 and 46, Blenheim Street 0 15 18 £285 17 2 Total Drainage.—During the past nine years, 1276 house-drains have been reconstructed in accordance with the Vestry's drainage regulations, including a certain number of combined systems of drainage. The drains laid in the parish, before there was any proper system of supervision by the Vestry's officers, are very commonly found to be very defective in respect of jointing. Water-closets. —Many old and defective pan closets and "long hopper" closets have been, during recent years, taken out and replaced by improved forms of " short hopper" closet. The flushing of the closets by 2-gallon water-waste-preventers is generally fairly satisfactory, although these waste-preventers appear to be often out of order, especially those of cheap make. It is to be regretted that the Chelsea Water Company has not seen its way to sanction the use of 3-gallon water-waste-preventers in its district, as these are more effectual in flushing the water-closet basins, traps, and drains. Yards.—Generally speaking, the back yards of houses are now fairly well paved, in accordance with the Vestry's Byelaws under the Public Health (London) Act, and the drain inlets are now nearly everywhere protected by stoneware gulley traps. The sanitary importance of having good paving of yards in the neighbourhood of houses is, I consider, very great, as it prevents any filth accumulations soaking into the ground—a fruitful source of illness. Dust-bins.—Metal pails for the reception of house-refuse are now very largely in use in place of fixed brick bins, and are not only far more cleanly, but must materially lighten the labour of dust collection by the Vestry's workmen. Dung receptacles.—Iron wire cages resting on a cemented base have been very largely adopted by the owners of stables. Fixed brick receptacles are still in use in certain mews, but unless these are sunk below the level of the ground, or are otherwise a nuisance, notices are not served for their removal. A few sunken dung-pits still remain in places where there is no room for a manure cage, or where such a cage would interfere with the traffic, or with means of access to coach-house or stables. The removal of horse manure was very fairly well carried out during the past year, and fewer complaints of accumulations were received than usual. Unsound Food. —The Sanitary Inspectors have exercised a careful supervision over the food exposed for sale in the streets, stalls, and shops of the parish. A considerable amount of food which was 18 unwholesome has been condemned and destroyed, but it has not been found necessary to take any proceedings for the wilful sale or exposure for sale of unsound food. The Vestry has sanctioned the erection of a small crematorium for the destruction of unsound food, and this would prove a very great advantage to the sanitary administration of the parish. It has, however, unfortunately not been possible to acquire a suitable site for its erection. Disinfection. —The Washington Lyon high pressure steam disinfector continues to give every satisfaction, and its upkeep is most inexpensive. The station building, however, is unsatisfactory, owing to the constant settlement, which continues to develope large cracks and fissures in the walls. It is hardly possible to doubt that the structure would have collapsed before now, if it had not been for the iron tyes introduced some years ago. Mr. Davis, the assistant in the department, now carries out the steam disinfections, which is of great advantage in relieving the district inspectors of work taking them away from their other duties. During the past year in the home district, 62 rooms occupied by consumptives were disinfected after the death of the patient, and 14 in Kensal Town, in addition to the 665 premises disinfected for notifiable infectious diseases. Water-supply.—The whole of the home district now has a constant supply of water. In 1891 only 23 percent, of the houses in the district of the Chelsea Waterworks had a constant supply of water. During the years the conversion from intermittent to constant supply was proceeding, no steps were taken to do away with existing cisterns for the storage of water, consequently should at any time there be a scarcity of water in the district similar to that experienced of recent years in the district of the East London Company—a not impossible contingency having in view the abnormally low condition of the Thames during the past three summers, and the continually increasing amount of water abstracted by the Companies—there will be no such shortness of water with all its discomforts and evils as characterised the water famines in East London, as every house in Chelsea will have a cistern for the storage of water more or less adequate to the needs of the hours when the water is turned off from the main. It is much, however, to be desired that house owners would fix a screw-down draw-off tap on the rising main of every house, so that the occupier could draw his drinking water straight from the main, and be relieved of the necessity of drinking stored water. During the year a daily examination of the water drawn from the main has been made at the Town Hall, as regards its temperature and appearance, in a 2-ft. tube. The highest temperature attained during the year was 73° F. on the 2nd of August, and the lowest temperature 38.5° F. on the 28th of December. The temperature of the water was 70° F., or over, between the 12th July and the 12th August, and during the remainder of August was never less than 69° F. During 1898 the temperature of the water only exceeded 70° F. between the 21st and 25th of August, and did not exceed 69° F. for more than 10 days, so that in the past year the summer temperature of the water appears to have been abnormally high. The water was generally of good colour and 19 appearance during the year except in the month of November. From the 13th November to the 2nd December, the water had a distinctly yellow colour, and was cloudy and non-transparent on the 20th, 21st and 22nd November. REPORTS TO THE VESTRY During the past year I have had the honour to present to the Vestry reports upon the undermentioned subjects :— January 17th. Combined drainage at Nos. 5, 6 and 7, Eign's Cottages. March 14th. The prevention of tubercular diseases. ,, 28th. Combined drainage at Nos. 25 and 27, Denyer Street. April 11th. Chelsea Public Baths, Kensal Road, re Smoke nuisance. May 30th. Combined drainage at Nos. 29, 31, 33 and 35, College Street. The new ventilators for the low level sewer on the embankment. Smoke from Vigers Bros, and Royal Brewery chimnies. June 13th. Sewer ventilator at Cheyne Walk. September 26th. Hospital for Consumption re Smoke nuisance. November 7th. No. 27, Denyer Street. December 5th. Combined drainage at Nos. 45 and 46, Blenheim Street. Sewer ventilators at Cheyne Walk. 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 1899. I am, my Lord and Gentlemen, Your obedient servant, LOUIS C. PARKES, Medical Officer of Health. 20 Section IV. PUBLIC HEALTH DEPARTMENT. Summary of Nuisances and other matters reported on and Work done during the Year 1899. Home District. Kensal Town. Total. Houses and Premises:— *Reported on respecting nuisances complained of 1060 444 1504 Reported on with reference to infectious cases 410 196 606 Cleansed, whitewashed, and repaired 400 236 636 Defective roofs repaired 154 68 222 Disinfected after zymotic diseases 493 172 665 Cases of overcrowding abated 22 3 25 Dust-bins, new, provided 162 85 247 „ repaired 18 37 55 Underground rooms reported as occupied contrary to Act 12 12 - Houses closed as unfit for human habitation 3 3 - Drainage:— Drains opened, cleansed, and made sound „ trapped with stoneware gullies 453 180 633 „ trapped with stoneware gullies Water-closets cleansed and repaired 100 55 155 new pans and traps provided 261 81 342 Spout drains cleansed, repaired, or renewed 138 106 244 Sink, bath, and lavatory waste pipes disconnected 115 55 170 Soil pipes ventilated or repaired 25 100 75 „ new, provided 78 14 92 New drains laid, in accordance with Vestry's regulations (including 19 systems of combined drainage) 156 12 168 Additional w.c. accommodation provided 11 1 12 Water Supply:— For domestic purposes, provided where cut off by Water Company 16 1 17 For water-closets, or check cisterns provided 147 73 220 Main cisterns cleansed or repaired 28 66 94 „ new, provided 1 1 2 Nuisances abated arising from: — Keeping of animals 12 2 14 Accumulations of manure and other filth 64 54 118 Yards cleansed, paved, or drained 213 88 301 Smoke 9 1 10 Dung pits repaired, drained, &c., or cages, &c., provided 10 12 22 * 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. 21 Home District. Kensal Town. Total. Miscellaneous:— Dead bodies removed to public mortuary for sanitary reasons 5 5 10 Goods disinfected after infectious cases at station 2382 2382 - Goods destroyed after infectious cases 20 20 - Number of samples taken for analysis (Food and Drugs Act) 117 43 160 Unsound Food. Number of boxes of fruit, &c., condemned and destroyed 27* 3 30 Proceedings taken:— Notices issued for sanitary works, &c., including infectious diseases notices 1843 903 2746 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 9 2 11 Legal proceedings in respect of food adulteration 7 7 - Correspondence:— Number of letters written in connection with sanitary matters, including those of Medical Officer of Health 767 320 1087 Daily returns of infectious cases sent to Metropolitan Asylums Board 214 214 - Notification of infectious cases sent to School Authorities 324 163 487 Entries in Inspectors' Report Books 1020 500 1520 „ Inhabitants' Complaint Book 44 44 - Certificates of Disinfection given 333 163 496 Certificates of Infectious diseases for removal cases 319 139 458 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, (Chief), Home District. J. W. KING, W. THORPE, GEO. R. METZLER, Kensal Town. * This does not include unsound food condemned in the streets and destroyed, for which no condemn note was given. On the 6th November, 275 lbs. of sour pork were removed to the disinfecting station to be destroyed. 22 MAGISTERIAL PROCEEDINGS DURING 1899, UNDER THE SALE OF FOOD AND DRUGS ACT. Article purchased. Extent of Adulteration or Abstraction. Date of Hearing. Streets where purchased. Result. Keppel Street Milk 9% added water Feb. 14th Fine, £2. Costs, 10s. 6d. Lawrence Street Butter 73% foreign fat Feb. 21st Fine, £2. Costs, 10s. 6d. Stayton Street Milk 14% added water May 16th Fine, £3. Costs, 10s. 6d. Godfrey Street Milk 15% added water May 30th Fine, £3. Costs, 15s. 6d. Manor Street Milk 17% fat abstracted June 20th Fine, 10s. Chelsea Infirmary Milk 17% added water Sept. 26th Summons withdrawn on production of warranty. Oakley Crescent Coffee 99% chicory and 1% sand Nov. 28th Fine, £5. Costs, 10s. 6d. Total, £15 10s. Fines, and £2 17s. 6d. Costs. MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Date of Hearing. Nature of Nuisance or Complaint. Result. 3, Munro Terrace Foul and defective drains Feb. 7th Order for works in 14 days. 10, Petyt Place Foul and obstructed water-closet March 14th Adjourned (works in progress). 18, Lennox Gardens Failure to notify case of infectious disease by medical practitioner March 21st Fine, £2. Costs, 5s. 40, Slaidburn Street Filthy and dilapidated condition of premises, overcrowded state of ground floor rooms March 21st Closing order made. 5, Leader Street Defective drain-inlet, want of a dust-bin June 20th Abatement order, 7 days. Non-compliance with Byelaws of Houses let in lodgings June 20th Adjourned for 1 week. Withdrawn. 3, 11, 13 and 15 Pond Terrace Hans Crescent Removing offal during prohibited hours. Wm. Hooper July 18th Fine, 10s. Costs, 2s. 6d. July 25th „ „ „ Wm. Gordon Manor Street Fine, 20s. Costs, 2s. 6d. „ „ „ G. Norris July 25th Fine, 30s. Costs, 2s. 6d. Chelsea Embankment 119, Lancefield Street, Kensal Town Defective roof, dirty and dilapidated condition of the premises Dec. 5th Adjourned (works in progress). Withdrawn, 19th December. Defective roof, dirty and dilapidated condition of the premises 13, Beethoven Street, Kensal Town Dec. 19th Adjourned (works in progress). Withdrawn, 2nd January, 1900. Total, £5 Fines, and 12s. 6d. Costs. 25 24 BAKEHOUSES IN USE ON JANUARY 1st, 1900. Occupier. Above Ground. Below Ground. Street. 74, Arthur Street Solomon Keppler Below. ...... 93, Beaufort Street A. Coventry ...... „ 26, Blantyre Street Hetzler ...... „ 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 The Devonshire Bread Co. ...... „ Gerres 17, Coulson Street ...... „ 3, Dartrey Terrace Knee ...... „ 67, Flood Street J. Venner ... .. „ 95, Gass ....... „ C. M. Nash 153, Fulham Road ... .. „ 187, E. Pinnock ...... „ 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 ...... „ 351, Mardon ...... „ 399, Dohna „ ...... 414, Korle ...... „ Street. Occupier. Above Ground. Below Ground. 488, King's road Matthiae Below. ...... 502, „ J. Reus ...... „ 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, Reitze ...... „ 110, Wordley Above. ...... 23, Queen's Road Hilton Below. ...... 58, Rawling's Street Hannah ...... „ 150, Sloane Street Pennycuick ...... „ 43, Stayton Street Hahn Above. ...... 117, Sydney Street J. Humphry Below. ...... 25, Walton Street Burrows ...... „ 46, „ Channon ...... „ KENSAL TOWN DISTRICT. 549, Harrow Road A. Hudson Above. Below. 608, „ W. Y. Menzler „ ...... 690, „ Heinrich Geissler „ ...... 62, Herries Street Fredk. Spohr Below. ...... 83, „ A. Royston ...... „ 193, Kensal Road Francis Openham Frost ...... „ 300, „ ...... Above. ...... 226, Kilburn Lane James Guscott „ ...... 24, Mozart Street Henry Geo. Taylor ...... „ SLAUGHTER HOUSES. Street. Occupier. Crooked Usage Cridlan, P. and J. W. 169, Fulham Road Philp, J. 341, „ Buckingham, J. T. 52, King's Road Cobb, G. A. 54, „ „ 413, „ Rowland, Mrs. 82, Marlborough Road Iggulden, F. 90, „ „ „ 128, „ „ Little, G. Miles, A. 273, Kensal Road COW HOUSES. 54, Arthur Street Jennings, J. Church Street Emerton, J. 406, King's Road Jordan, G. 3a, Leverett Street Robinson, F. 10, Stayton Street Thomas, J.