CHE 8 Metropolitan Borough of Chelsea. ANNUAL REPORT For 1900, OP THE Medical Officer of health. LOUIS C. PARKES, M.D.; D.P.H. Lond. Univ.; M.R.C.S. Eng. FELLOW OP THE SANITARY INSTITUTE AND MEMBER OP THE BOARD OP EXAMINERS ; FELLOW OF THE SOCIETY OP MEDICAL OFFICERS OP HEALTH; MEMBER OF COUNCIL OP THE EPIDEMIOLOGICAL SOCIETY; LECTURER ON HYGIENE AND PUBLIC HEALTH AT ST. GEORGE'S HOSPITAL MEDICAL SCHOOL. TOWN HALL, KING'S ROAD, CHELSEA. 1901. TABLE OF CONTENTS. SEC. I.—STATISTICAL:— page. Population of Chelsea 3 Births and Birth-rate 3 Deaths and Death-rate 3 Statistical Tables. VII., VIII., IX., X. (Local Government Board Forms) 8 SEC. II.:— Infectious Diseases — Small-pox 12 Enteric Fever 13 Typhus 15 Scarlet Fever 15 Diphthotia 15 Prevalence of Scarlet Fever and Diphtheria in Western Loudon 16 Tho Case Mortality 17 Removal of Patients to Hospitals 18 Measles 18 SEC. III.:— A Retrospect of 40 years 19 Sanitary Administration in the early days of the Vestry 20 SEC. IV. The Sanitary condition of the Parish 23 SEC. V. Work of the Public Health Department— Summary of Nuisances and other matters reported on 25 Magisterial proceedings during 1900 27 List of Bake-houses, Cow-houses, and Slaughter-houses 32 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For 1900. Section I.-STATISTICAL. POPULATION OF CHELSEA. The estimated population of the Parish of Chelsea for the year 1900 is 96,990. The estimated population of each sub-district is as follows:— Chelsea North 42,417 75, 882 Chelsea South 33,405 Kensal Town 21,168 BIRTHS AND BIRTH-RATE FOR 1900. 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-rato per 1,000. Home District 1,674 22.1 Kensal Town 571 27.0 Whole Parish 2,245 23.1 London 130,868 28.5 In 1899 the birth-rate of the home district was 235, and of Kensal Town 28.8, the birth-rate of the whole parish being 24.7. The birth-rate of Chelsea for last year (23.l) is the lowest recorded. Table VII. shews the steady decline in the birth-rate of the parish during the past 10 years. DEATHS AND DEATH-RATE FOR 1900. The total number of deaths registered in the parish was 1,802. Of this total 277 were deaths, within the district, of non-parishioners— chiefly occurring in the hospitals of the parish; and 213 deaths of 4 parishioners of Chelsea occurred outside the district in various public institutions. There were, thereforo, 1,737 deaths of parishioners of Chelsea. Theso 1,737 deaths are equivalent to a death-rate for the year of 17.9 per 1,000, as against a death-rato of 19.6 per 1,000 in 1899. Table II. gives the death-rates of Chelsea and its constituent districts, and of London, during the past 10 years. Table II. Year. Homo District. Kensal Town. Chelsea. London. Death-rate. Death-rate. Death-rate. Death-rate. 1891 22.1 17.5 21.0 21.4 1892 21.9 17.8 20.9 20.7 1893 21.6 16.3 20.3 21.4 1894 17.6 14.1 16.8 17.8 1895 20.8 16.8 19.9 19.9 1896 19.0 18.2 19.1 18.6 1897 17.9 17.1 17.7 18.2 1898 18.1 18.7 18.2 18.7 1899 20.0 18.7 19.6 19.8 1900 18.1 17.2 17.9 18.7 Zymotic death-rate.—The death-rato in Chelsea from the seven principal zymotic diseases was 2.26 per 1,000 in 1900, the corresponding rate for London being 267 per 1,000. In 1899 the zymotic death-rate in Chelsea was 2.88 per 1,000. The decrease in 1900 is duo to a diminished prevalence of diphtheria, whooping cough, and diarrhœa; measles and enteric fever being the only diseases showing increases. Table III.—For the year 1900. ic death-rate. Diarrhoea death-rate. Phthisis death-rate. Other tubercular diseases death-rate. Respiratory diseases death-rate. Cancer death-rate. Deaths under 1 year to 1,000 births. Percentage of deaths under 5 to total deaths Home District 2.12 1.19 1.82 0.58 4.00 0.98 145 26.8 Kensal Town 2.74 1.56 1.56 0.57 3.54 1.28 158 34.3 Chelsea 2.26 1.27 1.76 0.58 3.90 1.04 148 28.4 London 2.67 1.25 1.75 0.67 3.81 0.93 160 36.0 Kensal Town again suffered somewhat severely from summer diarrhoea, but much less heavily than in the three preceding years. 5 Small-pox.— There were no deaths from small-pox in Chelsea in 1900. Two cases of the disease were notified during the course of the year. Measles.—This disease caused 33 deaths in 1900, as compared with 18 deaths in 1899, and 92 in 1898. Thirty of the deaths occurred in the home district, and 3 only in Kensal Town. The epidemic which was expected, and arrived in the early part of the year, was of but small intensity, and hardly affected Kensal Town at all. Scarlet Fever.—This disease caused only 7 deaths in 1900, as compared with 8 in 1898. Oat of the 8 deaths, only one belonged to Kensal Town. This is the lowest mortality from scarlet fever yet recorded, the annual average of the 16 years, 1881—99, being 18 deaths. Diphtheria.—This disease caused 18 deaths, of which number 14 occurred in the home district, and 4 in Kensal Town. Of the 18 deaths, 9 were under 5 years of age, and 9 were over 5; 11 deaths occurred in hospitals, and 7 at the patients' own homes. There has been an immense reduction in diphtheria mortality in Chelsea since the epidemic of 1896. In the home district in 1900 the prevalence and fatality of the disease were very similar to those of the preceding year, but in Kensal Town there was a marked reduction. Tahle IV.—Cases of, and Deaths from Diphtheria and Membranous Croup in the Ilome District, and in Kensal Town. CASES. 1890. 1891 1892. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. Home District 172 162 163 200 207 273 429 242 153 136 150 Kensal Town 129 33 38 39 42 32 60 71 119 100 31 DEATHS. Home District 32 20 32 43 41 52 96 45 22 13 14 Kensal Town 21 10 14 13 13 5 16 11 19 12 4 Whooping Cough.—Of the 18 deaths from whooping cough, 13 were of home district ohildren, and 5 were of Kensal Town children. In the previous year, 1899, this disease was epidemic in the home district in the early spring, and caused 60 deaths. 6 Table v.—Zymotic I) U case Mortality in Chelsea in 1900. Actual Number of Deaths in Chelsea. Chelsea's proportion of total London Deaths, according to its population. Average Number of Deaths annually in Chelsea in 1884—99. Measles 33 41 58 Scarlet Fever 7 8 18 Diphtheria 18 33 48 Whooping Cough 18 41 56 Enteric Fever 20 16 14 Diarrhoea 123 121 105 Enteric Fever.—The mortality from this disease was slightly higher than the average of the past 16 years. Of the 20 deaths, 12 belonged to Kensal Town, where enteric fever was very prevalent in a certain limited area south of the canal during the months of September, October, nnd November. (See page 13.) Diarrhæa.—The deaths in Chelsea in 1900 from diarrhœal diseases (diarrhoea, dysentery, cholera, gastro-enteritis, and enteritis) were 123 in number, which is somewhat less than the mortalities of the two preceding years—1899 and 1898. The great heat of the latter part of July was favourable to a high mortality, but was checked by the cooler weather which set in in August. Of the 123 deaths, 90 were of infants under one year of age; and 33 were of Kensal Town residents, as usual Kensal Town suffering somewhat more severely than the home district. Table YI.—Mortality from Diarrheal 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 1999 1450 1663 1900 1268 1251 The excessive prevalence of diarrhoea commenced in the last week of July, and continued throughout August and the greater part of September. In the 10 weeks ending the 15th September, only 64 deaths were registered, as compared with 116 in the similar corresponding period of 1899. In the past year, however, owing to the mildness of the autumn, diarrhoea continued to be prevalent and to cause an unusual mortality until quite the latter end of October. 7 Influenza.—The Dumber of deaths referred to influenza, as a primary or secondary cause of death, amounted to 61, as against 53 in 1899. Of the 61 deaths, 10 belonged to Kensal Town. Fifty-three out of the total deaths occurred in the first quarter of the year. In London generally influenza was widely spread from the commencement of the year—the epidemic having commenced in December, 1899— until the end of February. Out of the total of 1,949 deaths in the year, no fewer than 1,470 occurred in the first quarter, 1,127 being registered in the first 5 weeks of the quarter. In 1899, in London, there was no widespread epidemic until the latter end of December, but a total of 1,818 deaths was recorded for the year. Respiratory Diseases.—The death-rate from these diseases in Chelsea was 3'90 per 1,000, which is considerably less than the rate of 1899—4-23 per 1,000. The year was favourable to a low rate of mortality from these diseases, the winter and spring seasons being unusually mild. Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1900 was 2.34 per 1,000, as against 2.12 in London generally. The Kensal Town rate was 213 per 1,000, that of the home district being 2.40. The average death-rate from these diseases in Chelsea during the 16 years, 1884-99, is 2.84 per 1,000. Cancer.—Malignant cancerous diseases caused 101 deaths amongst Chelsea parishioners, of which number 27 belonged to Kensal Town. The annual average of the 16 years, 1884-99, is 80 deaths. The cancer death-rates are shown in Table III. Deaths in Public Institutions.—In 1900, 34.8 per cent, of the total deaths of parishioners of Chelsea occurred in public institutions, the average for the 9 years, 1891-9, being 31.0 per cent. Of the home district residents, 37.4 per cent, of the deaths occurred in public institutions, and of Kensal Town residents, 247 per cent. In London generally, 30.5 per cent, of the total deaths occurred in public institutions. In 1900, 17.6 per cent, of the total deaths of parishioners occurred in the Chelsea Workhouse and Infirmary, the average of the 9 years, 1891-9, being 15 per cent. Of the home district residents, 18.6 per cent, of the deaths occurred in the Workhouse and Infirmary, and of Kensal Town residents, 13-7 per cent. Alcoholism.—Only 39 deaths (=2 3 per cent, of the total) were registered as being due to alcoholism and cirrhosis of the liver. It is probable that this figure enormously understates the deaths which are really attributable to some form of alcoholic excess; in the same way as the 9 deaths attributed to venereal diseases grossly understate the real mortality caused by syphilis and its sequelae. Deaths in Lunatic Asylums.—Thirty-three deaths of Chelsea parishioners occurred in lunatic asylums. The average for the 10 years, 1891-1900, is 30 deaths annually, that is to say, only 16 per cent, of the total deaths take place in lunatic asylums. 8 TABLE VII. FOR WHOLE DISTRICT. Year. 1. Population estimated to Middle of each Year. 2. Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths in Public Institutions in Chelsea. 9. Deaths of non- residentsre gistered in District. 10 Deaths of Residents registered beyond District 11. Deaths at all Ages. Nbtt. No. 3. Rate.* 4. No. 5. Rate per 1000 Births regis'td 6. No. 7. Rate.* 8. No. 12. Rate.* 13 1890 95,618 2761 28.9 415 150 2107 22.0 701 369 241 1979 20.7 1891 96,273 2808 29.2 418 154 2209 22.9 821 374 184 2019 21.0 1892 96,351 2784 28.9 462 165 2158 22.4 750 343 202 2017 20.9 1893 96,430 2854 29.6 456 160 2125 22.0 765 412 245 1958 20.3 1894 96,508 2700 28.0 356 132 1720 17.8 658 332 229 1617 16.8 1895 96,587 2723 28.2 464 170 2002 20.7 682 323 241 1920 19.9 1896 96,666 2651 27.4 443 167 1903 19.7 648 305 251 1849 19.1 1897 96,745 2549 26.3 410 161 1777 18.4 668 298 235 1714 17.7 1898 96,823 2332 24.1 410 176 1827 18.9 678 300 231 1758 18.2 1899 96,902 2381 24.6 391 164 1927 19.9 661 255 225 1900 19.6 Averages for years 1890-1899. 96,490 2654 27.5 422 159 1975 20.5 703 331 228 1873 19.4 1900 96,990 2245 23.1 333 148 1802 18.6 662 277 213 1737 17.9 * Kates calculated per xooo of estimated population. Note.—The deaths to be included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the substraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of illness, and dying tnere ; and by the term "Residents" is meant persons who have been taken out of the district on account of illness, and have died elsewhere. Area of District in acres (exclusive of area covered by water) 794 At Census of 1891. Total population at all ages 96,263 Number of inhabited houses 12,195 Average number of persons per house 789 9 TABLE VIII. Names of Localities. CHELSEA. HOME DISTRICT. KENSAL TOWN. Year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 Year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 Year. (a.) (b.) (c.) (d.) (a.) (b.) (c.) (d.) (a.) (b.) (c.) (d.) 1890 .... • • • • .... .... .... .... .... • • • • .... .... 1891 96,273 2808 2019 418 74,502 2100 1639 311 21,770 708 380 107 1892 96,351 2784 2017 462 74,648 2060 1631 349 21,702 724 386 113 1893 96,430 2854 1958 456 74,794 2128 1607 346 21,635 726 351 110 1894 96,508 2700 1617 356 74,940 2028 1315 271 21,568 672 302 85 1895 96,587 2723 1920 464 75,086 2028 1559 341 21,500 695 361 123 1896 96,666 2651 1849 443 75,233 1999 1453 323 21,433 652 396 120 1897 96,745 2549 1709 410 75,380 1902 1344 287 21,367 647 365 123 1898 96,823 2332 1758 410 75,527 1761 1360 283 21,300 571 398 127 1899 96,902 2381 1900 391 75,674 1772 1505 277 21,234 609 395 114 Averages lor years 1890-1899. 96,587 2642 1861 423 75,087 1975 1490 310 21,501 667 370 114 1900 96,990 2245 1737 333 75,822 1674 1373 243 21,168 571 364 90 Notes.—(a.) The separate localities adopted for this Table should be areas of which the populations are obtainable from the census returns, such as wards, parishes or groups of parishes, or registration sub-districts. Block I may, if desired, be used for the whole district; and blocks 2, 3, for the several localities. In small districts without recognized divisions of known population this Table need not be filled up. (b.) Deaths oi residents occurring beyond the district are to be included in sub-columns c of this Table, and those of non-residents registered in the district excluded. [See note on Table VII. as to meaning of terms "resident" and "non-resident."] (c.) Deaths of residents occurring in public institutions are to be allotted to the respective localities, according to addresses of the deceased. 10 TABLE IX. Cases of Infectious Disease notified during the Year 1900. Notifiable Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from kach locality. At all Ages. At Ages+—Years. Chelsea North. Chelsea South. Kensal Town. Chelsea North. Chelsea South. Kensal Town. Chelsea. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox 2 .. .. .. 1 1 .. 1 1 .. 1 1 .. 2 Cholera 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. Diphtheria 179 3 44 102 19 ii 99 51 29 77 42 25 144 Membranous Croup 2 .. 1 1 .. .. .. .. .. 2 -• .. 1 1 Erysipelas 72 4 2 6 6 45 9 26 20 26 1 1 2 Scarlet Fever 232 8 65 123 22 14 .. 113 72 47 94 54 40 188 Typhus Fever 1 .. .. .. 1 .. .. 1 .. .. .. .. .. .. Enteric Fever 79 .. 4 24 20 31 .., 21 16 42 12 10 33 55 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever 3 .. .. .. .. 3 .. .. 1 2 1 2 3 Puerperal Fever 8 .. .. .. .. 8 .. 4 3 1 1 , , 1 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 579 15 116 256 69 114 9 265 165 149 186 108 102 396 Notes.—The localities adopted for this Table should be the same as those in Tables VIII. and X. State the name of the isolation hospital, if any, used by the sick of the district. Mark (h) the locality in which it is situated, or if not within the district, state where it is situated, and in what district. *This space may be used for record of other disease the notification (compulsory or voluntary) of which is in force in the district. +These age columns for notification should be filled up in all cases where the Medical Officer of Health, by inquiry or otherwise, has obtained the necessary information. 11 TABLE X. Causes of, and Ages at Death of Parishioners during the Year 1900. Causes of Death. Deaths in whole District at subjoined Ages. Deaths in Localities (at ali Ages). Deaths in Public Institutions. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and wards Chelsea North. Chelsea South. Kensal T own. Small Pox .. .. .. .. .. .. .. .. .. .. .. Measles 33 7 26 .. .. .. .. 20 10 3 1 Scarlet Fever 7 1 4 1 .. i .. 3 3 1 7 Whooping Cough 18 10 8 .. .. .. .. 8 5 5 .. Diphtheria and Membranous Croup 18 1 8 9 .. .. .. 11 3 4 11 Croup 1 .. 1 .. .. .. .. .. .. 1 .. Typhus .. .. .. Fever Enteric 20 .. 3 7 9 1 .. 4 4 12 10 Other continued .. Epidemic Influenza 61 2 .. .. 2 32 25 29 22 10 16 Cholera .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. Diarrhœa (see Notes at foot) 82 67 7 .. 1 1 6 32 24 26 13 Enteritis (see Notes at foot) 41 23 5 2 2 2 7 17 17 7 12 Puerperal Fever 9 .. .. .. .. 9 .. 5 3 1 2 Erysipelas 3 .. 1 .. .. 1 1 3 .. .. 1 other Septic Diseases 15 4 1 1 .. 8 1 9 2 4 8 Phthisis 171 .. 2 4 20 140 5 83 55 33 81 Other Tubercular Diseases 56 19 16 10 3 6 2 33 11 12 15 Cancer, Malignant Disease 101 .. .. .. 2 61 38 43 31 27 50 Bronchitis 196 25 14 .. .. 60 97 92 66 38 62 Pneumonia 93 9 16 8 2 42 21 40 37 16 25 Pleurisy 9 .. .. .. .. 6 3 5 2 2 2 Other Diseases of Respiratory Organs 80 23 24 .. 2 21 10 29 32 19 12 Alcoholism Cirrhosis of Liver 39 .. .. .. .. 33 6 17 14 8 17 Venereal Diseases 9 6 .. .. 1 2 .. 6 .. 3 4 Premature Birth 41 41 .. .. .. .. .. 15 16 10 1 Diseases and Accidents of Parturition 15 .. .. .. 4 11 .. 7 2 6 2 Heart Diseases 141 .. .. 5 7 68 61 54 64 23 61 Accidents 53 14 6 3 2 21 7 17 25 11 21 Suicides 13 .. .. .. 1 11 1 1 6 6 2 Rhenumatic Fever 6 .. .. 1 1 4 .. 1 3 2 1 Multiple Neuritis 3 .. .. .. .. 3 .. 1 1 1 .. Chicken Pox 1 .. 1 .. .. .. .. .. 1 .. .. All other causes 409 81 17 4 14 135 151 162 167 73 167 All causes 1737 333 160 50 73 679 442 747 626 364 604 Notes.—(a.) The deaths of residents occurring beyond the limits of the district are to be included in this Table, and deaths of non-residents occurring in the district are to be excluded. See note on Table VII. as to moaning of "Residents" and "Non-residents." (b.) Deaths of residents occurring in public institutions are to be allotcd to the respective localities according to the addresses of the deceased as given by the Registrars, and, in addition, to be classified under "Public Institutions." (c.) Under the heading of "Diarrhœa" are to be included deaths certified as from diarrhoea, alone or in combination with some other cause of ill-defined nature; and also deaths certified as from— Epidemic Enteritis; Zymotic Enteritis; Epidemic Diarrhoea. Summer Diarrhoea ; Dysentery and Dysenteric Diarrhoea; Choleraic Diarrhoea, Cholera, Cholera Nostras (in the absence of Asiatic Cholera). Under the heading of "Enteritis" are to be included those certified as from Gastro-enteritis, Mucoonteritis and Gastric Catarrh, unless from information obtained by enquiry from the certifying practitioner or otherwise, the Medical Officer of Health should have reason for including such deaths, especially those of infants, under the specific term "Diarrhœa." Deaths from Diarrhoea secondary to some other well-defined disease should be included under the latter. In recording the facts under the various headings of Tables VII., VIII., IX. and X., attention has been given to the noles on the Tables. 12 Section II. INFECTIOUS DISEASES. Small-pox.—Two cases of small-pox were notified in Chelsea in 1900. The circumstances attending both these cases are of interest, as showing how both very severe and very mild types of the disease are mistaken for other illnesses, with the result that the initial case forms the starting point for a more or less extended outbreak. The first case, that of Mrs. D., aged 39 years, was seen by me in consultation on the 21st May, and was removed to hospital on the same day. Mrs. D. was the widow of a valet, who had died of what was supposed to be malignant measles on the 9th May, in a neighbouring parish. After her husband's death, Mrs. D. was removed to St. George's Infirmary in the Fulham Road, but was discharged on the 16th May. She slept for two nights at a house in the Kensington district, and came to reside in Chelsea on the 18th May, being then ill. No further cases occurred in the house in Chelsea in which Mrs. D. was living, although all the inmates (adults) declined re vaccination. They were, however, quarantined for 14 days, and compensated for loss of work, three of them being employes of large omnibus companies. From the first case, that of the valet, Mr. D., who died on the 9th May, of what must have been hoemorrhagic small-pox, arose the following cases:—(1) Mrs. D., his wife, already alluded to ; (2) his son, who attended his father's funeral, and resided in a midland town. His illness was not diagnosed, and resulted in the infection of his child, a servant, and the child's nurse, the latter dying of confluent hoemorrhagic small-pox. All these cases occurred in an inn; and it is marvellous that a wide-spread epidemic did not result. (3) A housekeeper in the house where the valet died, was removed to a West End Hospital for pneumonia, and subsequently developed small-pox, infecting a nurse, a ward-maid, a patient, and two medical students of the Institution. (4) Four laundry maids at a Chiswick laundry, which received the "washing" from the house where the valet died, and who sorted the dirty linen, were attacked with small-pox. For some time they were thought to be suffering from chicken-pox, the disease being of the modified tpye. Two of these maids resided in Kensal Town. There was no spread of the disease from either of them; but the other two were the means of infecting some 9 or 10 others, mostly relatives or friends who had visited them when ill, before the disease was diagnosed. (5) A nurse in the St. George's Infirmary was infected by clothing brought by Mrs. D. from the house, where her husband died; and two children were infected from a similar source at the house in Kensington where Mrs. D. slept two nights, before coming to Chelsea. 13 The second case of small-pox was seen by me in consultation on the 19th November. The patient, aged 22, unvaccinated, was a servant in a large house in the east end of the parish. She was suffering from confluent small-pox, and was removed to hospital the same day. She appears to have contracted the disease from the master of the house, who returned to London from Paris, where small-pox was then somewhat prevalent, on the 18th October. On the 20th October, he was taken ill, and had a rash on the 25th October; but he was supposed to be suffering from some form of influenza. He was ill for rather over a fortnight. About the 11th or 12th November, the unvaccinated servant was attacked with what proved to be confluent small-pox; another servant (vaccinated) was also taken ill at the same time, and sent to her home, as she was believed to be suffering from chicken-pox; and the lady of the house was ill, but developed no rash. There was no further spread, either in the house, after tho servant had been removed to hospital, or in the home of the other servant who was sent away with supposed chicken-pox. All tho other inmates of the house were revaccinated with successful results, except in the cases of the master and mistress of the house, whose arms did not "take." The former undoubtedly had just recovered from an attack of small-pox, and the latter most probably had an attack of what is known as Variola sine Eruptions. It is interesting to observe, that out of the 10 people living in this house, who were exposed to infection from the original case, 9 were vaccinated, and one unvaccinated. The one unvaccinated developed a severe form of confluent small-pox; one of tho vaccinated developed the disease in its mild, modified form, which was mistaken for chickenpox, whilst another was ill with symptoms pointing to small-pox, but without rash. Tho other seven, although undoubtedly exposed to infection, escaped. In London during 1900, 89 cases of small-pox were notified, as against 29 in 1899, and 35 in 1898. In the eight parishes forming the Western district of London (population 799,857), 25 cases of small-pox were notified, as against only one case in 1899, and 3 in 1898. Enteric Fever.—The number of cases of enteric fever notified in Chelsea in 1900 was 79 (home district, 37; Kensal Town, 42). In addition there were 3 cases of continued fever—two being in Kensal Town, and one in the home district. Of the 44 cases of enterio fever in Kensal Town (including the two cases of continued fever, which were undoubtedly enteric), no fewer than 41 were notified between the 1st September and the end of the year. There was in fact a localised outbreak of enteric fever causing 17 cases (primary) in the part of Kensal Town south of the canal, in the immediate neighbourhood of West, Middle, and South Rows. The dates of onset of these primary cases varied between the 25th of August and the 16th September; and it is probable that the source of infection 14 was operative about the third week of August, and was possibly operative for some days, including the 23rd of August, as on this day one of the sufferers, who had been away in Kent for 3 months, returned to her home. She was taken ill on the 30th August, so that the incubation period in her case could not have been longer than 7 days. Four of these primary cases were members of the same family, the remaining 13 cases occurring in separate houses in the affected locality. Most of the patients were young people under 20 years of age, two were between the ages of 20 and 30, and two were over 30. Dr. J. Hamer, Assistant Medical Officer of Health to the County of London, co-operated in an endeavour to trace the source of infection of this outbreak, but nothing definite was ascertainable. Suspicion at one time attached to the milk supply, as a large proportion of the cases had in all probability derived their milk from a particular dairy company. Inasmuch, however, as this dairy company is in a very large way of business, and supplies the trade very largely in this and other parts of London, the fact of the majority of the patients taking milk from this particular source, is merely another way of stating that the majority of the residents in the district do the same. Inquiry was made as to the possibility of infected water, infected shell-fish, fruit, ice-creams, and temperance drinks, having played any part in the origin of the outbreak, but without result. The last of the primary cases was taken ill about the end of the second week in September. Other cases followed, but they were secondary to the first cases; although the interval elapsing between the onset of the last primary and the commencement of the first secondary case was probably not more than a few days. The secondary cases appear to be 17 in number. This number includes seven persons in one family (father, mother, and 5 children), the five children being infected, and becoming ill at dates varying between the 21st September and the 10th October, from a sister, who was one of the primary cases (date of onset, the 29th August). This girl's case was not diagnosed by the medical man attending her, but she was treated for "influenza and diarrhœa" in her own home amongst her numerous relatives; and it was not until the 26th September, that she was removed to hospital. Tho father and mother were the last to succumb to the infection on tho 17th and 20th of October, and the house being then emptied of its occupants was thoroughly overhauled, cleansed, and disinfected, This occurrence illustrates the infectiveness of enteric fever, when cases of the disease are treated at homo in the houses of the poor, and there is an absence of all precautions to prevent the spread of infection. Of the remaining 10 secondary cases, 7 were probably attributable to visits to some of the primary cases, after the latter were taken ill, but before removal to hospital. Three of these cases occurred in ono family, after visiting a brother in a neighbouring house, who was ono of the primary cases. 15 Five out of the 17 primary cases terminated fatally, and three of the 17 secondary cases, making a total of 8 deaths out of 34 cases (case mortality=23.2 per cent.) Perhaps the most remarkable feature of the outbreak was its extremely localised nature; nearly all of the 13 houses primarily invaded being within 100 yards of a common centre. The case-rate per 10,000 of the population in the home district was only 5.0 in 1900, as compared with 5.7 per 10,000 for 1899. These are exceptionally low rates. The Kensal Town rate, owing to the outbreak above alluded to, was 20.8 per 10,000. Out of the 38 cases occurring in the home district in 1900, in 7 the infection was probably acquired outside London. Twenty-two out of the 38 cases were notified in the fourth quarter of the year. Typhus.—The case of typhus notified the 5th September, was that of a nurse in the Chelsea Infirmary, who was taken ill about the end of August. Tho case was seen by me in consultation with the medical officers of the Infirmary, and was a typical case of the disease. It was not possible to trace exactly tho source of infection, but a case of typhus was under treatment in the Paddington Infirmary from the 8th to the 14th August, that being the only possible source of infection, so far as known. There was no spread from this case to other nurses in the Infirmary. Only seven cases of typhus were notified in the whole of London during 1900. Scarlet Fetcr.—This disease was less prevalent in Chelsea in 1900 than in 1899,tho case rate per 10,000 of the population being 239 in 1900, as against 29.1 in 1899. Tho case-rate for West London was 27.0 per 10,000, and for London generally 30.0 per 10,000. The disease was prevalent to a slightly less extent in Kensal Town than in the home district, tho case-rates being respectively 22.2 and 244. The autumnal exacerbation in prevalence of scarlet fever in Chelsea in 1900 was only slightly marked. A very early decline set in after the 2nd week in November, which was followed by an unusual increase in cases in the latter half of December. Tho fall in notified cases following the closure of the schools (Board Schools on the 26th July), was well marked. Only 5 cases at school age (3 to 13 years) wore notified in the four weeks following school closure as against 16 and 18 school-age cases in the two preceding four weekly periods. Tho percentage of cases of school ago was 66 per cent, in Chelsea, 66 per cent, in the home district, and 68 per cent, in Kensal Town. Diphtheria.—There was again a diminution in the prevalence of this disease in Chelsea in 1900, as compared with 1899, the case-rate per 10,000 of the population being only 18.7, as against 24.4 in 1899. n the home district, the diphtheria caso-rate in 1900 was 19.8, as against 18.0 in 1899. In Kensal Town, however, the diphtheria prevalence was much diminished, the rato being only 14 6 per 10,000 in 1900, as against 47.1 in 1899. 16 In the home district, the largest number of cases notified in any one month was in July (20 notifications). In August there were only 3 notifications of the disease—the smallest number of any month in the year—this reduction being undoubtedly due to the school holidays, and the absence of many children from London. After the first week in September, when the schools had recommenced, there was a marked recrudescence of the disease. In the three weeks ending the 1st September, only one caso of diphtheria had been notified in the entire parish—showing a greater freedom from this complaint than has prevailed for many years past. The percentage of cases of school age (3 to 13 years) was 66 per cent, in Chelsea, 60 per cent, in the home district, and 67 per cent, in Kensal Town. During March, April, and the early part of May, a large proportion—over 60 per cent.—of the cases of diphtheria notified in the home district were children attending or living in the same house with a child attending a Board School in the central portion of the parish— the same school that was concerned in the propagation of the epidemic in 1896. The majority (13) of these children were attending the infants' department, 2 were in the girls', and 1 in the boys' department. Cases occurred in 5 out of 7 of the class-rooms in the infants' department. No cases occurred in connection with the 6chool after the 13th May. I wrote to the Medical Officer of the London School Board suggesting the closing of the infants' department, and the disinfection of the 5 class-rooms concerned; but shortly afterwards the outbreak was at an end, and I believe it was not considered necessary to take any further action. During September, 4 cases of diphtheria were notified in the persons of children attending one of the Church Schools. In this instance also the infection appears to have spread from one child to another during school attendance, although an interval of a week elapsed between the successive cases; that is to say, in each case there was an interval of a week between the day on which a girl was absent from school for illness, subsequently notified as diphtheria, and the day on which the next case absented herself for a similar reason. During the year 5 cases notified as diphtheria which were sent to the M.A.B. Hospitals, were subsequently stated not to be suffering from the disease. Prevalence of Scarlet Fever, Diphtheria, and Enteric Fever in West London. The following table XI. 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. 17 Table XI.—Notifications per 10,000 of Population. Scarlet Fever. Diphtheria. Enteric Fever. 1899 1890-9 1900 1899 1890-9 1900 1900 Chelsea (Home District) 29.9 42.9 24.4 18.0 28.4 19.8 5.0 Kensington 25.6 35.2 21.1 14.9 16.8 19.1 6.5 Fulham 65.5 50.6 40.2 40.8 26.9 47.1 6.9 Hammersmith 40.6 41.4 31.9 17.6 21.0 22.8 9.5 Paddington 29.8 36.4 23.5 15.9 20.6 11.9 4.5 St. George's, Hanover Square 24.5 33.9 20.5 11.3 13.2 11.3 7.1 Westminster 38.3 36.5 23.6 19.5 17.5 20.3 6.2 St. James' 22.3 30.8 28.8 16.9 15.5 18.1 5.6 West London 36.0 39.4 27.0 20.9 20.9 22.5 7.0 London 39.9 48.8 30.0 30.2 25.1 26.0 9.5 In 1900, as in 1899, Fulham had the highest case-rates from scarlet fever and diphtheria. Diphtheria was even more prevalent in Fulham in 1900 than it was in 1899. Fortunately there does not appear to be any special tendency for this high prevalence of diphtheria in Fulham to spread eastwards to Chelsea—the case-rates for the past two years in Chelsea being fairly satisfactory. In 1900, Chelsea (home district) had the smallest enteric fever case-rate of any of the West London Parishes, with the exception of Paddington. 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 11 years, 1890—1900. Table XII.—Case Mortality in Chelsea, and in London, 1890—1900. 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 14.8 25.0 19.3 1899 2.8 2.2 10.6 14.2 28.1 18.0 1900 3.0 2.6 9.9 13.2 24.4 17.5 18 The fatality of scarlet fever continues to be very low, whilst that of diphtheria steadily decreases, as the result of the iucreasing use of antitoxic serum in the treatment of this disease. The decline in fatality characterising the past 3 years, as compared with the years preceding the use of antitoxin, is most noteworthy. The high fatality rate of enteric fever in Chelsea of recent years is shown by the Table. There appears to bo no special reason for this circumstance, but it is probably not unusual when the cases are mostly sporadic, many of them being imported, and the general prevalence of the disease is slight. Removals to Hospitals.—Table XIII. exhibits the removals of patients suffering from scarlet fever, diphtheria, and enteric fever, from their homes to hospitals in each of the 11 years, 1890—1900, expressed as percentages of the total number of cases notified. Table XIII.—Percentage Removals to Hospitals. Scarlet Fever. Diphtheria. Enteric Fever. 1890 37 20 29 1891 40 15 22 1892 1 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 1899 77 76 69 1900 81 80 71 The progressive increase in the percentage of cases of all three diseases that are removed to hospital is most satisfactory, and is the highest testimonial to the utility of the M.A.B. hospitals, and their appreciation by all classes of ratepayers. Measles.—Measles was epidemic in the spring of 1900 in the home district, but the visitation was of a comparatively mild character as compared with the two preceding epidemics, 1898 and 1896, in each of which over 100 lives were sacrificed. In the first two quarters of 1900, there were only 31 deaths from measles, and adding 12 for the last quarter of 1899, the total of deaths in the epidemic only amounts to 43. Kensal Town appears to have escaped this epidemic, there being only 4 deaths registered in the three quarters above mentioned. At the latter end of 1899, I addressed a circular letter to all school teachers in the home district, urging the importance, during the progress of an epidemic of measles, of excluding from school all children who show any traces of nasal or faucial catarrh, which are often the early and very infectious stages in the development of attaoks of measles. 19 Section III. A RETROSPECT OF 40 YEARS. The Vestry of Chelsea was created in 1855, and had 45 years of office. During this period very great changes have been brought about in sanitary administration, and the public health has enormously benefited. Comparing the two decennial periods, 1856—1865, and 1890—99, the first 10 years and the last 10 complete years of the Vesfry's existence. The average birth-rate (for 10 years) has been reduced 15 per cent., namely from 32.3 per 1,000 to 27.5 per 1,000, and this rate is being still further reduced. The general death-rate has been reduced from 24.3 to 19.4—a 20 per cent. reduction. The following Table shows the reductions in the mortalities from the more common preventible diseases. Table XIV.—Death-rates per 100,000 living. 1856—65. 1890-99. Percentage Reduction. Small-pox 16.4 0.21 87 % Measles 69.5 53.5 23 % Scarlet Fever and Diphtheria 111.9 74.9 33 % Whooping Cough 79.9 51.6 35 % Diarrhoea 114.9 106.8 7 % Fever 69.4 13.8 80 % Phthisis 344.3 193.0 44 % Respiratory Diseases 444.8 407.7 8% Small-pox has only caused 2 deaths in the last 10 years, whereas it was the cause of 104 deaths in the Vestry's first 10 years of office. In the early days of the Vestry, only a proportion of the cases, namely those chargeable to the parish, were removed by the Guardians to smallpox hospitals, which were within London, and situated in populous neighbourhoods. These hospitals were subsequently shown to act as centres for the diffusion of infection in their neighbourhoods. At the present time, every case is removed to the hospital ships on the Thames in Long Reach, and there is rarely any spread from known cases of the disease. Typhus has practically disappeared from Chelsea and from London. There has been only one undoubted case in Chelsea in 10 years. Between 1856 and 1865, typhus and enteric fever, which were not at that time separated in the returns, caused 440 deaths. In the last 10 years there have been no deaths from typhus; and enteric fever has only caused 127 deaths. 20 Scarlet fever and diphtheria mortality, which were not separated in the earlier period, show a reduction of 33 per cent. The death rate of 74.9 (for 1890-9), is made up as follows:— scarlet fever 20.1 per 100,000, and diphtheria 54.8 per 100,000. The increase in diphtheria in the last 10 years, as compared with the two previous decennia, is the least satisfactory feature in the vital statistics of London and its parishes. The comparatively small reduction in the death-rate from diarrhœal diseases—diseases chiefly affecting infants under one year of age—is a matter for comment, considering the 15 per cent. reduction in the birth-rate, and the proportionally smaller number of infants to the population at the present time than formerly existed. To balance the saving of life from other causes, there is a set-off of 441 deaths from influenza in Chelsea in the last 10 years (death-rate 45.7 per 100,000), a cause of mortality which was apparently altogether absent in 1856-65. The prevalence of influenza no doubt accounts for the comparatively small reduction in mortality from respiratory diseases. The 44 per cent. reduction in mortality from pulmonary tuberculosis (phthisis) is a satisfactory feature of the returns. SANITARY ADMINISTRATION IN THE EARLY DAYS OF THE VESTRY. In the early days of the Vestry, as the result of past neglect, nuisances of all kinds abounded, and a very great deal of time was occupied in securing their abatement. Between the 1st January, 1856, and the 25th March, 1857, no fewer than 138 legal proceedings were taken to compel compliance with the Vestry's notices, and 42 works were executed by the Vestry in default of the owners. Proceedings were taken under the Nuisances Removal Acts to obtain orders from the magistrates for sanitary works considered necessary by the Vestry; or the works considered necessary could be executed by the Vestry under powers conferred by the Metropolis Local Management Acts, and the costs recovered. The Police Magistrates of those days for the most part adopted attitudes hostile to the Vestries. They appear to have been but little convinced of the necessity for sanitary works at all, as is shown by a Memorial presented by the Vestry to the Home Secretary in 1866. In this Memorial is set out (1) the inability of the Vestry to recover costs incurred for executing sanitary works on private property under the Metropolis Local Management Acts, where the owners were in default; (2) the decisions of a particular Police Magistrate, who declined to make orders under the Nuisances Removal Acts, on the ground that the Vestry could itself do the work under the Metropolis Local Management Acts ; and who rejected the evidence of the Medical Officer of Health and Inspector of Nuisances, in order to visit himself the premises complained of, which invariably ended in the summons being dismissed. 21 In 1865, the same Magistrate let off with a 5s. fine the owner of a pig which had suffered from hog-typhus—the carcase having been by him prepared and dressed for human food in the form of sausages—an almost incredible decision at the present time. A great many summonses were taken out iu respect of pig-keeping in yards and areas about houses, and not always with successful results. In 1864, proceedings were taken in respect of pigs kept in large numbers in Bull's Gardens, under Michael Angelo Taylor's Act, which prohibits pigs from being kept within 40 yards of a street. The magistrates, however, disagreed; and on appeal tho Court of Common Pleas decided against the Vestry It is interesting to observe that the owner of Wickham Place, which was condemned and demolished by the Vestry in 1892 under the Housing of the "Working Classes Act, was sent to prison in 1860, in default of paying fines for sanitary neglect of his property; and that in 1864, outbreaks of typhus occurred in Wickham Place and in Mermaid's Yard (also demolished). Nuisances were constantly arising on the Thames fore-shore from the sewers which discharged direct into the Thames; and the question as to who was responsible for the nuisance led to much correspondence between the Vestry and the Metropolitan Board of Works, without anything much being done to abate the nuisance. The foul state of open ditches in Kensal Town was also much complained of. In 1866, London was invaded by Asiatic cholera. There was an outbreak of the disease in White Hart Court, Chelsea, and 21 deaths in all were registered in the parish. The Vestry displayed commendable sanitary activity. A sanitary staff of labourers was organised to visit the courts and alleys, with which the older parts of Chelsea at that time abounded. These men cleansed cisterns, privies, and drains, and limewashed, cleansed, and disinfected the interiors of the houses. All the public pumps from the shallow wells in the parish were closed in July, but it was not until the following year, 1867, that the pumps were permanently removed. Steps were also taken to obtain a fresh supply of water for the poorer classes on Sundays, and to prevent overcrowding of their habitations. With a view to the latter purpose, Regulations for Houses let in Lodgings or occupied by members of more than one family, under the Sanitary Act of 1866, were framed, adopted, and enforced. In 1867, the Vestry attempted to recover from the owners concerned, the expenses incurred by the special cholera sanitary staff in rendering decently clean and habitable the properties, whioh by the neglect of such owners, had become so highly insanitary. These proceedings, however, failed ; and the rates were saddled with all the expenditure incurred to fight the cholera. On the whole, so far as one can judge from the somewhat limited information now available as to the proceedings of the Vestry and its officers in the early days, it would seem that having regard to the then very undeveloped state of public opinion on the utility of sanitary measures, to the hostility of the Courts of reference (the Police 22 Magistrates), and to the unhealthy conditions of the dwelling houses prevailing through long years of previous neglect, the earlier Vestries and their Officers did most notable sanitary work, and laid the foundations for all the great sanitary improvements which, after a lapse of 40 years are now accomplished, or in process of accomplishment. During the past 40 years a large number of very valuable municipal improvements have been carried through, including the main drainage of London, and the interception of the sewage from the Thames in its course through the metropolis; the purification of the Thames by the treatment of the sewage at the sewer outfalls; the Thames Embankment; the removal of all the Water Companies' intakes from the metropolitan portion of the Thames to the comparatively unpolluted reaches of the upper river; the provision of a constant water supply; the provision of most admirable isolation hospitals, open to all ratepayers, free of cost, for the treatment of cases of small-pox, scarlet fever, diphtheria, enteric fever, and typhus; a splendid ambulance service for the removal of cases from their homes to hospital, etc. In our own district, wo have benefited equally with tho rest of London by all these municipal improvements, and wo have, in addition, much improved our own sewers and house drains; roads also have been widened, open spaces secured for the public, and some of tho worst slums of old Chelsea have been demolished. The old parish has lost much of its quondam quaint and picturesque features, but has gained immensely in health, comfort, and convenience. 23 Section IV. THE SANITARY CONDITION OF THE PARISH. The tabular statements prepared by the Sanitary Inspectors show that in the home district 1523 separate premises were inspected by them during 1900, 427 of this number being with reference to cases of infectious disease. In Kensal Town, 507 premises have been inspected, 123 of this number being in reference to cases of infectious disease. It has only been necessary to take legal proceedings in 38 cases (see appended statement), to enforce the due carrying out of the Vestry's notices under the Public Health (London) Act. The subject of the housing and re-housing of the working classes in the home district, on the expiration of the leases of their present dwellings, to which allusion was made in my annual report for 1899, has again been the subject of very careful consideration by the Public Health Committee during 1900, and reports have been presented to the Vestry on the subject. It is gratifying to know that the new Borough Council has shown no less appreciation of the great importance of the issues involved to very large classes of Chelsea's present population, than did its predecessor, the Vestry; and that the Public Health Committee of the Borough Council is empowered to continue the necessary investigations, in order to report to the Council as to the expediency of adopting Part III. of the Housing of the "Working Classes Act, 1890, with a view to the provision of lodging houses for the working classes, either within or outside the Borough, under tho powers conferred in the Housing of the Working Classes Act, 1890, the Committee being also empowered to enter into negotiations for tho acquisition of sites. Combined Drainage.—Twenty-one systems of combined drainage, for which the owners were responsible, were sanctioned by the Vestry in the course of 1900. In addition, 3 systems of combined drainage, which were sewers for which the Vestry was responsible, were executed at the cost of the latter body. Combined Drainage Works executed by the Vestry, and their Cost. £ s. d. 1900—January. Nos. 7 and 8, Stewarts-grove 13 15 0 „ June. Nos. 85, 85a, and 87, King's-road 25 0 0 ,, October. Nos. 22 and 24, Marlborough-road 16 0 0 Total £54 15 0 The total amount previously expended by the Vestry on similar works was £285 17s. 2d. (1896—99). Drainage.—During the year, 175 new drains for single houses have been reconstructed in accordance with the Vestry's drainage regulations. 24 Water-supply.—During the year a daily examination of the water drawn from the Chelsea Waterworks 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 74.5° F. on the 26th and 27th July, and the lowest temperature was 37° F. from the 12th to the 17th February. The temperature of the water was 70° or over, between the 17th July and the 2nd of August—a period of 16 days. In 1899, the temperature of the water was 70° or over, from the 12th July to the 12th August—a period of 31 days. The water was generally of good colour and appearance during the year, except from the 2nd to the 17th March, when it had a distinct brown tint. Disinfection.—During the year 598 premises have been disinfected after cases of infectious disease, 61 of these being rooms which had been in occupation by persons suffering from phthisis. REPORTS TO THE VESTRY. During tho past year I have had the honour to present to tho Vestry reports upon the undermentioned subjects:— January 16th.—Combined drainage at Nos. 7 and 8, Stewart's-grove. Messrs. Vigers Bros.' chimney. June 12th.—The Sale of Food and Drugs Acts. Combined drainage at Nos. 85, 85a, and 87, King's-road. Uncertified deaths and Inquests cases in London, from 1890 to 1899. June 23th.—Discharge of grit from the chimneys of the Chelsea Electricity Supply Company, Manor-street. Exposure in public of a scarlet fever patient. July 10th.—Drainage of Nos. 85, 85a, and 87, King's-road. The Housing of the Working Classes in Chelsea. July 24th.—The Public Mortuary in Arthur-street. No. 15, Stadiumstreet. October 23rd.—Combined drainage at Nos. 22, and 24, Marlboroughroad. Plague Precautions. The progress of sanitary administration during the past 45 years. 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 1900. I am, my Lord and Gentlemen, Your obedient Servant, LOUIS C. PARKES, Medical Officer of Health. 25 Section V. PUBLIC HEALTH DEPARTMENT. Summary of Nuisances and other matters reported on and Work done during the Year 1900. Houses and Premises:— Home District. Kensal Town. Total. *Reported on respecting nuisances complained Of 1096 384 1480 Reported on with reference to infectious cases 427 123 550 Cleansed, whitewashed, and repaired 397 180 577 Defective roofs repaired 102 84 186 Disinfected after zymotic diseases 498 100 598 Cases of overcrowding abated 23 11 34 Dust-bins, new, provided 125 80 205 „ repaired 13 21 34 Underground rooms reported as occupied contrary to Act 4 — 4 Houses closed as unfit for human habitation 12 — 12 Drainage:— Drains opened, cleansed, and made sound 624 194 818 ,, trapped with stoneware gullies Water-closets cleansed and repaired 65 13 78 „ new pans and traps provided 308 49 357 Spout drains cleansed, repaired, or renewed 167 127 294 Sink, bath, and lavatory waste pipes disconnected 99 38 137 Drains and soil pipes ventilated or repaired 72 37 109 Soil pipes, new, provided 113 7 120 New drains laid, in accordance with Vestry's regulations (including 24 systems of combined drainage) 186 13 199 Additional w.c. accommodation provided 14 1 15 Water Supply:— For domestic purposes, provided where cut off by Water Company 21 7 28 For water-closets, or check cisterns provided and repaired 188 61 249 Main cisterns cleansed or repaired 51 43 94 ,, new, provided 1 1 2 Nuisances abated arising from:— Keeping of animals 19 8 27 Accumulations of manure and other filth 74 41 115 Yards cleansed, paved, or drained 385 111 496 Smoke 9 — 9 Dung-pits repaired, drained, &c.,or cages, &c., provided 7 18 25 26 Miscellaneous:— Home District. Kensal Town. Total. Dead bodies removed to public mortuary for sanitary reasons 4 6 10 Goods disinfected after infectious cases at station 2893 628 3521 Goods destroyed after infectious cases 86 2 88 Number of samples taken for analysis (Food and Drugs Act) 141 36 177 Unsound Food. Number of boxes of fruit, &c., condemned and destroyed 3* 4 7 Proceedings taken:— Notices issued for sanitary works, Ac., including infectious diseases notices 1481 674 2155 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 37 1 38 Legal proceedings in respect of food adulteration 11 1 12 Correspondence:— Number of letters written in connection with sanitary matters, including those of Medical Officer of Health 972 330 1302 Daily returns of infectious cases sent to Metropolitan Asylums Board 193 — 193 Notification of infectious cases sent to School Authorities 319 94 413 Entries in Inspectors' Report Books 1012 384 1396 ,, Inhabitants' Complaint Book 73 — 73 Certificates of Disinfection given 321 100 421 Certificates of infectious diseases for removal cases 348 88 436 The cow-houses and slaughter-houses were inspected by the Medical Officer of Health prior to licenses being renewed in October last, and a list of the retail bakehouses under inspection ill Chelsea forms a separate Appendix. Sanitary Inspectors. ALEXANDER GRANT (Chief), J. W. KING, W. THORPE, GEO. R. METZLER, Kensal Town. Home District. * This does not include unsound food condemned in the streets and destroyed, for which no condcmn note was given. 27 MAGISTERIAL PROCEEDINGS DURING 1900, UNDER THE SALE OF FOOD AND DRUGS ACT. Streets where Purchased. Article Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Basalt. Marlborough-road Butter 87.4% foreign fat Mar. 13th Fine £2 10s. Costs, 10s. 6d. Lots-road Milk 10% added water May 1st Fine £2. Costs, 10s. 6d. Leader-street Milk 18% fat abstracted May 1st Fine £3. Costs, 10s. 6d. Norman-street Milk 10% added water May 1st Fine £3. Costs, 10s. 6d. Keppel-street Milk 10% added water May 22nd Warranty produced. Summons withdrawn Phene-street Milk 8% added water May 22nd Warranty produced. Summons withdrawn. Milk Giving a false warranty May 29th Summons dismissed. Keppel-street Milk Giving a false warranty May 29th Summons dismissed. King's-road Milk added water Oct. 30th Case withdrawn. Costs, £2 2s. Leader-street Milk 18% added water Nov. 6th Fine £2. Costs, 10s. 6d. Dartrey-terrace Butter 47.8% of margarine Nov. 27th Fine 10s. 6d. Costs, 10s. 6d. Kilburn-lane, Kensal Town Milk 17% added water June 19th Defendant had absconded, so summons could not be served. Total, £13 0s. 6d. Fines, and £5 5s. 0d. Costs. 28 29 MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Date of Hearing. Result. 18, Gillray-square Dirty condition of rooms, defective drains, soil pipe, water-closet, stack-pipe, defective roof to washhouse. Jan. 16th Order for works in 14 days. 19, Gillray-square Ditto ditto Jan. 16th Ditto ditto. 537, King's-road An emission of black smoke from chimney shaft Jan. 30th Order for abatement. Fine £2. 23, Flood-street Defective roof, dilapidated ceiling Feb. 20th Work done. Summons withdrawn St. James' House, Meek-street. Defective soil pipes, water-closets, check cistern, drain inlets, roof, and dirty condition of ceiling Mar. 13th Ditto ditto. Chelsea Embankment. Removing offensive matter during prohibited hours. (Win. Atkins). Apr. 3rd Fined £1 and 2s. 6d. costs. 8, Little Blenheimstreet. Foul and obstructed drains April 10th Order for works in 7 days. 74, Walton-street .. Foul and obstructed water-closet May 1st Ditto ditto. 86, College-street ... Defective drains, soil pipe, and container closet May 15th Order for works in 14 days. r 27, Manor-street .. * - Accumulation of rubbish in washhouse, defective roof, dirty condition of walls and ceilings on top floor. May 15th Order for works in 14 days. Orford-street Removing offensive matter during prohibited hours. (Dr. Wharte). June 12th Fined £2. Ditto Removing offensive matter during prohibited hours, (iJames Collins). June 12th Fined 5s. Marlborough-road.. Ditto ditto (Steven Wooding) ... June 19th Fined £2. Costs, 5s. Keppel-street Ditto ditto (William Miller) ... June 19th Fined £1. Cale-street Ditto ditto (John Dowling) ... June 19th Fined £1. Costs, 5s. King's-road Ditto ditto (Daniel Ball) June 19th Fined 10s. Costs, 5s. Ditto Ditto ditto (William Summers) June 19th Summons withdrawn. 38, Cale-street Defective drain inlet in yard June 19th Order for works in 14 days. 40, Cale-street Defective drain inlet in yard, rain-water pipe connected direct to drain, want of a proper dustbin, defective water-closet, and want of proper flushing apparatus to same. June 19th Ditto ditto. 42, Cale-street Defective drain inlet in yard, rain-water pipe connected direct to drain, sink waste-pipe connected direct to drain, defective w.c., and want of proper flushing apparatus to same. June 19th .. Ditto ditto. 30 81 MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Date of Hearing. Result. 44, Cale-street Defective w.c.'s and want of proper flushing apparatus to same, defective soil pipe, defective roof, dirty condition of walls and ceiling of kitchen on first floor. June 19th ... Order for works in 14 days. 85, King's-road Foul and defective drains June 19th Order for works in 3 days. 59, Park-walk Want of proper and sufficient sanitary accommodation for the workmen. June 19th Work done. Summons withdrawn. 71, Queen's-road ... An emission of black smoke from chimney shaft June 26th Fined £1, and abatement Order made. 85, King's-road Failing to comply with an abatement Order made by the Magistrates at Kensington Sessions on 19th June, 1900. July 3rd . Fined £1 per day for 3 days. Ditto Ditto ditto July 10th Fined £1 per day for 7 days. 36, Leader-street ... Exposing herself in the public streets whilst suffering from a dangerous infectious disease. July 31st Fined 5s. 33, 34, 35 and 36, Manor-gardens. Premises in such a state as to be a nuisance, or injurious or dangerous to health. July 31st Closing Orders made. 24, Slaidburn-street.. An accumulation of filth in front room, top floor Oct. 16th Fined £1. Order for work in 3 days. 24, Slaidburn-street.. Failing to comply with an abatement Order made by the Magistrates at Kensington Sessions on 16th October, 1900. Oct. 30th Fined 10s. a day for 6 days (£3). 13, Little Orfordstreet. Failing to provide a proper and sufficient supply of water to the premises. Nov. 13th Closing Order made. 310, King's-road ... Defective roof. Nov. 13th Work done. Summons withdrawn. Cadogan-place Removing offensive matter during prohibited hours. (Henry Davis). Nov. 20th Fined £1. Costs, 2s. 6d. 45, Denyer-street .. Defective yard surface, want of a proper dustbin, defective roof, dirty condition of walls and ceilings of washhouse and room on first floor. Dec. 4th Order for works in 7 days. 519, Harrow-road, Kensal Town. Want of a proper and sufficient supply of water to the premises. Feb. 27th .. Vestry's notice to be complied with within 7 days. Total: £20 Fines, and £1 Costs. 32 BAKEHOUSES IN USE ON JANUARY 1st, 1901. Street. Occupier. Above Ground. Below Ground. 74, Arthur-street Solomon Keppler ...... Below. 93, Beaufort-street A.Coventry „ 26, Blantyre-street Hetzler ...... „ 55, Burnaby-street Loe ...... „ 21, Brompton-road J, Cadogan-street Callard, Stewart & Watt. Summers ...... „ „ 2, Cale-street H. Judkins Above. „ 77, Cheyne-walk W. Spells ...... Below. 20, Church-street E. Bauer ...... „ 60, College-street Samuel Mills Vines ...... „ 17, Coulson-street Gerres ...... „ 3, Dartrey-terrace Knee ...... „ 67, Flood-street J. Venner ...... „ 95, „ C. Gass ...... „ 153, Fulham-road C. M. Nash ...... „ 187, „ E. Pinnock ...... „ 323, ,, H. S. Burge ...... „ 15, Green-street Bott ...... „ 53, Godfrey-street H. Becker ...... „ 102, Keppel-street Harton ...... „ 47, King's-road Pennycuick ...... „ 83, ,, J. Humphry ...... „ 88, „ Akast ...... „ 134, „ Buckea ...... „ 33 Street. Occupier. Above Ground. Below Ground. 145, King's-road J. Humphry ...... Below. 302, „ Wm. Musgrove ...... „ 351, „ H. J. Mardon ...... „ 399, „ Dohna ...... „ 414, „ Korle ...... „ 488, „ Matthiae ...... „ 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 L. Lorenz ...... Below. 62, Marlborough-road ...... „ 100, „ „ Reitze ...... „ 110, „ „ Wordley Above. „ 7, Pavilion-road Mason Above. „ 23, Queen's-road G.Hilton ...... Below. 3, Pont-street Hue ...... „ 58, Eawlings-street Hannah ...... „ 150, Sloane-street Pennycuick ...... „ 43, Stayton-street Hahn Above. „ 117, Sydney-street J. Humphry ...... Below. 25, Walton-street Burrows ...... „ 84, Westbourne-street Tilbury ...... „ 34 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, ,, ,, „ COW-HOUSES. 54, Arthur Street Jennings, J. Church Street Emerton, J. 406, King's Road Jorden, G. 3a, Leverett Street Robinson, F. 10, Stayton Street Thomas, J.