Bestry of the Parsih of Fulham. (Annual Report OF THE Medical Officer of Health J. CHARLES JACKSON. For the Year ending December 31st, 1894, Fulham Steam Printing Workks. bestrn of the Parish of Fulham ANNUAL REPORT OF THE Medical Officer of Health, J. CHARLES JACKSON. For the Year ending December 31st, 1894. INDEX. PAGE Age Distribution in Fulham 4 „ „ „London and other Districts 6 Area of Parish 4 Bakehouses 43 Births and Birth Rate 6 Bye Laws under Public Health Act 46 Census Returns 3 Certificates under Customs and Inland Revenue Acts 44 Common Lodging Houses 44 Constitutional Diseases, Deaths from 31 Continued Fever 25 Corrected Death Rates 7 County Council, Appeals to 53 Cow Houses 44 Croup, Membranous 22 Deaths and Death Rate 7 Deaths Occurring Outside the District 37 Density of Population 4 Developmental Diseases, Deaths from 31 PAGE Diarrhcea 28 „ Excess of in Fulham 29 „ Notification of 29 Eietetic Diseases, Deaths from 30 Diphtheria 22 „ and Schools 23 „ and Sewer Ventilation 25 Disinfection 39 Erysipelas 26 Enteric Fever 26 Excess of Births over Deaths 6 Factories 63 Factory and Workshop Act 45 Food Supply, Supervision of 58 Housing of the Working Classes Act, Proceedings under 48 Illegitimate Children, Births of 6 „ „ Deaths of 8 Infantile Mortality 7 Influenza 30 Inquests 34 Insurance of Infants 8 Integumentary System, Deaths from Diseases of 32 Local Diseases, Deaths from 31 Marriages and Marriage Rate 5 Measles 26 Mortality at Diffeient Ages 7 „ and Overcrowding 47 Nervous System, Death from Diseases of 31 New Property, Supervision of 63 PAGE Notified Infectious Diseases 10 Overcrowding 47 Phthisis, Deaths from 31 Population 3 „ Natural Increase of 6 Puerperal Fever 25 Public Health Act, Prosecutions under 49 Public Institutions, Deaths in Respiratory System, Deaths from Diseases of 32 Sanitary Work, Summary of 64 Sale of Food and Drugs Acts 54 „ „ „ Proceedings under 56 „ „ „ Amendment of 58 Scarlet Fever 19 „ Return Cases of 21 Schools, Sanitary Condition of 62 Septic Diseases, Deaths from 30 Sewer Ventilation 41 „ Ventilation and Diphtheria 25 Sex Distribution 4 Shelter Accommodation 39 Slaughter Houses 43 Small pox 11 „ Table of Cases of 13 „ and Vaccination 18 Statistical Tables 65 Staff of Sanitary Department 60 Stillborn Children 6 Uncertified Deaths 34 Underground Rooms 45 Union Infirmary 35 PAGE Vgrants and Disease 18 Vaccination, Returns of 38 Venereal Diseases, Deaths from 30 Violence, Deaths from 88 Water Supply 40 Western Fever Hospital 36 Whooping Cough 26 Zymotic Diseases, Deaths from 9 „ „ Excess of in Fulham 10 Ful 2 Town Hall, Fulham, S.W. To the Vestry of the Parish of Fulham, Gentlemen, I beg to submit to you my Annual Report on the vital statistics and the conditions affecting the health of the district for the year 1894. The statistics of Marriages, Births and Deaths relate to the fifty-two weeks ending December 29th, 1894. POPULATION. The population of Fulham as enumerated at the Census taken in April, 1891, was 91,640, having increased from 42,900 during the preceding ten years. The population in the middle of 1894, as calculated in the usual manner on the hypothesis that the rates of increase which prevailed between 1881 and 1891 have been maintained since, was 110,993, but there is reason to believe that this figure is somewhat too high and a more accurate estimate can probably be made from the number of inhabited houses on the rate-books, in the same way as the population in April last was estimated for the purposes of the Equalisation of Rates Act, and, calculated thus, the population was, at the end of June, 1894, 107,880, and on this figure the statistics in this report are based. As an accurate estimate of the population is the first essential in vital statistics, it is satisfactory to know that under the Equalisation of Rates Act a census will be taken for the purpose of ascertaining the number of persons present within each parish in the administrative county of London on the night of Sunday, March 29th, 1896. When the census was only taken every ten years, errors in the estimated populations of districts of as much as 15 and 20 per cent, have been made, utterly invalidating any statistics based on the erroneous estimates. Area and Density of the Population. The area of Fulham is 1701 acres and there are 61 persons to the acre. The County of London has an average density of 58 persons to the acre ranging from 211 and 197 in St. George's, Southwark, and Whitechapel, to 9, 15 and 18 persons to the acre in Plumstead, Lewisham and Wandsworth, respectively. A considerable portion of Fulham, probably some 500 acres, is still unbuilt on, but most of it is described as " valuable building land, ripe for immediate development ;" and as the four most crowded enumeration districts, with an area of about 33 acres, contained a population, at the time of the census, of 8,880 persons or 269 to the acre, a further large increase in the population of the parish is probable. Age and Sex Distribution. The following Table gives the estimated number of persons living in Fulham at different age periods:— Under 5 15,211 5 to 15 24,270 15 „ 25 18,557 25 „ 35 19,420 35 „ 45 13,701 45 „ 55 8,415 55 „ 65 4,854 65 „ 75 2,589 Over 75 863 Assuming the proportion of males to females to be the same at the time of the census there are 50,418 males and 57,462 females. The following Table gives the number of persons at different ages in Fulham, London and other areas, expressed in per centages of the total population : — Under 5 Over 75 5-15 15-25 25-35 35-45 45-55 55-65 65-75 Fulham . 14.1 22.5 17.2 18.0 12.7 7.8 4.5 2.4 0.8 London 11.9 20.5 20.1 17.3 12.4 8.7 5.2 2.9 1.0 13.4 Rural Districts 12.3 23.7 17.8 10.7 8.8 6.7 4.6 2.0 19.9 15.7 5.8 3.0 1.0 Urban Districts 12.3 22.5 11.8 8.5 15.1 11.5 8.6 5.7 3.4 1.3 England & Wales 12.3 22.8 19.3 The differences in the age constitution of the districts given in the above table are considerable, and similar differences will be found in comparing the age and sex distribution in the various London districts; and as age and sex constitution has a considerable influence on the death-rate of a community, the recorded death-rates require correction before they can be used for purposes of comparison. 'I he age and sex distribution in Fulham is more favourable to a low death-rate than that of England, but not so favourable as that of London as a whole, nor as that of the adjoining parishes. MARRIAGES AND MARRIAGE RATE. 789 marriages took place in Fulham last year, against 735, 759 and 705 in the three preceding years. The marriage-rate, i.e. persons married per 1000 inhabitants was 14-6, and the rates for the whole of London and for England and Wales were 16.8 and 15.0. BIRTHS AND BIRTH RATE. The births registered in the year numbered 3,763 —1,937 males and 1,826 females. There was one birth to 28"7 inhabitants and 100 births of males to 94 - 3 of females. The 3,763 births were equal to a birth rate of 34.9 per 1000 inhabitants, which, although considerably higher than that of the whole of London which was 30.1, is the lowest yet recorded in Fulham. Excess of Births over Deaths. The natural increase of the population by excess of births over deaths was 1,866, compared with 1,671, 1,428 and 1,679 in the three preceding years. Illegitimate Children. The birth of illegitimate children numbered 139 —65 males and 74 females, forming 3 - 7 per cent, of the total births. Still-born Children. 169 still-born children were buried in Fulham Cemetery, being in the proportion of 1 still-born child to every 22 births. A record of still-births is much needed and among the recommendations of the Select Committee of the House of Commons for the improvement of Death Certification and Registration is one to the effect that still-births which have reached the stage of development of seven months should be registered upon the certificate of a registered medical practitioner, and that it should not be permitted to bury or otherwise dispose of the still-birth until an order for burial has been issued by the registrar. This is certainly desirable, but there seems to be no adequate reason why it should apply only to still-births of seven months gestation and upwards, and that cases under that age should be left unprovided for. A medical certificate and an order for burial should be required in every case of still-birth, irrespective of the period of gestation. DEATHS AND DEATH RATE. The deaths of 2,105 persons —1,046 males and 1,059 females —were registered in Fulham during the year; but of these 445 were of persons not belonging to the district, who died in public institutions within the parish, while the deaths of 237 persons belonging to Fulham occurred in institutions situated outside the parish. There were therefore 1,897 deaths of parishioners of Fulham, compared with 2,024, 2,068 and 1,868 in the three preceding years. The death rate per 1000 living was 17*6, which is the lowest recorded in Fulham for some time past. The rates for the three previous years have been 19*3, 19 - 9 and 197. The rate for London was 17 - 4, which is the lowest recorded since the establishment of civil registration, nearly 60 years ago, the nearest approach to so low a death rate having been 18*0 in 1889. Correction for Age and Sex Distribution. The death rate corrected for Age and Sex Distribution was 18.4, and that of London 18.5. MORTALITY AT DIFFERENT AGES. Infantile Mortality. Of the 1,897 deaths registered, 559, or 29 per cent, were those of children under one year of age. The rate of infant mortality measured by the proportion of deaths under one year to births registered was 149, as compared with 177, 166 and 163 for the three previous years. The rate for the whole of London was 143, the lowest rates among the London Sanitary Districts being those of Stoke Newington and Plumstead with 83 and 94 per 1000, and the highest those of St. Martin's-in-the-Fields and St. George's, Southwark, where the proportions were 210 and 186 deaths to 1000 births. In the 32 large towns of England the rate was 159 per 1000, varying from 121 and 131 at Croydon and Portsmouth to 174 and 217 at Liverpool and Preston Deaths of Illegitimate Children. 50 of the children who died before attaining the age of one year were illegitimate, the mortality among them being in the proportion of 417 deaths to 1000 births, or nearly three times as heavy as that of children born in wedlock Childhood. Between the ages of 1 and 5 years 394 deaths were registered, so that the deaths of children under the age of 5 years numbered 953, or 50 per cent, of the total number of deaths. 1 hese deaths were equal to an annual rate of 62.6 per 1000 of the population estimated to be living at this age Although the rate of mortality of children under 1 year is somewhat under, that of children between the age of 1 and 5 is considerably in excess of the average, a result mainly due to the severe epidemic of measles in the spring of the year Insurance of Infants Certificates under the Friendly Societies Acts were issued during the year in respect of 480 children under the age of 5 years, and 81 in respect of those between 5 and 15; thus 58 per cent, of the children who died before attaining the age of 5 were insured. Mortality at School Age. At the age of 5 to 15 years, which is approximately the school period of life, there were 106 deaths, corresponding to an annual rate of 4.4 per 1000 of the population estimated to be living at that age. Mortality at Adolescence. At the age of 15 to 25 years 75 deaths were recorded, the rate of mortality being 4"0. Mortality at Maturity, At the age of 25 to 65 years there were 525 deaths, a number equivalent to a death rate of 113. Mortality at Decline, At the age of 65 and over, 238 persons died, the death rate at this age-period being 68.9. Deaths and Death rate from Zymotic Diseases. 426 deaths were due to the principal Zymotic Diseases, viz.:- Smallpox 3 35 Scarlet Fever Diphtheria and Membranous Croup 108 Enteric Fever 5 Measles 160 Whooping Cough ... 58 Diarrhœa 57 426 The death rate from these diseases was 3.9 per 1000 living, as compared with 3.3 for last year, and 2"6 for the whole of London. Only three Sanitary Areas in London had a higher Zymotic death rate than Fulham, viz.: St. George's-in-the-East, Limehouse and Mile End, and it also exceeded that of any of the 32 large towns in England. The excess of mortality from these diseases in Fulham will be seen from the following Table: — Disease Fulham's proportion if mortality was the same as in London. Fulham's proportion if mortality was the same as in other Western districts, viz., Hammersmith, Chelsea & Kensington Actual number of deaths in Fulham. Smallpox 3 2 0 Scarlet Fever 35 23 16 Diphtheria and Membranous Croup 108 64 54 Enteric Fever 5 15 14 Measles 160 80 75 Whooping Cough 58 53 45 Diarrhœa 56 44 40 In considering these figures the relative proportions of the number of children under 5, in the respective populations, must be considered, as in Fulham 14.1 per cent, of the population are under 5 years of age, in London 11.9, and in the three other Western Districts 10 per cent., but even allowing for this difference in the age constitution of the districts, the mortality in Fulham from the Zymotic diseases mainly fatal to young children was excessive. NOTIFIABLE INFECTIOUS DISEASES. The following Table gives the number of cases of infectious disease notified in Fulham since 1890, when compulsory notification came into force, excluding duplicate notifications :— 1890. 1891. 1892. 1893. 1894. Smallpox 3 32 40 118 Scarlet Fever 286 517 701 529 Diphtheria 70 69 96 230 329 Membranous Croup 23 13 15 20 13 Enteric Fever 72 41 58 37 51 Continued Fever 6 2 Typhus Fever 2 3 1 Cholera 5 Puerperal Fever 6 9 10 18 10 Erysipelas 114 67 104 153 113 576 330 1224 1073 786 Smallpox. Forty cases of Smallpox were notified during the year, against 32 in 1893. A large proportion of the cases were infected by persons suffering from an unrecognised form of the disease. The most conspicuous instance of this occurred in February in Margravine Ward. At the beginning of that month two patients were notified as suffering from Smallpox, viz.: a barmaid at the Greyhound Hotel, and a youth living in Ancill Street, employed as a dyer ; the source of infection could not be traced in either case, but on February 12th a letter was received from a district visitor, stating that at 16, Greyhound Road there were several cases of sickness which she feared might be of an infectious nature. The house on being visited was found to be tenanted by four families. On the first floor was a man who had evidently just recovered from Smallpox, and stated that he returned from Basford, in Nottinghamshire, on January Ist, was taken ill on January 5th, and attended by a medical practitioner from January 11th to January 25th, but since then, and even during that time, had been about the district, and among other places, had visited the Greyhound Hotel. From subsequent enquiries it was ascertained that during the latter part of December he had been employed at the Nottingham Borough Smallpox Hospital in Basford, and, though strongly advised - - - - - - - - - - - by the Medical Superintendent to be re-vaccinated, had persistently refused. It is clear that the outbreak of Smallpox in the neighbourhood of the Greyhound Road originated with this man. On the ground floor of the same house were a brother and sister, aged 21 and 31, who kept a small sweetstuff shop, and who were both suffering from Smallpox, the girl who was actually attending to the shop having had the disease for about a fortnight and the man for about a week, both patients being under the care of a medical practitioner. The basement floor of the house was occupied by a man, aged 55, and his wife ; the man was suffering from Smallpox, having been attacked about four days previously, and his wife had just recovered from the same disease, and in her case also the nature of the disease had been mistaken by a medical practitioner. The three patients who were actually suffering from the disease were at once removed to the Hospital Ship, the shop was closed, and the whole house and its contents were disinfected. With a focus of infection like this, which had existed for upwards of four weeks in a poor and somewhat squalid neighbourhood, like that of Greyhound Road, a severe outbreak of Smallpox might have been anticipated ; as it was, there were only eleven persons who were apparently infected, directly or indirectly, by the cases at 16, Greyhound Road, viz. : the barmaid at the Greyhound Hotel; 2 cases at 44, Ancill Street ; a brother and sister of the occupiers of the shop at 16, Greyhound Road, living in Bayonne Road , 4 cases in Tasso Road, and here again the first cases were for some time regarded as Chicken Pox ; a child at 33, Greyhound Road, and a man living in Hannell Road. Judging from the subsequent epidemic in Marylebone, which originated under somewhat similar conditions, Fulham must be considered to have had a very fortunate escape. In the last annual report, in commenting on some cases which had been notified as Smallpox, but subsequently proved not to be of that nature, the following remarks, a repetition of which is justified by the history of the foregoing cases, were made : — "The difficulty of diagnosing many cases of Smallpox is well known and it must be remembered that as London was practically free from Smallpox during the six years prior to 1892, and therefore many practitioners have never had the opportunity of seeing cases of the disease, mistakes of this nature must almost of necessity be not infrequent. Thus, in 1891, of 90 patients throughout London certified to be suffering from Smallpox, and removed from their homes by the Metropolitan Asylums Board's ambulances, 27 or 30 per cent, proved not to have Smallpox. In 1892 out of 412 cases, 93, or 22 per cent, were similarly found to have been incorrectly certified. It is, however, obvious that as the arrangements of the Managers for removing patients are so admirable, that there can be no danger to the patient in removal, and as the patient is not allowed to proceed to the Hospital Ships, and so be exposed to infection, until the diagnosis is confirmed, it is better where means of complete isolation are wanting that doubtful cases should be at once notified, so that they can be promptly removed and isolated, than that the risk should be run of spreading the disease broadcast by the neglect, or the impossibility of taking proper precautions." In most of the other instances where the disease was communicated by persons suffering from it in an unrecognised form, the disease had been of such a mild nature that no medical practitioner had been called to the first case. With regard to the Langford Road case it is worthy of note that though the child D. M. was about while the rash was visible and played during that time with probably dozens of other children, only four were infected, and of these three were unvaccinated. As showing how Smallpox may be spread, and how difficult it may be to trace the source of infection, it may be mentioned that F. S., who originated the disease in Ashington Road, was about during the whole of the time he was suffering from the disease, and that he was at a Music Hall on the fourth and on the fifth days of his illness. All the cases, excepting the two in Greyhound Road, who had really recovered before they were notified, were removed to the Metropolitan Asylums Board's Smallpox Hospital. Mortality. —Three cases terminated fatally, two being unvaccinated. The following Table gives a synopsis of the particulars of the cases: — Case. Sex. Age. Residence. Date of attack as stated by patient or friends. Date of Notification. Probable source of infection. Vaccinated. Re-vaccinated. Result. Recov'rd, I. A. G. F. 30 36, Mirabel st. Jan. 24th Jan. 30th From a woman in same house, who was ill about 3 weeks before with "pain in back, and a few spots on face." Was treated for influenza. Yes. Yes. M. 2. J. S. 15 44, Ancill st. Jan. 26th Jan. 30th ? Case 5. No. „ „ 3.M.K. F. 14 Rylston road Feb. 2nd Feb.5th Case 1. „ „ „ 4.E.G. F. 16 44, Ancill St. „ 5th „ 9th Case 2. „ „ „ 5. J .F. M. 60 16, Greyhound road Jan. 9th „ 12th Nottingham Borough Smallpox Hospital. „ „ „ 6.L.D. F. 26 Greyhound H'tel Feb. 6th „ 9th Case 5. „ „ „ Says she had smallpox when 15. 7.R.M. F. 31 16, Greyhound road Jan. 29th „ 12th Case 5. „ „ 8.K.M. M. 21 Feb. 5th Case 5. „ „ „ „ No. 11 „ 9.C.G. F. 55 Jan. 21st Case 5. „ „ „ „ „ „ „ 10.G.G. 54 M. Feb. 10th Case 9. „ „ „ „ „ „ „ 11. J. M. M. 18 105 Bayonne rd. „ 19th „ 22nd Case 7 or 8. „ „ „ Revaccinated. Result. Date of Notification. Probable source of infection. Vaccinated. Sex. Age. Residence. Date of attack as stated by patient or friends. Case. Case 7 or 8. F. Yes. No. Recov'rd. 12.E.M. 10 105, Bayonnerd. Feb. 24th Feb. 26th M. „ 22nd „ 13.G.M. 25 52, Hannell rd. „ 19th „ „ „ „ „ F. 32, Tasso road „ 10th „ 27th „ 14.M.M. 14 „ „ „ „ „ F. 15.C.M. 35 „ 22nd Case 14. „ „ „ „ „ „ „ „ M. 16.H.B. 7 33 Greyh'nd.rd. „ 26th Mar. Ist Case 7 or 8. „ „ „ F. „ 12th Case 14 or 15. 17.S.T. 19 32,Tasso road Mar.9th „ „ „ M. „ 14th „ 17th Case 15. „ 18.E.T. 19 „ „ „ „ M. Died. 19. J. T. 35 108, Tilton st. „ 26th „ 26th ? at docks where he worked. „ „ M. Recov'rd. ? ? 20.W.A. 33 1a, Clay brook rd. „ 25th April 3rd Not known. M. Returned from Wharf, April 16, Not Small-pox. 21.E.C. 31 19, Hannell rd. April 7th „ 10th F. 77, Comeragh rd. „ 14th „ 17th Not known. Yes. No. „ 22.E.E. 16 M. 23.C.M. 10 Wandsworth Bridge rd. May 23rd May 26th ? Covent Garden Market. „ „ „ 24.M.M. M. 25 9,Lalor street „ 19th „ 23rd Not known. Is a Conductor, L.G.O.Co. „ „ „ Case. Date of Notification. Result. Sex. Age. Residence. Date of attack as stated by patient or friends. Probable source of infection. Vaccinated. Revaccinated. 21 Yes. 25.E.D. F. 13, Stamford pic. May 25th May 30th Not known. Is a laundress. No. Recov'rd. 30 26. G. M. M. Western Ambulance Station. „ Aug. 16th Driver of Metropolitan Asylums Board's Ambulance. Yes. „ „ 4 By sister, R. M., who had been ill about 3 weeks before with headache and a few spots, but was not attended by a medical practitioner. No. Died. 27.D.M. M. 44t Langford rd. Aug. 27th „ 30th 5 28. W. M. M „ 29th „ 30th As Case 27. Died. „ „ „ 15 29.A.B. F. 42b,„ Sept. 2nd Recov'rd. „ „ „ „ „ „ 44t, „ 14 30.K.M. F. Yes. No. „ „ „ „ „ „ „ „ 17 14, Ancill street 31. E. M. M. Had been lodging at 10, Campbell st. Probably was infected by G. D., a carman employed by Mr. Mears, who, 2 or 3 weeks previously, had been ill and had some "spots," but had no medical attendance. Aug. 26th Aug. 31st „ „ „ 43 10, Campbell St. As Case 31. 32.E.D. F. „ 29th Sept. 2nd „ „ „ 42, Aspenlea rd. A carman employed by Mr. Mears. Probably infected by G. D., as Case 31. 33 „ 27th 33. W. E. M. „ „ „ „ Case. Sex. Age. Residence. Date of attack as stated by patient or friends. Date of Notification. Probable source of infection. Vaccinated. Re-vaccinated. Result. Sept. 17th Yes. No. Recov'rd. 34. V. W. M. M 14, Ancill street Sept. 14th Case 31. 35.M.D. F. „ 13th „ 15th Case 32. 12 10, Campbell St. „ „ „ 36.L.M. F. 17 22, Ashington rd. „ 25th „ 27th F. S., who had a few " spots " about a fortnight previously, and had been employed at Shepherdess Walk, Shoreditch, whence 4 cases were removed. „ „ „ 37.L.W. F. 16 8, Campbell St. „ 26th „ 30th Case 35. „ „ „ 38.W.M. M. 16 14, Ancill street „ 25th „ Case 34. „ „ „ „ 39.F.S. F. 23 22, Ashingtonrd Oct. 10th Oct. 12th Case 36. „ „ „ ? ? 40. A. M. F. 27 12, Epirus road „ 14th „ 16th Employed at New St., Marylebone, Came to Fulham Oct. 15th. „ The following Table gives the fatality of vaccinated and unvaccinated cases in Fulham during the last two years: — Age Vaccinated Deaths Unvaccinated Deaths Under 5 years 2 2 5 to 15 years 8 2 1 15 „ 25 „ 24 1 25 „ 35 „ 15 35 „ 45 „ 7 1 45 „ 55 „ 3 55 „ 65 „ 4 1 1 Over 65 years 1 1 61 1 7 5 Vagrants and Disease. Allusion was made in last year's report to the frequency with which infectious diseases are spread by vagrants, and a Conference was held at the County Hall, Spring Gardens, on July 19th, between members of the Public Health and Housing Committee, and representatives of Urban Sanitary Authorities, County Councils, Vestries and District Boards, and the Metropolitan Asylums Board, to consider the question, at which the following resolutions were made : — 1. That common shelters which are not subject to the law relating to common lodging-houses should be made subject to such law. 2. That there should be power to the local authority to require medical examination of all persons entering common lodging-houses and casual wards, and that each inmate of a common lodging-house or casual ward should, on admission, have a bath of fresh water. 3. That the local authority should have power to order the keeper of a common lodging-house in which there has been - - - - - - - - - - - - - - - - infectious disease, to refuse fresh admissions for such time as may be required by the authority. 4. That the local authority should be empowered to require the temporary closing of any common lodging-house in which infectious disease has occurred. 5. That the local sanitary authorities should have power to require the detention of any inmate of a common lodginghouse or casual ward who may reasonably be suspected of being liable to convey infectious disease. 6. That means should be provided for the detention and isolation of any vagrant found wandering in a public place, if reasonably suspected of being liable to convey infectious disease. 7. That the local authority should have full power to require the disinfection of the person and clothes of any person in a common lodging-house or casual ward, whether infected or exposed to infection. 8. That arrangements should be made by which the occurrence of infectious disease in common lodging-houses or casual wards should be made known by the local authority of the district to the local authorities of other districts. 9. That local authorities should be empowered to require the vaccination or re-vaccination of persons in common lodging-houses or casual wards who are exposed to the infection of smallpox. Scarlet Fever. 529 cases were notified of this disease, which, though showing a decline as compared with last year, was still prevalent throughout the district, The distribution of the cases was as under:— Population in 1891 Cases Deaths Barons Court Ward 12051 43 1 Hurlingham „ 3710 24 2 Lillie „ 16096 79 7 Margravine „ 13592 107 5 Munster „ 10295 123 11 Sands End „ 11740 71 7 Town „ 8524 36 1 Walham „ 14525 46 1 529 35 412, or 78 per cent,, of those suffering from the disease were removed to the Hospitals of the Metropolitan Asylums Board. Mortality. —The disease was the cause of 35 deaths (9 in excess of the average for the last 8 years) representing a case mortality of 6 - 6 per cent. All the deaths occurred in the Hospitals of the Metropolitan Asylums Board, the fatality among those treated there being 8.7 per cent., as no deaths occurred among the 117 patients treated in their own homes. The case mortality was higher than last year, when it was 4.7 for all cases, and the disease seems to have been of a more severe type, especially towards the end of the year, as during the last 3 months, of 140 cases notified, 15 proved fatal. The difference in the mortality among those treated in the Hospital and those treated at home is very marked; many of those, however, who were not removed were not notified until convalescent, the disease having been so mild that they were only seen by a medical practitioner by chance when desquamating. The following Table gives the cases and deaths in age periods:— Cases Deaths Under 1 year 9 3 1 to 5 years 168 20 5,, 15 „ 298 12 15„ 25 „ 38 - 25„ 35 „ 10 - 35„ 45 „ 4 - 45 „ 55 „ 2 - 529 35 Return Cases. In 24 instances the disease occurred within 7 days of the return of another member from a Hospital after a similar attack. The return cases are too numerous to be accounted for by mere coincidence; and though, in some cases, it is quite possible that the infection was conveyed by some article of clothing which had been worn by the first patient at the commencement of the illness, and put away without being disinfected, and on his return again brought into use, probably in the majority of instances the infection was directly conveyed by the returning patient. That a certain number of such cases should occur seems to be unavoidable, for their occurrence in a certain proportion is universal wherever Hospital isolation is practiced. It must be remembered that the virus seems sometimes to be suspended in the person, probably in the mucous membrane of the throat after its activity in the tissues has ceased, and moreover that recrudescence of the disease, especially recurrent sore throat, may occur, and it is doubtful how late such true recrudescences may take place, and renew the infective condition of the patient. It would be well if a warning card were sent out with each discharged patient, urging the desirability of maintaining a certain degree of isolation for at least a fortnight after the patient is discharged, and especially the importance of not allowing the other children to sleep with or kiss the returned patient. Diphtheria and Membranous Croup. 329 cases of Diphtheria and 13 of Membranous Croup, which is identical with Laryngeal Diphtheria, were notified during the year, against 250 in the previous year. The distribution of the cases was as under: — Population in 1891 Cases Deaths Barons Court Ward 12051 9 3 Hurlingham „ 3710 8 4 Lillie „ Margravine „ 13295 37 10 16096 53 15 Munster „ 10295 82 26 Sands End „ 11740 97 29 Town „ 8524 16 8 Walham „ 14525 40 13 342 108 238 patients, or 70 per cent., were removed to the Hospital. Mortality.— The disease caused 108 deaths, giving a case mortality of 31.6 per cent. Of the 237 treated in Hospitals, 74, or 317 per cent., died, and of the 105 treated at home, 34, or 32'4 per cent., died. In London, of 11,186 cases notified, 2,637, or 23.5 per cent., proved fatal. The death-rate per 1000 in Fulham from Diphtheria was 1.0, as compared with 0.6for the whole of London, and was higher than in any sanitary district in the Metropolis, excepting in Bethnal Green and St. George's in the East. The following Table shows the ages of the cases of Diphtheria and Membranous Croup and the fatality at different ages :— Age Cases Deaths Mortality Under 1 year 10 7 70 per cent. 1 to 2 years 20 12 60 „ 2 „ 3 „ 28 14 50 „ 3 „ 4 „ 45 18 40 „ 4 „ 5 „ 32 14 45 „ 5 „10 „ 126 38 30 „ 10 „ 15 „ 35 3 8 „ 15 „ 25 „ 15 „ 25„ - „ 25 „ 35 „ 23 2 9 „ 342 108 31.6 School Influence. The question of the influence of primary schools in promoting the spread of Diphtheria has been much discussed for some time past, and the cases recorded in Fulham last year appear to afford some evidence that the spread of the disease was promoted by school attendance. Comparing 1894 with 1893 it maybe noticed that although the disease was much more prevalent in 1894, the increased prevalence of the disease was entirely among children between the age of 3 and 10, 203 cases having been notified of children of that age in 1894, against 112 in 1893, and there were 175 cases among children attending school in 1894, against 99 in 1893, the increase in the number of cases among children under 15 attending school being 76 per cent., and among children under 15 not attending school 32 per cent. The special incidence of the disease on particular schools during certain periods will be noticed in the Table, which gives the number of children attending the various schools in the district who were notified as suffering from Diphtheria. Thus in the Sherbrook Road School, between June 12th and August 7th, when the holidays commenced, 20 of the children attending the school were notified as suffering from Diphtheria while the disease, was, comparatively speaking, absent during that time from the three adjacent schools —Munster Road, Lillie Road and St. Thomas's—which draw a large number of their children from the same district as does Sherbrook Road School. Again, at the end of the year several children in the Infants' Department of St. Thomas's School contracted the disease, 10 cases being notified between Nov. 27th and Dec. 7th, when the department was closed by the Managers, at my request, until after the Christmas vacation, and since then until now the school has been free from the disease. Table showing the number of children attending the Board and other primary schools in Fulham who were notified in each month as suffering from Diphtheria : Jan. Feb. March April May June July Aug. Sept. Oct. Nov Dec. Total Ackmar Road - 3 - 1 - - - 1 1 - 6 2 14 All Saints' (Denominational) - 1 - - - - - - - - - - 1 Biscay Road - - - 1 - 3 1 - - - - - 5 Everington St. - 2 - - - 4 - - - 1 - 1 8 Halford Road 2 - - - - - - - - - 2 - 4 Harwood Rd. - - 1 1 2 - 1 - 2 1 - - 8 Holy Cross (Denominational) - - - - - - - - - 1 - 1 2 Hugon Road - - - - - - - - - - - 3 3 Langford Rd. - 3 2 6 1 1 2 - 5 6 4 6 36 Lillie Road 3 1 2 2 - - - - 3 2 - 3 16 Munster Rd. - 1 - 1 - 2 - - 1 1 4 1 11 North End Rd. 1 - 1 - - 1 3 - 1 - - - 7 Star Road 1 - - - 1 2 - - - - - - 4 Sherbrook Rd. 1 1 - 1 1 12 8 3 3 4 - - 84 St. John's (Denominational) - - - - - - - - 1 - - 1 2 St. Thomas' (Denominational) 1 1 - - 1 2 - 1 - 1 3 9 19 William Street - - - 1 - - 1 - 1 - - - 3 Influence of Sewer Ventilators. In a great number of instances, when enquiries were being made as to the probable source of infection, complaints were made of the smells arising from an adjacent open manhole or ventilator ; and there certainly was a larger proportion of cases in the houses near the manholes than elsewhere. Thus, of 231 cases, 96 occurred in houses situated within 10 yards of a sewer ventilator, and 64 in houses at a distance of from 10 to 20, and as the distance between these ventilators averages about 80 yards, there were more than twice as many cases in houses within 20 yards as there were in an equal number of houses more than 20 yards from a ventilator. It is quite possible that the offensive emanations from these ventilators, to which the occupants of adjacent houses are constantly exposed, may have such an injurious effect on their general health as to predispose to the disease. Enteric or Typhoid Fever. Thirty-seven cases were notified, against 58 last year; and the disease was the cause of 5 deaths, the case mortality—13 per cent.—being markedly lower than last year, when 16, or 271, of the cases proved fatal. On referring to Table H in the Appendix, it will be seen that the rate of incidence of this disease was lower in Fulham than in any Metropolitan Sanitary District. Twenty-six patients were removed to the Hospital. In the majority of instances the disease was apparently contracted outside the parish. Continued Fever. Two cases were notified. Puerperal Fever. Ten cases were notified, of which seven proved fatal, the deaths from septic poisoning after childbirth being in the proportion of 1.8 deaths to 1000 births. Each of the ten patients was attended by a different medical practitioner and nurse. Erysipelas. One hundred and thirteen cases of this disease were notified, and it was the cause of 6 deaths, 3 being of children under one year of age. The death of one child was ascribed to Erysipelas occuring one month after vaccination. NON-NOTIFIABLE ZYMOTIC DISEASES. Measles. This disease was epidemic in the parish in the Spring, and was the cause of 160 deaths, of which 149 occurred during the three months March, April and May. The average number of deaths during the preceding 8 years was 69. Of the deaths, 37 were those of children under the age of one year, and 111 of children between one and five years. The death-rate from the disease was To in Fulham and 0-7 in the whole of the Metropolis. The mortality from Measles showed a marked excess throughout London last year; but, excepting Limehouse, Fulham showed the highest proportional fatality of any sanitary area. The epidemic commenced in the southern part of the parish, among the children attending the Langford Road Board School, which was, at the request of the Sanitary Authority, closed from March Ist to March 28th, with apparently good effect to the district served by it. The question of the desirability of adding Measles to the list of notifiable diseases was considered by the Vestry but was deferred, as it was recognised that to commence notification when a severe epidemic was prevailing would simply result in a large expenditure of money, without having the slightest effect in checking the spread of the disease. If Measles is to be notified, the notification must be commenced when the district is free from the disease, so that such measures as are possible may be taken at the outset to check it. As the 160 deaths from it must have represented something like 4000 cases, it is clear that the cost of notification, disinfection, and the increase in the staff which would be necessary, would be considerable. As far as can be gathered from the experience of those districts where the notification of Measles is in force, the results, in the absence of isolation hospitals, do not seem to be commensurate with the heavy outlay incurred. The Local Government Board are now engaged in an enquiry on the subject, and being in a position to obtain all the details bearing on the question, will probably be able to form an authoritative opinion; though, of course, an enquiry of this nature must necessarily be of long duration. In reply to a request made by the parish of Westminster to confirm its order, providing that Measles should be added to the list of infectious diseases required to be notified, the Board replied that, pending the completion of enquiries on the subject, they had deferred the consideration of the request. A modified system of notification of Measles has been suggested, and is, I believe, in force in some provincial towns, by which the first attack in every house invaded is notified, but no subsequent case arising in the same house within 30 days. This would, at any rate, have an educational effect, by impressing upon parents the serious nature of the disease, and the attendance at schools from infected houses could be controlled much more effectively than is now the case ; for, though at present the children are excluded by the teachers as soon as it is known that there is a case of Measles in the house, as a rule the teachers only become aware of this when a child who has been attending the particular school is absent through the disease, and have no means of knowing that a house is infected when a child not attending any school, or a child attending some other school, is affected. Another question of great importance is that of the provision of hospital accommodation for the children of the poor when suffering from Measles; not so much on the ground of the necessity for isolation, but for the sake of the welfare of the patients, as a large proportion of those who succumb to the disease would be saved if they could be removed from the unfavourable conditions by which they are surrounded, and treated in a rational manner. The wide differences noted in the fatality of epidemics of Measles depend mainly on the condition, unfavourable or the reverse, of the populations invaded; and if Table K be examined, it will be noticed that nearly all the deaths occurred in streets tenanted by the poor. It is to be hoped that, viewing the heavy mortality from Measles, which is greater than the mortality from all notifiable diseases put together, it will not be long before some hospital accommodation for these cases is provided. Whooping Cough Whooping Cough was the cause of 58 deaths, the average number for the preceding eight years being 57. Of these, 29 were of children under one year of age, and 29 of children between one and five years. The death-rates for Fulham and London from this disease were 054 and 0-48 per 1000 respectively. Although the case mortality of Whooping Cough is low, the disease kills more children than any Zymotic disease except Diarrhoea. Unfortunately, it is always looked upon as a very trivial ailment, and comparatively little care is taken of the sufferers, who usually succumb to one of the pulmonary complications of the disease induced by neglect. Diarrhcea. Under the heading Diarrhcea are included several different affections, confounded with one another on account of the presence of Diarrhcea as a symptom, but there is no doubt that Summer Diarrhcea, which is so fatal to young children, is essentially a specific disease. The cold summer experienced had a marked effect on the mortality from Diarrhcea, which throughout the country was much below the average. In London the deaths due to it numbered 1769, as compared with an average for the preceding ten years of 3226. In Fulham 57 deaths were registered, 36 of which occurred in August and September, the average number for the preceding eight years being 97. 45 of the deaths were those of infants under the age of one year, and in addition to these, the majority of the deaths, numbering 24, of infants ascribed to Gastro-enteritis and Gastro Enteric Catarrh were probably of the same nature. The death-rate from the disease was 0.5 per 1000, and that for the whole of the Metropolis 0.4. The rate for the parish compares less unfavourably with those for other London sanitary districts than it has ever done, as Fulham has been for many years past invariably conspicuous by a high mortality from Diarrhcea, the following being the rates in London and Fulham during the past ten years:— 1885 to 1891 1892 1893 1894 London 0.69 0.6 0.8 0.4 Fulham 1.1 0.94 1.2 0.5 In fact, during the nine years, 1885—1893, the rate of mortality from Diarrhcea was higher in Fulham than in any sanitary district in London, excepting in St. George's in the East. That it should be in excess of the mortality obtaining in poor and crowded districts, with populations containing larger percentages of young children, like Shoreditch, Bethnal Green, Whitechapel and St. George's, Southwark, is most unsatisfactory. In July last the Local Government Board issued a circular letter, calling the attention of sanitary authorities to the fact that Cholera, from which certain parts of Europe had never been entirely free since the Summer of 1892, was again showing signs of recrudescence on the Continent, and that as it was found that in those localities where Cholera made some headway in 1893 there had been antecedent Diarrhcea, generally quite excessive in amount, often choleraic in type, they thought it desirable to remind sanitary authorities that the utmost vigilance should be exercised within their respective districts to control any Diarrhcea which might be suspicious, either in character or amount ; and, with a view of facilitating action in this direction, the Board stated that they would give favourable consideration to any application that might be addressed to them for their approval to add Diarrhcea to the list of notifiable diseases until the termination of the Summer quarter. The Vestry, on consideration of the circular, decided that as cases of Diarrhoea of a severe or choleraic type were notified as English Cholera or Choleraic Diarrhoea, and that as the parish was at that time comparatively free from Diarrhoea, there having been onlyfour deaths from it during the preceding six weeks, compared with 66 during the corresponding period of the previous year, and any abnormal increase in the character and amount of the disease would be at once shown by the mortality and by the returns of the District Medical Officers, there was no occasion at that time to make application to the Local Government Board for their approval to add Diarrhoea to the list of notifiable diseases for the rest of the quarter. The only Sanitary Authorities in London who scheduled Diarrhoea as a dangerous infectious disease were those of St. George's, Hanover Square, St. Giles' and Holborn. Influenza. Thirteen deaths were directly attributed to Influenza, 12 of which occurred in the first quarter of the year. The deaths attributed to this disease during the three previous years numbered 39, 5!) and 47. Other Miasmatic Diseases. Six deaths of children under five years were ascribed to the disease known variously as Rotheln, Epidemic Roseola and Rubeola. Septic Diseases. From Septic diseases, other than Erysipelas and Puerperal Fever, there were 7 deaths. Venereal Diseases. Ten deaths were attributed to these diseases, of which 8 were due to Congenital Syphilis. CLASS lII.—DIETETIC DISEASES. Nine deaths were directly stated to be due to alcoholic excess. Probably, if the recommendation of the Select Committee of the House of Commons for the improvement of death certificates and registration, " that medical practitioners should be required to send certificates of death to the Registrar, instead of handing them to the representatives of the deceased," were carried out, the number of deaths in this class would be materially increased. CLASS IV.—CONSTITUTIONAL DISEASES. The number of deaths from diseases in this group were 356, being 19 per cent, of the total number of deaths. Of these, 155 were due to Phthisis and 81 to other tubercular diseases, as Tubercular Meningitis, Tabes Mesenterica and General Tuberculosis, these diseases thus accounting for 12 - 3 per cent, of all the deaths ; and it is probable that some of the deaths ascribed to Marasmus, Debility and Convulsions were also of a tubercular nature. Eighty-four deaths were registered from Cancer, 71 being persons of 45 years and upwards. Rheumatic Fever was responsible for 6 deaths, and Chronic Rheumatism and Gout for 5. CLASS V.—DEVELOPMENTAL DISEASES. From diseases of this class 136 deaths were certified, 81 being of infants from premature birth, atelectasis, or noninflation of lungs, and congenital malformation; and 55 deaths were returned as due to "old age." CLASS VI.—LOCAL DISEASES. The diseases of this group were responsible for 762 deaths, or 40 per cent, of the total number, the following being the principal classes:— 1.—Diseases of Nervous System. From these there were 139 deaths, 56 being from Apoplexy, etc., 16 from Insanity and General Paralysis of the Insane, and 20 from Convulsions. 2. —Diseases of the Circulatory System. Diseases of the Heart and Blood-vessels were accountable for 96 deaths. 3. —Diseases of Respiratory System. From these diseases, Phthisis being excluded, there were 368 deaths, or 19 per cent, of the deaths from all causes. Of these, Pneumonia was responsible for 149, and Bronchitis for 194 deaths. 4.—Diseases of Reproductive System. Thirteen deaths were registered in this class, seven being due to flooding and other accidents of childbirth. The total number of deaths recorded as occurring within 21 days of childbirth was 17, the causes assigned being the following:— Septic Diseases 7 Flooding and other Accidents of Childbirth 7 Pneumonia 1 Diarrhœa 1 Phthisis 1 17 Or 1 death to 221 births. 5 Diseases of the Integumentary System. Two men, aged 61 and 59, died in the Fulham Union Infirmary from Epidemic Exfoliative Dermatitis, a contagious skin disease, which has of late attracted attention, severe epidemics of' it having occurred in Paddington, Marylebone and Bethnal Green Infirmaries. There were only these two cases in the Fulham Union Infirmary last year. From the other classes of Local Diseases there were 140 deaths. CLASS VII.—DEATHS FROM VIOLENCE. Different forms of violence caused 55 deaths. Accident or Negligence. Falls 9 Fractures and Contusions Run Over 8 Burns 7 Drowning 7 Poison 1 Infants in Bed 5 Suffocation Otherwise 2 Other Injuries 7 46 Suicide. Drowning 2 Poison 4 Hanging 1 Jumped from Window 1 8 Homicide, Wound of Throat 1 55 The death-rate from violence was 0.52, as against 0.75 for London. CLASS VIII.-ILL-DEFINED AND NOT SPECIFIED CAUSES. Under this heading there were 108 deaths, the great majority, viz., 95, being certified as due to Debility, Inanition, or Marasmus. CERTIFICATION OF THE CAUSES OF DEATH. Of the 1897 deaths registered, 1758, or 92.7 per cent., were duly certified by registered medical practitioners, and 134, or 7.8 per cent., by the Coroner after inquest, while the causes of only 5, or 0.3 per cent., were uncertified. INQUESTS. Of the 134 inquests held on parishioners, 110 were held in the parish, and 24 at institutions outside. The subjects were males, 83; females, 51, and their ages — Under 5 51 5 to 60 59 Over 60 24 79 deaths were due to natural causes, and 55 to violence. Those due to natural causes may be classified as follows:— Zymotic Diseases 9 Tubercular 1 Diseases of Respiratory Organs 19 Diseases of Circulatory System 22 Convulsions and other Diseases of the Nervous System 8 Alcoholism 2 Improper or Insufficient Food 3 Other Diseases 13 Cause not ascertained 2 79 The deaths due to violence have already been classified. UNCERTIFIED DEATHS. Three of these were of prematurely-born infants, none of whom lived for 24 hours. The other two were of persons aged 35 and 48, and the death was in each case ascribed to Phthisis. The proportion of uncertified deaths was in London 0 9 per cent., and in England and Wales 20. The Select Committee of the House of Commons appointed to inquire into the sufficiency of the existing law.as to the disposal of the dead, for securing an accurate record of the causes of death in all cases, and especially for detecting them where death may have been due to poison, violence, or criminal neglect, made their report in 1893. The most important recommendations, in addition to the one respecting still-birth previously alluded to, were That in no case should a death be registered without the production of a certificate of the cause of death signed by a registered medical practitioner, or by a Coroner after inquest. That a registered medical practitioner should be appointed as public medical certifier of the cause of death in which a certificate from a medical practitioner is not forthcoming. That a medical attendant should be required, before giving a certificate of death, to personally inspect the body. No steps have yet been taken to carry out the recommendations of the Committee. DEATHS IN PUBLIC INSTITUTIONS." Fulham Union Infirmary and Workhouse. This institution, situated in Fulham, serves for the two parishes of Fulham and Hammersmith. 383 deaths occurred in the Infirmary and 18 in the Workhouse; of these 207 were of parishioners of Fulham, and 194 of persons belonging to Hammersmith ; their ages being as under:— Under 1 68 1 to 5 59 5 to 15 4 15 to 25 20 25 to 65 149 Over 65 101 Western Fever Hospital. 326 deaths occurred at the Western Fever Hospital. Of these 86 were of parishioners and 240 of persons belonging to other districts. The deaths were due to Scarlet Fever 110 Diphtheria 183 Enteric Fever 16 Other Diseases 17 326 Extension of the Western Fever Hospital. An inquiry with regard to the proposal of the Metropolitan Asylums Board to purchase certain land adjoining their Hospital at Fulham, was held by Dr. Downes, one of the Inspectors of the Local Government Board, on May 2nd, and objections to the proposed extension were raised by the Vestry, but after consideration of the report made by Dr. Downes, the Board issued an order authorising the purchase. The main objection of the Vestry was the depreciation of the neighbouring property by the proximity of a hospital for infectious diseases. That the Hospital does depreciate property is unquestionable, but this mischief has already been done and it is more than doubtful if the proposed extension will have any additional effect, while it is of the highest importance that the Hospital shall be made as serviceable as possible by the erection of the additional Diphtheria and Isolation Wards which are required. Deaths Occurring Outside the District among Persons Belonging Thereto. The deaths of parishioners at public institutions and other places outside the parish numbered 237, and occurred in the following institutions:— St. George's Hospital 53 West London 29 Middlesex 1 Charing Cross „ 1 King's College „ 1 Westminster „ 3 Gu y's „ 2 Lon don „ 2 St. Bartholomew's „ 1 St. Thomas's „ 7 University College„ 2 German „ 1 Italian „ 2 Queen's Jubilee „ 3 Brompton „ for Diseases of Chest 14 North London „ for Consumption 1 Victoria „ for Children 26 Gt. Ormond St.„ „ „ 2 Ca ncer „ 5 Samaritan „ 1 Queen Charlotte's „ 1 National „ 2 St. Elizabeth's „ 1 Hospital for Diseases of Throat, Golden Square 1 South Western Fever Hospital 5 Fountain Fever Hospital 3 North Western Fever Hospital 12 Hospital Ships 3 Cane Hill Asylum 3 Banstead „ 5 Hanwell „ 8 Leavesden „ 6 Colney Hatch „ 1 Caterham „ 10 Camberwell House Asylum 2 Ilford Asylum 1 St. George's Infirmary 1 Chelsea Infirmary 2 Kensington „ 1 Friedenheim 1 Home for Aged Blind 1 Hampstead Home 1 In private houses and elsewhere in other parishes 9 237 VACCINATION. The following Tables, furnished by Mr. Collins, the Vaccination Officer, give the Vaccination returns for 1893, and for the first six months of 1894, those for the last six months not being yet complete: — Supplemental Return for 1893 for the Parish of fulham. Insusceptible of Vaccination. Had Small Pox. Dead. Postponed by Medical Certificate. Removed. Outstanding. No. of Births Registered from 1st Jan., 1893. to 31st Dec. 1893. Successfully Vaccinated. 22 459 29 348 6 3704 2840 - Return of Vaccination for the Period from January to June, 1894, Parish of Fulham. No. of Births Registered from 1st Jan. to 30th June, 1894. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead. Postponed by Medical Certificate. Removed. Outstanding. 1490 8 145 17 1855 - 158 37 The return for 1893 is the most unsatisfactory yet issued for Fulham, showing that the number of children remaining "unaccounted for" amounted to 10 per cent, of the total births. In no previous year has the number been more than 7 per cent. No doubt the long delay in the issue of the report of the Royal Commission on Vaccination is accountable for this, increasing, as it does, the difficulty of enforcing the Acts. The Commission has now been sitting for nearly six years, and has concluded taking evidence, so that its decision could be at once made known, even if the detailed report were published later. DISINFECTION. Infected articles were disinfected by the contractor, Mr. Lacy, Townmead Wharf, by whom the articles were also collected. Mr. Lacy's disinfecting plant is of the most approved pattern and has proved fully equal to all demands made upon it. The infected articles were always promptly removed, and the work most efficiently done. The weight of the articles disinfected was 1468 cwt., and the amount paid by the Vestry to Mr. Lacy ,£9l8. Accommodation for Temporary Shelter. The necessity for the acquisition or erection of some premises where persons can be temporarily housed during the disinfection of their dwellings has again been brought under the notice of the Vestry, as the want of this accommodation was on several occasions severely felt, and the Vestry had already decided that such shelter should be provided. Some land has recently been purchased on which both the necessary "shelter" and disinfecting apparatus can be erected so that there is now no reason why the Vestry should delay any longer in carrying out their resolution. WATER SUPPLY. At the end of 1893 the only houses in the parish having an intermittent supply were some 660 in that portion supplied by the West Middlesex Company, and these, according to the Company, have now been given a "constant service." It would seem, however, that this Company's main is incapable of really giving a " constant" supply. There were many complaints of insufficient pressure from residents in the district supplied by that Company, and especially from tenants on the Queen's Club Gardens Estate, where there are some 300 flats now occupied. During last summer there was no water supply to these flats for several hours in the day and it was obvious that the " constant" supply was a mere phrase, and in a letter of the Company's Secretary, in answer to complaints about the failure of the supply, the following significant words occur, " I am directed to add that it is in contemplation to lay a larger main for the increasing supplies of the district," thereby admitting that the existing main is insufficient. Quality of the Water. Samples of the water supplied by both Companies, taken in November last, were pronounced by Mr. Clayton, the Public Analyst, to be of unsatisfactory quality and not suitable for dietetic purposes. The reports of the Analyst were forwarded to the Local Government Board. Water Cut Off by The Water Companies. During the year notices, under Sect. 49 of the Public Health Act, were given by the Companies in respect of 495 occupied houses from which the water had been cut off. The Vestry have persisted in their policy of refusing to take any action in these cases, although, as has been repeatedly pointed out, they are adopting an unwise and unjustifiable course in deliberately refusing to carry out, for sentimental reasons, the provisions of the Public Health Act. The Vestry, in March last, presented a petition to the Local Government Board asking the Board to promote legislation which would preclude Water Companies from cutting off the supply of water to occupied houses, and were informed that the suggestion in the petition would be noted, but that there was no measure before Parliament, on the part of the Government, for dealing with the London water. The Vestry should undoubtedly do all in their power to secure an alteration of the law, by which, if they do their duty they are practically in the position of debt collectors for the Companies; but until this alteration is secured they should certainly carry out their duties under the Act, SEWER VENTILATION. As usual, constant complaints were received of the offensive smells arising from the manholes and surface ventilators in the roadways, and in June last I suggested to the Vestry, in a report on the question, that in connection with the new sewer which they were constructing in the Wandsworth Bridge Road as many pipe ventilators should be erected as possible, and with that view permission was obtained from a number of owners to have these ventilators fixed against their houses, but unfortunately the Vestry did not avail themselves of the opportunity of ascertaining whether the ventilation of the sewer in this way would remedy the present admitted nuisance. In the report for 1893 it was remarked that " it is to be greatly regretted, too, that although hundreds of houses are built yearly, in no single instance has the Vestry's recommendation, urging on builders the desirability of providing and fixing ventilators up the fronts of the houses between the syphon trap and the sewer, been acted on. If this were done, and it could be done when building at a trifling cost, much future trouble would be avoided"; but since then this has been carried out in some houses recently built on the Burlington Estate, in which the builder has used Sykes' Intercepting Trap, which provides for the ventilation both of the sewer and the house-drain, and it is to be hoped that other builders will follow this example by using either Sykes' or some similar form of Interceptor, and so prevent in new streets the abominable nuisance now caused by the partially ventilated sewers in the old streets. PUBLIC MORTUARY. 123 bodies were removed to the Mortuary during the year and were admitted as follows:— At the request of the Coroner 93 Brought in by the Police 25 At the request of the Medical Officer of Health 5 123 Four of the last being cases of infectious disease. Inquests were held on 119, and post-mortem examinations were made in 66 of the above cases. HOUSE REFUSE. A weekly visit is made to all premises for the collection of house refuse, and the service has been fairly satisfactory. 620 complaints of non-removal of dust were received, but a very large proportion of these were due to the refusal of the servants to allow the refuse to be removed when the usual weekly call was made. It is not generally known that by Section 125 of the Metropolis Management Act, 1855, which, as no bye-law for the like object has been yet made, is still in force : " Any occupier of any house or other person who refuses or does not permit any ashes, filth, etc., to be taken away by the scavengers appointed is liable to a penalty of £5." As frequent a removal as possible of the dust-bin contents is greatly to be desired, and, at any rate, during the summer months, the removals should be effected at least twice a week, and probably this c ould be done without much additional cost if the small galvanised iron receptacles, placed in an accessible position, were universally adopted. BAKEHOUSES. There are 76 Bakehouses in Fulham which have been regularly inspected during the year and have been found in a fairly satisfactory condition. As I pointed out last year, it is to be regretted that underground Bakehouses are still being erected in new districts, and legislation is needed to provide that no newly erected Bakehouse should be permitted to be underground. At a Conference held at the Vestry Hall of the Parish of St. George, Southwark, at the Meeting in October last, to consider the amendment of the law regulating Bake- houses,the following resolutions were approved:— That the present state of the Law relating to Bakehouses requires amendment by the addition of the following clauses to the Public Health (London) Act, 1891:— (a) That uniform Metropolitan Bye-laws regulating Bakehouses be made by the London County Council, and be confirmed by the Local Government Board, and that the duty of enforcing these Byelaws shall devolve upon the various Local Sanitary Authorities. (b) That the portions of the Bye-laws regulating the structure of Bakehouses do not apply to existing Bakeries. (c) That the London County Council be empowered to frame Bye-laws for the construction of underground Bakehouses, and that all Bakehouses erected after the passing of such Bye-laws shall conform thereto. SLAUGHTER-HOUSES. The licenses of the undermentioned slaughter-houses were renewed in October last by the County Council, no objection to the renewal being raised by the Vestry. They are but little used, the parish being mainly supplied by the dead meat trade, and have always been found well kept. Situation. Licensee. 62, Melmoth Place T. H. Belcher. 603, King's Road H. S. Jones. 611, Fulham Road J. Cragg. 88 & 90, High Street E.&G. Kingston. 640, King's Road H. E. Shalders. 105, Hammersmith Rd H. Boughton. COW-HOUSES. The licenses of the following Cow-houses were renewed by the County Council in October, the renewal of the licenses being unopposed. Situation. Licensee. Average No. of cows kept. 36, Burlington Road E. Evans 5 2, Haldane Road W. Pettitt 15 42, Waterford Road Willison & Co. 4 28, Vanston Place R. Turvey 5 COMMON LODGING HOUSES. The control of these has been transferred to the London County Council. The following are the registered Common Lodging Houses in Fulham. Situation. Authorised No. of Lodgers. 541, King's Road 51 16, Stamford Road 15 38, Stamford Road 20 CERTIFICATES UNDER CUSTOMS AND INLAND REVENUE ACTS, 1890 & 1891. Certificates for exemption from Inhabited House Duty have been granted in respect of 95 houses and refused in respect of 25. BYE-LAWS UNDER PUBLIC HEALTH (LONDON) ACT. The Bye-laws made by the Vestry under Section 94 in respect of houses let in lodgings or occupied by members of more than one family have been confirmed by the Local Government Board, and steps are now being taken to register houses under them. The limit of exemption, viz., 3/6 a week, provided by the Bye-laws, is, however, too low, and should be raised to at least 7/-. FACTORY AND WORKSHOP ACT, 1891. Increased duties have been placed on the Sanitary staff by the above Act, and the circular issued by the Home Secretary relating to outworkers, but with the existing number of Inspectors it is not possible to attend to them thoroughly, so that the Act in Fulham is almost a " dead letter. The above remarks were made in the report for last year and it is to be regretted that they must be repeated. UNDERGROUND ROOMS. A number of underground rooms in Greyhound Road were found to be separately occupied, and in all cases on notice being served, the illegal occupation was discontinued. In October last notices were served in respect of the illegal occupation of certain underground rooms in Langford Road which were not being complied with. Proceedings were taken on the recommendation of the Sanitary Committee against the owner. When the case came before the magistrate it was adjourned in order that the owner might apply to the Vestry for a dispensation under Section 96 of the Public Health Act 1891, which provides that the Sanitary Authority may, on the application of the owner, dispense with or modify any of the requisites for underground rooms mentioned in the Act " which involve the structural alteration of the building if they are of opinion that they can properly do so, having due regard to the fitness of the rooms for human habitation, to the house accommodation in the district and to the sanitary condition of the inhabitants, and to other circumstances, but any requisite which was required be/ore the passing of this Act shall not be so dispensed with or modified." The question was referred to a "View Committee," who inspected the premises, and finding that they did not comply with the conditions for underground rooms which were required by Section 103 of the Metropolis Management Act, 1855, recommended the Vestry to inform the owner that his application for a dispensation could not be entertained. The owner then feeling aggrieved by the dispensation not being allowed, appealed to the Local Government Board, who have power under the Act to refuse the dispensation or allow it wholly or partly as if they were the Sanitary Authority. The Local Government Board having considered the owner's petition decided that, having regard to Section 96, Sub-sections 3 and 5 of the Public Health Act, the Board have no power to dispense with the requisite that the area be not less than three feet in width in every part, and accordingly refused the appeal. The Law and Parliamentary Committee of the Vestry, in whose hands, legal proceedings having been commenced the matter now was, then thought fit to decide that no further action be taken by the Vestry, and accordingly instructed the Solicitor to the Vestry to withdraw the summons against the owner when the case came on again for hearing. Why the Sanitary Authority should thus stultify themselves is hard to understand. A direct contravention of the Public Health Act is brought under their notice, the matter is gone into by a specially appointed committee who viewed the premises and were unanimous in their opinion that, even if the Act did not explicitly state that no dispensation could be granted if the requirements enacted as essential 40 years ago were not complied with, having regard to the want of fitness of the rooms for human habitation, they were unable to recommend that a dispensation should be granted ; the Local Government Board, on being appealed to, refuse the petition, and then a Committee, composed exclusively of members of the Vestry who had not visited the premises, reverse the proceedings of the Sanitary Authority and permit rooms which, in the opinion of their Sanitary Officers, of those members of the Sanitary Authority who had visited the premises, of medical practitioners in practice in the neighbourhood, are unfit for human habitation, to be occupied in direct contravention of the Public Health Act they are bound to administer. OVERCROWDING. 20 houses were certified as being overcrowded and notices to abate the overcrowding were served on the persons responsible for it which were complied with; but as I have already pointed out, it is evident, from the census returns, that there is a good deal of overcrowding in the parish, but it escapes notice, as the staff of inspectors is too limited to undertake a systematic examination, even of the very poor property, which is so eminently desirable. Much good could probably be effected if district visitors and others who visit the poor, would always inform the Sanitary Department of any case of apparent overcrowding, and of any insanitary condition they meet with. At present it is greatly to be regretted that so little information is received from those who necessarily have an intimate knowledge of the conditions under which the majority of the poor live. Mortality and Overcrowding. The following Table, prepared by Mr. Murphy, shows how overcrowding and high death-rate go together in London: — Proportions of total population living more than two in a room (in tenements of less than 5 rooms). Death rate all causes, 1885 to 1892. Districts with under 15 per cent. 17.5 „ 15 to 20 „ „ 19.5 „ „ 20 to 25 „ 20.2 „ 25 to 30 „ „ 21.8 „ 30 to 35 „ „ 23.9 over 35 „ „ 25.1 HOUSING OF THE WORKING CLASSES ACT, 1890. The following houses were represented to the Sanitary Authority under the Act as being in a state so injurious or dangerous to health as to be unfit for human habitation: — Number of Dwellings Action Taken Subsequent Action 7 Repaired by Owner Re-opened 1 to 7 Melton st. 46, 48, 50, 52 and 54, Field rd. 5 „ „ „ Closed by Owner Demolished 39, 41, 41a, 43, High st. 4 Still closed 211, Dawes rd. 1 „ „ 2 1 and 2, Bedford place „ „ „ 3, 5, 19, Portland place 3 Closed by Owner Re-opened Closed by Magistrates order Demolished 10, 11, 12, Distillery lane 3 Repaired by Owner Re-opened 1, 2, 4, 5, 6, 7, 8, 9, John st. 8 Repaired Order Detemined Re-opened Closed by Magistrate's order 48, 50, 52, 54, 56, 58, 60, 62, 64, 74, 76, 78, 80, 82, 84, 86, Parsons Green lane 16 Still closed 41 5 to 45, (inclusive) Crown st. Closed by Magistrate's order 90 Total number of Houses Description of Premises. Prosecutions under the Public Health (London) Act, 1891, were instituted by the Vestry in the following cases: — Fined 2/- and 3 - costs. Owner 2, Bagley's lane Failing to comply with Vestry's notice. 11, Maxwell road Fined .£lO and 3/- costs. „ „ „ „ 98, Waterford rd. Fowls and pigeons so kept as to be a nuisance. Dismissed. £3 3s. costs against Vestry. „ Withdrawn on payment of costs, and an undertaking that work should be done. Millshot Farm, Crabtree lane Failing to comply with Vestry's notice. „ 37, Greyhound rd. Fined £3 and 6/- costs. „ „ „ „ 9, Rosaline road Insanitary premises. Order: works to be done in 6 weeks, and 6/- costs „ „ 11, „ „ „ „ „ „ 13, „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ 17, „ „ „ „ „ „ „ „ 19, „ „ „ „ „ „ 21, „ „ „ „ „ „ „ 23, „ „ „ „ „ „ „ „ 25, „ „ „ „ „ „ „ 77, May street Closing Order, 6/- costs. „ „ „ Occupier 5,Bagley's lane Order, 6/ - costs „ „ Failing to comply with notice of the Vestry. Owner 5, Edith villas Fined £3 and 6/- costs. Work to be done in 14 days. 43, Greyhound rd. Owner Insanitary premises. Closing Order. 6/- costs. 37, „ „ Failing to comply with notice of the Vestry. Fined £5 and 2/- costs. „ 125, North End rd. Insanitary premises. Withdrawn on payment of costs, 2/-. Work done. „ 340, Fulham road Withdrawn on payment of costs, 2/- Work done. „ „ „ 40, Dimsdale road Order 21 days. 6/- costs. „ „ „ Vacant land in Bayonne road Accumulation of refuse. Order to fence in land in 14 days. 6/- costs. „ 4, Disbrowe road Insanitary premises. Order 14 days. 6/-costs. „ 17, Caroline place „ „ „ „ „ 50, Lillie road Failing to comply with notice of the Vestry. Fined £3 and 5/- costs. „ 84, Greyhound rd. Insanitary premises. Order 14 days. 6/-costs. „ 49, Mimosa street Order 7 days. 6/- costs. „ „ „ 37, Victoria road Failing to comply with notice of the Vestry. Fined 10/- and 2/-costs. „ „ „ 28, „ „ „ „ „ 29, „ „ „ „ „ „ „ 30, „ „ „ „ „ „ „ 31, „ „ „ „ „ „ „ 32, „ „ „ „ „ „ „ Old Rose, Waterford road Insanitary premises. Order 14 days. 3/- costs. „ 63, High street „ „ „ „ „ 33, Greyhound rd. Owner Insanitary premises. Order, 3/- costs. Occupier Overcrowding. Withdrawn. „ „ Owner 30, Grove avenue Insanitary premises. Order 14 days. 6/-costs 18, „ „ „ „ „ „ „ 32, Delaford st. Withdrawn on payment of costs, 3/- Work done. „ „ „ 51, Brecon road Withdrawn on payment of costs. Work done. „ „ „ 96, Lillie road Order 14 days. 3/-costs. „ „ „ „ „ 6, Kenneth rd. „ „ „ 13, New Crown terrace Order 21 days. 6/-costs. „ „ „ 31, Grove avenue Withdrawn on payment of costs, 2/- Work done. „ „ „ 33, „ „ „ „ „ „ „ 48, „ „ „ „ „ „ „ 39, „ „ „ „ „ „ „ 54, Victoria road Order 14 days. 6/-costs. „ „ „ 51, „ „ „ „ „ „ „ 52, „ „ „ „ „ „ „ 60, „ „ „ „ „ „ „ 16, Richmond place Order 1 month. 6/- costs. „ „ „ Order 7 days. 6/- costs. 10, Everington st. „ „ „ 1, Waldemar avenue Failing to comply with notice of the Vestry. Fined £5 and 6/- costs. „ Owner 6, Gledstanes rd. Insanitary premises. Order 2 months. 6/-costs. 77, Lillie road Order 14 days. 6/- costs. „ „ „ 144, High street Order 21 days. 6/- costs. „ „ „ 133, Fulham Palace road Withdrawn. Work done. „ „ „ „ 20, Claxton grove „ „ „ „ C. Gadd 30, Church path Exposing unsound pears for sale. Fined 5/- Owner 559a, King's rd. Insanitary premises. Withdrawn. House closed. J. Stevens 255, North End road Selling unsound food (Rabbits) Fined 10/- and 12/6 costs. Owner Vacant land in Bayonne road Failing to comply with magistrate's order to abate nuisance. Ordered to complete work in 7 days. 21/- costs. 54, Kinnoul rd. Failing to comply with notice of the Vestry. Fined £5 and 4/- costs. „ Wickens, Pease & Co., Ltd. Removing offensive refuse during prohibited hours. Fined £1 and 2/-costs. Removing offensive refuse during prohibited hours Fined £2 and 2/- costs. „ Owner 2b, Langford rd. Suffering an underground room, not complying with the provisions of Public Health Act, to be occupied. Withdrawn. „ Insanitary premises. Order 21 days. 6/-costs. 41, Lilyville rd. 43, „ „ „ „ „ „ „ 45, „ „ „ „ „ „ „ Owner 126, Dawes road Insanitary premises Order 14 days, 6/- costs. 294, Greyh'nd rd. Failing to comply with notice of the Vestry. Dismissed. „ Vacant land, Stanley road „ „ „ „ 42m, Langford rd. „ „ „ „ 22t, Langford rd. Insanitary premises. Withdrawn. „ Land abutting on Townmead road Pigs kept in an improper place. Order 28 days. 3/- costs. „ 38, Yeldham rd. Failing to comply with notice of the Vestry. Withdrawn. Work done. „ 34, Claxton grove „ „ „ „ „ London Road Car Co. Failing to comply with requisitions of notice to remove manure every 48 hours. Fined £2 and 2/- costs. APPEALS TO THE LONDON COUNTY COUNCIL. Appeals against orders of the Vestry served under Section 41 of the Public Health Act, 1891, in respect of 27, 28, 29, 30, 31, 32 and 33, Victoria Road, and 1, 5, 7, 9, 11, 15, 17, 19, 21, 23, 25 and 27, Rectory Road, were heard by the Appeal Committee of the Council. In the case of the houses in Victoria Road the Council confirmed part of the order of the Vestry and adjourned the consideration of the other, but before the case was put down for the adjourned hearing, the owner complied with all the requirements of the Vestry. In the case of the houses in Rectory Road the Council confirmed three items of the order of the Vestry, but allowed the appeal in respect of two. An appeal against an order of the Vestry, served under Section 85 of the Metropolis Local Management Act, 1855, in respect of the drainage of 38, Stanley Road was also partly heard, but the owners having undertaken to do certain work to the satisfaction of the Vestry, the order was withdrawn SALE OF FOOD AND DRUGS ACTS. The following samples were taken for analysis during the year: — Milk 46 samples Cocoa 8 „ Sugar 1 „ Precipitated Sulphur 6 „ Olive Oil 5 „ Mustard 4 „ Pepper 4 „ Butter 10 „ Lard 4 „ Coffee 6 „ Arrowroot 4 „ Brandy 2 „ Whisky 9 „ Vinegar 6 „ Condensed Milk 3 „ 118 Of the 46 samples of milk submitted to the Analyst, 10, or 21.7 per cent., were certified to be adulterated, and 5 samples were stated to be of very inferior quality, so that only twothirds of the samples could be regarded as quite genuine. In the record of the prosecutions it will be noticed that the method of milk adulteration most in favour was that of removing the cream, and that one defendant was fined no less than six times for this offence. This man, who traded as the Burleigh Park Dairy Company, avowedly sold separated or skimmed milk, and professed to label his barrows with the words " separated milk," and to give explicit instructions to his men to sell the milk as separated milk; but, as a rule, the label was removed, and the men cried "pure new milk," so that the customers always imagined they were getting genuine milk. The practice of removing the cream is, if anything, a more pernicious form of sophistication than the addition of water, for cows' milk is the sole food of many children ; and as an infant requires three-quarters of the fat required by a man in ordinary work the effect of removing the greater portion of this most essential constituent is the starvation of any unfortunate child fed on it. It is gratifying to know that the fines inflicted had a deterrent effect, and that the Burleigh Park Dairy Company have discontinued, at any rate for the present, their business in Fulham. Proceedings under Sale of Food and Drugs Act. Defendant. Offence. Result. H. Hanson, 15, New Yard, Great Queen st. Milk adulterated with 49 parts of added water Withdrawn Fined £5 and 12/6 costs H. Leader, 105, Bishop's rd. Coffee adulterated wtth 74 parts of chicory Fined £1 and 12/6 costs J.S Pargeter, 632, King's rd. Cocoa adulterated with 43 per cent, starch and sugar M. H. Bull, 3, Peterboro' cott, Bagley's lane Milk adulterated with 11 per cent, added water Fined £1 and 12/6 costs Cocoa adulterated with 26 per cent, starch and sugar Fined £1 and 12/6 costs J. Rothe, 87, Waterford rd. H. Greenwood, 283, Wandsworth Bridge rd. Cocoa adulterated with 40 per cent, starch and sugar Dismissed, £ 11/-costs against the Vestry Milk 65 per cent, of the fat abstracted. Fined £55/- and 25/- costs J. Turner, 5, Bothwell st. F. Stevens, The Leylands, Malta rd., Leyton Milk with 22 per cent, fat abstracted Fined £2 and 12/6 costs Milk with 25 per cent, of fat abstracted Fined £1 and 12/6 costs F. Stevens, The Leylands, Malta rd., Ley ton Result. Defendant. Offence. F. Stevens, The Leylands, Malta rd., Leyton Milk with 23 per cent, of fat abstracted Fined £2 and 12/6 costs Milk with 58 per cent, fat abstracted Fined £10 and 37/6 costs F. Stevens, The Leylands, Malta rd., Leyton F. Stevens, The Leylands, Malta rd., Leyton Milk with 53 per cent, fat abstracted Fined £5 Milk with 37 per cent. of fat abstracted F. Stevens, The Leylands, Malta rd., Leyton Fined £5 E. Turner, 1, Bothwell st. Milk with 27 per cent, of fat abstracted Defendant absconded before day appointed for hearing summons In the list of the proceedings taken in 1893 was the case of the Vestry against Messrs. Bertram and Co., for having sold milk adulterated with 36 per cent, of added water, which was dismissed by the magistrate on the ground that the defendant had purchased the milk under a written warranty of its purity, and had no reason to believe that when it was sold it was otherwise, and that there was evidence before him (the magistrate) from which he might infer, assuming that it was not sold in the same state as when the defendant purchased it, that the change was not made by himself or his servants, or to his or their knowledge. The magistrate stated a case on the question whether the decision was right in point of law. When the appeal was heard in March last by Mr. Justice Matthew and Mr. Justice Collins, the decision of the magistrate was reversed. Mr. Justice Matthew, in giving judgment, said, "that the conditions of the Section as to warranty had not been satisfied. It was not proved and was not found that the milk was in the same state when sold to the customer as when it was received. There was strong evidence that the milk, when delivered to the defendant, corresponded with the warranty, but when it was sold to the prosecutor it had clearly been adulterated. It was, then, for the seller to show not only that he had received it under a warranty of genuineness, but that when sold it was in the same state as when received. But this the magistrate had not found. The case therefore fell short of what was required to relieve the seller, and the magistrate ought to have convicted him." On the case being remitted to the magistrate he imposed a fine of £b and £44s. costs. The number of samples taken, viz., 1 for every 914 inhabitants, as compared with 1 for every 529 persons in London in 1893, is much too small to act as an efficient check to adulteration, and I must again repeat the recommendation made last year, which I have frequently urged upon the Vestry, that a Sanitary Inspector should be appointed, whose special duties would be to procure samples under the Sale of Food and Drugs Act; to undertake a general supervision, as far as practicable, of the food supply and the frequent inspection of bakehouses and other places where food is prepared. Amendment of Sale of Food and Drugs Acts. The necessity for the amendment of the existing law regulating the sale of food and drugs has long been recognised, and a Conference to consider the question was held at the Vestry Hall, Mount Street, in June last, at which the following resolutions were adopted : — 1. Inspectors or other duly authorised persons should be empowered to take samples of food and drugs at any railway station where the articles are in course of delivery, bv consignors or wholesale dealers, whether within or outside the district for which they are appointed, which may be consigned or addressed to any person or Company within the limits of their respective districts. 2. Difficulty Arising out of Warranties.—This Conference is of opinion that the best way of meeting the object aimed at would be to repeal the 25th Section of the principal Act, and to substitute a provision similar to the proviso in Section 42 of the Public Health (London) Act, 1891, to the effect that where a person is charged with an offence under the principal Act he shall be entitled, upon information duly laid by him, to have any other person, being the wholesale trader, manufacturer, or other person from whom he purference xthe article, brought before the Court at the time of the hearing of the charge, and if he proves to the satisfaction of the Court that he purchased it as the article for which he sold it, and that he sold the article in the same state in which he received it, he shall be exempt from all penalties, and the said trader, manufacturer, or other person may be summarily convicted of the offence. 3. That in all prosecutions under the Acts, when two or more persons are brought before the Court, the onus shall be thrown upon the original defendant, to prove to the satisfaction of the Court that he has sold the article as he received it, and that the adulteration has been carried out by another defendant before he shall be exempt from conviction. 4. With any article bearing a label, the label shall describe the contents of the package, and when the contents are sold as a mixture, the proportions of the mixture shall be stated. The article sold shall be held to conform to the name or description on the label to which the greatest prominence is given, and any article differing in substance or purity or proportion from such description or descriptions shall be held to be an adulteration under the Act. 5. That a standard for milk, and milk products, and other articles admitting of definition, should be fixed by the Local Government Board, with power for them to alter in case of exceptional seasons. 6. That all articles of Food and Drugs imported as merchandise into, and landed at any port in Great Britain and Ireland, which come from a foreign country, shall be subject to examination, inspection and analysis by officers of the Sanitary Authority of the Port, in the same way as tea is now examined by an Analyst appointed by the Commissioners for Customs under Section 30 of the Sale of Food and Drugs Act, 1875. 7. That a minimum penalty of 40s. be imposed for all offences under the Act, and that the defendant shall be liable to a double penalty, with or without imprisonment, in cases of second or subsequent offences. 8. That all itinerant vendors of Food or Drugs shall only sell from vehicles or vessels or other receptacles having printed thereon the name and address of the person, who shall be responsible as master for such sale; and all itinerant purveyors of milk, whether employers or employed, shall be registered with the County Council of the district, and it shall be an offence, under the Act for the vendor of any article to give a false name and address of himself, or his employer, to an Officer under the Act. 9. That a copy of the resolutions passed by this Conference be forwarded to the Select Committee appointed by the House of Commons to enquire into the working of the Acts, with the request that evidence may be called before the Committee in support of the views urged therein. A select Committee of the House of Commons was appointed last year to enquire into the law for the suppression of adulteration and is now taking evidence. THE STAFF OF THE SANITARY DEPARTMENT. The attention of the Vestry was drawn, in the report for 1893, to the urgent necessity for an increase in the Sanitary Staff,' but as during the year the recommendation that additional Sanitary Inspectors should be appointed was not acted on, it is necessary to again bring the facts before the Vestry, who must remember that no Sanitary Inspector has been appointed since January, 1891, and since then the Public Health Act, 1891, the Factory and Workshop Act, 1891, have come into force, both entailing many additional duties on the Sanitary Authority, and moreover the population of the parish has increased by some 20,000, and about 3,000 new houses have been erected. How Fulham compares with the rest of the Metropolis, and with other towns, in its proportion of Sanitary Inspectors will be seen by the following figures:— To Each Inspector: Houses Persons Fulham 5,000 .. 37,000 London 2,500 ... 19,320 Fifteen large towns 2,700 ... 15,000 which shows clearly how wanting, in sanitary supervision, is the parish, whether compared with the rest of London or with other large towns. It is not, too, merely that the number of Inspectors' is inadequate, but much of their time, which might with advantage be devoted to outdoor work, is taken up with clerical work, owing to the clerical staff being also insufficient. Allusion has already in this report been made to the neglect of necessary work in connection with the Factory and Workshop Act, the Sale of Food and Drugs Act, and other matters, owing to the inadequate staff, and a strong additional reason for increasing the number of Inspectors is the need for a systematic house to house inspection of the parish, which has been repeatedly urged upon the Vestry, as the mere attention to complaints and inspection of houses where infectious disease has occurred is quite inadequate to effect any real improvement in the sanitary condition of the district. In considering, too, the proportion of Inspectors to the houses in the parish, it must not be forgotten that, as was shown last year, there are, in Fulham, some 13,000 tenements of less than 4 rooms, and that 2,000 of these are overcrowded, being inhabited by over 2 persons to a room, while 4,500 are inhabited by 2 persons to a room. Property of this sort obviously requires most frequent and regular inspection; and, in all probability, if there were such, instead of harassing property owners, a cry which is frequently raised, it would really benefit them by teaching the occupiers, to whose careless and dirty habits insanitary conditions are so frequently due, the necessity for a more cleanly and orderly mode of life which would result in a material saving to the owner. With these facts before them I trust that the Vestry will at once recognise the duty devolving upon them by appointing, at least, two additional Inspectors and another Clerk, for even with this addition the proportion of Inspectors to population would be slightly lower than that obtaining in London. Since the above was written the Vestry have resolved to appoint one additional Sanitary Inspector, and to reappoint the other Inspectors, subject to the approval of the Local Government Board. By this they will receive half the salaries paid to the Inspectors from the London County Council, so that now the staff can be increased in the manner suggested above without any additional cost to the ratepayers of Fulham. SANITARY CONDITION OF SCHOOLS. Several of the Board and other primary schools in the parish have been inspected, and in 5 instances notices were served requiring sanitary amendments which were complied with. I also visited the private schools in the district and reported on them to the Vestry, especially with regard to the amount of space in, and the ventilation of, the class-rooms, and the sanitary conveniences. SMOKE NUISANCES. 13 notices requiring the abatement of smoke nuisances were served ; and numerous complaints having been received of the smoke arising from one manufactory in Fulham, the Vestry appointed a temporary Inspector to observe and report on the alleged nuisance. PIG KEEPING. Swine were found to be kept near Townmead Road in an unfit place, i.e., within 40 yards of a public place. Proceedings were taken and an order was made prohibiting the using of the premises for that purpose. FACTORIES. Frequent inspections were made of factories in the district concerning which complaints were made, and notices served in cases where any nuisance was observed. SUPERVISION OF NEW PROPERTY. The attention of the Vestry has more than once been called to the necessity for more supervision being exercised over new property. At present the drains of new houses are always very carefully tested, but frequently, owing to the time of the drainage Inspector being fully occupied, no inspection is made of the sanitary fittings, which subsequently are sometimes found not to have been constructed in accordance with the Bye-laws; and as the houses have generally changed hands, the new owner naturally feels aggrieved when called upon to make certain alterations, having purchased the house on the understanding that all the sanitary arrangements had been approved by the Local Authority. In some instances even houses have been found to be occupied in such an unfinished condition as to be quite unfit for human habitation. No newly-erected house should be permitted to be occupied until not merely the drains, but all the sanitary appliances have been inspected and approved, and the Vestry should at once increase their staff, so that this may be carried out. GENERAL SANITARY WORK. The subjoined Table gives a record of the work done during the year by your Sanitary Officials. It is unnecessary to detail the various improvements effected. In all cases when a house is inspected it is endeavoured to place it in every respect in a thoroughly sanitary condition. North South Walham Ward, Ward. Ward. Number of complaints received and attended to, excluding complaints of non-removal of dust ... 326 450 607 1383 Number of Dwelling Houses inspected - - - - 920 1094 670 2684 Miscellaneous Inspections - 360 | 320 430 1110 Number of Re-inspections - 3150 . 2914 1856 7920 Uotices issued for Sanitary amendments under Public Health Act: Intimations - - 675 1163 621 2459 Statutory Notices - 226 441 233 900 I have given a resume of the work done in the Sanitary Department during the year but cannot conclude without recording my opinion that the thanks of the Vestry are due to the Sanitary Inspectors and to the Clerk to the Sanitary Department for the zeal and discretion with which they have carried out the important duties devolving on them. I am, Gentlemen, Your obedient servant, J. CHARLES JACKSON, Feb, 22nd, 1895. Medical Officer of Health. Chart Shewing Week by Week the Number of Cases of Scarlet Fever, Diphtheria and Membranous Croup &Smallpox. JVolified- by Medical as having occurred un the PARISH of FuLHAM during the 52 Weeks ending December 29 th 1894. Blue Scarlet Fever. Red Diphiheria and Membranous Croup Black, Smallpox,. APPENDIX. Statistical Tables Tables A and B are prepared in according with the instrucations of the Local Govefrnment Board. (A.) Table of DEATH during the year 1894, in the Parish of FULHAM, classified according to Discases ages and localities. Mortility from all Causes, at subjected Ages, (A) Table of DEATH during the year 1894, in the parish of FULHAM, classified according to Diseases, Ages and Localities. Name of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. (Columns for pøpulations and Births are in Table B.) (g) 25 and under 65 3 5 6 (c) Under 1 year. (e) 5 and under 15 (f) 15 and under 25 (h) 65 and upwards. 1 2 4 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 (d) 1 and under 5 (b) At al Ages. Mem branous group Scarlatina. Fevers, Smallpox. Diphtheria ? and Dysentery Pneynønia and ? Heart Disease. Rheumatic Fever. Enteric ør Typhøid Cøntinued. Relapsing. Puerperal Erysipelas Whooping Cough All other Diseases. Total Typhus. Measles. ? Chølera ? Ague. (i) Under 5 5 upaward 20 5 3 130 51 46 10 163 5 12 311 756 ... ... ... Fulham 1878 485 171 58 48 849 177 ... ... ... ... .. ... ... 5 upward 9 4 2 12 3 6 102 123 35 25 275 622 ... ... ... ... ... 6 ... ... ... ... 17 under 5 ... 24 2 34 1 1 44 123 ... ... ... ... ... ... ... ... ... ... ... ... Fulham Union Infirmary 383 64 59 4 20 137 99 ... 5 upward ... 1 2 2 34 51 31 4 135 260 ... ... ... ... ... ... ... ... ... ... ... ... ... Fulham Workhouse Under 5 ... ... 1 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 4 12 2 ... ... ... 5 upward ... ... 1 1 1 1 10 14 .. .. ... ... ... ... ... ... ... ... ... ... ... ... 81 102 1 1 5 Under 5 ... ... 1 ... 4 195 wetern Fever Hospital 326 10 185 10 ... ... ... ... ... ... ... ... ... ... ... 105 15 1 ... 29 81 1 5 131 5 upwrds ... ... 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 68 48 ... ... 6 13 155 203 Under 5 122 11 362 1078 Totals 2105 563 515 162 78 518 279 81 ... 1 3 ... ... ... ... 5 upwrds ... 29 90 4 12 5 6 138 175 87 30 425 1027 ... 20 6 ... ... ... ... ... ... The subjouned number have also to be taken into account in judging of the above record of Motrtality. Deaths occuring outside the district among persons belonging thereto. 237 32 42 Under 5 5 upwrds. Under 5 5 upwrds. 1 2 ... ... 2 ... 58 19 20 22 107 14 19 6 75 59 ... ... ... ... ... ... ... ... ... 1 1 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 10 ... ... 10 ... 6 ... 2 ... ... ... ... ... ... ... ... ... ... 23 1 16 13 10 22 24 1 14 ... 23 4 17 1 8 25 90 19 80 74 163 199 246 76 445 55 Death occuring within the district among persons not belonging thereto. 36 163 20 95 (B) Table of POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health during the year 1894 in the FULHAM District; classified according to Diseases, Ages, and Localities. New Cases of Sicknenn in each locality coming to the knowledge of the Medical Officer of Health. Number of such Cases removed from their Homes in the Several localities or treatment in Isolation Hospital. Population at all Ages. (d) Registered Births. Names of Localities adopted for the purpose of these statistics; public institutions being shown as separate localities. 5 (e) Aged under 5 or over 5. 1 2 3 4 6 7 8 9 10 11 12 13 2 3 4 5 6 7 8 9 10 11 Estimated to middle of 1894. (C.) 1 Membranous Croup. Fevers. Fevers. Census, 1891. (b.) Membranous Crøup, Diphtheria. Typhoid. Enteric or Continued. Scarlatina. Diphtheria. Continued Relapsing Scarlatina. Relapsing. Puerperal. Eraysipelas Smallpox Enerie Typhoid, Puerperal. Erysipelas Smallpox. Typhus. Cholera. Typhus Chølera Under 5 1 171 124 11 1 11 1 128 96 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... FULHAM 91640 107880 3763 5 upwrds, 39 352 205 2 35 2 10 92 37 278 139 25 ... ... ... ... ... ... ... ... ... ... ... ... 2 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fulham Workhouse 6 ... ... ... 5 upwrds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 6 Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fulham Union Infirmary 1 2 5 upwrds, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 Totals 107880 1 177 91640 3763 124 11 1 13 1 134 96 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwrds. 39 352 2 36 10 25 205 2 100 37 278 139 ... ... ... ... ... ... ... (C) DEATHS REGISTERED FROM ALL CAUSES DURNG THE YEAR 1894. Note.—The deaths of Non-Residents occurring in Public Institutions are excluded, and the deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. Ages. Total under 5 85 and upwds. Total 1893 CAUSES OF DEATH. 0—1 1-5 5—15 15—25 25—35 35—45 45— 55 55—65 65—75 75—85 Total I. Specific Febrile or Zymotic Diseases 132 240 61 6 11 8 5 2 4 5 372 474 431 ... 1 II. Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... III. Dietetic Diseases 2 1 10 8 1 6 1 ... ... ... ... ... ... ... IV. Constitutional Diseases 53 32 17 36 36 62 56 31 26 6 1 85 356 348 V. Developmental Diseases 81 1 13 26 15 81 136 137 ... ... ... ... ... ... VI. Local Diseases 189 108 19 28 33 73 75 94 100 31 8 297 658 903 VII. Deaths from Violence 55 63 7 9 9 4 3 8 8 6 1 16 ... ... VIII. Deaths from ill defined and not specified ci causes 133 96 5 1 1 1 2 2 101 108 .. ... ... ... Totals 559 394 106 75 84 157 148 136 146 68 24 953 1897 2024 Ages. 85 & upwds. Total under 5 Total 1893 0—1 35—45 45—55 55—65 15—75 75—85 Total CAUSES OF DEATH. 1-5 5—15 15—25 25—35 I.—Specific Febrile or Zymotic Diseases. I. — Miasmatic Diseases. 1 3 3 1 1 1 Smallpox ... ... .. ... ... ... ... ... 148 160 12 Measles 37 111 12 ... ... ... ... ... ... ... ... 24 35 34 Scarlet Fever 3 21 11 ... ... ... ... ... ... ... ... 68 Typhus Fever ... ... ... ... ... 58 ... ... ... ... ... ... ... ... ... 29 29 58 81 Whooping Cough ... ... ... ... ... ... ... ... ... Diphtheria and Membranous Croup 70 108 65 6 64 36 1 1 ... ... ... ... ... ... Simple Continued and Illdefined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 1 5 16 Enteric and Typhoid Fever ... ... ... ... ... ... ... ... 3 3 1 3 3 13 39 Influenza ... ... ... ... ... ... ... 6 6 2 Other Miasmatic Diseases 1 5 ... ... ... ... ... ... ... ... ... 2. Diarrhæal Diseases. Cholera 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa Dysentery 45 7 1 1 2 1 52 57 133 ... ... ... ... ... 3. Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... .. ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Zoogenous Diseases. Cowpox and Effects of Vaccination 69 ... ... ... ... ... ... ... .. ... ... .. ... ... ... Oher Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Venereal Diseases. Syphilis 15 7 1 8 8 ... ... ... ... ... ... ... ... ... Gonorrhœa, Stricture of Urethra 2 2 1 1 ... ... ... ... ... ... ... ... ... ... 6. Septic Diseases. Erysipelas 3 1 1 1 3 6 11 ... ... ... ... ... ... ... Over 85 Total under 5 Total 1893 CAUSES OF DEATH. 0-5 1-5 5— 15 15-25 25-35 35-45 45-55 55—65 65—75 75-S5 Total Pyæmia, Septicæmia 1 1 1 1 3 2 7 3 ... ... ... ... ... ... 1 3 3 Puerperal Fever 7 12 ... ... ... ... ... ... ... ... ... II.- Parasitic Throat and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... .. ... ... ... ... ... 70 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... .. ... ... III.-Dietetic Diseases. Want of Breast Milk, Starvation 1 1 1 ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... .. ... Chronic Alcoholism 5 2 1 8 7 ... ... ... ... ... ... .. ... ... Delirium Tremens 1 1 1 ... ... ... ... ... ... ... ... ... ... ... IV.—Constitutional Diseases. 1 1 2 1 1 6 24 Rheumatic Fever ... ... ... ... ... ... ... 4 3 Rheumatism 1 1 1 1 ... ... ... ... ... ... ... ... 1 2 Gout 1 ... ... ... ... ... ... ... ... ... ... ... 12 12 10 Rickets 6 6 ... ... ... ... ... ... ... ... ... 1 13 30 17 17 4 1 1 84 65 Cancer, Malignant Disease 1 ... ... .. 13 1 14 14 18 Tabes Mesenterica ... ... ... ... ... ... ... ... ... Tubercular Meningitis, Hy drocephalus 18 25 25 71 8 10 6 1 ... ... ... ... ... ... ... 30 43 24 10 5 9 155 151 Phthisis 4 5 6 28 ... ... Other forms of Tuberculosis, Scrofula 42 41 4 2 2 30 37 20 10 ... ... ... ... ... Purpura, Hæemorrhagic Dia thesis 1 3 1 1 2 ... ... ... ... ... ... ... ... ... Anæamia, Chlorosis, Leucocythaemia 3 8 2 1 ... ... .. ... ... ... ... ... ... ... 1 4 1 1 7 4 Glycosuria, Diabetes Mellitus ... ... ... ... ... ... ... ... Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ages. CAUSES OF DEATH. 0-1 1—5 5-15 15—25 25-35 35—45 Over 85 Total under 5 Total 1893 45—55 55-65 65-75 75-85 Total V.—Developmental Diseases. Premature Birth 68 68 68 66 ... ... ... ... ... ... ... ... ... ... Atelectasis 6 10 ... ... ... ... 6 6 ... ... ... ... ... ... Congenital Malformations 7 ... 7 7 7 ... ... ... ... ... ... ... .. ... Old Age 1 13 26 15 55 54 ... ... ... ... ... ... ... ... 72 VI.-Local I. — Diseases of Nervous System. Inflammation of Brain or Membranes Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis Insanity, General Paralysis of the Insane Epilepsy 8 11 2 2 2 19 25 24 ... ... ... ... ... ... 6 9 13 19 8 55 72 ... ... .. ... ... ... ... 1 4 7 2 2 ... ... ... ... 16 19 ... ... ... 1 2 4 2 2 ... ... ... 11 10 ... ... ... ... Convulsions 18 2 20 20 42 ... ... ... ... ... ... ... ... ... Laryngismus Stridulus (Spasm of Glottis) 1 1 1 3 ... ... ... ... ... ... ... ... ... ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans 1 1 1 1 3 7 7 ... ... ... .. ... .. ... Other Diseases of the Nervous System 2 1 1 4 3 ... ... ... ... ... ... ... .. ... 2. Diseases of Organs of Special Sense— e.g., of Ear, Eye, Nose 3 3 4 1 ... 73 ... ... ... ... ... ... ... ... ... 3. Diseases of the Circulatory System— Pericarditis 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Endocarditis 2 1 .. 1 ... ... ... ... ... .. ... ... ... ... Valvular Diseases of Heart 2 4 3 8 2 4 2 23 35 ... ... ... ... ... 1 Other Diseases of Heart 1 2 2 3 5 8 7 14 16 1 3 60 73 Aneurism 3 4 1 8 4 ... ... ... ... ... ... ... ... ... Embolism, Thrombosis 1 1 2 ... ... ... ... ... ... ... ... ... ... ... Ages. Over 85 Total under 5 CAUSES OF DEATH. 0—1 1—5 5-15 15-25 25—35 35—45 45 —55 55—65 65 —75 75- 85 Total. Total. Other Diseases of Blood Vessels 3 1 1 1 ... ... ... ... ... ... 3 ... ... ... 4. Diseases of the Respiratory System— Laryngitis 3 4 7 7 6 ... ... ... ... ... ... ... ... ... Emphysema, Asthma 2 1 3 7 ... ... ... ... ... ... ... ... ... ... 74 Bronchitis 66 36 1 6 16 22 31 13 3 102 194 218 ... ... Pneumonia 53 39 5 4 2 12 12 18 3 1 92 149 152 ... Pleurisy 1 1 1 1 3 3 1 2 ... ... 11 13 ... ... Other Diseases of the Respiratory System 1 2 1 1 4 10 ... ... ... ... ... ... ... ... 5. Diseases of the Digestive System— Dentition 5 4 9 9 11 ... ... ... ... ... ... ... ... ... 1 Sore Throat, Quinsy Diseases of Stomach ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 1 4 12 ... ... ... ... ... ... ... Enteritis 21 3 2 24 26 40 ... ... ... ... ... ... ... ... Obstructive Diseases of Intestines 1 2 13 12 2 1 1 1 2 3 2 ... ... ... 4 1 1 2 3 1 1 3 2 5 18 9 Peritonitis ... ... Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 Cirrhosis of Liver 3 5 2 3 13 ... ... ... ... ... ... ... ... 75 Jaundice and other Diseases of Liver ... 5 12 1 ... 1 2 1 1 ... ... ... ... ... Other Diseases of Digestive System 1 2 1 1 1 1 ... 1 7 8 ... ... ... ... 6. Diseases of Lymphatic System, eg., of Lymphatics and of Spleen 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... 7. Diseases of Gland-like Organs of uncertain use, eg., Broncholele Addison's Disease, 1 1 3 Ages. CAUSES OF DEATH. Over 85 Total under 5 0—1 1-5 5 —15 15—25 25—35 35—45 45—55 55 — 65 65-75 75—85 Total 8. Diseases of the Urinary System— Nephritis 1 1 1 2 2 ... ... 1 8 ... ... ... ... Bright's Disease, Albuminuria 1 1 4 4 7 3 1 ... ... ... 1 21 ... Disease of Bladder or Prostate 2 2 2 1 7 ... ... ... ... ... ... ... ... Other Diseases of Urinary System .. ... ... ... ... ... ... ... ... ... ... ... ... 9. Diseases of Reproductive System — (a) Of Organs of Generation— Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs 2 3 ... ... ... ... ... ... ... 5 ... ... ... (b) Of Parturition— Abortion, Miscarriage 1 .. ... ... 1 ... ... ... ... ... ... ... .. Puerperal Convulsions 2 ... ... ... ... ... 2 ... ... ... ... ... ... Placenta Praevia, Flooding... 1 1 4 ... ... ... ... ... ... .. ... ... ... ... Other Accidents of Childbirth 2 2 4 3 ... ... ... ... ... ... ... ... ... ... 10. Diseases of Joints and Bones Caries, Necrosis 1 4 1 ... ... ... ... ... ... ... ... ... ... ... 2 Arthritis, Ostitis, Periostitis 1 1 2 1 ... ... ... ... ... ... ... ... ... Other Diseases of Joints and Bones ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Diseases of the Integumentary System— Carbuncle, Phlegmon 1 ... 1 2 ... ... ... ... ... ... ... ... ... ... Other Diseases of Integumentary System ... 1 1 2 3 ... ... ... ... ... ... ... ... ... Vll.—Deaths from Violence. I. Accident or Negligence— Fractures and Contusions 6 4 4 3 3 7 23 24 1 1 1 ... ... ... Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... Age. Over 85 Total under 5 Total 1893 CAUSES OF DEATH. 0-1 1-5 5—15 5-25 25—35 35—45 45— 55 55—65 65—75 75—85 Total Burns or Scalds 3 1 1 1 1 3 7 6 ... ... ... ... ... ... Poison 1 1 3 ... ... ... ... ... ... ... ... ... ... ... Drowning 3 1 2 1 7 5 ... ... ... ... ... ... ... ... Suffocation 5 1 1 5 7 13 ... ... ... ... ... ... ... ... Otherwise 1 1 3 ... ... ... ... ... ... ... ... ... ... ... 2. Homicide — Manslaughter 78 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Murder 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 3. Suicide— Gunshot Wounds ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Poison 1 1 ... 1 1 4 6 ... ... ... ... ... ... ... Drowning 1 1 2 ... ... ... ... ... ... ... ... ... ... ... Hanging ... 1 1 ... ... ... .. ... ... ... ... ... ... ... 1 1 Otherwise ... ... ... ... .. ... ... ... ... ... ... ... VIII. Deaths from III-defined and not specified Causes — Dropsy 1 8 1 ... ... ... ... ... ... ... ... ... ... ... 94 95 113 Debility, Atrophy, Inanition 90 4 1 .. ... ... ... ... ... ... ... Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour 1 1 3 ... ... ... ... ... ... ... ... ... ... ... 79 1 5 2 1 1 3 Abscess ... ... ... ... ... ... ... ... 2 3 2 Hæmorrhage 2 1 ... ... ... ... ... ... ... ... ... Sudden death, cause not ascertained 1 1 2 1 ... ... ... ... ... ... ... ... ... ... Cause not specified or ill-de fined 2 2 2 8 ... ... ... ... ... ... ... ... ... ... 68 953 1897 2024 559 394 106 75 84 157 146 115 136 24 Totals (D) Summary of Table C, showing number of Deaths of Parishioners in each Class and Order. I. SPECIFIC FEBRILE OR ZYMOTIC DISEASES— 1. Miasmatic Diseases 388 2. Diarrhœl 57 3. Malarial - 4. Zoogenous - 5. Venereal 10 6. Septic 20 II. PARASITIC DISEASES - III. DIETETIC DISEASES 10 IV. CONSTITUTIONAL DISEASES 356 V. DEVELOPMENTAL DISEASES 136 VI. LOCAL DISEASES— 1. Diseases of Nervous System 139 2. Diseases of Organs of Special Sense 3 3. Diseases of Circulatory System 96 4. Diseases of Respiratory System 368 5. Diseases of Digestive System 95 6. Diseases of Lymphatic System 1 7. Diseases of Glandlike Organs of uncertain use 1 8. Diseases of Urinary System 36 9. Diseases of Reproductive System— a. Diseases of Organs of Generation 5 b. Diseases of Parturition 8 10. Diseases of Locomotive System 3 11. Diseases of Integumentary System 3 VII. VIOLENCE— 1. Accident or Negligence 46 2. Suicide 8 3. Homicide 1 VIII. ILL-DEFINED AND NOT SPECIFIED CAUSES 108 Total 1897 (E) Showing the number of Deaths at All Ages in 1894 from certain Groups of Diseases, and proportions to 1000 of Population, and to 1000 Deaths from all causes. Deaths per 1000 of population at all ages. Deaths per 1000 of Total Deaths at all ages. Total Deaths. 1. Principal Zymotic Diseases 3.9 230 426 2. Pulmonary Diseases 368 3.4 193 3. Tubercular Diseases 236 2.2 124 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria and Membranous Croup, Whooping Cough, Typhus, Enteric and Simple Continued Fevers and Diarrhoea. 3. Includes Phthisis, Scrofula, Tuberculosis, Tabes and Tubercular Meningitis. (F) INFANTILE MORTALITY IN FULHAM. Table showing the number of deaths of Infants under One Year from certain diseases, and the proportion to 1000 births and to 1000 deaths from all causes under One Year. Deaths per 1000 of Total Deaths under one year. Total Deaths. Deaths per 1000 Births. 66.2 Measles 37 9.8 29 7.7 51.8 (c) Whooping Cough a Other Common Infectious Diseases 9 2.4 16.0 11.9 80.0 Diarrhœa 45 11.9 80.0 b Tubercular Diseases 45 4.8 32.0 Convulsions 18 14.2 c Other Nervous Diseases 8 2.1 Lung Diseases (not Phthisis) 120 31.9 213.0 282.6 d Wasting Diseases 158 41.9 Found Dead in Bed 0.9 5 1.3 a These are Small-pox, Scarlet Fever, Diphtheria, Membranous Croup and Enteric Fever. b These are Phthisis, Tubercular Meningitis, Tabes Mesenterica and General Tuberculosis. c These are Meningitis and other Diseases of Brain and Spinal Cord. d These are Premature Birth, and such ill-defined causes as Atrophy Marasmus, Debility, Inanition, &cr Showing the deaths from the principal Zymotic diseases since 1886, when Fulham was separated from Hammersmith. Proportion of deaths to 1000 deaths in 8 year, 1887—1893 Annual Average for 8 years. Proportion of deaths to 1000 deaths in 1894. Deaths in 1894. 1886 1887 1888 1889 1890 1891 1892 1893 1.6 Smallpox 3 1 3 .5 .3 ... ... ... ... ... ... 79 Measles 57 70 52 125 27 128 12 69 39 160 84 Scarlet Fever 40 30 14 23 32 8 29 34 26 15.5 35 18 Diphtheria 12 19 10 12 22 31 31 65 25 15 108 57 Whooping Cough 50 30 67 68 69 30 65 81 57 33 58 30 Enteric Fever 13 16 11 6 19 8 2 16 11 7 5 2.6 Typhus Fever 1 ... ... ... ... ... ... ... ... ... ... ... Simple Continued Fever 1 .. ... ... ... ... ... ... ... ... ... ... 30 Diarrhœa 81 95 77 82 112 107 93 133 97 57 57 Showing the number of cases of Infectious Diseases notified to the several Metropolitan Medical Officers of Health during the year 1894. Estimated population in the middle of 1894. Diphtheria, Membranous Croup. Annual rate per 1000 persons living. Other continued fevers. Puerperal fever. Scarlet-fever. Typhus fever. Enteric fever. Sanitary Areas. Small-pox. Erysipelas. Cholera. Total. West Districts. ... Fulham 107880 40 529 342 37 2 10 113 ... 1073 9.9 ... Paddington 121583 28 288 383 ... 71 3 5 123 901 7.4 87 8 971 Kensington 167350 17 385 279 1 8 186 5.8 ... Hammersmith 105696 10 330 189 54 4 5 95 687 6.5 ... ... ... Chelsea 99052 14 318 251 1 92 1 10 142 829 8.4 ... St. George, Hanover Square 75033 11 257 106 66 4 1 52 ... 497 6.6 ... 302 Westminster 54414 1 148 73 ... 46 1 ... 33 5.6 ... St. James, Westminster 23571 59 38 24 2 1 23 150 6.4 3 ... Sanitary Areas. Diphtheria, Membranous Croup. Annual rate per 1000 persons living. Estimated population in the middle of 1894. Total. Other continued fevers. Puerperal fever. Typhus fever. Enteric fever. Scarlet fever. Small-pox, Erysipelas. Cholera. North Districts. Marylebone 138554 1584 308 560 287 1 151 6 10 261 11.5 ... 6.2 Hampstead 75443 18 232 99 49 1 5 66 470 ... ... 85 St. Pancras 233739 97 1274 511 1 200 2 12 468 1 2566 11.0 Islington 331900 84 1512 882 1 267 7 24 410 3187 9.6 ... Stoke Newington 23 34172 3 92 54 16 1 189 5.5 ... ... ... Hackney 211493 36 1030 581 195 9 14 2130 10.1 265 ... ... Central Districts. 6.2 St. Giles 38144 7 87 43 1 34 63 235 ... ... ... St. Martin-in-the-Fields 13783 1 21 17 15 1 15 70 5.1 ... ... ... Annual rate per 1000 persons living. Estimated population in the middle of 1894. Diphtheria, Membranous Croup, Other continued fevers. Puerperal fever. Typhus fever. Enteric fever. Scarlet fever. Sanitary Areas. Small-pox. Erysipelas. Cholera. Total. Central Districts continued. Strand 23179 5 56 29 15 1 11 117 5.1 ... ... ... Holborn 32438 8 80 29 72 77 266 82 ... ... ... ... Clerkenwell 65312 7 223 162 66 2 4 101 565 8.7 ... ... 86 St. Luke 41168 16 124 64 15 1 95 315 7.7 ... ... ... City of London 34832 1 80 43 81 1 42 198 5.7 ... ... ... East Districts. Shoreditch 123186 29 486 302 80 3 5 198 1103 9.0 ... ... Bethnal Green 129840 85 512 559 2 146 7 8 262 1 1 582 12.2 Whitechapel 75498 11 269 181 36 7 99 603 8.0 .. ... ... St. George-in-the-East 45360 5 219 206 62 1 3 72 568 12.6 ... ... 57000 9 376 194 45 2 3 83 Limehouse 712 12.5 ... ... Diphtheria, Membranous Croup. Annual rate per 1000 persons living. Estimated population in the middle of 1894. Cholera. Other continued fevers. Puerperal fever. Scarlet fever. Typhus fever. Enteric fever. Sanitary Areas. Small-pox. Erysipelas. Total. East Districts continued. Mile End Old Town 108242 45 578 347 79 4 163 1216 11.3 ... ... ... Poplar 170217 113 799 692 212 12 8 361 2197 12.9 ... ... 87 South Districts. St. Saviour, Southwark 26712 2 103 90 8 1 34 238 8.9 ... ... ... St. George, Southwark 60060 7 287 185 29 1 75 1 585 9.8 ... ... Newington 118512 12984 15 549 325 86 6 174 1155 9.8 ... ... ... St. Olave, Southwark 34 28 6 17 85 6.6 ... ... ... ... ... Bermondsey 84053 8 391 268 2 51 1 1 94 816 9.7 ... Rotherhithe 40365 7 330 150 3 25 6 2 116 639 15.9 ... Diphtheria, Membranous Croup Annual rate per 1000 persons living. Estimated population in the middle of 1894. Other continued fevers. Puerperal fever. Scarlet fever. Typhus fever. Enteric fever. Sanitary Areas. Small-pox. Erysipelas. Cholera. Total. South Districts continued. Lambeth 282574 26 1173 624 3 257 50 16 307 13 2469 8.8 Battersea 161558 12 834 505 136 4 13 299 2 1805 11.2 Wandsworth 179518 3 674 354 131 12 20 247 1 1442 8.1 ... Camberwell 248893 16 933 2 127 1 16 328 718 2141 8.6 ... Greenwich 173128 25 1053 578 164 3 17 257 2097 12.1 ... ... Lewisham (excluding Penge) 79903 7 258 153 46 3 9 106 582 7.3 ... ... Woolwich 42309 14 238 49 1 13 1 3 32 351 8.3 ... Lee 38172 9 180 46 2 24 25 1 287 7.5 ... ... Plumstead 59233 22 461 23 1 1 63 1 120 692 11.7 ... Port of London 7 18 5 13 2 45 ... ... ... ... ... ... Comparative Analysis of the mortality in London, the Western Districts and Fulham during the year 1894. Deaths per 1,000 living from Deaths under 1 year per 1,000 births. Whooping Cough. Enteric Fever. Diphtheria. All Causes. Scarlatina. Diarrhœa. Phthisis. Zymotic Diseases. Small-pox. Measles. 143 London 17.4 2.6 .02 .75 .22 .61 .48 .14 .41 1.69 Six Western Districts 1.57 144 16.0 2.1 .008 .62 .13 .48 .39 .15 .33 Fulham 17.6 3.9 .03 1.5 .32 1.0 .55 .05 .54 1.4 149 The Western Districts comprise Chelsea, Hammersmith, Kensington, Paddington, St. George's, Hanover Square and Westminster. Giving the meteorological conditions of each week of the year ending December 29th, 1894, together with the number of deaths from certain diseases and at certain ages. Highest Temperature. Lowest Temperature. Mean height of Barometer. Rainfall— in inches. Sunshine— in hours. Prevailing Wind. Total Deaths. Deaths under 1 year. Deaths over 60. Deaths from Respiratory Diseases. Deaths from Phthisis. Deaths from Zymotic Diseases excluding Diarrhœa. Deaths from Diarrhœa. Deaths from Influenza. Week Ending Mean Temperature. 26.5 37.7 12.8 29.98 0.56 3.4 S.W., N.E.& E. 42 11 12 5 5 1 1 7 Jan. 6th „ 13th 37.5 24.5 29.76 0.43 7.0 S.E. & S. 50 13 18 17 5 4 1 2 52.1 „ 20th 51.0 44.0 29.58 0.86 9.2 S.W. 36 8 2 13 3 7 1 ... 45.0 90 41.6 52.2 25.3 0.71 10.0 S.W. & N.W. 35 10 5 10 2 2 ... 1 „ 27th 29.65 42.0 32.2 29.67 0.69 18.5 S.W. 28 8 4 5 2 7 2 Feb. 3rd 52.0 1 „ 10th 46.0 55.1 35.7 29.93 0.27 6.9 S.W. 31 10 5 10 2 4 1 1 „ 17th 54.3 29.78 0.60 8.1 S.W., N.W. & S.E. 38 14 5 7 5 5 1 1 30.3 41.0 „ 24th 34.3 49.1 30.05 0.21 38 N.E. & S.W. 42 8 8 11 6 4 ... 1 24.4 Mar. 3rd 44.0 55.9 29.75 0.45 15.6 S.W. 34 9 5 15 3 5 ... ... 31.5 „ 10th 44.2 55.3 29.64 0.19 14.4 S.W. & N.W. 45 12 10 10 6 6 .. 1 30.4 25.4 1 ... 17th 42.6 56.5 30.2 20.49 041 Variable 42 12 4 10 2 15 Mar. 24th 45.5 57.0 37.8 30.15 0.00 20.6 E.N.E. 45 11 5 12 3 11 1 ... „ 31st 48.2 68.0 29.4 0.00 60.5 E.N.E. & E. 64 20 8 7 4 23 ... 1 29.88 50.6 690 39.1 29.82 36.9 E.N.E. 49 15 6 12 2 14 ... ... April 7th 0.01 „ 14th 55.2 75.8 39.4 29.70 0 06 37.7 Variable 50 13 3 11 2 17 ... ... 48.7 63.0 37.9 29.63 0.26 18.6 63 15 7 12 2 26 ... ... 21st Variable „ 28th 49.5 62.0 34.3 29.58 0.98 27.7 S.E. & S.W. 41 9 1 2 14 ... ... 12 May . 5th 48.8 62.5 36.4 29.85 14.0 S.W. & N.W. 51 12 6 9 2 18 ... ... 0.18 51.0 64.7 39.6 0.44 23.8 S.W. 33 8 6 4 3 13 ... ... „ 12th 29.70 91 „ 19th 54.5 70.0 382 0.09 36.5 Variable 42 13 11 1 10 ... ... 29.87 5 48.2 70.4 32.3 29.84 0.42 N.E. & N.W. 39 13 4 5 3 10 1 ... „ 26th 39.9 June 2nd 50.1 65.0 38.1 29.55 0.67 30.5 31 14 1 2 9 1 S.W. 8 ... 9th 56.1 46.3 29.68 1.07 8.9 26 3 5 5 1 7 1 68.1 Variable ... „ 16th 56.3 740 45.1 29.80 0.46 15.7 S.W. & N.W. 40 9 6 4 4 11 ... ... 75.4 47.9 0.32 29.0 32 12 3 4 3 1 ... „ 23rd 58.9 29.84 S.W. 8 „ 30th 63.8 82.1 48.5 3007 0.00 67.5 36 6 6 4 8 ... ... S.W. & N.E. 2 Deaths from Zymotic Dis eases excluding Diarrhœa. Week Ending Mean Temperature. Highest Temperature. Mean height of Barometer. Rainfall— in inches. Sunshine— in hours. Prevailing Winds. Total Deaths. Deaths under 1 year. Deaths from Respiratory Diseases. Deaths from Phthisis. Deaths from Diarrhoea. Deaths over 60. Deaths trom Influenza Lowest Temperature. July 7th 66.0 86.0 51.9 29.94 0.19 53.6 Variable 28 3 10 3 1 5 ... ... 59.2 74.0 49.0 29.47 2.27 39.9 S.W. 34 10 5 7 5 2 ... „ 14th ... „ 21st 59.1 50.4 29.66 0.30 16.6 27 11 5 3 2 3 4 S.W. 72.0 ... 62.8 51.8 29.78 33.9 Variable 38 15 4 5 5 ... 8 3 79.4 0.39 „ 28th 92 62.1 78.0 52.1 0.19 S.W. 33 9 6 1 4 4 4 Aug. 4th 29.66 18.6 ... 38 21 1 3 2 4 7 ... „ 11th 60.4 74.1 51.9 29.72 0.52 19.9 S.W. 1 3 8 59.2 30.5 29.72 0.94 30.7 S.W. & N.W. 33 15 2 4 „ 18th 45.2 ... 24 2 2 3 6 25th 57.4 73.2 44.2 29.76 1.50 14.0 S.W. & N.E. 12 2 ... 33 10 3 5 5 6 2 Sept. 1st 60.8 79.0 47.5 29.96 0.00 28.6 Variable ... 8th 52.7 40.4 29.85 0.54 17.6 N.E.,N.W.& S.W. 33 13 5 5 3 4 5 68.9 ... 27 13 6 2 3 „ 15th 54.8 66.8 44.1 0.02 17.2 N.W. & N.E. 2 2 30.16 .. 55.9 68.2 49.1 29.93 0.11 N.E. 25 9 4 1 3 1 „ 22nd 3.0 3 ... Sept. 29th 52.5 41.4 29.81 14.7 E. & N. 36 11 6 6 3 ... 66.3 0.59 4 ... Oct. 6th 52.8 62.0 42.5 0.12 13.9 26 7 4 4 2 ... 30.05 N.E. 3 ... „ 13th 53.0 62.0 44.6 29.99 0.66 1.7 Variable 21 5 3 5 ... ... 2 2 „ 20th 44.3 56.0 30.5 29.71 0.19 7.3 N.W. & N.E. 33 10 7 7 1 7 2 ... „ 27th 61.2 35.0 29.33 1.35 9.3 S.W. 34 14 5 9 5 2 ... 50.3 ... Nov. 3rd 64.9 45.7 29.66 2.16 11.8 S.W. 34 14 5 ... 4 2 ... 54.0 6 „ 10th 50.3 59.5 40.5 29.63 0.64 22.8 32 8 7 2 2 ... ... S.W. & S. 5 „ 17th 47.0 55.5 41.8 29.38 2.03 20.4 S.W. & S.E. 23 8 ... 2 2 ... ... 5 93 „ 24th 44.0 56.0 31.1 30.12 0.13 15.6 Variable 35 6 7 6 3 6 ... ... Dec. 1st 40.3 31.5 30.21 0.00 2.7 N.E. & N.W. 40 9 6 9 3 6 ... 47.8 ... 39.8 48.6 30.3 29.80 0.17 4.4 41 16 8 10 5 9 ... ... 8th N.E. & S.W. „ 15th 45.4 52.9 31.9 0.97 4.4 38 4 7 8 5 ... 29.94 S.E. & S.W. 3 1 „ 22nd 43.9 51.6 31.8 29.66 0.59 3.0 S.W. 42 11 11 10 2 6 ... ... „ 29th 43.0 50.0 38.6 30.06 0.22 1.7 S.W. & N.W. 24 7 4 5 5 5 ... ... (K) Showing the localities in which cases of Notifiable Infectious Diseases and Deaths from Measles and Diarrhoea occurred during the year. The asterisks denote fatal cases of the Notifiable Diseases. Diphtheria Membranous Croup Small-pox Enteric fever Continued fever Puerperal fever Cholera Erysipelas Deaths from Measles Deaths from Diarrhœa Scarlet Fever Ackmar road 1 .. ... ... ... ... ... ... ... ... ... Adeney road 4 1 ... ... ... ... ... ... ... 1 2 Aintree street 2 2* ... ... ... ... ... ... ... ... ... Alderville road 2 1 ... ... 1* ... ... ... ... ... ... 8* 2 5 ... ... ... ... 1 4 1 Ancill street ... Anselm road 1 ... ... ... ... ... ... ... ... ... ... Archel road 3 1 ... ... ... ... ... ... 1 2 ... Armadale road 4 ... ... ... ... ... ... ... ... ... ... Ashington road ... 1 2 ... ... ... ... ... ... ... ... Aspenlea road 3* 2* ... 1 ... ... ... ... 2* 1 ... Aston terrace 1 ... ... ... ... ... ... ... ... ... ... Auriol road 1 ... ... ... 1 ... ... ... ... ... ... Avalon road 5 ... .. ... ... ... ... ... ... ... ... Averill street 7* ... ... ... ... ... ... ... ... 1 ... Avonmore road 1 ... ... ... 1 ... ... ... ... ... ... Bagley's lane ... 1 25 ... ... ... ... ... ... ... ... Barclay road ... 1 ... ... ... ... ... ... ... .. ... Enteric fever Continued fever Puerperal fever Cholera Erysipelas Deaths from Measles Scarlet fever Diphtheria Membranous Croup Small-pox Baron's Court road 1 1 ... ... ... ... ... ... 2 ... ... Barton street ... ... ... ... ... ... ... ... ... ... Basuto road 4 ... ... ... ... ... ... ... 1 ... Bayonne road 6 2 ... 2 ... ... ... ... ... 3 Beaufort mews 1 ... ... ... ... ... ... ... 1 2 Beryl road 6 ... 1* ... ... ... ... ... 1 1 Betteridge road ... ... ... ... ... ... .. ... ... 1 Biscay road 10 ... ... ... ... ... ... ... ... ... ... Bishop's road 1* 1 ... ... 1* ... ... ... ... 1 ... Blake road ... ... ... ... ... ... ... ... ... ... Bloom Park road 1 ... ... ... ... .. ... ... ... ... ... Bovingdon road ... 2 ... ... ... ... ... ... ... ... ... Bothwell street 2 ... ... ... ... ... ... ... ... ... ... Bramber road 2* 2** ... ... ... ... ... ... ... 2 Brecon road 1 ... ... ... ... ... .. ... ... 3 ... Breer street ... 1 ... ... ... ... ... ... ... ... Britannia road 1 ... 1 ... 1 ... ... ... ... 1 Brookville road 5 ... ... ... ... ... ... ... ... ... Broughton road 4* 5* ... ... ... ... 1* ... 3* ... .. Broxholme road ... ... ... ... 1 ... ... ... 1* 2 ... Bulow road ... 1* ... ... ... ... ... ... 1 ... Burnthwaite road 6 4* ... ... 1 1 ... ... ... 1 Cambria street 1 ... ... ... ... ... ... ... ... 1 Campbell street ... ... ... 3 1 ... ... ... ... ... ... Campana road 4 7** ... ... ... ... ... ... 1 1 Carlton mews ... 2* ... ... ... ... ... ... ... ... ... 1 2 Caroline place ... ... ... ... ... ... ... ... Scarlet fever Diphtheria Membranous Croup Small-pox Enteric fever Continued fever Puerperal fever Cholera Erysipelas Deaths from Measles Deaths from Diarrhœa Cassidy road 2 3 ... ... 1 ... ... ... ... .. ... Castletown road ... ... ... ... ... ... ... ... ... ... ... Cedar road ... 4*** ... ... ... ... ... ... ... ... ... Charleville road ... 1* ... ... ... ... ... ... ... ... ... Chelmsford street 2 ... ... 1 ... ... ... ... ... ... ... 2 1* ... ... 1 ... ... ... ... 2 1 Chesson road Chaldon road 2* ... ... ... ... ... ... ... ... ... 2 Church row .. 1* ... ... 1 ... ... ... ... ... ... Church path 5 ... 2 ... 1* ... ... ... ... ... ... Claxton grove 2* 2 1 1 3 ... ... ... ... ... ... Claybrook road 4* 1* ... 1 2 ... ... ... 2 ... 1 Clenstone terrace 1* ... ... ... ... ... ... ... ... ... ... Comeragh road 1 ... ... 1 1 ... ... ... ... ... ... 1 ... ... Coniger road 8* ... ... ... ... ... ... ... Coomer road 2 1 6 3* ... ... ... ... ... ... 1 Cornwall street ... 1 ... ... ... ... ... ... 1 ... ... Crab Tree lane ... 2 ... .. ... ... ... ... 1 ... ... Cranbury road 6* 5* ... ... ... ... ... ... ... 2 1 1 ... .. 3 ... Crefeld road 1 1 ... ... ... ... Cresford road ... ... ... ... ... ... ... ... 1 ... ... Cristowe road 2* ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Crown street Dalebury road 1 ... ... ... ... ... ... ... ... ... ... Dancer road 1 ... ... ... ... ... ... ... ... ... ... Darlan road 2 2** ... ... ... ... ... ... ... ... ... Dawes road 4 4**** ... ... ... ... .. ... 1 ... 1 Dawson street ... ... ... ... ... ... ... ... ... 1 ... Scarlet fever Diphtheria Membranous Croup Small-pox Enteric fever Continued fever Puerperal fever Cholera Erysipelas Deaths from Measles 1 3* 1 ... ... ... ... ... 1 1 ... Delaford street Delorme street 3 1 ... ... ... ... ... ... ... ... Delvino road 3 ... ... ... ... ... ... ... .. .. ... Devonshire street ... ... ... ... ... ... ... ... ... 1 ... Dieppe street ... 1 ... ... ... ... ... ... ... ... 1 Dimsdale road 1 2 ... ... ... ... ... ... ... .. ... Disbrowe road 4 ... ... ... ... ... ... ... 1 .. ... ... Doria road ... 1* ... ... ... ... ... ... ... ... Dorncliffe road ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... 1 ... ... ... 1 1 ... Dymock street ... Ediscombe road 1 ... ... ... ... ... ... ... ... ... ... Edith road 3 ... ... ... ... ... ... ... ... ... . Edith row 1 ... ... ... ... ... ... ... ... ... ... Edith villas 2 ... ... ... ... ... ... ... ... ... ... Eelbrook terrace 1* ... ... ... ... ... ... ... ... ... ... Epirus road ... 1* ... ... ... ... ... ... 1 ... ... Epple road ... ... ... ... ... ... 1* ... ... ... ... Estcourt road 16** 13** 1 ... ... ... ... ... 3 4 1 Eustace road 1 ... ... ... ... ... ... ... ... ... ... Everington street 1 1 ... ... ... ... 1 ... ... 1 ... Ewald road .. ... ... ... ... ... ... ... 1 1 1 Fabian road 2 1 ... ... ... ... ... ... ... 1 ... Factory lane ... 2* ... ... ... ... ... ... ... 1 ... Fane street ... ... ... ... 1 ... ... ... ... ... ... 4 1 ... ... ... ... ... ... ... ... 1 Farm lane Favart road ... 1 ... ... ... ... ... ... ... ... ... Scarlet fever Diphtheria Membranous Croup Small-pox Enteric fever Continued fever Puerperal fever Cholera Erysipelas Deaths from Measles Deaths from Diarrhœa Fernhurst road 1 1 ... ... ... ... ... ... ... ... ... 1 1 1 Field road ... ... ... ... ... ... ... ... Filmer road 5 ... ... ... ... ... ... ... ... ... ... Foskett road 1 ... ... ... ... ... ... ... ... ... ... Francis street 1 ... ... ... ... ... ... ... ... ... ... 1* ... ... ... 1* ... 2 ... 1 Fulham Palace road 7 3*** Fulham Park road 1 ... ... ... ... ... ... ... ... ... ... Fulham road 8 4** 1 ... 1 ... ... ... 2 1 ... Furness road 2 5*** ... ... ... ... ... ... ... ... ... Garden row ... 7** ... ... ... ... ... ... 1 1 ... Garvan road 1 8**** ... ... ... ... ... ... ... 4 1 Gastein road ... 1 ... ... ... ... ... ... ... 1 ... Gilstead road ... 2 ... ... ... ... ... ... ... 1 .. Gironde road 2 ... ... ... ... ... ... ... ... ... ... Glazbury road 2 ... ... ... ... ... ... ... ... ... ... Gledstanes road 1 ... ... ... .. ... ... ... ... ... ... Gowan avenue 1 1* ... ... ... ... ... ... ... ... ... Greyhound road ... 2* ... 7 ... ... ... ... 1 3 ... Grimston road 1 1 1* ... ... ... ... ... ... ... ... Goldings buildings ... ... ... ... ... ... ... ... ... 1 ... Grove avenue 2 ... ... ... ... ... ... ... 1 1 ... Grove terrace 2 ... ... ... ... .. ... ... ... 2 ... Gwendyr road ... ... ... ... ... 1 ... ... ... ... ... Haldane road 1* 1 ... ... ... ... ... ... 1 ... ... Halford road 9 1* ... ... ... ... ... ... 1 1 ... Hammersmith road 4 ... ... ... 1 ... ... ... 1 ... ... Scarlet Fever Diphtheria Membranous Croup Small-pox Continued fever Puerperal fever Erysipelas Deaths from Measles Enteric fever Cholera Hannell road 2* 3** 2 ... ... 1* 1 2 ... ... Hartismere road 2 3 ... ... ... ... ... ... ... 2 Hartopp avenue ... .. ... ... ... ... ... ... ... ... Harwood road 3 2 ... ... ... ... ... ... 2 ... Harwood terrace ... 1 ... ... ... ... ... ... 1 1 1* ... ... ... ... ... ... ... ... Hatfield street 1 Hazlebury road 7 6** ... ... ... ... 1* ... ... 1 High street 5 ... ... ... ... ... ... ... ... ... Hilmer street 2 ... ... ... ... ... ... ... ... 1 Homestead road 4 2 ... ... ... ... ... ... ... ... Horder road 1 1 ... ... ... ... ... ... ... ... Hugon road ... 3* ... ... ... ... ... ... ... ... Humbolt road 2 ... ... ... ... ... ... ... 1 2 Hurlingham road 1 ... ... ... 1 ... ... ... ... ... Imperial cottages 4 ... ... ... ... ... ... ... ... 1 Irene road... 1 3 ... ... ... ... ... ... ... ... Jerdan place ... ... ... ... ... ... ... ... 1 ... Jervis road 1 ... ... ... ... ... ... ... ... ... John street 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Kempson road 1 ... Kenneth road ... 3 ... ... ... ... ... ... ... ... Kilmaine road 3 2 ... ... ... ... ... ... ... 1 King's road 16* 2 ... ... ... ... 1* ... 2 1 Kingwood road 4 ... ... ... ... ... ... ... 1 ... 5 1* ... 1 ... ... ... ... 2 Kinnoul road 3 Knivet road 1 ... ... ... ... ... ... ... ... ... Scarlet fever Diphtheria Membranous Croup Small-pox Enteric fever Continued fever Puerperal fever Cholera Erysipelas Deaths from Measles Deaths from Diarrhœa Lalor street ... ... ... 1 ... ... ... ... ... ... ... Langford road 2 12*** ... 4** ... ... ... ... 2* 2 ... Lanfrey place ... ... ... ... ... ... ... ... ... 1 ... Laundry road 6 ... ... ... ... ... ... ... ... 2 ... Lawn terrace 2 ... ... ... ... ... ... ... ... ... ... Letterstone road ... 1 ... ... ... ... ... ... ... ... ... Lettice road 3 ... ... ... ... ... ... ... ... ... ... Lillie road 4 3 ... ... ... ... ... ... 2 2 1 Lilyville road 1 ... ... ... ... ... ... ... ... ... ... Lintaine grove 2 4* ... ... 1 ... ... ... ... 4 ... Lisgar terrace ... ... ... ... ... ... ... ... 1* 1 ... Linver road 4 ... ... ... 3 ... ... ... ... 1 ... Lodge avenue ... ... ... ... ... ... ... ... ... 1 ... Lurgan avenue 1 ... ... ... ... ... ... ... ... ... ... Margravine gardens ... ... ... ... ... ... ... ... 1 ... ... Margravine road Marinefield road ... 6* ... ... ... ... ... ... ... ... ... Marville road 6 3 ... ... ... ... ... ... ... ... ... Maxwell road 1 2 ... ... 1* ... ... ... 1 1 ... May street 4 1* ... ... ... ... ... ... 1 ... 1 Melmoth place 1 ... ... ... ... ... ... ... 1 ... ... Merrington road ... ... ... ... ... ... ... ... ... ... 1 Mendora road 2 1* ... ... ... ... ... ... ... 3 ... Milton street ... ... ... ... ... ... ... ... ... 1 ... Mirabel road 3* 2 ... 1 ... ... ... ... 1 ... ... Molesford road 1 ... ... ... ... ... ... ... ... ... ... Moore Park road ... 1* ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Scarlet fever Diphtheria Membranous Croup Small-pox Enteric fever Continued fever Puerperal fever Cholera Erysipelas Deaths from Measles Mooltan street 4 1 ... ... ... ... 1 ... ... 2 Mornington Avenue 1 ... ... ... ... ... ... ... ... ... Mulgrave road 2* 2 ... ... ... ... ... ... ... ... ... Mund street 2 ... ... ... ... ... ... ... ... ... ... Munden street 1 ... ... ... ... ... ... ... 1 ... ... Munden place ... ... ... ... ... ... ... ... ... 1 Munster road 4* ... ... ... ... ... ... ... 1 1 3 ... Musard road 5 1 ... ... ... ... ... ... Musgrave crescent ... 2* 1* ... ... ... ... ... 1 ... Napier avenue ... 2 ... ... ... ... ... ... ... ... Neville terrace ... 1 ... ... ... ... ... ... ... 1 Northampton place 1 ... ... ... ... ... ... ... ... ... North End road 12 2 ... ... ... ... ... ... 3 1 Oakbury road 1 4* 1* ... ... ... ... ... 1 ... ... Orbain road ... 1 ... ... ... ... ... ... ... 2 Oxberry avenue 2 ... ... ... ... ... ... ... ... ... Parkville road 1 1 ... ... ... ... ... ... ... ... Parthenia road 1 ... ... ... ... ... ... ... ... ... ... 5** 5 ... ... ... ... ... ... ... 1 Pellant road Pear Tree terrace 1 ... ... ... ... ... ... ... ... ... ... Perham road 2 ... ... ... ... ... ... ... ... ... Portland street 1 ... 5 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Princes Mews Protheroe road 16 8* ... ... ... ... ... ... ... 4 Puerperal fever Cholera ... Membranous Croup Continued fever Scarlet fever Enteric fever Deaths from Measles Deaths from Diarrhœa Diphtheria Small-pox Erysipelas Purcell crescent ... 3 ** ... ... ... ... ... ... ... 1 ... Pursers Cross road ... 4** ... ... 1 ... ... ... ... 2 ... Queen's Club gardens 1 1 ... ... ... ... ... ... 2 ... ... Radipole road 2 ... ... ... 1* ... ... ... ... ... ... Rectory road 2 ... ... 1 ... ... ... ... ... ... 3 Reporton road 4* 3 ... ... ... ... ... ... 2 ... ... Richmond place 2 ... ... ... 1 ... ... ... ... ... ... Rigault road ... 2** ... ... ... ... ... ... ... ... ... Ringmere avenue ... 1 ... ... ... ... ... ... ... ... ... Rosaline road 9 4** ... ... ... ... ... ... ... ... 2 Rosaville road 2 2** ... ... ... ... ... ... ... ... 1 Rosebury road 8* 3* ... ... ... ... ... ... ... 2 ... Rostrevor road 2 1* ... ... ... ... ... ... ... ... ... Rylston road 4* 5*** ... 1 ... ... 1* ... 2 ... ... St. Andrew's road 1 ... ... ... ... ... ... ... ... ... ... St. Dunstans road 2 1 ... ... ... ... ... ... ... ... ... St. George's square 1 ... ... ... ... ... ... ... ... ... ... St. Maur road ... 1* ... ... ... ... ... ... 1 ... ... St. Oswalds road 1 ... ... ... ... ... ... ... ... 2 ... St. Thomas' road 1 1 ... ... ... ... ... ... ... 1 ... Sandilands road 9*** 1 1 ... ... ... ... ... ... ... ... Seagrave road 1 ... ... 1 ... ... ... ... ... 2 1 Scarlet fever Diphtheria Membranous Croup Small-pox Enteric fever Continued fever Puerperal fever Cholera Erysipelas Deaths from Measles Sherbrook road 7 12*** ... ... 2* ... ... ... 3 1 Shorrolds road 3* ... ... ... ... ... ... ... 2 ... Sotheron road ... ... ... ... ... ... ... ... 1 ... Stamford place ... ... ... 1 1 ... ... ... ... ... Stamford road ... 4*** ... ... ... ... ... ... 1 ... Stanley road 1 6*** ... ... ... ... ... ... 4 1 Star road ... ... ... ... ... ... ... ... ... 1 Stonor road 1 ... ... ... ... ... ... ... 1 ... Strode road 5** 2* ... ... ... ... ... ... ... ... Sylvio street ... ... ... ... ... ... ... ... ... 2 Talgarth road ... 1 ... ... ... ... ... ... ... ... Tasso road 3 1 ... 4 ... ... ... ... ... 1 Tournay road 2 1 ... ... ... ... ... ... ... ... Townmead road ... 1* ... ... ... ... ... ... ... 2 Tilton street ... 2** ... 1* ... ... ... ... ... 1 Turneville road ... ... ... ... ... ... ... ... ... 2 Vanston place ... 1 ... ... ... ... ... ... 1 ... Varna road 2 2* ... ... ... ... ... ... ... ... ... 2* ... ... ... ... ... ... ... ... Victoria crescent Victoria road ... 1 ... ... ... ... ... ... 1 1 Waldemar avenue 4* 1* ... ... 1 ... ... ... ... ... Walham avenue 1* 1 ... ... ... ... ... ... 1 5 Walham grove ... 1 ... ... ... ... ... ... ... 2 Walham Yard 1 ... ... ... ... ... ... ... ... ... Wandsworth Bridge rd. 16** 7 1 1 1 ... ... ... 1 1 2 Scarlet fever Diphtheria Membranous Croup Small-pox Enteric fever Continued fever Puerperal fever Cholera Erysipelas Deaths from Measles Waterford road 2 1 1 ... 1 ... ... ... ... ... ... Werley avenue 4 1* ... ... ... ... ... ... ... 1 1 Whittingstall road ... ... ... ... ... ... ... ... 1 1 1 William street 1* ... ... ... ... ... ... ... ... ... ... Wyfold road 4 ... ... ... ... ... ... ... ... ... 1 Yeldham road 7 1 ... ... 1 ... ... ... ... 1 ... Fulham Union Infirm'ry 6 ... ... ... 1 ... 1 ... 3 ... ... Fulham Workhouse ... 1* ... ... ... ... ... ... 5 ... ...