Bestrn of the Earisp of fulbam London [PUBLIC HEALTH DEPARTMENT] With the Medical Officer of Heath's Compoliments Town Hall, Walham Grèn, S.W. Counnil of the Brrangh of Hutham. ANNUAL REPORT OF THE Medical Officer of Health, J. CHARLES JACKSON. For the Year ending December 31st, 1900. INDEX PAGE. Accidents, deaths from 45 Arsenic in Beer 59 Bakehouses 47 Births 4 Cancer, Deaths from 39 Childbirth, Deaths after 40 Cowsheds 47 Customs and Inland Revenue Acts 46 Dairies 47 Deaths and Death-rates 7 Deaths occurring outside the District 42 Death-rate, Corrected 8 Deaths at different ages 9 Diarrhœa 36 Diphtheria 25 „ Comparative Prevalence of 28 „ Fatality of 36 „ and Langford Road Board School 78 „ and Primary Schools 31 „ Recurrence of 28 Disinfection 45 Drainage, Combined 46 „ House 46 Enteric Fever 32 Enteritis 36 Erysipelas 34 Heart, Deaths from Diseases of 40 House Accommodation 49 Houses let in lodgings 46 Illegitimate Children, Births of 5 „ „ Deaths of 6 Infants, Deaths of 9 „ Insurance of 10 Infectious Diseases, Notification of 15 „ „ Localities of 67 „ „ in London Sanitary Districts 66 Influenza, Deaths from 38 Inquests 41 Isolation of Infectious Cases 33 Marriages 4 Measles 36 Meteorological Conditions & Mortality 61 Milk Standards Inquiry 39 Mortuary 44 PAGE- Open Spaces 49 Overcrowding 49 Phthisis 38 Population 3 „ Density of 5 „ Increase of 4 „ Natural Increase of 5 Prosecutions 51 Public Institutions, Deaths in 41 Puerperal Fever 34 Refuse, Removal of 48 „ Disposal of 48 Respiratory Diseases, Deaths from 39 Return Cases, Dr. Simpson's Report on 19 Sale of Food and Drugs Acts, Proceed- ings under 55 Sale of Food and Drugs Acts, Prose- cutions under 56 Sanitary Work 60 Scarlet Fever 19 „ Comparative Fatality of home and hospital cases of 27 Schools, Children on rolls of 32 Sewers 49 Smallpox 17 Smoke Nuisances 48 Tubercular Diseases, Deaths from 38 Vaccination, Statistics of 44 Venereal Diseases, Deaths from 39 Wards, Deaths in 11 „ Zymotic Diseases in 16 Whooping Cough, Deaths from 36 Zymotic Diseases, Comparative Mortality from 12 Zymotic Diseases, Deaths from 11 Town Hall, Fulham, S.W. To the Mayor, Aldermen and Councillors of the Borough of Fullam. Sir and Gentlemen, I have the honour to present to you my Annual Report on the vital statistics and the conditions affecting the health of the district for the year 1900. The statistics of births, deaths and infectious diseases, relate to the 52 weeks ending December 29th, 1900. POPULATION. The population of Fulham at the Census taken on March 29th, 1896, was 113,781, having increased from 91,640 during the previous five years. The population in the middle of 1900, as estimated on the hypothesis that the rate of increase which prevailed between 1891 and 1896 has been continued since, was 136,383. Since, however, this report was written, the Census was taken on April Ist, and from the unrevised figures which have been obtained, it appears that the population was somewhat overestimated, it being on that day 137,289; so that it may be estimated that in the middle of 1900 the population was 133,630, and on this figure the statistics in this report are based. The following table shows the increase in population of the district during the last 50 years. TABLE I. Population. No. of Houses. Persons to the Acre. Year. 1851 Census 1,975 7·0 11,886 2,583 9·1 15,539 1861 „ 1871 23,378 3,900 13·7 1881 42,900 25·2 6,685 1891 91,640 12,866 53·9 1896 „ 113,781 15,266 67·0 1900 „ estimated 133,630 18,000 78·6 The County of London has an average density of 59 persons to the acre, and of the 28 newly established boroughs, 13 are more thickly populated than Fulham, the density ranging from 14, 18 and 24 persons to the acre in Woolwich, Lewisham and Wandsworth, to 175, 176 and 184, in Stepney, Southwark, and Shoreditch. Marriages and Marriage Rate. 1,162 marriages were solemnized in Fulham during the year, compared with 1,028, 1,095 and 1153, in the three previous years. The marriage rate (i. e. persons married per 1,000 inhabitants), was 17·3 ; the rate for the metropolis being 17·6, and that for England and Wales 16·6. Births and Birth Rate. The births registered during the year numbered 4,525 —2,316 males and 2209 females. There was one birth to every 30 inhabitants, and 100 births of males to 95·4 of females. These births correspond to a birth-rate of 33·9 per 1,000, being the lowest yet recorded in Fulham. The birth-rate of the metropolis was 29·2, which was lower than in any preceding year; and in the three adjoining parishes the rates were, Kensington 20·7, Hammersmith 27·2, and Chelsea 23·2. In the other sanitary districts the rates ranged fron 13.1 in St. Martin-in-the-Fields, 14.8 in the City of London, and 16.0 in St. George, Hanover Square, to 37.6 in Mile End, 44.6 in St. George-in-the-East, and 44.9 in St. Luke. In the 32 large provincial towns the birth-rate was 29.8, ranging from 22·8 in Huddersfield, 23·0 in Halifax, and 23.1 in Bradford, to 35·8 in Sunderland, 36·0 in Liverpool, and 36·3 in Gateshead. In Table II the number of births and the birth-rate for the 10 years —1890 to 1899 —are given. Illegitimate Children. The birth-rate of illegitimate children numbered 185 —86 males and 99 females—forming 41 per cent, of the total births. Still-born Children. 172 still-born children were buried in Fulham Cemetery, being in the proportion of one still-born child to every 25.5 living. Excess of Births over Deaths. The natural increase of the population by the excess of births over deaths was 2,178, compared with 2,076, 2,139 and 2,079 in the three preceding years. The following Table, prepared in accordance with the instructions of the Local Government Board, gives the population of, and the births and deaths occurring in, Fulham in 1900 and the ten preceding years. TABLE II. FOR WHOLE DISTRICT. Births. Deaths under One Year of Age Deaths at all Ages. Total. Deaths at all Ages. Nett. * Rates calculated per 1,000 of estimated population. Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition in the number in Column 11. By the term " Non-residents" is meant persons brought into the district on account of illness, and dying there ; and by the term " Residents "is meant persons who have been taken out of the district on account of illness, and have died elsewhere. Area of District in acres (exclusive of area covered by water) 1701. Total population at all ages 91,640 At Census of 1891 Number of inhabited nouses 12,866 Average number of persons per house 7.12 2498 666 1900. 698 133,630 17·6 2347 173 376 18·8 33·9 4525 146 19·0 2247 3875 Averages for years 1890-1899. 2056 206 397 20·8 172 35·7 108,368 666 19·4 21·1 35·5 4574 2497 452 1899. 235 189 862 128,720 17·3 19·5 722 1898. 207 475 648 812 788 167 34·7 124,000 2148 4306 17·0 679 662 4106 1897. 209 161 119,550 2030 419 18·8 34·4 20·7 710 115,008 1896. 175 4068 2053 805 186 508 34·8 1895. 17.5 19.9 21·2 35·7 110,385 218 360 632 187 2195 735 3930 35·5 1894. 17·6 149 237 445 19·9 559 3763 1868 707 105,884 36·5 1893. 19·9 2024 447 460 22·1 659 3711 226 177 101,472 586 37·0 3596 1892. 190 357 21·9 97,126 166 579 19·9 1963 37·5 1891. 206 287 518 21·0 2714 2416 2240 2375 2337 2105 2245 2130 1949 166 590 3547 92,860 19·7 1868 175 35·5 1890. 223 476 22·1 1956 182 582 3141 88,675 21·5 1908 Year, 1 Rate.* 13 Rate 8 Number. 7 Rate per 1000 Births registered. 6 Number. 5 Rate.* 4 Number. 3 Num ber. 12 Deaths of Residents registered beyond District. 11 Deaths of Non-residents registered in the District. 10 Deaths in Pubdic Institutions. 9 Population estimated to middle of each year. 2 Deaths and Death Rate. The deaths of 2,498 persons — 1,292 males and 1,206 females — were registered in Fulham during the year, but of these 376 —203 males and 173 females—were of persons not resident in the district who died in public institutions within the borough ; while the deaths of 225 persons— l32 males and 93 females—belonging to Fulham occurred outside the district, chiefly in various public institutions. There were therefore 2,347 deaths of residents in Fulham— l,220 males and 1,127 females—the mortality being at the rate of 17.6 per 1,000 for the year ; the rate for males being 19.2 and for females 16.1. The death-rate of the County of London was 18.6, and of the three adjoining districts, that of Kensington was 15.8, of Hammersmith 17.2, and of Chelsea 18.0. The lowest rates in the 43 sanitary districts into which the metropolis was formerly divided, were 11.3 in Hampstead, 12.6 in Stoke Newington, and 13.8 in St. George, Hanover Square; the highest rates were 26.5 in Holborn, 26.8 in St. Luke, and 27.3 in St. George, Southwark. Among the 32 large provincial towns in England and Wales, the lowest rates were those of Cardiff 13.8, Croydon 14.6, and West Ham 16.0; and the highest those of Manchester 241, Salford 25.1, and Liverpool 25.7. Correction for Age and Sex Distribution. In comparing the death-rate of different areas, regard must be paid to the differences of age and sex distribution of the populations upon which such death-rates are calculated, and the recorded death-rates require correction before they can be used for the purpose of comparison. The following table shows the crude death rates and the death-rates corrected for differences in the age and sex constitution of the population, of Fulham, the three adjoining districts and the County of London. TABLE III. Crude Death-rate. Corrected Death-rate. Fulham 17.6 18.44 15.8 17.41 Kensington Hammersmith 17.2 18.25 18.0 Chelsea 19.21 18.6 19.82 County of London Seasonal Mortality. The mortality in the four quarters was as under. TABLE IV. No. of Deaths. Death-rate. First quarter. 735 22.0 Second „ 523 15.7 Third 556 16.6 Fourth „ 533 16.0 Mortality in former years. The following Table gives the death-rates of Fulham and of London, uncorrected for age and sex distribution, during the previous 10 years :— TABLE V. Fulham Death-rate per 1,000. London Death-rate per 1,000. 21.5 1890 21.4 1891 19.7 21.0 1892 19.9 20.3 1893 19.9 21.0 1894 17.4 17.6 19.9 19.5 1895 18.2 1896 17.5 17.8 1897 17.0 17.3 18.5 1898 19.6 1899 19.4 Average of years 1890-1899 19.0 19.5 The difference between the rate for 1900 and that for the previous 10 years in Fulham represents a saving of 192 lives. MORTALITY AT DIFFERENT AGES. Infantile Mortality. Of the 2,347 deaths registered 666 or '28"2 per cent, were of infants under the age of one year, and the rate of infant mortality measured by the proportion of deaths under one year, to births registered, was equal to 146 per 1,000. The corresponding rate of the County of London was 158 per 1,000, the rates in the various sanitary districts ranging from 100 in Hampstead, 107 in St. George, Hanover Square, and 108 in Stoke Newington, to 209 in St. George, Southwark, 228 in Limehouse, and 240 in Holborn. Among the 32 large provincial towns the lowest proportions were— 132 in Croydon, Huddersfield and Halifax, and 133 in Bristol; the highest proportions were 206 in Wolverhampton, 207 in Salford, 220 in Blackburn, and 236 in Preston. The rate for the year is the lowest yet recorded, and for the first time the infantile mortality was lower in Fulham than in the County of London. The following table gives the infantile mortality in London, Fulham and the adjoining parishes for the preceding 10 years:— TABLE VI. Deaths under One Year per 1000 Births. Mean for 10 years. 1890. '90-'99 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. 182 177 149 176 Fulham 166 166 187 161 167 189 172 146 179 171 163 160 182 171 Hammersmith 167 147 183 183 170 162 175 178 Kensington 171 159 169 173 166 181 180 173 168 180 155 169 150 164 158 131 161 176 164 158 Chelsea 150 149 143 154 154 164 165 159 166 159 London 162 161 166 158 DEATHS OF ILLEGITIMATE CHILDREN. 64 of the children who died before attaining the age of one year were illegitimate, the mortality among them being in the proportion of 345 deaths to 1,000 births, or more than twice as heavy as that of children born in wedlock. Between the ages of 1 and 5 years 339 deaths were registered, so that the deaths of children under the age of 5 years numbered 1,005, or 42.8 per cent, of the total number of deaths. These deaths were equal to an annual rate of 53.4 per 1,000 of the population estimated to be living at that age, the corresponding rate for the metropolis being 55.7. Insurance of Infants. Certificates under the Friendly Societies' Acts were issued in respect of 380 children under the age of 5 years, 38 per cent, of the children dying at this age being insured. Mortality at School Age. At the age of 5 to 15 years which is approximately the school period of life, there were 92 deaths or 4 per cent, of those at all ages, being equal to an annual rate of 3.1 per 1,000 of those estimated to be living at that age. Mortality at Adolescence. Between the ages of 15 to 25 years, 85 or 3.6 per cent, of the deaths were recorded, the rate of' mortality being 3.7. Mortality at Maturity 792 or 33.8 per cent, of the deaths occurred between the ages of 25 and 65, the mortality at that age period being at the rate of 13.8 per 1,000. Mortality at Decline. At the age of 65 and upwards there were 373 deaths or 15.8 per cent, of the total number, corresponding to a death rate of 87 .2. Distribution of Deaths. The deaths from various causes occurring at certain age periods in the eight wards of the borough will be found in Table XI. The following Table gives the Death-rates of each Ward: — TABLE VII. Death rate per 1,000 of the estimated population. Baron's Court Ward Lillie Ward Walham Ward Margravine Ward Munster Ward Hurlingham Ward Sand's End Ward Town Ward 12.9 18.3 20.2 19.4 18.2 13.1 16.3 15.9 The above may be considered fairly satisfactory, no part of the borough showing an exceptionally high death-rate. Deaths and Death-rate from Zymotic Diseases. 397 deaths were due to the seven principal Zymotic diseases, viz.:— TABLE VIII. Smallpox - Measles 80 Scarlet Fever 23 Diphtheria 65 Whooping Cough 54 Enteric and Continued Fever 19 Diarrhœa 156 397 These deaths are equal to a death-rate per 1,000 living of 2.97, the corresponding rate of the County of London being 2.19; of the three adjoining parishes, that of Kensington was 1.66, of Hammersmith, 2.23, and of Chelsea, 1.77. In the various sanitary areas of the Metropolis the Zymotic death-rates ranged from 0.78 in St. George, Hanover Square, 0.84 in St. Martin-in-the-Fields, and 0.89 in the City of London, to 3.40 in Rotherhithe, 3.53 in St. George, Southwark, and 4.10 in Limehouse. The deaths that occurred from Zymotic diseases in each ward of the borough will be found in Table XI., and the following Table gives the death-rate from each disease in the eight wards : — TABLE IX. Deaths from the principal Zymotic Diseases per 1,000 of the population Measles. Scarlet Fever. Whooping Cough. Diphtheria. Typhoid Fever. Diarrhœa. Total. 0.09 0.09 0.23 0.06 0.19 0.11 0.42 0.09 0.08 0.33 0.69 0.43 0.44 0.11 0.58 0.18 0.08 0.39 0.39 0.16 0.42 0.31 0.50 0.62 0.11 0.75 0.55 Barons Court Ward 1.10 Lillie Ward 0.61 0.62 1.10 0.70 0.22 0.59 0.09 0.09 0.74 2.28 Walham Ward 0.23 0.77 2.85 Margravine Ward 1.66 0.31 4.06 Munster Ward 0.15 0.00 0.13 0.09 2.01 4.11 1.22 Hurlingham Ward 1.77 1.17 Sand's End Ward 3.64 Town Ward 0.46 1.46 Comparative mortality from Zymotic Diseases in Fulham, London, and the three adjoining Districts. The following Table shows the mortality from Zymotic diseases in Fulham as compared with London and the three adjacent parishes:— TABLE X. Disease. Smallpox Scarlet Fever Diphtheria and Membranous Croup Enteric Fever Measles Whooping Cough Diarrhœa Actual Number of deaths in Fulham. 0 23 65 19 80 54 156 Fulham's proportion if mortality was the same as in London. 0 11 46 20 57 57 100 Fulham's proportion if mortality was the same as in 3 adjoining Western districts, viz., Hammersmith, Chelsea and Kensington. 0 7 35 19 77 17 95 In judging these figures, the age-constitution of the districts must be taken into consideration, as these diseases, with the exception of Smallpox and Enteric Fever, are mainly fatal to young children. In Fulham no less than 18 per cent, of the population are in attendance at the Board and other primary schools, or about double the proportion obtaining in the adjoining districts. Croup 3 2 1 ... ... 2 2 ... 1 ... ... Typhus 13 ... ... 2 15 Fever Enteric ... 19 ... 2 1 2 3 5 4 ... 3 1 ... Other continued ... ... 49 ... ... ... Epidemic Influenza 3 ... 23 ... ... ... ... ... ... ... ... ... ... ... 21 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 7 5 4 6 5 5 11 ... ... 2 ... Cholera ... ... Plague ... 135 ... ... ... 18 Diarrhœa 156 3 5 16 9 27 55 11 28 5 18 24 Enteritis 33 4 ... 4 1 ... ... ... 1 4 3 5 15 ... 3 1 ... 1 4 ... ... ... ... 3 Puerperal fever 3 1 ... ... ... ... 1 1 ... 1 ... Erysipelas 13 3 ... ... ... ... ... ... ... ... 1 4 5 4 1 ... 3 ... 3 2 ... 4 12 3 ... 2 5 2 1 3 1 1 5 ... ... 1 ... 8 Other septic diseases ... 3 5 2 40 153 7 ... 22 Phthisis 210 5 43 26 26 37 5 31 14 6 80 24 3 11 Other tubercular diseases 89 34 16 2 9 10 24 14 7 15 8 ... 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes of, and Ages at, Death during Year 1900.—(continued.) Deaths in whole District at subjoined Ages. Deaths in Localities (at all Ages.) Barons Court Ward. Town Ward. Not specified. Lillie Ward. Hurlingham Ward. Death in Public Institutions Causes of death Under 1 rgravine Ward. Sands End Ward. 1 and under 5 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Walham Ward. Munster Ward. All Ages. Cancer, malignant disease 110 1 1 78 30 10 25 13 4 16 8 20 13 1 36 Bronchitis 240 ... 59 ... 29 1 65 86 12 40 34 42 55 10 31 13 3 51 51 Pneumonia 247 66 ... 61 3 3 ... 6 ... 84 27 18 48 30 32 51 8 37 19 4 Pleurisy 9 1 7 1 2 1 ... 2 2 ... 1 1 1 ... Other diseases of Respiratory organs 14 4 3 1 ... 6 ... 1 2 1 ... 7 ... 3 ... ... 1 NOTIFIABLE INFECTIOUS DISEASES. The following table gives the number of cases of infectious diseases notified in Fulham since 1890, when compulsory notification came into force, excluding duplicate notifications : — TABLE XII. 1892 1897 1890 1891 1893 1894 1895 1896 1898 1899 1900 Smallpox 40 2 2 1 - 3 32 - 9 811 - 286 118 701 529 339 847 Scarlet Fever 517 627 - 759 552 96 341 514 Diphtheria 70 69 230 329 368 378 465 630 23 13 15 20 13 18 14 10 11 14 Membranous Croup 11 72 41 58 37 57 53 53 71 111 Enteric Fever 51 92 6 Continued Fever - 2 3 5 5 1 1 2 - 2 3 - - 1 - - Typhus Fever - - - 2 - 1 4 Cholera - - 5 - - - 6 6 10 - 10 6 6 14 8 13 Puerperal Fever 18 - - 9 99 134 121 Erysipelas 114 67 104 153 113 94 178 154 573 Totals 327 786 1124 1073 887 1149 1354 1488 1683 1459 Distribution of the Cases. Table XIII gives the number of cases notified in, and Table XIV the number of cases per 1,000 of the estimated population of, each ward. 5 60 36 49 24 - 29 70 158 61 26 145 145 33 50 102 29 Scarlet Fever 552 329 36 119 11 16 24 11 - - - - - - - - - - - - - - - - - - - - - Typhus Fever - - - - 23 6 35 6 15 20 22 1 7 16 22 3 8 17 1 Enteric Fever 92 - 27 1 18 13 1 1 2 1 - - - - - - - - - - - - - - - Relapsing Fever - - - - - - - - - - 1 - - - 1 - - - - - 1 - 1 - - - - Continued Fever 2 - - - - - - 1 1 1 - 1 - 1 1 3 - 1 - - - 8 - 2 - - 1 1 3 - - Puerperal Fever 9 - - - - - - - Plague - - - - - - - - - - - - - - - - - - - 1459 23 22 174 380 689 131 214 69 199 102 342 68 399 75 27 37 146 66 132 273 48 334 51 16 TABLE XIV. Cases of Infectious Diseases notified per 1,000 inhabitants. Smallpox. Diphtheria & Membranous Croup. Scarlet Fever. Enteric Fever. Erysipelas. Barons Court Ward 0.00 2.5 2.1 0.5 0.6 Lillie Ward 0.00 3.4 4.3 0.7 1.1 Walham Ward 0.00 2.8 2.9 1.4 1.6 Margravine Ward 0.18 3.7 4.5 1.2 1.0 Munster Ward 0.04 4.3 6.2 0.8 1.1 Hurlingham Ward 0.00 4.0 1.8 0.1 1.6 Sands End Ward 0.21 6.2 7.7 0.9 1.1 Town Ward 0.00 3.0 3.6 0.9 0.6 Small-pox. Nine cases of Small-pox were notified in Fulham during the year. In January, two cases were notified in a house in Claxton Grove, and the son, living in Chaldon Road, of one of the patients, who had visited his father before the nature of his illness was suspected, was subsequently attacked. It was ascertained that the husband of one of the patients had been employed in December as a carpenter at the Hull Small-pox Hospital, the disease being then very prevalent in that town, and though exposed to infection had refused to be vaccinated. He returned home just before Christmas and was taken ill a few days afterwards, but the nature of the disease, which was unquestionably Small-pox in a mild form, was not recognised. It is worthy of note that a similar case occurred in Fulham in 1894, when a man who had been working at the Nottingham Small-pox Hospital and had refused to be vaccinated had an unrecognised attack of the disease shortly after his return to Fulham, which gave rise to 20 cases in the neighbourhood. It would be well if local authorities insisted that everyone employed in a Small-pox Hospital should be vaccinated, and, when they leave their employment, information should certainly be sent to the Sanitary Authority of the district to which they are returning, in the same way as information is sent by Port Sanitary Authorities respecting passengers who have arrived from infected ports. In May, five cases occurred in a house in Wandsworth Bridge Road, the source of the disease being a girl living in the same house, who had had an attack of what was supposed to be Chicken - pox. This girl had been employed in a laundry in Chiswick, to which had been sent the linen from a house in Westminster in which a valet had died from what was supposed to be Malignant Measles. From this case in Westminster, the following cases were ascertained to have arisen: — 1. —The widow of the man, who, after her husband's death, was removed to St. George Infirmary, remaining there 3 days, where a nurse who had attended her was infected by her clothing. She then stayed for two nights in a house in Kensington where two children were infected, and then went to Chelsea where she was seen by the Medical Officer of Health and removed to the Smallpox Hospital. 2. —The son of the first patient, who resided in a Midland town, attended his father's funeral, and, after his return home, was attacked with the disease, which was not diagnosed, and gave rise to three other cases. 3. —A housekeeper in the same block of flats in which the valet died, who had visited him when ill, was removed to St. Mary's Hospital with Pneumonia, subsequently developed Smallpox and infected two nurses, a patient, and two students at the hospital. 4. —Four girls, including the one living in Wandsworth Bridge Road, who were employed in the sorting-room at the Chiswick Laundry, were attacked, the disease being at first supposed to be Chicken-pox, from whom, in all, eight other cases resulted. In November, a girl living in Bayonne Road was found to be suffering from a mild attack of Small-pox, which had been regarded as Chicken-pox. This girl had been employed in a house in Chelsea, and had been most probably infected, together with a fellow servant occupying the same bedroom, by the master of the house, who. after his return from Paris in October, had an illness which had been looked upon as Influenza, Scarlet Fever. There was a marked diminution in the prevalence of this disease in Fulham in 1900, as compared with the previous year, 552 cases being notified, as against 811 in 1899, but the case-rate was again higher in Fulham than in London and the three adjoining parishes, as will be seen from the following table:— TABLE XV. Number of cases of Scarlet Fever notified per 1,000 of the population. Average 10 years, 1890-1899. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 Fulham 3.4 1.3 5.5 6.8 4.9 3.0 5.4 6.3 6.5 6.5 5.0 4.05 Kensington 2.3 1.9 4.3 5.6 2.3 3.1 6.0 4.4 2.8 2.6 3.7 2.11 Hammersmith 3.6 2.3 4.6 6.7 3.2 3.6 5.1 3.7 4.3 4.1 4.5 3.19 Chelsea Home District 3.3 2.0 5.0 6.5 3.1 6.6 5.7 4.1 3.5 3.0 4.3 2.44 London 3.7 2.7 6.4 8.6 4.3 4.5 5.8 5.1 3.8 4.0 3.00 4.8 The disease was again more prevalent in the South than in the North of the borough, but this is probably accounted for by the age constitution of the districts. Of the 552 cases, 464 or 84 per cent, were removed to an isolation hospital. Mortality The disease was again generally of a mild type, but the fatality was slightly in excess of that of the previous year, there being 23 deaths, representing a case mortality of 4.2 per cent, compared with 3.9 per cent, in 1899. Of the 464 removed to hospital 22 or 4.8 per cent, and of the 88 not removed to hospital 1 or 1.10 per cent. died. Return Cases. In seven instances the disease occurred within 10 days of the return of a child, living in the same house, from one of the Metropolitan Asylum Board's Hospitals after recovery from a similar attack. The report of Dr. Simpson, who investigated, on behalf of the Asylums Board, all the return cases which occurred between October 1898 and March 1899, has been recently published by the Managers. Dr. Simpson summarises his conclusions as follows : — 1. " That before investigation into causes the return cases were 339, giving a percentage of 3.4 on the total discharges from hospital, 3.8 per cent, being scarlet fever and 2.3 per cent, diphtheria. 2. That after inquiry it was found that 123 cases or 36 per cent, were not return cases, or at least furnished no evidence in support <">f their being return cases; that 36, or 10 per cent., were cases of a doubtful nature, in which it was impossible to decide whether they were return cases or not, that 17, or 5 per cent, were cases in which it was impossible to dissociate infected clothing or house infection from personal infection ; and that 159, or 47 per cent., were probably return cases which gave on the total discharge a percentage of 1.6 instead of 3.4. 3. That there were 111 primary infective cases, a number which is equal to 11 per cent, on the total discharges, 1.3 being scarlet and .5 being diphtheria. 4. That the percentage of the primary infective cases varies from .5 to 1.3 in the different infectious hospitals of the Board. 5. That 80 per cent, of the primary infective cases are connected with discharges from mucous membranes, the discharges from the nose in scarlet fever forming 40 per cent, of the cases and in diphtheria 28 per cent. 6. That warm baths immediately before the patient is sent out of hospital do not remove this infection, and that warm baths and exposure in the winter to the vicissitudes of the weather contribute to the increase of the infection, and bring back rhinorrhœa and otorrhœa. 7. That mere duration of detention in hospital is no standard as to the limit of infection, and no guarantee that the patient shall be freed of infection, and that long detention in infective wards will not reduce the percentage of return cases. 8. That the discharges from mucous membranes on which infection has been sown are probably the carriers and not the causal agents of infection, and that local and antiseptic treatment combined with transference to less infective wards are likely to be more effective than long detention in reducing the percentage of return cases. 9. That the Medical Officer of Health should be notified as to discharge of patient from hospital, or printed instructions should be given to parent or guardian, in order that suitable precautions shall be taken at home. 10. That if more attention were paid by the sanitary authorities to disinfection by steam of clothes, &c., as distinguished from bedding, the number of fresh cases arising in houses to which patients are discharged from the Board's hospitals would likely be reduced. 11. That a comparison between quarantine in hospital and quarantine at home shows that 91 per cent, of the scarlet fever cases treated at home were isolated less than 8 weeks and 57 per cent, less than 6 weeks, and 82 per cent, of the diphtheric cases were isolated less than 4 weeks and 37 per cent, less than 2 weeks ; while in hospital 71 per cent, of the scarlet fever cases were detained 8 weeks and longer extending to 12 and 15 weeks, and 94 per cent, of the diphtheria cases were detained 4 weeks and longer. 12. That the isolation at home is insufficient in duration as a rule and that the isolation in hospital if, if anything, too long, and that return cases are not due to premature discharge. 13. That a reduction in the duration of the detention of scarlet fever and diphtheria cases in hospital, would likely tend to theriain the metropolis, as it would permit of a greater number being removed to hospital with the same accommodation as exists at present." The Managers of the Asylums Board referred Dr. Simpson's report, together with the comments upon it of the several Medical Superintendents of the hospitals, to the Royal College of Physicians, informing them that, " looking at the importance of the subject and to the bearing it has upon the administration of the large infectious hospitals under the Asylum Board's control, they would greatly value the expression by the College of an opinion as to whether, and, if so, under what conditions, the present period of detention in hospital could consistently with public safety be shortened. " The report of the Fever Committee appointed by the College was as follows :— 1. " The Committee have carefully considered Dr. Simpson's report and the documents referring thereto, for the purpose of expressing an opinion as to whether, and if so, under what conditions, the present period of detention of patients in the hospitals of the Metropolitan Asylums Board could consistently with public safety be shortened. 2. The Committee are impressed with the small percentage of those cases which, on investigation, were found to have given rise to fresh infection, viz., 1.1 per cent, on the total cases discharged from hospital, of diphtheria and scarlet fever taken together. They also note that of these, no fewer than 80 per cent, were suffering from some mucous discharge, either during their stay in hospital, or shortly subsequent to their return home. 3. The total number of return cases of diphtheria was 21, equal to a percentage of .5 on the cases of diphtheria discharged. With reference to the length of detention after diphtheria, the Committee are of opinion that this can only be left to the discretion of the several medical superintendents. The importance of the question of return cases mainly turns on the length of detention of scarlet fever cases, which are more numerous than those of diphtheria. The proportion of the return cases in diphtheria is small, viz., .5 per cent, of the patients discharged after suffering from that disease ; and apart from that difficulty which is occasionally experienced in respect to the recognition of the specific bacillus, a difference of opinion exists as to the practicability of regulating a patient's detention by bacteriological examination alone. 4. The total number of return cases of scarlet fever was 90, giving a percentage of 1.3 of the total number discharged. In endeavouring to arrive at a definite conclusion as to the necessary length of detention in scarlet fever, there are two points on which elucidation is required. The degree of infectivity attaching to — (a) The desquamation of the skin. (b) Any mucous discharge occurring during convalescence. In respect of the infectivity of the later desquamation of the skin in scarlet fever, it is to be observed in Dr. Simpson's investigation, that in only 2.7 per cent, was there any reason to suspect desquamation of the skin as the cause of secondary infection. The relatively high degree of infectivity of the mucous discharges as compared with the later desquamation of the skin in scarlet fever, as shown in the report, is one which is obtaining an increasing support among those of the profession who have had much to do with infectious diseases. It would suggest that possibly too much importance has been hitherto attached to the infectivity of the skin during the later weeks of scarlatinal convalescence. The Committee have communicated with the authorities of many hospitals in other large cities in this country, in America, in Germany, and have ascertained that the period of detention insisted on is of somewhat shorter duration than is practised in those of the Metropolitan Asylums Board. Unfortunately, no corresponding record of the incidence of the return cases is available for comparison with that recently obtained for the Metropolitan Asylums Board In respect to the infectivity of the mucous discharges, the question raised by the Managers of the Metropolitan Asylums Board is of the highest importance, for on its solution depends the practice which it would be advisable to adopt. If it can be proved that the discharge after a time constitutes simply the vehicle, as suggested by Dr. Simpson, and is not in its nature infective, as is usually believed, it is obvious that the practice of removing the patient from an infective environment for a short period before return to his home is one which should be adopted. But on this point the Committee are unable to express a decided opinion, with the evidence at present available. 5. In order to arrive at a satisfactory conclusion, the Committee are of opinion that information should be obtained as to whether (a) The mucous discharges in themselves are infectious from patient to patient. (b) Their infectivity quickly dies out on removal of the patient to an uninfected environment. And further, in order to place the inquiry on a firmer basis than at present, that the investigations should extend over a longer period than six months, so that not only all seasons of the year may be included in the scope of the investigations, but that the data available should be more numerous. The Committee are of opinion that there is not sufficient evidence at present before them to enable them to lay down any definite period of time as necessary for the detention of patients recovering from scarlet fever. With the object of obtaining further evidence the Committee recommend— (I.) That in each hospital a couple of wards identical in respect to cubic space per bed, etc., should be set aside and administered on a different principle, the sex of the children being the same, and the age as far as possible ; that in one ward the cases subject to mucous discharges from nose or ear be rigorously excluded ; that immediately on the appearance of any such discharge the patient should be removed : and that all nozzles and syringes should be kept in antiseptic solutions. In the other ward no special attention should be paid to these discharges, other than hitherto adopted. The incidence of either rhinorrhœa or otorrhœa should be compared. Cases of " septic scarlet fever" should be excluded from both. (II.) That, if possible, in certain hospitals, with the approval of the medical superintendents, two or more rooms previously disinfected be reserved for the isolation after, six or eight weeks' detention, of single patients who are suffering from rhinorrhœa or otorrhœa, but whose desquamation is completed. Each patient so secluded should be kept for ten days or a fortnight before returning home. During this period of detention, the affected parts should be regularly irrigated and syringed with some reliable antiseptic, and great care should be taken that the nozzle of the apparatus be kept in a germicidal solution. On the expiration of the quarantine the patient should be sent home, whether the discharge has ceased or not, and the room should be disinfected prior to the reception of another patient. The subsequent history of the case should be investigated. (III). That the inquiry into the facts connected with the incidence of return cases at the Managers' hospitals should be continued for a further period of twelve months, and that the scope of the inquiry should include the history of the cases discharged under the conditions mentioned." The medical superintendents of the several hospitals have been authorised, provided that the efficiency of their hospitals is in no way impaired, to carry out the suggestions contained in recommendations (I) and (II). As regards recommendation (III), the Hospitals Committee have in contemplation arrangements for the continuance of the investigation for a further period. Diphtheria. There was again an increase in the prevalence of this disease in Fulham, 630 cases of diphtheria and 11 of membranous croup which is identical with laryngeal diphtheria, being notified ; the incidence-rate being 4.6 as compared with 3.2, 3.8 and 4.0 in the three preceding years. During the first 9 months of the year there was no very exceptional prevalence of diphtheria as compared with the three previous years, 378 cases being notified during that period, but the usual autumnal rise was much more marked than heretofore, and the disease assumed epidemic proportions in the Sands End and Munster Wards. The occurrence of several cases among the children in one of the classes in the infants' department of Langford Road Board School, led the "Vestry to require the Managers to close the classroom and to exclude the children living in the same houses as the children attending that class. The London School Board appealed to the Education Department against the action of the Vestry and the report dealing with the matter, which was furnished at the request of the Local Government Board to whom the question was referred, will be found in the appendix to this report. The Local Government Board subsequently informed the Education Department that, in their opinion, the action of the Vestry was not unreasonable. Mortality.—The disease was the cause of 65 deaths, giving a case mortality of 10.2 per cent, being the lowest yet recorded. The decline in the fatality of the disease, which is mainly due to the use of anti-toxic serum, will be seen from the following table: — TABLE XVI. Number of Cases. Number of Deaths. Year. Deaths per 100 cases. 1891 82 31 37.8 1892 111 30 27.0 1893 250 65 26.1 1894 342 108 31.6 1895 386 77 20.0 1896 355 78 22.0 1897 388 62 16.3 1898 476 61 12.8 1899 528 59 11.2 1900 641 65 10.2 Of the cases removed to hospital, 48, or 8.6 per cent., and of those kept at home, 17, or 20.3 per cent., died. The difference in the fatality of hospital and home cases is especially marked in young children, as will be seen from the subjoined table ; the fatality among children under 5 removed to hospital being 11.4 per cent., and among those of the same age kept at home, 48'.0 per cent. There is no doubt that if the nature of the disease were more promptly recognised, and cases treated in the earliest stages with anti-toxic serum, the fatality of diphtheria would be still further reduced. TABLE XVII. Showing the fatality at different aye periods of the cases treated at home and of those removed to hospital:— Cases removed to Hospital. Cases treated at home. Age. Mortality per cent. No. of Cases. No. of Cases. Deaths. Deaths. Mortality per cent. 0-1 11 1 9.1 1 1 100 1—2 23 6 26.1 4 4 100 2—3 42 7 16.7 6 3 50 3-4 68 3 4.4 5 4-5 67 7 10.5 9 4 44.5 5-10 218 14 6.4 26 4 15.4 10-15 66 7 10.6 12 1 8.3 15—25 36 3 8.4 10 19 25 —35 9 35—45 5 1 45—55 2 1 48 Total 557 8.6 84 17 20.3 There is a marked contrast between the fatality of Diphtheria and of Scarlet Fever as regards home and hospital cases. It might be expected that the fatality of both diseases would be less in cases treated at home than in those treated in hospital, as in the former class we get a larger proportion of adults in whom the diseases are less fatal, and also a larger proportion of mild and doubtful cases. This has always been the case as regards Scarlet Fever, but in Diphtheria the reverse obtains, as will be seen from the following table, which embraces all the notified cases between 1893 and 1900. TABLE XVIII. Showing the fatality of cases of Scarlet Fever and of Diphtheria treated at home and in hospital during the 8 years 1893-1900. Cases Cases Fatality treated removed. Deaths. per cent. at home. Deaths. Fatality. Scarlet Fever 3,850 200 5.2 1,305 32 2.5 Diphtheria 2,356 339 14.4 760 188 24.7 - - - - - - - - - - - - - - - - Return Cases. In two instances the disease occurred within 10 days of the return of a patient, living in the same house, from one of the Metropolitan Asvlum Board's hospitals, after recovery from a similar attack. Recurrence of the Disease. In the report for 1899. an instance of the persistence of the infectiousness of the disease was quoted, and it would seem that, in some instances, the disease assumes a chronic form with a liability to recurrences of acute symptoms. Thus, in five instances, patients were re-admitted into hospitals suffering from Diphtheria in an acute form within seven days of their return after apparent recovery from a similar attack, and the following case was probably an instance of this: — A. C., aged 6 years. Female. Admitted into hospital, suffering from Diphtheria Jan. 28th, 1900. Discharged Mar. 26th, 1900. Re-admitted, suffering from Diphtheria. Mar. 28th, 1900. Discharged May 5th, 1900. Re-admitted, suffering from Diphtheria. June 5th, 1900. Discharged Aug. 25th, 1900. Re-admitted, suffering from Diphtheria. Oct. 27th, 1900. Discharged Dec. 14th, 1900. Comparative prevalence of Diphtheria. In London there was a decrease of Diphtheria in 1900. 11,994 cases being notified against 13,692 in 1899. The disease showed a higher proportional prevalence in Fulham than in any other sanitary district, but in seven districts the fatality was greater than in Fulham. The comparative prevalence and fatality of Diphtheria, during recent years, in Fulham, the adjoining parishes and London, will be seen from the two following tables, which give the rates of incidence and mortality of the disease in the several localities:— TABLE XIX. Deaths from Diphtheria per 1,000 Inhabitants. Average for 10 yrs 1890-99. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 Fulham 0.25 0.21 0.32 0.63 0.99 0.70 0.66 0.52 0.49 0.45 0.52 0.47 Kensington 0.20 0.17 0.20 0.49 0.46 0.53 0.40 0.47 0.15 0.25 0.33 0.16 Hammersmith 0.51 0.75 0.74 0.53 0.49 0.43 0.49 0.28 0.21 0.23 0.47 0.25 Chelsea 0.58 0.17 0.41 0.54 0.56 0.59 1.17 0.56 0.43 0.27 0.53 0.18 London 0.33 0.32 0.44 0.75 0.61 0.52 0.59 0.50 0.39 0.43 0.49 0.34 TABLE XX. Cases notified per 1,000 Inhabitants. Average for 10 yrs 1890-1899 1891 1900 1890 1892 1893 1894 1895 1896 1897 1898 1899 Fulham 1.1 0.7 1.0 2.2 3.1 3.4 3.0 3.2 3.8 4.0 2.8 4.7 Kensington 1.4 2.2 1.0 2.1 1.6 2.2 2.1 1.9 1.2 1.5 1.7 1.9 Hammersmith 2.8 2.9 2.7 2.7 1.7 1.8 2.1 1.5 1.5 1.8 2.1 2.3 Chelsea (Home District 2.3 1.0 2.2 2.7 2.8 3.6 5.7 3.2 2.0 2.5 2.8 2.0 London 1.5 1.4 1.9 3.0 2.4 2.5 3.1 3.0 2.6 3.0 2.6 2.6 School Influences. Both Diphtheria anil Scarlet Fever being especially diseases of children, we must expect that the daily aggregation of such individuals will tend to widen its prevalence, especially as, not infrequently, the disease being of a mild type, children actually suffering have been found to be attending school. The following tables give the number of children in actual attendance at each school who were notified in each month as suffering from Scarlet Fever and Diphtheria, and Table XXIII. gives the number of children on the roll of each primary school in Fulhain, from which the large susceptible population of the district can be seen, TABLE XXI. Number of children attending the Board and other primary Schools who were notified in each month as suffering from Scarlet Fever. August. March. April. May. June. July. Sept. School. Feb. Oct. Nov. Dec. Jan. Ackmar Road 1 1 1 2 3 2 4 4 3 3 All Saints (Denominational Elizabethan (denominational ... 4 7 1 2 1 2 1 7 3 3 Everington St. 3 Fulham Palace Road 1 1 Halford Road 3 2 1 2 1 7 3 4 Harwood Road 1 1 4 2 1 1 2 1 Holy Cross (Denominational 2 Hugon Road 5 2 3 2 6 3 2 4 5 3 Kingwood Road 1 1 1 1 1 5 1 1 7 2 Langford Road. 2 1 2 2 1 2 7 1 1 3 2 2 Lillie Road 2 2 1 1 2 3 6 Munster Road 1 1 1 1 2 3 2 1 1 1 5 1 1 North End Rd. 1 1 Sherbrooke Rd. 1 1 2 3 4 3 2 St. Dunstan's Road St. Thomas's Road (Denominational) 1 2 1 St. John's (Denominational) 2 Star Road 3 1 1 1 1 3 1 Townmead Rd. 2 3 William Street 1 1 19 42 21 15 13 23 17 24 2 25 38 21 260 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE XXII. Number of children attending the Board and other primary Schools in Fulham who were notified in each month as suffering from Diphtheria. August. March. July. School. April. June. Sept. Nov. Dec. Feb. May. Oct. Jan. 1 1 1 ... Ackmar Road 1 1 3 All Saints (Denominational) ... ... ... Elizabethan (denominational) ... 1 ... 1 ... Everington St 3 1 2 2 Fulham Palace Road ... ... Halford Road 1 1 1 1 3 ... 1 1 ... ... ... 2 Harwood Road 1 1 2 7 1 Holy Cross (Denominational) 2 3 2 1 1 Hugon Road 2 2 1 2 3 1 5 10 4 4 1 Kingwood Road 2 3 5 1 4 ... Langford Road ... 2 3 1 1 3 18 8 2 Lillie Road 3 2 2 1 3 6 1 1 1 3 2 Munster Road 2 1 2 1 8 3 1 North End Rd 2 1 2 7 2 Sherbrooke Rd. 1 1 5 10 2 2 St. Dunstan's Road 3 3 2 2 3 3 5 4 St. Thomas's Road (Denominational) 5 5 1 3 1 St. John's (Denominational) 1 1 1 1 2 1 Star Road 1 3 3 8 2 2 1 2 Townmead Rd 1 1 William Street 1 1 2 1 20 9 19 26 14 25 13 29 6 24 76 31 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE XXIII. Showing the number of children on the rolls of the Board and other primary Schools in Fulham. Boys. Girls. Infants. Mixed. Total. Ackmar Road Board School 527 550 609 1,686 - Everington Street 440 413 572 1,425 Fulham Palace Road „ 253 214 467 Halford Road 495 480 629 1,604 Harwood Road „ 410 392 520 1,322 Hugon Road 430 433 536 1,399 1,453 Kingwood Road 461 456 536 Langford Road 555 595 675 1,825 Lillie Road 508 527 612 1,647 Munster Road 466 465 605 1,536 North End Road 373 389 529 1,291 St. Dunstan's Road 460 466 400 1,326 Sherbrooke Road 426 472 646 1,544 Star Road 375 380 502 1,257 Townmead Road 167 152 146 465 William Street 475 513 509 1,497 All Saints' Denominational 179 179 Elizabethan - 30 48 78 Holy Cross 140 182 322 St. John's 265 268 533 St. Thomas's 298 261 290 849 7,045 6,944 9004 712 23,705 Enteric Fever. 92 cases were notified or 6.9 per 10,000 inhabitants, the disease being less prevalent than in 1899. Fatality.—There were 19 deaths, giving a case mortality of 20.7 per cent., the average for the past seven years being 20.8. Personal infection by unrecognised cases gave rise to 3 subsequent cases in a house in Walham Avenue, to 3 in a house in Francis Street, and to 2 in a house in St. Olaf's Road. In 3 cases the disease was attributed to shellfish. In 7 cases the disease was contracted outside the district, - - ... - - - - - - - - - - - - - - - - - - - - - - TABLE XXIV. Incidence of Enteric Fever in Fulham, London and adjoining districts, during the last ten years Cases of Enteric Fever notified per 1000, inhabitants: Average for 10 yrs 1890-1899 1890. 1891. 1892. 1894. 1895. 1896. 1897. 1898. 1899. 1900. 1893. Fulham 0.82 0.55 0.43 0.56 0.32 0.52 0.46 0.44 0.53 0.84 0.55 0.69 Kensington 0.49 0.62 0.31 0.59 0.56 0.62 0.42 0.61 0.54 0.61 0.58 0.58 Hammersmith 0.70 0.46 0.41 0.65 0.51 0.54 0.49 0.42 0.57 1.01 0.57 0.90 Chelsea 0.68 0.50 0.52 0.77 0.92 0.73 0.68 0.54 0.57 0.60 0.64 0.84 London 0.71 0.85 0.61 0.92 0.53 0.80 0.72 0.70 0.68 1.00 0.78 0.97 Isolation of patients suffering from infectious diseases. Accommodation for persons suffering from Scarlet Fever, Diphtheria, Enteric Fever, Typhus Fever, and Small-pox, is provided by the Managers of the Metropolitan Asylums Board at their various hospitals, and the increasing recognition by the public of the advantages accruing from the isolation of the infectious sick, is shown by the steadily increasing proportion of patients suffering from those diseases who are removed to hospital. TABLE XXV. Percentage of notified cases in Fulham removed to isolation Hospitals. Scarlet Fever. Diptheria. Enteric Fever. 1891 64.4 41.5 37.3 ....... 1892 75.0 64.0 66.0 ...... 1893 63.6 48.0 45.0 1894 78.0 70.0 70.0 1895 70.0 74.0 45.6 1896 62.5 60.0 38.0 1897 75.0 65.0 41.5 1898 79.0 81.1 50.0 1899 81.7 81.6 51.0 1900 84.0 86.9 72.5 In these years the accommodation in the Board's hospitals was inadequate, and many patients remained at home who otherwise would have been removed, ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... - ...... All the cases of Small-pox which have occurred in Fulham have been removed to the hospital ships. Continued Fever.—Two cases were notified as Continued Fever. Typhus Fever.—No case of Typhus Fever has been notified in Fulham since 1893. Erysipelas.—154 persons were certified to be suffering from Erysipelas, which was the assigned cause of 13 deaths. Puerperal Fever.—Nine cases or two per 1,000 births were notified, of which three or 67 per 1,000 births proved fatal. In addition to the disinfection of the bedding, &c., and of the houses in which cases occur, the clothing of the nurses who have attended the cases is always disinfected, and explicit instructions are given to them respecting the thorough disinfection of their persons before undertaking other cases. That the mere lapse of time affords no security is shown by the following case. In December, a woman died from Puerperal Septicaemia, in the Western Fever Hospital, to which she had been removed, having been certified to be suffering from Scarlet Fever. Five months afterwards her sister-in-law, residing in another part of the borough, was notified as suffering from Puerperal Fever, and died on the 5th day after confinement. It was ascertained that some of the clothing and linen, which had been used by the first patient, had been given to her sister-at-law, without, it would appear, having been given up to be disinfected with the bedding, &c.; and as no other source of infection was in any degree probable, there is the strongest presumption that the infection was conveyed by the linen. Deaths from Non-notifiable Zymotic Diseases. Measles.—The usual biennial epidemic of Measles which commenced in November, 1899, continued for the first three months of 1900, during which period there were GO deaths, and during the year 80 deaths were ascribed to the disease. The fatality of Measles in the various wards of the Borough will be seen in Table XI. Among the factors which tend to spread Measles may be reckoned the carelessness and ignorance of parents who make no attempt to prevent their children who are suffering from the disease from associating with others, it being no uncommon thing for children to be found attending school who are obviously suffering from the disease. With a view of preventing this and of endeavouring to bring home to parents the fact that Measles is a dangerous infectious disease, the late Vestry, in 1897, requested the Local Government Board to sanction the application to Measles, in addition to the other diseases specified in the Act, of the provisions of Section 68 of the Public Health (London) Act, 1891, which render a person liable to a penalty who, "while suffering from any dangerous infectious disease, wilfully exposes himself without proper precautions against spreading the disease, or being in charge of any person so suffering, so exposes such sufferer." To this request the Local Government Board replied " that the question of extending certain of the provisions of the Public Health (London) Act, 1891, to diseases other than those specified in Section 55 of the Act is one which would be more satisfactorily considered with regard to the metropolis as a whole than with regard to individual sanitary districts. Under Sections 56 (b) and 58 this could be done by the London County Council with the Board's approval, and the Board would suggest that, in the first instance, if the Vestry are desirable that the provisions of Section 68 should be made applicable to Measles, they should bring the matter under the attention of the County Council." The Vestry accordingly communicated with the London County Council, who have recently been again in communication with the Metropolitan Borough Councils, to ascertain their views on the matter. With regard to the question of the notification of Measles, I would reiterate my opinion that a modified system of notification of Measles should be tried, by which the first attack in every house invaded shall be notified, but no subsequent case occurring in the same house within thirty days; and, as in so many cases no doctor is called in, it would also be essential to enforce dual notification by the parent or guardian as well as by the doctor, and the exception as to secondary cases should apply only to notification by the medical practitioner. I must also again draw attention to the necessity of providing 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 who would be saved if they could be removed from the unfavourable conditions by which they are surrounded and treated in a rational manner. Whooping Cough. 54 deaths were ascribed to this disease, being 17 below the average for the last 7 years, allowing for the increase of the population. The death-rate was 041 and that of the County of London 0.44. Diarrhoea. Under the heading Diarrhoea are included several different affections, confounded with one another on account of the presence of Diarrhoea as a symptom, but there is no doubt that Summer Diarrhoea, which is so fatal to infants, is essentially a specific disease. In previous reports mention has been made of the want of uniformity in the classification of deaths from Diarrhoea, owing to the various names used in death certificates in respect of deaths due to epidemic Diarrhoea and the consequent invalidation of comparative statistics dealing with the diarrhœal and zymotic death-rates. A circular letter was sent last year to all medical practitioners residing in Fulham, drawing their attention to the fact that the Royal College of Physicians had, consequent upon representations made by the Society of Medical Officers of Health, sanctioned the use of the terms Epidemic Enteritis or Zymotic Enteritis as a synonym for Epidemic Diarrhoea, the latter being the title authorised by the " Nomenclature of Diseases " and recommended the entire disuse as synonyms of Epidemic Diarrhoea of such terms as Gastro-Enteritis, Muco-Enteritis or Gastric Catarrh, As a result of this, there was a marked diminution in the number of deaths under these latter headings, and where they were used enquiries were made of the certifying practitioners as to whether they considered these deaths to have been of the nature of Epidemic Diarrhoea, and when this was the case the deaths are included under the head of Diarrhoea. In 1900, Diarrhoea was the cause of 156 deaths, including 11 ascribed to Gastro-Enteritis, which were stated by the certifying practitioner to be of the nature of Epidemic Diarrhoea. In 1899, Diarrhoea was given as the cause of 183 deaths, while 141 were ascribed to Enteritis, Gastro-Enteritis, etc., as against 33 in 1900, so that the actual decline in the fatality of this disease was much greater than is shown by the figures for Diarrhoea alone. The mortality was equal to a rate of 1.17 per 1,000 which was only exceeded by five of the London Sanitary Districts. In the 33 large towns Diarrhoea caused a mortality equal to a rate of 0.94 per 1,000, ranging from 0.23 in Halifax, 0.29 in Bradford, 0.37 in Newcastle-upon-Tyne, to 1.44 in Liverpool, 1.52 in Sheffield, 1.67 in Preston and I.68 in Hull. The following table gives the Diarrhœal death-rate of Fulham, London, and the adjoining parishes during the last 10 years:— TABLE XXVI. Deaths from Diarrhœa per 1,000 living. Average of io yrs-1890-1899 1895 1896 1890 1891 1892 1893 1894 1897 1898 1899 1900 Pulham 1.04 1.16 0.94 1.30 0.53 1.18 1.15 1.21 1.45 1.40 1.14 1.17 0.46 Kensington 0.52 0.41 0.60 0.33 0.68 0.35 0.70 0.64 0.59 0.53 0.62 Hammersmith 0.96 0.90 0.70 0.79 0.79 0.80 0.46 1.20 1.12 0.93 0.86 0.86 Chelsea 0.50 0.62 0.77 0.76 0.34 0.82 0.67 1.03 0.77 0.66 0.70 0.85 London 0.66 0.57 0.60 0.80 0.41 0.82 0.71 0.92 0.97 0.92 0.75 0.80 It will be noticed in Table XI that upwards of 80 per cent, of the total registered deaths from Diarrhoea occur under one year of age, and it has been pointed out that to state the deaths from Diarrhoea in terms of the total population unfairly handicaps tricts with a large infantile population, i.e.—a high birth-rate, and that the statement of the relation borne by the total number of deaths from Diarrhoea to the number of births affords a more accurate method of comparison. Calculated in this way, the Diarrhœal rates for Fulham, the adjoining Parishes and London, are as follows: — TABLE XXVII. Deaths from Diarrhœa per 1,000 Births in 1900. Fulham 34.5 Kensington 30.0 Hammersmith 31.7 Chelsea 36.5 London 27.0 The following Table gives the number of deaths per 1,000 births ascribed to Diarrhoea and Enteritis since 1893 in Fulham and London. TABLE XXVIII. Deaths from Diarrhœa and Enteritis per 1,000 Births. Fulham. London. 1893 45.3 32.1 1894 22.1 ... 21.0 1895 45.1 38.3 1896 46.9 36.8 ... 1897 52.1 48.0 ... 1898 61.7 52.5 1899 70.8 56.4 1900 43.9 43.8 Influenza. 49 deaths were directly attributed to Influenza, which was epidemic in the beginning of the year. In the three preceding years it caused 19, 24 and 49 deaths. Deaths from Tubercular Diseases. Of these 210 were due to Phthisis and 89 to other tubercular diseases such as Tubercular Meningitis, Tabes Mesenterica, and General Tuberculosis, these diseases accounting for 12.8 per cent, of the deaths from all causes and it is probable that many of the deaths ascribed to Marasmus, Debility, Convulsions, etc., were tubercular in nature. ... ... ... ... ... ... ... ... ... ... 45.1 ... ... In the several Wards of the Borough the death-rates from Phthisis were as under: — TABLE XXIX. Deaths per 1,000 of the estimated population of each Ward from Phthisis and other Tubercular Diseases. Death-rate from Phthisis. Death-rate from other Tubercular Diseases. Death-rate from all Tubercular Diseases. Baron's Court Ward 1.7 0.16 1.86 Lillie Ward 2.0 0.42 2.42 Walham Ward 2.0 0.77 2.77 Margravine Ward 1.6 1.40 3.00 Munster Ward 1.4 0.50 1.90 Hurlingham Ward 1.33 0.5 0.78 Sands End Ward 1.3 0.63 1.93 Town Ward 1.3 0.73 2.03 TABLE XXX. Table giving the Phthisis death-rate of Fulham, the adjoining parishes and London for 1900, and the preceding 7 years. Average for 7 years. 1893 1894 1895 1896 1897 1898 1899 1900 Fulham 1.51 1.57 1.51 1.75 1.90 1.42 1.40 1.66 1.53 1.47 1.83 1.55 1.57 Kensington 1.53 1.49 1.42 1.44 1.26 1.34 1.43 1.18 Hammersmith 1.58 1.56 1.40 1.39 1.48 1.72 1.52 1.61 Chelsea 1.92 1.82 1.80 1.74 1.79 1.78 1.72 1.64 1.72 1.77 1.68 1.71 1.72 1.82 1.76 1.80 London Cancer. Malignant diseases caused 110 deaths, the average for the preceding 7 years being 99. Venereal Diseases. These were the assigned cause of 11 deaths. Diseases of the Respiratory System From these diseases there were 510 deaths, or 21.8 per cent, of the deaths from all causes, being 30 above the average of the last 7 years, allowing for the increase of the population. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Heart. 142 deaths were ascribed to diseases of the heart. Diseases and Accidents of Parturition. Six deaths were registered as due to diseases and accidents of parturition. The total number of deaths reported as occurring within 21 days of childbirth was 16, the causes assigned being : — TABLE XXXI. Septicæmia 3 Erysipelas 1 Scarlet Fever 1 Enteric Fever 1 Enteritis 1 Albumenuria 1 Gastric Ulcer 1 Pneumonia 1 Puerperal Convulsions 2 Hæmorrhage 4 16 Or one death to every 283 births. Deaths from Violence. Different forms of violence caused 87 deaths. TABLE XXXII. Accident or Negligence. Falls 23 Run over 8 Burns 6 Drowning 3 Suffocation of infants in bed 24 Otherwise 12 76 Suicides 9 Manslaughter 1 Murder 1 87 Certification of the Causes of Death. Of the 2,847 deaths registered, 2,155 or 91.8 per cent, were duly certified by registered medical practitioners, and 189 or 8.1 per cent, by the Coronor after inquest, only 3 or 0.13 per cent, being uncertified. Inquests. Of the 189 held on parishioners, 152 were held in the parish, and 37 outside. Their ages were — TABLE XXXIII. Under 5 71 5 to 65 93 Over 65 25 189 The accidental deaths have been already classified, and those due to natural causes may be classified as follows:— TABLE XXXIV. Zymotic diseases 4 Respiratory 22 Tubercular 8 Circulatory 36 Convulsions and other diseases of the nervous system 10 Other diseases 32 112 DEATHS IN PUBLIC INSTITUTIONS. Fulham Infirmary and Workhouse. Although the two parishes, Fulham and Hammersmith, which formerly constituted the Fulham Unions, are now separated for poor law purposes, the poor of Hammersmith are still, by an arrangement between the Boards of Guardians, received into this institution. In 1900, 527 deaths occurred in the Infirmary, and 22 in the Workhouse. Of these, 308 were parishioners of Fulham and 241 belonged to Hammersmith and other parishes. Western Fever Hospital. 171 deaths occurred in the Western Fever Hospital. Of these, 68 belonged to Fulham and 103 to other Metropolitan Districts. Of the 2,347 deaths registered during the year 487 or 25 per cent took place in public institutions. The percentages in the several classes of institutions in Fulham and London were as follows :— TABLE XXXV. Fulham. London. Deaths occurring in Workhouses and Workhouse Infirmaries 13.2 15.8 Deaths occurring in Metropolitan Asylums Board Hospitals 35 2.0 Deaths occurring in other Hospitals 6.6 10.3 Deaths occurring in Public Lunatic and Imbecile Asylums 1.7 2.4 25.0 30.5 Deaths occurring outside the District among persons belonging thereto. The deaths of parishioners in public institutions and elsewhere outside the parish numbered 225, and occurred in the following places:— TABLE XXXVI. Number of Deaths of residents in Fulham. St. George's Hospital 55 West London Hospital 25 Charing Cross Hospital 5 St. Bartholomew's Hospital 3 Guy's Hospital 1 3 King's College Hospital Middlesex Hospital 2 5 Westminster Hospital 2 London Hospital St. Thomas' Hospital 2 St. Mary's Hospital 5 Jubilee Hospital 3 Bolingbroke Hospital 1 Brompton Hospital for Consumption 12 Cancer Hospital 9 Royal Chest Hospital 1 Victoria Hospital for Children 10 Hospital for Children, Paddington 1 Evelina Hospital for Children 1 Cheyne Hospital 1 Belgrave Hospital for Children 1 Chelsea Hospital for Women 2 Hospital for Women, Euston Road 1 National Hospital for Nervous Diseases 2 Hospital for Diseases of Heart, Soho 1 Fountain Fever Hospital 10 Grove Fever Hospital 4 Hanwell Asylum 11 Leavesden Asylum 5 Darenth Asylum 1 Dartford Asylum 3 Ilford Asylum 2 Caterham Asylum 2 Banstead Asylum 5 Cane Hill Asylum. 4 Colney Hatch Asylum 2 Manor House Asylum, Epsom 2 Camberwell House Asylum 1 Middlesex County Asylum 2 Friedenheim 1 St. Joseph's Home 1 St. George's Infirmary 1 In private houses and elsewhere in other districts 14 225 Public Mortuary 186 bodies were removed to the Mortuary during the year and were admitted as follows : — TABLE XXXVII. At the request of the Coroner 160 Brought in by the Police 22 At the request of the Medical Officer of Health 4 186 Inquests were held on 183, and post-mortem examinations were made in 102 of the above cases. VACCINATION. The following Tables, furnished by Mr. Davies, the Vaccination Officer, give the Vaccination returns for 1899, and for the first six months of 1900, those for the last six months not being yet complete :— TABLE XXXVIII. Supplemental Return for 1899, fur the Parish of Fulham. No of Births Registered from 1st Jan. 1899, to 30th June, 1900. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead. Postponed by Medical Certificate. Removed. Outstanding. Certificates Granted under Clause 2 of the Vaccination Act of 1898. 4,581 3360 27 I — 615 76 340 44 66 Return of Vaccinatiun fur the period from January to June, 1900, for the Parish of Fulham. TABLE XXXIX. No. of Births Registered from 1st Jan., 1899, to 31st Dec., 1900. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead. Postponed by Medical Certificate. Removed. Outstanding. Certificates Granted under Clause 2 of the Vaccination Act of 1898. 2,251 1707 167 - 197 99 21 1 26 6 It is gratifying to note that the "conscientiousobjections" have fallen from 90 in 1898 to 66 in 1899, and the proportion of cases " not fully accounted for " from 15.2 per cent, in 1898 to 10 per cent, in 1899. DISINFECTION. Infected articles were disinfected as heretofore by the contractor, Mr. Lacy, St. John's Wharf, by whom they were also collected. The weight of the articles disinfected was 2.009 cwt., and the amount paid to Mr. Lacy, £1256. During the last three years, the cost of disinfection has averaged £1,247 a year. The disinfecting station which has been erected at a cost of £4,330, in Townmead Road, is now in use. This is most complete in every respect, and comprises two Equifex Disinfecting Stoves, the largest being 9 feet long by 6 feet diameter, and a well equipped laundry for washing and cleansing articles when necessary. BACTERIOLOGICAL EXAMINATIONS. In 1897, the Vestry made arrangements with the Jenner Institute of Preventive Medicine for the bacteriological examination of suspected material, and increasing use is being made by medical practitioners of the facilities afforded them of availing themselves of this important aid to diagnosis, 102 specimens being examined in 1898, 164 in 1899, and 289 in 1900. Diphtheria.—Material from 247 cases was examined, and the Klebs-Löffler, or true Diphtheria bacillus was isolated in 90, and the pseudo-diphtheritic, or Hoffman's bacillus, in 44. Enteric Fever. —Blood from 23 cases was examined, and the Widal, or Typhoid reaction, was obtained in 8. Tuberculosis.—Sputum from 19 cases was examined, and the bacillus of Tubercle was found in 7. HOUSES LET IN LODGINGS. There are 329 houses on the register. I reported last year that difficulties had arisen in connection with the definition of the term " landlord" in the bye-laws, and new bye-laws were framed by the late Vestry to obviate this and such other difficulties which had been experienced, these are still under the consideration of the Local Government Board, and pending their approval the registration of houses let in lodgings remains in abeyance. CUSTOMS AND INLAND REVENUE ACTS 1890 and 1891. Certificates under these Acts were granted in respect of 78 separate tenements and refused in respect of 262. Notice has been given to the Surveyor of Taxes that all certificates granted will be withdrawn after April 5th, 1901, and that those owners who wish to claim exemption from or abatement of inhabited house duty for the financial year ending April 5th, 1902, must apply for a renewal of the certificates. COMBINED DRAINAGE. Tenders for the reconstruction of the " sewer portions " of 48 systems of combined drainage at a cost of £783 were accepted during the year, and the sum of £55 was paid to owners of houses in respect of drainage work executed by them in compliance with the notices of the late Yestry in connection with house drains which were " sewers" within the meaning of the Metropolis Local Management Act. There seems to be no prospect of any amendment of the present inequitable law, as the London County Council appear to have dropped their Bill to amend the definition of the word " drain " in the Metropolis Management Act. HOUSE DRAINAGE. Steady progress continues to be made with the work of bringing the drainage of the houses in the borough into a thoroughly sound condition, and the drains of 410 houses were reconstructed in accordance with modern requirements during the year. By the standing orders recently adopted by the Council the supervision of the drains and sanitary appliances of new houses has been transferred from the Works to the Public Health Department, and the two drainage inspectors employed in this work placed under the direction of the Medical Officer of Health. No bye-laws for regulating the dimensions, form and construction of drains under Section 202 of the Metropolis Management Act, 1855, have yet been made by the London County Council, although a draft of proposed bye-laws was forwarded to the late Vestry by the Council in 1896. DAIRIES AND COWSHEDS. By the London Government Act, 1899, the duty of enforcing the bye-laws and regulations with respect to cowsheds, dairies and milkshops was transferred to the Borough Council. There are 3 licensed cowsheds and 210 registered dairies and milkshops in Fulham, and arrangements have been made for their regular inspection. BAKEHOUSES. There are 85 bakehouses in Fulham. of which 70 are underground. These on inspection were found in fair condition. By the Factory and Workshop Acts Amendment Bill, which has been brought in by the Home Secretary, it is provided (1.) That after the first day of January, 1904, an underground bakehouse shall not be used, unless certified by the District Council to be suitable for that purpose, and for the purpose of this section an underground bakehouse shall mean a bakehouse, any room of which is so situate that the surface of the floor is more than three feet below the surface of the footway of the adjoining street, or of the ground adjoining or nearest to the room. (2.) An underground bakehouse shall not be certified as suitable unless the District Council is satisfied that it is suitable as regards construction, light, ventilation and in all other respects. This is a desirable amendment of the law, but it would be advisable to enact that the certificate must be renewed every five years. SMOKE NUISANCES. Ten abatement notices under the Public Health (London) Act, were served in respect of smoke nuisances, and three offenders were prosecuted, fines and costs to the amount of £3l 1s. being imposed. HOUSE REFUSE. The weekly service for the removal of house refuse has been fairly regular, but some better system of dealing with the arrears consequent upon public holidays should be devised, the complaints respecting the delay in removal being always numerous after these. It is also to be regretted that the local authority have not provided for a more frequent removal of the refuse from flats, the necessity for which I have frequently pressed upon them, as owing to the limited open space in connection with these buildings, an accumulation of over three or four days' refuse gives rise to a serious nuisance. In fact, having regard to the importance of prompt removal of house refuse, which, containing as it does, a condererable quantity of vegetable matter, very speedily becomes most offensive, the Council should, in my opinion, provide at least a bi-weekly service. DISPOSAL OF REFUSE. This is now burnt at the Destructor erected by the Horsfall Company at the Townmead Road Wharf. The working of this has been most successful, and this method of disposal is much more satisfactory than that of removal by barges, formerly practised. SEWERS. The sewers belonging to the local authority were always at once thoroughly flushed, on complaints being made respecting offensive smells from the surface ventilators, and ventilating shafts were placed in all suitable places, when permission from the owners of the houses could be obtained. The flooding of the basements in the neighbourhood of Field Road, owing to the inadequacy of the County Council's main sewer, was again brought under the notice of the Council. OPEN SPACES. Fulham possesses about fifty acres of open spaces, or 3 per cent, of its area, as compared with 8.2 per cent, for all London. I have, in former reports, urged the necessity, in view of the rapid increase of the population, for additional open spaces, and it is to be hoped that the Council's negotiations for the acquirement of some 22 acres adjacent to Wandsworth Bridge Road, for this purpose, will not fall through, as there is a large working class population in the immediate neighbourhood, and the advantage it will be, especially to the children, is inestimable. HOUSE ACCOMMODATION.—OVERCROWDING. In Fulham, with its large working class population, the housing question is of paramount importance, as the increasing demand, due to constant immigration from other districts, the rise in the value of land, and the enhanced cost of building operations, tend steadily to raise the rents of working class property. With regard to the amount of overcrowding that actually exists, it is difficult to speak with absolute confidence, as the Census figures on which we must mainly rely for information, are ten years old; but I have no reason to think that, although the population has largely increased, the proportion of those living in overcrowded conditions is greater than it was in 1891. At that time Fulham, as regards overcrowding, compared favourably with London as a whole, 14.3 per cent, of the population living in overcrowded conditions, i.e., more than two persons to a room, compared with 20.8 per cent, in the County of London. The details, however, of the Census of 1901 will shortly be procurable, and then a more accurate knowledge of this point can be formed. The question that the Council must shortly decide, is whether they should avail themselves of their powers under Part 111 of the Housing of the Working Classes Act, 1890, and build houses for the working classes. The Surveyor has prepared a list of the vacant lands in Fulham, embracing some 190 acres, which are available, but it is to be feared that the price of land in the borough, which probably could not be bought under £2,500 an acre, and the increased cost of building would preclude the erec- tion of houses which would return the interest on the capital borrowed, if let at the rents they should be, if they are to benefit those for whom they are intended, i.e., at about 2/-, or at the most 2/6 per week a room. With regard to the increased cost of building, it may be mentioned that the experience of the London County Council in connection with the buildings they have erected, is that the combined effect of the rise in the cost of materials and rates of wages, and the decrease in the number of bricks laid per diem, has been to raise the price of brickwork per rod from £11 in 1890 to £20 15s. at the end of 1898. The Council will, however, if they build some houses for their own employes on their vacant land in Townmead Road, as they have resolved, be able to ascertain by practical experience whether they can with advantage extend their operations in this direction. Prosecutions under the Public Health (London) Act, and the Metropolis Local Management Acts. Proceedings under the Public Health (London) Act. and the Metropolis Local Management Acts, were instituted in the following cases : — TABLE XL. Defendant. Offence. Result. Penalty. Costs. J. Painter, 2, Dowell mews Failing to remove manure. Convicted. 0 13 0 0 2 0 F. Stevens, 3, Dowell mews Ditto. Ditto. 1 14 0 0 2 0 C. Allam, 48, Sherbrooke road Ditto. 0 10 0 0 2 0 Ditto. Defendant. Offence. Result. Penalty. Costs. J. Kinsey, 191, North End road Ditto. Dismissed. .. .. Wm. Rolfe, 7, Dowell mews .. .. Ditto. Ditto. A. Alexander, 9, Dowell mews Ditto. Ditto. .. .. Ditto. C. Howell, 226, North End road Convicted. 0 0 7 0 2 0 Ditto. Ditto. R. Martin, 17, Lintaine grove 0 5 0 0 2 0 Dismissed. F. Stevens, 17, Dowell mews Ditto. .. .. Ditto. Convicted. James Morgan, 18, Dowell mews 0 0 10 0 2 0 0 R. Knowles, 141, Victoria street Ditto. Ditto. 0 6 2 0 0 R. Brand, 2, Mulgrave road Ditto. Ditto. 0 7 0 0 2 0 Ditto. Ditto. 0 0 W. Kirby, 15, Dowell mews 5 0 2 0 Owner of 637, Fulham road Premises in such a state as to be a nuisance. Order made to abate nuisance within 14 days. .. 3 0 0 Order made to abate nuisance within 28 days. Owner of 19, Munster road .. 0 3 0 Premises in such a state as to be a nuisance. Owner of 9, Munster road Ditto. 0 Ditto. 3 0 .. Ditto. Ditto. .. Owner of 7, Munster road 0 3 0 Defendant. Offence. Result. Penalty. Costs. Ditto. Owner of 5, Munster road Ditto. 0 3 0 .. Ditto. Owner of 11, Munster road Ditto. .. 0 8 0 Failing to comply with the Vestry's notice to re-lay the drain at 3, Lalor street. 5 Walter Hall, 38, Chancery lane Convicted. 0 0 .. Walter Hall, 38, Chancery lane Premises No. 3, Lalor street, in such a state as to be a nuisance. Order made to abate nuisance within 14 days. 0 6 0 .. Owner of 100, Townmead road Premises in such a state as to be a nuisance. Ditto. .. 0 6 0 London Road Car Company Chimney of the factory in Farm lane giving forth black smoke in such quantity as to be a nuisance on Feb. 27th, 1900 Convicted. 0 1 0 3 0 1 London Road Car Company Ditto on Mar. 6th. Ditto. 3 0 0 0 2 0 Ditto on Mar. 26th. Ditto. 3 London Road Car Company 0 0 0 2 0 Ditto. J. W. Gee, Failing to comply with the Vestry in order to re-lay the drain at 44, Marville road. 2 0 0 1 1 0 Premises at rear of 125, North End road, in such a state as to be a nuisance. Order made to abate nuisance within 14 days. Midland Railway Company 0 8 0 .. London Road Car Company Ditto. Withdrawn on payment of costs. 4 4 0 .. J. Pearson, Ditto. Ditto. .. .. Defendant Offence. Result. Penalty. Costs. J. S. Hodgkin & Co. Chimney of dyeing works sending forth black smoKe in such quantity as to be a nuisance on May Bth. Convicted. 0 10 10 10 0 0 J. 8. Hodgkin & Co. Ditto. Ditto. 0 10 0 .. .. Occupier of 153, North End road Premises in such a state as to be a nuisance. Closing order. 0 6 0 0 Owner of 15, Mimosa street Ditto. Order made to abate nuisance within 14 days. 3 0 .. Owner of 25, Mimosa street Ditto. Ditto. .. 0 0 3 0 .. Owner of 28, Dancer street Ditto. Ditto. 3 0 0 J. L. Smith, Normand mews Failing to remove manure. Convicted. 6 10 0 2 0 0 A. T. Wallis, Ditto. 5 2 Allowing 19, Bronsart road to be occupied without having obtained a certificate of water supply. 0 0 0 Occupier of 20, Epple road Premises in such a state as to be a nuisance. Order made to abate nuisance within 48 hours. 0 6 0 .. Convicted. 0 Drain at 2, Hazlebury road in such a state as to be a nuisance, which arose from the wilful act or default of the defendants. F. & J. Silles 5 0 0 2 0 Defendant. Offence. Result. Penalty. Costs. Occupier of 153, North End road Failing to comply with the magistrate's order to close the premises Ditto. 5 0 0 .. F. Fielder, 21, Inverness terrace Failing to remove manure. Ditto. 2 0 0 0 2 0 London General Omnibus Company Ditto. Ditto. 5 0 0 0 2 0 Fulham Pottery Co. Ditto. Ditto. 1 0 0 0 2 0 Wickens Pease & Co. Removing offensive refuse during prohibited hours. Dismissed. .. .. T. Temple Allowing 131a,Munster road to be occupied without having obtained a certificate of water supply. Convicted. 10 0 0 0 2 0 0 Henrici Laundry Walham Green Chimney of laundry giving forth black smoke in such quantity as to be a nuisance. (3 summonses). Ditto. 9 0 0 0 6 Owner of 7, Mirabel street Premises in such a state as to be a nuisance. Order made for work to be done within 14 days. 1 1 0 .. 2 0 J. Olding Allowing 61, Langford road to be occupied without a certificate of water supply. Convicted. 2 0 0 0 J. Hills Depositing filth in the roadway. Ditto. 0 8 0 0 2 0 C. Taylor, 24, Greyhound road Exposing for sale unsound meat. Ditto. 3 0 0 0 2 0 £ 74 15 0 23 4 0 In 27 other cases in which proceedings had been instituted, the summonses were withdrawn on the payment of the costs of the summonses, the works necessary to abate the nuisances having been executed. PROCEEDINGS UNDER THE SALE OF FOOD AND DRUGS ACTS. TABLE XLI. The following samples were taken for analysis in 1900: No. of Samples. No. adulterated. Percentage of Adulteration. Article. 89 12.4 Milk 11 Butter 117 8 6.9 Margarine 22 1 4.8 Coffee 5 - - - - - - - - - - - 6.6 - - - - - Lard 10 - Mustard 9 - - - - - - - - 1 - - - - Camphorated Oil 1 Salad Oil 1 Baking Powder 10 Seidlitz Powder 2 Vinegar 3 Pepper 5 Tinned Peas 6 Whisky 15 Brandy 12 Gin 5 Ale 46 Glucose 3 Invert Sugar 2 - 363 21 5.8 In the three preceding years the percentage of adulterated samples was 12.6, 11 1, and 13.1. One sample was obtained to every 368 persons, the proportion in London, in 1898, being one sample to every 390 persons. TABLE XLII. Proceedings were instituted in the following cases:- Result. Penalty. Costs. Defendant. Offence. A. Wrangham, 240, North End road Selling butter adulterted with 90 per cent, of margarine Convicted 0 10 0 0 12 A. Wrangham, 240, North End road Selling margarine by retail without properly marked wrapper Convicted .. 0 2 J. Helm, 236, Lillie road Selling butter adulterated with 90 per cent, of margarine Convicted 2 0 0 0 12 J. Helm, 236, Lillie road Selling margarine by retail without properly marked wrapper Convicted .. 0 2 The Grocery & Provision Shop Association, 6, Salisbury Pavement Selling margarine containing an excess of butter fat Convcted 1 0 0 0 12 Alice Scarlett, 48, Bagley's lane Selling milk from which 12 per cent. of its natural fat had been extracted Convicted 0 0 0 2 4 T. Bashford, 8, Greyhound road Selling butter adulterated with 90 per cent, of margarine Convicted 3 0 0 0 12 T. Bashford, 8, Greyhound road Selling margarine by retail without a proper wrapper Convicted .. 2 0 E. James, 2, Everington street Selling butter adulterated with 90 per cent, of margarine Convicted 7 0 0 0 12 W. J. Shillitoe, 162, Wandsworth Bridge road Selling milk from which 25 per cent, of its fat had been extracted Convicted 3 0 0 0 12 0 E. James, 2, Everington street Exposing margarine for sale by retail unlabelled Convicted 3 0 0 12 Offence. Result. Penalty. Cost. Defendant. Delivery to the Guardians at the Fulham Workhouse milk from which 8 per cent, of fat had been abstracted Withdrawn warranty proved The Great Western & Metropolitan Dairies' Company. 9, Harrow street .. .. E. P. Gibbs, 324, Lillie road Selling milk adulterated with 10 per cent, of added water Convicted 2 0 0 0 12 6 W. Edwards, 607. King's road Selling milk adulterated with 6 per cent, of added water Dismissed warranty proved .. .. W. Edwards, 607, King's road Selling milk from which 25 per cent, of its fat had been abstracted Dismissed warranty proved .. .. Whiteman & Cox, 47, Princes road, W. Giving a false warrantry in respect of milk found to be adulterated Withdrawn on payment of costs .. 2 0 0 R. Fairbain, 2, Munster road Exposing margarine for sale unlabelled Convicted 5 0 0 0 2 0 E. Cooper, 2, Munster road Exposing margarine for sale unlabelled Convicted 3 0 0 0 2 0 J. Mason, 46, Parsons Green lane Selling milk adulterated with 10 per cent, of added water Convicted 0 10 0 0 12 6 A. G. Holland, 78, Parsons Green lane Selling milk adulterated with 6 per cent, of added water Convicted 0 10 0 0 12 6 E. Satteley, 135, Dawes road Selling milk from which 10 per cent, of fat had been abstracted Convicted 0 1 0 0 12 6 A. Suckling, 2, Ashburnham road Selling milk from which 8 per cent, of its fat had been abstracted Dismissed warranty proved .. .. Defendant. Offence. Result. Penalty. Costs. E. Byrne, Clyde Dairy, Rylston road Selling milk from which 6 per cent. of its fat had been abstracted Convicted 1 0 0 0 12 6 Selling whiskey adulterated with 8 per cent. of added water (31° under proof) W. Wells, Harwood Arms Convicted 1 0 0 0 16 6 0 A.Marriott-Matthew. 157, Dawes road Selling milk adulterated with 10 per cent, of added water Dismisssed warranty proved 16 6 .. H. Brown, 2, Dieppe street Selling butter adulterated with 90 per cent, of margarine Convicted 15 0 0 0 12 6 0 J. T. Marsh, 319, Lillie Road Convicted Selling butter adulterated with 90 per cent, of margarine 8 0 0 12 6 0 W. H. Evans, 225, Munster road Convicted 3 Selling butter adulterated with 40 cent. of margarine 0 0 12 6 .. 0 W. H. Evans, 225, Munster road Selling margarine by retail without a proper wrapper Convicted 2 0 Selling butter adultera-ted with 50 per cent, of margarine Convicted 0 W. S. Robinson, 191, Munster road 3 0 0 12 6 Selling margarine by retail without a proper wrapper 0 W. S. Robinson, 191, Munster road Convicted .. 2 0 The Salisbury, Gillingham & Semley Dairies' Company Giving a false warrantry in respect of milk sold to A. Marriott-Matthews .. Dismissed .. .. 0 .. Total £ 66 10 14 9 0 Arsenic in Beer. In November, general attention was called to the contamination of a quantity of beer, chiefly in Lancashire and the Midlands, by Arsenic, which was derived from the glucose used in brewing, and the resulting poisoning of a large number of the consumers, the effect of the poison being to cause an inflammatory affection of the ends and trunks of the nerves, which is known as Peripheral Neuritis. 46 samples of Ale, procured in Fulham, and also samples of Glucose and Invert Sugar, which are manufactured at the Saccharine Works, Fulham Palace Road, were examined and found to be free from Arsenic ; neither has any been found in the very large number of samples which have been tested in the metropolis. Samples are also being taken of Golden Syrup, Jams, Confectionery, and other articles, in which Glucose is used, in order that they may be tested for Arsenic. The Milk Standard's Enquiry. The report of the Committee appointed by the Board of Agriculture to report upon the Milk Standards and Regulations, under Section 4 of the Sale of Food and Drugs Act, 1899, has recently been issued. The Committee recommend :— 1. That the Total Milk Solids dried at 100°c shall be taken into account, and that when the Total Milk Solids do not amount to 12 % of the Milk, the presumption shall be that the Milk is not genuine, and the Vendor be called upon to defend himself against a prosecution. 2. That where the Total Milk Solids fall below 12%, those Milks, in which the amount of milk-fat falls below 3.25%, shall be presumed to have had fat abstracted ; and that those Milks in which the non-fatty solids fall below 8.5% shall be presumed to have been watered. In calculating the percentage of fat removed or the amount of water added, the analyst is to have regard to the above limits of 3.25% fat and of 8.5% non-fatty solids ; and, when the non-fatty solids fall below 8.5%, the analyst shall also take into account the extent to which the milk fat exceeds 3.25%. GENERAL SANITARY WORK. 825 complaints, or fewer by 140 than in any of the previous seven years, were received and attended to, and 2,933 notices under the Public Health, (London) Act, were served in respect of nuisances discovered in the course of house to house inspection, and the inspection of houses consequent upon complaints, or the existence of infectious disease. I have pleasure in again concluding my report by expressing my opinion that all the members of the Staff of the Public Health Department have endeavoured zealously and faithfully to discharge their important duties, and I can testify to the interest which they take in their work, and to the thoroughness with which it is performed. I am, Gentlemen, Your obedient Servant, J. CHARLES JACKSON. March 31st, 1901. CHART SHEWING WEEK BY WEEK THE NUMBER OF CASES OF DIPHTHERIA AND MEMBRANOUS CROUP. Notified by Medical Practitioners as having occurred in the 52 weeks ending December 29th, 1900. CHART SHEWING WEEK BY WEEK THE NUMBER OF CASES OF SCARLET FEVER AND ENTERIC FEVER. Notified by Medical Practitioners as having occurred in the 52 weeks ending December 29th, 1900. „ 27 44.5 53.0 25.9 42.5 29.8 0.32 5.0 S.W. 54 14 7 14 6 5 3 3 February 3 35.2 39.9 30.2 42.3 29.5 0.96 3.1 N.N.E. 54 14 8 14 3 8 2 1 „ 10 31.0 38.7 18.0 40.2 29.6 0.29 19.3 N.N.E. 52 16 6 7 1 8 8 1 „ 17 35.3 47.9 21.4 88.4 29.3 1.46 13.5 Variable 14 6 1 - 44 6 11 3 41.2 58.9 33.0 39.5 29.1 0.51 18.3 S.W. 15 „ 24 53 7 18 3 9 - - 43.1 57.5 33.3 42.7 29.7 0.65 5.3 Variable 56 12 1 - March 3 7 16 5 7 55.0 35.0 41.9 30.1 N.E. 3 „ 10 39.2 0.02 15.3 37 4 10 14 6 - - „ 17 40.8 55.3 25.5 42.1 29.9 0.08 Variable 7 8 8 1 13.4 36 2 8 2 „ 24 38.8 52.8 21.6 41.3 29.5 S.N.E. 6 0.61 23.1 39 11 8 4 6 - - 31 37.0 50.5 27.6 40.9 29.7 0.16 26.3 Variable 53 11 15 14 6 3 - - Mean Temperature. Highest Temperature. Lowest Temperature. Mean Temperature of the earth 3-ft. below surface. 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. April 7 41.9 25.7 29.6 0.45 27.0 Variable 48 8 - 56.1 16 13 40.9 5 4 1 48.0 64.1 32.5 42.7 0.22 S.W. 52 15 14 7 3 1 14 29.6 31.9 14 - „ 21 51.8 39.1 45.0 30.1 0.15 57 6 4 76.1 Variable 17 17 - 50.8 4 2 47.5 72.4 47.1 29.9 39.9 Variable 44 9 4 - - 8 28 31.2 0.06 17 4 62 May 5 52.7 70.4 36.2 47.7 29.7 0.19 41.4 S.W. 37 8 9 15 - 1 - 1 50.9 34.7 49.9 0.36 4 12 72.2 29.6 23.1 S.W. & N.E. 27 9 4 3 1 1 - 47.1 63.9 37.0 49.5 0.01 39.1 N.N.E. 7 9 29.9 19 40 8 5 - - - 53.0 65.7 36.8 50.5 29.7 0.81 33.1 13 S.W.& N. 45 11 „ 26 12 3 - - 1 June 2 54.0 70.0 41.1 52.1 30.0 S.W.& N. 35 5 8 - 0.24 31.1 5 4 4 2 „ 9 75.5 45.3 53.3 29.7 N. & S. W. 39 7 10 58.4 0.19 54.0 7 8 4 1 - 64.4 89.4 49.2 56.1 29.8 60.0 S. E. & S.* W. 33 6 5 0.44 1 „ 16 13 4 - 2 34 7 - 59.7 52.9 1 23 73.9 47.4 57.8 29.7 0.77 S. W. 8 4 4 6 57.6 72.8 47.4 29.7 23.5 S. W. & N. W. 10 1 - „ 30 57.6 1.15 32 2 2 2 5 63 - 6 6 3 9 6 14 46 S.W. 32.5 0.35 29.7 59.3 43.1 73.9 56.9 29 1 6 7 4 2 6 15 38 S.W. 41.9 0.07 30.0 59.8 41.2 82.6 60.5 22 - 10 6 4 3 7 21 45 Variable 44.1 0.00 30.1 59.5 43.2 70.9 58.4 15 - 7 2 3 9 7 16 41 Variable 40.8 0.00 30.0 60.4 41.7 74.1 55.7 8 - 18 1 6 1 5 29 49 N,E. & S. W. 21.8 0.62 30.0 61.5 45.9 75.1 59.2 Septem. 1 - 12 7 2 2 7 20 47 S.W. 45.8 0.56 29.6 62.7 48.2 79.8 61.0 25 - 12 4 7 3 5 20 45 N.E. 72.7 0.05 30.0 61.7 52.0 82.1 66.7 18 - 15 3 4 5 6 26 51 S.W. 18.0 0.74 29.7 62.2 50.4 72.1 56.5 11 1 16 - 7 4 5 26 56 S.W. 50.4 0.58 29.6 65.1 50.8 790 61.9 August 4 - 16 2 4 3 24 47 Variable 56.8 0.84 29.8 65.3 57.9 98.0 71.1 28 - 3 3 6 5 5 7 12 41 Variable 83.2 0.00 29.9 62.5 52.6 94.0 72.1 „ 21 - 2 4 1 2 4 9 28 Variable 76.2 0.00 29.8 59.3 46.3 84.7 51.9 14 - - 4 6 1 5 2 22 Variable 47.5 0.57 29.8 58.2 48.2 75.1 59.2 July 7 Deaths from Influenza. Deaths from Diarrhœa. Deaths from Zymotic Diseases excluding Diaarhœa. Deaths from Phthisis Deaths from Respiratory Diseases. Deaths over 60. Deaths under 1 year. Total Deaths. Prevailing Wind. Sunshine in hours. Rainfall in inches Mean height of Barometer. Mean Temperature of the earth 3-ft below surface. Lowest Temperature. Highest Temperature. Mean Temperature. Week ending. Week ending. Mean Temperature. Highest Temperature. Lowest Temperature. Mean Temperature of the earth 3-ft below surface. 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. October 6 54.2 65.9 38.1 57.9 29.7 0.54 30.5 S. W. 40 15 12 4 1 5 2 S. W. 38 16 1 13 55.3 74.2 40.0 57.1 29.9 0.03 34.8 10 7 48.1 63.0 35.6 55.1 29.8 0.05 21.3 W. &. N 41 11 8 4 2 20 7 27 N. & S. W. 45 7 57.3 37.4 53.5 29.8 14.0 8 47.2 0.30 13 6 6 65.0 39.0 13.2 S. W. & N. 52.7 0.92 46 11 Novem. 3 52.7 29.8 9 9 4 5 29.5 0.41 18.8 S. E. & S. W. 10 48.8 56.5 35.2 53.1 35 11 6 4 3 3 6.0 10 - 51.2 29.4 2 17 45.0 57.6 26.8 0.81 S. W. & N.E. 32 6 7 24 42.4 49.1 49.5 29.7 0.09 6.4 N. E. S. E. 33.4 38 8 8 9 4 3 44.9 53.0 29.3 48.4 7.9 Variable 41 9 0.66 14 Decem. 1 39.3 12 2 4 48.3 29 6 0.77 45 14 14 8 47.4 56.3 37.5 3.1 S.W. 5 5 3 48.7 0.21 7.2 S. W. 16 4 15 48.4 55.8 38.0 30 0 44 17 4 3 44.5 48.3 0.38 23.4 S. W 15 22 53.9 32.3 29.9 44 14 16 3 3 42.7 53.2 30 7 47.1 0.30 S. W. 44 20 4 2 29 29.6 4.6 4 17 1894 1895 1896 1897 1898 1899 1900 0.38 0.02 0.02 - - 0.01 0.07 0.03 - - - - - - 5.07 3.12 5.37 6.34 6.49 6.50 4.05 0.32 0.20 0.19 0.23 0.28 0.26 0.17 3.26 3.57 3.05 3.24 3.81 4.05 4.77 0.99 0.70 0.66 0.52 0.49 0.45 0.49 0.39 0.57 0.50 0.45 0.58 0.85 0.67 0.05 0.10 0.08 0.10 0.14 0.19 0.14 - - - - - - - - - 0.01 - 0.03 - - - 1.09 0.89 0.85 1.12 0.97 1.37 1.15 0.06 0.05 0.04 0.03 0.05 0.06 0.09 - - - - - - - - - - - - - TABLE XLV. Showing the number of cases of Infectious Diseases notified to the several Metropolitan Medical Officers of Health during the year 1900. Sanitary Areas. Notified Cases of Infectious Disease. Small-pox. Scarlet Fever. Diphtheria.* Typhus Fever. Enteric Fever. Other continued Fevers. Puerperal Fever. Erysipelas. Cholera. Total. LONDON 88 13,809 11,994 7 4,306 74 237 4,771 5 35,291 West Districts. Paddington 5 306 153 2 56 3 6 123 - 654 Kensington 7 366 336 - 106 10 9 160 - 994 Hammersmith 9 352 252 - 103 2 6 113 - 830 Fulham 9 552 642 - 92 2 9 153 - 1459 Chelsea 2 233 180 1 81 3 7 71 1 579 St. George, Hanover-square 2 167 91 - 55 3 1 47 - 366 Westminster - 122 105 - 31 - 4 53 - 315 St. James, Westminster - 62 39 - 12 - - 16 - 129 North Districts. Marylebone 5 382 216 - 82 - 5 200 - 890 Hampstead - 224 160 - 50 - 4 50 - 488 St. Pancras 7 658 590 - 356 1 11 234 - 1857 Islington 2 1088 637 1 267 6 16 294 - 2311 Stoke Newington - 126 130 - 24 - 4 30 - 314 Hackney 16 695 622 1 228 5 15 230 - 1812 Central Districts. St. Giles - 98 60 - 33 - 1 51 - 243 St. Martin-in-the-Fields - 24 13 - 10 - - 4 - 51 Strand - 79 39 - 10 1 - 9 - 138 Holborn - 99 67 - 24 1 - 41 - 232 Clerkenwell - 138 121 - 60 1 1 75 - 396 St. Luke - 96 76 - 32 - 1 58 - 263 City of London - 83 66 - 29 - - 21 - 199 East Districts. I I ... Shoreditch 3 327 354 - 126 2 8 171 - 991 Bethnal Green 4 370 407 - 153 1 8 234 - 1177 Whitechapel 1 399 262 1 79 - 6 128 - 876 St. George-in-the-East 7 138 118 - 65 - 7 85 - 420 Limehouse 1 172 180 - 75 1 2 107 - 538 Mile End Old Town 1 334 297 - 119 - 6 176 - 933 Poplar 2 498 645 1 268 2 10 194 - 1620 South Districts. I St. Saviour, Southwark - 82 116 - 27 - 2 23 - 250 St. George, Southwark - 251 221 - 179 1 3 75 - 730 Newington 1 356 447 - 101 - 10 134 1 1050 St. Olave, Southwark - 37 14 - 7 - - 9 - 67 Bermondsey - 258 352 - 120 - 6 60 - 796 Rotherhithe - 102 113 - 77 - 3 71 - 366 Lambeth - 824 849 - 279 17 12 238 2 2221 Battersea - 545 316 - 205 1 6 164 - 1237 Wandsworth 4 673 453 - 153 1 15 206 - 1505 Camberwell 3 817 901 - 186 6 10 216 - 2139 Greenwich - 685 522 - 177 2 11 239 - 1636 Lewisham (excluding Penge) - 418 311 - 59 - 4 70 - 862 Woolwich 2 134 99 - 23 - 2 39 - 299 Lee - 137 163 - 18 - 2 24 - 344 Plumstead - 298 242 - 39 2 4 73 - 658 Fort of London 2 4 17 - 30 - - 2 11 56 * Including 209 cases of Membranous Croup. TABLE XLVI. Showing the localities in which cases of Notifiable Infectious Diseases and Deaths from Measles and Diarrhœa occured during the year. (The figures in brackets denote the number of houses in which the cases occurred. The asterisks denote the fatal cases of Notifiable Diseases. Erysipelas. Deaths from Measles. Deaths from Diarrhœa. Small-pox. Scarlet Fever. Diptheria and Membraneous Croup. Enteric Fever. Puerperal Fever. ... ... ... ... 1 ... ... ... ... ... ... ... ... 2(2) ... 1 ... 2(2) ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3(3) ... ... *1 3(1) 1 ... *1 3 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2(2) ... ... 2(2) ... ... ... Acfold road Ackmar road Adeney road Aintree street ... ... Alderville road ... ... Allestree road ... ... Althea street ... Ancill street Anselm road ... Archel road ... Argon mews ... ... ... ... ... Armadale road - ... Ashcombe street ... Ashington road ... ... ... ... ... Ashton terrace ... ... ... ... ... Aspenlea road ... Atalanta street ... Auriol road ... ... 1 ... 3(3) *7(5) 6(5) 1 *4(1) *17 (6) *5(3) 3(3) 1 1 *1 1 1 6(3) ... *1 2(2) 3(3) 1 *1 ... ... 1 ... 4(3) 5(3) 2(2) **2(1) ... 1 ... ... ... ... ... 1 ... 6(4) 1 ... ... 7(6) 1 1 ... 4(2) ... ... ... Avalon road ... Averill street ... Avonmore road ... Bagley's lane ... Barclay Road ... ... Barons Court road ... ... ... ... ... ... ... ... Barton street ... ... 4(3) 1 ... ... ... 1 ... 1 ... ... 2(2) ... ... 3(2) ... ... ... ... ... 1 ... ... ... ... ... Basuto road ... Bayonne Road Beaufort mews ... ... 2(2) 5(5) 1 8(8) 1 ... ... 5(5) ... ... *1 ... 5(5) 2(2) 1 Beaumont crescent ... ... ... ... ... ... ... ... Bedford place ... ... ... ... ... ... ... ... Beryl road ... Beltran road ... 2(2) 1 **5(5) 3(3) 1 ... ... ... 1 ... ... ... 1 2(2) Betteridge road Biscay road Bishop's mews Bishop's Pk. mansions Bishop's road Bishop's terrace Blake road Bloom Park road Bothwell street Bovingdon road Bowerdean street Bramber road Brandenburgh road Brecon road Breer street Britannia road Broadway Brookville road Broomhouse road Bronsart road Broughton road Buer street Bulow road Burlington road Burnfoot avenue Burnthwaite road Byam street Branksea street Cambria street Campbell street Campana road Carlton mews Caroline place Cassidy road Castletown road Cedar road Chaldon road Challoner road Charleville road Chelmsford street Chesilton road Chesson road Church path Clancarty road Small-pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Erysipelas. Deaths from Measles. Deaths from Diarrhœa. 1 3 (3) ... *2(2) ... *2(2) 2(1) ... ... 1 ... ... *3(2) 3(3) 2(2) ... 3(2) 1 1 4(4) ... *7(3) 1 ... 1 2(2) ... ... ... 3(3) ... ... 2(2) 4(3) 1 ... ... ... 1 ... *4(3) 1 ... 1 1 ... ... 2(2) ... ... ... ... 1 ... 2(2) 2(2) 3(3) 5(5) 2(2) ... 4(1) ... *2 (1) *7(5) ... 7(6) 7(6) ... 4(4) 2(2) ... ... ... ... 1 2(2) 1 ... ... 1 ... 1 ... ... 5(5) 2(2) 2(2) 1 ... ... ... ... ... ... ... ... ... *1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... *1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2(2) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 *1 ... ... 1 ... ... ... ... ... ... ... 1 ... 2(2) ... ... ... 2(2) ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 2(2) ... ... ... ... 1 ... ... 2(2) ... 2(1) 1 ... ... ... ... *1 ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 4(4) ... ... ... ... 2(2) ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2(2) 2(2) ... 1 1 ... ... ... ... 1 ... 1 1 3(1) ... ... ... ... 1 ... 2(2) ... ... 2(2) ... ... *1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Claxton grove Claybrook road Clonmel road Colehill lane Comeragh mews Comeragh road Coniger road Coomer road Cornwall street Cortayne road Crab Tree lane Cranbury road Crefeld road Cresford road Crookham road Cristowe road Crondace road Cumberland crescent. Dalebury road Dancer road Danehurst street Darlan road Dawes road Dawson street Delaford street Delorme street Delvino road De Morgan road Devonshire street Dieppe street Dimsdale road Disbrowe road Distillery lane Dolby road Doria road Dorncliffe road Dowell mews Dymock street Durrell road Eddiscombe road Edenvale street Edgarley terrace Small-pox. 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Erysipelas. Deaths from Measles. Deaths from Diarrhœa. 11(6) 7(6) ... ... ... 2(1) 3(3) 3(2) 1 1 ... 1 1 1 ... ... ... ... 1 ... ... ... *8(4) ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 2(2) **8(5) ... ... ... ... ... 2(2) ... ... ... ... 1 ... 3(2) 2(2) ... ... ... ... ... 7(5) ... ... ... ... 1 1 3(3) *7(6) *1 ... ... ... ... 1 ... *2(1) ... ... 4(4) ... ... 1 ... ... ... ... ... ... *3(1) ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 2(2) ... ... ... ... ... ... 2(2) ... ... ... ... ... ... ... 1 1 ... ... ... ... 2(2) ... ... ... ... 1 ... 4(3) 2(2) *2(2) ... 1 ... 1 2(1) 2(2) *1 ... ... 1 ... 1 **12(7) ... ... 2(2) 2(2) 1 *5(3) *3 (3) 1 ... 2(2) 1 1 1 ... ... ... 1 ... ... 4(3) 5(2) ... 1 ... 1 1 1 2(1) ... ... ... ... 1 ... *2(2) ... ... ... 1 3(2) 1 ... ... *1 ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 1 2(2) ... ... ... ... ... ... 1 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... 4(3) 5(5) 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 3(2) 7(4) 1 ... 1 ... ... ... ... ... ... ... ... ... Edith row Edith villas Effie road Eli mews Eli street Elmdale street Elmstone road Elthiron road Epirus road Epple road Estcourt road Eustace road Everington street Ewald road Fabian road Factory lane Fairholme road Fane street Farm lane Favart road ... Felden street Fernhurst road Field road Filmer road Firth gardens Foskett road Francis street Friston street Fulham Palace road Fulham Park gardens Fulham Park road Fulham road Furness road Garvan road Gastein road George square Gilstead road Gironde road Gledstanes road Gowan avenue Glenrosa street Goodson road Greyhound road Small-pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever Erysipelas. Deaths from Measles. Deaths from Diarrhœa. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2(2) ... 1 ... 1 ... 3(3) 4(3) ... 3(2) ... *3(3) 1 ... ... 3(3) ... 1 1 2(2) 4 (2) ... 2(2) ... 2(1) 5(2) ... ... *14 (9) *3 (2) 1 2(2) ... ... 1 ... 5(2) 1 1 9(5) 1 ... ... ... ... *1 **7(6) ... ... 5(4) ... 4(3) 2(2) ... 1 2(2) ... ... *2(2) ... 1 ... 1 *2 (1) ... ... 1 1 1 *1 ... 8(6) 7 (3) 1 2(2) ... *3 (2) ... ... 2(2) 3(3) ... *2(2) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2(2) ... ... ... 4(1) ... ... ... ... 1 ... ... ... ... ... ... ... 2(2) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... *1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 ... *1 ... ... 1 *1 1 ... 2(2) 2 (2) ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... 1 2(2) 1 ... ... ... ... ... 1 ... ... ... ... ... 2(1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4(3) ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 3(3) ... ... 2(2) ... 1 ... ... 1 ... ... 4(4) Small-pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Erysipelas. Deaths from Measles. Deaths from Diarrhoea. Grimston road Grove avenue Grove terrace Guion road Gunterstone road Gwendyr road Haldane road Halford road Hamble street Hammersmith road Hannell road Harbledown road Hartismere road Hartopp avenue Harwood road Harwood terrace Hatfield street Hazlebury road Hestercombe avenue High street Hilmer street Hildyard road Holyport road Homestead road Horder road Hugon road Humbolt road Hurlingham road Imperial cottages Imperial road Irene road Ismailia road Jerdan place Jervis road John street Kempson road Kenneth road Kilmaine road Kimbell gardens Kings road Kingwood road ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 3(2) 1 1 2 4(3) 1 ... 1 1 *1 3(3) 2(1) ... *2(2) ... 1 2(2) 2(1) 2(2) 1 ... 3(3) 3(3) 3(2) 2(1) ... 1 ... ... 1 ... ... ... 1 ... 1 2(2) ... **3(1) ... ... 1 ... 1 1 *8 (4) ... 3(3) ... *1 6 (5) 4(3) 2(2) *1 8(5) ... **3(3) 2(2) ... *2(2) 1 1 ... 4(3) ... 1 ... ... ... ... ... ... ... ... 8(5) 2(2) 1 1 ... *2 (2) ... ... ... ... 1 1 ... ... 2(2) ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2(1) 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ...... 3 (2) 2(2) *2(2) ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... 3(3) ... 1 ... 1 ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... 2(2) ... 1 ... ... ... 1 2(2) ... ... ... ... 2(2) ... 1 ... 2(2) ... ... ... ... 1 ... 1 ... 1 ... ... 1 1 1 ... ... ... ... ... ... ... ... ... Small-pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Erysipelas. Deaths from Measles. Deaths from Diarrhoea. Kinnoul road ... ... 2(2) ... ... ... ... 1 Knivett road ... ... ... ... ... ... 1 ... Kilkee street *2(1) ... 3(2) ... ... ... ... 1 ... ... ... Lalor street ... ... 1 ... ... 1 Lambrook terrace ... ... ... ... ... ... ... **7(6) 2(2) 1 Langford road *1 ... 1 1 ... Lanfrey place 1 ... *1 ... ... ... ... ... 1 Laundry road 5 (3) ... ... 1 1 ... ... Lawn terrace ... ... ... ... ... ... ... ... Letterstone road 2 1 ... ... ... 1 ... ... Lillie road *16(13) ****13(9) *1 ... 3(3) ... ... ... Lilyville road ... 1 ... ... ... ... ... ... Lindrop street ... ... 1 ... ... ... ... ... 2(2) ... ... Lintaine grove 1 ... ... ... ... Linver road ... ... ... ... 1 ... ... ... Lisgar terrace ... ... ... ... ... ... ... ... Lodge avenue ... ... 2(2) ... ... *1 ... 1 Lurgan avenue ... ... 1 ... ... ... ... 1 ... 2(2) ... Mablethorpe road ... ... ... ... 4(4) Margravine gardens ... 2(2) ... ... ... ... ... ... Margravine road ... ... 2(2) ... ... ... ... 2(2) Marinefield road ... ... ... ... ... ... ... ... ... ... ... ... ... ... bv ... ... ... ... ... ... ... ... *3(2) ... ... **2 (1) 1 5(3) Marville road 2(2) 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Matheson road 1 Maxwell road ... ... ... May street 4(4) ... 1 ... ... ... ... ... ... ... ... ... 2(2) ... Melmoth place Mendora road 2(2) 5(2) ... ... 1 3(2) 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Merrington road ... ... ... 1 ... ... Milton street 2 (1) 1 Mimosa street 3 (2) *5(2) Mirabel road 4(4) *3(2) ... ... 2(2) ... ... ... 1 ... 1 ... ... ... ... ... Molesford road ... Mooltan street *4(3) ... 1 Moore Park road 3(2) *3(3) ... 1 ... ... 1 Mornington road ... ... ... ... ... ... ... Moylan road 2(2) Mulgrave road ... 6(6) ... ... ... 1 *1 ... 1 2(2) ... ... Mund street ... ... ... ... ... Munden street ... 2(2) 1 *1 Munster road *8(7) 1 ... ... 1 ... ... 4(4) ... ... Musard road 2(2) 6(6) ... 1 Musgrave crescent Deaths from Measles. Deaths from Diarrhoea. Small-pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Erysipelas. ... Napier avenue ... 1 1 ... ... ... 1 ... ... *1 ... ... ... ... ... Narborough street ... 5 (5) *7 (7) ... ... 3(3) 1 2(2) New Kings road *1 Normand road ... ... ... ... ... ... 2(2) Northampton place 1 ... ... ... ... ... 2(2) North End road 4 (3) 2(2) 2(2) ... ... ... ... Novello street ... 1 1 1 ... ... ... 1 *7 (6) ... ... ... ... ... 3 (3) ... ... ... Oakbury road *3(3) 3(3) Orbain road ... ... 2(2) ... ... Orchard place 3(1) 1 ... ... ... ... ... Orchard street ... ... ... ... ... ... ... ... Oxberry avenue ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Palliser road ... ... ... ... ... ... ... Parkville road ... ... ... ... ... ... ... 1 ... ... ... Parsons Green ... ... ... ... ... ... ... Parsons Green lane ... ... 1 ... ... ... ... ... ... ... ... Parthenia road 1 ... ... 2(2) ... ... ... Pellant road ... ... 2(2) ... 2(2) Perrymead street **8 (4) ... 1 ... ... ... 2 (2) ... ... ... ... ... Perham road ... ... ... ... Peterborough road ... 1 1 ... 1 1 Peterborough villas ... ... ... ... ... ... ... ... 4(3) ... Petley road 1 ... ... ... ... ... *1 ... ... ... ... ... 5(4) ... ... ... ... ... ... ... ... ... ... ... Playfair street ... 1 ... ... ... ... Portland place ... Portland street ... 1 1 ... Pownall road ... 1 ... 1 Prince of Wales mews Protheroe road 1 ... ... 2(2) 4(4) *13 (7) ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 Purcell crescent 5(3) ... ... ... ... Purcers Cross road ... 1 1 ... 3(3) ... ... ... ... ... ... ... ... ... ... ... Queens Club gardens, Querrinn street ... ... ... ... ... ... ... ... ... 7(5) 1 **4 (3) ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Radipole road Rainville street 1 1 Ranelagh avenue ... 1 ... ... 2(2) Rectory road 3(3) *2(2) ... 1 Reporton road 2(2) 5(5) 1 1 1 ... ... ... Richmond road 2(2) ... ... ... 1 ... ... ... Rickett street ... ... ... ... Rigault road ... 1 ... ... ... ... ... ... Small-pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Deaths from Measles. Deaths from Diarrhœa. Erysipelas. Ringmer avenue ... *1 2(2) ... ... ... ... ... Rock avenue ... ... 1 ... ... ... 1 0 Rosaline road ... ... 4(3) ... ... ... ... ... Rosaville road ... ... 2(2) ... ... ... ... ... Rosebury road ... 7(4) 5(4) 1 ... ... ... ... Rostrevor road ... 1 ... ... ... ... ... ... Rowallan road ... 2(1) 2(2) ... ... ... ... 1 Ruby terrace ... ... ... ... ... ... ... ... Roxby place ... 1 1 ... ... ... ... ... Ryecroft street ... ... ... ... ... ... ... ... Rylston road ... 3(2) 5(4) ... ... ... ... 1 St. Alban's terrace ... ... ... ... ... ... ... ... St. Dunstan's road ... 3(2) 5(4) 1 ... ... 1 ... St. Maur road ... 8(6) ... ... ... ... ... ... St. Olaf's road ... 5(4) 5(3) 5(3) ... 2(2) ... 1 St. Oswald's-road ... 3(2) ... ... ... ... ... ... St. Peter's terrace ... 1 ... ... ... ... ... ... St. Thomas' road ... 1 *1 ... ... 1 2(2) ... Sandilands road ... 7(4) 8(6) ... ... 1 2(2) ... Seagrave mews ... ... 1 ... ... ... ... 1 Seagrave road ... 2(2) ... ... ... ... ... 1 Settrington street ... 5(4) 1 ... ... 1 ... 1 Sherbrooke road ... 3(3) *7 (5) ... ... 1 ... 1 Shorrolds road ... 1 3(3) ... ... ... ... 1 Shottendane road ... ... ... ... ... ... ... ... Sotheron road ... ... ... ... ... ... ... ... Stamford road ... ... 1 ... ... 2(2) ... ... Stamford place ... *1 ... ... ... ... ... ... Stamford street ... *1 ... ... ... ... ... ... Stanley road ... 4(4) *4 (4) ... ... 2(2) 1 ... Stanwick road ... 1 *3(2) ... ... 3(2) 1 1 Star road ... 1 *3 (2) ... ... 3(2) 1 1 Stokenchurch street ... 3(2) ... ... ... ... ... ... Stonor road ... 1 ... ... ... 1 ... Strode road ... 1 2 (2) ... ... 1 1 2(2) Studdridge street ... ... ... ... ... ... ... ... Suffolk street ... ... ... ... ... 1 1 1 Stephendale road ... ***17(11) **14(9) *2(2) 1 1 ... 1 Talgarth road ... 1 ... 1 ... 2(2) ... ... Tarso road ... 2(2) *3(3) 1 ... 1 ... ... Tilton street ... ... 2(2) ... ... 1 ... ... Tournay road ... ... 2(2) 1 ... ... ... ... Townmead road ... 2(2) *8 (8) 3(2) *1 * 1 ... 4(4) Small-pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Erysipelas. Deaths from Measles. Deaths from Diarrhœa. Turneville road ... 1 2(2) ... *1 1 ... ... Tyrawley road ... ... 3(1) ... ... ... ... ... Tynemouth street ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Varna road ... 1 3(2) ... ... ... ... ... Vereker road ... ... 1 ... ... ... ... ... Vernon street ... ... 1 ... ... ... ... ... Victoria road ... 3(2) 1 2(2) ... 1 ... 2(2) Vera road ... ... 2(1) ... ... ... ... 1 Waldemar avenue ... 1 ... *1 ... ... ... ... Walham avenue ... ... 3(3) *4 (1) ... ... 2(2) 5(5) Walham grove ... 1 ... ... ... ... ... ... Wandon road ... ... ... ... ... ... ... ... Wandsworth Bdge. rd. 5 13 (12) 6(3) 5 ... *7 (7) ... ... Wardo avenue 5 1 *8 (6) 2(2) ... ... ... 2(2) Waterford road ... ... *3(3) ... ... 1 ... ... Werley avenue ... 1 1 ... ... ... 2(2) 1 Westbury terrace ... 1 ... ... ... ... ... ... Wheatsheaf terrace ... ... ... ... ... ... ... ... Whittingstall road ... ... ... ... ... ... ... ... Wigan street ... ... 1 ... ... 1 ... ... William street ... ... ... ... ... ... ... ... Wyfold road ... 2(1) ... ... ... ... ... ... Whiteley's cottages ... ... ... ... ... ... ... ... Winchendon road ... 1 2(2) 1 ... ... ... 1 Woolneigh street ... ... 1 ... ... ... ... ... Yeldham road ... 4(4) 5(4) ... ... ... ... 1 Fulham Union Infirmary ... 4 2 1 ... 3 ... ... Fulham Workhouse ... 7 2 ... ... 8 ... ... APPENDIX. REPORT ON DIPHTHERIA IN CONNECTION WITH LANGFORD ROAD SCHOOL. The prevalence of Diphtheria in Fulham, with special reference to the closure of class-room "H" in the Infants department of Langford Road Board School. On October 23rd, in a report respecting the prevalence of Diphtheria in Fulham, I advised the Sanitary Authority, as some cases had occurred among the children in class-room "H" of the Infants' Department of Langford Road Board School, to request the School Board to close that class-room for a period of 14 days, and also to exclude from the school the children living in the same houses as the children attending the class-room in question. The class-room was accordingly closed and the children excluded from the school from October 26th to November 8th, inclusive. On November 8th, the following letter was received from the Local Government Board : — Local Government Board, Whitehall, S.W. November 7th, 1900. Sir, I am directed by the Local Government Board to forward to the Vestry of the Parish of Fulham, for their observations, the accompanying copy of a communication from the School Board for London, which the Board have received from the Board of Education, with reference to the closure of the Fulham Langford Road Board School on account of the presence of Diphtheria. lam also to request that that the Vestry will call upon their Medical Officer of Health for a report on the Outbreak of Diphtheria referred to, and, if the order objected to was made on his advice, on the grounds of such advice. A copy of such report should be forwarded to the Board. I am, Sir, Your obedient Servant, JOHN LTHIBY, Assistant Secretary. W. J. H. Denselow, Esq., Vestry Clerk. Copy. School Board for London, Victoria Embankment, W.C. 31st October, 1900. Sir, Fulham Langford Road School. I am instructed to report to the Board of Education, that on the 24th instant, on account of the presence of Diphtheria, an order was received from the Sanitary Authority for class-room "H" of the above school to be closed for a period of 14 days, and also for the exclusion from the school of all the children living in the same houses as the children attending the class-room mentioned. On inquiry, it is found that only five cases of Diphtheria have occurred in class.room " H," which has an attendance of 111 children. Under the circumstances, the Board are of opinion that the steps taken are unnecessary, and a doubt exists as to whether in such a case as this, children can legally be excluded from obtaining proper educational advantages, when not residents in infected houses. lam therefore directed to appeal to the Board of Education against the action of the Sanitary Authority in the matter. The Secretary, Board of Education, Whitehall, S.W. I am, Sir, Your obedient servant, G. H. CROAD, Clerk to the Board. Before explaining the circumstances that led me to advise the Sanitary Authority to close the class-room in question, I will briefly deal with the prevalence of Diphtheria in the district during the past three months. In the first eight months of the year, although there was more Diphtheria, proportionally, in Fulham, than in the rest of London, there was no exceptional prevalence of the disease compared with the corresponding period of the two previous years, the cases notified representing an annual rate per 1,000 of the estimated population. of 3.55 in 1900, 3.35 in 1899, and 3.78 in 1898. The usual autumnal rise has, however, been this year much more marked, and the cases notified have been much in excess of any previous year, being equivalent for the thirteen weeks ending November 24th, to an annual rate of 7.44 per 1,000 compared with 5.44 per 1,000 in the corresponding period of 1899, and 3.87 in that of 1898. The disease has been most prevalent in the Munster and Sand's End Wards, especially in the latter, as will be seen from the following tables:— Cases of Dipl theria notified in the severa I Wards of the District during the 13 weeks ending November 24th, 1900. The unbracketed figures denote the total number of cases notified, and those in brackets the number of secondary cases, i.e., the cases occurring in houses in which there had been a previous case during the period under consideration. WEEK ENDING— WARDS. September. October. November. 1 8 15 22 29 6 13 20 27 3 10 17 24 Baron's Court ... ... 2 (1) 1 1 1 ... 1 1 ... ... 7(1) Margravine I I 1 1 3 2 2 1 2 ... 2 1 2 3 (1) 1 20 (1) Lillie ... 1 1 1 2 7 5(1) ... 3 (2) 2 1 ... 23 (1) Munster 1 2(1) 2 6(3) 3(2) 14(3) 13(5) 3 4(2) 3(1) 2 3 1 Walham .. 1 2 .. 1 1 3 4(1) 3(2) 1 1 .. Town .. ... .. .. 2 .. 4(1) 1 3 (1) 1 3(1) 2(1) 2(1) Sands End .. 4(3) 7(1) 3 8(1) 3(2) 3 11(3) 24(12) 12(5) 12(2) 15(7) 5(2) Hurlingham .. 1 .. 1 .. 1 .. 2 .. .. .. 1 .. 6 Fulham Union Infirmary .. .. .. .. .. .. .. .. .. .. .. 2 .. .. Infirmary .. .. .. .. .. .. .. .. .. .. 2 .. I Total 1 10 14 16 17 23 30 25 38 24 22 28 9 The cases notified correspond to the following annual rates per 1,000 of the estimated population of each ward. Baron's Court Ward 2.00 per 1,000. Margravine 3.71 3.71 „ „ Lillie 4.34 „ Munster 10.37 „ Walham 4.25 4.25 „ „ Town „ 5.00 „ „ Sand's End „ 18.28 „ „ Hurlingham „ 4.00 „ „ Altogether, 257 cases were notified in Fulham from 191 houses during the 13 weeks ending the 24th November, and of these 3 contracted the disease outside the District, and 5 were found after admission to hospital, to be not suffering from Diphtheria. The prevalence of the disease was largely due to the existence of unrecognised cases, and in 15 households I found, as the result of enquiries which I made at the time, strong evidence that other members of the family had, in all probability, previously suffered from mild attacks of the disease, which had entirely escaped detection. Subsequent bacteriological examination, by the Jenner Institute, of material which I took from the patients tended to confirm this view. The following were instances of mistaken diagnosis from which other cases resulted. A child was ascertained to have died from Diphtheria who had been an out patient at the Victoria Hospital, and had attended there the afternoon prior to the morning of his death, being supposed to be suffering from Bronchitis. In October, a child, seven years of age, living in Langford Road, died in St. Thomas's Hospital from Diphtheritic Paralysis, the nature of the initial illness not having been recognised until his admission into the hospital, about 10 days before his death. In two cases the infection appeared to have been conveyed by the " washing" which had been sent home from an infected house before the nature of the illness was known. Milk.—With regard to other circumstances having a possible relation to the prevalence of the disease, there was no evidence pointing to the milk supply, as the sources of supply were very numerous, and not more than four of the families affected were served by any one vendor. In 26 households invaded, condensed milk was said to be used. Sewers. —There were some complaints respecting the offensive smells from the surface sewer ventilators adjacent to infected houses, but no opinion can be formed as to whether these exercised predisposing influence. Extra gangs were employed by the Surveyor in flushing the sewers and cleansing the gullies in the streets in which cases occurred. Sanitary defects were found in many of the houses, but 65 per cent, of the cases occurred either in newly built houses in which the drains had been constructed under the supervision of the Vestry, and subjected to a water test, or in houses in which the drainage had recently been reconstructed. It is noticeable that in this outbreak, the disease, as in the last four years, has been most prevalent in the Sand's End district, and especially in the new houses built upon made up ground. School Influence. —Irrespective of the Langford Road School cases which are dealt with in detail below, there is reason to think that other school attendances had some effect in promoting the spread of the disease during the period referred to. In the two wards chiefly affected, the proportion of " first " cases occurring among school attendants was noticeably greater than in the wards which were less affected, the figures being as under : — Percentage of Primary cases attending school. Percentage of Primary cases not attending school. Sand's End Ward 65 per cent. 35 per cent. Munster Ward 56 „ 44 „ Other Wards 43 „ 57 „ The schools, among the pupils of which the largest number of cases occurred were the following : — Sherbrooke Road Board School. (Munster Ward). —In the 13 weeks there were 11 primary cases in the Infants' Department, 6 classes being affected, and 2 in the Boys', but in three of the cases among the infants, the children were probably infected by cases in neighbouring houses. Hugon Road Board School. (Sand's End Ward). —There were 7 cases in the Infant's Department, in 3 classes, and 2 in the Girls' Department, but one of these had certainly no connection with the school. Minister Road Board School. (Munster Ward).- —There were 7 cases among the Infants, in 3 classes, and 1 each among the girls and boys. Holy Cross Denominational School. (Hurlingham Ward). — There were 5 cases in the Infants' and 1 in the Boys' School. There were strong grounds for believing that in, at any rate, four of these cases, the disease was contracted in school. St. Dunstan's Road Board School. (Margravine Ward.) — There were 5 cases among the Infants, and 4 among the Girls. Langford Road Board School. (Sand's End Ward). —Deal- ing now with this school, there was during the first six weeks of the period under consideration, no exceptional incidence of the disease upon the children attending that school, the following being the cases notified subsequent to the reopening of the school on August 27th, after the summer holidays : — Child. Department. Date of notification. Last attendance. M.H. Boys Ist standard Sept. 21st Sept. 17th. A.F. Infants', Class A „ 22nd.. „ 21st. F.S. Boys', 3rd standard Oct. 6th Oct. 4th. F.S „ „ „ „ 15th Oct. 12th. The last two boys lived in neighbouring houses and played together, and there is reason to believe that there had been a mild unrecognised case in the house of the boy first notified. Nine other members of the families of the two boys were subsequently attacked, On October 15th, two children were notified, who, I was informed, had attended class-room " H," Infants' Department, up to October 12th, but I have since ascertained that I was misinformed respecting C.S., and that he attended class " F," and that it was his brother who was in class " H." On October 19th, a boy in Langford Road, not attending any school, was notified as suffering from Diphtheria, and on making enquiries, I found that his sister had been attending class " H " up till October 16th, and was said to have had prior to that date, a " cold and slight sore throat," and on bacteriological examination, the Bacillus Diphtherias was isolated from the nasal secretion, so that it would appear that this child was attending class-room " H," while in an infective condition. On October 20th and 22nd, two children were notified who had been attending claps "H " up to October 19th, and, at my request, the Head-mistress of the Infants' Department furnished me with the names of 12 other children who were said to be absent from that class on account of illness. These I visited, and three of them I found to be suffering from undoubted Diphtheria, two of whom had been attending class "H" up to October 19th, while the third had been sent home ill from that class on the day I saw her, viz., October 22nd. I also found two other children who then showed no clinical signs of Diphtheria, but had a history of some slight throat trouble, and on bacteriological examination, the Bacillus Diphtherife was isolated in each case. Therefore, since October 12th, in a class with an average attendance, since the holidays, of 90, and with 110 on the roll, there had been 6 cases of Diphtheria of a rather severe type, viz.:— F.S., last attendance, October 12th. ID., „ „ „ 19th. L.B., „ „ „ „ H N., „ „ „ „ J.F., „ „ „ „ P.F.,„ „ „ 22nd. Of these, 5 had, so far as I could ascertain, no relations with each other except in school, their homes lay in opposite directions, and there had been no other cases in them; in fact up to that time, in three of the loads, no case of Diphtheria had been notified of late, so that there was a very strong presumption that at any rate the four who were simultaneously attacked, were infected by some child attending the class. Moreover, in addition to these, there were the three other children who had been attending that class, who, though showing no clinical signs of Diphtheria at the time of my inspection, had suspicious previous histories, and from whom the Diphtheria Bacillus was subsequently isolated. Hence, having regard to the prevalence of the disease in the district, its special incidence on the children attending this class, and my knowledge that not only had they been exposed to the infection of mild, or perhaps I should say, Bacteriological Diphtheria, but also to that of acute Diphtheria in the person of P.F., who was sent from school so suffering, I had no hesitation in advising the Sanitary Authority to require the closure of that class-room, and also the exclusion of the children living in the same houses, as otherwise there was, in my opinion, grave danger of a more general outbreak in the school. There was, I considered, no reason for any further steps to be taken at that time, as the rest of the, school was not affected. The only other recent case in the remaining classes of the Infants' Department, with some 600 children on the roll, was one in class " F," and at that time, as I have stated, I was under the impression that this child was attending class " H." In the Boy's Department, in addition to the two cases in Standard 3, above-mentioned, a boy in Standard 1 was notified on October 21st, and on enquiry, I ascertained that on October 14th, a boy sitting next to him had vomited when in school, been absent for a few days ill, and had then returned to school; but on examining him in the school, I found him suffering from mild Diphtheria, and at his home found his sister, who had been attending the Infants' school, and had sickened after him, suffering from the disease in a severe form, neither case having been notified. There have been, however, no other primary cases notified in this Department up to the present time. In the Girls' Department there had been no case up to the time of the closure of class " H," but since then four cases have been notified, viz. : — October 25th, 2nd Standard. „ 29th, 4th „ Noveinber 4th, 5th „ „ 14th, 2nd „ but one of these was found, after admission to hospital, not to be suffering from Diphtheria. After the closure of class " H " on the 26th October, and the exclusion from school of the other children from the same houses, the Head-mistress continued to furnish me with the names of those absent on account of alleged illness from other classes. From class " G," which adjoins class " H," there were several absentees, and one of them I found to be suffering from undoubted Diphtheria, although not notified, while two others, though then showing no clinical signs of Diphtheria, had a history of slight sore throat, and on bacteriological examination, the Bacillus Diphtheria! was found. There were, however, no further cases in the Infants' Department until November 4th, when a child was notified, who had been excluded from school in consequenc of her brother being in class " H," and on enquiry, 1 was informed that he had been somewhat unwell, prior to the closure of the class, and on bacteriological examination, the Diphtheria Bacillus was isolated, so that, but for the closure of the classroom, this child would have continued attending in apparently an infective condition. Two days after this, a child in the next house, attending school, who had played with these children was also notified. Since then, two cases have been notified in classes " B" and " E," Infants' Department, on November Kith and on November 20th respectively, and one of these was probably infected by a child in an adjacent house, with whom he played, so that although the disease had continued prevalent in the district, there has, since the closing of class " H," been no exceptional incidence upon the children attending the school. With regard to the question raised by the School Board, that children cannot be legally excluded from obtaining proper educational advantages when not residents in infectious houses," it is of course beyond my province to express any opinion, but I may remind you that the steps taken in this case have been no new departure on the part of the Sanitary Authority, as it has always been their custom, when ordering the closure of a parti cular class, to also require the exclusion of the other residents in the homes of the children of the closed class, and the extracts from my annual reports which will be found in the appendix to this report, furnish several instances of this proceeding. I may point out that if the partial closure, hitherto requested by the Sanitary Authority, cannot be enforced, the alternative will be, in cases similar to these, to close either the entire department or the whole school, with the result that there would be, in either case, an interference with the education of a much larger number of children. In the present case, by the method adopted there were excluded from school:— Infants' Department, including those in class "H" 210 Girls' „ 69 Boys' „ 67 336 while in the whole school there were :— Infants' Department 702 Boys' „ 514 Girls' „ 583 1,799 so that interference with education was minimised in a marked degree. The experience I have had of these class outbreaks, leads me to believe that they are usually due to the attendance at school of a child or children suffering from unrecognised Diphtheria, and the best course, in my opinion, to check any further spread of the disease, is to promptly close the infected class, and as it is always probable that pome other members of the class have been already infected, and as the relatives of the unrecognised case or cases have also been exposed to infection, it is certainly necessary, if partial closure is to be effective, to also exclude the children living in the same houses as the children belonging to the infected class. By this immediate action, I believe that the risk of the invasion of the whole school is materially lessened, and the subsequent closure of the whole school possibly obviated. J. CHARLES JACKSON, Medical Officer of Health. Public Health Department. Town Hall, Fulham, S.W., November 26th, 1900. APPENDIX Annual Report for 1897. In May there was an outbreak of Diphtheria among the girls in the second standard at Harwood Road Board School, six children living in Fulham and one living in Chelsea being notified as suffering from Diphtheria between May 19th and May 26th, and as these children did not live near together, and there were no other children in any of the other classes of the school affected, it was most probable that they were infected in the class-room itself by some child who was suffering from a mild and unrecognised form of the disease, and accordingly the Vestry, at their meeting on May 26th, on my recommendation, passed a resolution requiring the Managers " to close the room occupied by the girls' second standard, and known as Class Room " C " for a period of fourteen days, and to exclude from the school the girls in the second standard, and also the children residing in the same houses as those girls." This was at once done, the class-room being closed from May 27th to June 9th, with satisfactory results, as excluding secondary cases occurring in the same family, there were only two other cases among the children attending that school, who were notified on May 31st and June Ist respectively, but on June 7th four children residing in a house in New Kings Road were notified as suffering from Diphtheria, and on investigation it was ascertained that another member of the family who was in the second standard in the girls' department at Harwood Road School, had been ill with a sore throat about a fortnight or three weeks before, but the illness had been of so mild a character that no medical practitioner had been called in. This child had probably had a mild attack of Diphtheria, and as she was attending school up to May 26th, when the school was closed, it is quite possible that the outbreak in the particular class-room originated with her. Annual Report for 1898. In the following three instances in which three or more cases occurred in one class-room, the prompt closure of the affected class-room, together with the exclusion of the children living in the same house as the children attending that class-room was attended with successful results. Between May 23rd and May 26th there were four cases among children attending class-room " E " in the Infants' Department of St. Dunstan's School and the room was in consequence closed on May 27th until June 13th, and on May 30th, two cases having occurred in class-room " F " in the same Department, that room was also closed until the same day. There were subsequently five other cases among children who had been attending the affected class-rooms, but none among the children in the rest of the school. Between June 18th and 20th three cases of Diphtheria were reported in class-room " D," in the Infants' Department of William Street Board School, and on bacteriological examination it was also ascertained that another child must have been attending that class while suffering from a mild attack of the disease. The room was at once closed at the request of the Vestry, for a fortnight, and though two other children belonging to the same class were subsequently affected, there were no other cases in the rest of the school. On October 10th and 11th, four children attending class-room " E " of the Infants' Department of Ackmar Road Board School were notified as suffering from Diphtheria, and the room was closed until October 26th. Four other children who had been attending the class were subsequently notified, but with the exception of four secondary cases occurring in the families of the affected children in class-room "E," there were no other cases in the school until October 30th. It was subsequently ascertained that a child had been attending class-room " E " between October 1st and October 10th, who, from the results of a bacteriological examination had undoubtedly been suffering at the time from a mild attack of Diphtheria, Annual Report for 1899. In October a number of cases occurred among the children attending class " A " of the Infants' Department of Star Road Board School, and that class was closed from October 24th to November 10th, and the children living in the same houses as the children attending that class were also excluded.