THE VESTRY OF THE Parish of Saint George, HANOVER SQUARE. MEDICAL OFFICER'S REPORT FOR THE YEAR ENDED 30th DECEMBER, 1893. JUNE, 1894. London: PRINTED BY WIGHTMAN & CO., Westminster Press, 104 & 106, regency Street, S.W. 1894. REPORT ON THE SANITARY CONDITION of the Parish of St. George, Hanover Square, FOR THE YEAR 1893, BY W. H. CORFIELD, M.A., M.D. (Oxon), F.R.C.P. (Lond.), Professor of Hygiene and Public Health in University College, London; Past President of the Society of Medical Officers of Health ; Honorary Member of the Society of Hygiene of France ; Honorary Corresponding Member of the Royal Society of Public Health of Belgium; of the Imperial Society of Medicine of Constantinople; and of the Royal Society of Hygiene of Italy; Fellow of the Medical Society of Sweden.; MEDICAL OFFICER OF HEALTH (BEING HIS TWENTY-SECOND ANNUAL REPORT) To the Vestry of the Parish of St. George, Hanover Square. My Lords and Gentlemen, The total number of deaths registered in the Parish during the 52 weeks ending December 30th, 1893, was 1716, against an average of 1821 during the preceding ten years. Of these deaths 654 were those of NonParishioners, (Table II), leaving 1,062 deaths of Parishioners. To these however must be added 155 deaths of our Parishioners in Public Institutions in the Metropolis outside of the Parish and in the extra Metropolitan Asylums, so that the corrected total of deaths of our Parishioners was only 1,217, or 178 less than the average during the preceding ten years. (See Table I). In my last Annual Report I explained the manner in which I estimated the population for the middle of the year 1892 ; applying the same method, I calculate that the population of the Parish at the middle of 1893, was as follows:- Mayfair - - 23,291 Belgravia - - 55,592 Whole Parish - - 78,883 2 It must, however, be borne in mind that this estimate is based upon the Census population of 1891, which I believe to be, for reasons given in previous Annual Reports, considerably too low, in fact some thousands below the real population. The calculated death-rates are therefore no doubt all too high ; they are as follows:— Mayfair - - - 10 74 per 1,000 Belgravia - - 17.32 Whole Parish - - 15.38 per annum It will be seen from Table I. that the death-rate of the Parish during 1893 was nevertheless the lowest on record, and nearly one per thousand lower than the average of the preceding ten years. Table I. year. Gross Total of Deaths. Deaths in Public Institutions. Proportional Share of Deaths in Public Institutions Corrected Total of Deaths. (52 weeks). Corrected Death-rate per 1,000 per annum (52 weeks). 1883 1,845 829 390 1,406 15.70 1884 (53 weeks) 1,873 769 384 1.460 16.30 1885 1,773 766 436 1,443 16.11 1886 1,900 797 435 1,538 17.17 1887 1,727 762 473 1,438 16.05 1888 1,817 861 482 1,438 16.05 1889 1,664 756 363 1,271 15.82 1890 (53 weeks) 1,986 997 340 1,304 16.46 Deaths of Nonparishioners in the Parish. Deaths of Parishioners in Public Institutions outside the Parish. 1891 1,877 904 144 1,312 16.22 1892 1,751 564 147 1,334 16.97 Average during ten years, 1883-1892 1,821 ... ... 1,395 16.43 1893 1,716 654 155 1,217 15.38 Average during ten years, 1881-1893 1,808 ... ... 1,376 16.30 3 Table II. Deaths in Public Institutions in the Parish. Parishioners, NonParish ioners. Mayfair. Belgravia. SubDistrict not stated. Fulham Road Workhouse 96 62 46 264 St. George's Union Workhouse 2 2 8 St. George's Hospital 23 76 3 360 Belgrave Children's ditto 8 6 St. Gabriel's ditto 0 Other Places in the Parish 5 1 16 Total in the Parish 29 153 52 654 In Public Institutions in London, outside of the Parish, and in the Extra Metropolitan Asylums 23 106 26 Table iii. Death-rates per 1,000 per annum. 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 28 Large English Towns 21.6 20.6 20.9 20.8 19.2 19.3 21.3 22.3 *20.7 *21.6 London 20.4 19.8 19.9 19.6 13.5 18.3 21.5 21.4 20.6 21.3 Greater London 19.7 19.2 19.3 18.9 17.8 17.3 20.1 19.8 19.3 19.7 St. George's, Hanover sq. 16.30 16.11 17.17 16.05 16.05 14.19 14.56 14.65 16.97 15.38 *33 Towns. From Table III, we see that the death-rate of London proper amounted to 21.3, which "was 1.2 per thousand in excess of the average rate in the previous five years, having been raised considerably by the mortality from Diphtheria and Influenza." The death-rate of greater London with an estimated population of 5,849,707, was 197, or rather higher than in the preceding year, and exactly equal to the average of the previous three years, but nearly 4.3 per thousand higher than the death-rate of this parish. 4 The death-rate of the 33 largest English towns was 21.6, which is nearly 1 per thousand higher than that recorded for the previous year. As usual, the death-rate of this parish was lower than that of any one of the 33 largest English towns, the nearest to it being:- Croydon 16.30 Huddersfield 17.20 Halifax 17.36 Portsmouth 18.22 Derby 18.24 Brighton 18.42 Nottingham 18.46 West Ham 18.91 Bristol 18.93 and the highest being:- Wolverhampton 23.27 Blackburn 23.28 Sal ford • 24.08 Bolton 24.12 Manchester 24.90 Preston 26.37 Liverpool 27.34 The death-rate of Edinburgh was 19.8, or nearly the same as that of Greater London (19.7), that of Glasgow 23.4, and that of Dublin 27.0. As usual, the lowest death-rates in Foreign cities were higher than the death-rate of this parish, the nearest to it being those of :- Sydney 15.7 Brisbane 16.3 Christiania 17.5 San Francisco 17.9 5 Amsterdam 18.6 Cincinnati 18.7 and the highest being:- Calcutta 25.9 Trieste 27.9 New Orleans 28.1 Bombay 28.1 Breslau 29.1 St. Petersburg 30.6 Moscow 35.9 Alexandria 36.3 Madras 40.9 Cairo 50.9 In Berlin the rate was 210, in Paris 21.8 and in Vienna 24.0. Table IV. year. Registered Births. Birth-rate per 1,000 per annum (52 weeks.) Deaths of Children under 1 Year. Total. Percentage to Registered Births. Percentage to Total Deaths of Parishioners 1891 1,610 17.96 216 13.41 16.45 1892 1,519 19.31 220 14.48 16.49 1893 1,496 18.90 204 13.64 16.76 From Table IV. we see that the number of births in the Parish was 1,496, and that the birth-rate was 18.90 per thousand per annum, as against 19.31 in 1892. The birth-rate for London proper was 31.9, that of greater London being 30.6, and that of the outer ring 29.6. The average birth-rate of the 33 largest English towns was 31.9, or exactly the same as that of 1892, the highest being those of Gateshead, 36.5; Cardiff. 36.1; and Liverpool, 36.0; and the lowest those of Brighton, 25.4; Halifax, 24.6; and Huddersfield, 23.8. 6 The number of deaths of children under one year of age (Parishioners; see Table A at end of Report) was 204; the percentage of such deaths to registered births was 13.64, and to total deaths of parishioners, 16.76; thus the mortality of children under one year of age was 136 to a thousand births, or 9 less than in 1892, while in London generally it was 164, and the average for the 33 largest English towns was 181, the highest being Leicester, 204; Burnley, 213; and Preston, 223, deaths of children under one year of age to a thousand births. Table V. YEAR. a. Persons aged sixty years and upwards. b. Violence. C Inquest Cases. d. Uncertified. Percentages to Gross Total of Deaths. a. b. C. D. 1884 543 106 132 31 28.99 5.66 7.0 1.66 1885 557 79 106 22 31.42 4.46 60 1.25 1886 604 79 135 41 31.79 4.16 7.1 2.15 1887 521 88 122 20 30.17 5.09 7.0 1.15 1888 541 90 124 22 29.77 4.95 6.8 1.21 1889 523 77 116 30 31.43 4.63 7.0 1.80 1890 650 94 130 22 32.73 4.73 6.5 1.10 1891 627 95 144 17 33.33 5.05 7.6 0 .97 1892 581 115 159 15 33.18 6.57 9.1 0.87 1893 541 98 145 15 31.53 5.42 8.4 0.87 London 1893 21,815 3,425 7,432 794 23.83 3.74 8.1 0.87 From Table V. it appears that there were 541 registered deaths of persons aged 60 and upwards, giving a percentage of 31.53 of the gross total of deaths, "as against a percentage for London generally of only 23.83. There were, however, (see Table VI.) only 307 deaths of parishioners of 65 years and upwards, giving a percentage of 25.23 of the corrected total of deaths. From Table V. we also see that 93 violent deaths were registered in the parish, being 5.42 per cent. of the total deaths, but of the 93 deaths registered under this heading, only 56 were those of parishioners (see Table VI.), giving a percentage of 4.6 of the corrected 7 total of deaths, which is however, nearly one per thousand higher than that of London generally, than the rate for the Parish in 1892. The Inquest cases held in the Parish numbered 145, being more than in any previous year mentioned in the Table, except 1892, when they were 159. They were equivalent to 8.4 per cent. of the gross total of deaths, as against 8.1 in London generally. Table VI. Non-Parishioners excluded. Year. A Persons aged sixty year's and upwards. b Violence. Percentages to corrected Total of Deaths. A B 1890 404 33 30.82 2.5 1891 405 37 30.85 2.8 1892 396 50 29.66 3.7 1893 *307 56 25.23 4.6 * 65 years and upwards. The number or registered deaths uncertified as to cause was 15, or the same as in 1892, and equivalent to 0.87 per cent. of the gross total of deaths, exactly the same as in London generally. Table VII. SUB-DISTRICT, Population at middle of 1893. Births. Birth-rate. Deaths of Parishioners. Deaths (corrected). Death-rate (corrected). Hanover Square Mayfair Mayfair 23,291 254 10 87 228 251 10.74 Belgravia 55,592 1,242 22.27 911 966 17.32 Sub - district not stated 78 Whole Parish 78,883 1,496 18.90 1,217 1,217 15.38 8 Table VIII. BIRTH-RATES. DEATH-RATES. 1884. 1885. 1886. 1887. 1888. 1889. 1890. 1891. 1892 1893. 1884. 1885. 1886. 1887. 1888. 1889. 1890. 1891. 1892. 1893. Hanover Sq. 16.46 15.36 14.00 13.67 13.74 11.83 9.95 8.95 11.32 10.87 15.54 15.18 15.42 12.75 13.47 12.09 9.32 10.08 11.62 10.74 Mayfair 15.20 14.16 14.45 12.44 11.19 11.49 Belgravia 23.87 22.24 22.46 22.53 21.31 22.14 21.34 22.59 22.71 22.27 17.40 17.49 18.79 17.75 17.38 15.27 17.24 17.00 19.25 17.32 Whole Parish 21.18 19.73 19.66 19.53 18.74 18.64 17.49 17.96 19.31 18.90 16.30 16.11 17.17 16.05 16.05 14.19 14.56 14.65 16.97 15.38 9 From Tables VII. and VIII. it appears that the birth-rate of the Mayfair Sub-District was 10.87, as against 11.32 in 1892 and 8.95 in 1891; while that of the Belgravia Sub- District was 22.27, as against 22.71 in 1892, and that the corrected death-rate of the Mayfair Sub-District was 10.74, as against 11.62 in 1892, and that of the Belgravia SubDistrict was 17.32, as against 19.25 in 1892. It must, however, be remembered that these rates are calculated on too small a population. From the birth and death rates in Table VIII., I have calculated, as usual, "the mean length of life." I use the term "mean length of life" instead of "mean duration of life" (as I explained in my Annual Report for 1890) in order to prevent confusion, as the term "mean duration of life" is a technical expression, which means the length of life as calculated by the life-table method. The "mean length of life" stated in this report is calculated by means of Dr. Bristowe's formula. Mean Length of Life. Mayfair Sub-District 97.96 Belgravia 52.03 Whole Parish. 59.58 The calculated mean length of life in this Parish during the last 19 years has been as follows :- In 1875 it was 46.67 years. „ 1876 „ 47.96 „ „ 1877 „ 49.52 „ „ 1878 „ 48.03 „ „ 1879 „ 48.55 „ „ 1880 „ 58.01 „ „ 1881 „ 50.26 „ 10 In 1882 it was 52.56 years. „ 1883 „ 55.09 „ „ 1884- „ 53.78 „ „ 1885 „ 56.11 „ „ 1886 „ 54.46 „ „ 1887 „ 56.49 „ „ 1888 „ 57.71 „ „ 1889 „ 61.43 „ „ 1890 „ 62.67 „ „ 1891 „ 61.62 „ „ 1892 „ 55.27 „ „ 1893 „ 59.58 „ So that the mean length of life in this Parish during those 19 years has averaged over 54½ years, while during the last ten years it has averaged nearly 60 years. The mean length of life in London during the last 16 years has been, according to my calculation, as follows :— In 1878 it was 34.24 years. „ 1879 „ 34.23 „ „ 1880 „ 35.17 „ „ 1881 „ 35.87 „ „ 1882 „ 36.82 „ „ 1883 „ 37.88 „ „ 1884 „ 38.08 „ N.B.—These figures „ 1885 „ 39.29 „ are too high, being calculated from erroneous estimates of the Population of London „ 1889 „ 43.27 „ „ 1890 „ 41.10 „ „ 1891 „ 38.28 „ „ 1892 „ 39.58 „ „ 1893 „ 38.61 „ Table IX. Showing the number of Deaths registered in the Parish in each of the ten years, 1883 to 1892, from the principal infectious Diseases and Diarrhæa, and the number in 1893. DISEASE. 1883. 1884. 1885. 1888. 1887. 1888. 1889. 1890. 1891. 1892. Annual Average of ten years, 1883—1892. Proportion of Deaths to 1,000 Deaths in ten years, 1883—1892. 1893. Proportion of Deaths to 1,000 Deaths in 1893. Small-pox 0 2 2 0 0 0 0 0 0 0 0.4 0.22 0 0 Measles 13 40 21 20 30 12 49 49 13 49 29.6 16.25 2 1.02 Scarlet Fever 11 7 10 2 16 8 1 1 1 4 6.1 3.35 5 2.90 Diphtheria 27 25 35 32 22 52 36 29 16 25 29.9 16.42 49 28.50 Whooping Cough 21 43 19 40 23 28 81 48 24 20 29.7 16.31 13 7.50 Typhus Fever 0 ] 0 0 0 0 0 0 0 0 0.1 0.05 0 0 Enteric (orTyplioid)Fever 21 22 8 12 15 5 18 12 14 10 13.7 7.52 27 15.70 Simple Continued Fever 8 1 2 1 2 1 1 2 1 0 1.9 1.04 2 1.02 Diarrhoea 27 44 37 45 58 27 31 29 39 20 35.7 19.60 34 19.80 Cholera 1 0 2 1 0 0 0 1 0 1 0.6 0.33 0 0 Total 129 185 136 153 166 133 167 171 108 129 147.7 81.11 132 76.92 N.I3.—In this Table the deaths of Non-Parishioners registered in the Parish are included. 12 From Table IX. it will be seen that the total number of deaths from infectious diseases and diarrhoea registered in the Parish (including deaths of Non-Parishioners), was 132, or nearly 16 be'ow the average of the previous 10 years. If, however, we subtract the deaths of Non-Parishioners (56) and add those of Parishioners dying of these diseases in Public Institutions outside of the Parish (32) the total becomes 108, as shown in Table X., which is equivalent to a zymotic death-rate of only 1.36, as against 1.68 in 1892, the rate for London being 3.08, and that for the 33 largest English towns 3.18. The only large town showing a lower zymotic death-rate than this Parish is Huddersfield, with 1.24. The highest zymotic death-rates in the Country are furnished by Blackburn, 4.08; Hull and Salford each 4.14; Bolton, 4.65, and Preston 6.01. Table X. Deaths of Parishioners from the principal Infectious Diseases and from Diarrhoea. Disease. 1890. 1891. 1892. 1893. Small-Pox 0 0 0 3 Measles 45 13 48 2 Scarlet Fever 2 6 12 24 Diphtheria 12 19 23 26 Whooping Cough 48 21 19 12 Typhus Fever 0 0 0 0 Enteric(or Typhoid) Fever 5 9 8 11 Simple continued Fever 2 1 0 2 Diarrhoea 29 31 21 28 Cholera 0 0 1 0 Total 143 100 132 108 Influenza 27 46 75 13 13 Taking these diseases separately, according to the order in which they are placed in Table IX., we find that:— Small-Pox caused no death in the Parish, but 3 deaths of our Parishioners in Public Institutions outside of the Parish. (Table A.) Measles: caused only 2 deaths, the lowest number ever recorded in the Parish, and only about one-fifteenth of the annual average. Scarlet Fever caused only 5 deaths in the Parish, but no less than 19 deaths of Parishioners occurred from the disease in Public Institutions outside of the Parish. Diphtheria: no less than 49 deaths were registered in the Parish from this disease, but 31 of these were those of NonParishioners. On the other hand, there were 8 deaths of Parishioners from Diphtheria in Public Institutions outside the Parish, so that 26 Parishioners died of Diphtheria. (There were also 6 deaths of Parishioners from Membranous Croup.) This disease is still exceedingly prevalent in London and in some of the other great towns, the average death-rate from it, in the 33 largest English towns in 1893 being over twice the average of the preceding 10 years. Whooping Cough: only 12 deaths were registered, all of Parishioners, as against 20 in 1892, and 24 in 1891, and an average of nearly 30 during the previous 10 years. Typhus Fever was not, so far as I am aware, present in the Parish during the year, and only one death from it has been recorded in the Parish since 1881. Enteric (or Typhoid) Fever: no less than 27 deaths were registered, or nearly twice the corrected average for the previous 10 years. But of these 27 deaths, 17 were those of 14 Non-Parishioners in St. George's Hospital; on the other hand, one of our Parishioners died of this disease in a Public Institution outside of the Parish, so that there were in all 11 deaths of Parishioners from this disease. Simple continued Fever: two deaths, both of Parishioners, were registered from this disease. Diarrhoea: 34 deaths were registered, being 14 more than in 1892, and nearly equal to the average of the previous 10 years. Of these deaths, however, 7 were those of NonParishioners. On the other hand, there was 1 death of a Parishioner from Diarrhoea in a Public Institution outside of the Parish. I may note that the mean temperature of each quarter of the year was above the average, that of the Spring quarter being no less than 4.7 degrees above the average of the last 122 years. The mean temperature of the year was 51.1 degrees, or 2.5 degrees above the average of 122 years, and 1.9 above the average of the previous 52 years. No death from English Cholera was registered. Influenza: only 13 deaths were registered in the Parish from this disease (as against 75 in 1892 and 46 in 1891). As there is no special column for this disease in the table (A), ordered by the Local Government Board to be used, the deaths from it are entered under other headings according to the information given in the certificates. Cases of Infectious Diseases. The following table shows the number of cases certified by Medical Attendants in 1890, 1891, 1892, and 1893:— 15 Table XI. Name of disease. Number of Cases certified. 1890. 1891. 1892. 1893. Scarlet Fever 145 122 318 567 Enteric Fever 40 26 42 62 Continued Fever 5 2 1 2 Diphtheria 64 74 118 111 Erysipelas 37 41 57 76 Membranous Croup. 1 2 1 7 Small-Pox 0 1* 1 21 Puerperal Fever 0 2 2 3 English Cholera 0 0 1 2 292 270 541 851 Of the above 851 cases certified last year only 12 were notified by 11 householders. One case was notified by the householder, but not certified by the Medical Attendant, who, however, told the householder to notify the case, and thought that that was all that was necessary. The large number of cases certified during the year was due to the mild but wide-spread epidemic of Scarlet Fever, accompanied by Diphtheria, which has prevailed in London. One case certified as Scarlet Fever was returned from the Fever Hospital as not being a case of that disease. It will also be noticed that there was a considerable increase in the number of cases of Enteric Fever and of Erysipelas, probably due to the exceptionally warm weather, and also a notable recrudescence of Small Pox. The temporary shelter which the Vestry have provided and furnished in the basement of the offices at No. 1, * This case, however, on being removed to the Small-Pox Hospital was found not to be ft case of that disease, 16 Pimlico Road, for the use of persons compelled to leave their houses during the process of disinfection after infectious disease, has been occupied seven times during the year (once for a whole night) Sanitary Work For the year ending December 30th, 1893 The following tables, prepared by Mr Albert Taylor, your Chief Sanitary Inspector, from his Report Book, show the amount of sanitary work done I have added the figures for 1892 for comparison:– Table XII 1892. 1893. Houses and Premises inspected 1,422 1,841 „ re-inspected 3,449 4,159 References to Surveyor 62 44 Notices issued (preliminary) 769 1,042 „ (statutory) 172 145 Summonses taken out 1 5 Table XIII Nuisances dealt with 1892. 1893. Soil Pipes ventilated 210 341 Bath, Sink, and other Waste Pipes disconnected 411 765 Drains unstopped or repaired 282 299 Defective Drains re-constructed 129 358 New trapped gullies fixed 762 1,131 Water Closet apparatus cleaned and repaired 143 104 New Water Closets fixed 637 669 New Water Waste Preventer Cisterns fixed 697 720 Drinking Water Cisterns cleaned and repaired 31 58 17  1892. 1893. Houses provided with water 9 22 Water Supply of W.C.'s separated from drinking water 84 92 Ashpits and Dustbins repaired 52 27 New Moveable Dustbins provided 60 32 Yard surfaces paved or repaired 61 20 Cesspools abolished 6 4 Overcrowding abated 9 33 Houses and Premises cleansed 43 75 Roofs and rain-water pipes repaired 30 22 Offensive accumulations removed 81 46 Dung-pits abolished and moveable wire cages substituted 10 26 Nuisances from the keeping of animals 22 10 Underground Rooms discontinued for use as sleeping apartments 12 6 Smoke Nuisances — 9 Removal of Hog's Wash in unsuitable receptacles – 21 Miscellaneous Nuisances 131 156 3,912 5,046 Drains tested and found defective 133 423 „ satisfactory 15 62 Drains of Premises undergoing alteration or re-construction superintended and tested 127 133 It will be noticed that a considerably larger number of houses were inspected and re-inspected than in 1892, many more preliminary notices were served, but fewer statutory notices were required. It was, however, necessary to take legal proceedings in five cases to enforce the abatement of nuisances. 18 The houses let in lodgings have been inspected, and the regulations as to cleansing, &c, enforced in each case; 73 additional houses have been registered. The total number of applications for dust removal were: in the In-Wards 4,547, and in the Out-Wards 2,014. The Home Secretary having issued an order under Section 65 of the Factory and Workshop Act, 1878, and Section 27 of the Factory and Workshop Act, 1891, requiring the occupiers of certain Factories and Workshops,* and the Contractors employed by them, to keep lists of out-workers, and having prescribed forms for the purpose, such forms have been printed and distributed in the parish, and an additional Inspector (Mr. F. H. Aris) has been appointed, one of whose duties is to inspect the lists of such out-workers and to ascertain the condition of their dwellings, and especially the presence of cases of infectious disease therein. A register of workshops and work-places in the parish has been prepared to facilitate the work of the Inspectors It contains the following:— Tailors 182 Dressmakers and Milliners 226 Corset Makers 18 Bedding makers 1 Boot makers 19 Cabinet makers 6 Woodturners 3 Total 455 * For the manufacture of— 1. Articles of Wearing Apparel. 2. Electro-Plate. 3. Cabinet, Furniture and Upholstery Work, and 4. Files. 19 Mr. Taylor reports that:— "A house to house inspection has been made of all the premises in Conduit and Maddox streets, which come within the operation of these Acts, while a number of inspections have been made in various parts of the district as the result of special complaints. The number of workshops and work-places inspected was 86; of these, the sanitary arrangements of 75 were found defective, the drains of 26 having to be reconstructed. These 86 premises contained 188 work-rooms, 42 of which were overcrowded, and ten in a dirty and unwholesome condition. There were 540 persons found employed in these workrooms, or 182 in excess of the accommodation, taking 250 cubic feet as the minimum amount of cubic space allowed for each person for such places." In all cases where it seemed to be necessary, measures have been taken to diminish the number of persons in workshops so as to prevent overcrowding. There are 56 bake-houses on the register; they have been inspected thoroughly during the year, and the sanitary condition of many of them has been greatly improved, notices having been issued, and the necessary improvements carried out by the owners; but legislation is necessary to compel the closing of all bakehouses that are situated in underground rooms. The slaughterhouses, of which there are three licensed in the parish, and the one licensed cowhouse now left, have been regularly inspected and found to be satisfactorily conducted. The same may be said of the street stalls and butchers' shops, to which frequent visits are paid, but it has not been 20 necessary to seize any article of food as unfit for human consumption Table XIV. Infectious Diseases and Disinfection. 1892. 1893. Infectious cases reported 557 851 Medical certificates received 636 950 Certificates of infectious cases sent to School Teachers 104 276 Houses in which infectious disease occurred 510 745 Visits made to infected houses — 2,405 Patients removed to the hospitals 349 462 Houses disinfected 431 632 Eooms disinfected 472 676 Articles of clothing, bedding, &c, disinfected 5,556 11,352 Disinfectants have been distributed to the public when required, and personal instructions given as to their proper use. The number of articles of clothing, &c., disinfected was more than double that in 1892, so that it was at times found necessary to employ outside assistance in disinfecting the articles, in order to prevent delay and inconvenience to the public. The new super-heated steam disinfecting apparatus, erected by Messrs. Goddard, Massey and Warner, works most satisfactorily. The preparations made by me in 1892, in case of an invasion of cholera, were described in my last annual report; the arrangements made still hold good and could be set to work at any time. 21 The following Table shows the number of bodies received in the Mortuary during the 52 weeks ending December 30th, 1893, as compiled from the returns furnished to me monthly by the Mortuary Keeper, Mr. Coles, and his successor, Mr. Birch. Table XV. Return showing the number of bodies received into the Mortuary, Ebury Bridge, during the 52 weeks ending December 30th, 1893. Cause of Death. Number. Post Mortems. Inquests. Deaths from Scarlet Fever 0 0 0 Do Diphtheria 0 0 0 Found Drowned 8 8 8 Found Dead 2 2 2 Born Dead 4 3 0 Murder 6 6 6 Suicide 16 15 16 Deaths from Natural Causes 71 49 53 Deaths from Accidents 49 45 49 Totals 156 128 134 Bodies were brought to the Mortuary in 17 of the above cases, because there was not sufficient accommodation for them at home. The results of the analyses of the water supplied to the Parish by the two companies during each of the twelve months have been submitted to me by your Public Analyst, Mr Charles E. Cassal, and I have reported on them monthly. (See the Report of the Public Analyst). I wish to express my entire satisfaction with the manner in which the Sanitary Inspectors have performed their duties during the year. 22 23 (A) TABLE OF DEATHS during the year 1893 in the Metropoly Sanitary District of St. George's, Hanover Square, classified according to Diseses. Ages, and Localities. Localities. (a) Mobtality from all causes, at subjoined Ages. (i) Mobtality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all Ages. Under 1. 1—5. 5—15. 15-25. 25—65. 65 & upwards. 1 2 3 4 5 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Fevers. Cholera. Erysipelas. Measles. Whooping ' Coneh. Diarrhoea and Dysentery. Rheumatic Eever. Ague. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Continued. Relapsing. Puerperal. (b) (c) (d) (e) (f) (g) (h) Mayfair 176 30 9 4 9 76 48 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 ... ... 5 8 1 3 17 39 5 upwds. ... ... 2 ... 2 1 ... 1 ... ... ... ... ... ... ... 10 43 16 6 56 137 Belgravia 657 147 51 19 22 244 174 Under 5 ... 2 4 4 ... 1 ... ... ... 1 2 12 18 ... ... 19 42 5 6 82 198 5 upwds. ... 3 2 2 4 ... ... 2 ... 1 ... ... ... 2 ... 60 110 72 13 188 459 St. George's Infirmary (Fulham Road) 114 4 ... 1 4 .44 61 Under 5 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 2 4 5 upwds. ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... 16 32 6 1 52 110 Union Workhouse 4 2 ... ... ... 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 St. George's Hospital 102 7 11 8 9 64 3 Under 5 ... ... 6 ... ... ... ... ... ... ... ... ... 1 ... ... 2 6 ... ... 3 18 5 upwds. ... ... 3 ... 4 ... ... ... ... ... ... ... 1 1 ... 7 14 8 14 32 84 Belgrave Children's Hospital 8 2 2 4 ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 4 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 4 River Thames 1 ... ... ... 1 ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... .•• ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Total 1062 192 73 36 45 430 286 Under 5 ... 2 10 4 ... l ... ... ... 2 2 12 24 ... ... 25 59 7 10 104 262 5 upwds ... 3 8 2 10 l ... 3 ... 2 ... ... 3 3 ... 94 200 103 36 332 800 The subjoined numbers have also to be taken into judging of the above records of Mortality. Parishioners Dying outside Parish 155 12 27 10 5 80 21 Under 5 ... 8 5 ... ... ... ... ... ... ... ... ... 1 ... ... 4 8 ... ... 13 39 5 upwds. 3 11 3 1 ... ... ... ... 3 ... ... ... 1 ... 18 8 14 10 44 116 Non-Parishioners dying in parish. 654 29 36 46 49 354 140 Under 5 ... ... 18 ... ... ... ... ... ... ... ... ... 5 ... ... 4 13 ... 3 22 65 5 upwds. ... ... 13 ... 17 ... ... ... ... 3 ... 1 2 1 ... 112 117 71 42 210 589 24 25 (B) TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year, 1893, in the Metropolitan Sanitary District of St. George's, Hanover Square, classified according to Diseases, Ages, and Localities. Localities. (a) Population at all Ages. Registered Births. Ages. (e) New Oases of Sickness in each locality. Number of such cases removed from home to hospital. 1 2 3 4 5 6 7 9 10 11 Totals. 1 2 3 4 5 6 7 8 9 10 11 Totals. Census 1891. Estimated to Middle of 1893.* Smallpox. Scarlet Fever. Diphtheria. Membranous Croup. Fever Fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric (or Typhoid). Relapsing. Puerperal. Typhus. Enteric (or Typhoid). Continued. Relapsing. Puerperal. (b) (c) (d) Mayfair 23,731 23,291 254 Under 5 ... 14 ... ... ... ... ... ... ... 1 15 ... 9 ... ... ... ... ... ... ... ... ... 9 5 upwards 7 78 12 ... ... 21 ... 1 ... 13 133 6 49 4 ... ... 6 ... ... ... ... 3 68 Belgravia 54,628 55,592 1,242 Under 5 ... 115 34 4 ... 2 ... ... ... 4 160 ... 73 23 ... ... ... ... ... ... ... 1 97 5 upwards 14 357 65 3 ... 39 ... 2 2 51 533 10 234 45 ... ... 22 ... ... ... ... 4 315 St. George's Infirmary (Fulham Road) ... ... ... Under 5 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Union Workhouse ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... 2 2 2 ... ... ... ... ... ... ... ... ... 2 4 St. George's Hospital. ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ••• ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... 3 ... ... ... ... ... ... ... 3 6 ... 3 1 ... ... 1 ... ... ... ... ... 5 Belgrave Children's Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Orthopaedic Hospital Hanover Square) ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ... ... 1,496 Under 5 ... 129 34 4 ... 2 ... ... ... 7 177 ... 82 23 ... ... ... ... ... ... ... 1 106 5 upwards 21 438 77 3 ... 60 ... 3 2 69 674 18 286 50 ... ... 29 ... ... ... ... 9 392 "Notification of Infectious Disease" has been compulsory in the District since October 31st, 1889. The Isolation Hospitals are the Hospitals of the Metropolitan Asylums Board, and occasionally the London Fever Hospital and the London Small-Pox Hospital, 26 For the information of the Parishioners, I may mention that a hospital carriage for removing persons suffering from infectious diseases (including Diphtheria) is kept at the Workhouse in Wallis's Yard, Buckingham Palace Road, and that the ambulance belonging to the Metropolitan Asylums Board is kept at Seagrave Road, Fulham; but those who are in a position to bear the expenses of their support should apply at the London Fever Hospital, Liverpool Road, Islington; (or, in case of Small-pox, at the Highgate Small-pox Hospital), where they can be accommodated on favourable terms.Also that a refuge has been provided at No. 1, Pimlieo Road, for the use of persons during the disinfection of their rooms. I have the honour to be, My Lords and Gentlemen, Your obedient Servant, W. H. CORFIELD. 19, Savile Row, London, W., June, 1894.