THE YESTEY of the Parish of Saint Dearge. HANOVER SQUARE. MEDICAL OFFICER'S REPORT fob the year ended 20th december, 1894. JUNE, 1895 3Lonbon: FEINTED BY WKiHTMAN & CO., "The Westminster Pbess," 104 & 106, Regency Street, S.W. 18 9 5. REPORT on THE SANITARY CONDITION of the Parish of St. Beorge, Hanober Square, FOR THE YEAR 1894 . 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, and of the Hungarian Society of Public Health; 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 Sxoeden; MEDICAL OFFICER OF HEALTH (BEING HIS TWENTY-THIRD ANNUAL REPORT), Do the Bestrn of the Parish of st. Seorge, Hanover Square. My Lords and Gentlemen, The total number of deaths registered in the Parish during the 52 weeks ending December 29th, 1894, was 1,510, against an average of 1,808 during the preceding ten years. Of these deaths 554 were those of NonParishioners (Table II.), leaving 956 deaths of Parishioners. To these, however, must be added 140 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 1,096, or 280 less than the average during the preceding ten years. (See Table I.) In my Annual Report for 1892 I explained the manner in which I estimated the population for the middle of that year; applying the same method, I calculate that the population of the Parish at the middle of 1894 was as follows :— Mayfair - - 23,097 Belgravia - - 56,026 Whole Parish - 79,123 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- - - 10.531 Belgravia - - 15.10 * Whole Parish - - 13.8oJ per 1000 per annum. It will be seen from Table I. that the death-rate of the Parish during 1894 was nevertheless the lowest on record, being no less than 2J per thousand lower than the average of the preceding ten vears. 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). 1884 (53 weeks) 1,873 769 384 1.460 16.30 1885 I 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 1893 1,716 654 155 1,217 15.38 Average during ten years, 1884-1893 1,808 ... ... 1,376 16.30 1 894 1,510 554 140 1,096 13.80 Average during ten years, 1885-1894 1,772 ... ... 1,340 16.05 Applying the correction for age and sex distribution (factor = 1.10438), given by Mr. Murphy in his Annual Report to the London County Council for 1893, the death-rate of the Parish for 1894 would be 15.24, 3 Table II. Deaths in Public Institutions in the Parish. Parishioners. Mayfair. Belgravia. SubDistrict not stated. NonParish ioners. Fulbam Road Workhouse 7 56 51 213 St. George's Union Workhouse • • • 3 2 3 St. George's, Hospital 10 44 4 323 Belgrave Children's ditto • • • 4 • • • 6 Gordon Hospital for Cancer .... ... • • * 1 Other Places in the Parish 1 3 6 8 Total in the Parish 18 110 63 554 In Public Institutions in London, outside of the Parish, and in the Extra Metropolitan Asylums 32 95 13 ... Table III. Death-rates per 1,000 per annum. 1885 1886 1887 1888 1889 1890 1891 1892 1893 1894 28 Large English Towns - 20.6 20.9 20.8 19.2 19.3 21.3 22.3 *20.7 *21.6 *18 .1 London 19.8 19.9 19.6 13.5 18.3 21.5 21.4 20.6 21.3 17.8 Greater London 19.2 19.3 18.9 17.8 17.3 20.1 19.8 19.3 19.7 16.5 St. George's, Plan over sq. 16.11 17.17 16.05 16.05 14.19 14.56 14.65 16.97 15.38 13.80 *33 Towns. From Table III, we see that the death.rate of London proper amounted to 17.8, which "was lower by 2.6 than the average rate in the previous ten years," and in fact the lowest on record. The death-rate of greater London with an estimated population of 5,948,300, was 16.5, or over 3 per thousand less than in 1893, and nearly 1 per thousand less than in 1879, when it was 17.3, the lowest rate previously recorded. The death-rate of the 33 largest English towns was 18 .1, which is 3.5 per thousand lower than that recorded for the 4 previous year. The death-rate of this parish was lower than that of any one of the 33 largest English towns except Croydon, the nearest to it being:— Croydon 13.3 Leicester 14.7 Derby 15.0 Portsmouth 15.2 Huddersfield 15.8 West Ham 16.2 Cardiff 16.2 Brighton 16.4 Halifax 16.5 and the highest being :— Manchester 20.4 Wolverhampton 20.7 Preston 20.8 Sunderland 20.8 Salford 21.0 Liverpool 23.8 The death-rate of Edinburgh was 17.5, or nearly the same as that of London (17.8), that of Glasgow 19.8 and that of Dublin 24.8. Although our death-rate was so exceptionally low, I have for the first time to record that the death-rate of one Colonial City was lower, viz., Brisbane, with a rate of only 12.5. The lowest death-rates of all other Colonial and Foreign cities were higher than the death-rate of this parish, the nearest to it being those of:— Sydney 14.2 St. Louis 16.1 The Hague 16.9 Hamburg 18.0 Berlin 18.2 Amsterdam 18.3 Cincinnati 18.3 Stockholm 18.3 Table IV. YEAR. Registered Births. Birth-rate per 1,000 per annum (52 weeks.) Deaths op 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 16.76 189 4 1,499 18.88 177 11.81 12.78 From Table IV. we see that the number of births in the Parish was 1,499, and that the birth-rate was 18.88 per thousand per annum, as against 18.90 in 1893. The birth-rate for London proper was 30.1, as against 31.9 in 1893. The average birth-rate of the 33 largest English towns was 30.7, as against 31.9 in 1892 and 1893, the highest being those of Liverpool 35.4, Sunderland 35.1, Cardiff 34.4 ; and the lowest those of Brighton 25.8, Croydon 25.0, Halifax 23.1, and Huddersfield 20.2. The number of deaths of children under one year of age (Parishioners; see Table A at end of Report) was only 177 ; 5 and the highest being:— Calcutta 29.8 Trieste 30.2 St. Petersburg 31.4 Bombay 33.3 Moscow 34.2 Madras . 36.7 Alexandria 40.6 Cairo 52.0 In Berlin the rate was 18.2, in Paris 20.3, and in Vienna 22.8 ; all lower than in 1893. But it is worthy of remark that most of the foreign cities had higher death-rates in 1894 than in 1893, owingto the prevalence of Diarrhceal Diseases, including Cholera. 6 the percentage of such deaths to registered births was 11.81, and to total deaths of parishioners, 12.78 ; thus the mortality of children under one year of age was only 118 to a thousand births, or 18 less than in 1893, while in London generally it was 143, and the average for the 33 largest English towns was 152, the highest being Nottingham 174, Salford 174, Liverpool 179, and Preston 217, deaths of children under one year of age to a thousand births. Table V. YEAR. A. Persons aged sixty years and upwards. B. Injuries. G. Inquest Cases. D. Uncertified. Percentages to Gross Total of Deaths. A. B. C. D. 1885 557 79 106 22 31.42 4.46 6.0 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 2977 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 33.38 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 1894 465 70 120 9 30.79 4.63 7.9 0.59 London 1894 17,212 3,147 6.663 651 22.34 4 85 8.6 0.80 From Table Y. it appears that there were 465 registered deaths of persons aged 60 and upwards, giving a percentage of 3079 of the gross total of deaths, as against a percentage for London generally of only 22.34. There were, however, (see Table VI.) only 257 deaths of parishioners of 65 years and upwards, giving a percentage of 18.55 of the corrected total of deaths. From Table V. we also see that 70 deaths from injuries were registered in the Parish, being 4.63 per cent, of the total deaths, but of the 70 deaths registered under this heading only 35 were those of parishioners, and 8 parishioners died from injuries outside of the Parish, making a total of 43 deaths of parishioners from " Injuries " (see 7 Table VI.), and giving a percentage of 3.03 of the corrected total of deaths, or 1.8 lower than that of London generally, and considerably lower than the rate for the Parish in 1893. The Inquest cases held in the Parish numbered 120. They were equivalent to 7.9 per cent, of the gross total of deaths, as against 8.6 in London generally. TABLE VI. Non-Parishioners excluded. Year. A Persons aged sixty years and upwards. B Injuries. Percentages to corrected Total of Deaths. A B 1890 404 33 30.82 2.5 1891 405 37 30.85 2.8 J 892 396 50 29.66 3.7 1893 *307 56 25.23 4.6 1894 *257 43 23.45 3.0 *65 years and upwards. The number of registered deaths uncertified as to cause was only 9, or lower than in any previous year, and equivalent to 0*59 per cent, of the gross total of deaths, that of London generally being 0*80 per cent. Table VII. SUB-DISTRICT. Population at middle of 1891. Births. Birth-rate. Deaths of Parishioners. Deaths (corrected). Death-rate (corrected). Hanover Square Mayfair Mayfair 23,097 261 11.26 222 244 10.53 Belgravia 56,026 1,238 22.02 798 852 15.16 Gub - district not stated 76 Whole Parish 79,123 1,499 18.95 1,096 1,096 13.80 Table VIII. BIRTH-RATES. DEATH-RATES. 1885. 1886. 1887. 18S8. 1889. 1890. 1891. 1892 1893. 1894. 1885. 1886. 1887. 1888. 1889. 1890. 1891. 1892. 1893. 1894. Hanover Sq 15.36 14.00 13.67 13.74 11.83 9.95 8.95 11.32 10.87 11.26 15.18 15.42 12.75 13.47 12.09 9.32 10.08 11.62 10.74 10.53 Mayfair 14.16 14.15 11.19 11.49 Belgravia 22.24 22.46 22.53 21.31 22.14 21.34 22.59 22.71 22.27 22.02 17.49 18.79 17.75 17.38 15.27 17.24 17.00 19.25 17.32 15.16 Whole Parish 19.73 19.66 19.53 18.74 18.64 17.49 17.96 19.31 18.90 18.95 16.11 17.17 16 .05 16.05 14.19 14.56 14.65 16.97 15.38 13.80 8 9 From Tables VII. and VIII. it appears that the birth-rate of the Mayfair Sub-District was 11.26, as against 10.87 in 1893; while that of the Belgravia Sub-District was 22.02, as against 22.27 in 1893, and that the corrected death-rate of the Mayfair Sub-District was 10.53, as against 10.74 in 1893, and that of the Belgravia Sub-District was 15'16, as against 17.32 in 1893. 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 92.15 Belgravia 45.70 Whole Parish 66.19 The calculated mean length of life in this Parish during the last 20 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 „ „ 1882 „ 52.56 „ „ 1883 „ 55.09 ,, 10 In 1884 it was 53.78 years „ 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 „ „ 1894 „ 66.19 „ So that the mean length of life in this Parish during those 20 years has averaged over 55 years, while during the last ten years it has averaged over 59 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 „ „ 1885 „ 39.29 „ „ 1886 „ 39.31 „ „ 1887 „ 39.98 „ „ 1888 „ 41.77 „ „ 1889 „ 43.27 „ „ 1890 „ 4110 „ N.B.—These figures are too high, being calculated from erroneous estimates of the Population of London. „ 1891 „ 38.28 „ „ 1892 „ 39.58 „ „ 1893 „ 38.61 „ „ 1894 „ 43.81 „ Table IX. Showing the number of Deaths registered in the Parish in each of the ten years, 1884 to 1893, from the principal infectious Diseases and Diarrhoea% ancl the number in 1894. DISEASE. 1881. 1885. 1886. 1887. 1888. 1889. 1890. 1891. 1892. 1893. Annual Average of ten years, 1884—1893. Proportion of Deaths to 1,000 Deaths in ten years, 1884—1893. 1894. Proportion of Deaths to 1,000 Deaths in 1894. Small-pox 2 2 0 0 0 0 0 0 0 0 0.4 0.22 0 0 Measles 40 21 20 30 12 49 49 13 49 9 28.5 15.76 31 20.53 Scarlet Fever 7 10 2 16 8 1 1 1 4 5 5 .5 3.04 1 0.66 Diphtheria 25 35 32 22 52 36 29 16 25 49 32.1 1776 24 15.89 Whooping Cough 43 19 40 23 28 31 48 24 20 13 28.9 15.99 24 15.89 Typhus Fever 1 0 0 0 0 0 0 0 0 0 0.1 0.05 0 0 Enteric (orTyphoid)Fever 22 8 12 15 5 18 12 14 10 27 14.3 7.91 23 15.23 Simple Continued Fever 1 9 1 2 1 1 2 1 0 2 1.3 0.72 2 1.34 Diarrhoea 44 37 45 58 27 31 29 39 20 34 36.4 20.13 14 9.27 Cholera 0 9 1 0 0 0 1 0 1 0 0.5 0.28 0 0 Total 185 13 6 153 166 133 167 171 108 129 132 148.0 81.86 119 78.81 N.B.—In this Table the deaths of Non.Parishioners registered in the Parish are included. 11 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 119, or 29 below the average of the previous 10 years. If, however, we subtract the deaths of non-parishioners (38) an,d add those of Parishioners dying of these diseases in Public Institutions outside of the Parish (17), the total becomes 98, as shown in Table X., which is equivalent to a zymotic death-rate of only 1.23, as against 1.36 in 1893, the rate for London being 2.66, and that for the 33 largest English towns 2.44. The only large towns showing a lower zymotic death-rate than this Parish are Halifax, with 0.87, and Brighton, with 1.21. The highest zymotic death-rates in the country are furnished by West Ham, 3.19; Wolverhampton, 3.23; Salford, 3.25 ; and Liverpool, 3.41. TABLE X. Deaths of Parishioners from the principal Infectious Diseases and from Diarrhoea :— Disease. 1890. 1891. 1892, 1893. 1894. Small-Pox 0 0 0 3 1 Measles 45 13 48 2 29 Scarlet Fever 2 6 12 24 10 Diphtheria 12 19 23 26 18 Whooping Cough 48 21 19 12 20 Typhus Fever 0 0 0 0 0 Enteri c (Ty phoid) F ever 5 . 9 8 11 8 Simple continued Fever 2 1 0 2 2 Diarrhoea 29 31 21 28 10 Cholera 0 0 1 0 0 Total 143 100 132 108 98 Influenza 27 46 75 13 15 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 1 death of a Parishioner in a Public Institution outside of the Parish. (Table A.) Measles caused 29 deaths of Parishioners, or 2 over the annual average. Scarlet Fever caused only 1 death in the Parish, but 9 deaths of Parishioners occurred from the disease in Public Institutions outside of the Parish. Diphtheria : 24? deaths were registered in the Parish from this disease, but 11 of these were those of Non.Parishioners. On the other hand, there were 5 deaths of Parishioners from Diphtheria in Public Institutions outside the Parish, so that 18 Parishioners died of Diptheria as against 26 in 1893. (There was also 1 death of a Parishioner from Membraneous 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 1894 being 65 per cent, above the average of the preceding 10 years. Whooping Cough: 20 deaths were registered, all of Parishioners: the annual average of the previous 4 years having been 25. O 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. 1 4 Enteric (Typhoid) Fever : no less than 23 deaths were registered, or nearly twice the corrected average for the previous 10 years. But of these 23 deaths, 16 were those of 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 only 8 deaths of Parishioners from this disease. Simple continued Fever : two deaths, both of Parishioners, were registered from this disease. Diarrhoea : only 14 deaths were registered, being 20 less than in 1893, and 22 less than the average of the previous 10 years. Of these deaths, moreover, 5 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, so that only 10 Parishioners died of this disease during 1894. I may note that the mean temperature of each quarter of the year was above the average, except that of the Summer quarter which was 1.2 degrees below the average of the last 123 years, and 1.6 below that of the last 53 years. The mean temperature of the year was 49'9 degrees, or 1.3 degrees above the average of 123 years, and 0.7 above the average of the previous 53 years. No death from English Cholera was registered. Influenza : 15 deaths of Parishioners were recorded from this disease (as against 13 in 1893, 75 in 1892, and 46 in 1891). One Non-Parishioner also died from it in the Parish. 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. 15 Cases of Infectious Diseases. The following table shows the number of cases certified by Medical Attendants in 1890, 1891, 1892, 1893, and 1894: — Table XI. Name of Diseases. Numberof Cases certified. 1890. 1891. 1892. 1893. 1894. Scarlet Fever 145 122 318 567 255 Enteric Fever 40 26 42 62 65 Continued Fever 5 2 1 2 4 Diphtheria 64 74 118 111 97 Erysipelas 37 41 57 76 45 Membraneous Croup 1 2 1 7 3 Small-Pox 0 1* 1 21 10 Puerperal Fever 0 2 2 3 3 English Cholera 0 0 1 2 0 292 270 541 851 482 * This ease, however, on being removed to the Small-Pox Hospital was found not to be a case of that disease. Of the above 482 cases certified last year only 5 were also notified by householders. On account of a suggestion from the Local Government Board, the Vestry decided to place Diarrhoea on the list of notifiable diseases (in view of the presence of Cholera in this country) during part of the quarter ending September 29th, 1894, and 101 cases were certified by Medical Attendants. Of the 65 cases of Enteric Fever no fewer than 29 were certified in November and December, and only 14 in the three previous months when the seasonal prevalence of that disease usually takes place, and on investigation I find that 16 This is usually the case, as is shown by the following table :— Cases of Enteric Fever. year. Aug., Sept. and Oct. November and December. No. of Cases. Average per month. No. of Cases. Average per month. 1891 6 2 12 6 1892 15 5 15 7.5 1893 16 5.3 18 9 1894 14 4.6 29 14.5 This follows upon the delivery of insufficiently filtered Thames Water when the river is in flood, which was especially noticeable last year, the samples taken in November being very bad indeed. Some cases of this disease in London and elsewhere were believed to have been traced to the consumption of sewage polluted oysters, but this cause would apply equally to September and October. The temporary shelter which the Vestry have provided and furnished in the basement of the offices at No. 1, Pimlico Road, for the use of persons compelled to leave their houses during the process of disinfection after infectious disease, has not been occupied during the year. Sanitary Work. For the year ending December, 29th, 1894. The following tables, prepared by Mr. Albert Taylor, your Chief Sanitary Inspector, show the amount of sanitary work done. I have added the figures for 1893 for comparison :— Table XII. 1893. 1894. Houses and Premises inspected 1,841 2,042 ,, j, re-inspected 4,159 4,397 References to Surveyor 44 26 Notices issued (preliminary) 1,042 1,125 ,, (statutory) 145 113 Summonses taken out 5 16 Convictions obtained 5 16 17 Table XIII. Nuisances dealt with. 1893. 1894. Soil Pipes ventilated 341 375 Bath, Sink, and other Waste Pipes disconnected 765 699 Drains unstopped or repaired 299 106 Defective Drains re-constructed 358 320 New trapped gullies fixed 1,131 831 Water Closet apparatus cleaned and repaired 101 85 New Water Closets fixed 669 651 New Water Waste Preventer Cisterns fixed 720 676 Drinking Water Cisterns cleaned and repaired 58 75 Houses provided with water 22 27 Water Supply of W.C.'s separated from drinking water 92 147 Ashpits and Dustbins repaired 27 27 New Moveable Dustbins provided 32 84 Yard surfaces paved or repaired 20 20 Cesspools abolished 4 4 Overcrowding abated 33 38 Houses and Premises cleansed 75 125 Eoofs and rain-water pipes repaired 22 46 Offensive accumulations removed 46 32 Dung-pits abolished and moveable wire cages substituted 26 250 Nuisances from the keeping of animals 10 8 Underground Rooms discontinued for use as sleeping apartments 6 18 Smoke Nuisances 9 4 Removal of Hog's Wash in unsuitable receptacles 21 21 Miscellaneous Nuisances 156 97 5,046 4,766 18 1893. 1894. Drains tested and found defective 423 426 ,, „ „ satisfactory 62 30 Drains of Premises undergoing alteration or re-construction superintended and tested 133 182 It will be noticed that a considerably larger number of houses were inspected and re-inspected than in 1893, many more preliminary notices were served, but fewer statutory notices were required. It was, however, necessary to take legal proceedings in 16 cases to enforce the abatement of nuisances. At the request of your Committee of Works I prepared a Special Report on the Model Bye-Laws for Houses let in Lodgings, proposed by the Local Government Board, under the"Public Health (London) Act, 1891," comparing them with the Bye-Laws then in force in this Parish; and I recommended the adoption of the proposed Bye-Laws with certain modifications; this was done, and the new Bye-Laws were confirmed by the Local Government Board, and are now in force. There are 73 houses let in lodgings. They have been inspected, and the regulations as to cleansing complied with. The total number of applications for the removal of house refuse were:-In the In-Wards, 2.926; in Grosvenor Place District, 1715; and in South Belgravia District, 1392. With regard to the Factory and Workshop Acts, Mr. Taylor reports that:— "A house to house inspection has been made of all the premises in Mill, George, Brook, Princes and Hanover streets, and in Hanover Square, 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. 19 The number of workshops and work-places inspected was 108; of these, the sanitary arrangements of 94 were found defective, the drains of 47 having to be reconstructed. These 108 premises contained 137 work-rooms, 37 of which were overcrowded, and nine in a dirty and unwholesome condition. There were 910 persons found employed in these workrooms, or 125 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, of which 51 are in use; these have been inspected thoroughly during the year, and the sanitary condition of some of them has been improved, notices having been issued, and the necessary improvements carried out by the owners. There are now no cowsheds in the Parish. The licensed slaughterhouses, of which there are now only three in the Parish, 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 necessary to seize any article of food as unfit for human consumption. The Mewses in the Parish are frequently inspected, and are generally satisfactory, except during the height of the season, when there is great difficulty in getting rid of the dung, because the farmers are too busy to fetch it away. 20 Table XIV. Infectious Diseases and Disinfection. 1893. 1894. Infectious cases reported 851 583* Medical certificates received 950 633* Certificates of infectious cases sent to School Teachers 276 210 Houses in which infectious diseases occurred 745 506 Visits made to infected houses 2,405 1,196 Patients removed to the hospitals 462 348 Houses disinfected 632 363 Rooms disinfected 676 420 Articles of clothing, bedding, &c., disinfected 11,352 8,630 *Including Diarrhœa. Legal proceedings were taken against a man and his wife in Pimlico for having failed to report a case of Scarlet Fever, to which they had not called in a medical attendant; they were convicted and fined altogether seven shillings and twenty-five shillings costs. Certificates are now sent to the Head Teachers of Schools after disinfection has been carried out in houses where there are children who go to school, so that the Head Teachers may know when to re-admit the children from those houses. 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 considerably less than that in 1893, when the epidemic of Scarlet Fever was prevalent. At the request of your Committee of Works, I had a series of Bacteriological investigations made into the power of various disinfectants to destroy organisms, the result of which confirmed the advice I gave to the Vestry many years ago, to use Alkalised Gas Creosote as the general disinfectant, and not to distribute Carbolic Acid to the public. 21 The preparations made by me in 1892, in case of an invasion of cholera, were described in my annual report for that year; the arrangements made still hold good and could be set to work at any time. The following Table shows the number of bodies received in the Mortuary during the 52 weeks ending December 29th, 1894, as compiled from the returns furnished to me monthly by the Mortuary Keeper, Mr. Birch. Table XV. Return showing the number of bodies received into the Mortuary, Ebury Bridge, during the 52 weeks ending December 29th, 1894. Cause of Death. Number. Post Mortems. Inquests. Deaths from Scarlet Fever 0 0 0 Do. Diphtheria 0 0 0 Found Drowned 4 4 4 Found Dead 11 11 11 Born Dead 0 0 0 Murder 0 0 0 Suicide 18 18 18 Deaths from Natural Causes 47 37 36 Deaths from Accidents 40 39 38 Totals 120 109 107 Bodies were brought to the Mortuary in 12 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.) 22 (A) TABLE OF DEATHS during the year 1894 in the Metropolitan Diseases, Ages, Localities. Mortality From all causes, at subjoined Ages. (i) Mortality At all Ages. Under 1. 1—-5. 5—15. 15—25. 25—65. 65 & upwards. 1 2 3 4 5 smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus. (a) (b) (c) (d) (e) (f) (g) (h) Mayfair 172 22 13 7 3 73 54 Under 5 ... ... ... ... ... 5 upwds. 1 Belgravia 593 137 78 15 18 209 136 Under 5 ... ... 3 1 ... 5 upwds. ... ... 2 ... ... St. George's Infirmary (Fulham Road) 112 4 4 4 1 54 47 Under 5 1 5 upwds. Union Workhouse 5 3 1 i Under 5 5 upwds. St. George's Hospital 60 9 3 4 41 3 Under 5 4 5 upwds. 3 Belgrave Children's Hospital 4 1 1 2 ... Under 5 5 upwds. Other places in the Parish ... 10 4 1 5 Under 5 5 upwds. Net Total ... 956 171 105 29 27 383 241 Under o 8 i 5 upwds. I 5 The subjoined numbers have also to be taken into account Parishioners dying outside parish... 140 6 21 8 10 79 16 Under 5 7 4 ... 5 upwds. i 2 1 ... Non - Parishioners dying in parish. 554 26 44 27 47 302 108 Under 5 8 ... 5 upwds. 3 ... 23 Sanitary District of St. George's, Hanover Square, classified according to and Localities. from subjoined causes, distinguishing deaths of children under flve years of age. 6 7 § i y 10 11 12 13 14 15 16 17 is 1 19 ] 20 21 22 Fevers. Cholera. Erysipelas. Measles. Whooping Coil eh. Diarrhoea and Dysentery, j Rheumatic Fever. Ague. 1 Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. orTyphoid.j Continued. Relapsing. Puerperal. 1 3 I 3 10 17 35 4 1 2 1 i 2 11 26 24 4 60 137 1 1 24 16 3 1 17 41 4 3 100 215 2 ... 2 2 5 48 79 53 11 174 378 1 2 1 3 8 i 14 2« 8 1 54 104 .. 3 3 ... 1 1 2 1 1 3 9 I 1 i V 5 9 b 19 51 ... 2 2 1 1 2 ... 4 4 * * * ... 6 6 1 1 27 19 5 2 ... 22 56 4 7 123 276 6 2 1 3 2 1 4 8 ... 81 136 94 28 308 680 n judging of the above records of Mortality. ... j 1 5 3 2 5 27 1 ... 27 13 6 6 56 113 2 4 4 7 17 5 1 22 70 16 ... 2 1 92 80 51 34 205 484 24 ( B) TABLE 0F POPULATION, BIRTHS, AND OF NEW the Mcdical Officer of Health, during the year 1894, in the classified according to Diseases, Population at all Ages. Registered Births. Ages. New Cases of Sickness in 1 1 a a I 4 5 1 6 1 7 Localities. Census 1891. Estimated to Middle of 181)4. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Typhus. Enteric (or Typhoid). | Continued.' (") (b) (c) (i) M Mayfair . 261 Under 5 n 5 i 5 upwards... i 41 15 i 22 2 Belgravia 1238 Under 5 ... OS 27 ■2 I 5 upwards.. 9 135 50 41 2 St. George's Infirmary (Fulham Road) Under 5 5 upwards... Union Workhouse ... Under 5 ... 5 upwards... ... St. George's Hospital.. ... Under 5 ... 5 upwards.. 3 Bel«;rave Children's' Hospital Under 5 5 upwards... 2 Total 1499 Under 5 ... 74 32 2 2 5 upwards... 10 181 65 1 63 4 " Notification of Infectious Disease " has been compulsory in the District since Metropolitan Asylums Board, and occasionally the London 25 CASES OF INFECTIOUS SICKNESS, coming to the knowledge of Metropolitan Sanitary District of St. George's, Hanover Square, Ages, and Localities. each locality. Number of such cases removed prom home to hospitals. 8 I 9 i 10 ii 12 Totals. 1 2 8 4 5 0 7 8 9 10 ii Totals. Fevers. Cholera. Erysipelas. Diarrhoea. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevebs. Cholera. Erysipelas. Relapsing. Puerperal. Typhus. Enteric (or Typhoid). j Continued. Relapsing. Puerperal. 2 19 10 3 18 1 <i 4 93 i 37 4 7 i 50 3 21 117 56 22 1 79 2 31 74 344 9 125 42 ... 17 2 195 ... 2 2 2 8 6 2 2 ... ... 2 2 3 23 136 66 25 i ... 1 92 ... 3 42 78 447 io 166 46 ; ... 24 i 4 251 October 31st, 1889. The Isolation Hospitals are the Hospitals of the Fever Hospital and the London Small Pox Hospital. 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 Seagrove 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, Pimlico 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, 1895. -