Ac 432(3) ST MARY ABBOTTS KRM 103 THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION, &c., &C., of the Parish of St. Mary Abbotts, KENSINGTON, FOR THE YEAR 1876. by T. ORME DUDFIELD, M.D., (Vice-President of the Society of Medical Officers of Health, etc.,) MEDICAL OFFICER OF HEALTH. KENSINGTON: J. Wakeham, Printer, 4, Bedford Terrace, Church Street. 1877. 18 1a CONTENTS. PAGE Prefatory Remarks 5 Death Rate, (1873.6) Parochial and Metropolitan 5 Registration ("Kensington") District and Registration Sub- districts, what they comprise 6 Wards, division of Kensington into (foot note) 6 Sub-districts (registration) relative rate of mortality in the 7 „ Population of the 7 Sexes, relative rate of mortality in the 7 Zymotic Diseases, general remarks on the mortality from 8 „ „ Measles, epidemic of 8 „ „ Small Pox „ 8 „ „ Epidemic and Epizootic 8 Hospital accommodation for the non-pauper infections sick 10 „ „ (local) Sanitary authorities urged by Local Government Board to provide 10 „ „ In-operative provision of Poor Law Amendment Act, 1876, in relation to 11 „ „ Action of the Metropolitan Asylum's Board in relation to 12—18 „ „ Views of the Vestry (13), of Medical Officer (14), and of Society of Medical Officers of Health in relation to 17 „ „ Scheme for providing "Public Health (Metropolis) Bill, 1877" 19 Small Pox, history of the epidemic (1876-77) 21—33 „ how spread 22 „ Comparison between the epidemics of 1871-2 and 1876-7 23 „ Illustrative cases and outbreaks of 23 —30 „ neglect of vaccination, a principal cause of severe outbreak of 30 „ rate of mortality from, in vaccinated and cinated persons 31 Vaccination, remarks by Registrar-General, on protective influence of 31 Unvaccinated children, 350 discovered by a house to house visitation 31 Small Pox, salient statistical results of the epidemic of 32 "Fever," remarks on the mortality from 33 „ Enteric or Typhoid, erroneous statement that it is "chronic in South Kensington," refuted 33 Zymotic Diseases, erroneous statement that "the death rate from, in South Kensington is steadily increasing," refuted 35 4 page Zymotic Diseases, death rate from, in the Parish, in the "West Districts," and in all London 36 „ number of deaths, and death rates from, striking variations in three successive half-years 37 "Fever," deaths from, in Brompton in 1875-6 (Table) 39 Zymotic Diseases, deaths from the principal, in Brompton, 1865-76 (Table) 40 Population of Kensington 41 „ great excess of female 41 „ and wealth, evidences of growth in 42 Marriages and Marriage Rate 42 Births and Birth Rate 42 Deaths and Death Rate 43 Death, special causes of 44—51 Public Institutions, deaths in 51 Inquests 53 Neglect of the Sick, a principal cause for the holding of inquests 53 Deaths "not certified " 54 Unregistered and Unqualified Medical Practitioners 54 Deaths, with "no medical attendant" 55 Meteorology 56 Vaccination 56 "Vaccinated" and "Vaccinized"—a distinction 57 Slaughterhouses, licensed 57 „ Bye-laws; inadequate penalties for offences under the 58 Cowsheds, licensed 59 „ proposal by Metropolitan Board of Works to regulate by bye-laws 59 Cattle Plague, an outbreak of 60 Bakehouses 61 Sanitary Work 61 Dust, removal of 61 Manure, non-removal of, from Mews, &c. 62 "Public Health (Metropolis) Bill, 1877," remarks on the 63 Legal Proceedings, loss of time, and delay in 65 "Virginia Place," houses in, closed under ' Torrens' Act' . 65 Sanitary Wants—Mortuary and Disinfecting Chamber 66 Baths and Wash-houses 67 Water Supply 67 „ Abstract of Dr. Frankland's Annual Report 68 „ „ Colonel Bolton's „ 70 „ a new scheme of, for London 72 Gas 74 „ complaint of nuisance in the manufacture of 75 Conclusion 76 APPENDIX. Statistical and other Tables, I—XII. 79 TWENTY-FIRST ANNUAL REPORT OF THE MEDICAL OFFICER OE HEALTH, Being for the Year 1876. To the Vestry of the Parish of St. Mary Abbotts, Kensington. Gentlemen, I propose in the present report, as on former occasions, to place before your Vestry the vital statistics for the registration year, which in 1876 terminated on the 30th December. The ordinary sanitary statistics will be compiled as usual for the 52 weeks ended 25th March, 1877, the close of the Vestry year. Other subjects of interest will be dealt with as occasion may seem to require. The year 1876, judged by the rate of mortality, may be considered an average year in a sanitary point of view. The deaths, including those of non-parishioners in public institutions, were 2,896, an increase of 110 upon the number registered in 1875, as the number registered in 1875 was an increase of 90 upon the number registered in 1874. But as the population increases rapidly year by year, so necessarily must the gross number of deaths. Between July, 1874, and the same period of 1875, the estimated increase in population was 5,500; and to the middle of 1876 a further estimated increase of 4,500 occurred, raising the total to 148,000. The deaths registered (2,896) were equivalent to 19.5 per 1,000 living, exactly the decennial average rate ; but if the deaths of non-parishioners in the Brompton Hospital for Consumption and Diseases of the Chest (109), and the deaths that took place at St. Joseph's House, Notting Hill (36), be deducted, the rate falls to 18.6 per 1,000. A certain number of parishioners, however, die away from their homes, and it seems only fair, therefore, in comparing the parochial with the Metropolitan rate of mortality, to allow for these deaths, and hence, in all the statistics that follow, the death of non-parishioners within the parish, will be retained as a compensatory allowance for the deaths of parishioners beyond the limits of the parish. Calculating the death-rate in Kensington, then, at 19.5 per 1,000, it will be seen by the subjoined statement that the parish still retains its favourable position:— Death-rate 1876. 1875. 1874. 1873. Kensington 19.5 19.4 19.5 18.3 per 1,000 London 22.3 23.7 22.5 22.5 „ West Districts 21.0 22.1 20.9 20.5 „ North 21.4 22.3 21.8 21.2 „ Central 24.0 26.0 25.6 25.0 „ East 24.0 25.5 25.4 25.2 „ South 22.1 24.0 21.5 22.0 „ 6 It must be admitted, however, that while in 1876 the rate of mortality in the Metropolis as a whole, and in the several groups of districts, exhibits a decline as compared with that of the preceding year, the rate in Kensington was stationary, and this was due to the prevalence of certain infantile diseases of the zymotic class, viz., measles, whooping cough, and diarrhoea, the deaths from these diseases in 1876 having exceeded the number registered in 1875 by one hundred and forty-one; thus accounting, moreover, for the increase in the number of deaths from the seven principal zymotic diseases, from 372 in 1875 to 498 in 1876. The death-rate from these diseases, nevertheless (3.3 per 1,000 persons living), was only .1 per 1,000 above the decennial average (3.2.) Registration Sub-Districts.—"Kensington"* parish is divided for registration purposes into two sub-districts of unequal size, the northern and largest of which, "Kensington Town," comprises an area of 1,497 acres, and an estimated population at the middle of the year of 110,000. The "Brompton" sub-district has an area of 639 acres, and an estimated population of 38,000. A considerable portion of the parish is still open ground; but building operations are proceeding rapidly, though not during the past year at the extraordinary rate of the immediately preceding years. Thus the new houses brought into rating in the year ended July, 1876, were only 504 as against 777 in the preceding year. The Brompton sub-district, however, has become the centre of greatest building activity, and the houses erected in South Kensington, Earl's Court, &c., are large and of a superior character, mainly designed for the well-to-do classes. * "Kensington" is the title of a registration district, which includes the parishes of Paddington, Fulham, and Hammersmith. The subjoined figures shew the relative proportions of Kensington parish, and the other parishes comprised in the registration district of Kensington:— Area in statute acres. Inhabited houses, Population, 1871. 1871. Kensington 2,190 15,735 120,299 Paddington 1,251 11,847 96,813 Hammersmith 2,287 6,719 42,691 Fulham 1,716 3,469 23,350 For some parochial purposes it may be added that Kensington parish is divided into wards. The subjoined figures show the acreage of the several wards, and other particulars of interest. Name of Ward. Area in statute acres. Inhabited houses, 1871. Population, 1871. Rateable annual value of property, 1871. Holy Trinity, Brompton 439 3,224 22,128 £246,716 St. John, Notting 905 7,730 62,475 £365,012 Hill, and St. James, Norland St. Mary Abbotts 846 4,781 35,696 £323,992 2,190 15,735 120,299 £935,720 7 The two sub-districts differ widely in respect of the social status of their inhabitants. Speaking generally the rich and well-to-do form a large proportion of the population in "Bromptoh," the "poor" being few in number; while the Town sub-district contains a large preponderance of the poorer classes. And though the constant decrease in out-door relief, which is set out in the published reports of the proceedings of the Board of Guardians might seem to point to a different conclusion, I believe that the poor inhabitants are increasing in number in the northern parts of the parish. The poor in Kensington, however, have one advantage over the poor in some other parts of the Metropolis, especially in the East end, viz., that they live in houses obviously intended for a superior class of people: miles of streets of such houses being now inhabited by a class of persons who, in the older parts of the Metropolis, find shelter in dwellings that by comparison might be described as squalid. Rents are high, as might be expected, and there is a good deal of overcrowding, which leads me to anticipate the probability that ere long, unless a remedy is provided, of which I do not see any present prospect, the Kensington rate of mortality will approximate more nearly to the Metropolitan rate than hitherto. It is difficult to estimate with precision the relative population of registration sub-districts at inter-census periods; but from a careful consideration of the number of inhabited dwellings, &c., I am disposed to believe that the estimate of 38,000 as the population of Brompton in July, 1876, is very near the mark, and that in the previous year I was rather below the mark in fixing it at 35,250. Assuming the correctness of this estimate, the following figures show how widely the sub-districts differ in respect of their vital statistics. Deducting the deaths of non-parishioners at the Consumption Hospital, and adding a fair proportion of the deaths in the parish infirmary to those registered in Brompton, it would appear that the rate of mortality in the latter district was only 14.9 per 1,000 persons living, while the rate in the "Town" subdistrict was 20.2 per 1,000. An equally striking difference is parent in the sex death-rate. The census of 1871 revealed the fact of a great disproportion in the relative numbers of the sexes, and assuming a continuance of the same ratio it would appear that the excess of female population was 27,500 in July, 1876, and that the death-rate in females was only 16 per 1,000 the males-rate being 24.6. In an estimated male population of 60,250 there were 1487 deaths, while the deaths in the female population of 87,750 were only 1,409. It need hardly be stated that these remarkable facts of excessive female population and low female death-rate have an influence on the sanitary statistics of a very pervading character, and constitute a warning to us not to rely on a low gross death-rate as an infallible evidence of salubrity. 8 The birth-rate in Kensington is low by comparison with that of London. Last year it was 32.9 per 1,000 (London 36.5.) In this respect again, we have evidence of a material difference between the sub-districts in the character of their population. The rich Brompton district with, no doubt, a larger excess of females, including domestic servants, had a birth-rate of only 21.9 per 1,000, while in the Town sub-district, with its larger proportion of poor people—a fecund race, the birth-rate was 33.3 per 1,000. Having said so much in illustration of the diiferences that prevail and distinguish the two sub-districts—differences that make sanitary work easy in the South, and so arduous in the north, I propose, before passing to the detailed subjects of the annual report, to submit some observations on the mortality, &c., from the ZYMOTIC DISEASES. The year 1876 was chiefly characterised, so far at least as Kensington is concerned, by the somewhat extensive prevalence of certain of these diseases. Measles was very prevalent and very fatal. It caused 128 deaths, 103 of which were registered in the first half of the year. The corrected decennial average number of deaths from this disease is 65. It is to be feared that parents, the poor especially, under-rate the importance of measles, and the same remark applies with at least equal force to the other specially infantile diseases—whooping-cough and diarrhoea. It is a well-known fact that the great majority of the deaths from these diseases occur among the poor, and though in respect of measles and whooping-cough the influence of infection is necessarily more intense where the overcrowding is greatest, it must be apparent that if the same care were taken of their children by the poor as among the rich (though it is generally impossible), the class-mortality from the same diseases would not present such extreme differences. The deaths from uncomplicated measles are few by comparison. Out of 103 deaths registered in the first half of the year, only 12 were so returned; while 52 were attributed to complications affecting the breathing organs alone. The deaths were spread over a large area in the North. As usual Brompton enjoyed a comparative immunity, the deaths in that sub-district numbering 16 as against 112 in the "Town" sub-district. Small-Pox.—Towards the close of the year, small-pox became epidemic in London. The disease had been in remarkable abeyance since the close of the great epidemic of 1871-2. In Kensington not one death from this cause was registered between January, 1873, and February, 1876. In the latter year, however, 8 deaths 9 were registered, all in the "Town" sub-district; and the malady, which assumed serious proportions towards the close of the year, is at the present time (June) prevailing with almost undiminished force. In my last report I narrated some striking fatal cases, the nature of which had unfortunately been mistaken at the first. It is impossible to say to what an extent the spread of the disease may be attributed to such oversight, and to the concealment of nonfatal cases, owing to the want of a national registration of disease ? But, by way of comparison, to take a disease in the lower animals, cattle plague, which has lately excited much alarm throughout the country, does anybody doubt the large proportions this virulent infectious disease would have attained if the earlier cases had been overlooked or concealed ? or can anyone doubt the success of the "stamping-out" process, by which it was so speedily eradicated ? We cannot, of course, "stamp-out" disease in man by the process applied in cattle disease: but if the law required the disclosure of every case of infectious disease, and if we had the same power to deal stringently with infected people and infected houses in order to prevent the spread of an epidemic, that the Inspectors of the Privy Council enjoy in dealing with cattle and cowsheds in epizootics, I, for one, entertain no doubt that a disease like smallpox would rarely if ever attain the proportions of a serious epidemic. Our powers are very limited indeed, though we must thankfully admit the advantages conferred on the Metropolis through the establishment of hospitals by the Metropolitan Asylums Board, under the Metropolitan Poor Act of 1867. Speaking generally these hospitals have been as freely open to receive the sick whom we desired to send into them as though they had been under our control;—not of right, but of grace. The Poor Law Guardians might have declined taking many of the sick on the ground of their not being paupers, strictly so called; although they became so by the mere fact of receiving such (nearly always) gratuitous relief. But they did not do so, and the "Managers" received all comers without question. I speak of course with reference to Kensington cases. What has happened in other parts of London I am not in a position to state, but I have reason to believe that in some districts there has been some friction in the relations between Poor Law and Sanitary Authorities. The possibility of any such friction should be at once removed; for while conceding the generally satisfactory working of the dual system, in Kensington, it must be admitted that its success is entirely dependent on the existence of good feeling between the authorities; and on the intelligent appreciation by the Board of Guardians of the necessities of the position. Boards of Guardians, if they thought fit to do so, might at any moment practically close the asylum doors against a large proportion of the infected sick on the plea that they are not paupers. The Local 10 ment Board could only offer advice. The weight of public opinion might control the action of Guardians: but nothing short of legislation could set matters right in such an assumed difficulty. While therefore cordially acknowledging the generally satisfactory working of the present system, I cannot too strongly advocate a change that shall either place the hospitals under the charge of the local Sanitary Authorities (i.e. the Vestries and District Boards of Works) in some shape or other; or, at the least, give the Sanitary Authorities the absolute right of sending to the hospitals (on payment) any cases they may deem it necessary to isolate away from home. This question of HOSPITAL ACCOMMODATION FOR THE NONPAUPER INFECTIOUS SICK has of late been raised and discussed in a spirit which seems to hold out a prospect of an early and a satisfactory settlement. It is so important that I offer no apology for putting a brief resume of facts on record, the more particularly as there is now a pretty general consensus of opinion in favour of views I have all along advocated, of the necessity of making provision for isolating in hospitals all proper cases, and of placing hospital relief on the same footing as vaccination, i.e., by depauperising it. In January of the present year the epidemic showing no signs of abatement, and the new hospitals of the Managers at Fulham and Deptford being not nearly ready for occupation, the Local Government Board addressed a communication to the several sanitary authorities, in which they said "looking to the present crowded state of the hospitals: to the extension of the disease in the Metropolis, and to the proportions the epidemic is likely to assume," the Yestries, &c., should provide hospital accommodation for "that large class of persons not needing relief, but whose isolation in hospitals is necessary for preventing the spread of the disease." They stated "that the hospitals provided for the reception of cases of small pox by the Metropolitan Asylums Board were essentially intended to meet the requirements of the destitute class, and that the admission into these hospitals of persons not in need of poor relief was altogether exceptional, and only allowable upon condition— (1) that the individual case is one of urgency, and (2) that there is sufficient accommodation for the patient without infringing upon the space required for paupers." The Board expressed their fear, which the event has not justified, that the accommodation at the disposal of the Asylums Board would not exceed the amount required for this class, and they requested to be informed what provision your Yestry had made, or proposed to make, for the non-pauper class of the sick poor under section 37 of the Sanitary Act, 1866 ? This question of hospital accommodation for non-pauper sick 11 had been raised some months previously in a correspondence between the Clerk to the Guardians and myself, which was submitted to your Vestry in my report (No. 12, 1876) dated 28th November. In August, 1876, the Guardians having acceded to our request for their active co-operation, informed the Local Government Board that they had instructed their Relieving Officers "to furnish orders for the admission into Poor Law hospitals of any persons whom the sanitary authorities recommend for removal and admission there,"* and they desired the opinion of the Board on the legality of the course they had adopted. The Board in their reply dated 6th September, directed the attention of the Guardians to section 42 of the "Poor Law Amendment Act, 1876,"† "under which" the Board stated that, "the class of cases referred to by the Guardians," (i.e., poor persons not being paupers), "is provided for;" and "the Guardians therefore need not intervene in the matter." Any hope we might have entertained that the power we had so long sought of being able to send our poor (non-pauper) sick to the hospitals under the misty and vacillating section of the Act referred to by the Board, and which has never yet been put into operation, was quickly dispelled by the publication of a circular letter from the Clerk to the Managers of the Asylums Board, addressed to the Clerks of Boards of Guardians as follows:— "The Metropolitan Asylum Board, 37, Norfolk Street, Strand, London, Dear Sir, October 24th, 1876. The attention of the managers having been drawn to the Divided Parishes and the Poor Law Amendment Act, 1876, and some misapprehension appearing to have arisen in reference to the meaning of section 42, I am directed to remind you that the hospitals of the Managers are intended for the reception only of paupers chargeable to the parishes and unions in the Metropolis. I am directed at the same time to state that the medical superintendents of the hospitals would only be justified in admitting any person not a pauper, if they should be satisfied that a refusal to admit such person might be attended with dangerous results. I am, dear Sir, Yours faithfully, W. F. JEBB, Clerk." * Letter from the Clerk to the Guardians to the Local Government Board, 12th August, 1876. † The section reads as follows:—"If the Managers of a district constituted under the provisions of the Metropolitan Poor Acts shall have admitted any sick person into their asylum not being a pauper, but under circumstances of urgency, they shall have and may exercise the like powers over such person, and shall have the like remedies for the recovery of all reasonable charges incurred on behalf of any such person as are conferred by the Poor Law Acts upon Guardians over paupers, and for the recovery of relief given or deemed to be given by way of loan to such pauper. ''But the said powers and remedies shall not be exercised or put in force by the Managers until they shall have been authorised to do so by the Local Government Board, and shall be exercised subject to any restriction which may be imposed from time to time by the Board. "Provided also, that no sum shall be recoverable by Managers under the provisions of this Act in respect of any expenses incurred by them other than those which shall be the subject of a separate charge in respect of an inmate to any union or parish in the district," 12 The Local Government Board appear by their letter dated Jan. 2, quoted above, to have acquiesced in the views of the Managers, thus practically withdrawing the opinion expressed in their letter to the Guardians (Sept. 6, 1876) that the 42nd section of the Poor Law Amendment Act, 1876, provided for the non-pauper sick. We were thus left pretty much in the same position as when in 1875 I addressed a letter to the Local Government Board with a view to ascertain whether we might not arrange with the Managers for the admission into the Asylums of certain cases of non-pauper sick at the cost of the Nuisance Authority—and without the intervention of the Poor Law Officials? I was especially desirous that the time of the District Medical Officer should not be needlessly occupied, and that the certificate of any duly registered medical practitioner should be accepted as evidence of the nature of the infectious disease—a plan that would often save valuable time, and prevent delay in the removal of the sick. The special enquiries I addressed to the Board were—(1) "Whether it was absolutely necessary that the Poor Law Medical Officer should sign the medical certificate required to enable the removal of fever and small pox cases to the Poor Law Hospitals? and (2) whether a patient could be admitted into the said hospitals at the expense of the Sanitary Authority under section 26 of the Sanitary Act, 1866?" The Board's reply did not specifically state that we could not make an arrangement with the Managers for the admission of non-paupers; but this was its real purport, for they stated in effect that the only modes in which persons can properly obtain admission into the hospitals were by an order signed by the Believing Officer or the Master of the workhouse, and upon a certificate of a District or Workhouse Medical Officer; in other words as a pauper. And so it has continued up to this hour, for the halting provisions of the 42nd section of the Poor Law Amendment Act, 1876, have not been carried into effect by the required order of the Board, so that with few exceptions, for which we are indebted to the courage of certain Medical Officers of Health in sending cases to the hospital doors, and the discretion of the Medical Superintendents in admitting them (such action on either side having no warrant in strict law), the sick have been admitted as paupers and through Poor Law agency, though in rare cases the Guardians have received or enforced some after repayment in part of the expenses incurred in the relief of the sick. At the point we have now reached, the Managers of the Asylums Board having issued their prohibitory circular of the 24th Oct, thus defining their legal position as an integral part of the Poor Law system, proceeded to take up the whole question in a broad public spirit, their attention having been drawn to it by communications from various vestries "relative to the provision of hospital 13 accommodation for small pox patients not being paupers." The Committee for General Purposes, in a report dated February 22nd, 1877, which was subsequently adopted by the Managers, stated that "a large proportion of the patients received into the hospitals of the Managers belong to a class above that of paupers, although they are sent as paupers with certificates from the parochial medical officers and relieving officers." The Committee further stated that on the 15th February, 1877, "the proportion of patients" (in the several asylums) "who acknowledged to having previously received parochial relief, was under 10 per cent." The replies of the Vestries, &c., to the circular letter of the Local Government Board, dated 2nd January, 1877, on the subject of hospital accommodation, confirmed the Committee in "the belief that adequate provision for the isolation and treatment of epidemic infectious diseases in the Metropolis does not exist," and they arrived at the following conclusions:— (a.) That such provision could be best made in a comprehensive and systematic manner, by one Central Authority acting for the whole Metropolis, not only for pauper patients, but for other classes desirous of hospital accommodation. (b) That such Central Authority should not be merely a Department of Poor Law Administration, but should have the powers of the Sanitary Acts conferred upon it. (c) That either the Metropolitan Asylums Board should be merged into such Central Authority, or should itself be that authority, in which case its constitution should be altered and adapted to its enlarged duties and responsibilities. A copy of the above report was directed to be transmitted to each of the Sanitary Authorities of the Metropolis, also to the Medical Officers of Health, and they were invited to express their opinions thereon to the Managers. Your Vestry referred the subject to the Special Purposes Committee, whose report thereon unanimously adopted, was as follows:— "Tour Committee have to report that they have very carefully considered the several suggestions contained in the report sent from the Managers, and have had before them a report presented by this Committee to the Yestry on the 17th January, 1877, submitting that it is inexpedient and unnecessary for this Vestry to provide hospital accommodation, seeing that the whole of the cases can be so easily dealt with by extending the powers of the Metropolitan Asylum Board so as to enable them to provide for all persons in the Metropolis suffering from small pox or other infectious disease, and requiring isolation in hospitals. "Your Committee agree with the Managers that adequate provision 14 for the isolation and treatment of epidemic infectious diseases in the Metropolis does not exist, and that such provision could be best made in a comprehensive and systematic manner by one Central Authority acting for the whole Metropolis, not only for pauper patients, but for other classes in need of Hospital accommodation. "Tour Committee are also of opinion that the Metropolitan Asylum Board should be such Central Authority, its constitution being altered and adapted to its enlarged duties and responsibilities; that the expenses of persons not being paupers admitted into the hospitals at the recommendations of Yestries and District Boards under seo. 37 of the Sanitary Act, 1866, should be defrayed out of a Metropolitan Rate or Common Fund, and that the relief so granted to persons suffering from infectious disease should not be deemed parish or poor relief, and should not involve the loss of any rights possessed by the said persons." My opinion having been desired by the Managers, I replied in the following terms:— "I have much pleasure in complying with the request of the Managers ef the Metropolitan Asylum District, for the expression of my opinion on the Report of the 'Committee for General Purposes relative to the provision of hospital accommodation for small pox patients not being paupers.' "In the first place, I fully endorse the opinion of the Committee, that 'adequate provision for the isolation and treatment of epidemic infeotious diseases in the Metropolis does not exist.' And I coneur in their' conclusion (a) that such provision could be best made in a comprehensive and systematic manner by one Central Authority acting for the whole Metropolis.' "The cause of the present deficiency is not far to seek. The 37th section of 'the Sanitary Act, 1866,' gave the local sanitary authorities power to provide hospitals for the 'sick inhabitants' of their several districts, and this power would probably have been acted upon, had not the 'Metropolitan Poor Act, 1867,' (under whioh the Asylums of the Managers have been established), appeared to supercede by a general provision for the entire Metropolis the necessity for separate action by the Yestries and District Boards. "The Managers have nearly met the requirements of the Metropolis, by providing hospital accommodation out of all proportion to the wants of the pauper class—thus doing the work which legally devolved on the sanitary authorities: and they appear willing, if called on, to extend and to complete the task. "The question now is, shall they do so; or shall the duty be discharged by those to whom it rightfully belongs? "For my own part I should be content to see the Managers go on as heretofore, providing accommodation for all comers, but with authority to receive payment for such non-pauper oases as the Yestries and District Boards may send under the provisions of the 37th seotion of the Sanitary Act, 1866—on two conditions; viz.:—(1) That such payment should be made out of a Metropolitan rate or common fund, and (2) That relief in the hospitals should be placed on the same footing as public vaccination, so as not to entail any loss of social or political status on its recipients, it being for the interest of the community that infectious diseases should be dealt with at the cost of the community, so far as regards hospital accommodation. This plan has the merit of simplicity—involves the fewest changes, and would entail little or no delay in execution. "But if these conditions are inadmissible, (and seeing that 90 per cent, of the sick in the Asylums are 'not paupers,') I should prefer a 15 severance of the connection between Poor Law Administration and the hospital treatment of infeotious diseases. This might be effected by the constitution of a 'Central Authority' (on the plan of the Metropolitan Board of Works), to be elected by the Vestries and District Boards of Works, and having power to provide accommodation for all persons 'whose isolation in hospitals is necessary for preventing the spread of disease.' "On grounds of public policy I would transfer the execution of the vaccination acts in the Metropolis to the same authority. "What 'powers under the Sanitary Acts' beyond those contained in the 37th section of the Sanitary Act, 1866, the proposed 'Central Authority' would require I do not know; but I venture to believe that the provision of hospital accommodation would meet the necessities of the case, leaving the local administration of the Sanitary Acts un. touched. "This 'public hospital' system would probably entail some additional expense on the ratepayers, but none commensurate with the benefits that would accrue from the safe treatment of infectious diseases which is the object in view; and whatever the increase in cost it would be borne in the same spirit as the charge rendered necessary by the establishment of a fire brigade; for it would be regarded as a premium paid for insurance against a risk as much more serious than fire, as health and life are more precious than property. "Special provision should be made at each hospital for persons who are able and willing to pay for their maintenance, if room for such cases cannot be found, or made, at the London Small Pox Hospital at Highgate, and at the London Fever Hospital. "But the poor ratepayer, the dependent classes and those sick persona whose isolation is enforced or solicited for the good of the community, viz., with a view to prevent the spread of disease, should have free admission. "It is, perhaps, hardly necessary to point out that these are the classes for whom our voluntary general hospitals (where infectious diseases are not admissible) have been established and are supported. Nominally excluded from the Asylums they yet form the great bulk of their inmates through the wise disregard by the Guardians of the strict letter of the law. Sanitary Officials have had difficulty enough in persuading many such persons to go into the hospitals, and the refusal of others has frequently led to an extension of disease. What proportions the present epidemic would have attained had the generality of such cases been excluded can be better imagined than described. The exaction of payment from the sufferers will be fatal to any scheme which aims at complete isolation in suitable cases. "It would be easy to enlarge on the subject, to which I have long given earnest attention, and whieh I have dealt with, in reports addressed to my Vestry, the latest of which I beg to submit to the Managers in further exposition of my views.'' In the report referred to in the last paragraph of my letter to the Managers (No. 15, 1876, read January 10,1877), I had dealt exhaustively with the letter of the Local Government Board (Jan. 2, 1877), in which your Yestry were urged to provide hospital accommodation for the non-pauper sick under the 37th section of the Sanitary Act, 1866; and after pointing out the several modes in which this object as a means to meet a temporary emergency could be met, I concluded by stating my opinion that "The wisest course with respect to the future, for all time, would be 16 to ask the Metropolitan Asylums Board to go on providing whatever hospital accommodation may be required for all classes, as they did, to the extent of 2,000 beds, in the last epidemic, when, with legitimate satisfaction, they were able to boast they had not turned a sick case from the doors. It may be true, "I added," that, by the strict letter of the law the Managers were appointed to provide for the pauper class only, described, however, in the preamble of the Metropolitan Poor Act, 1867, as the 'sick poor,' and in the body of the Act as persons 'chargeable to unions and parishes.' The object of the Act, however, it may be fairly believed, was as much preventive or sanitary, as medical or curative. There is good reason for believing that the Managers took this view of the case at the outset, and that they contemplated the provision of hospital accommodation on a much larger scale than has been done, judging from the space they procured for the purpose in different parts of the Metropolis. These sites are adequate for sick persons in all classes of the community, 'whose isolation in hospitals is necessary for preventing the spread of infectious diseases.' Practically, moreover, I believe I am correct in stating that a large proportion, if not the majority, of cases treated in union hospitals from the beginning have been persons 'not destitute,' not 'paupers,' not 'in need of poor relief,' excepting as the result of sickness—the Guardians throughout London having with a wise discretion sent, and the Managers admitted, all comers. Let it be remembered, moreover, that if expense is in question, Guardians and Managers alike can compel those who are able to do so to pay for their own maintenance. Separate hospitals, or special wards in the same hospital might be set apart for those who can pay, and indeed, classification of persons is in any case necessary. But the question of isolation of cases is of more importance to the community than the question of cost; and whether sanitary authorities or the Asylums Managers provide the accommodation, the same ratepayers will have to find the money. The work can be done more cheaply, more speedily, and more efficiently by one Central Board, than by numerous local sanitary authorities. The hospitals once built, moreover, and a skeleton staff of doctors, nurses, and other officers provided, we should be prepared for any epidemic, and should be spared the periodical recurrence of panics. On the other hand, if vestries and district boards provide local hospitals, not only will the first outlay be great, but each will require a staff of officers, got together with much expense, and with difficulty, only to be scattered at the close of the epidemic; and, possibly after all, the hospitals will not be wanted, unless the beds in the Poor Law Hospitals should remain untenanted! It may be said, however, that it is not right to 'pauperise' people by sending them to' rate supported hospitals but why need they be pauperised, even supposing they are not able to maintain themselves? It is the fact that we often succeed in effecting the removal of sick persons by the most earnest entreaties addressed to parents, and by appeals to a sense of public duty. The oases are sent to hospital for the benefit of the community, as much as (or, rather, a great deal more than) for the benefit of the individual, though I would be the last to underrate the benefits of hospital treatment of infectious diseases. Why, then, should not the precedent of vaccination legislation be followed when dealing with the disease which it is the object and, in the vast majority of cases, the effect of vaccination to prevent? Any gentleman who hears me may go and be re-vaccinated at the present moment, and within a few doors of this Hall, at the public cost, and out of the poor's rate, without being pauperised— without losing his privileges as an elector. Why? In order to lessen the risk to the community of his catching small-pox, which is justly regarded as a public danger. Is it reasonable, then, to pauperise an artizan, when he is so unfortunate as to suffer in his household, or person, from the disease we are so anxious to prevont, because he, unwillingly indeed, but 17 from a sense of public duty, and for the benefit of the community, con gents to go, or let his child go, to a rate supported hospital? Would not a vestry hospital be a 'rate supported hospital?' I confess I fail to see any practical diiference between hospitals supported by rates. It is a question of taking the money out of the right hand pocket or the left. In such a case all distinotions of pauper or non-pauper should be abolished. Treat all alike as suffering from a personal calamity, which may grow into a public danger, and act on the principle salus populus, suprema lex. But again I say, and if we are to consider questions of economy, if there be a difference in the eost of one plan and the other, the palm of economy must be awarded to the Asylum plan, for the Managers and the G-uardians can, as already stated, recover the expenses of maintenance if they think fit; and the Guardians, at least, are already provided with a staff of collectors for this very purpose. "The present outcry is for a 'Central Health Board for the Metropolis.' The Asylum Managers practically constitute such a board, and, if necessary, they could be endowed with legal powers to provide all the hospital accommodation required for the safe treatment of the infectious diseases. A measure to extend their power in this direction could be passed next month if Parliament thought fit. Practically, such a measure would be tantamount to a consolidation of sanitary authorities—a central board to provide hospitals, local boards, with an efficient staff to carry out the details of sanitary work, to visit the sick, to remove suitable cases to the hospitals, to see to disinfection, &c. The benefit to this metropolis would be incalculable. The fact, however, cannot be too often repeated, that, practically, the Managers can even now do all, or nearly all, that is necessary, at the present time, though theoretically it may be ultra vires. Therefore, it is desirable the law should be amended; and it is fair to infer that the Government, which has consolidated the Public Health Acts for all England, London only excepted, and at the head of which is the author of the famous saying,'Sanitas sanitatum, omnia sanitas,' would yield a ready consent to such a measure; while the skill and energy with which the Managers of the Asylums Board have hitherto performed their arduous and important duties afford ample guarantees for the success of so grand and beneficent a scheme. If, however, contrary to my expestation, this plan should prove impracticable—from whatever cause—permanent provision of hospital accommodation may be made by the voluntary united, or the independent, action of vestries and district boards, or by the creation of a Central Health Board, on the model of the Metropolitan Board of Works, or the Sick Asylums Board, for which, however, Parliamentary powers would be necessary." It may be added that the Society of Medical Officers of Health, before which I had on more than one occasion advocated my views, as set out above, took into consideration the report of the Managers, and expressed agreement "with the opinion 'that adequate provision for the isolation and treatment of epidemic infectious disease in the Metropolis does not exist,' and under existing circumstances the Society endorses the conclusion that such provision could be best made in a comprehensive and systematic manner by one Central Authority acting for the whole Metropolis." "As regards the constitution of the Authority and the administration of the infectious disease Hospitals, the Society is of opinion that such Hospitals, regarded in the light of a sanitary provision for the advantage of the general population, should be 18 completely dissevered from any relation with pauperism." (May 1877.) On the 16th June, 1877, the Committee for General Purposes of the Metropolitan Asylums Board, reported inter alia the purport of the replies received from the Sanitary Authorities to their report (February 22nd) showing that certain Vestries and District Boards and numerous Medical Officers of Health had signified their (general) "concurrence with the views expressed by the Managers." Other Vestries, &c., while concurring mainly with the views expressed by the Managers, disagreed with the somewhat obscure recommendation that "the proposed Central Authority should have the powers of the Sanitary Acts conferred upon it," evidently, the Committee add, through misconception of its meaning. The Committee, therefore, explained that they did not intend "that the Central Authority should supersede or interfere with the existing Vestries and District Boards in the ordinary and important duties which devolve upon them, but merely that it should have such powers of the Sanitary Acts conferred as would enable it to deal efficiently with all cases of epidemic infectious diseases occurring in the Metropolis, and to take steps for checking the spread of such diseases." (Parenthetically it may be observed that this would be to interfere with and to supersede the existing authorities, whose duty it is to take such steps for checking the spread of infectious diseases : and that, in the opinion of the Committee, they deserve to be so superseded, would seem to be apparent in the next paragraph of their report in which they say that) "Little has been done by the existing Sanitary Authorities of the Metropolis to check the spread of small pox, and that still less have efficient steps, or has general action been taken to stamp it out: and hence it cannot be a matter of surprise that the disease has continued to rage so virulently for so lengthened a period." Leaving it to others to decide to what extent this reproach may be deserved by the Sanitary Authorities; and to what extent these are impeded in their action by insufficient powers, I venture to say that these bodies even "with the explanation now afforded of the meaning of the recommendation with regard to the delegation of the powers of the Sanitary Acts," would not look on the "constitution of such a Central Authority as a great public safeguard, and as the most desirable plan of relieving them of a very difficult and unpleasant part of their duties," nor would they be prepared to admit that these duties "from various causes they are unable to satisfactorily perform.* It need hardly be stated that the above reports were forwarded * The Committee's Report was, I believe, "received" by the Managers; who took action on it so far only as to wait on the Local Government Board to obtain information as to the Board's views of the position the Managers would hold in the event of the 64th clause of the Public Health (Metropolis) Bill, 1877, referred to subsequently, becoming law. 19 to the Local Government Board, which had already received considerable enlightenment as to the views of Sanitary Authorities on the provision of hospital accommodation for "that large class of persons not needing relief, but whose isolation in hospitals is necessary for preventing the spread of the disease" i.e., Small Pox. (Local Government Board's letter, Jan. 2, 1877). The result of this enlightenment is now visible in the provisions of the "Public Health (Metropolis) Bill, 1877, which, though not printed, was read a second time in the House of Commons on the 11th June, 1877. The 56th to the 63rd clauses of the Bill (omitting the 57th and 58th) give power to the "local authority" (i.e., Vestry or District Board of Works) to provide hospitals by re-enacting the 37th clause of the Sanitary Act, 1866; enable the Local Government Board to combine such authorities on their application for providing hospitals; provide for the management of the hospitals by a joint committee: for the expenses of the Committee, and confer borrowing powers, &c., &c. I do not enter into details on this part of the scheme, because I do not expect it will be put into operation whenever the Bill may pass. I venture, however, to quote in its entirety the 64th section, to which I attach the greatest importance, viz.: — "The Managers of any asylum district constituted under the Metropolitan Poor Act, 1867, and the Acts amending the same, may, from time to time, with the approval of the Local Government Board, contract with any local authority under this Act for the reception, care, and maintenance in any hospital belonging to or under the control of such managers, of any person suffering from any dangerous infectious disorder within the district of any such local authority." It is to be hoped that when the Bill is in Committee the permissive power to contract will be made an obligatory one on the Managers; and it is to be remarked that, although it is probable only the Managers of the Metropolitan Asylums Board would ever think of entering into such a contract for the reception of the infectious sick, all the "sick asylums" Boards (and there are several such in the Metropolis) are embraced within the terms of the section. I think it may be fairly inferred from all that has taken place that the Local Government Board is not disposed to alter the constitution of the Metropolitan Asylums Board, and that they are of opinion (as I am) that "the provision of hospital accommodation" by this excellent Board "would meet the necessities of the case, leaving the local administration of the Sanitary Acts untouched." In a roundabout way the 57th clause of the Bill makes a provision which would have the desired effect of depauperising the relief given to the "non-pauper" sick in the hospitals, it being assumed that such cases would in future be sent by the sanitary authorities, and not through the agency of the Poor Law officials. The clause 20 provides for the "recovery of cost of maintenance of patient in hospital;" any expenses incurred by a local authority in maintaining the non-pauper patient in the hospital "shall be deemed to be a debt due from such patient to the local authority, and may be recovered from him at any time within six months after his discharge from such hospital, &c., or from his estate in the event of his dying in such hospital, &c." No doubt cases will from time to time be admitted into the hospitals to which this section will be applicable, and there will be other cases where the patient will be willing and desirous to pay all the expenses incurred on his behalf (though in my judgment the London Small Pox Hospital at Highgate, and the London Fever Hospital at Islington are the more suitable establishments for such cases); but I am convinced that the object we all have at heart, viz., the isolation in a hospital of every suitable case needing to be isolated, will be utterly frustrated if any attempt is made to make the hospitals generally self-supporting. I need not enter into the question here, however, as I have already dealt with it above, and in a special report on the Bill which I addressed to your Yestry on the 27th June. I am convinced, moreover, that the compulsory exaction of payment will fall through in practice; for the mere threat of such an exaction would have the effect of rendering the hospitals comparatively useless. The non-pauper sick would not go to them; the pauper sick would not fill a tenth of the beds. Moreover at the present time, though the Guardians have ample powers to recover just as the 'local authority' would have under the proposed Bill, they have realized the absolute futility of the endeavour to do so in all but the rarest cases; and I contend, that in generally abstaining from pressing their legal claims, they have exercised an admirable discretion, and justly earned the thanks of the community by which the hospitals are maintained for the public good. I object to sham legislation and to the creation of powers not intended to be used. I object to the permissive " may " in the administration of sanitary law. Either a thing should be done or it should not. If it is right make it compulsory. If it is wrong or indifferent leave it alone. Let us face this question boldly and firmly, and act up to the views that are now held by nearly all authorities, by dealing with infectious diseases as we do with vaccination. Stamp them out at the public cost, charge the expense to a Metropolitan rate. Separate the relief in hospitals from all taint of pauperism; but let us at the same time press for additional powers to enable us to collect into the public rate-supported hospital any sick person whose retention " at home " is a danger to the occupants of the same house and to the locality. Let us, moreover, take whatever other steps may be necessary to deal effectively with infectious disease, especially by providing disinfecting chambers, mortuaries, &c. 21 I have ventured thus to place on record a sketch of the Bteps which have led up to our present more hopeful position; in the belief that we are on the eve of great and beneficial changes, and that your Vestry will have no cause to regret the part we have taken in helping to bring about a satisfactory solution of one of the most interesting problems that could be brought under the notice of sanitary authorities, or with which sanitary officials have to deal. Small-Pox.—History of the Epidemic. Although the epidemic is not by any means over at the present writing (August) we see, I believe, the beginning of the end in the considerable decrease in the number of cases in the northern parts of the parish. There was, it is true, a decided increase in the number of fresh cases in June and July, in the south-western corner of Brompton, but our success in isolating the sick led us to entertain a hope, justified by the event, that the disease would not spread as we should have expected it to do in more crowded and poorer parts of the parish, such e.g. as Kensal New Town, where much difficulty, from a variety of causes, has been experienced in effecting the removal of the sick to the hospital. I think the time has arrived, therefore, when the leading facts of the epidemic, so far as they are known to us, may be stated—not that I have much, if anything, new, to say on the subject, as I have kept your Vestry regularly informed of its progress. The annual report of the Medical Officer, however, being a permanent record, it appears desirable to recapitulate herein whatever of interest in a sanitary point of view may have happened, though dealt with already, piecemeal, in my monthly reports. Small-pox, then, began to spread epidemically in Kensington, so far as we know (this reservation being necessary, owing to the concealment of cases, always more common and more easy at the commencement of an epidemic) in the late autumn of 1876. For many months the disease was almost entirely confined to the northern parts of the parish, and of these no section suffered so severely as Kensal New Town. The portions of this district belonging to Paddington and Chelsea appear to have been invaded in an equal degree. The cases in the South Sanitary district, i.e., all Kensington south of the Uxbridge Road, were few in number, and occurred sporadically until June, 1877, when they increased considerably, why orwherefore I am unable to say: but popular opinion ascribed the spread of the disease to infection derived from the new hospital west of the railway and cemetery at Brompton, between the Lillie Bridge and London Athletic Club Grounds, an opinion in my judgment not tenable. Some persons again, thought the disease might have been spread by the clothes of the hospital nurses in their intercourse with the outer world, but I have no reason to doubt that the precautions taken to guard against this not impossible source of 22 infection were sufficient, and that the fact cannot thus be explained. The cases in this southern district were more scattered than in the north, and we had no such groups of cases in single houses or in streets, &c., as I have had occasion to call attention to as occurring in Kensal New Town, &c. The spread of the disease in a general way may be attributed to the neglect of vaccination under circumstances elsewhere adverted to, and especially to the neglect of re-vaccination: to the concealment and consequent nonremoval of cases, to the overcrowded condition of the houses, and to the want of caution on the part of the sufferers, in the case of adults: of the parents, when children were the victims. An adult having a slight attack of modified small-pox may scarcely feel ill, and if disinclined to go to the hospital, is still less disposed to submit to the needful restraints "at home," And what a "home" it is in too many cases! Who can wonder that the patient is glad to get into the fresh air, and to mix with friends and neighbours? Should the sickness be not severe, and the sufferer be not much marked, say on the face, he or she is disposed to conceal the nature of the illness and go to work—in the workshop or the laundry, it may be. Here we have a fruitful sowing of the seeds of disease; and even if the father or mother of the family be not sick they often go to their daily labour from rooms full of' deadly germs which they may convey in their clothes and sow broadcast. The "clean clothes" sent home from the laundry may in like manner become the channel of infection. Certain it is that in many cases we have found manglers and ironers going constantly to and fro between the pestilential "home" and the laundry, prior to the report of sickness in their families. Children too, how difficult to keep them at home when they begin to get better! Parents are glad to get rid of them for quietness, and that the little ones may benefit by the purer air outside the dwelling. And if they go not out, how imposible it is to keep them to their rooms! On the staircase the infection is constantly spread to other families in houses let out in tenements. We have had. many well-authenticated examples, moreover, of the spread of infection through every part of the house, when there appears to have been a thorough anxiety on all hands to prevent it—showing that in the strict sense of the word, the sufferer was "without proper accommodation," though lodged in a separate room with his nurse. But then, the nurse is usually the wife or mother, and it is too much to expect that in the ranks of the poor those precautions which are so successful in large houses tenanted by single families can be practised; hence it follows that there is no safety unless the patient is removed without delay at the commencement of the attack, and the room, clothing, &c., disinfected. In many instances where this has been done, no second case has been recorded. It is astonishing, however, how little people are impressed with the importance of 23 dealing energetically with a first case of illness. They hope there will not be a second, and they often say if there should be, the patient shall go to the hospital. Often the father will send his child, but will not go himself. Vaccination again is hot seldom railed against till small-pox appears, and then when the mischief has begun, and perhaps cannot be stopped, the people rush to the public vaccinator. Through schools the disease may be spread, for as no law forbids the exposure of infected things on the body of uninfected persons (so we are advised); children may go to school in garments reeking with infection ; and unless attention is called to the possibilty of sickness in the house by the absence of a pupil, the school-officer has no warning of the risk to which the entire establishment is exposed. It is no uncommon thing I fear for infected clothes to be sent to the wash without previous effectual disinfection, and it is a common practice to hang out infected clothing, bedding, &c., in the back yards, called by courtesy gardens, and thus the winds are made to diffuse disease in every direction. In all these ways we know the malady has been spread; and indeed, considering the facilities for the diffusion of infection, and our limited powers to check it, the marvel is not that we have had so much, but that we have had so little small pox in our midst. On the whole our efforts for effecting the removal of the sick have been more successful during the present epidemic than in that which raged in 1871-2, and the deaths 'at home' have consequently been fewer. Thus in 1871 there were 62 deaths 'at home' and 58 in the hospitals : and in 1872 the deaths 'at home' and in hospital were 39 and 29 respectively, whereas in the 12 months ended July 31st, 1877, the deaths at home were only 25, and those in the hospitals 44. It must be confessed, however, that the present epidemic has not attained the proportions of the former one, for while our highest monthly record of cases in 1871-2 was 116, the largest monthly total during the present epidemic has been 50 only. Estimating the mortality at 20 per cent. on the attacks, the cases kept at home would be 125, our record to the end of July giving 108, thus showing a smaller number of concealed or unknown cases than in 1871, when we heard of 164 cases only, out of an estimated total of 310. Following the custom of former reports, I now proceed to mention a few local outbreaks of the disease which were traced to their origin; for information of this kind tends to destroy the fatalistic belief that as infection is "in the air," it is useless to try to prevent the spread of disease. The first group of cases I shall mention commenced—at any rate our knowledge of it began in the kitchen of Denbigh Villa, in Denbigh Terrace. The primary case was that of a man aged 52 years, of whose illness we heard nothing till the case was approaching a fatal termination, 24 It appeared that on the day of his death the widow called in two little girls, neighbours' children, to write letters, &c. One of these children was in due course attacked at her home a few doors off in Denbigh Terrace. Ocoupying the parlours of Denbigh Villa were a married couple, with whom a widowed niece was staying on a visit. This woman went down into the rooms occupied by the family of the deeeased, and subsequently was taken ill. Both these eases were removed to the hospital, and both recovered. To return to the second house in Denbigh Terrace. On the top floor of this six-roomed house there lived a married couple and their son, a pupil teacher at a neighbouring school. On account of the little girl's illness the latter discontinued his usual work, and about a week after her removal he was taken ill, and was removed to the hospital, where he did well. The occupier of this house (father of the little girl) with his wife and four children lived in the parlour and one room in the basement. A few days after the removal of the young man the poor woman (wife of the occupier) was confined, and with her infant immediately suffered from small-pox. The child died when six days old ; the mother recovered. It was, of course, impossible to remove these last cases to the hospital. Some little time after these cases had been dealt with as an apparently isolated outbreak, we heard of nine cases in two houses in Lonsdale Road, at some distance from Denbigh Terrace. The first of these cases appeared to be distinctly traceable to infection received from the little letter-writer referred to above. It began in the middle of September, and though the nine cases occurred in three families, in two houses, and in the practice of three medical men, we heard nothing of the outbreak till attention was called to it by the registration of a death on the 30th October. The place was at once visited and thereafter kept under supervision. It was found that five children in one family in the first house had been affected, and all recovered. In a second family three children were attacked, and two, aged seven and nine years respectively, died. One case, that of a married woman, occurred in the adjoining house, and she died shortly after giving birth prematurely to a child, which survived its birth only a few hours. This woman had not gone into the infected house, and her illness was, presumably, the consequence of the exposure of infected clothing in the adjoining backyard. The next case in this group was that of a man who was on intimate terms with one of the above mentioned families, and who is supposed to have received the infection from the clothing of the father of the sick children ; the father living in the same room with them, and going about his ordinary avocations without any precautions against the spread of the disease. This same man, or his son, in similar circumstances, appeared to have been the originator of a still further outbreak by which two men were stricken. One of these men died, and his sister was infected while nursing him. The history of the attack in the second of these men is curious. The infecting man wishing to attend the funeral of his little sister who had died, he said, of bronchitis (the secondary disease named in the medical certificate of the cause of death!) borrowed his friend's coat, that he might make a respectable appearance. Thirteen days afterwards the lender was stricken with small-pox ! How 25 many more cases may have been caused, through un traced ramifications of infection from these multiplied sources, it is impossible to say. It may be remarked, however, that in addition to the cases mentioned above (none of which, save the group of nine, occurred in Lonsdale Road) numerous others subsequently occurred in several houses on the south side of Lonsdale Road, where the disease first appeared, and not one on the other side of the road. There is good ground for the belief that the disease was spread by infected clothing, bedding, &c., hung out in the back yard ; anyhow, we were unable to trace the successive cases to any intercommunication between the families in the several houses, wherein the disease made its appearance. The following cases deserve mention as demonstrating the danger of infected body clothing:— A case of small pox was sent to the hospital from the Brompton Consumption Hospital. It is to be presumed that the sufferer contracted the disease by contact with the infected clothing of a visitor, as she had been in the hospital nearly two months. A similar case occurred in connection with St. George's Hospital, the patient having fallen ill at such a time after her discharge as to prove she must have received the infection in the hospital from a visitor, for there were no cases of the disease in the hospital at the time, though cases did occur subsequently. A baby, aged six weeks, being ill, a woman living in another street nursed the child, whs died in her lap. Out of this lap the woman herself and her children ate shrimps for tea the same night, and in about thirteen days her girl, aged twelve years, sickened with small-pox, and was sent to the hospital. Again. A woman who lived in the same house where the baby died, went occasionally into the sick room, After the usual period of incubation, this woman's husband and her daughter were taken ill and removed to the hospital. Now, as not one of these sufferers went near the sick baby, it is clear they were infected by the clothing worn by the women (themselves unaffected throughout) who assisted in nursing the child, and who probably were ignorant of the danger to which they were exposing their families. Take another case :— A girl was very ill of small-pox. The mother was a laundress, and one of her children had already had small-pox recently. The house was (as usual) full of people, from whom she was anxious to conceal the nature of the illness. The father, a carpenter, employed in a builder's workshop at South Kensington, slept in the same room with the girl, acting as her nurse, and each morning he went to his work in his infected clothes. We got her removed to the hospital, and we do not know that she was the cause of spreading the disease. At one period in the epidemic, however, there were numerous cases among stonemasons and their families, the men working in shops in an adjoining parish. We could not account for the outbreak save on the supposition that the contagium had been conveyed in the mens' clothing. The practice of exposing infected clothing is a common and dangerous one, and there can be no doubt that by it the disease is frequently disseminated. It has, indeed, been a most instructive 26 study to trace the spread of the infection in this way, as we have been able to do, from street to street, from house to house, and from person to person, but it is the opinion of the Law and Parliamentary Committee of your Vestry that the 38th section of the Sanitary Act, 1866, is not adequate to meet such exposure of infected things. The section referred to provides that "any person, who without previous disinfection exposes any bedding, clothing, or other things which have been exposed to infection from any dangerous infectious disorder shall on conviction of such offence, before any justice, be liable to a penalty not exceeding five pounds." If any person conveyed through the street a coat or dress that had been for ever so short a time exposed to infection in a sick room, he would be liable to the penalty; but it would seem that a person may with impunity, wear, in public places, a suit of clothes that had been for an entire night exposed to infection in the same sick room! The danger is as great in the one case as in the other. Again, if any person " moves or exposes " in a public place any infected bedding, &c., unless it is in course of transmission, under proper precautions, to a disinfecting chamber, he is liable to the penalty. But it would seem that he may with impunity expose that same bedding in a back yard, over the dwarf walls of which the winds impartially disseminate the poison it contains in every direction. The following case is deserving of notice as showing the farreaching effects of neglect of sanitary precautions. Several cases of small pox had occurred in a house, and the family laundress, hearing of the illness from time to time, caused enquiry to be made if it was an infectious character, and the reply was invariably " No." Early in January a child died, and the enquiry being repeated the same answer was given, the statement made being that the child had died from diarrhoea—the secondary disease mentioned in the certificate of the cause of death. The condition of one of the sheets sent to the wash on the day following the child's death (it was covered with scabs, &c.) left no doubt on the mind of the laundress of the nature of the illness ; and, pressing her enquiries, she ascertained that the child had died from small pox. There is reason to believe that for several weeks the infected clothing had been sent with other things to the wash without any, or only very imperfect, previous disinfection. The date of the offence, however, specially referred to below was Monday, December the 18th. On the 19th December the daughter and niece of the laundress sorted the clothes, and on Monday, the 1st January—exactly thirteen days afterwards, the true period of incubation of small pox—both were taken ill. About this time the nephew of the laundress, a soldier on leave of absence, went to the house on a visit. He left for Birmingham on the evening of the 15th January, very ill, with all the symptoms of an attack of small pox, and he died on the 18th. The regimental surgeon who had charge of this case, not being acquainted with the soldier's immediate history, did not recognise the disease as small pox. The death was registered as " (Epidemic) Spinal Meningitis." I received a letter from the Medical Officer of Health, however, who wrote—" I should be inclined to conclude that the disease was hemorrhagic small pox killing before the true eruption appeared. The 27 man had great pain in the head and back, vomiting, and a purpuric eruption.'' He also said, " the woman who washed his clothes took small pox and died on the 8th February, and expressed her belief that she took the disease from the clothes " That she did, I fear there can be no doubt, and the case is mentioned as another illustration of the danger of washing infected garments, &c., until after they have been efficiently purified by the combined agency of heat and chemical disinfectants. By direction of your Vestry proceedings were taken at the Hammersmith Police Court against the person who had sent the infected clothes to the laundry, and he was fined two pounds and costs. Danger has frequently arisen from the non-detection of the disease. This may be from the mildness of the attack, for then the disease is sometimes supposed to be chicken-pox, or if it is suspected to be small-pox, the case is thought of too little importance to be sent away. The following instances may be cited by way of illustration:— A child being taken ill, an " unregistered " practitioner was called in, who failed to recognise the disease as small-pox. A fortnight after two other cases occurred in the same family, clearly due to infection from the first case. A sick adult relative living in the same house visited one of the popular dispensaries, where advice and medicine are supplied for a very small fee. Two days after he died, somewhat suddenly and unexpectedly. The cause of death returned was " syncope," or fainting. There is no reason to doubt that he died of small-pox, and within a fortnight two other members of the family were stricken, and removed to the hospital. There were three deaths of unvaccinated children in this family. Again, there is infection in the dead body as the following cases show:— Two undertaker's men were engaged to remove a body from one of the hospitals. They had to place it in the shell. At the expiration of a fortnightthey were both in the hospital, suffering from small-pox themselves, and one of them (unvaccinated) died. This case shows the danger of contact, even with the dead, and illustrates the necessity of immediate coffining, disinfection, and speedy burial. The following cases are not without interest:— A man applied for relief at a dispensary one day early in the Christmas holidays. The officers were absent, and ho was directed to call again next day. The eruption of small-pox was then fully out on him ! Ho had been drinking with his friends, and going from one public-house bar to another in the interval between his visits to the dispensary. Steps were being taken to remove him in the parish ambulance to a hospital, when it was discovered that he belonged to another parish, and he was forthwith sent away, and directed to go straight home ! A poor female tramp had a sick baby. She took the child to a dispensary, and spent a long time in the common waiting room with a number of other people. The child was found to be suffering from smallpox, and an order for the ambulance to take mother and child to the hospital was given. The woman had no home, and no place to wait in ; to with the child in her arms she went through the streets to the residence of the ambulance driver, where her presence excited no small alarm. She was sent back to the dispensary, whence, some hours afterwards, she and the child were conveyed to tho hospital. 28 Take another case:— Two lads, who had the disease very mildly, shared a room on the ground floor with their father and sister. The father was persuaded tolet the boys go to the hospital that they might be out of harm's way and not spread the disease ; but when he found he would have to pay he refused. The boys being, in one sense, scarcely ill, though still infective and dangerous to others, is it to be wondered at, that their father, an artizan, should have been unwilling to go to a considerable expense merely for the sake of the health of other people when he had, as he thought, no reason to fear any further ill-consequences to himself or his family from " keeping his children at home? He was, however, subsequently attacked by the disease himself. Another case, illustrating the danger of keeping patients at home, may be cited:— A young woman was reported ill on the 28th December, and her family refused to let her be Bent to the hospital. Four or five weeks after this, three other members of the family were stricken and removed to Hampstead. The isolation, by removal, of the first case, even within a fortnight from the commencement of the attack would have saved the other members of the family. The following outbreak was a peculiarly painful one :— Two children were lying ill in a kitchen at a house in Grolborne-terrace. Living and sleeping in this room were three other children, as well as the mother and father. The latter was following his usual avocation daily. As he refused to allow the children to be sent to the hospital, a magistrate's order was obtained for their removal, on the ground that they were " without proper lodging or accommodation." The father having disobeyed and obstructed the execution of the magistrate's order, he was summoned to appear before Mr. Bridge at the Hammersmith Police Court, by whom, on his continued disobedience, he was sentenced to two months' imprisonment in default of paying a fine of five pounds, for he had none but infected goods, which could not be distrained * The magistrate directed that bis order should be read to the wife, and that if she disobeyed it she should be brought before him. She did disobey and was summoned accordingly, Inspector Langman supplied a nurse to take charge of the children in the mother's absence, and provided them with much-needed food and firing. Husband and wife appeared together at the Court, the former having found means to pay the fine; and expressed contrition for their disobedience and gave consent to the children being sent to the hospital, where they did well. Subsequently two other persons, a mother and her recently born infant, were attacked in the same house and both died. Another case in an adjoining house was traced to the same source of infection. The following fatal case excited a good deal of stir at the time, and was the cause of a sharp local outbreak :— The deceased, a single woman about 34 years of age, and apparently ®f morose and eccentric habits, lived alone in a first floor front room in a state of extreme squalor. On Sunday, March 18th, 1877, a female friend called to see her but was not admitted into her room. She opened the *I believe this was the first case in which the additional powers to enforce the removal of cases of infectious diseases had been put in operation. These powers conferred by the Sanitary Acts Amendment Act, 1874 (37 and 38 Vic. cap. 89, sec 51), were rendered necessary by the incompleteness of the 26th section of the Sanitary Act, 1866, to which, at my instance, your Vestry called the attention of the Local Government Board. 29 door a few inches and said she thought she had small-pox or erysipelas. From that day she was seen no more alive, nor was anything so much as heard of her by the other inhabitants of the house; but her dog began to bark and howl on Wednesday, the 21st, and continued to do so until the door of the room was broken open late at night on Friday, the 23rd, when the wretched creature was found lying on her back in bed, naked, exposed, and dead, probably having died three days previously. The state of the room, from filth of every sort, and the evidences of entire neglect and wretchedness, exceeds belief. A medical man was called in and recognised small-pox as one of the diseases from which the deceased had suffered. The coroner was communicated with, but not deeming an inquest to be necessary, he directed his officer to report the case to me. Several other cases subsequently occurred in this house; but the dates prove that the infection was derived from the living woman, and not, as was supposed, from the dead body. A fatal case occurred under the care of an unregistered practitioner :— We were unable to persuade the patient, a married woman, to go to the hospital, though her husband gave his consent. The family were very poor, and it subsequently transpired that they subsisted during the week the illness lasted upon money obtained by pledging infected things with no fewer than three pawnbrokers, all in the adjoining parish of Paddington ! A boy having died from small-pox, and there having been no medical attendant, an inquest was held and a verdict of manslaughter was returned against the woman in whose charge the boy had been placed owing to the outbreak of the disease in his father's dwelling. (The boy's brother also had the disease, was sent to the hospital and recovered.) The grand jury ignored the bill on the graver count, and no evidence being offered on the minor count, charging the woman with a misdemeanour, she was discharged. The proceedings, however, will not have been without good effects.* In the course of one month no fewer than seven cases of small pox were reported in as many houses, the sufferers being domesticservants, who, no doubt, had contracted the disease in the course of Sunday visits to friends. No second case occurred in any of the houses referred to, all the cases having been removed to the hospitals and the infected rooms, clothing, bedding, &c., having been properly disinfected. The fact is mentioned as an illustration of a peculiar danger, and it shows the necessity for judicious restriction of domestic visitations during the prevalence of epidemic disease. *The following case reported in the daily papers on March 2nd shows that the law is strong enough to reach and to punish in such cases of neglect:—"At the Manchester Assizes, Agnes Turner was charged with having caused the death of her Bon Robert Turner, 18, by neglecting to procure proper medical aid for him. It appeared that the lad was suffering from small pox, and his mother, fearing that he would be removed to the Small Pox Hospital if it were known that he was affected with the disease, kept the secret until the possibility of recovery was hopeless. The prisoner was found guilty, and the judge sentenced her to two months' imprisonment without hard labour." 30 The last outbreak I shall refer to occurred quite recently (June and July, 1877.) This outbreak is perhaps, the most striking that has come under our notice during the epidemic. Twenty-one persons lived in a house, in Wheatstone Road, viz., three families in the parlour, first, and second floors, respectively, besides a single man in the kitchen who had bad small pox previously. The disease made its appearance in the parlour floor of the house some time in June, the first case being tbat of a girl aged ten. The parents of this child attempted to conceal the nature ef the disease, even from the father's brother, who lived on the first floor, and who has been the greatest sufferer from the outbreak. No preventive measures were taken to check the spread of the disease. On the 19th of June the suspicion entertained that the child had small pox was communicated to us in an anonymous letter. The house was visited the same day, and tho suspicion proved to be just. In three rooms there lived the parents and two children. The sick girl was in a room by herself, and the mother was nursing her. An absolute refusal was returned to Inspector Langman's urgent and repeated requests that the child might be sent to the hospital, it not being a case in which the compulsory powers of removal could be enforced. Other cases, to the number of ten, subsequently occurred, and these, with one exception, which was very light and was concealed from us, were sent to the Fulham Hospital. Of the 22 inmates of the house, 11 were attacked and four died, including one adult, the father of the little girl who was first taken ill and who recovered. This child, it is stated, was running about for days with the scabs of the disease on her facc ; and it is said, moreover, that the blankets in which she lay, covered with scabs, were hung over the yard wall, a mode of exposure of an infected. thing which your Vestry's Law and Parliamentary Committee have advised is not an offence within the meaning of the 38th section of the Sanitary Act, 1866. At the rear of the house in which these people lived, two other cases occurred in other two houses, the disease apparently having been spread by the exposure of the beforementioned blankets, which, by the way, first excited suspicion as to the nature of the illness. Of these two cases one died. The most striking fact, perhaps, in connection with this outbreak, is the condition of the household as to vaccination. The man who died bad not been vaccinated; nor had either of the dead children, two aged 5 years, one 4 years, and one 9 months, two of these being the children of the deceased man's brother. The boy, 7 years old, who was very dangerously ill, had not been vaccinated. The girl first attacked, aged 10, had not been vaccinated. The other six persons attacked, all of whom had been previously vaccinated, had the disease very lightly indeed. It may be asked how was it that these people, the children especially, had not been vaccinated ? The answer is simple. Those of the children that were born since the Compulsory Vaccination Act came into operation, were, with two exceptions, not born in the parish : and their cases had, therefore, never come under the notice of the vaccination officer. Of the two excepted cases the vaccination had in one of them been repeatedly postponed on account of the child's ill-health— (he died) ; and in the other case (also dead) the sorrowing mother confessed that she had changed her residence from place to place repeatedly, to escape the 31 notice of the vaccination officer—having formerly an objection to vaccination, which she no longer entertains ! This explanation is necessary to clear an efficient officer from the imputation of neglect of duty that might otherwise be thought to attach to him. There may, nay, there must be, many similar cases to the above, in respect of non-vaccination in Kensington, especially in children over five years of age; for we know that for several years past the population has increased, year by year, by the addition of between two and three thousand immigrants. There is no means of discovering these cases except by a house to house visitation.* It may be mentioned that the rate of mortality from small pox in vaccinated persons is about 13 per cent., and in unvaccinated persons nearly 50 per cent. But it should be mentioned that though the mortality in "vaccinated " persons taken as a whole, may be as high as 13 per cent., the mortality in "vaccinized" persons is much lower; lower in proportion to the efficiency of the vaccination. Death from this disease in an efficiently re-vaccinated person is an almost unknown occurrence. The Registrar-General towards the close of the year published some startling statistics, showing the protective iufluence of vaccination in children below the age of four years:— "There were," he says, " 348,441 children living in London in the middle of this year between the ages of one and five years; 317,081 had been successfully vaccinated, and 31,360 were unvaccinated. At these ages 50 deaths from small pox were registered in London between 1st January and 18th November, 1876. Of these, one was certified to be a vaccinated case, 35 to be unvaccinated, and in 14 cases the medical certificates did not furnish any information as to vaccination. Disregarding the 'not stated' cases, it appears that only one death from small-pox occurred among the 317,081 vaccinated children living in London between one and five years of age : whereas, 35 deaths from this disease were recorded among the 31,360 unvaccinated children at the same ages. Thus, in equal numbers living, 372 deaths from small pox occurred among unvaccinated to one death from the same cause among vaccinated children at * A house to house visitation was commenced soon after the above paragraph was written, and the Vaccination Officer reported the results as follow:—"Three hundred streets and places were visited, numbering 7,996 houses inhabited by 21,000 separate families, resulting in a discovery of 290 unvaccinated children born in all parts of the Kingdom, and some on the Continent Several born in this parish were not registered, others never reside at the place of birth registered." Certain parochial schools were also inspected, and 60 unvaccinated children discovered out of a total of 2,089. An application by the Guardians to the School Board for London for permission to inspect the children in " Board Schools," was not acceded to, the Board not seeing their way to concur in the suggestion of the Guardians that the Vaccination Officer be allowed to inspect the children in Board Schools. More than 300 of the 350 children referred to were vaccinated shortly after discovery. All were duly accounted for, and in four cases only were legal proceedings found necessary. 32 these ages." It may be added that, in a subsequent report, the Registrar-General stated that the one death of a vaccinated child from small pox . occurred so soon after vaccination, that the child must have been infected with small pox six days before it was vaccinated. It only remains in concluding this portion of the report to state a few salient particulars bearing on the rise and fall of the epidemic, and the deaths due to it. The total number of cases recorded in my department from 2nd October, 1876, to 30th September, 1877, was 421. Of these 292 occurred in the North. and 129 in the South Sanitarv District. The subjoined table shows the monthly number of cases recorded in each district; but it should be mentioned that not a few of the cases were not heard of till they had been completed, so that they really belong to an earlier period in the epidemic than that assigned to them. No. of Report. Date of Report. Cases Reported. Sanitary Districts. Sent to Hospitals. Treatd. at Home. North. South. 1876. No. 10 1876. Nov. 15 13 12 1 4 9 14 Deo. 13 36 22 14 28 8 15 1877. Jan. 10 40 24 16 30 10 1877. 1 Feb. 7 43 34 9 24 19 2 Mar. 7 26 24 2 15 11 3 April 4 24 22 2 18 6 4 May 2 39 32 7 23 16 5 „ 30 43 38 5 29 14 6 June 27 50 28 22 40 10 7 July 25 43 25 18 38 5 8 Aug. 22 39 17 22 32 7 9 Sept. 19 Recorded 12 7 5 9 3 to „ 30 13 7 6 5 8 Totals 421 292 129 295 126 Two hundred and ninety-five of the cases were removed to the hospitals—nearly all of them to the hospitals under the management of the Metropolitan Asylums Board—while 126 were treated at home. The deaths "at home" in the 12 months from October, 1876, to September, 1877, were 26, while the deaths in the hospitals were 58. The rate of mortality, therefore, at home (in known cases) was 20.6 per cent.; at the hospitals 19.7 per cent. Of the cases in the North 144 were above and 148 below 15 years of age, while in the South District the attacks over 15 years were 109, as against 20 under that age. 33 The information as to previous vaccination is too vague to be relied on. The disease was known to exist in 86 houses, in 142 streets; viz.: in 164 houses in 72 streets in the North, and 122 houses in 70 streets in the South Sanitary District. Every case was duly visited as soon as it became known, and no effort was spared to effect removal to a hospital whenever necessary. The houses in which the disease appeared were disinfected— during the latter part of the epidemic by an officer appointed for the purpose—and steps were taken to ensure the proper disinfection of infected wearing apparel, bedding, &c., &c. Two of the contractor's men engaged in this work took the disease, and one of them died. I am not acquainted with a single case in which the disease could be traced to retained infectiveness in rooms, or in clothing, &c., that had been disinfected ; and I mention this not only as an evidence of the care and thoroughness with which the work was carried out, but also as a proof of the efficacy of the processes adopted. It affords me great satisfaction to testify that the Sanitary Inspectors performed their duties in connection with the epidemic, difficult as those duties often were, and dangerous always, with exemplary fidelity. Fever.—The subject of "Fever" was much discussed in 1876, owing to a published statement by a well-known parishioner that "typhoid fever waschronic in South Kensington." This statement, unsupported by a single fact, was shown at the time to be erroneous. I think it desirable, nevertheless, in this annual report, to refer again to the subject. The total deaths from " Fever " in the year were 37, according to the Registrar General—16 below the corrected decennial average. Six of these deaths, all in the "Town" sub-district were returned as simple continued fever, and three, in the same district as typhus fever. With respect to the last named disease I shall only observe that every year two or three deaths are certified from this cause, but seeing that the cases, notwithstanding the extremely infectious character of the disease, have invariably occurred singly and in separate localities, it may be allowable to question whether the several deaths may not have been due to some other disease assuming a " typhoid " form at the last ? Enteric fever is made accountable for 27 deaths, 25 of them in the " Town " and two only in the " Brompton sub-district." The first of the deaths from Typhoid fever in Brompton occurred in Yeoman's Row, one of the poorest streets in the parish, the victim being a child in the fourth year of his age ; and the other in Finborough Road, on the Redcliffe estate, the deceased being described as a " gentleman," 38 years of age. With reference to the latter case, the medical man who attended the 34 patient informed me that " the disease did not originate in Kensington, but in the patient's place of business ; " where, he added, " the drains were very bad." So much for the actual mortality from " fever " in Brompton (which includes South Kensington) with its population of 38,000 souls. The deaths in the Town sub-district were 25 in number nominally, but several of the cases were proved to have originated outside the parish, or to have been imported; while others, which were incorrectly returned by the Registrar General as enteric fever, owing doubtless to some indefinitenessin the medical certificates of the cause of death, were stated by the medical men in attendance not to have been cases of Typhoid fever at all. Eight of the 27 deaths occurred below the age of 5 years, and 6 between 5 and 17 years of age, the ages at death in the remaining cases ranging between 21 and 67. The actual number of deaths registered from Typhoid fever in 1875, was 21, equal to 1.4 deaths to 10,000 persons living, the rate in London being 2.4 per 10,000. The deaths were equivalent to 7.5 in every 1,000 deaths in the parish, and to 10.3 in the Metropolis as a whole. In 1876 the nominal figures were not quite so favourable to the parish, for the deaths in Kensington and London respectively were 1.8 and 2.2per 10,000 persons living, and 9.3 and 10 in every 1,000 deaths. But if the deaths that were really not due to Typhoid fever at all be deducted, the figures present a much more favourable complexion, and still more would this be the case if the deaths that were imported were subtracted. It may be added that some of the deaths were due to sanitary defects—two of them, especially, connected with interior iron soil-pipes, of which it was impossible my department could have any knowledge without previous information, and which were at once removed when the houses were inspected on revelation of the disease by the registration of death. In another case a gentleman lost his life from standing over his own water-closet while clearing away an obstruction. If all these cases are taken into consideration, the importance of 'fever' mortality is much attenuated; and probably if a similar enquiry were instituted in other parishes, it would lead to similar results. But to return to the alleged chronic prevalence of typhoid fever in South Kensington, it was stated—after it had been shown that no death from this cause had occurred—that the " disease may be chronic, although it may not terminate in death, and may exist, especially among well-to-do people, although the Medical Officer of Health may be unacquainted with any cases of illness." Within moderate limits the former part of this statement may be admitted to be correct: but inasmuch as the mortality from typhoid fever it one in six cases (not one in twenty as stated), it is obvious thas the cases could not be numerous : while as to the latter part of the statement, the accuracy of which is not impugned, it might be 35 mentioned — (1) that when application was made to the parishioner asking him to " specify the particular houses or streets in which typhoid fever is chronic in South Kensington," he " declined for reasons which must be obvious," to furnish the desired information ; and (2) that with the approval of your Vestry I have on three occasions specially appealed to my medical brethren for information of the occurrence of infectious diseases, so that if we are without such information as we should possess, it is not for want of effort to obtain it. I am free, indeed, to confess that we obtain little information of non-fatal infectious diseases among the well-to-do classes (the exceptional instances being those in which our sanitary assistance is sought) nor do I expect any material difference in this respect, until such time as we shall have an official registration of diseases or a legislative enactment for the compulsory disclosure to the sanitary authority of infectious diseases —a measure, the necessity of which I have constantly advocated. As regards fatal cases of infectious disease, it may not be out of place to remark that your Yestry were the first in London to take measures to obtain immediate information of deaths, by entering into a special arrangement with the sub-district Registrars: so that during my term of office every such case has been reported to me within a few hours after registration of death. And as it has been sought to affix a stigma of special unhealthiness on one of the most attractive and salubrious localities in all London : it may be permissible to state that whereas the Metropolitan death-rate last year was 22.3 per 1,000, and that of Kensington generally (including the deaths of non-parishioners in the Consumption Hospital, &c.) 19.5 per 1,000, the rate in the Brompton sub-district (population 38,000) which includes South Kensington, was only 14.9 per 1,000. I might have concluded here, my notice of a statement beyond question injurious, though wholly unfounded, but that, in the course of the public discussion to which it gave rise, the Lancet stated (Aug. 12, 1876, p. 266) that " the zymotic death-rate of the South Kensington district is steadily increasing," and that " a death-rate from zymotic diseases of more than 2 per 1,000 persons living is absurdly high for such a suburb as South Kensington." To this the reply is that the death-rate from zymotic diseases quoted is not that for South Kensington, but for the Brompton registration sub-district; and that in order to form a just notion of the proper or usual death-rate from such diseases in any district, it is necessary to take into the calculation a sufficient number of years. The reason for this is obvious, and was well expressed by the Sanitary Commissioner of the Lancet (at page 258) in the same number of that journal. "In attaching importance to an increased death-rate from zymotic diseases during any period, reference " he says, " must be made to prior conditions. A 36 longed immunity from measles, whooping cough, or scarlet fever, is sooner or later certain to be compensated by an increase proportionately great, because during the years of immunity the population susceptible to such diseases has continued to increase." This principle should have been borne in mind in considering the present case, for though it is true, as stated, that the death rate from zymotic diseases was higher in 1875, and in the fast half of 1876 than in the year 1874 (with which a comparison was made to the disadvantage of the district,) this higher rate, which still was not above the decennial rate, was caused, as the same writer well puts it, " rather by an increase of population susceptible from prior immunity than from unsanitary conditions " as had been assumed. With a view to a fair and legitimate comparison of the past and present death-rate from zvmotic diseases in the Brompton district, the following table has been drawn up, showing the death-rate per 1,000 persons living from the seven principal diseases during the ten years 1865-74 :— 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 30 1.6 2.2 3.1 2.6 3.9 2.2 2.2 1.6 1.6 or an average of 2.4 per 1,000. The death-rate in 1875 was an average one of 2.4 per 1,000 and the rate in 1876 up to the time of the discussion, was 2.5 per 1,000, or .1 above the average, though far below the maximum 3.9. But observe what followed. The deaths from these diseases which in the first 33 weeks of 1876, were equivalent to 2.5 per 1,000 persons living were for the whole year equivalent to only 1.7 per 1,000, or .7 below the decennial average. In the last nineteen weeks of 1876 there were only four deaths from the principal zymotic diseases in a population of 38,000 : and the figures during the current year are not less favourable. Moreover, if we take the 12 years 1865-76, and divide them into two equal periods (the latter period corresponding to my tenure of office), it appears that the deathrate from zymotic diseases in the first six years was 2.73 per 1,000, and in the latter six years only 1.96. The error in the statement that " the zymotic death-rate of the South Kensington district is steadily increasing," arose from comparing the mortality in average years (1875 and first half of 1876) with that of an exceptionally low year, 1874. But it was further stated that the zymotic death rate was too high for such a suburb as South Kensington—a statement I could only meet by a comparison which might naturally appear invidious; but having calculated the death rate in 1875 from these diseases in all Kensington, in the Brompton sub-district, including South Kensington, and in the other parishes comprised in the Registrar 37 General's "West Districts of London," and having compared these with one another and with the Metropolitan rate, I came to the conclusion that the Lancet writer's conclusions were not borne out. But I will let the figures speak for themselves. Death-rate from seven principal zymotic diseases, 1875:— Parish of Paddington 2.8 per 1,000 Parishes of Fulham and Hammersmith 5.2 „ Parish of Chelsea 4.2 ,, „ St. George, Hanover Square 2.4 „ Parishes of St. Margaret and St. John, Westminster 4.7 „ Westminster Union 2.8 „ Parish of Kensington 2.5 „ Brompton sub-district 2.4 „ All London 3.9 „ I do not wish to attach too great importance to the above figures (and I have already entered a protest against deductions drawn from insufficient data), but I think they may be taken with others to show that South Kensington is not open to the reproach levelled against it. I need perhaps have added nothing to prove the inutility of taking gross numbers, in short periods, with a view to reliable deductions from vital statistics; but the following figures so eloquently point out the fallacy which may arise from so doing, that I shall not weaken them by comment. Total number of deaths registered from the seven principal diseases of the zymotic class in Kensington for three half-years ended:— June 30,1876. December 31,1876. June 30,1877. 312 189 91 Annual death-rate per 1000 persons living from these diseases in the half-years ended :— June 30,1876. December 31,1876. June 30, 1877. 4.2 2.4 l.2 Before concluding these observations, it may be remarked that in the controversy, it having been assumed by the parishioner, that sewer gas from defective drainage is the only cause of Typhoid Fever, I stated my opinion that an equally fruitful source of sewer gas poisoning is the absence of ventilation in drains otherwise well planned. The prevalent custom, moreover, of connecting 38 water cisterns with sewers through the medium of " waste pipes " so called; and the dirty neglected state into which cisterns are allowed to fall, sometimes through forgetfulness, perhaps, but often because they are practically inaccessible, are dangerous nuisances, fruitful sources of disease, on which I have on various occasions addressed warnings to every householder in Kensington I have already alluded to the fact that many cases of typhoid fever are imported, and should not, therefore, be reckoned in any estimate of the sanitary condition of the parish, as judged by the prevalence of this malady, and I have mentioned an error into which the Registrar General is liable to fall, of overstating the deaths from typhoid fever, through want of clearness in medical certificates of the cause of death. It may be added that there is reason to believe that error has crept into his invaluable " returns " from the loose use of the term "typhoid," which is often used to express a set of symptoms, rather than the specific disease " Enteric fever,"— as when towards the close of a lingering illness, e.g. pneumonia, the case assumes a typhoid character, which does not mean that the patient had Enteric fever, though from the wording of the certificate this might naturally be assumed to be the case. The following tables are reprinted from my Special Report (August 23rd, 1876,) on the "Alleged Chronic prevalence of Typhoid fever in South Kensington Deaths from " Fever " in 1875-6.—Brompton Sub-district. Date. Sex. Age. Description. Terms of Certificate. Place of Death. Remarks. 1875 Jan. 14 M. 44 Carman. Fever, Hemorrhage, Exhaustion. Ifield Road. Classed as simple continued fever. March 15 M. 29 Butler. Pnenmonia of right lung with typhoid fever, 15 days. Richmond Road. June 2 M. 77 Gentleman. Typhoid fever, Congestion of the lungs. Thistle Grove. June 4 M. 59 Gentleman. Typhoid, 4 weeks, Pneumonia, Exhaustion. Redcliffe Road. June 13 F. 59 Wife of a Painter. Typhoid fever. Pleuro-pneumonia. Yeoman's Row. June 16 F. 23 Domestic Servant.* Enteric fever, Congestion of the lungs. Consumption Hospital. July 28 M. 71 Gentleman. Typhoid fever. Seymour Place, Fulham Road. Sept. 19 F. 27 Gentleman. Typhoid fever, 20 days, Perforation of bowel, 24 hrs. Thurloe Place. Dec. 3 F. 47 Wife of a labourer. Typhoid fever, 14 days, Congestion of lungs. Ifield Road. Dec. 5. 1876. F. 18 Wife of an Ironmonger. Gastric fever, 10 days. Clairville Grove. Classed as simple continued fever. July 6 M. 3½ Son of a Labourer. Typhoid fever, Perforation of bowel, collapse. Yeoman's Row. Aug. 24 M. 38 Gentleman. Typhoid, 3 weeks, uraemia † Finborough Road. * An out-patient at the Hospital, from Penge, admitted because found to be suffering from typhoid fever. † Disease originated at deceased's place of business, not in Kensington. Deaths from the Seven principal Diseases of the Zymotic class in the Brompton Registration Sub-district in the Twelve Years—1865-76. The Year Small pox Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Typhoid Fever. Simple continued Fever. Diarrhœa Total Deaths. Deaths per 1,000 living. 1865 1 13 11 — 1 — 18† — 24 68 3.0 1866 1 6 5 — 11 — 2 — 14 39 1.6 1867 11 2 6 — 13 — 9 — 15 56 2.2 1868 1 8 33 °7 5 — 8 — 18 80 3.1 1869 4 2 22 1 7 — 15 — 20 71 2.6 1870 1 11 45 5 10 2 9 3 23 109 3.9 1871 9 4 7 2 7 2 8 2 23 64 2.2 1872 1 15 7 2 8 — 8 — 26 67 2.2 1873 — 10 2 3 7 — 8 — 24 54 1.6 1874 — 6 4 2 9 — 9 4 22 56 1.6 1875 — 11 25 8 20 — 9 2 12 87 2.4 1876 — 16 17 4 10 — 2 — 16 65 1.7 ° First year of separate registration (1868) f Registered generally as " Fever " until the year 1870. 41 POPULATION. The population of Kensington estimated to the middle of the year, was 148,000, the increase of 4,500 being partly due to an excess of births over deaths (1,604) ; the larger portion, however, resulting from immigration (2,896). The "Town" sub-district contained in round numbers 110,000 persons, and Brompton 38,000. The males numbered 60.250; the females, 87,750—excess of females over males 27,500. The subjoined table shows the relative numbers of persons of each sex at the census of 1871, arranged in groups according to age:— AGES OF MALES AND FEMALES, 1871. A11 Ages. Under 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 to 95 95 and upwds. Males, 4S977 7065 10198 8948 8317 5963 4339 2464 1270 378 33 2 Females 71322 7147 11527 16585 14203 9030 6241 3768 2000 667 97 7 Total, 20299 14212 21722 25533 22520 15043 10580 6232 3270 1045 130 9 In former reports I have referred to the probable causes of the excessive preponderance of females in our population, and ascribed it to (1) the large number of female domestic servants always met with in a wealthy district; (2) the numerous schools for girls; (3) the popularity of Kensington as a place of residence, and (4) the superior longevity of women, The density of the population was about 67 to an acre, making no allowance for uncovered ground, the extent of which I am not in a position to estimate with accuracy ; but independently of the cemeteries, at Brompton and Kensal Green; and Holland Park, the outskirts of which are slowly coming into the builders' hands, there are still many acres available for building purposes. Not very many years probably will pass, however, ere Kensington will be completely built, and then, with a population stationary within narrow limits, vital statistics will be capable of a more definite handling than is possible now when, year by year, there is a large increase, the amount of which is to some extent matter of conjecture, although as I have before observed, I believe the estimate to be not very wide of the truth. The basis of the estimate of population is the number of inhabited houses, and the known average number of persons to a house at the census. In July, 1876, there were 18,944 inhabited dwellings—an increase of 504 upon the number at the corresponding period in the preceding year. Of this total a not insignificant proportion would be stables having inhabited rooms, and situated in mews. (The number of mews is about 150.) 42 At the census, 1871, the number of persons on an average in each house was 7.8. The density was somewhat greater in the Town sub-district, and only 7 per house in Brompton. The subjoined table exhibits at a glance some of the evidences of the growth of Kensington within the present century :— The Year. Population. Rateable value of Property. The Year. 1801 8,556 £75,916 1823 1821 14,428 93,397 1833 1841 26,834 142,772 1843 1851 44,053 257,103 1853 1861 70,108 375,333 1860 1871 120,299 590,711 1865 1876 148,000 817,326 1879 1877 (July) 151,500 1,345,806 (October) 1877 MARRIAGES. The number of marriages celebrated in 1876 was 1,417, viz.:— In the Church 1,211 At Nonconformist Chapels 46 At Roman Catholic „ 65 At the Superintendent Registrar's Office 95 Total 1417 The marriage rate (i.e, number of persons married to 1,000 population) was 19. The rate in England and Wales in 1874 was 17.1 and in 1875, 16.8. The number of marriages in Kensington in 1875 was 1,346; in 1874, 1,311; in 1873, 1241; in 1872 1,122; in 1871, 1,131. BIRTHS. Four thousand five hundred births (viz., 2,271 males and 2,229 females), 3,667 in the Town sub-district, and 833 in Brompton were registered. The birth-rate in the entire parish was 32.9, (increase over 1855,1.7) to 1,000 persons living; 33.3 in the Town sub-district, 21.9 in Brompton. The decennial birth-rate in Kensington (1866-75) was 31.8 per 1,000. The Metropolitan rate last year was 36.5. The relative proportions of the sexes born were 101.8 males to 100 females: the male births forming 50.4 and the females 49 6 per cent. of the total number. The low birthrate in Kensington, and particularly in the Brompton sub-district, is obviously due to the disproportion in the relative number of the sexes, and to the excess of (unmarried) female population. The illegitimate births registered were 186, equal to 3.3 per cent. on total births: 78 of these took place at the parish workhouse, which is within the Town sub-district, and where 105 children (including five still births) were born. The legitimate births in the workhouse were 24, and three children were born of widows. Only 11 illegitimate births were registered in Brompton. 43 The subjoined table shows the quarterly number of births of each sex registered in each sub-district:— Kensington Town Sub-District. Brompton Sub-District. Males. Females Total. Males. Females. Total. Grand Total. 1st Quarter 529 447 976 94 135 229 1205 2nd „ 413 427 840 118 98 216 1056 3rd „ 470 480 950 102 98 200 1150 4th „ 457 444 901 88 100 188 1089 Total - 1869 1798 3667 402 431 833 4500 DEATHS. Two thousand eight hundred and ninety-six deaths were registered in 1876, viz., 2,276 in the Town sub-district and 620 in Brompton. The deaths in the " Town " include 225 registered at the Parish Infirmary and Workhouse, and 36 that took place at St. Joseph's House, Notting Hill, while the Brompton total includes 113 at the Consumption Hospital. After deducting the deaths of non-parishioners at the last-named institution, and distributing those that occurred at the workhouse, the deaths in the Town sub-district were 2,219, and in Brompton 568. These numbers are equal to a death rate for the whole parish of 18.6 per 1.000. But, as before stated, the deaths at the Brompton Hospital are left in the statistical tables to compensate for the deaths of parishioners in hospitals and at other places beyond the limits of Kensington, and these deaths raise the rate to 19.3 per 1,000. The rate in the Town sub-district was 20.2., and in Brompton only 14 9 per 1,000. Fourteen hundred and eighty. seven males died in an estimated population of 60,250 = 24'6 per 1,000 persons living, or one death to 40.5 persons living. Only 1,409 females died in an estimated population of 87,750, the death rate being 16 per 1000, or one death to 622 persons living. Compared with 1875 the deaths of males show an increase of 137, and those of females a decrease of 27. The deaths under one year of age were 771, the increase of 95 on the number in 1875, being due to the prevalence of infantile diseases of the zymotic class. These deaths were equivalent to 26.6 per cent. on total deaths, and to 17.1 per cent. on the births registered. The corresponding per centages in all London were 25.7 and 15.7 respectively. The deaths under five years of age, 1,305, were equal to 29.4 per cent. on registered births (London rate 26.9), and to 45.5 per cent. on total deaths (London 42.7). Six hundred and one persons died at 60 years of age and upwards. This number is 41 less than in 1875, and is equivalent to 20.7 on the total deaths, the equivalent per centage in all London being 20. 44 The deaths of illegitimate children under five years of age, as registered, were 93 (viz., 88 in the Town sub-district and five in Brompton), equal to 3.3 per cent. on total deaths, and to 50 per cent. on the registered illegitimate births, The subjoined table shows the quarterly number of deaths of each sex registered in each sub-district:— Kensington Town Sub-District. Brompton Sub-District. Males. Females. Total. Males. Females. Total. Grand Total. 1st Quarter 309 348 657 96 80 176 833 2nd „ 326 273 599 83 82 165 764 3rd „ 295 265 560 82 52 134 694 4th „ 224 236 460 72 73 145 605 Total - 1154 1122 2276 333 287 620 2896 The subjoined table shows the death-rate in 13 periods of four weeks, corresponding to my monthly reports, and the average temperature of the air :— Date of Report. Death-rate per 1,000 living. Mean Temperature of the air. Five weeks ended Feb. 5, 1876. 23.8 37.3 Four ,, March 4 22.5 41.9 ,, April 1 22.2 40.6 ,, ,, ,, 29 22.0 47.4 ,, ,, May 27 20.7 48.0 ,, ,, June 24 21.2 57.3 ,, ,, July 22 20 3 66.1 ,, ,, Aug. 19 21.2 65.8 ,, ,, Sept. 16 14.0 54.9 ,, ,, Oct. 14 14.9 56.4 ,, ,, Nov. 11 17.9 45.6 ,, ,, Dec. 13 15.2 46.8 Three ,, 99 31 16.5 41.9 Average - 19.4 500 SPECIAL CAUSES OF DEATH. Zymotic Diseases.—As already stated, the year 1876 was characterised by the prevalence of certain of the diseases of the zymotic class, viz., small pox, measles, and whooping cough, in an epidemic form, the result being that the deaths from the seven principal diseases rose from 372 in 1875 to 498 in 1876 (increase 126) ; and the proportion of deaths from 133 to 172 in every 1,000 deaths. The zymotic death-rate was 3.3 per 1,000 persons living (decennial average 3.2), an increase over the rate in 1875 (2.5 ) of 8. The rate in all London last year was 3.6 per 1,000 living, and 162 deaths in every 1,000 deaths. The deaths occurred in the registration sub-districts in the subjoined proportions :— Town. Brompton. Total. Deaths, per 1,000 deaths. Small Pox 8 0 8 2.7 Measles 112 16 128 44,3 Scarlet Fever 42 17 59 20.4 Diphtheria 13 4 17 5.8 Whooping Cough 114 10 124 42.9 Fever 34 2 36 12.4 Diarrhcea 110 16 126 43 5 Total 433 65 498 172.0 It will thus be seen that while the deaths in Brompton fell from 87 to 65, the number in the Town sub-district rose from 285 to 433. Of the total deaths no fewer than 309 took place in the first half of the year, and only 189 (including 107 from diarrhoea,) in the second half, viz.:— Disease. First half of the Year. Second half of the Year. Small Pox 1 7 Measles 110 18 Scarlet Fever 44 15 Diphtheria 10 7 Whooping Cough "Fever" 109 15 16 20 Diarrhcea 19 107 309 189 Small Pox.—The eight deaths from this disease were registered in the Town sub-district, one each in the first and third quarters and six in the fourth quarter. Measles was fatal to 128 children, viz,, 112 in the Town subdistrict, and 16 in Brompton : the quarterly number of deaths being, respectively, 31, 79, 17 and 1 ; 110 in the first half of the year, during which (as also in the latter part of 1875), the malady raged epidemically. In the fourth quarter of last year there was but one death from this disease, and, I may add, the mortality from it has since been very low. The corrected decennial average number of deaths from measles is 65. Scarlet Fever.—The 59 deaths from this disease, 42 in the Town sub-district and 17 in Brompton, show a decline of 24 from the 45 46 number in 1875 (83), and they were 37 below the corrected decennial average. Forty-four of the deaths were registered in the first half of the year, and 15 in the second. Diphtheria was the cause of 17 deaths : 13 in the Town subdistrict, and 4 in Brompton ; 6, 4, 5, and 2 deaths in the four quarters respectively. These deaths were 6 below the number in 1875. Whooping Cough.—One hundred and twenty-four deaths from this disease were registered, viz., 114 in the Town sub-district, and 10 in Brompton. The disease was severely epidemic in the first half of the year when the deaths registered were 109, only 15 deaths having been registered in the second half. The corrected decennial average number of deaths from whooping cough is 74. " Fever."—The deaths from the three separate diseases classed under this heading by the Registrar General were 37; 8 above the number registered in 1875 and 16 below the corrected decennial average. Typhus Fever was the cause of 3 deaths, in as many houses. Enteric Fever is made accountable for 26 deaths, 24 of them in the Town sub-district. The quarterly numbers of the deaths were 8, 2, 6, and 10. Simple continued Fever.—The six deaths from this disease were registered in the Town sub-district. Diarrhcea.—The deaths from this malady were 126; or 18 below the corrected decennial average, viz., 110 in the Town subdistrict and 16 in Brompton. The prevalence of diarrhcea as a fatal disease in young children is determined by a high temperature of the air. The deaths are always few in the winter quarters, and last year they numbered only 20 in these quarters, 10 in each. The relative proportion of the deaths in the summer quarters depends on the degree of heat. In 1876 the season was backward, and we had little " summer " before July; and thus it happened that only 9 deaths occurred from diarrhcea in the second quarter of the year. Then followed many weeks of brilliant hot weather which was attended with a large increase in the mortality from this disease, the deaths registered being no fewer than 97. Of the total deaths from diarrhcea, 91 occurred in the first year of life, and fifteen in the second. One hundred and nine of the deaths took place below the age of five years, and 13 at ages above 55, six of them between the ages of 75 and 85. Simple Cholera.—Six deaths in the Town sub-district were registered, nearly all of them in the practice of one gentleman. I have no sufficient reason for supposing that the cases differed materially from other cases of acute and somewhat rapidly fatal diarrhoea. 47 Other Zymotic Diseases.— Croup was the cause of 13 deaths, 11 of them under 5 years of age, only 2 of them in the Brompton sub-district. Nine of the deaths took place in the first half of the year. Erysipelas was the cause of 15 deaths in the Town sub-district, six of them below the age of 5 years. The deaths from this disease in 1875 were 22. Puerperal Fever (Metria) was the registered cause of only six deaths last year, a considerable reduction on the numbers recorded in preceding years. Four of the deaths occurred in the Town subdistrict. Two deaths took place between the ages 15—25 years ; three between 25—35, and one between 35—45. Fifteen deaths were ascribed to the accidents and ordinary diseases incident to Childbirth; 14 of them in the Town sub-district. Thus the total deaths connected, by registration, with the puerperal state were 21 or .4 per 1.000 registered births. Rheumatism was the cause of 19 deaths, 15 in the Town subdistrict. Fourteen of the deaths occurred in the first half of the year. Many of these deaths were immediately due to heart disease, arising in the course of an acute attack of rheumatic fever. Enthetic Diseases.—Syphilis, the only fatal disease in this " order " named, was the registered cause of 10 deaths, all in the Town sub-district, and all in children, nine of them in the first year of life. Dietic Diseases.—The principal malady named in this order, Alcoholism, was accountable for 8 deaths (6 in the Town subdistrict); 3 ascribed to Delirium tremens, and 5 to Intemperance. If all the disease and all the deaths due to the abuse of alcoholic stimulants could be put on record, the sum total would be very great. Man's ingenuity in the discovery of alcohol is accountable for a large part of the misery of the human race ! Parasitic Diseases.—Eleven deaths were due to Thrush : (9 in the Town sub-district) 8 of them in the first year of life, 2 in the second. CONSTITUTIONAL DISEASES. Five hundred and sixty-three deaths were ascribed to the diseases in this great class, which includes two orders (1) Diathetic, and (2) Tubercular. One hundred of these deaths were registered in the Brompton sub-district. Order 1. Diathetic.- The deaths from the maladies comprised in this order, 91 in number, viz., 72 in the Town sub district, and 19 in Brompton were, Gout, 4, Dropsy, 13, Cancer, 69, and Mortification, 5. Of the 69 deaths attributed to Cancer, 51 were 48 tered in the Town sub-district and 18 in Brompton, and they occurred in the four quarters respectively as follows:—24, 18, 18, and 9. The great majority of these cases occur late in life. Between 15 and 45 years of age, there were 12 deaths; 45 to 55, 12; 55 to 65, 26, and 9 at ages above 65. The parts principally affected by this disease or constitutional taint, are the viscera or internal organs : very commonly the uterus in females. Order 2. Tubercular.—The diseases in this important order were the registered causes of 47 2 deaths, viz., 391 in the Town sub-district, and 81 in Brompton. The deaths occurred in the four quarters respectively in the following numbers:—121, 128, 128, and 95—216 in the winter, and 256 in the summer quarters. Some little care has been required in locating the deaths as registered under the correct headings, it being for example not uncommon to find " phthisis " returned as the cause of death in the earliest infancy, whereas it is well known that scrofulous disease as a rule manifests its presence in other parts and organs than the lungs at this early stage of existence. Such cases, therefore, have been grouped under the head Scrofula and Tuberculosis : the deaths from which were 50 (41 in the Town sub-district and 9 in Brompton). Tabes mesenterica, consumption of the bowels, as it is sometimes popularly called, was the cause of 50 deaths (46 in the Town sub-district). Of the 100 deaths due to these varieties of tubercular disease. 41 occurred in the first year of life, and 27 in the second year. Hydrocephalus (water on the brain,) and Tubercular meningitis caused 79 deaths, 66 in the Town sub-district and 13 in Brompton. Phthisis was returned in 293 cases irrespective of the Brompton Consumption Hospital, the subject of remark elsewhere. Of these 293 deaths, 238 were registered in the Town sub-district, and 55 in Brompton. The quarterly numbers were 79, 79, 72, and 63 respectively. Eight of the deaths took place in persons below 15 years of age ; between 15 and 25 there were 52 deaths; 25 to 35, 93 ; 35 to 45, 59; 45 to 55, 54 ; 55 to 65, 22; and 5 above 65. LOCAL DISEASES. The diseases grouped in this great class, caused 1,216 deaths, one less than in the previous year. Order 1. Nervous System.—The diseases of the nervous system were accountable for 287 deaths (number in 1875, 285), viz., 223 in the Town sub-district and 64 in Brompton. Cephalitis (inflammation of the substance of the brain) was returned in 15 cases. Brain Disease in 80, (8 only in Brompton). Insanity was the registered cause of death in two cases, and Epilepsy in 9, one of these only taking place in Brompton. The remaining diseases are Apoplexy and Paralysis, which for the most part belong to the 49 latter period of life, and Convulsions, which is almost exclusively a disease (or a symptom of disease) in infancy. Apoplexy caused 59 deaths, and paralysis 45; of these 101 deaths, 74 belong to the Town sub-district, and 30 to Brompton. Convulsions were fatal to 77 persons, 75 of them below the age of five years, viz., 47 under one year,'21 between 1 and 2, and 7 between 2 and 5 years. Taking the nervous diseases altogether, it appears that the quarterly numbers of deaths were 77, 66, 73, and 71. Apoplexy and Brain disease were about equally fatal in the two halves of the year ; but paralysis which caused only 16 deaths in the first half, was fatal in 29 cases in the second half; while convulsions was much more fatal in the first half (48 deaths) than in the second (29 deaths). Apoplexy was returned in 40 cases under 65, and in 14 over that age, whereas the deaths from paralysis occurred in 17 cases only under 65 years, and in 28 over that age. Order 2. Organs of Circulation.—Total deaths 146; 107 in the Town sub-district, and 39 in Brompton, viz., Pericarditis, 5, and Aneurism, 3 (all in the Town sub-district). Heart-disease, 138; 99 and 39 in the Town and Brompton respectively. (The deaths from heart disease as a complication of rheumatic fever are included in class 1, order 1, under the head of Rheumatism.) The deaths from heart-disease, &c., included here, occurred in the several quarters as follows: 45, 33, 34, and 34; twenty took place below 25 years of age, between 25 and 55 there were 35 deaths, and 91 above 55. Order 3. Respiratory Organs.—The deaths from the diseases of these organs were 582, viz., 482 in the Town sub-district, and 100 in Brompton. The quarterly numbers were 224, 138, 64, and 156. The deaths due to the several diseases were Laryngitis and Spasm of the Glottis, 18, Bronchitis, 315, Pneumonia, 197, Asthma, 13, and "Lung Disease" 39. Of the deaths from bronchitis and pneumonia respectively, 138 and 125 occurred below the age of five years, 44 and 66 between 5—55, and 133 and 28 above 55 years. Thus from these two most common diseases of the breathing organs, the deaths were, as usual, most numerous at the earliest and the latest periods of life: of 512 deaths at all ages, 424 having occurred under 5, and above 55, years of age. The deaths from all diseases of these organs were, in accordance with rule, most numerous in the winter quarters, although owing to the mildness of the weather in the fourth quarter the difference was not so marked as usual. Still the deaths in the cold first and fourth quarters of the year exceeded those registered in the summer quarters by 178, the respective numbers being 380 and 202. Order 4. Digestive Organs.—The diseases of the organs principally concerned in the process of food-digestion were fatal 50 in 118 cases, 90 in the Town sub-district, and 28 in Brompton. At the head of the list stands "Liver Disease," as the registered cause of 43 deaths. Peritonitis comes next, 13 deaths; then Enteritis, 11, Ulceration of Intestines, 10, Stomach diseases, 2, Jaundice, 9, Ileus, 6. Order 5. Urinary Organs.—The deaths due to the diseases in this order were 57, 41 in the Town sub-district, and 16 in Brompton. Twenty-seven of them were ascribed to Bright's disease. (Nephria), and 13 to "Kidney disease." Nephritis and Diabetes were fatal in 6 and 5 cases respectively. Calculus (stone) and Cystitis in 1 and 5 cases each. Order 6. Organs of Generation.—The diseases of these organs, Ovarian Dropsy and Uterus disease, were returned in 3 and 7 cases respectively ; 10 deaths in all. Order 7. Organs of Locomotion.—Three deaths were registered from Arthritis, and 3 from Joint disease. Order 8. Integumentary System—The deaths from diseases of the skin were 9, viz., 8 due to Phleymon {Abscess), and 1 to Ulcer. Class 4.—DEVELOPMENTAL DISEASES. The deaths from the diseases grouped in this class were 336, viz., 285 in the Town Sub-district, and 51 in Brompton. Order 1. Diseases of Children.—Eighty-one deaths were returned under the several heads following:—Premature birth, 38, Teething, 34, Malformations, 9. Order 2. Diseases of Adults.— Childbirth was the registered cause of 15 deaths, only one of which occurred in the Brompton Sub-district. Order 3. Diseases of Old People.— Old Age was the "cause " of death in 81 persons, 68 in the Town Sub-district, and 13 in Brompton; 42 of these deaths occurred between 75 and 85; 21 between 85 and 95, and 2 above 95 years of age. Order 4. Diseases of Nutrition.—One hundred and fifty-nine deaths from Atrophy and Debility were registered; 141 in the Town Sub-district, and 18 in Brompton. Two of these deaths were of old people, and of the remainder 152 occurred in the first year of life. How many of these deaths were really due to diseases such as scrofula, syphilis, &c., and how many to want of proper food and care, cannot of course, be ascertained ; but no inconsiderable proportion of the whole number we may be quite sure. Class 5.—VIOLENT DEATHS. Forty-five deaths were due to violence, 32 in the Town Sub-district, and 13 in Brompton. Fractures and contusions head the list, 15 deaths ; and suffocation comes next, 12 deaths. Burns and 51 scalds, 2; wounds, 2; and "otherwise," 1, complete the list of deaths due to accident or negligence (32). Murder or Manslaughter was the registered cause of two deaths of infants. Suicide by wounds (5 deaths), by poison (2), by drowning (1), and by hanging (3), was perpetrated in 11 instances, of which no fewer than 8 occurred in Brompton. Lastly. The cause of death in nine cases was either not specified or ill-defined. A death was registered from Hydrophobia but contrary to the usual practice in such cases, an inquest was not held, the Coroner, in all probability, not having been informed of the case. The deceased, a woman aged 63 years, was bitten by her own little dog three months before her death. Three days before this event, which happened in September, she was about her house, and apparently well. She was attended by an unqualified practitioner until the day before her death, when symptoms appeared that led to a registered medical man being called in, and he certified the cause of death as registered. But the little dog was alive and well when the case was investigated some days after the fatal event! The case of a lady, aged 76, who died in Earl's Terrace from "senile decay, vomiting from eating decayed salmon and consequent exhaustion," may be cited as an instance of the danger of using unsound and unwholesome food. This lady, it may be mentioned, died intestate, and having no lawful heirs her estate, valued at £140,000, lapsed to the Crown. DEATHS IN PUBLIC INSTITUTIONS. There are numerous minor " public institutions " in the parish, but the only institutions calling for notice here, are (1) the Hospital for Consumption and Diseases of the Chest at Brompton, (2) the Parish Infirmary, and Workhouse, and (3) St. Joseph's House, Portobello Road, Notting Hill. The latter indeed cannot be called a public institution in the same sense as the other establishments, being a Roman Catholic Home for aged poor persons, most of whom, however, have probably been in residence long enough to acquire the status of parishioners from whatever locality originally received. The Infirmary for the treatment of the sick poor of Marylebone will, ere very long, form an important addition to the list of public institutions, a site for it having been acquired at Notting Hill. The deaths in the Workhouse and the Brompton Hospital were equal to 11.7 per cent. of the total deaths in Kensington, while the deaths in large public institutions in all London, formed 18 per cent. of total deaths. The Hospital for Consumption and Diseases of the Chest. —The deaths in this institution were 113, (83 males and 30 52 females), 27, 31, 31 and 24 in the four quarters respectively: 51 in the winter, and 62 in the summer quarters. Five of the deceased were parishioners ; of the remainder 57 were Londoners, 29 came from suburban counties, and 22 from more distant parts of the country. As usual, phthisis (consumption) was the cause of nearly all the deaths—103 of them being ascribed to this constitutional malady, with some secondary diseases in a few instances. Heart disease was returned in three cases; "lung disease" in five; "brain disease" in one, and " tumor " in one. Thirteen of the patients died at ages below 20 ; 44 between 20 and 30 ; 36 between 30 and 40; 14 between 40 and 50 ; and 6 between 50 and 60 years of age. The Parish Infirmary and Workhouse.—The deaths in these institutions, which are under the medical charge of Dr. Whitmore, to whose courtesy I am indebted for the subjoined particulars, were 227 in number, viz.; 117 males, and 110 females. The quarterly numbers of deaths were 69, 67, 48, and 43—136 of the deaths, therefore, took place in the first half of the year, when, in all parts of the parish, the mortality was so much higher than in the second half in which the deaths at the Infirmary were only 91. The deaths under one year of age, were 22, viz.: Atrophy or marasmus (15), whooping-cough (2), bronchitis, (2), congenital syphilis (1), premature birth (1), want of breast milk (1). The deaths between 1 and 60 years of age were 109, viz. : Measles, (2), chicken-pox (1), whooping cough (2), erysipelas (2), diarrhoea (3), privation (1), abscess (2), dropsy (1), cancer (]), ulcerative stomatitis (1), caries of spine(2), scrofula (1), enlarged glands (1), phthisis (43).apoplexy (1), epilepsy (1), convulsions (3), brain disease (11), heart disease (2), oedema of larynx (1),bronchitis (7), pneumonia(5), ascites, (1), stricture of rectum, (1), fistula in ano (1), cirrhosis of liver (l), jaundice (1), uraemia (1), kidney disease (2), joint disease (1), ulcer (1), detached placenta (1), phlegmasia dolens (1), puerperal convulsions (1), atrophy (2). The deaths at 60 and upwards were. 96, viz. : from 60 to 70, 44; from 70 to 80, 34; from 80 to 90, 16 One female at 90, and another at 98, died from " old age." The other registered causes of death were, erysipelas (2), diarrhoea. (7), purpura (2), dropsy (2), cancer (6), senile gangrene (1), caries of spine (1), phthisis (1), apoplexy (2), paralysis (1), insanity (1), brain disease (22), heart disease (5), bronchitis (26), vomiting (1), tonsillitis (1), ascites (4), liver disease (1), joint disease, (1), ulcer (1), old age (8). Two inquests were held : (1) female, 40, verdict, "apoplexy" (cerebal hoemorrhage), no post mortem (2), Male, 61, verdict, " Sudden death, heart disease," post mortem. St. Joseph's House.—The deaths in this institution were 36 in number, 22 males and 14 females. Only one of these deaths took place below the age of 60 years. The causes of death were the 53 diseases, common to old age, viz., heart diseases in 11 cases ; lung diseases, 7 ; brain diseases, 9 ; liver and kidney, and sundry other diseases, 9. INQUESTS. The cause of death in 166 cases was returned by the Coroner (inquests), viz., 132 in the Town sub-district and 34 in Brompton. The cause of death was ascertained in 127 instances by examination after death. The ground for inquiry in 82 cases was the suddenness of the death. In other 43 cases the deceased had been found dead in bed or otherwise. Forty deaths were due to violence, 11 being suicidal, viz., 2 by poisoning with carbolic acid (females aged 19 and 54), pistol shot 2, cut-throat 2, hanging 3, run over by train I, drowning 1. The violent (accidental) deaths were 29 in number, viz ,by suffocation (infants) 9, falls 6, run over 3, crushed (by fall of earth, and by a horse) 2, injuries to head 3, burns 2, choked 1, poisoned by narcotic (how or by whom unknown) one infant of two months, starved 1, (manslaughter), wilful murder 1. Of the remaining 124 cases, with the exception of a few in which the verdict was of a somewhat indefinite character, the deaths were due to visceral diseases ; including 41 cases of brain diseases, (apoplexy, convulsions, epilepsy, &c.) ; lung diseases 20, heart diseases 29, scrofulous diseases 5, stomach and kidney diseases 3 each, spasm of glottis 7, diarrhoea 4, &c. Eighty nine of the deceased were males and 77 females. Sixty-six were infants one year old and under. Among the cases included under the general headings "sudden" and " found dead," very many were deaths from diseases of the most ordinary type, which any medical man would have recognised. It is fair to infer therefore, that the deceased had been neglected, that no medical man had been called in, although the illnesses must have been attended with symptoms of a more or less serious and painful character. An inquest would have been unnecessary in every such case but for the fact that no medical certificate of the cause of death was forthcoming. I have always felt that the mere return of the cause of death by the jury in the coroner's court scarcely meets the necessities of justice, regarding, as I do, the death of a person at any age from acute maladies like pneumonia, or bronchitis, &c., when there has been no medical attendance, as a prima facie evidence of neglect as much calling for a verdict of manslaughter as the distinct refusal of one of the " peculiar people '' to call in medical aid in sickness. A Kensington jury has taken this view in one case that occurred during the current year. A boy died from small pox, and the woman in whose charge he had been placed having failed to obtain medical advice a verdict of manslaughter was returned at the inquest held on the body of the child. It is true that the Grand Jury ignored the bill on the graver 54 count, and that no evidence was tendered on the minor count of misdemeanour, so that the woman escaped any legal penalty for neglect. It cannot be doubted, however, that the moral effect of the course adopted by the jury will be good; and it may be fairly held that similar neglect to call in medical assistance in cases of more ordinary diseases should be regarded in quite as serious a light. I have only to add that the deaths registered on the information of the coroner were 5.7 per cent. of the total deaths in Kensington, the proportionate per centage in all London being 6.8. The deaths by violence were 1.7 per cent. of all deaths in the parish, and 3'7 per cent. in all London. DEATHS "NOT CERTIFIED." There is no sign of diminution in the number of uncertified deaths, i.e., deaths of persons who had been attended in the last illness by unregistered, i.e., unqualified practitioners of medicine. The number in 1876 was 33, (1.1 per cent. on total deaths); twentythree of them occurred in one man's "practice," and nine in another. Besides these admitted cases there were others in which a registered practitioner was called in at the last gasp with a view to the certificate. It appears to be a not uncommon thing for unqualified practitioners to retain the services of properly qualified men with a direct view to certification. Altogether the present state of the question is highly unsatisfactory, and it will be so until it is made somebody's business to protect the public from imposture. I use this hard word advisedly, because I am satisfied that many persons employ unregistered practitioners in total ignorance of their disqualification. I brought the subject very prominently forward a few months ago, and suggested means for putting an end to an admitted evil, but your Vestry, acting under the advice of the Law Committee, (themselves fully impressed with the gravity of the subject) decided that it would be ultra vires to prosecute offenders. It is to be hoped that ere long the duty of prosecuting in such cases will be rendered obligatory on some authority, and I cannot imagine a better authority than that which administers the Sanitary laws, whether it be a vestry, a corporation, or a board of guardians. Cases that have been decided in the High Court of Justice, on appeal, have done much to settle the law of the subject, and have swept away many of the legal cobwebs, with which both stipendiary and unpaid magistrates had obscured it; and there is little difficulty now in obtaining a conviction. A society of qualified medical men, instituted for the purpose, has prosecuted numerous offenders with success ; but while we must feel that the members have thereby conferred a great service on the community, it must be admitted that their proceedings expose them to misconstruction. In a matter 55 moreover, of national importance, as the statistics of uncertified deaths prove this to be, it ought not to be left to individuals to vindicate the law at their own cost. An unregistered practitioner in this parish was successfully proceeded against some time ago, and a mitigated penalty of £5 was imposed. Notice of appeal was given, but the appeal, it need hardly be said, was not prosecuted, while the offender did not intermit his practice for a single day. Many cases of small pox, it may be stated, have been treated in their homes by unqualified men, to the great danger of the public through the spread of the disease. It is noteworthy that many unregistered persons, nearly all indeed, practice with a sham degree of Medicine doctor, purchased, in absentia from an University in the Western Hemisphere which has no legal existence. The cause of death as given in the " certificates " furnished by unregistered practitioners is entered in the death registers and in the Registrar General's weeklv returns. The certificates are declared to be " invalid," the sub-district registrars are directed to ignore them, and they write " not certified " in the marginal column; but so long as the giving of such certificates is not forbidden ; so long, moreover, as deaths are registered on the information these certificates supply, we need not expect any change in the practice. Your Vestry forwarded my report, containing suggestions for putting a stop to irregular certification to the Registrar General and to the Local Government Board. The Registrar General in his reply naturally observed that it was no part of his duty to prosecute illegal practitioners, while the Local Government Board promised their attention to the subject. But nothing has been done, though it is open to any person under the Police Act to become a common informer, and to initiate proceedings under the Medical Act, 1858. The Apothecaries Act can be enforced only with the consent of the Society, and the penalties imposed go to the Society, while those under the Medical Act go to the Receiver of the Metropolitan Police! The "not certified" deaths in 1876 were ascribed to a variety of diseases, including phthisis, pneumonia, scrofulous affections, measles, erysipelas, &c., and the ages of the deceased ranged from a few hours to three score and ten years. "NO MEDICAL ATTENDANT" is the return made in cases where a certificate of the cause of death is not forthcoming. It would be the proper description of all the cases treated of in the last section ; for surely it is as irrational to style unqualified men "medical practitioners," as to dub everyone who has picked up a smattering of law with the title of lawyer. The man who pretends to be a lawyer, who takes the title and practices without qualification is very properly punished, and surely an equal measure of severity ought 56 to be visited on those who tamper with human life, mislead the public, and often inflict the worst injury on unsuspecting people. There were seven deaths last year, in which there had been " no medical attendant," besides those, the causes of which were to some extent explained by the previous knowledge of the deceased by medical practitioners. METEOROLOGY. The mean temperature of the air at Greenwich in 1876 was 50o.l Fahr., or .8 above the average of 36 years (1840-75). The averages of the four quarters were 39°.8, 510.7, 61°.8 and 47°. The highest reading by day (84°) occurred in the week ending July 22, and the lowest by night (17°.2) in the first week of the year. The hottest week in the year was that which ended August 19th, mean reading 72 , and the coldest that which ended January 15th (30o.7). The mean temperature of the fourth quarter was more than 7° above the mean of the first. and less than 5° below that of the second (or summer) quarter. The influence of these meteorological facts is very conspicuously seen in the vital statistics of the year. The dampness of the atmosphere {i.e., the difference between the dew point temperature and air temperature) was 6"4 (average of 35 years 5.6). The rain fall was 23.9 inches, the average in 36 years being 24.1 inches. VACCINATION. Table X (appendix) for which I am indebted to Mr. Shattock, the vaccination officer, presents the usual satisfactory results— more satisfactory indeed than could almost be hoped for, seeing how great is the extent of the parish, and that one officer has sole control of this important business. The figures are their own best commentary, and they prove with what zeal and probably unsurpassed success the vaccination laws are carried out in Kensington. Owing to the prevalence of small pox the facilities for revaccination were increased, and in addition to the usual day-times, arrangements were made at all the stations which afforded working people an opportunity of being re-vaccinated in the evening, of which large numbers availed themselves. The Guardians of the Poor are at the present time (July) taking steps to discover unvaccinated children by a house-to-house visitation.* The necessity for this step is obvious, for it is only since the passing of the last Act in 1871 that compulsory vaccination has been carried out with anything like satisfactory efficiency. A special difficulty, moreover, has existed in Kensington, owing to the fact that the population has largely increased by * Vide foot note, page 31. 37 tion for many years past, and it is impossible to say how many of these newcomers may have been unvaccinated children. It is to be hoped that some light may be thrown on this question in the course of the house-to-house visitation. I have taken occasion in former reports to point out the advantages of vaccination and re-vaccination, and shown the general effect of the operation in preventing small-pox: and its influence both in modifying the disease when it occurs, and in controlling the mortality. I do not think it necessary to do more now than refer to the observations contained in previous reports. I may, however, notice some pertinent remarks by the Registrar-General, contained in the" Weekly Return,'' (No. 23), dated 11th June, 1877, on a subject of much interest: for it is certain that vaccination has been brought into some disrepute by the loose use of terms to which the Registrar-General refers. He says, " the word ' vaccinated ' is ambiguous, for it is applied (1) popularly, to the operation of puncturing the skin and inserting vaccine lymph without reference to its effect: and (2) scientifically, to vaccination that induces cow pox. Two words are needed, and the word ' vaccinized ' might be used with advantage in the second case, when cow pox is induced, and distinct marks are left. Should the word vaccinized not be used, a child must not be described in the medical certificate as ' vaccinated,' unless it had distinct marks of cow pox before the appearance of the small pox eruption." These remarks will receive the respectful attention of the medical profession, and it may be hoped that before very long we shall have clearer evidence than heretofore of the fatality of small pox after successful vaccination, which implies a condition of complete alteration or modification of the entire system, very much the same in nature as follows upon small pox:—Cow pox, which is given to man by vaccination, being the small pox of the cow, a mild disease both in the animal and in man. Hence if a certain number of true Jennerian vesicles are not produced a person should not be described as "vaccinized." Vaccination is no trivial operation, and every point connected with it needs to be studied with the utmost care, while the operation itself should be surrounded with all those precautions in selecting the vaccine givers, and in the time and mode of vaccination which Jenner, himself the most careful of vaccinators, deemed essential to secure a successful, i.e., a protective result. LICENSED SLAUGHTER HOUSES. The licensed slaughter houses at the present time are 31 in number two less than last year, viz., 21 in the North, and 10 in the South Sanitary District (vide Table 11 appendix). No application has as yet been made for a license "to establish the business of a 58 slaughterer of cattle anew," since the passing of the Act in 1874. On the whole the slaughter houses are better kept than formerly, but considerable diligence in supervision is still necessary. In accordance with the recommendation of the Select Committee of 1873, and under the powers of the Act, they have been made " subject to regulations " that are "uniform," "precise," and (on paper) "stringent." The difficulty, however, is to get the magistrates to see the necessity of enforcing the regulations in the strict sense intended by Parliament, and contemplated by the framers of the byelaws. The penalties originally proposed for breaches of the byelaws were reduced by the Metropolitan Board of Works at the instance of the Local Government Board, acting on the advice of the Law Officers of the Crown that, whatever the amount, they could not be mitigated by the Justices ; but in no case has the full penalty been imposed for any offence arising within this parish, and generally the fine has been reduced to an extent calculated to bring the bye-laws into disrepute, and to defeat the object of special legislation. Not long since a case of an aggravated character was taken before the Court, and notwithstanding that the offender pleaded guilty, the magistrate on his own view that the summons was not drawn in exact accordance with the terms of the infringed bye-law (it was in his power to make any necessary correction) dismissed the summons, at the same time expressing his sense of the character of the offence, by administering a sharp warning to the defendant! The summons had been drawn out in your Vestry's offices as usual; the customary fee for this service being, as a matter of course, paid into the exchequer of che Court. Proceedings in another case were directed by your Vestry to be taken against the licensees of a slaughterhouse for having on their premises the carcase of a diseased sheep dressed as for "food of man." The magistrate dismissed the summons on the statement of the defendants that they intended and had arranged to send the carcase away; but the statement made to your Sanitary Committee, on whose advice the proceedings were instituted, was to the effect that the sheep had been brought in from the park dead, on the morning of the day it was seen by the Committee, and that it was " going away." Notice of the diseased carcase being on the premises, had not been given to the 'local authority,' (i.e., Metropolitan Board of Works) or to the 'cattle inspector of the district,' as required by the 11th bye-law. In a similar case sometime ago, the same magistrate held that the presence of a carcase of a cow which had been taken after death to a slaughter house and there dressed as for food for man, was evidence of intention, and the butcher was fined ten pounds. It may be mentioned that the Metropolitan Board of Works (the "Local Authority,") has not taken any proceedings for offences under the bye-laws in this parish. 59 LICENSED COWSHEDS. The licensed cowsheds are 28 in number (vide Table XII. in Appendix), viz., 17 in the North, and 11 in the South Sanitary District. They contain about 500 cows : and have been regularly inspected thronghout the year. In April, 1877, licenses were granted for five new cowsheds, and in every case the magistrates fixed the maximum number of cows to be kept in each, your Yestry's standard of 800 cubic feet per cow being adopted. In 1875 I drew attention to ,the necessity of regulating these establishments (and dairies) by uniform bye-laws: and I pointed out how this important object might be secured, viz., by getting the " Government to pass a short Act, conferring on the Metropolitan Board of Works the same powers in respect of cowsheds that they already possess in respect of slaughter-houses, unless the Board should be of opinion that the third section of the Slaughter Houses (Metropolis) Act, 1874, could be so construed as to include the business of a dairyman." The Board appear to have been of that opinion, and that the business might be regulated as an " offensive trade," and sometime back referred the whole subject to one of their committees. But any such action on the part of the Board, which is open to objection, moreover, will probably prove unnecessary, the Government having shown a willingness to deal with the subject in a more direct manner.* And although the Public Health (Metropolis) Bill, 1877 (clause 69), in which the proposed powers to frame bye laws for this purpose were included, has been withdrawn for the present session, we may reasonably expect that legislation will not be long delayed. It cannot be doubted, as I stated in a recent report, that " the more direct plan of regulating the business of a dairyman and a cowkeeper by byelaws authorised to be made, with a view to prevent the spread of disease, is to be preferred to that of classing so important a business with ' offensive trades.' The question, moreover, would be but half settled if the dairies were left out of consideration, which would necessarily be the case were the machinery provided by the Slaughter Houses Act put into operation." I am free to confess the satisfaction with which the promise of a great sanitary reform to which I have contributed fills me : and I gratefully acknowledge the support my views have received from your Yestry, and especially from the Sanitary Committee. Whenever the necessary powers are conferred on the " Local Authorities " (i.e., Commissioners of Sewers for the City, and the Board of Works for all London outside the City limits), I venture to believe those bodies will find the task of framing bye-laws not a difficult one, the *The Board, nevertheless, have resolved to deal with the Cowsheds under the Slaughterhouses Act, that is, provided they can obtain the consent of the Local Government Board, which is necessary before any trade not mentioned in the Act can be declared to be "an offensive trade'' within the meaning of the third section. 60 Society of Medical Officers of Health having drawn up a code (vide my Annual Report for 1875, page 41), which has been submitted to the Local Government Board, the " Local Authorities," and the Sanitary Authorities of the Metropolis, and which will probably be found to contain all that is necessary. It is to be hoped, however, that the Board of Works will content themselves with framing the bye-laws, and will leave the execution of them to the Vestries and District Boards, the Sanitary Authorities, and their officers. In the City the same authority will have the duty of framing and of carrying out the bye-laws, being provided with the necessary sanitary staff. But while the advantages of regulating cowsheds and dairies in Town is undeniable; yet, considering how large a proportion of the milk supply is obtained from the country, it must be confessed that any measure that does not provide for the regulation of the Country Dairies, &c., would be a very imperfect protection to the Metropolis. It will not be forgotten that the milk that was the occasion of the great Marylebone Typhoid Fever endemic a few years ago, was obtained from a dairy many miles distant from Town, the sanitary condition of which was found and acknowledged to be simply shocking. Many similar outbreaks due to insanitary conditions have been placed on record. Only last year I had occasion to investigate a complaint of numerous cases of illness clearly due to an impure milk supply, also from the country, and it was shown that the sanitary arrangements at the farm were defective, and that the water supply, the immediate cause of the mischief was as bad as it well could be. In connection with the subject of cowsheds may be mentioned an outbreak of Cattle Plague, which took place in 1877. The history of the outbreak is shortly as follows:—On the 17th of April a cow in a shed at Ledbury-mews, Notting-hill, was taken ill, and was removed to a slaughter-house for examination after death, the supposition being that the animal was affected with " lung plague " (pleuro-pneumonia). It was found, however, to be suffering from rinderpest, and the outbreak of the disease having been reported to the Veterinary Department of the Privy Council, the shed was declared to be infected, and put under surveillance. Six days afterwards, on the 23rd April, the remaining twelve cows were simultaneously attacked, and were killed at the shed : the carcases were disinfected, and removed in vans to Whitechapel, there to be reduced to pulp by superheated steam. The premises and the manure were disinfected, and, in all probability, the outbreak would have been an isolated one, but for the unfortunate circumstance that on the opposite side of the mews there was another shed, in which at the time there were 38 cows. The distance between the sheds was too small to permit any sanguine hope that the cattle in the second shed would escape; and, in fact, on 61 the 25th April three of the cows were taken ill and were slaughtered, the carcases being removed with the usual precautions. The freedom of the remaining cows from disease was ascertained, and thereupon the whole of them, 35 in number, were killed and dressed in the shed, and sent to the meat market. The hides and offal were disinfected, and conveyed to the boiling house; the manure was disinfected, taken away and buried. The woodwork of both sheds was to some extent destroyed, the buildings were disinfected, and not used again for 30 days. The theory of the origin of the outbreak is as follows :—The cows in the first shed (which was licensed only on the 3rd of April), were brought on 7th April from an old shed in the fields at Notting. hill, where there had been a sale of a much larger number on the 6th; and it is supposed that the infection was carried to the old shed in the clothes of some one or more of the persons engaged in the trade, who viewed th e cattle on the 5th, and attended the sale on the following day. The nearest cowshed to that from which the cows were removed is at Willesden, where the plague had already proved very destructive, but as the Willesden shed is about a mile distant from the shed in the fields there is no good reason for believing that the contagium was, or could have been carried in the atmosphere. It may be mentioned that the secretion of milk in cows ceases, almost instantly, in the very first stage of this malignant disease. BAKEHOUSES. The bakehouses, 117 in number, viz., 66 in the North and 51 in the South Sanitary district have been regularly inspected, and the provisions of the Act relating to them, carried out as fully as possible. SANITARY WORK. The sanitary work of the year executed by the inspectors, so far as it is capable of being set out on paper, is stated in Table VI. (Appendix ;) and Table VIa, shows the details of same as recorded in my monthly reports. A very large amount of sanitary work, however, e.g., abatement and removal of nuisances, cleansing of dwelling houses, &c., &c., is done through the influence exercised by the inspectors, without any necessity for the formal order of your Vestry. The number of complaints received, and returned in thecomplaint book was 1,357, of which by far the larger proportion resulted from inspections by the sanitary officials in the ordinary course of duty. The actual number of orders issued for the sanitary amendment of premises, &c., was 1,530, viz , 776 in the North, and. 754 in the South Sanitary District. DUST REMOVAL. The subject of dust removal has a special interest for us at the present time, your Vestry having now undertaken the work 62 out the intervention of contractors ; but the new system is too recent to enable us to speak with confidence of results, though these I am satisfied will be all that the parishioners could desire, provided the work is carried out methodically. I am of opinion that the parish should be mapped out into districts of convenient size, and that a call should be made at every house in each district on a given day. If dust-bins are made proper use of, it will not be found necessary to remove their contents more frequently than once a week. If the weekly call is made, and, whatever the reason, the men are not permitted to take away the refuse, the householder would be exclusively responsible for any inconvenience that might arise. All the arrangements would be dislocated by an attempt to go over the same ground twice in one week in order to attend to " complaints." The statistics that follow relate exclusively to the contractors year ended March 25th, during which 4,571 communications with reference to the removal of dust were received, viz., 2,022 from the North and 2549 from the South contract district. The gross numbers in the two preceding years were (1874) 6,000, and (1875) 4,775. The actual complaints of non-removal in 1876 were 85, viz., 34 in the North and 51 in the South. (The numbers in 1874-5 were 1,010 and 223) The orders issued to the contractors for the removal of dust, principally as the result of inspections, were 9,247. I cannot conclude this part of my report without an expression of satisfaction with the zeal and industry with which Dust Inspector Gaylard has conducted this portion of his duties. To his appointment, which your Vestry made on my request two years ago, I attribute most satisfactory results, and I am glad to know that the experience he has acquired in the Sanitary department has proved of essential service in the organization of the new system. NON-REMOVAL OF MANURE. I referred at length to this subject in my last Annual Report; and I recur to it now to urge again a suggestion I then made, viz., that as your Vestry have the power under sec. 95 of 25th and 26th Vic., cap. 102, to collect and remove stable manure, with the consent of the owners thereof, it would be advisable to exercise that power, inasmuch as the addition of the dung, &c., to ashes, &c., would increase the manurial value of the latter, and thus enable your Vestry to obtain a good price for the parish refuse Many owners of horses would gladly be relieved of the trouble of removing the manure, which is often not inconsiderable at certain seasons of the year. In other cases your Vestry might reasonably insist on the "regulations with respect to the removal of manure, &c., from mews, stables, and other like places," being strictly carried out, viz., by the receptacles being 63 cleared "three times a week," particularly in warm weather, and in thickly populated localities, or when the mews are close to houses, and especially wherever sunken dung-pits are found. Rather than submit to the inconvenience of carrying out these regulations, which are strictly necessary in a sanitary point of view, many horseowners would gladly avail themselves of your Vestry's staff: and it might be reasonably expected that the system would in course of time become self-supporting and even remunerative. The number of mews in the parish is 148. In too many of the mews, &c., dung pits are sunk in the ground ; and wherever these are found nuisance is sure to arise, not only in the locality, but also in the course of removal. We have had occasion to serve notices for filling up of such receptacles, and for the providing of racks above the surface of the mews. It would be well if this system could be generally introduced ; for, although the brick dung pit of ordinary construction is an improvement on the covered pit, it is liable to become a nuisance if neglected, and especially if it is not drained. The iron rack on the other hand admits the air freely, and allows the straw to dry, so that unless the manure is suffered to become rotten in the stable, no unpleasantness is caused by it either in the receptacle, or at the time of removal. PARLIAMENTARY. A Bill of considerable importance called the " Public Health (Metropolis) Bill, 1877," was introduced into the House of Commons late in the Session, (1877), and met with great opposition from the Sanitary Authorities of the Metropolis, on various grounds. The mode in which this Bill was introduced, and read a second time even, viz, as a blank sheet of paper, the Bill not having been printed, excited much disapproval as the principle of a measure is usually supposed to be affirmed by its passing a second reading. It was supposed also that the Bill would increase the power of the Local Government in two ways, viz., (1) by giving them extraordinary rights of interference in the event of default by sanitary authorities in the execution of their duties; the Board apparently to be the judge of such default: and (2) by transferring to the Board certain powers originally exercised by the Privy Council and the Home Secretary. To the general surprise, however, it transpired that these latter powers had been transferred to the Board by the Act, by which the Board was constituted in its present state, and known as the Local Government Board Act, (1871). In previous sections of the present report, I have referred to certain clauses of the Bill dealing with hospital accommodation for cases of infectious disease (page 10), and the " byelaws for the regulation of Dairies and Cowsheds" (page 59), &c. I pass on therefore to notice some other subjects, one of the most important being the power proposed to be conferred on the 64 Metropolitan Board of Works to make "byelaws as to foundations of houses with a view to the prevention of injury to health." The clause (68) however, does not go nearly far enough, and would have to be considerably extended to make it as useful as it might be. Sections 13 and 83 give increased powers and facilities for the abatement of nuisances, and would prove useful. Under sections 24 and 28 the local authority would be able to take proceedings for the removal of nuisances from offensive trades, &c., arising' without the district. Section 44 makes an " inn " and a "shop" a "public place," in respect of the exposure of a person suffering from an infectious disease; while section 40 enables the local authority to destroy infected clothing, bedding, &c., and to give compensation for the same. Sections 49 to 55 (omitting 54 which contains new provisions) which have been much objected to, are a re-enactment of clauses in the Diseases Prevention Act, 1855, and were intended to apply, and have hitherto been applied only in the case of imported diseases, such as Cholera. This fact might, with advantage, be made clear. The clauses are capable of amendment. The powers in respect of the interment of the dead and house to house visitation should be extended. The Bill, as a whole, it may be added, professes to do for the Metropolis what the Public Health Act of 1875 did as regards England generally, viz., consolidate and amend the sanitary law; but it falls short of so ambitious and laudable a purpose. The sanitary clauses of the Metropolis Management Acts, the Slaughterhouses Act, and the Water Acts are altogether omitted. In other words, it omits all reference to offensive trades, to sewerage and drainage, and to water supply. The Bill re-enacts the provisions of the Sanitary Act, 1866, with respect to mortuaries and disinfecting chambers, but it gives no power to local authorities to facilitate the acquisition of sites, although it enables the Local Government Board to direct the local authority to provide and fit up a mortuary. It re-enacts the lodging-house (35th) clause of the same Act, without making provision for uniformity in the bye-laws, so that the local authority of every district might carry out its own views in respect of the proper allowance of cubic space in inhabited rooms, &c., (37th). The Bill, moreover, would deprive sanitary officials of all control over common lodging-houses, (94th). But, inasmuch as consolidation and amendment of sanitary law are much wanted and would prove very useful—while consolidation alone, if comprehensive, would be a great boon to all who are engaged in the sanitary work of the Metropolis ; it is to be hoped that in the next session of Parliament a measure divested of the objectionable features of the present Bill will be introduced to do what this Bill professes to, but does not accomplish. 65 In withdrawing the Bill the president is reported to have said that "if he re-introduced it, it would be his duty to amend the Sanitary Law of the Metropolis more than could be properly done in a mere Consolidation Bill In withdrawing the present measure, therefore, he did not bind himself to introduce the same Bill next session, although he trusted it would be possible to introduce it in an amended state." LEGAL PROCEEDINGS. The cases taken before the Police magistrates were 61 in number, but for the most part they were of an ordinary sort, not calling for comment. One of the most serious matters in connection with judicial proceedings is the loss of time they involve. It is no uncommon thing for your Vestry's officers to spend the whole morning in the police-court, only to find their business postponed at the last. Whatever may have been the case when the present police-court arrangements were settled, they are most inconvenient and unsatisfactory now. Only one half the magistrate's time is occupied at Hammersmith, and he then posts off to Wandsworth to complete his day's work, whatever may be the state of business in the home court. At the very least, the whole day should be devoted to the business coming before the " Hammersmith " police-court, a large district which includes Kensington, a parish that has increased manyfold since the existing districts were settled. A more satisfactory plan would be a division of the district which should assign a court to Kensington. Failing some better arrangement, I am disposed to believe that we ought to take, at least, some portion of our business before the Justices, who frequently hold their court in the Vestry Hall. Some relief of the difficulty might perhaps be obtained by an arrangement with the stipendiary magistrate to take sanitary business (as a rule) at a certain hour on one day in the week. An arrangement of this sort is made in respect of School Board business, which practically monopolises one day in each week. I have already alluded in other portions of the report to the proceedings taken against a man who neglected to obey a Justices' order for the removal of his children suffering from smallpox. In another similar case we were unsuccessful through a defect in the drawing up of the order addressed to the defendant instead of to a constable. The defendant disobeyed the order, but escaped the penalty of his disobedience owing to the above mentioned error. Virginia Place.—A great scandal arose in the course of the present year, owing to the disgraceful condition of certain houses in this place, known as Devil's Alley. They were inhabited by the lowest class of poor persons, who paid no rent, 66 and came from all parts of town. The doors and all interior wood fittings had been more or less destroyed and carried off; the water supply had been cut off, and the waterclosets were in a filthy state. I had already reported some months previously that the houses were unfit for human habitation (under Torrens' Act) and your Yestry's surveyor had reported as to the reparations necessary to make them habitable. For a long time no " owner " could be found, and when at last an agent of the owner was found no disposition was shown to repair the houses, and the agent professed his inabdity to clear out the inhabitants. Proceedings were therefore taken in the police-court and the houses were closed by justice's order; the inhabitants were removed, and the doors and windows were boarded up. The houses cannot be legally re-occupied without a further order of the magistrate, rescinding the former order, and declaring them fit for human habitation. SANITARY WANTS. Mortuary and Disinfecting Chamber are still among our sanitary wants. In the (withdrawn) Public Health (Metropolis) Bill, 1877, the President of the Local Government Board proposed to take power to enable the Board to compel the erection of mortuaries, but without making any provision to enable local authorities to acquire sites. In this parish, as in others probably, the difficulty of obtaining a suitable site for a mortuary is a real hindrance to the carrying out of the intention of your Vestry; but it is a difficulty which, nevertheless, might be overcome. I am of opinion still, however, that the proper site for a mortuary is the disused burial ground at the rear of the Vestry Hall; and should this site ultimately become available, no doubt an arrangement could be effected for holding inquests in the Vestry Hall, thus avoiding the necessity which now drives the Coroner, the jury, and the witnesses (the latter often in a state of much mental distress) to the public-house. Although we have no Disinfecting Chamber, I cannot say the poor parishioners have been losers from the want of it, for in every case where infectious disease has occurred, all infected articles have been thoroughly disinfected, cleansed also, and returned in a wholesome condition to the owners. This could not have been done had we simply possessed a disinfecting chamber of whatever construction. The work has been satisfactorily carried out by the firm to which your Vestry have delegated it: but the expense, it need scarcely be added, has been considerable : amounting in the last twelve months (August, 1876, to July, 1877) to the sum of £246 lis. 0d The number of articles disinfected was 4,114, including 553 beds and mattresses, 1,528 articles of bedding, (sheets, blankets, bolsters, pillows, &c.,) 668 articles of adults and children's clothing, besides carpets, curtains, &c. 67 In the course of the present year your Vestry have made arrangements whereby every room in which there has been a case of small-pox or other dangerous infectious disorder has been thoroughly disinfected by an officer appointed for the purpose. This excellent system, the only one on which any reliance can be placed, is now in full and satisfactory operation. BATHS AND WASHHOUSES. No step was taken last year with a view to putting into operation the Act for providing baths and wash-houses. Considering the great and increasing value of land, the longer the matter is delayed, the less likely the Act is to be adopted, from the growing difficulty of obtaining a suitable site or sites. WATER SUPPLY Impressed with the sanitary importance of the Water Supply question, and believing it to be desirable that the individual members of your Vestry, as the sanitary authority of this great parish, should receive the best information procurable on all points connected therewith, it has been my custom year by year to summarise the report of Professor Frankland, which is drawn up for the Registrar General. Last year, I was able to add some valuable information culled from the monthly reports of Colonel Bolton, R.E., the Water Examiner under the Water Act, 1871. Dr. Frankland's report deals mainly with the quality of the water in its chemical and microscopical aspects, and in relation to its fitness for drinking and for domestic use. It need scarcely be stated that his opinion is adverse as regards the waters obtained (especially; from the Thames, whence our local supply is derived; although as regards the water distributed by one company, the West Middlesex, he allows that it is always clear and bright because well filtered, a standard of excellence in these respects that the other companies will shortly attain, works being in progress having this end in view. It is with the quantity of water, its condition in bulk at the intakes, and its physical qualities as delivered to consumers, with whatever that relates to filtration, storage, and distribution —the machinery of water supply, therefore, that Colonel Bolton's reports deal ; but it should be borne in mind that the Metropolis Water Act, 1871, under which this gentleman holds his appointment, was passed with a view to a system of " constant supply," which as regards the parish of Kensington is practically a dead letter. I propose, as usual, to present a summary of Dr. Frankland and Colonel Bolton's reports. Dr. Frankland, it will be seen, speaks highly of the water obtained by the Kent Company from the deep wells sunk in the chalk, and which for the sake of comparison 68 he takes as his standard of purity, and his observations hereon assume greater importance on the present occasion, considered in connection with a scheme which has just been propounded by eminent engineers, under the auspices of the "Water Authority," (i.e., Metropolitan Board of Works), with the object of supplying the Metropolis with potable water from this source. Dr. Frankland reminds us that our water supply is derived from the Thames, the Lea, the " New River," and the deep wells in the chalk. The range of temperature of the river waters is considerable—no less, last year, than 350.5 Fahr ; viz., from 33°.8 in January, to 70°.7 in July and August. Thus they were in danger of freezing in winter ; and they were unpleasantly vapid and warm in summer. The deep well water, on the other hand, had a range of only 8°.1 Fahr, viz., from 500. to 58°.1 The amount of solid impurity in the waters is much the same year by year. It is composed of a variety of substances, most of them harmless when the water is used for dietetic purposes, but injurious when used for washing. The really objectionable part consists of organic matter; and is sometimes dangerous to health. This is almost, if not quite, exclusively found in river waters ; and is to a great extent of animal origin. "On the whole the year, 1876, was very favourable for the river waters. Up to the end of November the rainfall was greatly below the average, and in consequence much polluting matter, which would otherwise have been washed into the rivers, was retained nearer to its source. Some months the river waters contained much less organic impurity than usual: indeed in August and October the New River Water was chemically purer than the deep well water of the Kent Company. When, however, the heavy rains of December set in, the accumulated filth of the summer and autumn was swept into the neighbouring streams, the Thames overflowed its banks, washing the manure from cultivated land, and liberating the water from stagnant ponds and ditches. Thus during the last month of the year, the Thames was laden with organic matters of the most objectionable origin, which were carried down to the intakes of the Metropolitan Water Companies : they passed through the filters, and were distributed to consumers. Since January, 1873, the Thames has never been in such a filthy plight, and although most of the water companies drawing from this river have greatly improved their subsidence and filtration plant since that date, no care, foresight, or appliance could convert the 'puddle' (to quote an entry in the books of the West Middlesex Company) which entered the Companies' works, into wholesome potable water fit for dietetic purposes. These uncontrollable and frequently occurring outbreaks render this river a very undesirable source of water for domestic use." 69 As usual the West Middlesex delivered the best water of the five companies drawing their supply from the Thames. The deep well water of the Kent Company is distinguished from the other supplies by containing a less proportion of organic matter, and is therefore taken as the standard of comparisor in the following table, which shows the amount of organic elements (organic carbon and organic nitrogen) in it, and in the Thames water supplied to this parish :— Sources. Maximum. Minimum, Average. Deep Wells. Kent .o 1.0 1.0 West Middlesex Thames 6.7 1.8 3.3 Grand Junction 7.6 1.9 3.6 Chelsea 7.0 1.9 3.9 The following table exhibits the results of observations as to the degree of efficiency of filtration of Thames water distributed by the Companies:— Names of Companies. Number of occasions when clear and transparent. Number of occasions • when slightly turbid. Number of occasions when turbid. Number of occasions when very turbid. West Middlesex 12 0 0 0 Grand Junction 8 4 0 0 Chelsea 7 4 1 0 The West Middlesex Company, it thus appears, supplied water on all occasions, in an efficiently filtered condition; but it is admitted that the filtration of the river water has undergone great and continuous improvement since Professor Frankland first instituted his observations on the subject in 1868. The sediment deposited by turbid water on standing, when examined by the microscope, is almost always found to contain numbers of living and moving organisms. The subjoined table shows how frequently these organisms have been observed in the water supplied by the local companies:— Names of Companies. Number of occasions when moving organisms were found 1869 1870 1871 1872 1873 1874 1875 1876 West Middlesex 0 0 0 0 0 0 0 0 Grand Junction 4 1 1 2 3 5 7 3 Chelsea 3 2 2 3 2 7 4 4 The "hardness" of the Thames water, or the weight of carbonate of lime, or its equivalent of other soap destroying substances, found in 100,000 parts of water, was, on an average 20° or parts in 1875, and 19°.8 or parts in 1876. Large quantities of soap or soda are required to soften the water before it is used for washing. This softening could be accomplished for a small fraction of the expense before the distribution of the water by the use of lime as practised on 70 similar waters at various places in the Provinces. There is good reason for the belief, however, that soft and moderately hard waters if equally free from deleterious organic substances, are equally wholesome for dietetic purposes. The subjoined table exhibits the averages for 1876 of solid impurity, and other particulars, the numbers relating to 100,000 parts of each water :— Namb of Company. Temperature in Centigrade Degrees. Total Solid Impurity. Organic Carbon. Organic Nitrogen. Ammonia. Nitrogen as Nitrates and Nitrites. Total Combined Nitrogen. Previous Sewage or Animal Contamination. (Estimated.) Chlorine. Total Hardness. Proportionate Amount of organic Elements. that in the Kent Company's Water being taken as 1. Kent o 13.1 40.70 .047 .012 .0 .411 .423 3791 2.36 26.8 1.0 West Middlesex 11.8 28.09 .159 .030 .001 .224 .255 1929 1.62 19.8 3.3 Grand Junction 10.9 28.53 .170 .033 .001 .229 .263 1979 1.61 20.0 3.6 Chelsea 11.0 28.47 .190 .033 .001 .240 .274 2085 1.64 19.8 3.9 Colonel Bolton reports that the intakes of all the local companies are now high up the river at Hampton and Molesey. The West Middlesex Company having large reservoir capacity for subsidence, avoid taking in water during floods; a new filter bed at Barnes has been taken into use. The construction by the Grand Junction Company of further impounding reservoirs for subsidence at the intake at Hampton (so as to avoid the flood waters) is in contemplation, as this company will require such reservoirs before they can deliver effectually filtered water during the period when floods prevail. The Chelsea Company's works at Molesey are rapidly approaching completion. Two out of four new storage reservoirs will shortly be taken into use, and then we may expect that this Company will supply water as little open to objection as that drawn from the river by the West Middlesex Company. With reference to the question of filtration, Colonel Bolton informs us that the rate should not exceed 540 gallons per square yard of filter bed each 24 hours, and at this rate filtration should be effectual. Colonel Bolton persistently calls attention in his monthly reports to the 14th regulation made under the Metropolis Water Act, 1871, relative to waste-pipes, to which I also have frequently adverted. This regulation, he says, if carried out in its integrity, will prevent contamination of the water from the gases generated by sewage, which are extremely liable to flow back into the cisterns, and become absorbed by the water, unless the overflow pipe is brought outside the house, and the end left exposed to the air, instead of being carried into the drain. The terms of the regulation are as follow :—" No overflow or waste- 71 pipe, other than a ' warning-pipe,' shall be attached to any cistern supplied with water by the Company, and every such overflow or waste-pipe existing at the time when these regulations came into operation (i.e., in 1872) shall be removed, or at the option of the consumer, shall be converted into an efficient ' warning pipe ' within two calender months next after the Company shall have given to the occupier of, or left at the premises in which such cistern is situate, a notice in writing requiring such alteration to be made." I am not quite disposed to agree with the water examiner that the "particular object," if the means by this, the only object, of the above regulation, is to prevent the waste of water; for in that case we might be poisoned with impunity for all the companies would care, provided they were not inconvenienced by any shortness in the supply of water. I have always contended that a very particular object of the regulation was, as Colonel Bolton puts it, "to get rid of the poisonous effluvia and gases from the drains which would otherwise ascend through the waste pipe, and not only be partly absorbed by the water in the cistern, but be partly mixed with the air in the houses, thereby becoming a cause of fever and disease." In such terms, Colonel Bolton, month after month, and year after year, reports to the Local Government Board, which is a sort of Board of Health, but all without effect. In respect of old houses and old fittings, no change is made; the waste-pipes continue undisturbed. The companies hold that "existing fittings" must be deemed to be "approved fittings" under the 35th regulation, and therefore that they have no right to issue, generally, any order to abolish waste-pipes under the 14th regulation. At all events they do not—with one exception. The Chelsea Company took the subject up earnestly, and got the waste-pipes abolished at a time when the scarcity of their water supply rendered economy necessary ; and thus they effected a great sanitary improvement at no great cost to individual householders ; and without difficulty, it may be added, householders, on a proper explanation being made, recognizing the necessity and advantage in a sanitary point of view of the abolition of the waste-pipes. I entered upon this question, however, so fully in my last annual report, that I shall forbear further remarks now, meanwhile continuing to hope that some means may shortly be found of inducing the companies to put the regulation into force, or of enabling the sanitary authority to do it for them. I entirely concur in the advice Colonel Bolton gives to householders to attend to the fittings and cleanliness of their cisterns, upon which depends in a great measure the purity and abundance of the domestic water supply; and I have been permitted, once again, in the present year to impress the necessity of such attention to cleanliness, &c., by addressing a paper containing information on the subject 72 to every householder in the parish. The warning is greatly needed, for I am confident much disease is caused through the medium of the water supply: and though the amount of it would he diminished by the universal abolition of the waste pipe that so often connects the interior of the cistern with the house drains and the common sewer, we cannot expect an entire removal of this source of disease, so long as householders remain negligent of the condition of the receptacles themselves. A NEW SCHEME OF WATER SUPPLY. The water supply of the Metropolis has received an unusual amount of attention during the current year. On the one hand a Select Committee of the House of Commons, appointed mainly to consider the means at the disposal of the Metropolitan Board of Works for the extinction of fire has reported, recommending that the water system should be consolidated in the hands of a public authority, which, in dealing with the question of constant supply, pressure, and pipage, should be bound to have regard not only to the convenience of consumers, but also to the requirements for the extinction of fire. It is estimated that the purchase of the undertakings of the water companies would involve an outlay of £25,000,000, and that the annual charge on the Metropolis for interest (at 3½ per cent) on this outlay, and in the outlay for alteration of pipage, and on the cost of hydrants, and on the cost of altered house fittings, together with the increased cost of pumping for higher pressure required by jets ; and the cost of management (diminished owing to concentration) would amount to £1,612,250 per annum, equal to about 16½d. in the pound on the present rateable value of the Metropolis, no improvement whatever having for this outlay been made in the quality of the drinking water, and nothing having been attained but a better provision for the extinction of fires. On the other hand a scheme has lately been submitted to the Metropolitan Board of Works by Sir Joseph Bazalgette, Mr. Bramwell, and Mr. Edward Easton, having for its objects a far more adequate provision for the extinction of fire, and an abundant supply of drinking water free from the objections to which the present supply, derived from riparian sources, is open. These gentlemen propose, as the only practicable mode of dealing with the question within limits of expenditure which the ratepayers of the Metropolis would be likely to tolerate, to separate the water for drinking purposes, aud for the extinguishment of fire, from the water (supplied by the companies) which is used for all other purposes. They admit the impossibility of changing the sources of supply for all purposes, for they say it is impossible to provide otherwise than as at present 125,000,000 million gallons of water daily, of water 73 that is unobjectionable; they consider, however, that it is quite practicable to obtain 30,000,000 million gallons per diem, or even more than that quantity of water, of the best possible quality for dietetic purposes (i.e., drinking and cooking), viz., the pure spring water from wells sunk in the chalk. Estimating the consumption at two gallons per head per diem for these purposes, as a liberal supply they show that it is possible to double that allowance, and to provide in addition an ample supply for fire brigade purposes, which by a system of hydrants could be delivered at great pressure and in abundant quantity so as to be available for the extinguishment of fire in the loftiest buildings without the intervention of fire engines. They would have made on the high ground to the North and South of London reservoirs at a height of 400 feet above ordnance datum, supplied by pumping engines drawing their supply of spring water at distances of from 8 to 15 miles beyond the reservoirs—in the open country— all the reservoirs to be united by large arterial mains traversing London from North to South; and these mains to be united by subsidiary mains from which a supply pipe would deliver water to an air-tight receptacle, in each house, of a capacity of 3 to 10 gallons, and filled automatically. It is needless to enter into further details of this plan, but it may be stated that for economy and other reasons the mains would be placed under the footways, and that on them at the time they are laid down the hydrants would be placed. The authors of the scheme consider that even if the property of the water companies were acquired by the governing body, this plan is the only feasible one by which the present complaints on the score of bad quality of the water, considered in respect of its potability, and the deficient quantity, &c., and insufficient pressure for fire brigade purposes, could be satisfied. They ask, therefore, apart from all the questions and difficulties connected with the acquisition by the governing body of the property of the water companies—which would be resisted, and would involve years of parliamentary warfare—why should not the plan be at once carried out, leaving the question of the acquisition of the companies for after consideration ? I have thought it right to lay this epitome of an important subject before your Vestry, as it is one of vast importance for ratepayers and sanitary authorities alike. I shall conclude my remarks by stating that the eminent authorities who are responsible for the scheme estimate the cost of carrying it out at £5,500,000, viz., for a separate supply of potable water, under sufficient pressure for extinguishing fires, including the house fittings, and also the hydrants. The annual cost attendant upon such a capital expenditure, and for pumping and cost of management is set down, at £225,000, equal to about 2½d. in the pound on the rateable value of the Metropolis. As 74 the gross income of the water companies in 1874 was equal to 11½d. in the pound, these sums together would make a charge of 14d. in the pound, or a saving of 2½d. in the pound, close on £225,000, as against 16|d. the cost of purchasing the property of the water companies, without improvement in the quality of the drinking water; but with better provision than at present for the extinction of fire. GAS. The subjoined tables are taken from the quarterly reports of the chief gas examiner, and show the results of testings conducted at the station in the Ladbroke Grove, Not-tina- Hill. 1. Maximum, minimum, and average lighting power of the gas in standard sperm candles :— Maximum. Minimum Average. Quarter ended Mar. 31st, 1876 17.6 16.0 16.8 Quarter ended June 30th, 1876 17.7 16.1 16.7 Quarter ended Sept. 30th, 1876 17.8 16.1 16.7 Quarter ended Dec. 31st, 1876 18.4 15.5 16.9 Averages, whole year 17.9 15.9 16.8 The gas which was tested on nearly every week day throughout the year fell short of the standard (16 candles) on two occasions only, viz., October 12th (15.6), and October 13th (15.5 candles). 2. Grains of sulphur in 100 cubic feet of gas:— Maximum. Minimum. Average. 1st Quarter 17.7 10.0 13.9 2nd „ 18.8 10.3 14.30 3rd „ 17.9 7.1 13.60 4th „ 16.5 11.6 15.4 Averages, whole year 17.5 9.7 14.3 The maximum impurity allowed, viz., 25 grains of sulphur in 100 cubic feet of gas, during the winter months, and 20 grains in the summer months was not attained on any occasion. Nor was sulphuretted hydrogen (which is absolutely prohibited) detected at any time. The maximum amount of ammonia impurity which is permitted is grains in 100 cubic feet of gas. Great care, however, is taken to extract the whole of this valuable product, and on no occasion was there so much as one grain per 100 cubic feet of gas : usually there was none. The average meter system has now been applied to the public lighting—with what results yet remains to be seen. The parishioners will in any case, however, have the satisfaction of 75 knowing that the quantity of gas for which they pay is really consumed in the street lamps. The only complaint connected with gas that came to my knowledge related to a nuisance arising out of the parish, viz., at the works of the Gas Light and Coke Company, formerly belonging to the Imperial Gas Company, and situated in the parish of Fulham. Numerous parishioners complained in the month of October of very offensive smells proceeding from these works, and by desire of your Yestry I investigated the matter, and reported thereon in November, the resident engineer at the works having given me every facility in the course of my enquiry. Without going into unnecessary and technical details, it may be stated that the cause of the offensive smell was the "lime process" by which gas is purified from excess of sulphur compounds. The "Gas Referees" have prescribed a maximum of impurity to be allowed, and for the winter months this, as before stated, is fixed at 25 grains of sulphur in 100 cubic feet of gas. The required degree of purity cannot be attained, in the present state of chemical knowledge, without the use of lime, and it is said that the lime process cannot be employed without creating nuisance. The nuisance arises when the covers of the purifiers are removed for changing the fouled lime which becomes charged with the sulphur and other compounds, and is very offensive. The principal ingredients in the nuisance are a gas, sulphuretted hydrogen; and a heavy vapour, bisulphide of carbon. The sulphuretted hydrogen is removed by passing the gas through hydrated peroxide of iron; but no practical means are known of dealing with the whole of the bisulphide, some of which therefore is allowed to escape into the open air at the highest point of the works. A less efficient mode of purification than the lime process is that by the oxide of iron. The effect of substituting it for the other would be an increase of about 10 grains of sulphur in the 100 cubic feet of gas. It is a question of evils, no doubt, but I am of opinion it would be better to have more sul-. phur left in the gas, even to be burnt in our houses, practically, into sulphuric acid, than that the air should be poisoned by so foul a stench—if this were an inevitable result. As the Company have another manufactory at Kensal Green (in this parish), it is right to observe that no complaint had been received from that quarter. The lime process is in partial use there, and the amount of sulphur impurity during the year never exceeded 18 grains in 100 cubic feet. At these works, however, the purifiers are in an enclosed building, the site of the works is elevated, and the supply of gas to the district is supplemented by a 24-inch main from Beckton. The Fulham works on the other hand, lie low, the purifiers, which were being increased 76 in number at the time of my investigation, are in the open air, and the local manufacture was not supplemented from Beckton, as I understood that it would be ere long. Whether these differences in the circumstances of the two cases were adequate to explain the occurrence of complaint in the one, and the absence of complaint in the other, is a question I did not pretend to decide. But I think the low level of the gas works at Fulham is against them, as the heavy and offensive vapours escape into the air at no great (if any) altitude above the level of the adjoining district within this parish, so that the wind carries them to, rather than above, the houses. It is a curious fact that about the same time similar complaints were made of nuisance in the neighbourhood of other works belonging to the Gas Light and Coke Company. The Company were anxious to be allowed to dispense with the lime process of purification, and they certainly succeeded in demonstrating its offiensiveness. The Gas Referees were firm in insisting on the required degree of purity of the gas qua sulphur; and certain sanitary authorities having threatened proceedings against the Company for creating a nuisance, the cause of complaint ceased. The Company, however, brought a Bill into Parliament in the current session with the object of freeing themselves from their responsibilities in respect of the sulphur. It was strongly opposed, and having been referred to a Select Committee the Company were defeated, and withdrew the measure. The regulations of the referees, therefore, continue in force: and I must confess that I do not see any reason for altering them, seeing that, as before stated, the sulphur impurity at the Kensal Green works did not, on any occasion last year attain even the summer maximum, viz., 20 grains in 100 cubic feet of gas. The highest amount recorded was only 18.1 grains, and the average for the year was only 14.3 grains, the minimum being 7.1 grains. No complaint has reached me in connection with these works, and I am unable to explain why the manufacture at other works cannot be conducted with the same success as at Kensal Green. What is done at one place may be done at another; and if a satisfactory result can be attained at Kensal Green where it is found necessary to make only partial use of the lime process, the referees are not likely to reduce the standard of their requirements; while metropolitan authorities will not cease to oppose every attempt to degrade the standard of purity of the gas. I have only in conclusion to express my satisfaction with the way in which I have been supported throughout the year by the Sanitary Inspectors, who have performed their duties with zeal and efficiency, specially dangerous as those duties have been. The 77 clerical and much special sanitary work has been ably carried out by Mr. Rudman. Of Dust-Inspector Gaylard's services I have already spoken; and the disinfecting-officer is doing his work well. The Vaccination Officer, Mr. Shattock, and the aub-district Registrars of Births and Deaths (Mr. C. R. Barnes and Mr. Hume), have on all occasions shewn the utmost readiness to afford me every assistance and information in their respective departments—while from several members of the official poor law staff, I have received much valuable help, which I take this opportunity of acknowledging. Lastly, I desire also to express my grateful sense of the manner in which my own efforts in the discharge of the duties of my office have been appreciated and supported by your Vestry. I am, Gentlemen, Your obedient Servant, T. ORME DUDFIELD, M.D., Medical Officer of Health. To the Yestry of Kensington, October, 1877. APPENDIX. Note.—The forms for Tables I.— VI. have been settled by the Society of Medical Officers of Health to ensure uniformity of Statistical returns. TABLE I. Estimated population 1870, at the middle of the year, and in 10 previous years; number of inhabited houses; Births, Deaths, and Marriages (gross numbers). Year. Estimated Population* Number of Houses. Registered Births. Deaths. Marriages. 1876. 148,000 18,044 4,499 2,896 1875 143,500 18,444 4,478 2,786 1,346 1874 138,000 17,667 4,356 2,696 1,311 1873 133,000 16,920 4,182 2,436 1,243 1872 127,400 16,206 4,041 2,171 1,132 1871 121,500 15,394 3,804 2,328 1,131 1870 116.350 15,279 3,705 2,473 892† 1869 111,350 14,654 3,625 2,249 891† 1868 106,350 14,029 3,522 2,232 984† 1867 101,350 13,404 3,158 1,933 974† 1866 96,350 12,779 3 080 1,966 984† Average of 10 years 1866 1875 119,515 15,477 3,795 2,327 „ Notes.—Population at Census, 1871, 120,234 Area in Statute Acres, 2,190. Average number of persons in each house at Census, 1871, 7.8. *The population is estimated to the middle of the year. Between 1803 and 1871 inclusive, a yearly addition has been made to the population based on the known increase between the Censuses of 1861 and 1871. The same principle has been adopted with regard to the number of inhabited houses, in the absence of specific information on the subject, such as has been forthcoming since 1871. Some of the figures in this and subsequent Tables differ from those in former reports, as the result of a revision of the estimated population, based upon the best attainable information. The population at the Census, 1861, was 70,108. †The returns of marriages for the years 1865-70, inclusive, do not include those that took place at the Superintendent Registrar's Office, concerning which I have no information. TABLE II. Showing Birth and Death Rate : Deaths of Children, and Deaths in Public Institutions 1876, and 10 previous years The Year. Births per 1000 of the population. Death rate per 1000 living. Deaths of Childr under 1 year per cent. to Total Deaths. Deaths of Children under 1 year per cent. to Registered Births. Deaths of Children under 3 years per cent. to Total Deaths. Deaths in Public Institutions 1876 32.9 19.5 26.6 17.1 44.6 338* 1875 31.2 19.4 25.0 15.6 40.3 338 1874 31.7 19.5 28.5 17.5 45.4 252 1873 31.4 18.3 27.0 15.9 40.0 272 1872 32.1 17.0 28.9 15.6 44.2 264 1871 31.3 19.1 25.0 15.0 41.6 252 1870 32.1 21.2 24.0 16.4 42.9 330 1869 32.5 20.2 † † † 313 1868 33.1 21.0 † † † 303 1867 31.2 19.0 † † 40.6 221 1866 32.0 20.4 † † 41.6 248 Average of 10 Years, 1866—76. 81.8 19.5 † † 42.0 289 *Viz. The Workhouse (225), and the Hospital for Chest Diseases at Brompton (113.) † No information. Note.—The calculation in this Table are made on the gross number of deaths registered without deduction of those of non-parishioners at public institutions. TABLE III. Deaths Registered from all causes during the year 1876. (The Deaths in Public Institutions of non-residents being excluded.) CAUSES OP DEATH. AGES. Total deaths under Five. Grand Total SUB-DISTRICT. Under 1. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. Kensington Town. Brompton. (classes) I. ZYMOTTC DISEASES 211 123 119 56 20 11 23 10 13 10 8 1 ... 455 605 522 83 II. CONSTITUTIONAL 70 47 40 21 57 98 70 69 54 29 7 1 ... 157 563 463 100 III. LOCAL 252 106 62 38 30 52 81 108 171 190 119 8 ... 419 1217 961 255 IV. DEVELOPMENTAL 220 13 4 1 5 3 7 ... 3 16 41 21 2 237 336 285 51 V. VIOLENT DEATHS 12 2 1 3 3 5 5 4 6 2 2 ... ... 15 45 32 13 (Not specified) 7 ... ... ... ... ... ... 1 1 ... ... ... ... 7 9 3 6 I. ZYMOTIC DISEASES. Order 1.—miasmatic. 772 291 226 119 115 169 186 192 248 247 177 31 2 1290 2775 2267 508 Varicella 1 1 ... ... ... ... 1 ... ... ... ... ... ... 2 3 2 1 Smaii-pox 3 ... ... 2 ... ... 2 1 ... ... ... ... ... 3 8 ... Measles 30 46 45 5 2 ... ... ... ... ... ... ... ... 121 128 112 16 Scarlet Fever (Scarlatina) 1 8 27 20 ... 1 1 ... ... ... ... ... ... 36 58 41 17 Diphtheria 4 1 5 5 1 ... ... ... ... ... 1 ... ... 10 17 13 4 Quinsy ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... Croup 2 6 3 2 ... ... ... ... ... ... ... ... ... 11 13 11 2 Whooping-cough 53 36 28 7 ... ... ... ... ... ... ... ... ... 119 124 114 10 Typhus ... ... ... 1 ... ... 1 ... ... 1 ... ... ... ... 3 3 ... Enteric or Typhoid Fever ... 2 6 2 7 2 4 3 ... ... ... ... ... 8 26 24 ... Simple continued Fever 1 2 ... 2 1 ... ... ... ... ... ... ... ... 3 6 6 2 Erysipelas 3 2 1 1 1 ... 2 ... 2 ... 3 ... ... 6 15 15 ... Puerperal Fever (Metria) ... ... ... ... 2 3 1 ... ... ... ... ... ... ... 6 4 2 Carbuncle ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 3 1 2 Diarrhoea 91 15 3 ... 2 2 1 ... 4 3 4 1 ... 109 126 110 16 Simple Cholera 4 1 ... ... ... ... ... ... 2 ... ... ... ... 5 7 7 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism ... ... ... 7 1 3 4 3 ... 1 ... ... ... ... ... ... ... Other Zymotic Diseases ... ... ... ... ... ... 19 15 4 Pyemia ... ... ... 2 1 ... 1 1 ... 1 ... ... ... ... 6 4 2 Order 2—enthetic. Syphilis 9 1 ... ... ... ... ... ... ... ... ... ... ... 10 10 10 ... Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ganders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3.—dietic. Privation ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 2 1 1 Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Purpura and Scurvy ... ... ... ... ... ... ... ... ... 3 ... ... ... ... 3 3 ... Alcoholism a Del. Tremens ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 3 2 1 b Intemperance ... ... ... ... ... ... 2 1 2 ... ... ... ... ... 5 4 1 Order 4.—parasitic. Thrush 8 2 ... ... 1 ... ... ... ... ... ... ... ... 10 11 9 2 Worms, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 211 123 119 56 20 11 23 10 13 10 8 1 ... 455 .605 522 83 II. CONSTITUTIONAL DISEASES. Order 1.—diathetic. Grout ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 4 4 ... Dropsy ... ... 1 ... ... ... ... 2 4 4 2 ... ... 1 13 12 1 Cancer ... ... ... ... 1 4 7 12 26 17 2 ... ... 1 69 51 18 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mortification ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 5 5 ... Order 2. —Tubercular. Scrofula and Tuberculosis 12 16 11 4 2 1 3 ... 1 ... ... ... ... 39 50 41 9 Tabes Mesenterica 29 11 7 3 ... ... ... ... ... ... ... ... ... ...47 50 46 4 Phthisis ... 1 ... 7 52 93 59 54 22 5 ... ... ... 1 293 238 55 Hydrocephalus and Tubercular Meningitis 29 19 21 7 2 ... 1 ... ... ... ... ... ... 69 78 66 13 III. LOCAL DISEASES. 70 47 40 21 57 98 70 69 54 29 7 1 ... 157 563 463 100 Order 1.—Nervous system. Cephalitis 3 1 2 5 1 ... 2 ... ... 1 ... ... ... 6 15 11 4 Apoplexy 1 ... ... ... ... 3 5 19 16 8 7 ... ... 1 59 43 16 Paralysis 1 ... ... ... ... 2 ... 3 ... 15 12 1 ... 1 45 31 14 Insanity ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 ... Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... 1 ... ... 3 2 2 1 ... ... ... ... ... 1 9 8 1 Convulsions 47 21 7 2 ... ... ... ... ... ... ... ... ... 75 77 56 21 Brain Disease, &c. 7 2 4 3 1 2 4 8 13 21 14 1 ... 13 80 72 8 Order 2.—Organs of circulation. Pericarditis ... ... ... ... ... ... 1 1 1 2 ... ... ... ... 5 5 ... Aneurism ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... 3 3 ... Heart Disease, Ac. 6 ... ... 5 9 10 14 7 35 40 12 ... ... 6 138 99 39 Order 3.-respiratory organs. Laryngitis 5 7 2 1 ... 2 ... ... 1 ... ... ... ... 14 18 14 4 Bronchitis 81 40 17 5 1 8 10 20 41 47 40 5 ... 138 315 165 50 Pleurisy ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... Pneumonia 71 30 24 8 5 8 11 12 13 ... 4 ... ... 125 197 265 36 Asthma 1 ... ... ... ... ... 1 1 5 3 2 ... ... 125 13 9 4 Lung Disease, &c. 15 4 2 ... ... 2 6 1 1 3 4 ... ... 21 39 32 7 Order 4.—Digestive Organs. Gastritis 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 1 3 2 1 Enteritis 4 ... ... 1 ... ... ... ... 3 ... 1 ... ... 5 11 8 3 Peritonitis 2 ... ... 1 1 1 1 2 ... ... 1 ... ... 2 13 11 2 Ascites ... ... 1 ... ... ... ... 2 ... ... ... ... ... 2 3 2 1 Ulceration of Intestines 1 ... ... ... 1 1 1 1 2 2 1 ... ... 1 3 2 3 Hernia ... ... ... ... ... ... ... 1 1 1 ... ... ... ... 3 2 1 Ileus ... ... ... 1 ... ... ... ... 1 2 2 ... ... ... 6 5 1 Intussusception 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 1 1 Stricture of Intestines 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... Stomach Disease, &c. ... ... ... ... ... ... 1 ... 3 1 2 ... ... 1 9 8 1 Pancreas Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 9 8 1 Hepatitis ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... 3 1 2 Jaundice 2 ... ... ... 1 1 ... 1 2 2 ... ... ... 2 9 8 1 Liver Disease, &c. ... ... 1 ... ... 3 8 12 ... 7 3 ... ... 1 43 32 11 Spleen Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... M- ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... Order 5.—urinary organs. Nephritis ... ... ... 1 ... 1 1 ... ... 2 1 ... ... ... 6 5 1 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bright's Disease (Nephria) ... ... ... ... 1 3 3 9 ... 5 4 ... ... ... 28 22 6 Diabetes ... ... ... ... ... ... 1 ... 1 2 1 ... ... ... 5 3 2 Calculus (Stone) ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Cystitis ... ... ... ... ... ... ... ... 1 1 3 ... ... ... 5 3 2 Kidney Disease, &c. ... ... 1 1 1 1 1 2 1 2 1 ... ... 1 13 9 4 Order 6.—organs of generation. Ovarian Dropsy ... ... ... ... ... ... ... ... ... 2 1 ... ... ... 3 2 1 Uterus Disease, Ac. ... ... ... ... ... ... 2 1 3 1 ... ... ... ... 7 4 3 Order 7.—organs of locomotion. ... Synovitis (Arthritis) ... ... ... ... ... ... ... 1 1 1 ... ... ... ... 3 3 ... Joint Disease, &c. ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... 3 2 1 Order 8.—integumentary system. Phlegmon 2 ... ... 1 1 ... ... ... 2 1 1 ... ... 2 8 6 2 Ulcer ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Shin Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 252 106 62 38 30 52 81 108 171 190 119 8 ... 419 1217 961 255 IV. DEVELOPMENTAL DISEASES. Order 1.—diseases of children. Premature Birth 38 ... ... ... ... ... ... ... ... ... ... ... ... 38 38 27 11 Cyanosis 2 ... 1 ... ... ... ... ... ... ... ... ... ... 3 3 2 1 Spina Bifida 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 2 1 1 Other Malformations 4 ... ... ... ... ... ... ... ... ... ... ... ... 2 2 1 1 Teething 22 10 2 ... ... ... ... ... ... ... ... ... ... 4 34 4 34 3 29 1 5 Order 2.—diseases of adults. Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Childbirth (see Puerperal fever) ... ... ... ... 5 3 7 ... ... ... ... ... ... ... 15 14 1 Order 3.—diseases of old people. Old Age ... ... ... ... ... ... ... ... 2 15 41 21 2 ... 81 68 13 Order 4.—diseases of nutrition. Atrophy and Debility 152 3 1 1 ... ... ... ... ... 1 1 ... ... 156 159 141 18 220 13 4 1 5 3 7 ... 3 16 41 21 2 237 336 285 51 V. VIOLENT DEATHS, &c. Order 1.—accident or negligence. Fractures and Contusions 1 1 1 1 1 3 1 ... 2 2 2 ... ... 3 15 14 1 Wonnds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bums and Scalds ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Poison 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 2 ... Suffocation 9 ... ... ... ... ... ... ... 2 ... ... ... ... 9 12 11 ... Otherwise ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Order 3.—homicide. Murder and Manslaughter 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 2 ... 2 Order 4.—suicide. Wounds: Gunshot, Cut, Stab ... ... ... ... ... 1 2 2 ... ... ... ... ... ... 5 1 4 Poison ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 2 1 2 Drowning ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 2 Hanging ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 3 1 ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 5.—execution Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths (not classed) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden deaths (cause unascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 2 1 3 3 5 5 4 6 2 2 ... ... 15 45 32 13 Causes not specified or ill defined 7 ... ... ... ... ... ... 1 1 ... ... ... ... 7 9 3 6 CAUSES OF DEATH. lUnder 1. 1 to 2. 2 to 5. 5 to 15 15 to 25. 25 to 35 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. Total deaths under Five. Grand Total. | Ketsington Town. Brompton AGES. Sub Districts TABLE IV. Showing Mortality from certain classes of Diseases and proportions to Population, and to 1,000 Deaths, 1876, viz.— Diseases. Total Deaths. Deaths per 1000 of Population. Proportion of Deaths to 1000 Deaths. 1. Seven Principal Zymotic Diseases 498 3.3 172 2. Pulmonary (other than Phthisis) 583 3.9 201 3. Tubercular 393 2.6 136 4. Wasting Diseases of Infants (under 5) 197 1.3 169 5. Convulsive Diseases of Infants (under 5) 190 1.2 65 NOTES. 1. Includes Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Fever and Diarrhoea. 3. Includes Phthisis, Scrofula, Rickets, and Tabes. 4. Includes Marasmus, Atrophy, Debility, Want of Breast Milk, and Premature Birth. 5. Includes Hydrocephalus, Infantile Meningitis. Convulsions and Teething. TABLE V. Showing the number of Deaths in 10 years, 1866-75, from the seven principal Zymotic Diseases, and the number in 1876, &c. Disease. 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 Annual Average 10 years 1866—75 Proportion of Deaths to 1000 Deaths in 10 years, 1865—75 1876 Proportion of Deaths to 11 00 Deaths in 1876. Smallpox 10 29 4 6 8 120 68 1 0 0 24.6 16.5 8 2.7 Measles 40 19 84 27 70 64 43 38 121 23 52.9 23.5 128 44.3 Scarlet Fever 28 35 170 106 198 95 29 10 32 83 78.6 34.0 59 20.4 Diphtheria Not separately registered. 9 14 11 14 11 26 23 10.8 4.6 17 5.8 Whooping Cough 28 68 34 71 55 72 77 44 45 107 60.1 25.4 124 42.9 "Fever" 33 46 52 42 46 48 42 41 52 29 43.1 18.2 36 12.4 Diarrhoea 112 . 78 113 108 154 129 110 145 112 107 116.8 49.7 126 43.5 Total, Kensington 251 275 457 369 545 539 383 290 388 372 386.9 165.9 498 172 Total, London 14,761 11,660 14,925 17,413 16,476 19,455 12,699 11,385 11,230 13,411 13,341 187 12,565 162 Total, England & Wales 1865—74* 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1865—74 1865—74 1875 1875 92,030 82,692 72,587 97,352 90,380 100,497 103,801 91,743 89,286 96,279 88,200 185 82,332 151 The Totals for England and Wales are for the ten yeara 1865—74, compared with 1875, the last year of publication at present. TABLE VI. Inspectors' Report of the Sanitary Work completed in tbe year ended March 25th, 1877. Sub-districts. No. of Complaints received during the year. No. of Houses and Premises, &c., inspected. Results of Inspection. House Drains. Privies and W.C.'s. Dust Bins. Water Supply. Miscellaneous. Orders issued for Sanitary Amendments of Houses and Premises. Houses, Premises, &c., Cleansed, Repaired and Whitewashed. Houses Disinfected after Infectious Diseases. Repaired, Cleansed, &c. Trapped or Ventilated. Repaired, Covered, &c. Supplied with Water. New provided. New provided. | Repaired, Covered, &e. Cisterns (new) erected. Cisterns Cleansed, Repaired and Covered. No. of Lodging; Houses registered under 35th Clause of Sanitary Acts, 1866.* No. of Dust Complaints received and attended to. Removal of accumulations of Dung, Stagnant Water, Animal and other Refuse. Removal of Animals, &c., improperly kept. Regularly Inspected. Other Proceedings, e.g. Legal Proceedings. Bakehouses. Licensed Cowhouses. Licensed Slaughterhouses. North. 689 1645 652 566 26 152 122 84 172 2 18 92 14 76 ... 2022 72 16 66 17 21 51 South. 668 1574 658 592 16 138 85 67 119 ... 7 49 6 59 ... 2549 65 4 51 11 10 10 Total 1357 3219 1310 1168 42 290 207 151 291 2 25 141 20 135 ... 4571 137 20 117 28 31 61 * This Act has not been put into operation. TABLE Via. Summary of Monthly Returns of Sanitary Work done by the Inspectors. Date of Report. Houses Inspected. Mews Inspected. Slaughter Houses Inspected. Cowsheds Inspected. Bakehouses Inspected. Offensive Trades Inspected. Sanitary Orders Issued. Letters, &c. Received re Dust Removal. Complaints of nonremoval of Dust. Orders Issued for the removal of Dust. Date of Report. North South North South North South North South North South North South North South North South North South North North May 3,1876 104 95 20 27 8 6 7 7 10 11 0 0 61 70 150 236 2 3 332 396 May 3, 1876 May 31 „ 126 119 26 23 8 6 10 8 12 11 4 0 58 51 131 111 1 1 365 252 May 31 „ June 28 „ 156 138 28 34 9 7 8 9 13 12 8 0 53 64 176 308 0 7 378 535 June 30 „ July 26 „ 167 148 24 22 38 21 22 16 12 11 7 0 87 73 178 314 2 4 471 596 July 26 „ Aug. 23 „ 137 125 25 19 21 14 19 16 12 13 9 0 68 37 127 145 1 3 211 195 Aug. 23 „ Sept. 20 „ 78 117 21 36 21 10 12 10 14 16 4 0 32 48 39 41 0 0 87 82 Sept. 20 „ Oct. 18 „ 119 123 24 16 13 19 16 11 12 13 0 0 67 68 53 98 1 6 171 146 Oct. 18 „ Nov. 15 „ 125 112 36 28 11 8 14 10 22 16 4 0 76 65 49 80 1 3 137 153 Nov. 15 „ Dec. 13 „ 126 132 32 38 9 7 12 8 18 19 3 0 51 67 74 147 1 2 188 286 Dec. 13 „ Jan. 10,1877 104 109 29 32 12 5 11 8 22 22 2 0 58 38 240 248 9 6 454 450 Jan. 10,1877 Feb. 7 „ 132 106 34 29 10 6 13 7 9 13 5 0 58 56 4r44 328 11 8 1015 500 Feb. 7 „ March 7 „ 145 128 36 39 9 7 12 8 14 22 2 0 55 53 236 268 3 5 608 500 March 7 „ April 4 „ 126 132 39 42 12 8 14 9 18 20 6 0 52 64 125 225 2 3 330 409 April 4 „ Totals. 1645 1574 374 385 181 124 170 127 188 199 54 - 776 754 2022 2549 34 51 4747 4500 Totals. TABLE VII. Showing the Death rate per 1,000 persons living; the annual rate of Mortality per 1,000 living from seven Zymotic Diseases; and the proportion of Deaths from these Diseases to the total Deaths in Kensington and in all London in 1876, and in the ten years, 1866-75. The Year. Deaths per 1000 living. Total Deaths from seven Zymotic diseases, Kensington. Annual rate of Mortality per 1,000 living from seven Zymotic Diseases. Proportion of Deaths to 1000 Deaths from seven Zymotic diseases. The Year. Kensington. London. Kensington. London. Kensington. London. 1866 204 26.4 259 2.6 4.8 133 185 1866 1867 190 23.0 276 2.7 3.7 142 166 1867 1868 21.0 23.6 457 4.2 4.7 208 200 1868 1869 20.2 24.6 369 3.3 5.5 164 227 1869 1870 21.2 24.1 545 4.6 5.1 222 213 1870 1871 19.1 24.7 542 4.4 6.0 233 242 1871 1872 17.0 21.4 390 3.0 3.8 181 179 1872 1873 18.3 22.5 290 2.1 3.3 119 149 1873 1874 19.5 22.5 388 2.8 3.3 144 147 1874 1875 19.4 23.7 372 2.5 3.9 133 164 1875 Average of ten years. 19.5 23.6 388 3.2 4.4 167 187 Average of ten years. 1876 19.5 22.3 498 3.3 3.6 172 162 1876 TABLE VIII. Comparative Analysis of the Mortality in all London and in Kensington, in 52 weeks, ended 30th December, 1876. LOCALITY. Annual Death Rate per 1,000 living from all causes. Annual Death Rate per 1,000 living from principal Zymotic diseases. Per centage of Deaths under 1 year to Births Registered. Per Centage of Deaths to Total Deaths. Under 1 year of age. At 60 years of age and upwards. From 7 Zymotic diseases. From Violence. Registered upon information of the Coroner. (Inquests.) Registered in large Public Institutions. London 23.6 3.6 16.6 25 7 20 0 16 2 3.7 8 18.0 Kensington 19.5 3.3 17.1 26.6 20.1 17.2 1.7 5.7 11.7 TABLE IX. Showing the Principal Localities in which fatal uses of the chief Zymotic Diseases occured in 1876. Kensington Town Begistration Sub-District. Brompton Registration Sub-District. Locality. DISEASES. DISEASES. DISEASES. Small Pox. Measles. Scarlet Fever. Diphtheria Whooping Couph. Typhus. Enteric. B.C. F. Diarrhoea. Total. Locality. Small Pox. Measles. Scarlet Fever. Diphtheria Whooping Cough. Typhus. Enteric. S. C. F. Diarrhoea. Total. Locality. Small Pox Measles. Ncarlet Fever. Kiphtheria Whooping Couth. Typbas Enteric. N. C. F. Diarrhoea. Total Abingdon Villas ... ... ... ... ... ... 1 ... ... 1 Johnson Street ... ... 1 ... ... ... ... ... ... 1 Adrian Terrace ... ... 2 ... 1 ... ... ... ... 4 Abirgdon Road ... ... 1 ... ... ... 1 ... 1 3 Kensington Square ... ... ... ... ... ... 1 ... 1 Ashley Cottages ... ... ... ... ... ... ... ... 2 2 Absalom Koad ... ... 1 ... 1 ... ... ... 1 4 Lad broke Grove ... ... 3 ... ... ... ... ... 1 4 Bute Street ... ... 1 ... ... ... ... ... 1 2 Absalom Road ... ... ... ... ... ... 1 ... 4 8 ,, „ Road ... ... 1 ... 1 ... 1 ... 1 4 Chapel Place ... ... ... ... ... ... ... ... 3 3 Acklam Road ... 3 ... ... ... ... ... ... 2 2 Lancaster Road ... ... 4 1 ... 1 1 2 9 Colelierne Mews ... ... ... 1 ... ... ... ... 1 Adair Road ... ... ... 1 ... ... ... ... 1 2 Ledbury Road ... ... ... 1 1 ... ... ... 1 3 Elisor Mews ... ... ... 1 ... ... ... ... 1 Addison Road ... ... ... ... 1 ... ... ... ... 3 Lucerne Mews ... ... ... 1 ... ... ... ... ... 1 Finborough Road ... ... 1 ... 1 ... 1 ... ... 3 Admiral Place . 2 ... ... ... ... ... ... ... 3 Lonsdale Road 3 2 ... ... 6 ... ... ... ... 11 Garden Row ... ... 1 ... ... ... ... ... ... 1 „ Terrace ... 2 ... ... 1 ... ... ... 1 2 Manchester Road ... 2 ... ... 2 ... ... ... 2 6 I field Road ... 1 1 ... ... ... ... ... ... 2 Archer Street ... ... ... ... 2 ... ... ... ... 2 Manchester Street ... 2 ... 1 ... ... ... ... ... 3 Montpelier Row ... ... ... ... ... ... ... ... 2 2 „ Mews ... ... 1 ... ... ... ... ... ... 1 Merton Road ... ... 1 ... ... ... ... ... ... 1 Princes Mews ... 1 1 ... ... ... ... ... ... 2 Aston Road ... ... ... ... 2 ... ... ... 2 5 Newcombe Street ... 2 ... ... 1 ... 1 ... ... 4 Queen's Gardens ... 1 ... ... 1 ... ... ... ... 2 A ppleford Road ... 2 1 ... ... ... ... ... 2 5 Norland Square ... ... ... 1 ... ... ... ... ... 1 Queen's Gate ... ... 1 ... ... ... ... ... ... 1 Bangor Street ... 2 ... ... ... ... ... ... 1 3 Notting Hill Square 1 1 ... ... 1 ... ... ... ... 3 Queen's Road ... ... 2 ... ... ... ... ... ... 2 Barandon Street ... 2 ... ... ... ... ... ... 1 3 Orchard Street ... ... 1 ... ... ... ... ... ... 1 Rutland Street ... 2 1 ... ... ... ... ... ... 3 Barracks (The) ... ... ... ... ... ... 1 ... ... 1 Oxford Gardens 1 ... ... ... ... ... ... ... 1 2 St. Mark's Road ... ... 1 . ... ... ... ... ... 1 Basing Road ... ... ... ... ... ... ... ... 2 2 Pamber Street ... ... ... ... ... ... ... ... 2 2 Stamfurd Cottages ... ... 1 ... ... ... ... ... ... 1 Bevington Road ... ... ... ... 2 ... ... ... ... 3 Peel Street ... ... 1 ... 2 ... ... ... ... 3 Thurloe Square ... ... ... 1 ... ... ... ... ... 1 Blagrove Road ... 1 ... ... ... ... 1 ... 1 2 Pembroke Place ... 1 ... ... 1 ... ... ... ... 2 Warwick Road ... ... 1 ... ... ... ... ... ... 1 Blenheim Crescent ... ... 4 ... 3 ... ... ... ... 7 Petersham Mews ... ... ... ... ... ... ... ... ... ... West Crom well Road . ... 1 ... ... ... ... ... ... 1 Blechynden Street ... ... 1 ... ... ... ... ... ... 2 Portland Road 1 2 ... ... 4 ... ... ... 3 10 Yeoman's Row ... 2 2 ... ... ... 1 ... 1 6 Blithfield Street ... 3 ... ... 2 ... ... 1 ... 6 Portobello Road 1 5 1 2 4 ... 1 ... 5 19 „ Mews ... ... ... ... ... ... ... ... 2 2 Pottery Lane ... ... ... ... ... ... ... ... ... ... Bramley Road ... 3 ... ... 2 ... ... ... 4 9 Prince's Place ... ... ... 1 ... 1 ... ... ... 2 Bransford Street ... ... 1 ... ... ... ... ... ... 1 „ Road ... ... ... ... 2 ... 1 ... 1 3 Britannia Terrace ... 1 ... ... 1 ... ... ... 1 3 Queen's Road ... ... ... ... 1 ... ... ... ... 2 Brunswick Gardens ... ... ... ... ... ... 1 ... ... 1 Queen's Terrace Mews ... ... ... 1 ... ... ... ... ... 1 „ Mews ... ... ... ... 2 ... ... ... ... 2 St. Ann's Road ... 3 1 ... 2 ... ... ... 2 8 „ Terrace ... ... ... ... 1 ... ... ... ... 2 St. Ervan's Road ... 3 3 ... 2 ... 1 ... 3 12 ... 1 ... ... ... ... ... ... ... 1 St. Clement's Road ... 2 ... ... 2 ... ... ... 3 7 Burden Mews ... ... 1 ... 2 ... ... ... 1 4 St. Katherine's Road ... 2 1 1 1 ... ... ... 2 7 Clarendon Road ... ... 1 ... 1 ... ... ... 2 4 St. James's Street 1 2 ... ... ... ... ... ... 1 4 Convent Gardens ... 1 ... ... 2 ... ... ... ... 4 St. Mark's Road ... ... ... ... 1 ... ... ... 1 2 Creseent Street ... 2 ... ... ... ... ... ... 2 2 Southam Street ... 1 2 ... ... ... ... 1 *3 7 Cornwall Road ... ... 1 ... ... ... 1 ... ... 2 Stamford Road ... ... 1 ... ... ... ... ... 1 2 Connaught Terrace ... 3 2 ... 3 ... 1 ... 3 12 Silehester Road ... ... ... ... 1 ... ... ... 1 2 Dartmoor Street 2 ... ... ... ... ... ... ... ... 2 Stoneleigh Street ... 1 ... ... 1 ... ... ... ... 2 Denbigh Terrace ... ... 1 ... ... ... ... ... ... 1 Swinbroke Road ... 1 1 ... 2 ... ... ... 4 Drayson Mews ... 1 ... ... ... ... ... ... 4 5 Talbot Grove ... ... 1 ... 2 ... ... ... ... 3 Edenham Street ... 2 ... ... ... ... ... ... ... 2 Talbot Mews ... 2 ... ... ... ... ... ... ... 2 Edwardes Place ... ... ... ... ... ... 1 ... ... 1 Tavistock Crescent ... 2 ... ... 2 ... ... ... 2 6 Eldon Road ... ... ... ... ... ... 1 ... ... 1 Thresher's Cottages ... ... 1 ... 1 ... ... ... 1 3 Faraday Road ... ... ... ... 1 ... ... ... 1 2 Treverton Street ... 3 ... ... 5 ... ... ... 1 9 Fowell Street ... 2 ... ... ... ... ... ... ... 2 Virginia Place ... 2 ... ... 1 . ... ... . 3 Golborne Road ... 1 1 6 ... ... ... 5 13 Walmer Road ... 3 ... ... 4 ... 2 ... 1 5 Hazlewood Creseent ... 3 ... ... 1 ... ... ... ... 4 Workhouse, The ... 2 ... ... 4 . . ... 9 15 Holland Lane ... ... 1 ... ... ... ... ... ... 1 Wornington Road ... 1 1 ... ... 1 ... ... 1 4 Holland Park Mews ... ... 1 ... ... ... ... ... ... 1 Uxbridge Street ... ... ... ... ... ... 1 ... ... 1 * Choleraic Diarrhœn. TABLE X. PARISH OF ST. MARY ABBOTTS, KENSINGTON. Return respecting the Vaccination of Children whose Births were Registered during the year 1876. TATE. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Birth List Sheets. Number of these Births duly entered in Columns 10, 11, and 13 of the Vaccination Register (Birth List Sheets) viz.: Number of these Births which are not entered in the Vaccination Register, on account of . Column 10 Successfully vaccinated. Column 11. Column 13. Dead. Un-vaccinstod. Postponement by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprized. Removal to places unknown, Or which cannot be reached. and cases not having been found. Cases still under proceedings by summons and otherwise. Insusceptible of Successful Vaccination. Had Small-pox. 1 2 3 4 5 6 8 9 10 1st January to 30th June Kensington Town 1821 1533 9 ... 160 20 10 89 ... Brompton 446 386 3 ... 36 2 1 18 ... 1st July to 31st Dec. Kensington Town 1865 1590 9 2 172 25 15 44 6 Brompton 390 339 2 ... 30 5 2 12 2 Total 4522 3848 22 2 398 52 28 163 8 TABLE XI. LICENSED SLAUGHTER HOUSES. SOUTH SANITARY DISTRICT, (10.) LOCALITY. LICENSEE. 11, Church Street, Kensington Mr. Stimpson 11, Peel Place, Silver Street „ Andrews The Mall, Silver Street ,, Wright 183, Brompton Road ,, French 60, Kensington High Street ,, English Phillimore Mews „ Clayton 15, High Street, Notting Hill ,, Short 133, Ditto ditto „ Candy 6. Addison Terrace, ditto „ Beall 35, Earl's Court Road ,, Matson NORTH SANITARY DISTRICT (21). 13, Archer Mews Mr. Bawcombe 20, Bolton Mews ,, Smith 195, Clarendon Road „ Rush 10, Edenham Mews „ Gibson Tavistock Mews Portobello Road „ Hughes 8, Vernon Mews, Portobello Road „ Young 196, Portobello Road. ,, Scoles Ledbury Mews „ French Lonsdale Mews „ Olney 50, Princes Road, Notting Hill ,, Parratt 98, Ditto ditto ,, Stovold 10, Princes Mews, Notting Hill „ Cole 10, Princes Road Mews ditto „ Coles Clarendon Mews ditto ,, Colley 41, Princes Place ditto ,, Pickworth 23, Norfolk Terrace ,, Matthews 61, Silchester Road „ Matthews 235, Walmer Road ,, Van Mary Place, Notting Dale „ Nind Royal Crescent Mews ,, Macpherson Ditto ditto „ Down TABLE XII. LICENSED COW SHEDS. SOUTH SANITARY DISTRICT. (11.) LOCALITY. LICENSEE. 5, Glos'ter Grove Mrs. Reeves 7, The Mall, Netting Hill Mr. Edwards Ditto Ditto „ Draper St. Mark's Road, Fulham Road ,, Starr Holland Park Farm „ E. C. Tisdall Ditto Dairy „ E. C. Tisdall Newland Terrace ,, E. C. Tisdall Warwick Road „ Pool Stratford Road „ Clarke Addison Cottage, Lorne Gardens „ Lyons Newcombe Street ,, Lunn NORTH SANITARY DISTRICT. (19.) 191, Portobello Road Messrs. Hughes and Son 207, Ditto Aylesbury Dairy Company 3, 4, 5, Angola Mews Mr. Jennings 4, 5, 6, Wornington Mews- ... ,, Jones Ledbury Mews „ Rennie Ditto ,, Liddiard 187, Walmer Road ,, Arnsby 235, Walmer Road „ Van 47, Tobin Street, Notting Dale ,, Bedgood 12, Blechynden Mews ,, White 14, ditto ,, Copperwheat 15, ditto ,, Salisbury 10, Talbot Mews „ Hornsby 3, 4, & 5, Archer Mews ,, Skingle 23, Bramley Road ,, Crew 27, Queen's Road ,, Williams 49, Tavistock Crescent „ Minter 2, Portobello Terrace Messrs. Ross & McCulIoch Elm Cottage, St. Mark's Road Mr. G. Attfield