KEN 104 THE ANNUAL REPORT on THE HEALTH, SANITARY CONDITION, &c., &c., of the Parish of St. Mary Abbotts, KENSINGTON, FOR THE YEAR 1877, by T. ORME DUDFIELD, M.D., MEDICAL OFFICER OP HEALTH. KENSINGTON: J. Wakeham, Printer, 4, Bedford Terrace, Church Street, 1878. CONTENTS. page Prefatory Remarks 5 Low Death Rate (General and Zymotic) in 1877 5 Death Rates (1873-7) Parochial and Metropolitan 5 Registration " (Kensington) " District, and Registration Sub-districts, what they comprise 6 Sub-districts ("Town " and " Brompton") differences in the rate of mortality, &c., in the 6 Zymotic Diseases 6 Small Pox, epidemic of 7 Typhus Fever, erroneous diagnosis of 10 Enteric Fever, endemic of 11 Hospital Accommodation for Non-pauper Infectious Sick, 19 ,, „ Action of Metropolitan Asylum District Board in relation to provision of 20 „ ,, Action of Vestry 21—2 ,, ,, Conference of Vestries and District Boards with respect to 22 Fulham Small Pox Hospital, mistakenly supposed to be a source of danger to the neighbourhood 24 Infections Diseases, prevention of 26 „ ,, Sources of information respecting the existence of 26 Population, &c., of Kensington, and of the Sub-districts, relative proportion of the sexes, number of inhabited houses, &c. 28 Kensington, evidences of the Growth, Wealth, &c., of (1801-78) 29 Marriages and Marriage-rate 29 Births and Birth-rate 29 Deaths and Death-rate (at ages and periods, and of the sexes) 30—32 iv contents. PAGE Deaths, special causes of 33—38 Public Institutions, deaths at 38 Inquests, facts in relation to, and the reason why so many Inquests are necessary 40 Violent Deaths 41 Deaths " not certified " (unqualified practitioners) 42 Meteorology 43 Vaccination, (Abolition of a "Station" &c.) 43 ,, Satisfactory character of Officer's Reports with respect to 46 Sanitary Department, history of 47 ,, „ Report by Special Purposes Committee on 49 Sanitary Work 53 Slaughter Houses, Licensed 54 Cowsheds „ proposed regulation of, by bye-laws 54 Bakehouses 57 Dust Removal 57 Manure (Stable) non-removal of 58 House Drainage 58 Public Urinals 59 Legal Proceedings 60 Mortuary and Disinfecting Chamber 61 Baths and Wash-houses 64 Water Supply 65 Gas 69 Conclusion 70 APPENDIX. Statistical and other Tables, I—XII. 76 TWENTY-SECOND ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, Being for the Year 1877, To the Vestry of the Parish of St. Mary Abbotts, Kensington. Gentlemen, The year 1877 was remarkable for the lowest death-rate in Kensington of which we have any authentic record. The estimated population at the middle of the year was 151,000, an increase, as compared with 1876, of 3,000. The deaths registered as occurring in the parish were 2,558, and were fewer by 338 than in 1876. This total includes 125 deaths of non-parishioners that took place in the Hospital at Brompton for Consumption and Diseases of the Chest, and are left in the account as a compensation for the deaths of parishioners that may have taken place at hospitals or other places outside the parish. In order to ascertain the correct death-rate, we must add to the deaths registered in the parish 66 that took place at the Hospitals of the Metropolitan Asylum District Board, viz, 60 caused by small-pox and six by "fever," thus raising the gross total to 2,624, a number equivalent to a death-rate of 17.3 per 1,000 persons living, the rate in the whole Metropolis having been 21.9 per 1,000. The Metropolitan rate was 0.4 per 1,000 below the rate in 1876 : the reduction in the Kensineton rate was 2.2 per 1,000. The following table shows the relative rates of mortality in all London, and the several great divisions thereof, and in Kensington, in the last five years: Death-rate. 1877. 1876. 1875. 1874. 1873. Kensington 17.3 19.5 19.4 19.5 18 3 per 1,000. London 21.9 22.3 23.7 22.5 22.5 „ West Districts 19.1 21.0 22.1 20.9 20.5 „ North ,, 21.8 21.4 22.3 21.8 21.2 „ Central ,, 24.1 24.0 26.0 25.6 25.0 „ East ,, 24.4 24.0 25.5 25.4 2.5.2 „ South „ 21.3 22.1 24.0 21.5 22.0 „ The most satisfactory features in the mortality statistics for 1877 are the diminished death-rate in childhood, and the low rate from zymotic diseases. Thus, instead of 1,305 deaths below the age of five years, and 771 below one year, the numbers in 1876, the deaths under these ages in 1877 were respectively 1,040 and 648, while the deaths from the seven principal diseases of the zymotic 6 class, including 66 that took place in the hospitals above referred to, were only 339 as against 498 actually registered in the parish in the previous year. As usual, however, there was a great difference both in the general and in the zymotic death-rate of the two registration sub-districts, "Kensington Town" and "Brompton," and very much to the advantage of the latter. The former district, hereinafter for brevity called the " Town," comprises the whole of the parish north of Kensington High Road, and a good slice south of that line. It has an area of 1,497 acres and it had an estimated population (at the middle of 1877) of 112,250. The "Brompton" area is 639 acres, and its estimated population was 38,750. The Town sub-district includes important open spaces; viz., Holland Park, Kensal Green Cemetery, and fields in the vicinity thereof in which, however, the builder is now hard at work, apian setting out five miles of new roads having been lately approved by your Yestry. The Brompton sub-district, which has been covered rapidly by new houses, many of them of a palatial character, within the last few years, comprises within its boundaries the West London or "Brompton" Cemetery. These two sub-districts make up the parish of Kensington: but "Kensington" as a registration district—the parish and the district being often confounded—comprises a great deal more; viz., 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 Inhabited houses, Population, acres. 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 Kensington parish is divided into wards. The sub joined figures shew the acreage of the several wards, and other particulars of interest which relate to the census year, 1871. 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 Hill and St. James, Norland 905 7,730 62,475 £365,012 St. Mary Abbotts 846 4,781 35,696 £323,992 2,190 15.735 120,299 £935,720 ZYMOTIC DISEASES. The death-rate from the principal zymotic diseases was, as already stated, very low in 1877, amounting to 2'2 per 1,000 living 7 for the whole parish, and to 1.5 per 1,000 only in the Bromptott Sub-district. The rate in all London and in "twenty large English Towns" was 3.5, and in "fifty other large Town Districts." throughout the kingdom 3.0 per 1,000. The death-rate from each of these diseases in Kensington, small-pox only excepted, was below the decennial average. The only diseases that call for special notice, besides small-pox, are the principal varieties of "Fever." Small Pox.—The epidemic of small-pox—an account of which occupied a large space in my last Annual Report, the history having been brought down to the month of September, 1877, when the disease appeared to be dying out, not in Kensington only, but in the Metropolis generally, began to assume larger proportions before the close of October, and continued to increase until the middle of April, in the current year, when it again began to decline. The subjoined table shows the progress and the fluctuations of the disease in this parish from what was practically the commencement of the epidemic in October, 1876, to the end of June, 1878 :— No. of Report. Date of Report. Cases Reported. Under 15 yrs. of age. Over 15 yrs. of age. Sanitary Districts. Sent to Hospital. Treated at home North South 1876. No. 10 1876. Nov. 15 13 5 8 12 1 4 9 14 Dec. 13 36 14 22 22 14 28 8 15 1877. Jan. 10 40 20 20 24 16 30 10 1877. 1 Feb. 7 43 14 29 34 9 24 19 2 Mar. 7 26 12 14 24 2 15 11 3 April 4 24 7 17 22 2 18 6 4 May 2 39 17 22 32 7 23 16 5 „ 30 43 21 22 38 5 29 14 6 June 27 50 20 30 28 22 40 10 7 July 25 43 21 22 25 18 38 5 8 Aug. 22 39 10 29 17 22 32 7 9 Sept. 19 12 3 9 7 5 9 3 10 Oct. 17 19 16 3 7 12 12 7 11 Nov. 14 11 4 7 4 7 8 3 12 Dec. 12 5 1 4 1 4 8 2 13 (to) 31 5 0 6 1 4 4 1 1878. 1 Feb. 6 8 3 5 6 2 7 1 3 Mar. 5 10 1 9 5 5 10 — 4 April 3 16 2 14 6 10 15 1 5 May 1 57 8 49 7 0 47 10 6 „ 29 55 23 32 21 4 35 20 8 June 26 23 8 15 7 6 18 5 Totals 617 230 387 350 267 149 168 8 Some particulars were given in my last report With respect to the cases that had occurred from the beginning of the epidemic down to the end of September, 1877. Since that date and to the end of June, 1878, viz., in nine months 198 eases have been reported, of which 58 occurred in the district north of the Uxbridge Road, and 140 in the district south thereof, the majority of the latter in the south-west part of the parish, in the Brompton Poor Law District: 147 of the sufferers were over, and 51 under 15 years of age. The cases recorded in the whole year, 1877, were 359 (240 north, and 119 south of Uxbridge Road). They occurred in 271 houses in 213 streets. Two hundred and fifty-five of the cases were removed to hospitals, and 104 were kept at home. The deaths in the hospitals were 60, and the deaths registered in the parish 24.* The rate of mortality in hospital and home treated cases, so far as known to us, was about the same. It is probable that some carefully concealed cases may not have come to our knowledge; and, in this event, the per centage of fatal cases would show higher at the hospital than ' at home.' But then it is notorious that many of the cases that are treated at home, are very light, while the gravity of other cases determines in the minds of parents and relatives the necessity for removal to the hospital. I need hardly say that the inspectors are instructed to press for the removal of all cases, and especially of light cases, for these are truly the most dangerous when kept at home, it being found difficult to induce the "sick" person to keep his room, and separate himself from the rest of the world, when he may be unconscious of anything being wrong with him, so far as he can judge by his own sensations, and especially in those instances when the rash is small in amount and more than usually modified and brief in its duration, as a result of previous vaccination. A large, and speaking generally, an increasingly large proportion of the cases have been sent to the hospitals, the popular objection to which, so far as this particular disease is concerned, would appear to be on the wane. Certain it is that the Inspectors do not often experience serious difficulty in getting patients removed, and but rarely meet with an absolute refusal. The cases which, as a rule, are treated at home, are cases that have been concealed, or cases in private houses having such good accommodation as to render removal unnecessary. In some cases that come within the latter class, however, removal to a hospital—the London Small Pox Hospital generally—has been desired by the patient. There has always been a marked difference in the classes of cases in the two great divisions of the parish, north and south of the Uxbridge Road. In the north children have formed a *The names of the streets where fatal cases occurred in Kensington are given in Table 9 (Appendix). 9 large per centage of the cases, whereas in the south they have comprised a somewhat small per centage of the sufferers, and as in the former epidemic, the cases in the north have been grouped more than in the south, where, as a rule, they have occurred singly. But even in the north the single cases have been more numerous during the last twelve months than in the previous year or in the last epidemic. This has been due in part, I believe, to the more early removal of first cases. The age of the children attacked in the south part of the parish has been on an average higher than in the north. In explanation of these differences, it may be stated that children are far more numerous in the north, and overcrowding is more common. In my last report I gave many illustrative cases of unsuspected channels of communication of the disease. I suspect none is more frequent than premature exposure of convalescent patients who have been treated at home. I well remember in the epidemic of 1871-2, having seen children playing in the streets and doing little errands, with the dying-out rash plainly visible. But no such cases have come to my knowledge during the present epidemic, and I believe more care is now taken to keep the disease from spreading, the public generally having been roused to a sense of the danger. It has happened in many cases that this sense of danger has been the cause of information reaching us of the existence of the disease, viz., through the medium of letters— anonymous or otherwise—and by confidential verbal communications. There appears good reason to suppose that the disease is spread sometimes through the medium of laundries, either by infection contained in clothing sent to be washed, or by infection distributed with washed clothes, when the disease has existed in the family of the laundress or her employes. A striking illustration of the danger of sending infected clothing to a laundry was given in my last Annual Report; and though I am not able to prove that the disease has actually been spread from a laundry by the business being carried on during the prevalence of sickness in the family of the laundress, we have done all that we could to put a check on the evil practice, and in a case that occurred during the present year where a boy, the son of a laundress, was ill, and the parents would not let him go to the hospital, but persisted in sending home the washed linen without previous disinfection, proceedings under the 38th section of the Sanitary Act, 1866, were taken at the Police-court before Mr. Bridge, who, as it was a first case, inflicted a mitigated penalty, but at the same time announced his intention to impose the full penalty (£5) in any proved case that should hereafter be brought before him. It is not known that any case of the sort had been previously tried, but I have no doubt of the importance of the 10 magistrate's decision, or that, judiciously used, it will be very useful as an example and as a warning, in the hands of the Sanitary Inspectors. As it has been stated in another section (Disinfecting Chamber) all sick rooms have been carefully disinfected by one of your Vestry's officers, and the clothing, bedding, and other things that had been exposed to infection have also been effectively disinfected by the firm to which this important work has been entrusted. "Typhus."—Two deaths from this disease were registered in December, 1877, and two more in January, 1878, there being nothing, however, to connect the cases in respect of origin, locality, &c. This being so exceptional an occurrence, and entertaining as I did, grave doubts as to the correctness of the diagnosis, I made a careful investigation of the cases. The first case was that of a little boy, aged four years, who died on the 22nd December at Bransford Street. The parents, two other children, and the deceased occupied two rooms, which the inspector found clean and decent when he went to disinfect them. No cause could be assigned for the disease, which is unusual at so early an age, and is commonly the product of infection, or the outcome of squalor, neglect, and unsanitary conditions generally, which had no existence in the present instance; and although the whole of the illness was passed at home, no other person contracted the disease. When I wished subsequently to make a personal enquiry into the case, I found that the family had left their lodgings, and they could not be traced. It may be mentioned that at about the same time as the boy died there was some scarlet fever in the street. The second case occurred at Earl's Court Road, and was that of a married woman, who was in the first instance attended by a local practitioner, who reported the case to me as one of "enteric fever, and that of a bad type"—an account supported by his description of the symptoms. The patient died on the 12th December under the care of another medical man (a friend of the family, from Kent), and on the day of her burial her husband was taken ill with unmistakeable symptoms of enteric or typhoid fever, and after a lengthened illness he recovered. In my account on an outbreak of typhoid fever in this parish (page 12), I have assumed that both these cases were cases of that disease, and not typhus at all. The third case occurred at Edenham Street, and proved fatal. It was certified as a death from "typhus, rheumatic fever," and I accordingly had the room, &c., disinfected. On making enquiry into the case—especially with the view of ascertaining whether the disease had extended, there being nearly twenty persons resident in the house, including the five children of the nurse-facts were mentioned which gave me the impression that this patient had died 11 from heart disease, consequent on the rheumatic fever; and on placing myself in communication with the certifying surgeon he admitted that there had been cardiac complication, but maintained the existence of typhus. As, however, the patient was perfectly conscious and rational to the last, I cannot but think there may have been an error in the diagnosis—a view borne out in some measure by the immunity of the other inhabitants of the house under circumstances calculated to favour the spread of so infectious a disease. The fourth and last case—whatever its nature, was imported from Marylebone. It was that of a young man who had been engaged in a large house of business in that parish. The patient was seen by the medical man who attended the previous case, but only once, viz., on We dnesday, the 23rd January, the patient dying on Sunday, the 27th, at St. Luke's Mews. The certificate given was "typhus:" and although the account I had of the case from the mother and sister of the deceased did not agree with my experience of typhus, I thought it desirable to write to the employers of the deceased, pointing out the posssible danger to their establishment, and requesting them to hand my letter to their Medical adviser. This gentleman promptly informed me that the young man, who had been under his care from the 16th to the 22nd of January, was "suffering from typhoid fever and not typhus." It would thus appear to be probable that the diagnosis of typhus in at least three, if not in all four of the cases, may have been an erroneous one, and being under this impression myself I have felt it my duty to say so, and for this reason:—Typhus fever is one of the most infectious of diseases—a disease it is difficult to prevent from spreading, except under the most favourable circumstances of isolation, &c. It is regarded, moreover, in some degree, as an opprobrium upon the district where it occurs, for its occurrence is a nearly sure sign of something very wrong in the sanitary condition of the people or their surroundings. Taking this view of the case, I presume, the Registrar-General specifies in his "Weekly Return" the very house as well as the street and parish where a death from this disease occurs. He did so with regard to the deaths on which I have made the foregoing remarks, and it therefore not only seemed incumbent on me to make a careful investigation of the cases, but it seemed to me equally a duty to your Vestry and myself that the conclusions to which the investigation had led me should be frankly stated. Enteric Fever.—The deaths registered from enteric fever, were fourteen in number. Ten of them occurred in the Town and four in the Brompton registration sub-district. The ages of the deceased may be ascertained by reference to Table 3, Appendix. The quarterly numbers of the deaths were 5, 3, 1, 5, respectively. 12 quiry into the history of the cases led me, as in former years, to the conclusion that some of the deaths registered as from " typhoid " were not cases of enteric fever, but different diseases, assuming at the approach of death a "typhoid" character. Some of the cases were imported. Two outbreaks attributed to milk call for notice. The first, an unimportant one, occurred in October, and so far as I know, comprised only eight or nine cases. Three children in a dairyman's family were taken ill—one at home, and the other two some days after they had left home on a visit, and these were the only cases in Kensington ; but I was informed that other five or six cases had occurred in two adjoining parishes—all children who had partaken of milk from the suspected dairy. All the outside cases appear to have commenced at about the same time as the first case in the dairyman's family, in the treatment of which proper precautions were taken under medical direction to prevent the spread of the disease. The premises on inspection were found in fair sanitary condition on the whole, some slight defects being remedied forthwith. The milk, which was served out in the shop to the carriers from the churns in which it had travelled, was obtained from two sources—a suburban dairy and a Hampshire farm—the latter supply through a South London milk dealer. I placed myself in communication with the Medical Officers of the respective districts, and ascertained that there had been no case of enteric fever in the families of the cowkeepers nor in the neighbourhood, and that there was no sanitary defect on the premises to which enteric fever could be traced. I submitted samples of the milks to your Vestry's analyst, who reported that the one contained 18 and the other 30 per cent. of added water—a circumstance which did not by any means invalidate the suspicion that the contagium might have been conveyed in the milk. Happily none of the cases, whatever their origin, proved fatal. The other outbreak, much more serious and very fatal, began at the end of November. The circumstances attending the cases pointed to a probable community of origin in the large majority of them, viz., from the use of a specifically infected milk. The mortality from enteric fever in the fourth quarter of 1877 had been rather below the average—but at about the middle of December I began to be aware that cases of the disease were somewhat more numerous than usual. At that time a medical man called on me and reported a fatal case in his own practice at a house in Fopstone Road. He stated that a second case had been sent from the same house to one of the hospitals, and that there was a third case at the adjoining house. Both families, he said, were supplied with milk from the same dairy, and he expressed a suspicion that the disease was due to the milk. Other cases came to my knowledge in the course of the next few days, and the matter assuming a 13 somewhat serious aspect, I addressed a circular letter to about one hundred medical men practising in the central and southern parts of the parish, requesting to be informed, Whether they had had any cases of Typhoid fever under their care within the previous six weeks; and asking particulars of any such cases, the probable origin of them, especially with reference to the existence of sanitary defects or a polluted water supply: I also asked to be informed of the source from which families, where sickness had occurred, obtained their daily supply of milk? To this circular I had about fifty replies, verbal or written, and a few new cases were thus discovered, raising the total number, between the middle of November and the end of January, 1878, to some thirty cases. Sixteen of the cases had this feature in common, that the families in which they occurred had their milk from one of the largest and best known dairies in the parish. The first of these cases was recognized on the 18th November, and the last case on or about the 16th December.* The 16 cases occurred in thirteen well-to-do families in as many houses and in nine streets. Ten of the sufferers were above 15 years of age, and six were children ranging in age from two years to eleven. Six were female domestic servants. The total number of persons in the several households was 161 — adults 113, children 48. Six of the persons attacked drank milk freely : most of the others in the usual quantity—i.e., a little—in two or three instances a very little, with tea, &c. Eight died—four at home and four in hospitals. The weekly number of cases was 2, 3, 6 and 5=16 : six males and ten females, † The circumstance that the sufferers had presumably partaken of milk obtained from one dairy naturally engaged my attention in the first instance and satisfied me of the prima facie reasonableness of the suspicion that had been so freely expressed regarding milk as the fons et origo maii. There was nothing novel in this suspicion, for milk has again and again been proved to be the medium in which the infective agency of typhoid fever had been conveyed. Milk has the power of absorbing the poison germs when stored in the vicinity of the sick or when exposed to the infected emanations from foul drains; but usually the poison has been introduced into the milk by the addition to it of specifically polluted water, i.e., water contaminated by the infective discharges from the bowels of the sick. It follows that in the investigation of outbreaks of typhoid fever, enquiry should be specially directed to the discovery of any source of polluted air or water : attention therefore was first given to the *Thirteen of the remaining cases were posterior in origin to December 16th. None of them had partaken of milk from the suspected dairy, and they do not call for any special notice. †For particulars of a somewhat important (17th) case that did not come to light till after the enquiry had been completed, vide page 19. 14 condition of the dairy and the cowshed, the latter being the most extensive in the parish. A careful inspection of these premises —made without warning—failed to reveal anything to account for the outbreak. There was no sickness in the dairyman's family ; the water supply was good, the cistern being clean and having no connection with any drain, soil-pipe, &c. The water supply at the cowshed was equally satisfactory (the cistern, indeed, having been erected some years ago at my instance) ; and the sanitary condition of the premises which are regularly inspected, presented no features to call for notice. The health of the ninety cows found in the shed was satisfactory. A diligent enquiry into the details of the business arrangements failed to reveal anything ; and, lastly, it was ascertained by visitation that there had been no illness—specific or otherwise—in the homes of any of the employes. I ascertained, however, that in addition to the ' shed ' milk the dairy had supplies of country milk from two Berkshire farms in the Wantage and Faringdon Unions respectively. The Wantage milk—about three hundred quarts—came from a model farm belonging to a gentleman of considerable landed estate. This milk was received only in the afternoon, and therefore was the product of the morning's milking. The Faringdon supply consisted of one ' churn ' (about 65 quarts) in the morning, and a like quantity in the evening. All the thirteen families had had country milk morning or evening. I lost no time, therefore, in putting myself in communication with the medical officers of health for the Wantage and Faringdon rural Sanitary Districts, begging them to have the farms inspected, " With a view of ascertaining (1) whether at or near them there were, or had lately been, any typhoid fever cases ; and (2) whether there were any sanitary defect or polluted water supply to which such an outbreak (as 1 had described) could be fairly traced ?" These gentlemen, Mr. Barker, of Wantage, and Mr. Maskelyne, of Faringdon, favoured me with reports which were exculpatory as regards the health of the people and the cows, and also with respect to the sanitary condition, water supply, &c., of the premises. Before the first of the reports came to hand, and having learned that the Wantage evening milk was sent to a large and respectable dairy in an adjoining parish, I communicated with the Medical Officer for that district, who informed me that he knew of no cases of typhoid fever in his district, and that he, personally a large consumer of milk, was a customer of the dairyman who received the Wantage milk. It came to my knowledge at a later period that the Kensington dairyman did not receive the Wantage milk until some days after the commencement of the epidemic. There being some unavoidable delay in getting information respecting the Faringdon milk, the dairyman, acting upon my advice, and simply as a matter of precaution, gave it up, but 15 not until the last clay of the year; so that, allowing a short period for incubation if this milk had been in fault, fresh cases of illness might have been expected, even so late as three weeks after the recognition of the last case. Bat none such occurred. The inference fairly deduceable from this immunity was borne out by two facts that subsequently came to my knowledge, viz., (1) that the two supplies of country milk were mixed for the evening delivery, so that practically the Faringdon milk, mixed with a large quantity of the Wantage milk, was supplied daily during the month to all the customers (about 500), and yet typhoid fever appeared in only thirteen families; and (2) that not only was the Faringdon milk sent out pure to many of the customers in the morning (this being the sole morning supply of country milk, and the "shed" milk never being mixed), but two local retail dairymen in a small way of business were supplied from the farm-churns night and morning, and yet no case of illness occurred among their customers, who are mostly poor people, served across the counter. Raving thus shown the want of evidence to connect the outbreak with milk, it may not be out of place to enquire whether it had the characteristics of "milk typhoid"—whether the facts tally with those of unquestionable endemics of this kind, which have been investigated by competent medical and sanitary authorities— e.g., the one at Islington, reported by Dr. Ballard, then (1870) the Medical Officer of Health for that parish, but now of the Local Government Board; and the other at Marylebone (1873), reported by Mr. J. Netten Radcliffe and Mr. Power, of the Local Government Board, and Dr. Whitmore, the Medical Officer of Health for the parish of Marylebone ? These endemics, agreeing in most particulars, presented one point of difference which rather increases their value for the present purpose, viz., that while the latter was proved due to the specific pollution by typhoid excreta, of the water used for dairy purposes, the pollution of water in the former appeared not to be of a specific character; but to depend on the absorption of sewer gas, under circumstances which I need not particularise. The first point to be noticed is the number of persons attacked in the several outbreaks? At Islington in ten weeks there were 175 cases in 70 families out of 142 which had milk from the offending dairy. At Marylebone 244 "unmistakeable" cases occurred within a period of four weeks and in 132 families, 118 of which had received the infected milk; 218 of the cases being found in these 118 families. In 77 out of 88 streets where the disease was met with, this milk had been supplied. The infective agency —the specific contagium of typhoid, was ultimately proved to have been in the milk from one farm, and this milk was sold as "nursery milk." So far as the general milk supply of the towndairy was contaminated, it was shown to have been due to the 16 mixture with surplus nursery milk. At Kensington there were 16 cases only, in four weeks, and in thirteen families. These families were spread over nine streets, comprised in six milk deliveries: in these nine streets the dairy counted 116 customers. In all these outbreaks women and children furnished the larger number of victims, probably either because women and children drink more freely of milk than men, or because, spending more of their time within doors, they are more exposed to the danger of breathing contaminated air. In the Islington outbreak, 44 men, 97 females above ten years of age, and 32 children, were attacked; in Marylebone, only 29 men, 119 women, and 96 children: in Kensington, two men, 8 women, and 6 children. The sufferers belonged to the better or well-to-do classes. At Marylebone and Kensington the proportion of sick female domestic servants was large—absolutely and relatively, and about equal, viz., Marylebone, 92 out of 244 cases (—37 per cent.) Kensington, 6 out of 16 (also 37 per cent.) So far the agreements. But when we inquire into the distribution of cases in families, we discover material differences. Thus, in Islington there were but 22 solitary attacks—out of 175: the cases mostly occurred in groups of from two to eight in a family, the average being a little over three. So in Marylebone groups of cases, ranging from three to six in a family, were observed, and in one house, out of 30 children, 18 were stricken: but in Kensington ten of the sixteen cases were solitary—there were only three groups of two cases in each, viz., in one family two young childdren; in another, a married couple; and in a third, a child and a nurse—the second cases occurring not simultaneously but after many days, so that for the purposes of the enquiry, qua origin of the outbreak, they may be entirely disregarded. In one house containing 28 persons, of whom 20 were children, and where 16 pints of milk were consumed daily, there was but one case—a servant. At the time of the Islington and Marylebone outbreaks, Typhoid fever was comparatively in abeyance in those portions of the parishes where the infected milk had not been distributed, and, I believe, in the Metropolis generally; but the Kensington cases occurred at a time when the disease is known to have been more than usually prevalent. In respect of the fatality the several outbreaks presented marked differences. Thus, in Islington about the ordinary percentage of cases (17) pioved fatal, a rather remarkable and suggestive fact qua origin, seeing that "milk typhoid" is usually a mild form of the malady: in Marylebone the mortality was only 10.6 per cent.; but in Kensington 8 out of 16 persons attacked died, equal to a rate of 50 per cent. This rate, however, would be considerably reduced if the whole of the cases were taken into account, for of 17 the 30 known cases only ten died, or 33.3 per cent. The high rate of mortality among the sick who had partaken of milk from the suspected dairy is, prima facie, an argument against the milk theory. But such an unusual fatality testifies to the virulence of the infective agency, whencesoever derived. It also suggests the questions, "11 ow was it that with a poison of such intensity distributed among so many hundred persons—if milk was the vehicle of the contagium—so few persons suffered, and they so sorely?" And if milk was not in fault, "To what cause or causes are we to attribute the outbreak ?" To the former question I can give no answer, but to the latter I would reply, "Presumably to one or other of those causes of water or air-pollution to which the occurrence of ordinary cases of typhoid fever is usually traceable," viz., to defective sewerage or drainage—to the breathing of polluted air, or the drinking of polluted water, leaving out of the question whether specific pollution of air or water, is essential to the causation of typhoid. And here I would observe that the possibility of such an origin had not been overlooked from the first, though the enquiiy was primarily directed to the discovery of the source of the suspected milk infection; and inspection of the houses where the disease had appeared did, in fact, reveal, in nearly all of them, such sanitary defects as would, in almost any of the 16 cases occurring singly, have been deemed adequate to account for the illness—the difficulty of admitting this explanation, however, being increased by the coincidence of a common source of milk supply. It is needless to detail here the various sanitary defects referred to; it may suffice to say that they comprised untrapped, unventilated, and otherwise defective drains; cisterns and baths in communication with drains by waste pipes; offensive water closets, in some cases near sleeping rooms; and in some of the streets sewers defective in construction or material, three of them having blind or dead ends. It will be conceded that such sanitary defects as the above are sufficient to account for the occurrence of typhoid fever in the individual cases; but excluding the milk theory of infection it is not easy to account for the occurrence of so many cases within so short a space of time, though at considerable distances apart. I have thought, however, that an explanation of the difficulty might be found in the facts—(1) that typhoid fever was unusually prevalent in the Metropolis at the time of this outbreak, and (2) than the streets in Kensington in which the disease appeared belong to the same system of drainage. The sewers are affluents of an underground river, known as the Counters Creek sewer, which traverses the parish near its western boundary, from north to south, teiminating at the Grosvenor Bridge Pumping Station. 18 Much infected excrementitious matter must have passed into the main sewer between November 18th and December 16th (and cases had certainly occurred in the course of it not long before): it is not difficult to conceive, therefore, that the air circulating in it, and through its affluents, had become specifically poisoned, and that the gases escaping into houses where sanitary defects existed ; or becoming, in some cases, absorbed by the water in cisterns, may have caused the mischief. Insanitary conditions, it is well known, lower the health of those exposed to them and prepare the system to succumb readily to zymotic poisons. Such insanitary conditions existed in many of the houses, and the persons most exposed to them- not the chief milk drinkers, but the servants who inhabit basements were, as a class, the most numerous victims. The theory here put forward would help us to explain the high rate of mortality in our sixteen cases—a fatality which, as before observed, militates against the milk theory. It is consistent, moreover, with the results of the investigation of similar outbreaks in small towns, where the conditions were less complex, and the conclusions arrived at were of a more demonstrable character, and it is supported by certain inferences that may be fairly drawn from the facts of the cases:— For example, there was a case in each of two adjoining houses, the second case beginning thirteen days after the first. The milk in the second family was not obtained from the suspected dairy, and the illness was attributed to a sanitary defect similar to that which existed in the first house. In another street there were cases in adjoining houses—an interval of thirteen days separating them. The families had milk from the same suspected dairy: but in both houses there were similar sanitary defects. The same relations in respect to the situation of houses, and the commencement of cases, existed in a third instance: and in two others, in two streets, there was a similar state of things, though the houses were not so close together, but the milk in all these instances was obtained from the suspected dairy. This is the suspicious feature in the cases : but the essential facts to which I would allude are, (1) that in all the cases above glanced at sewer gas was found to have free entrance into the houses: and (2) that an interval of many days separated the cases, in respect of time, both in contiguous and detached houses in the same streets. Excluding secondary cases in the same houses, we have only 13 cases to deal with, and the points alluded to are applicable to eight of them. Had the outbreak depended on milk I cannot but think the cases would have been more numerous, and that there would have been large groups of cases occurring almost simultaneously : whereas, though there were many children in some 19 of the houses, no such thing happened. My own impression is that the infective agency operating in the first cases was contained in, and conveyed through, the sewers and house drains, and that the illness in second cases in the same streets may have been due to the infected condition of the sewers. In three of the streets, where eight cases occurred, the sewers, as before stated, have blind or dead ends, which always involve the risk of a heavy pressure of sewer-gas on the drain inlets of the adjoining houses, as I pointed out in a Special Report on the drainage of the Elsham Road and its vicinity (April 1875.) I shall add but one fact, and it is one of some importance, which came to my knowledge after the close of the enquiry. A case (seventeenth of the series) occurred in a family of seven persons, the milk being supplied from the suspected dairy, and within the period to which the other cases belong (viz., on December 10), the sick person, however, beiug the only member of the family who never took milk. I do not wish to attach too much importance to this case, but, taken in conjunction with the facts of other cases, (viz., of persons being affected who scarcely ever touched milk), I think it lends, negatively, some support to the theory by which I have sought to explain the outbreak in a manner opposed to my first impressions. HOSPITAL ACCOMMODATION FOR NON-PAUPER INFECTIOUS SICK. In my last annual report I entered fully into this important question, which has made little or no progress since the date of that report. Happily, the question is no longer one of pressing interest for this parish, as, owing to the cordial relations that exist between your Vestry and the Guardians of the Poor, the hospitals of the Asylum Board, of which the Guardians' officers hold the keys, are freely open to the non-pauper sick; the Guardians having recognized the necessity of isolating cases of infectious disease, and acting on the principle that it is better, and in the long run cheaper, to secure isolation, at the general cost for the general good, than to allow disease to spread from the want of it. It is obvious, moreover, that if the public purse must bear the charge, it matters little out of which pocket the money is taken, whether, that is, your Vestry pay out of one rate or the Guardians out of another. Without a hitch or obstacle of any kind, therefore, every case that we desired to have removed has been removed, and our thanks are due to the Guardians and to their officers for their co-operation with us in promoting the sanitary interests of the parishioners. But in some districts of the Metropolis, from whatever cause, things do not work so smoothly, and the proper mode of dealing 20 with the non-pauper sick is still a burning question. It is a question which should be settled, no doubt, and on some definite principle, forthwith, and it may be expected in quieter times to receive that attention from the Government and the Legislature to which its importance gives it a claim. The only suggestion of a public nature (so far as I know), that has been offered since the date of my last report, proceeded from the Board of Works for the Limehouse District who, in a Memorial addressed to the Metropolitan Asylum District Board—after setting out the "almost insurmountable obstacles" to provision of hospital accommodation being made by the Sanitary Authorities (under section 37 of the Sanitary Act, 1866), stated their opinion that "the most practicable way of overcoming the difficulty in providing Hospital accommodation for Non-Pauper cases in each district would be for the Metropolitan Asylum District Board, who already have the necessary staff and appliances, to make arrangements, upon the request of the Sanitary Authorities, to receive any person, not in receipt of parish relief, whom the Sanitary Authorities might require to have removed to Hospital, and that the Asylum Board should provide a separate Department for the accommodation of such cases, so that they could be kept distinct from Pauper Patients."* The Limehouse Board were further of opinion " that the Sanitary Authorities should pay for the accommodation provided for Non-Pauper cases by an annual payment, whether such accommodation is required or not, or by a fixed sum for each patient sent." The Asylum Board having referred this Memorial to the Committee for General Purposes, the Committee in their report dated 18th March, 1878, recounted the steps taken in 1877 by the Managers to meet the difficulty, and the conclusions to which they had unanimously arrived, and which were set out in my Annual Report for 1876, (page 13), and they referred to the action taken by the Managers in suggesting to the Local Government Board that clauses 56 and 64 of the " Public Health (Metropolis) Bill, 1877," should be amended by making it "Incumbent upon all Local" (i.e., Sanitary) "Authorities either to provide the requisite Hospital accommodation for their Districts, or failing their so doing, within a specified time, to contract with the Managers of the Metropolitan Asylum District for the reception into their Hospitals of persons other than paupers who may be suffering from infectious diseases. "The withdrawal of the Bill subsequent to its second reading, however, left this all important question in abeyance. "It will thus be seen," the Committee continue, " that the I. may be remarked that paupers constitute less than ten per cent, of the sick. 21 the Limehouse Board of Works have memorialised the Managers has already been fully considered and dealt with, and that the Managers used their best endeavours to obtain through the Local Government Board, the requisite authority to receive into their Hospitals, and, if necessary, powers to provide additional accommodation for, Patients other than those of the Pauper class. It now rests with the several sanitary authorities, either collectively or individually, to take the matter up and deal with it as they may think best " The Managers having taken thn subject into their consideration, resolved to forward the memorial of the Limehouse Board of Works, together with a copy of the Report thereon of the Committee for General Purposes to the several Sanitary Authorities: and they asked them to inform the Managers as to "how far they agree with the Limehouse Board of Works in the views which they have enunciated, and upon which they have memorialized the Managers ?" The reply of your Vestry to this question was forwarded in the shape of the Report of the Special Purposes Committee (March 20), on communications of a similar purport received from the Managers in 1877, and in which the views of the Limehouse Board of Works, and the views now apparently entertained by the Managers, appear to have been anticipated. The report was as follows:— "Your 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 Vestry 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 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 Au'hority acting for the whole Metropolis, not only for pauper patients, but for other classes in need of hospital accommodation. "Your 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 on the recommendation of Vestries and District Boards under sec. 37 of tho Sanitary Act, 1866, should be defrayed out of a Metropolitan Bate 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 asked at the same time, the views I 22 then entertained, and which subsequent experience has strengthened and confirmed, were set out in a letter to the Managers, published at page 15 in my Annual Report for 1876, and in a Report on the subject, dated January 10th, 1877. It will be interesting to learn, in due course, the general purport of the replies of the several Authorities to the circular letter of the Managers, and to see to what extent the views expressed in the above documents are generally entertained. I shall hope to find that there is a growing sentiment in favour of placing the provision of hospital accommodation for all classes in the able hands of the Managers, while reserving to the Sanitary Authorities, in their respective districts, the carrying out in all other respects of the provisions of the Sanitary Acts for the prevention of the spread of infectious diseases. Shortly after the above section on "hospital accommodation" was in type, a communication was addressed by the Limehouse Board of Works to the Vestries, &c., inviting them to appoint Delegates to attend a Conference "on the subject of the provision of hospital accommodation for persons suffering from infectious diseases." Your Vestry appointed four Delegates—viz., Drs. Daniell and Pocock, H. Jacobs, and W. A. Lindsay, Esqrs.—with whom I attended the Conference held at the Cannon-street Hotel, on the 16th June. At the first meeting no decision was arrived at, and this negative result appearing to be due to a want of information on the subject on the part of some of the Delegates from other parishes, and your Vestry having given great attention to it on many occasions during the last few years, your Delegates thought it desirable to cast into the form of a set of propositions the views which had at sundry times been expressed by your Vestry, and to recommend that a copy of them be sent to each of the Delegates from the several Vestries and District Boards of Works. The propositions referred to were as follows:— 1. That the provision of hospital accommodation for the large class of persons whose isolation in hospitals is necessary for preventing the spread of infectious diseases can be best made in a comprehensive and systematic manner by one Central Authority acting for the whole Metropolis. 2. That the Metropolitan Asylum District Board should be much Central Authority, the Managers already having in the several hospitals erected under their auspices, nearly sufficient accommodation to meet the requirements of the sick of all classes— excepting those who may be able and willing to pay for hospital treatment, and for whom provision is already made, or could be made at the London Fever Hospital and the London Small-pox Hospital. 3. That steps should be taken to obtain an Act of Parliament to alter the constitution of the Metropolitan Asylum District 23 Board by severing its connection with pauperism in so far as relates to the treatment of infectious diseases; and by providing for the election of a certain proportion of the "Managers" by the several Vestries and District Boards of Works, the Sanitary Authorities within the Metropolis. 4. That pending such legislative action, and seeing that the hospitals of the Managers have been established at the public cost and for the common good, no compulsory payment should be exacted from any persons whom the Sanitary Authorities may deem it necessary or expedient to remove to the hospitals for the sake of isolation; and all expenses incident to the maintenance of such persons in the hospitals should be defrayed out of the general rate. Note.—Under the proposed altered constitution of the Board the hospitals should be supported out of a Metropolitan rate; or power might be given to the Managers to issue precepts on the several SanitaryAuthorities for their quotas of the expenses. 5. That the admission into the Hospitals of persons suffering from infectious diseases should not involve the loss of any political or other rights by the said persons. Note.—It is proposed to place the treatment of infectious diseases on the same footing as Public Vaccination. In other words admission into the Hospitals should not be deemed to be Parish or poor relief It has been ascertained that on the 15th February, 1877, the proportion of patients in the several Asylums who acknowledged to having previously received parochial relief was under ten per cent. 6. That in order to facilitate the "stamping out" of infectious diseases provision should be made for the disclosure to the Sanitary Authority of all cases of such diseases in such manner as to the wisdom of Parliament may appear most expedient. Your Vestry referred the propositions for consideration and report to the Special Purposes Committee, and subsequently "believing that the principles therein contained are sound, and if carried into effect, would be conducive to the public welfare," adopted the propositions" as a basis of policy to guide the Delegates" from Kensington: and directed that" a copy thereof be forwarded to each of the Delegates of Vestries, &c., prior to the adjourned meeting of the Conference, to be held on the 16th July." It being well known that I had paid some considerable attention to the subject, and had dealt with it fully in my Annual Report for 1876, which moreover contains a summary of the proceedings of your Vestry, and other public bodies in relation thereto, the committee recommended, and your Vestry ordered that the section of the Report (p. 8—21) on" Hospital accommodation for the Non-pauper Infectious Sick," be reprinted, and a copy thereof sent to each of the Delegates. This was done, and it is not too much to say (for it was spontaneously admitted at the adjourned meeting of the Conference 24 held on the 16th July) that by the circulation of these documents an essential service has been rendered by your Vestry to the cause of sanitary reform, the light thereby thrown upon the whole question having "smoothed away every difficulty" and led, in the course of half an hour, to the unanimous adoption of the following resolution, viz.: "That in the opinion of this Conference many almost insurmountable obstacles present themselves to the carrying out by the Vestries and District Boards of the Metropolis of the powers conferred upon them by the 37th sec. of the Sanitary Act 1866. And it is further of opinion that it is desirable that provision should be made by Act of Parliament for one Authority acting for the whole Metropolis to provide hospital accommodation for nonpaupor persons suffering; from infectious disease, and is farther of opinion that such authority should be as far as possible representative." A further resolution to the effect "That a copy of the foregoing Resolution be sent to each of the Vestries and District Boards of the Metropolis, with an invitation to them to state whether they agree therewith," was also unanimously adopted, and the Conference adjourned to a day in October, to be subsequently fixed by the Limehouse Board of Works, for the consideration of the replies of the Yestries and District Boards, and to determine on the steps necessary to be taken to carry into effect, bv legislative action, the views embodied in the first resolution. FULHAM SMALL-POX HOSPITAL. In the month of March the Metropolitan Asylum District Board opened a hospital in the parish of Fulham, west of the railway and south of the West Brompton Station, for the treatment of infectious diseases. From that time to the present whenever there has been any increase in the number of small-pox cases in the south-west corner of the parish alarm has been occasioned by the suspicion that the hospital in some occult way may have been the cause of the spread of the disease. Excepting in one case,* where there appeared to be a probability that a female might have been indirectly infected by her daughter, a servant at the hospital, viz. by conlayium conveyed in body clothing, no case has been put forward to give colour to the suspicion which has been somewhat generally entertained, principally owing to the injudicious support it has received, without any scientific evidence, from a small number of professional men. That an infectious disease hospital might easily become a source of danger to the locality in which it is placed, viz. by the *Vide Monthly Report, No. 4 (April 3, 1878), page 27; and No. 6 (May 1), page 39, for the particulars of the case. 25 conveyance of infection indirectly, e.g., in the clothing of the officers, or of the visitors to the sick ; or even by the want of proper care on the part of the drivers of the ambulances, or the attendants on the sick en route, must, one would think, be obvious; and it speaks well for the success of the precautionary measures taken to avoid these sources of danger that they have scarcely been noticed even by those who are most hostile to this particular hospital, and who, it may be inferred, would have called attention to them had they possessed any information on which to found a charge. But such has not been the case; and the only charge brought against the hospital is that it has been the direct means of spreading the disease by coniagium carried across hundreds of yards of open spaces to the streets nearest the building—nearest, that is, in Kensington and Chelsea; for strange to say the disease, according to the evidence of my colleague, the Medical Officer of Health for Fulham, has been almost entirely absent from the district immediately contiguous to the hospital, the supposed centre of infection. Those who know how limited is the area of infection even in small-pox, would scarcely have conceived the possibility of such a theory being put forward in respect of the Fulham Hospital, seeing that on three sides it is far distant from inhabited houses, whatever suspicions might have been more or less reasonably entertained in respect of other hospitals less favourably situated. But even in respect of other hospitals I have not been able to obtain any reliable evidence against them; and surely this is a case in which the onus probandi rests with the accusers. With reference to the Fulham Hospital, I have entered so fully, in some of my Monthly Reports,* into the inquiry suggested by the suspicions referred to, that I do not feel it necessary at the present time to travel over the ground again, having, in the judgment of competent authorities, not merely demonstrated the want of evidence in support of the assertions on which the hospital theory of infection has been founded, but also shown the improbability of the hospital ever becoming a source of direct infection to the neighbourhood. It may be stated that the maximum number of Brompton cases of small-pox occurred both in 1877 and in 1878, at the periods of the greatest prevalence of the disease in the Metropolis generally, and that the supposed relation between these maxima, and the reception of acute cases of the disease at the hospital was founded on imperfect information. The Brompton outbreaks did not commence till long after the hospital had begun to receive acute cases, and they terminated in both years long before the hospital, owing to the decline of the epidemic, had ceased to receive this class of cases. *No. 9, 1877 (pawe 46), and No. 5,1878 (page 31), &c.; and a Special Report on the subject, No. 7, 1878. 26 PREVENTION OF THE SPREAD OF INFECTIOUS DISEASES Is one of the chief duties appertaining to the office I hold; and it is one which constantly engages the attention of all the officers in my Department. A difficulty with which we have to contend is the want of information of the occurrence of non-fatal cases of illness; and it has been my constant endeavour to increase our sources of such information. It may not be out of place to state what progress has been made :— 1. By virtue of the arrangement entered into between your Vestry and the Sub-district registrars of deaths, seven years ago, I duly receive notice of all deaths from the graver infectious diseases (small pox, scarlet fever, diphtheria, typhus, enteric and simple continued fevers), within a few hours after they have been registered. It may be observed that when a death has occurred from an infectious disease there is always a probability of finding other cases of illness in the same house or locality, and such discovery not unfrequently results from the Sanitary Inspector's visit. Now and then the registration of a death has been unduly delayed—sometimes probably with the object of temporary concealment of the cause of death. It would be well if registration within a limited period, say twenty-four hours, were made compulsory. 2. The Relieving Officers, by direction of the Board of Guardians, report all cases of infectious diseases that come under their cognizance, and generally these are cases that have been, or are about to be, removed to the hospitals of the Metropolitan Asylum District Board, admission to which (practically denied to no person) can only be obtained on the order of a relieving officer, or the master of a workhouse. 3. Similar information is given by the Resident Medical Officer of the Kensington Dispensary, by direction of the Committee of Management; but we seldom hear of sickness through any similar institution; and it is matter of regret that many cases that ought to be removed to the hospitals are kept at home, and treated by medical men attached to the so-called " provident dispensaries." 4. Medical men favour me occasionally with information of cases, and more especially when they desire assistance in order to get the sufferers (e.g., domestic servants") removed to the hospitals. 5. A somewhat important step in advance has been effected lately by the action of the London School Board, who, at my request, have instructed the Superintendents of Divisions throughout the Metropolis to desire the "Visitors" to report 27 to the several Medical Officers of Health any cases of infectious disease that may come to their knowledge in the discharge of their official duties, which take them constantly into the homes of the poorer classes. To facilitate the transmission of this information by the " Visitors," your Vestry authorised me to prepare a form for their use, which has been done. 6. Clergymen and District Visitors not unfrequently report cases of sickness. 7. The Resident Medical Officers of St. George's and St. Mary's Hospitals have on many occasions reported the admission of cases, or the application by inadmissible cases, of illness from houses in this parish. 8. Occasionally anonymous communications are the source of information, for I have not felt at liberty to disregard such communications, which have generally proved accurate. In these several ways many cases of illness come to our knowledge; but, all told, they form only a small percentage of total cases, as proved by the fact that the large majority of fatal cases remain unknown till after registration of death—a fact from which it is a fair inference that a still larger proportion of non-fatal cases never come to our knowledge at all. The only remedy for this regrettable state of affairs is legislation for the compulsory disclosure of the occurrence of infectious diseases. The only question among sanitarians is, Who should be the informant? As a rule the information will have to come, directly or indirectly, from medical men. In those cases, and they are not few, where either no medical aid is sought, or where unregistered practitioners are employed, the information, if supplied at all, must come from the head of the family or from the "occupier" of the house. Where there is a duly qualified medical man in attendance it would suffice to require that he should give a certificate showing the nature of the complaint, which it should then be the duty of the head of the family, or the occupier of the house, to forward without delay to the sanitary authority, as is done now in respect of the medical certificate of the cause of death. This is the plan recommended by the Society of Medical Officers of Health and it is I believe the course adopted in those boroughs where under Local Acts, the disclosure of such cases has already been enforced. Having regard to the relations of doctor and patient, it is useless to expect that the desired information will be at all generally given by medical men until it is made their duty as law-abiding citizens, to supply it: and even then the exaction should be made as little onerous as possible, whether or not the public service rendered by the giving of such certificates is recognised by the payment of a suitable fee. 28 POPULATION, &c. The estimated population of Kensington in July, 1877, was 151,000, an increase of 3,000 during the year, viz., 2,090, the balance of births in excess of the number of deaths, and 910 the gain by immigration. It is always difficult, as I have stated in former reports, to estimate the population at inter-census periods; I have good reason to suppose, however, that the above figures do not differ widely from the truth: based as they are on the number of inhabited dwellings, and on the known average number of persons to each house as ascertained at the last census. It is even more difficult to determine the relative proportion of the sexes, and the numbers of persons living at different groups of ages, seven years after a census, and especially in a district where the population has increased so rapidly, chiefly by immigration, as in Kensington. The subjoined table, however, furnishes us with some interesting and reliable figures on these points, ascertained at the census, 1871. AGES OF MALES AND FEMALES, 1871. All 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, 48977 7066 10198 8918 8317 5963 4339 2464 1270 378 33 2 Females 71322 7147 11527 16565 14203 9080 6241 3768 2000 667 97 7 Total, 120299 14212 21722 25533 22520 15043 105S0 6232 3270 1045 130 9 In April, 1871, the Kensington Town registration sub-district contained a population of 91,645, and the Brompton sub-district 28,654. So far the certainties. I estimate the population of the "Town," at the middle of 1877, to be 112,250, and that of Brompton 38,750. The population of the last named district has probably increased during the last two or three years at a greater relative rate than that of the Town sub-district—if we may judge from the activity in the building trade and the large number of new houses that have been built—not forgetting, however, that many of these have yet to find occupiers. I have greater diffidence in estimating the relative numbers of the sexes. We know that in 1871 there was an excess of more than 22,000 females. The population has since then increased by rather more than 30,000, and if the same relative proportions of the sexes have been preserved there should now be an excess of females amounting to 27,000; i. e., the males would number 62,000, and the females 89,000. The numerical preponderance of the female sex may be accounted for by the concurrence of a variety of causes, including (1) the large number 29 of female domestic servants, probably not far short of ten per cent. of the whole population; (2) the numerous girls' schools; (3) the residence from choice of many unmarried females, widows, &c, and (4), the superior longevity of women. The new houses brought into rating in the year were 386, a great falling off from the numbers in the three preceding years, viz., 504, 777, and 747 respectively. The total number of inhabited dwellings at the middle of the year was 19,330, in addition to which there were nearly 2,000 houses either empty or in course of erection. The average number of persons to a house at the census (whole parish) was 7.8: in theBrompton sub-district, however, 7 only. The area of the parish is 2,190 acres (viz., Town sub-district, 1,497 acres; Brompton, 693 acres), and if this space were wholly built over, the average density of the population would be 69 persons to an acre. As a matter of fact, however, many acres are as yet untouched by the builder, irrespective of open spaces like the cemeteries (Kensal Green and Brompton), and Holland Park, &c. 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 1876 1877 151,000 1,312,200 (April) 1878 MARRIAGES. The marriages in 1877 were 1,411, viz.— By the Church 1,160 At Roman Catholic places of worship 87 At Nonconformist ,, „ 62 At the Superintendent-Registrar's office 93 Total 1,411 The marriage rate (persons married to 1,000 population) was 18'7. The rate in England and Wales in 1875, last year of publication, was 16.8. The marriages in Kensington in the preceding five years (1872 to 1876) were 1,122, 1,241, 1,811, 1,546, and 1,417. BIRTHS and BIRTH-RATE. The births of 4,648 children (males 2,389 and females 2,259) were registered in 1877 3,771 in the Town sub-district, and 877 in Brompton. The birth-rate in the whole parish was 30.8 per 1,000=1 birth to 32.4 persons living; but the rate in the Town sub-district was 33.6 per 1,000 as against 22.6 per 1,000 in Brompton. The rate in the whole Metropolis was 36.1 per 1,000. 30 The decennial average birth rate in Kensington was 31.9 (see Table 2, Appendix). One hundred and five males were born to every 100 females, the males forming 51.5, and the females 48.5 per cent. of the total number of births. The low birth-rate in Kensington as a parish is due to the excess of female population above alluded to. The difference between the birth-rate in the whole Metropolis (36.1) and in the Brompton sub-district (22.6) is striking. The "Town" birth-rate does not present such a great contrast to the Metropolitan rate. The births exceeded the deaths by 2,090, a proportion greater than usual, and due to the low death-rate. The illegitimate births numbered 191, or 4T per cent. of total births. One hundred and seventy-one of the illegitimate births were registered In the Town sub-district, and 20 in Brompton. The former district contains the parish workhouse, where, out of 122 births, 86 were registered as illegitimate. The subjoined table shows the quarterly number of births of each sex registered in the sub-district:— Kensington Town Sub-District. Brompton. Sub-District. Grand Total. Males. Females. Total. Males. Females. Total. 1st Quarter 529 468 997 99 99 198 1,195 2nd „ 426 461 887 114 94 208 1,095 3rd „ 474 478 952 116 115 231 1,183 4th „ 507 428 935 121 116 240 1,1 75 Total 1,936 1,835 3,771 453 424 877 4,648 DEATHS AND DEATH RATE. The deaths registered in Kensington were 2,558, or 1 death to 59 of the population. The deaths were fewer by 338 than in 1876, without making any allowance for an increase of 3,000 in the population. The total, moreover, includes 124 deaths of nonparishioners in the Hospital at Brompton for Consumption and Diseases of the Chest. These deaths are retained in our statistics as a compensative allowance for the unknown number of deaths of parishioners which may have taken place in general hospitals and elsewhere outside the parish. To the total of 2,558, moreover, we must add 66, viz., the deaths from small-pox (60) and "fever" (6) in the hospitals of the Sick Asylum Board. The gross death-rate, therefore (reckoning the deaths at 2,624) was 17.3 per 1,000, as against 21.9 in the whole Metropolis, and 194, the decennial average in Kensington (see Table 2, Appendix). Of the deaths registered in the parish, 2,002 occurred in the Town sub-district (including 227 at the Parish Infirmary and Workhouse, and 33 at St. Joseph's House), and 5.57 in Brompton (including 130 at the Consumption Hospital). Twelve hundred and ninety males died out of an estimated population of 62,000, 31 —one death to 48 male persons living; and only 1,268 females out of 89,000 = 1 death to 70 living. Compared with 1876 the reduction in the number of deaths of males and females respectively is 197 and 141. After making the necessary corrections, viz, by apportioning the proper number of the deaths at public institutions to each of the sub-districts in proportion to their population, it would appear that while the deaths actually registered in the whole parish were equivalent to a rate of 16'9 per 1,000, the rate in the Town sub-district was 17 6, and in Brompton only 13.4 per 1,000. The death-rate in the male sex was 21.5 per 1,000, the rate in the female sex being one-third lower, viz, 14.2 per 1,000. It is important to notice that the relative rates of mortality in the sexes were almost identical in 1871, the census year, viz., males 22.3 and females 15.7 per 1,000; and this fact—the then population being known —points to the probability of the accuracy of my estimate of the relative number of the sexes living at the middle of 1877. The sex death rate in the whole Metropolis was males, 24.2; females, 199. The deaths of children under one year of age were only 648 instead of 771 as in 1876, and the deaths under five years of age only 1,040, a reduction of 265 as compared with the previous year. The deaths under 1 year and under 5 years respectively, were equal to 25.3 and 40.8 per cent. on total deaths, and to 13.9 and 22.3 per cent. on the registered births. The deaths at 60 years of age and upwards were 596, or 23.8 per cent. on the total deaths. For the sake of comparison it may be mentioned that in the Metropolis generally the deaths under 1 and under 5 years respectively were equal to 24 and 41.3 per cent. on total deaths, and to 14.6 and 242 per cent. on the registered births; while the deaths at 60 and upwards were equal to 20.5 per cent. on all deaths. The deaths of illegitimate children under five years were 98 (88 in the Town sub-district, and 10 in Brompton), equal to 3.7 per cent. on total deaths, and to 5T2 per cent. on the registered illegitimate births. The subjoined table shows the quarterly number of deaths of each sex registered in the sub-districts :— Kensington Town Sub-District. Brompton Sub-district. Grand Total. Males. Females. Total. Males. Females. Total. 1st Quarter 269 269 538 69 73 142 680 2nd „ 256 242 498 65 82 147 645 3rd „ 209 201 410 73 42 115 625 4th „ 280 275 5.55 74 79 153 708 Total 1,014 987 2,001 281 276 557 2,558 32 The subjoined table shows the number of deaths due to the chief great classes of diseases :— Kensington Town Sob-district. Brompton. Total. Per 1,000 Persons living. Per 1,000 Deaths Zymotic diseases 315 60 375 2.9 168 Constitutional ,, 390 93 413 3.2 184 Local „ 967 220 1187 7.8 454 Developmental „ 278 62 340 2.2 129 Violent ,, 29 12 41 0.3 15 The detailed causes of death are set out in Table 3, Appendix, in 13 divisions according to age. The ages at death (excluding the deaths of non-parishioners at the Brompton Hospital), were as follows :— There died under one year of age 648 Between one and two years 243 „ 2 and 5 „ 149 „ 5 and 15 „ 80 „ 15 „ 25 „ 76 ,, 25 „ 35 „ 148 „ 35 „ 45 „ 185 45 „ 55 „ 184 „ 55 ,, 65 „ 243 65 „ 75 „ 244 „ 75 „ 85 „ 186 „ 85 „ 95 „ 44 „ 95 „ upwards 4 The following table shows the death rate in 13 periods, 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. 3, 1877. 14.5 44°.1 Fahr. Four „ March 3 17.8 43.0 ,, ,, ,, 31 23.2 40.7 „ „ April 28 18.8 45.5 „ May 26 16.1 47.7 „ „ June 23 15.6 59.9 „ „ July 21 14.7 60.0 „ „ Aug. 18 15.5 62.6 „ „ Sept. 15 12.3 58. 6 ,, „ Oct. 13 15.0 49.0 „ ,, Nov. 10 16.4 49.1 „ „ Dec. 8 19.8 43.4 Three „ „ 29 21.5 37.8 33 SPECIAL CAUSES OF DEATH. Zymotic Diseases.— Exceptionally favourable as are all the vital statistics of 1877, the most satisfactory feature in them is the low rate of mortality from the diseases of the zymotic class— diseases considered to be of a more or less preventible character, and, therefore, of the highest interest to sanitarians. The deaths registered from the "seven principal" diseases (to adopt the customary phraseology, although nine diseases, including the three varieties of "fever" are embraced in this definition) were only 273 as against 498 in 1876—a reduction of 225. This number is the lowest on our record, regard being had to the increase in population. But in addition to the deaths from these diseases registered in Kensington a further number took place in the hospitals of the Metropolitan Asylum District Board, viz , 60 from small pox, and 6 from "fever." Including these deaths the total is raised to 339, viz, from small pox, 84; measles, 54; scarlet fever, 31; diphtheria, 10; whooping cough, 34; "fever," 21; including "typhus" 2—(as registered);* enteric fever, 14 (I have assumed that the 6 deaths in the hospitals were due to this disease), and simple continued fever, 5, and diarrhoea, 99. All these figures are below the average, small pox only excepted. In the subjoined statement of the number of deaths in the subdistricts only those registered in Kensington are included, as I do not know how many of the deaths in the hospitals belong to the Town and how many to the Brompton sub-district. Town. Brompton, Total. Small Pox 21 3 24 Measles 49 5 54 Scarlet Fever 25 6 31 Diphtheria 8 2 10 Whooping Cough 28 6 34 "Typhus" Fever 1 1 2 Enteric „ 10 4 14 Simple Continued Fever 4 1 5 Diarrhœa 91 8 99 Total 237 36 273 Thus 237 of the deaths were registered in the Town sub-district, and only 36 in Brompton. If we apportion the extra-parochial deaths in proportion to the population, the total deaths from these diseases would be approximately 279 in the ''Town" sub-district, and 54 in Brompton, and the death-rate from the principal zymotic *Vide page 11 for a statement of my reasons for questioning the validity of the diagnosis of "Typhus." 34 diseases in the Town would be 2.5 per 1000 living; in Brompton 1.3; in the whole parish, 2.2. In all London 3.5 per 1000. The deaths were equal to 129 in every 1,000 deaths in Kensington, and to 160 per 1,000 in all London. In England and Wales they were 150 per 1,000 in 1875, the latest year of publication. Other Diseases of the Zymotic Class.— Croup was the registered cause of 13 deaths; 12 under 5 years of age; 10 in the Town sub-district and 3 in Brompton. Erysipelas was the cause of 11 deaths all in the Town sub-district: only two of the deaths occurred under 5 years of age. Puerperal Fever (Metria) was the registered cause of 12 deaths, 8 in the Town sub-district and 4 in Brompton: 3 deaths between the age of 15 and 25, and 35 and 45 respectively, and 6 deaths between 25 and 35 years. Five deaths in the Town sub-district were ascribed to Childbirth (1 between 15 and 25, and 2 each in the next two decades). The distinction between the deaths in the two classes of cases is this, that while Metria is a specific and infectious disease, deaths from Childbirth simply, may be regarded mainly as accidental being generally due to hemorrhage (flooding). The total deaths registered as occasioned by, or occurring in, childbed were equal to 0.3 per cent. on the registered births. Rheumatism was the cause of 16 deaths (13 of them in the Town sub-district) all of them above 5 years of age. In most of the fatal cases of rheumatism the immediate cause of death is disease of the heart arising in the course of the malady. Many of the deaths from heart disease that occur in later life have their origin in rheumatic fever, though from a variety of circumstances the connection gets overlooked in the medical certificates of the cause of death. Enthetic Diseases.—The only fatal disease in this order was Syphilis, which occasioned 13 deaths, 11 in the Town sub-district, and 2 in Brompton—eight in the first year, and two in the second year of life. Dietic Diseases.—Thirteen deaths were due to the various diseases included in this order, viz., Privation 1, Purpura and Scurvy 3, and Alcoholism 9. Eight of the deaths ascribed to the abuse of alcohol occurred in the Town sub-district. The registered cause of death in six cases was delirium tremens, and in three intemperance. It is hardly necessary perhaps to say that if the whole of the deaths due directly and indirectly to the immoderate use of intoxicating liquors could be ascertained," alcoholism'' would occupy a much more important position in Table 3. Parasitic Diseases.—Five deaths in the first year of life, four of them in the Town sub-district, due to Aphtha (Thrush) are all that are included in this order. 35 CONSTITUTIONAL DISEASES. The second great class in the Registrar General's tables, viz, Constitutional diseases, comprises the causes of 483 deaths; 395 in the Town sub-district, and 88 in Brompton—80 below the number registered in 1876. The class includes two orders, viz., (1) Diathetic diseases, 109 deaths; (2) tubercular or scrofulous diseases (including phthisis) 374 deaths Order 1. Diathetic Diseases. —The fatal diseases were Gout (4), Dropsy (12), Cancer (88), and Mortification (5). Only twenty-three of the deaths occurred in Brompton, including 20 due to cancer. Order 2. Tubercular..—-374 deaths, viz., 309 in the Town sub-district, and 65 in Brompton. Scrofula and Tuberculosis occasioned 37 deaths, including three only in Brompton; Tabes mesenterica (" consumption of the bowels" as it is popularly called), 33 deaths, of which 5 were in Brompton; Phthisis 225 deaths, viz., 182 in the Town, and 43 in Brompton; Hydrocephalus (water on the brain), and Tubercular meningitis 79 deaths—14 in Brompton. The deaths from all these diseases were far more numerous in the Town sub-district than in Brompton, due regard being had to population. In Table 3 (Appendix) the deaths of non-parishioners at the Brompton Hospital, 124 in number, are excluded: nearly all of them were due to phthisis (vide page 40). Many deaths of children ascribed to other causes, e.g. premature birth, atrophy and debility, convulsions, &c., are doubtless due to the scrofulous taint, whether inherited or induced by want of care, proper food, air, light, &c., Sixty of the deaths in this order occurred in the first year of life, 39 in the second, and 29 between two and five, making 128 under five years of age. The deaths, in decades, in later life, were as follows Between 5 and 15 years, 29; 15 and 25, 44; 25 and 35, 69: 33 and 45, 53: 45 and 55, 33; 55 and 65, 12; 65 and upwards, 6. It is satisfactory to note that the deaths from tubercular diseases as an order, were nearly one hundred fewer than in 1876. The quarterly numbers of deaths were 104, 83, 97, and 90=187 in the summer, and 187 in the winter quarters. LOCAL DISEASES. This great class accounts for nearly half the deaths registered in the parish. It is sub-divided into eight orders, according to the systems or organs affected, and which will be noticed separately. In this class as in all others, the deaths in Brompton (218), were relatively far fewer than in the Town sub-district (966), regard being paid to the estimated population. Of the total 1,184, 36 more than one third (actually 406), occurred under five years of age. The deaths in this class in 1876 were 1,216. Order 1. Nervous System.— The diseases of the nervous system caused 288 deaths (one more than in I 876, and two more than in 1875), viz., 238 in the Town sub-district, and 50 in Brompton; 104 of them took place under five years of age. The several diseases were fatal as follows:-Cephalitis (inflammation of the structure of the brain) 2, Apoplexy 68 (51 and 17 in the Town and Brompton sub-districts respectively), Paralysis 40 (eight only in Brompton), Insanity and Chorea (St. Vitus's Dance) 1 each, Epilepsy 8 (Brompton 2), "Brain Disease" 75 (only 9 in Brompton), and "Convulsions"—a symptom of many diseases rather than a disease—93 (Brompton 14.) Of the 93 deaths attributed to convulsions all but one occurred under five years of age, and 68 under one year. Apoplexy and Paralysis—diseases of the later periods of life —were the causes of seven deaths under 35 years of age; seven between 35 and 45; and 20, 27, 26, and 19 in the next four decades; two deaths from apoplexy occurred between 85 and 95. Order 2. Organs of Circulation.— Total deaths 140—none below five years of age, and 27 only in Brompton. The fatal diseases were Pericarditis 1, Aneurism 5, and "Heart Disease" 134, viz., 108 and 26 in the Town and Brompton sub-districts respectively. Ten of the deaths took place between 5 and 35 years. In five decades above 35 years the deaths were 19, 19, 29, 39, and 16 respectively. Two deaths from heart disease occurred between 85 and 95. Order 3. Kespiratory Organs.- The deaths from the diseases of the organs of respiration were 538 (44 less than in 1876), 453 in the Town sub-district, 85 in Brompton, and 274 under five years of age. The quarterly numbers were 170, 150, 57, 161. The deaths due to the several diseases were Laryngitis and Spasm of the Glottis, 6 each, Bronchitis 290 (Town 245, Brompton 45), Pleurisy 9, Pneumonia (inflammation of the lungs) 177 (Town 148, Brompton 29), Asthma 6, and Lung Disease, &c., 43. Of the deaths from bronchitis and pneumonia respectively, 138 and 98 occurred under five years of age; 129 and 37 above 55. Between 5 and 55 the deaths from bronchitis and pneumonia were 23 and 42. These numbers correspond with the averages of former years; chest diseases being most fatal at the earlier and the latest stages of human life, their prevalence moreover, being most marked in the winter months. The deaths from all the diseases in this order, which were 170 and 164 in the first and fourth or winter quarters = J34, were only 150 and 57 = 207, in the second and third or summer quarters. Order 4. Digestive Organs.—The diseases of the organs chiefly concerned in the process of digestion, were accountable 37 for 119 deaths, of which 24 occurred under five years of age Eighty-three were registered in the Town sub-district, and 36 in Brompton. "Liver disease" was the cause of 40 deaths; Jaundice 13, and Stomach disease 18. Enteritis and Peritonitis (inflammation of the bowels, and of the external covering of the bowels) caused 10 and 7 deaths respectively. The other principal causes of death were Ulceration of the intestines 7, Hernia (rupture) 5, Pens (obstruction or twisting of the bowel) 8, and Intussusception (obstruction by displacement of the bowel after the manner that the foot of a stocking is drawn within the legpiece) 5. For other causes of death, vide Table 3 (Appendix.) Order 5. Urinary Organs.— The deaths due to the diseases of the urinary organs were 69—55 in the Town sub-district, and 14 in Brompton. Thirty eight were due to Bright's Disease (Nephria), 8 of them in Brompton. Cystitis (inflammation of the bladder), and "Kidney disease" each caused 10 deaths. Nephritis (inflammation of the kidneys) 5, Diabetes 4, and Calculus (stone) 2 deaths. Order 6. Organs of Generation.— The deaths from the diseases of these organs were 12, viz., from Ovarian Dropsy 7, and from "Uterus disease, &c.," 5. Order 7. Organs of Locomotion.—Five deaths were registered from the diseases of these organs, viz, from Synovitis (Arthritis—inflammation of joint) 3, and from "Joint disease, &c.," 2. Order 8. Integumentary System.—Thirteen deaths (only one in Brompton) occurred from the diseases of the skin, viz, 12 from Phlegmon (abscess), four of them under five years of age, and one from Ulcer. Class 4.—DEVELOPMENTAL DISEASES. This class contains four orders, and embraces the diseases (1) of children, (2) of adults, (3) of old people, and (4) of nutrition. The total deaths from these diseases were 340 (238 under five years of age), of which 278 were registered in the Town sub-district, and 62 in Brompton. Order 1. Diseases of Children.—Premature Birth was the chief "disease" and the assigned cause of 63 deaths, the majority of them within a few days or hours of birth. Teething comes next in order of fatality, 27 deaths, viz., 13 in the first and 14 in the second year of life. Five deaths were due to Cyanosis (congenital malformation of the heart). " Other malformations" caused 2 deaths. Order 2. Diseases of Adults.—"Childbirth" was the cause of 5 deaths—in the Town sub-district. Order 3. Diseases of Old People.— "Old Age," is the only 38 "disease" included in this order, and it was the registered cause of 88 deaths, viz., 65 in the Town sub-district, and 23 in Brompton. This cause of death was assigned in 3 cases between 55 and 65 years; in the next decennium there were 16 deaths: between 75 and 85, 47: between 85 and 95, 20: while upwards of 95 there were 2 deaths, one at 102 years. Order 4. Diseases of Nutrition.—"Atrophy and Debility" caused 149 deaths, of which only 20 were registered in Brompton. One hundred and twenty-seven of the deaths occurred in the first year. Between 45 and 85 years, 9 deaths were ascribed to these causes. Class 5.—VIOLENT DEATHS. Forty-one deaths (29 and 12 in the Town and Brompton respectively) were distributed over the orders comprised in this class, and which the Registrar-General numbers respectively (1) Accident or Negligence, (3) Homicide, (4) Suicide, and (5) Execution. Order 1. Accident or Negligence.—31 deaths, viz., from fractures and contusions, 19 (of which 9 were in Brompton); burns and scalds, 2; poison, 1; suffocation, 9. Eight of the deaths from suffocation were those of children (mostly young infants) under 5 years of age, and 5 of the deaths from fractures, &c., occurred below this age. Order 3. Homicide (three deaths.)—Murder 2, and Manslaughter, 1, in the Town sub-district. (For particulars of these cases, vide section on Inquests, page 40.) Order 4. Suicide.—Eight deaths (only 1 in Brompton), viz., by wounds, 2; poison, 4; hanging and "otherwise " 1 each. Order 5. Execution 0. Causes not specified or ill-defined.— Fourteen deaths, (two in Brompton) have been included under this head, owing to the impossibility of including them under any other heading. DEATHS IN PUBLIC INSTITUTIONS. The only "large public institutions" in this parish at present, are, (1) the Parish Infirmary and Workhouse, and (2) the Hospital for Consumption and Diseases of the Chest— the former being in the Town and the latter in the Brompton registration subdistrict. With respect to the smaller public, or quasi-public, institutions—such as the Barracks and the various homes, nurseries, &c., with one exception they do not furnish in the aggregate such a number of deaths as to call for special reference here. The exception is St. Joseph's House, Portobello Road, Notting Hill, an extensive charitable institution, containing some 250 39 inmates belonging to the Roman Catholic community, and in which 33 deaths occurred last year The deaths in the large public institutions last year were 354, equal to 13.5 per cent. on total deaths—the equivalent proportion in all London being 19 2 per cent. The Parish Infirmary and Workhouse.—I am again indebted to Dr. Whitmore, the Medical Superintendent of the Infirmary, for the statistics of the mortality at these institutions. The deaths registered last year were 223, viz., males 120, and females 103. The quarterly numbers were 44, 66, 54, and 59—10 i in the winter and 120 in the summer—an inversion of the usual order of things, the winter months being usually more fatal to old people who compose the majority of the inmates of our workhouses. The ages at death were as follows :—Under one year 25; between one year and sixty 97; sixty and upwards 101. Of the deaths in the latter group 38 occurred between 60 and 70 years; fifty-one between 70 and 80, and 12 at ages above 80. The greatest age was attained by a female who died at 86, from disease of the brain. One inquest was held—on a man aged 58, who died suddenly from " heart disease (P.M.)." The causes of death may be grouped as follows :— Under 1 Yr. Between 1 & 60. 60 & upward. Total. Diseases of the Brain 2 13 28 43 Diseases of the Heart - 8 3 11 Diseases of the Lungs 1 16 25 42 Diseases of other Viscera — 4 8 12 Diarrhoea 3 3 6 12 Whooping Cough 2 3 - 5 Erysipelas - 2 3 5 Dropsy - 2 2 4 Gangrene - 1 1 2 Cancer - 3 2 5 Syphilis 1 2 - 3 Premature Birth 3 - - 3 Want of Breast Milk 4 - - 4 Atrophy, Debility, &c 4 3 1 8 Tubercular (Scrofulous) Diseases 3 2 - 5 Phthisis - 30 3 33 Childbirth (Metritis) - 1 - 1 Abscess 2 1 - 3 Other diseases (single cases - 3 5 8 " Old Age" - - 14 14 25 97 101 223 40 The Hospital for Consumption and Diseases of the Chest.— The deaths in this institution were 130 (87 males and 43 females). Six only of the deceased were parishioners. This hospital, widely and favourably known, is less strictly than most others a merely Metropolitan Institution, drawing patients as it does from all parts of England. Of the 130 people who died in it last year, less than half had been residents in London—44 came from distant counties, and 27 from the Metropolitan Counties. The quarterly numbers of deaths were 35, 23, 31 and 41—76 deaths, that is, in the 1st and 4th, or winter quarters, and 54 in the 2nd and 3rd, or summer quarters. Phthisis (consumption) alone, was the registered cause of death in 106 cases, and with complications in other 13. Diseases of the heart, arteries, and lungs, not phthisical, were returned in eight cases, and there was one death each from tubercular meningitis, cancer, and diarrhoea. Death took place at ages as follows :— Ten Years and Under 3 11 to 20 Years 21 20 to 40 „ 89 40 to 60 „ 17 St. Joseph's House.— The deaths in this institution were 33, males 14 and females 19—22 in the winter and 11 in the summer quarters. They occurred mostly at great ages ranging, with three exceptions under 60, between 60 and 96. The causes of death were diseases of the brain 8, of the lungs 9, of the heart 4, of the kidneys 5, cancer 3, rheumatism 1, old age, &c., 3. A girl of 10 years died of chorea (St. Vitus's Dance), at St. Elizabeth's Home —a conventual establishment and school opposite St. Joseph's House. INQUESTS. The causes of death in 142 cases (males 63, and female 79), were returned by the Coroner (inquests), and were ascertained in 103 cases by post-mortem examination. The apparent reason for holding the inquest was the suddenness of the death or the finding of the dead body in 115 cases, and "violence" in 37. Forty-seven of the deceased were under one year of age, 22 between one and five; from five to twenty 3, twenty to sixty 48, above sixty 22. Many of the inquests w ere held on children who survived birth but a very short period. Among the violent deaths 26 are set down to accident, 8 as suicidal, 2 as "wilful murder," 1 as " manslaughter." 41 The verdicts may be classified thus :— Diseases of the brain (apoplexy, paralysis, convulsions, &c.) 33 Diseases of the heart (including rupture and aneurism) 30 „ of the Lungs 21 „ of other Viscera 5 „ Scrofulous 7 Croup 2 Spasm of the Glottis 4 Diarrhœa 1 Open Verdict, "Found dead" 2 Violent Accident 26 Suicide 8 Murder 2 Manslaughter 1 37 142 Violent Deaths.— Of the 26 deaths due to accident, nine were cases of suffocation—eight infants and one adult; the cause of the accident in the case of the adult being an escape of gas. Three persons were run over by a railway train, wagon, &c.; two were killed by being thrown from a vehicle. In eight cases the fatal accident was caused by a "fall." Crushed by machinery, kicked by a horse, poisoned, scalded—to these causes four deaths were ascribed, one to each. The deaths by suicide—the act being generally attributed to unsoundness of mind—were 8, viz., by hanging, pistol shot, cut throat, run over by train, one each; poison 4, viz., by carbolic acid, prussic acid, laudanum, and belladonna); "wilful murder" (without further explanation) was the verdict in two instances of newly born children found dead in public places. The verdict of "manslaughter" (the death being due to small pox), simply expressed the view entertained by the jury of the conduct of the person in charge of the deceased child in not obtaining medical assistance. This case was referred to in my last report at p. 29. The annual rate of mortality per 1,000 living at all ages, from violence, (47 deaths being returned by the RegistrarGeneral,) was 0.31 in Kensington, and 0 76 in all London. With respect to the numerous deaths due to diseases, and which formed the subject of enquiry in the Coroner's Court, I still hold to the view expressed in former reports, viz., that although in a good many cases the death may have been truly described as "sudden," yet in a large number of so-called " sudden deaths," or when the deceased is described as having been "found dead" or "found dead in bed," death was the result of 12 ness of such a nature, and of such duration, as to leave no excuse for the neglect to call in medical assistance. The Coroner's Court is a court of enquiry and record only, and the duty of the jury is simply to ascertain the cause of death. When Parliament in its wisdom shall have seen fit to create the office of a "public prosecutor," I venture to anticipate it will not be found possible to restrict prosecutions on the charge of "manslaughter" for the offence of not calling in medical aid for the sick to the "peculiar people —the offence being very common, and at present practically ignored, excepting in the case of the above-named sect, who justify their proceedings, to their own satisfaction at least, by conscientious, however erroneous, appeal to Holy Writ. Of the 142 inquests, 110 were held in the Town sub-district and 32 in Brompton. The percentage of deaths to total deaths thus registered from the certificate of the Coroner was 5.5 in Kensington (all London 6.4). DEATHS " NOT CERTIFIED." Twenty-seven deaths were returned as "not certified," i.e., the deceased had been attended during their last illness by unregistered and, it must be assumed, unqualified practitioners of medicine. A "medical" certificate is usually given in these cases by the practitioner, and though the certificate, is "invalid" at law, the cause of death is entered in the Register in accordance with the terms of the certificate. At present the giving of such certificate is net an offence under the Medical Act, any more than the irregular practice of medicine by unqualified persons. The only offence this Act recognises is the assumption of any title by which the person falsely claims to be "registered" under the Act. Under the Apothecaries' Act, however, it is an offence to practise medicine without qualification, and the Act has been successfully put in force many times. The sanction of the Company is necessary, believe, and they are entitled to whatever penalties may be recovered: but so far as I know they do not enforce their own Act. This it has been left to private associations of members of the profession to do—an unsatisfactory, however praiseworthy mode of proceeding. It may perhaps be said that if people think fit to go to an unqualified man they are at liberty to do so—as in this land of liberty, people are allowed to do many other unwise things—but it may reasonably be doubted whether many of the poor patients of the pseudodoctors are acquainted with their un-qualification and they are just the class who need protection. The actual number of "not certified" deaths was 27, but it is impossible to say how many more sick persons may have been attended to the last by unqualified men, by whom, with a view to certification, a qualified practitioner had been called in just before death. The 43 busiest of the unregistered practitioners, who practises under the shelter of a ''bogus" diploma obtained in absentia from a transatlantic "University," which has no legal existence, "certified" the cause of 21 deaths last year. Another practitioner, who has been fined once under the Medical Act, certified in 3 cases; a chemist in 2 and an unqualified assistant of a medical man in 1. Of the 27 deaths 13 took place in the first year of life; 9 between 1 and 6; at 13 years 1; adults, 4. The alleged causes of death were, small pox, 1; scarlet fever, 2; diarrhoea, 2; enteric fever. 1; delirium tremens, 1; phthisis, 1; lung diseases, 7, and the wasting diseases of children (often the result of bad food and bad management), 12. There was "no medical attendant" of any sort in 8 cases, including 5 infants, varying in age from 1 hour to 8 months, and the causes of whose death are variously described as premature birth, debility and convulsions. The death of a woman certified from "small-pox" should not have been so returned as she had not been seen during life by the medical man who was called in by the coroner's officer. The coroner deemed it unnecessary to hold an inquest. METEOROLOGY. The mean temperature of the air at Greenwich in 1877 was 49°.7 Fakr., or 0.4 above the average of 37 years (1840-76). The averages of the four quarters were 42°.4, 52 6, 58 6 and 45.0. The highest reading by day (88°.2) occurred in the weekending August 4, and the lowest reading by night (23°.5) in the week ending March 3. The hottest week in the year was that which ended August 18 (mean temperature 63.7), and the coldest that which ended March 10 (mean temperature 36.9). The dryness of the atmosphere (i.e., the difference between the dew-point temperature and air temperature) was 6°.6; average of 38 years (1840-1877) 5.6. The rain-fall was 26.8 inches, the average in 37 years being 24.2 inches. The low summer temperature and the excessive rainfall during the three first months of the year probably contributed to bring about the low rate of mortality which characterised the year 1877. VACCINATION. Public interest in the subject of vaccination, intensified as it always is during the prevalence of an epidemic of small-pox, has been specially quickened in this parish of late by the abolition of one of the Stations for public vaccination, and by a sharp but brief outburst of small-pox in the Brompton district— some persons going so far almost as to connect the two events as cause and effect. Down to the close of 1877 there were three Stations in 44 Kensington. A "North" or Notting; Hill Station at Cornwall Road. which served for the large district north of the Uxbridge Road ; a "Central" Station near Kensington High Street Railway Station, for the district between the Uxbridge and Kensington Roads, and a part of the parish south of the latter road; and a "South" or Brompton Station in the Brompton Road, at the corner of Michael's Grove—and, therefore, close to the southern boundary of the parish— for the "Brompton" Poor Law District. The new "South" Station, for the combined Central and South Districts, is at the Chapel in Hornton Street, close to the old "Central" Station. The distance of the remotest parts of this combined district from the Station is about one and a half miles The part of the district where small-pox has most prevailed—and of which I field Road may be taken as the centre - is about equi-distant from the old Brompton Station and the new South Station. The vaccination arrangements throughout the country are controlled by the Local Government Board, who have adopted the plan of attaching to each Station a district with a population sufficient to ensure a regular weekly number of infants adequate to provide for "arm to arm" (or "primary") vaccination. On an average of three years the annual number of primary vaccinations at the Brompton Station was about 190, or less than four weekly, taking no account of fluctuations which might sometimes endanger the maintenance of the supply of fresh lymph.* This number being deemed insufficient, the Local Government Board advised the Guardians to close the Station. It is too early, of course, to judge what effect, if any, this step will have on the course of public vaccination in Brompton; but we are justified in assuming, and no one doubts, that the Vaccination Officer will take care that infants are vaccinated at the proper time, either at the station or elsewhere. So far, moreover, it would appear there has been no falling off in numbers, for whereas on an average of three years the quarterly number of infant vaccinations at the Brompton Station was 47 (the number in the first quarter of 1877, was 42), the number of Brompton cases at the new station in the first quarter of 1878 was 44. I am not aware of any complaint having been made of the distance mothers have to travel to get their infants gratuitously vaccinated in the North district—though the extreme distances are greater than in the enlarged South district; and so far as I can ascertain, the arrangements at that station, where 1642 primary vaccinations were performed in 1877, are deemed satisfactory. In the old Central and South stations, now combined, the primary vaccinations in 1877 were 767, of which 191 were done at *On 28 occasions during 1877 the weekly number of primary vaccinations fell below four: on eleven occasions there were three; on ten occasions two; and on seven occasions only one. 45 the Brompton Station. But it may be said that infant vaccination is compulsory, and re-vaccination, which is so necessary as a preventive measure against small-pox, is not, and therefore, though the penalty for neglect of the former—to say nothing of the diligence of the Vaccination officer—may compel compliance with the law, there is no such inducement in regard to re-vaccination, which, therefore, may be neglected if great facilities for its performance are not provided This may be so, and all will agree that every reasonable facility should be offered to the public. Every adult should be re-vaccinated—the sooner it is done after 15 years of age, or even earlier when small-pox prevails, the better; and it is desirable that a law should be passed to make such re-vaccination compulsory. Until the people generally, whether from a sense of self-protection, or in obedience to law, submit to the operation, small-pox must continue to smoulder in our midst—and it will, from time to time, break out with epidemic violence. But if people are so indifferent about re-vaccination that they will not take the trouble to go a mile or two once in a life-time, to have the operation gratuitously performed, will they walk half-amile, a hundred yards, or any other distance, for the purpose? That is the question: and it may be fairly doubted whether those persons who during the last two years of the epidemic have been either unwilling to submit to re-vaccination, or too indifferent to find their way to the old station, would be induced to make the effort to get re-vaccinated, however the facilities for their so doing might be increased. It remains, of course, to be seen what proportion the re-vaccinations of Brompton adults at the new station will bear to the re-vaccinations at the old station. In one respect the case is not at all altered by the new arrangements, for the 13th section of the Vaccination Act (1867) Amendment Act, authorises a District Medical Officer to vaccinate any unvaccinated person, and to re-vaccinate all persons of suitable age, and not previously re-vaccinated, in any house where small-pox exists, and to be paid in respect of such services in the same manner as a public vaccinator. This power has been duly exercised, and I am informed that a large proportion of the re-vaccinations in the Brompton district have been done 'at home,' and not at the station, under this provision. The new arrangements effected by the abolition of the Brompton station, must, however, be considered to be on their trial, and as any views entertained in respect to them, now, may have to be modified hereafter, T, for one, do not intend to commit myself at present to a final opinion on the subject. Recognising, however, the apparent reasonableness of the grounds on which the new arrangements are based—considering, moreover, the topography of the district, the question of distances, &c., and the fact that free vaccination is done weekly to a large extent at St. George's 46 Hospital, which is not far from the Eastern boundary of Kensington (Sloane Street), and that no grievance is alleged in the North district, where the conditions are at the least as unfavourable as in Brompton, and that in no part of London is infant vaccination more universally practised than in Kensington, I have felt it my duty to point out that there is something to be said in favour of the plans adopted by the Vaccination Authorities, plans which must in due time be judged by their success or failure. In former annual reports it has been one of my most pleasant duties to bear testimony to the successful working of the Vaccination Laws in this parish, due to the loyalty of the Guardians, and to the energy with which the Vaccination Officer, Mr. C. Shattock, fulfils the onerous duties of his post. The testimony of the Local Government Board, in respect to this officer's last Report, proves that the high standard of former years is still maintained. In my last Report I referred, in a foot-note (at page 31), to the results of a house to house visitation, and an inspection of schools, which the Guardians had instituted with a view to the discovery of unvaccinated children, and I now give the Report of the Vaccination Officer thereon :— "Two hundred and seventy streets have been canvassed, numbering 7,996 inhabited houses, populated by upwards of 21,000 separate families, in which 290 unvaccinated children were discovered ; and from an inspection of nine schools, containing 2,089 children, 60 were found unprotected by vaccination, making a total of 350 cases. " Notices were at once served on the parents or persons having custody of such children, as to the requirements of the law. In many instances attempts were made to evade the Act by removal, but on being followed and again found they complied. "Of the 350 cases above referred to, 303 have since been vaccinated, and certificates sent in; 13 are now undergoing the operation; 27 are certified as unfit from ill health, and the vaccination consequently has been postponed, thus leaving four only of the 350 cases unaccounted for, and in which I find legal proceedings necessary. "The greater number of these children were born in other parishes, and by migration into this district the officers of the district in which they were born were evaded. Some were not registered, and others falsely registered—it was therefore impossible to reach them, but by the means adopted by your Board. "The 27 certified as unfit from ill-health will be kept in view, and the law enforced as soon as their state of health permits. "It is to be regretted that the School Board for London should have refused your application to inspect the children in their schools, inasmuch as that would have been a certain means of reaching those whose vaccination had been neglected. (October 10th, 1877.") The subjoined Report refers to Vaccination in 1876, and must be considered eminently satisfactory :— "During the year, 4,519 births were registered; in 409 instances the children died ere they attained the age of three months, or were in a fit state of health to undergo the operation ; 24 are certified as 47 tible of vaccination ; five had small-pox; 22 are still under medical certificates of unfitness from ill-health ; 21 have removed to other parishes, their addresses ascertained, and forwarded to the Vaccination Officers of such respective districts, reducing the number to be accounted for to 4,038, of which 3,889 have been successfully vaccinated, and certificates duly returned; the remaining 149 have left, or were unknown at the addresses given upon registration, being a loss of about 3 per cent. on the total number of births registered. (Vide Table X., Appendix.) "The average of the Metropolis has hitherto been about; 8 per cent., thus showing Kensington vaccination to be 5 per cent. better than that of the Metropolitan district generally. (February 6th, 1878.") In concluding my remarks on this important subject, I may observe that vaccination, like all other systems, must be judged by its fruits, and that those fruits in this parish have been just such as everybody acquainted with the subject might have anticipated. There has not been, to my knowledge, one death from small-pox, of a properly vaccinated infant: and in the Brompton sub-district where for the last few months the disease has chiefly prevailed, the number of children attacked has been small: very young children having generally escaped. The children who took the disease were for the most part of an age at which the effects of primary vaccination begin to wear out, an age approaching that at which re-vaccination begins to be necessary, and to prove successful. All which goes to show that no suspicion can be reasonably entertained respecting the state of infant vaccination in Kensington, while as regards re-vaccination— (the Guardians having on two occasions opened public stations in the evening,) adults have had abundant opportunities of being re-vaccinated without cost or undue trouble. Public notice of these arrangements and suitable advice, moroever, having been given both by your Vestry and by the Guardians, I feel that the Sanitary and the Vaccination Authorities will be absolved whatever may be the consequences, to individuals or to the community, of the neglect of re-vaccination. THE SANITARY STAFF. Towards the close of 1877 your Vestry referred "the duties and salaries of the subordinate officers in the department of the Medical Officer of Health," to the Special Purposes Committee for consideration and report. Shortly afterwards, however, Inspector Langman having fallen ill in the interval, it was thought well to defer the enquiry pending the result of that officer's illness. And when in March, 1878, Mr. Langman tendered his resignation, which was speedily followed by that of Inspector Wood, it became apparent that the scope of the reference must needs be enlarged. The Committee ultimately presented a report of considerable importance, the adoption of which by your Vestry having 48 tically re-constituted the Department, a brief notice of it may not be unacceptable at the present time. On the passing of the Metropolis Local Management Act, which called your Vestry into existence in 1855, two inspectors, Mr. Giles Lovett and Mr. G H. Wood, were appointed, Inspector Lovett taking cognizance of indoor nuisances and sanitary defects in all parts of the parish (the area of it being 2,190 acres, and its configuration—great length and little breadth—inconvenient) while Inspector Wood was chiefly if not wholly concerned with street obstructions and such like matters. At this time the estimated population of Kensington was 55,000, and the number of inhabited dwellings 7000. In 1866, the population having increased to 96,000, and the number of occupied dwellings to 12,000, your Vestry resolved to appoint an additional Inspector, and to divide the parish into three districts—a "north" district including all that part of the parish north of the centre of the Uxbridge Road, a "south" district embracing all that part of the parish south of the centre of Kensington Road, and a "central" district comprising the remainder of the parish, viz., that portion of it between the north and the south districts respectively. It was also settled that each officer should perform all the duties appertaining to the office of Sanitary Inspector, and Inspector of Nuisances, in his own district. The new arrangement, Mr. Langman having been appointed to the North, Mr. Wood to the Central, and Mr. Lovett to the South District, worked satisfactorily, and was reported on favourably by my predecessor after a year's experience of it. Not long afterwards, however, Inspector Lovett having resigned his appointment on account of ill-health, the Vestry resolved to combine the central and southern districts under Inspector Wood, thus reducing the staff to the original number. I am not prepared to say that the division of the parish thus effected was an unequal one—though the constant and almost portentous growth of the north district, tended more and more to make it so—-but it soon became apparent that the work of either district was hopelessly beyond the capacity of any one man. In 1871 I had the honour to be appointed the Medical Officer of Health, and soon afterwards the Vestry, at my request, resolved to relieve the Inspectors of some of their work, by appointing a Sanitary Clerk, who should be an Inspector also, but without district, and competent to undertake any special work at the discretion of the Medical Officer. Mr. Richard C. Rudman was the successful candidate for the new appointment. The next step towards placing the sanitary staff on a proper footing arose out of the frequency with which complaints were made by parishioners of the non-removal of dust and other refuse from their premises, and the necessary attention to which occupied much of the Inspectors' time to the great hindrance of them in 49 the discharge of their other duties. These complaints indeed became so numerous at last that it was impossible for the sanitary inspectors to make inspections, and all that could be done was to issue orders to the several contractors to remove the dust. The repetition of complaints by the same parties, on consecutive days or at short intervals, proving delay in executing the orders, 1 ventured, in March, 1875, to advise the Vestry to appoint a "Dust Inspector," which was done, in the person of Mr. Thomas Gaylard. To the duties of this office, those of Inspector under the "Sale of Food and Drugs Act" were subsequently added; this work being done, however, after office hours. Inspector Gaylard also undertook a certain amount of general sanitary work, as time and circumstances permitted. Excellent results followed the appointment of this officer—a part of whose special occupation, however, as an overlooker of the contractors' work, came to an end in 1877, when the contract system was discontinued. Lastly, my attention having often been directed to the unsatisfactory way in which the disinfection of rooms, after the occurrence of infectious diseases, was conducted—the process often being ineffectual, from the want of care or the ignorance of the poor occupiers, I recommended the appointment of a special officer to do the work; and Mr. James W. Wightman was appointed in April, 1877, his time being filled up in attending to minor sanitary matters, and in learning the duties of an Inspector. On Mr. Langman becoming disqualified by illness, the duties of his office were at first undertaken by Mr. Wightman, and subsequently were divided between that officer and Mr. Middleweek, who was temporarily appointed in January, 1878, with such assistance as Inspector Gaylard's attention to his other duties permitted him to give. I have now brought the history of the Sanitary Department down to the close of 1877, at which time the population of the parish had increased to about 152,000; the number of occupied dwellings (including stables and mews) being nearly 20,000, and the length of the streets subject to the control of your Vestry 65 to 70 miles. What has been stated will have given some idea of the importance of the question, with which the Special Purposes Committee had to grapple. Their report on it was as follows:— "With reference to 'the duties and salaries of the subordinate officers in the department of the Medical Officer of Health,' and as to filling up the vacancies caused by the resignation of Messrs. Langman and Wood, your Committee beg to report, That, owing to the great development of the Parish of late years—the large population, the number of inhabited dwellings, and the extensive mileage of the streets—the Parish should be divided for sanitary purposes into four districts, two north and two south of the Uxbridge-road, and to be named respectively North West, North East, Central, and South. 50 "To each of the above districts an Inspector should be attached, but not necessarily the same Inspector in permanence, as your Vestry may think it desirable, from time to time to change the districts, so as to accustom the officers to work in any portion of the Parish, in conformity with the principle laid down in the Report of the Special Committee appointed to consider " as to the Duties of the Inspectors," dated March 28th, 1866. "Office Hours.—The hours of duty of officers are from 9 a m. to 5 p m.; but it appearing that much loss of time has been unavoidably occasioned heretofore by the Inspectors leaving their work and going home to dine, it is recommended that in consideration of their giving up the dinner hour in the middle of the day, they should go off duty at half-past four o'clock—an arrangement which your Committee are informed would be agreeable to the existing officers. "Duties, &c., of the Several Inspectors.— Your Committee, having given careful consideration to this subject, beg to recommend—first, with reference to Inspector Richard C. Rudman, that he continue to perform the duties of "Sanitary Clerk and Special Inspector without district," as heretofore. "The Inspectors generally should attend at the office duly and punctually at nine o'clock, and, after signing the attendance-book, proceed to enter in a journal, to be provided for the purpose, a brief statement of the work done on the previous day—irrespective of any more detailed entries they may have found it necessary or desirable to make in a pocket diary, which it is recommended they should keep and make up at home at the close of each day's work. "The Inspectors should report to the Clerk of the Vestry any obstructions, &c., that may have come under their observation, and they should furnish the Sanitary Clerk with the necessary particulars of all notices requiring to be issued for the amendment of premises, or for the abatement of nuisances, &c "The serving of such notices will be one of the duties of Inspectors. Your Committee, however, would point out that it is of little use serving notices unless steps are taken to ascertain that the requirements of the Vestry are duly and punctually complied with; they would therefore recommend that it be the duty of the several Inspectors to ascertain in each case that the required work has been executed within the specified time; to report, without delay, any default; and to take such measures as your Vestry may have authorised to secure compliance with the law. "The necessity of serving the more formal notice under the order of your Vestry might be frequently obviated and considerable delay avoided, by the use of a form of preliminary notice, which each Inspector should carry in his pocket, fill up, and serve imme- 51 diately on the discovery of a nuisance—a step which, in a great number of cases, would effect all that is necessary. "The Inspectors should leave the office punctually at 10 o'clock, and proceed without delay to their several districts : and when they can more conveniently reach the scene of the day's duty by railway, your Committee recommend that they be authorised to do so by taking a third-class ticket, the cost of which will be trifling in comparison with the value of the time saved. The chief duty of an inspector is the systematic inspection of the houses occupied by the poorer classes, and houses let out in tenements. And in connection with this all-important duty your Committee would submit that the time has arrived when the 35th section of the Sanitary Act, 1866, should be put into operation—the section enabling the President of the Local Government Board, on the application of the Nuisance Authority, to empower the said authority to make regulations as to lodging-houses, viz.:— 1. For fixing the number of persons who may occupy a house or part of a house which is let in lodgings, or occupied by members of more than one family. 2. For the registration of houses thus let or occupied in lodgings. 3. For the inspection of such houses, and the keeping the same in a cleanly and wholesome state. 4. For enforcing therein the provision of privy accommodation, and other appliances and means of cleanliness in proportion to the number of lodgings and occupiers, and the cleansing and ventilation of the common passages and staircases. 5. For the cleansing and lime-whiting at stated times of such premises. "The Act enables your Vestry as the 'Nuisance Authority.' to provide for the enforcement of the above regulations by penalties for default: and duly carried out as it might and should be with the proposed increase in the sanitary staff, it would constitute an important fresh point of departure in the progressive efforts of your Vestry to improve the health of the people. "The details of the duties of the Inspectors under the several Acts of Parliament relating to the prevention of the spread of infectious diseases and to Slaughter Houses, Cowsheds, Bakehouses, &c., will have to be settled by the Medical Officer of Health, but your Committee desire to record their opinion and to recommend that each slaughter-house and cowshed should be visited once in every month at the least, and each bakehouse once in two months. Among other principal duties of the office may be cited the following, viz., regular attention to the condition of mews and generally to the state of the streets in respect to cleanliness, 52 obstructions, &c., and the systematic inspection of marine stores and other offensive trades, public and semi-public urinals, &c. "And here your Committee would observe that subject to the sanction of the Chief Commissioner, which should if possible be obtained, the Police might render important service to the public and to your Vestry, by co-operating with the Inspectors in enforcing the provisions of the law in respect of street obstructions and cognate matters. With reference to matters requiring the attendance of the Inspectors at the Police Court, and it appearing that such attendance has often occasioned considerable loss of time owing to the pressure of business at the Court, yonr committee beg to recommend that it be an instruction to the Clerk of the Vestry to endeavour to make an arrangement with the magistrates so that Vestry cases (emergencies only excepted) may be heard at a fixed hour on one day in the week. "But as many charges, e.g., for obstructions of the public footways, &c., might be equally well dealt with by the Justices of the Peace sitting at the Vestry Hall, and much time be thereby saved, your Committee recommend that such cases be taken before the Justices when practicable. "Moreover, the Justices being the Licensing Authority for Slaughter Houses and Cowsheds, it appears to your Committee that subject to the same reservation on the point of convenience, summonses for breaches of the slaughter-houses' bye-laws, and for nuisances arising in connection with cowsheds, &c., should also be taken before the Justices. Your Committee, however, in making this recommendation, feel that considerable latitude should be allowed to the Clerk's discretion, and they make it subject to this reservation. Your Committee have already referred to the necessity of system in the duty of house inspection, and in order that the Inspectors may be withdrawn as little as possible from this important work, and it appearing that letters are frequently addressed to the Inspectors requiring their attendance in various parts of the parish for purposes which on inspection prove to be beyond their powers, and thus much valuable time has been wasted, your Committee recommend that all letters addressed to a Sanitary Inspector should be deemed to be addressed, and should be submitted to the Medical Officer of Health as head of the Sanitary Department, and his instructions taken with reference thereto. "Your Committee having been informed that it has been customary for the Inspectors to be in attendance at all meetings of your Vestry and of the Works, Sanitary, and General Purposes Committee, and that their presence is very seldom required, recommend that the attendance of the Inspectors (Special Inspector Rudman only excepted), at such meetings be dispensed with, 53 less otherwise specially directed by your Vestry, the said Committee, the Clerk, or the Medical Officer of Health. "With respect to the appointment of officers to complete the staff of the Sanitary Department, your Committee having received an application from Inspector Gaylard soliciting a transfer from his present duties as Dust Inspector to those of Sanitary Inspector (for which he appears to be well fitted) recommend that he be appointed Sanitary Inspector and Inspector of Nuisances, and that he continue to discharge the duties of Inspector under the Sale of Food and Drugs Act as heretofore. "The Medical Officer of Health having reported that Acting Inspectors James W. Wightman and William Middleweek have discharged the duties entrusted to them in a satisfactory manner, your Committee recommend that they be appointed Sanitary Inspectors and Inspectors of Nuisances, and that Mr. Wightman do continue, with the assistance of one of the Vestry's labourers, to act as disinfector for the whole parish. "For the remaining appointment your Committee recommend that it be referred to the Chairman of your Committee, assisted by the Medical Officer and the Clerk, to select a suitable person for election by your Vestry as Inspector.* All the appointments to be made and held subject to the pleasure of your Vestry. "In conclusion, your Committee have only further to report that, although they have given great attention to the subject referred to them, they have not attempted to deal with it exhaustively, especially in respect of the details of the duties of the inspectors, which they think should be left very much to the Medical Officer to settle, subject to the provisions of the several Acts of Parliament relating thereto, and to the sanction of your Vestry. They believe, however, that the general plan and arrangements shadowed out in the present report, if thoroughly carried into effect, will prove serviceable, and place the Sanitary Department on a footingsomewhat commensurate with the importance of the interests committed to its charge." SANITARY WORK. The principal items of sanitary work done by the Inspectors are set out in Table 6 (Appendix), and the monthly quantities in Table 6a It may be stated, however, that a large amount of good work does not admit of a detailed statement, particularly in respect to the cleansing of houses, which is oftentimes done at the request of the Inspectors without formal notice on the part of your Vestry. By acquiring influence with the owners of small property and houses let out in tenements, it is possible for a discreet Inspector to do a good deal for the benefit of the occupants without having * This was done, and Mr, Thomas Abbott was subsequently appointed. 54 recourse to compulsory powers: and the diligence or success o an officer is by no means to be guaged by the number of notices or summonses served in his district. In another section (Sanitary Staff, page 47), I have referred to the great alteration made in the arrangements for carrying out the work of inspection, and which are of too recent date to call for critical remark. I take occasion, however, to renew the expression of my regret at the loss of Inspector Langman's services, a regret which is increased by the fact that his retirement was due to complete failure of health. Inspector Wood, after 23 years service, well deserved his retirement. LICENSED SLAUGHTER-HOUSES. The number of licensed slaughter-houses has undergone no change since last year. There are 21 north and 10 south of the Uxbridge Road, total 31 (vide Table 11, Appendix, for names of licensees, localities, &c.) The several premises have been inspected as usual; and I presume the bye laws relating to them have been duly observed by the licensees, no complaint having been reported by the sanitary inspectors, and no proceedings having been taken for offences under the bye-laws by the officers of the "local authority" (Metropolitan Board of Works). LICENSED COWSHEDS. The licensed cowsheds are now 30 in number, viz., 19 north of the Uxbridge Road, and 11 south thereo, (vide Table XII., Appendix for names of Licensees, Localities, &c.) In the case of sheds newly licensed within the last two or three years, the requirements of your Vestry have been carried into effect by the decisions of the Justices, who have limited the number of cows allowed to be kept so as to ensure a space of 800 cubic feet for each animal. This requirement is so reasonable that it ought now to be insisted on in all cowsheds.* In former reports I have enlarged on the reasons for placing cowsheds and dairies under regulation by bye-laws, I propose now, therefore, only to show what progress has been made in the matter, which is one of great sanitary interest. It will be remembered that the "Public Health (Metropolis) Bill, 1877," proposed inter alia to confer powers on the Metropolitan Board of Works to enable them to frame bye-laws for regulating the construction of cowsheds, and the conduct of the business of a cowkeeper. The Bill, however, was withdrawn subsequent to the second feading. The Metropolitan Board of Works, moreover, were not satisfied with the clause referred to (69th) because it did not give *The Vestry have since resolved to adopt the 800 feat standard for all cowsheds (May, 1878). 55 them the power to enforce the regulations which it would have authorised them to make. The Board, therefore, with a view to independent action referred to the Sanitary Committee the question of the desirability of bringing the business of a cowkeeper in the Metropolis under the operation of uniform regulations, and the Committee ultimately reported in favour of so doing, "chiefly with a view to improving the present unwholesome condition of the cowhouses . . . and consequently reducing epidemic "(or rather epizootic) "diseases in cows " The Committee regarded the alleged unwholesome condition of the sheds as the "result ofthe vestries having no statutory power of making and enforcing regulations, though the cowsheds are to some extent under their supervision," and they stated their conviction thatthe only way to remedy the "generally recognised evils" referred to, is to "bring the cow-houses under the operation of uniform regulations uniformly enforced;" and "the most expeditious and effective way of dealing with the question is to declare the business to be an offensive business under section 3 of the Slaughter Houses (Metropolis) Act, 1874. "The Board acting on this advice did in October, 1877, resolve and order "That the business of a cowkeeper be declared to be an 'offensive business' " under the said section. The 'order' of the Board in such case, however, has no validity unless confirmed by the Local Government Board; and this confirmation has been withheld, the Metropolitan Board having been informed that the powers they seek can be conferred only by a special Act for which up to the present time they have not shown any disposition to apply. There appears no probability of the Government re-introducing, this year, at least, the "Public Health (Metropolis) Bill," but they have taken a step which if carried into effect may prove productive of much good, viz., by proposing to confer power on the Privy Council to enable them to authorise "local authorities" to frame bye-laws for the regulation both of cowsheds and dairies, and the conduct of the business carried on thereat. Section 28* of the "Contagious Diseases (Animals) Bill," introduced in the House of Lords by the Duke of Richmond, runs thus :— "Dairies and Cowsheds—The Privy Council may from time to time make such orders as they think fit, subject and according to the provisions of this Act, for the following purposes or any of them:— 1. For prescribing and regulating the ventilation, drainage, and water supply of dairies and cowsheds in the occupation of cowkeepers or dairymen. 2. For securing the cleanliness of milk shops, and of ing vessels used for containing milk for sale. *In the "Act" it is the 33rd section; but as I have been unable to procure the Act I do not know in what precise terms the section has been passed. 56 3. For prescribing precautions to be taken for protecting milk against infection or contamination. 4. For authorising a local authority* to make regulations for the purposes aforesaid, or any of them, subject to such conditions, if any, as the Privy Council prescribes." Should the section pass into law, and be duly carried into effect by the Privy Council, we may venture to hope, ere long, to see some radical and necessary improvements effected, not only in the construction of cowsheds and the storage for milk, but also in the conduct of the business of those who deal in this most important article of diet. But, as I have pointed out in former reports, it will not be a sufficient protection of the sanitary interests of the metropolis to regulate by bye-laws the structure of its own cowsheds and dairies, and the conduct of the business of its own dairymen, &c., for by far the largest part of the milk supply is derived from the provinces, and residents in the metropolis may at any time suffer from sanitary defects in connection with country cowsheds, or dairies, as well as from disease either in the cows, or in the families of the people who send milk to town. An instance came to my knowledge last year, which illustrates very well one of the dangers glanced at, and proves the necessity of placing under supervisory regulations all dairies and cowsheds from which milk is supplied for general consumption. Several cases of illness (diarrhoea, vomiting, and febrile symptoms) occurred in a number of families supplied with milk from a particular dairy. An analysis of the milk showed that it had evidently been watered to the extent of about ten per cent. On the farm being visited from which the supply of milk was drawn, it was found that one of the cows had been and was suffering from some form of diarrhœa, and that her milk was being sent up to the London market; the milk, however, yielded a large percentage of solids, and did not, when drank, produce any sickness. The water used to cool the milk was very foul and taken from a pump supplied by drainage from the farmyard. The water when mixed with milk and drank (by the proprietor of the London dairy) produced violent sickness in a very short time. The average milk of the farm, when analysed, showed a higher percentage of solids than the milk as received in London, showing pretty clearly—physiologically and chemically—that it had been reduced with the fouled product of the pump. It need hardly be added that if there had chanced to be any typhoid fever at the farm very serious results might have *The Metropolitan Board of Works is the "local authority" for the whole of the metropolis, excepting the City of London. There is an advantage in this, viz., that the ''regulations," when made, will be of a uniform character. This bill, it may be mentioned, passed into law at the end of the Session, but it does not come into operation till the 30th September. 57 occurred. The "experiment" on the London consumers was tried twice, for as soon as the first batch of cases occurred the milk supply from the farm was discontinued; but a few days afterwards the proprietor of the dairy was induced to take the milk again, and the same results immediately ensued. Then followed the visitation of the farm and the discovery of the source of, impure water. The cause of the mischief having thus been discovered and removed, the effect ceased at once and for all.* BAKE-HOUSES. The Bakehouses, 121 in number, viz.: 69 in the North, and 52 in the South Sanitary district, have been regularly inspected, and the provisions of the Act relating to them carried out as fully as possible. The special duties that have hitherto devolved on your Vestry's Officers will, on 1st January next, be transferred to Government Officers, by virtue of a clause in the Factory and Workshop Act (1878), which places the Bakehouses under the supervision of the Inspectors appointed under the " Factory Acts.'' DUST REMOVAL. The removal of dust and ashes is now, and has been during the parochial year, 1877-8, wholly carried out by your Vestry. This work was commenced somewhat suddenly, and in a state of unpreparedness, on your Vestry's determination to abolish the contract system, and it is not surprising that many complaints of inattention were made du; ing the early months of the year. On the whole, however, there has been a decidcd improvement as compared with previous years under the contract system, as the figures in Table 6a (Appendix) will shew. In course of time the difficulties which, even now to some extent exist, and arise from the comparative novelty of the work, will be surmounted, and as the methodical system of calling at each house in the parish once, and once only, in every week is brought fully into play, it may be anticipated that the new order of things will prove increasingly satisfactory to the ratepayers. There is reason to believe that not only has no additional expense been incurred by the change of system, but rather the reverse, taking into consideration the fact that the sums demanded and paid for the work under contract rose yearly at a portentous rate. A large sum of money, indeed, has been received from the sale of dust to brick-makers: and this source of revenue might no doubt be considerably increased were it in the power of your Vestry to sort the dust and sell in the best market the several constituents of the dust bins. *I am indebted to Mr. Cleaver, the Public Analyst, who visited the farm and who did the analytical work, for some of the above particulars. 58 REMOVAL (OR NON-REMOVAL) OF STABLE MANURE. In my annual reports for 1875 and 1876, I referred to the nuisances arising from the neglect of the owners of horses to remove with sufficient frequency and regularity the contents of the dung pits, especially in mews, in conformity with the regulations of your Vestry. These regulations require the pits to be cleansed three times a week, viz., on alternate days; but as a matter of fact the refuse in question is removed far less frequently and at irregular intervals, and I pointed out the desirability of your Vestry undertaking the removal of the manure, &c., as the law enables you to do with the sanction of the owner, which sanction I have reason to believe it would not be difficult to obtain if it were understood that the penalties for non-compliance with the regulations would be enforced. I also referred to the increased value the addition of the manure would give to other refuse matter as slop, dust, &c., when your Vestry, having dispensed with the services of contractors, should be seeking a market for street and other refuse. That time has now arrived, and as it is most desirable on sanitary grounds that the regulations should be carried out strictly, I trust steps will be taken to give effect to my suggestion. That stable refuse has an appreciable value is obvious, for your Vestry have accepted a tender for the purchase of the stuff from the wharves and depots for one year, for about the sum of £70.. There are nearly One hundred and fifty mews in this parish, and the quantity of stable refuse must be very great in the aggregate, thongh the produce of a single stable can be of little value to the proprietor, or rather (as a rule) to his coachman. I cannot but believe therefore that it would pay in a commercial point of view to collect the stuff as proposed, and at the least I would urge a fair trial of the plan under the direction and supervision of the Wharves and Plant Committee. HOUSE DRAINAGE. The subject of house drainage has received considerable attention, it having been prominently brought under the notice of your Vestry in the form of a general statement, not wholly without foundation, that the powers of the Metropolis Local Management Acts relating thereto have not been fully exercised. The Report of the Works, Sanitary, and General Purposes Committee, to which it was referred to consider the "Principles of the Acts in relation to house drainage, and as to the best means of giving effect thereto,"shows that your Vestry have the power to require that all house-drains and connected works shall be properly laid and provided, and that all houses built, or to be built, shall be provided with sufficient drainage, to be properly constructed of suitable materials and under the supervision of your Vestry. 59 It is matter for regret that these powers have not been fully exercised during the twenty-three years the Act has been in operation—and in respect of the many thousand houses that have been constructed in the parish within that period. The 82nd section of the Act, however, will probably enable us to correct some of the faults of construction in existing drains, as it places drains, water-closets and connected works under the inspection of the Vestry and their officers, power being given, after twenty-four hours' notice, to enter premises and open the ground for the purpose of such inspection. By the 85th section, when any drain, &c., appears to be in bad order, the owner or occupier may be called upon to do the necessary works, and in case of default the Vestry may themselves do the work, and charge the owner or occupier, or sue for penalties. In order to the due carrying out of the provisions of the law with respect to drains new and old, it has been found necessary to appoint an additional officer in the Surveyor's Department, and such officer will be able I hope to give valuable assistance to the Sanitary Department by superintending the opening of drains for inspection under the above-mentioned 82nd clause. "Rules to be observed by builders in the construction of drains and connected works," have been framed, and your Vestry have resolved "that measures be adopted to ensure the proper construction of the underground or buried portion of all house drains, and also to secure the construction and provision of the connected works, apparatus and other matters specified in the Act. The Surveyor is authorised, when he shall think fit, in cases of emergency, to do this work, and afterwards report thereon to the Vestry. In other special cases, if it appears to the Surveyor that it would be for the advantage of the Parish that the drains should be constructed by the Vestry rather than by the builder, it will be his duty to report thereon with a view to the drains being so constructed. The importance in a sanitary point of view of this Report, with the rules, resolutions, &c., if duly carried out in practice cannot well be over estimated. PUBLIC URINALS. The subject of "necessary accommodation" came before your Vestry in November, having arisen out of complaints of the nuisances perpetrated in the vicinity of the Vestry Hall, on the foot-path leading to the Parish Church. The powers of Vestries are ample to enable them "to provide and maintain urinals, water-closets and like conveniences in situations where they deem such accommodation to be required, &c." (Metropolis Management Act, sect. 88), and your Vestry have already exercised these powers to the moderate extent of providing four urinals for the male sex, viz., 60 at Jenning's Buildings, Hooper's Court, Westbourne Grove, and the Mall. But deeming this accommodation insufficient, though it is in some measure supplemented by about forty external urinals of a semi-public character attached to public houses, your Vestry resolved to refer the whole question of providing adequate necessary accommodation for both sexes to the Works, Sanitary and General Purposes Committee for inquiry and report. The inquiry was delegated to a sub-committee which, after holding several meetings, and spending a day in viewing the sites that had been indicated as the most suitable, reported, recommending the postponement of the question of providing accommodation for women, and naming fifteen sites suitable for additional public urinals. The report of the sub committee was adopted by the Committee, the two sites first-named in the schedule attached to the Report were accepted, and it was then resolved to report progress. Your Vestry having considered the report of the Committee, disallowed the two sites in question, and referred the subject back to the Committee with an instruction that your Vestry "would not deem any scheme satisfactory that did not make provision for the requirements of the female sex" —a judicious reservation. This further reference came before the Committee in March, 1878, when it was unanimously resolved to postpone the whole question for a period of six months, and the report containing this resolution was in due course adopted by your Vestry. LEGAL PROCEEDINGS. Legal proceedings have been taken, on failure to obtain compliance with the notices served by order of your Vestry, in 18 instances, but there has been nothing of a character to call for special notice. Much loss of time in the Police Court has been experienced as usual in waiting for a hearing and by adjournments, owing to the insufficiency of the arrangements for the administration of justice. The half only of one Magistrate's time devoted to a District which comprises the whole of the Borough of Chelseawhatever may have been the case when the greater part of the principal parishes consisted of market gardens—is totally insufficient to cope with the business of the District, now that such open spaces have been covered with thousands of inhabited houses. It would be well worthy the consideration of your Vestry whether some steps should not be taken to obtain, as a minimum addition to the existing provision, the whole of the time of one Magistrate at the Hammersmith Police Court? Under the existing arrangements each Magistrate attends on three days in every week; the morning part of the day being spent at the 61 Court at Hammersmith, and the remaining hours at Wandsworth. Whether attendance at the Home Court by a Magistrate from 10 to 4 daily, would suffice for the speedy and punctual administration of justice is a question that time and experience only can answer. MORTUARY AND DISINFECTING CHAMBER. A public mortuary is still among the sanitary desiderata in Kensington, but negotiations are in progress the issue of which will probably remove the opprobrium of so important a parish being without a suitable temporary resting place for the dead — alike for the convenience of poor parishioners by whom such accommodation is greatly needed, and for the reception of the bodies of unknown persons who may die or be killed in the public streets. Hitherto in cases of sudden or accidental death of unknown persons bodies have been deposited in the Workhouse mortuary. This, however, is not a suitable place; and the use of it, moreover, is objected to by the Board of Guardians. Several years ago a Committee was appointed to give effect to the resolution of your Vestry to provide a mortuary, but nothing came of the labours of the Committee, as it was found impracticable to obtain a site. There is one site, however, which has always appeared to me superior to all others, viz., the disused Parish Churchyard, at the rear of the Vestry Hall; and it is highly satisfactory to me to know that the overtures which have now at length been made by your Vestry to the Churchwardens for a grant of that site, have been met by those gentlemen in a public spirit, which encourages the hope that, if no unforeseen obstacles should arise, we may hope before very long to see the building of a mortuary taken in hand. Though it scarcely falls within my province to advert to such a topic, I have, nevertheless, ventured to urge the desirability of combining with the mortuary suitable accommodation for the Coroner, so as to obviate the disagreeable necessity under which that gentlemen now lies of holding his court at public-houses. Should the mortuary, however, be erected on the proposed site, it would probably be deemed unnecessary to build a Court, for with two public buildings—the existing and the proposed New Vestry Hall, so closely adjacent, an arrangement could doubtless be made to place a room at the disposal of the Coroner. In this case, all that would be required in addition to two chambers for the dead (one for ordinary cases and the other for infectious cases), would be a convenient room for the use of medical men in making postmortem examinations under the Coroner's order. Reference having been made to "infectious cases," it is but right to mention that the Churchwardens, properly anxious for the safety of the public desired my opinion whether there would be any danger to persons 62 residing near or having to pass, the mortuary from the presence therein of the bodies of those who had died of infectious diseases? To which question I replied in the negative. The area of infection of the most infectious disease is comparatively limited; and there would be practically no danger if living persons suffering' from any such disease, or the bodies of persons who had died of the same disease, were exposed at such a distance as the proposed mortuary would be from the nearest inhabited dwelling. In practice, however, such bodies would be disinfected, and the coffins screwed down before removal to the mortuary. A further question having been raised, Whether the mortuary would be used? I may state that time would be required to educate the poor into a knowledge of the value of such an establishment; but I have no doubt that any aversion, from prejudice or custom, against the removal of the dead from amongst sorrowing survivors would be greatly mitigated by the sacred associations of the proposed site, especially if these should be sustained, as I advise, by the erection of a quasi-ecclesiastical structure. The funerals of poor persons conducted at the cost of the ratepayers, through the agency of the Board of Guardians, number some three hundred annually, and as a family often lives in a single room it would necessarily be a great relief to them—if they could be brought to see it—to be able to put their dead out of their sight pending the arrangements for interment. In course of time the natural feeling of unwillingness to use the mortuary would subside, and I hope give place to a spirit of thankfulness at such a provision having been made. This at any rate has been the course of events in other districts where, after a period of neglect, the mortuary has come to be more and more appreciated With respect to one class of cases, the infectious, the law safeguards public health by a provision which should be duly exercised, viz., by authorising a justice of the peace to order the removal of the body of any person who has died of an infectious disease, on the certificate of a duly qualified medical man showing that the retention of the dead body in the midst of the living is calculated to spread disease. My opinion having been asked, Whether more than one mortuary is necessary ? I have not hesitated to reply in the negative. The expense of the removal of a body to any part of the parish, would be practically the same, and as sufficient accommodation can be provided in one mortuary, it would be needless to go to the expense of a second, which would involve an annual charge for attendance, &c, to say nothing of the outlay on the site and the building.* It is no inconsiderable part of the advantage of the churchyard site that if your Vestry should see fit, the *The disused churchyard of Holy Trinity, Brompton, has been proposed as the site of a second mortuary. To this site no objection could be raised should it be found practicable to provide and maintain a mortuary for the local use of parishioners in Brompton. 63 mortuary might ultimately be placed under the charge of the keeper of the old Vestry Hall, thus reducing the annual expense to an insignificant minimum. In some of my former reports I have advocated the combination of a disinfecting chamber on the same site with the mortuary with the object of keeping down the charge for attendance, &c. Should the scheme for the erection of a mortuary in the churchyard be carried into effect, the two buildings could not be associated. It would then become a question whether it is necessary to provide such a chamber at all, seeing how well the plan of contracting for the performance of disinfection has worked—especially since the contractor has enlarged his premises, and thus made provision for dealing with the clothing, bedding, &c., of small pox and scarlet fever patients apart from all other infected things? A Committee of your Vestry gave great attention to the question of providing a chamber, referred to them in 1870, and we should doubtless have had one long ago, but that it was found impracticable to secure a site. The experience of the last two years, however (and it has been great owing to the prevalence of small pox), has satisfied me that the existing system of contracting is economical, expeditious, efficient, and more advantageous to the poor than any other. The contractor sends for the infected things by special messenger immediately on receipt of an order, and they are not only disinfected (by heat and chemical agency), but they are also cleansed and returned in a wholesome state to the owners. The latter part of the process could not be carried out if your Vestry had a disinfecting chamber of whatever construction. During the twelve months ended 25th March, articles of an endless variety have been disinfected, which weighed upwards of eleven tons, and the total charge for the work of disinfection and cleansing was £236 6s. Now, supposing that your Vestry should build a suitable chamber, it would be necessary to employ a staff of assistants to fetch and deliver the clothes, bedding, &c., and to attend to the apparatus whatever the state of health of the parish qua infectious disease. Under the present plan payment is made only for work done, so that in the absence of epidemics the charge is insignificant, and the average annual charge is much below what it probably would be if your Vestry provided a chamber. Not less important than the disinfection of clothing and bedding is the disinfection of the rooms, &c., occupied by the sick. Finding that in the majority of cases this work could not be efficiently carried out by the poor—and feeling that it was useless to purify the contents of the sick room if the room itself was left in an infectious state—I advised your Vestry to undertake the duty, and it has been done since May, 1877 ;no fewer than 360 dwelling 64 rooms in 312 houses having, in twelve months to 30th April last, been disinfected by your Vestry's officer to whom this duty has been entrusted. The work has been done in a very satisfactory manner; and though I am not prepared to speak in terms of absolute certainty, I have reason to believe that in no case where disinfection has been done by your Vestry's Officer and by the contractor, has infection been spread by contagium remaining in the sick room or its contents. It has not been found necessary, moreover, to destroy clothing, bedding, &c —a plan adopted in some parishes, and found to be very costly in the way of compensation. Should the negotiations above referred to for a site for a mortuary fall through, and should your Vestry be thus compelled to look elsewhere for a site, it would of course become a question whether a very complete establishment should not be provided, including mortuary (two rooms), a post mortem room, and a Coroner's Court; to which might then be added a disinfecting chamber of the most approved description—the entire establishment to be placed under the charge of a responsible officer who would act as keeper of the mortuary, and superintendent of disinfection. This plan would doubtless prove costly ; but whatever the expense there can be no question but that it should be carried into effect with as little delay as possible. I trust, however, that the necessity will not arise. BATHS AND WASHHOUSES. Your Vestry having previously expressed approval of the principle of the Acts for providing Public Baths and Washhouses, have now adopted them. The sanction of the Local Government Board has been obtained, and Commissioners will shortly be appointed to carry out a scheme. It is intended in the first instance to erect baths, &c., in the northern part of the parish at Notting Hill, and it may be fairly hoped, that, as one of the first and best results of the Commissioners' labours, many of the almost innumerable laundresses in that neighbourhood will use the washhouses; for, as a rule, nothing can be more unsatisfactory or insanitary, than the arrangements for the washing of family linen in the close and crowded houses occupied by the people who carry on this business. It may be hoped that in due course baths, &c , will be provided for the central and southern wards—separately or in combination: but whatever may be the case at Notting Hill, not the least of the difficulties in carrying out the Acts in the other wards will be the discovery of a site or sites purchaseable at a reasonable rate. The difficulty may prove well nigh insuperable in the South District, and will not be slight in the Central Ward, notwithstanding the compulsory powers for the acquisition of sites for carrying out the purposes of the Act. 65 WATER SUPPLY. The water supply of Kensington is in the hands of three Companies, (West Middlesex, Chelsea, and Grand Junction), which obtain water from the Thames above tidal influence, viz., at Hampton, Ditton, and Molesey. Professor Frankland, F.R.S., in his annual report to the Registrar General on the monthly analysis of the water supplied by the several Companies in 1877, furnishes some interesting information, which I propose, as usual to summarise. The average daily supply by the eight Companies was no less than 120,864,496 gallons. Of this quantity the Professor states 60 million gallons were sometimes much polluted with sewage matters, 52 million gallons and upwards were occasionally so polluted, but to a much less degree, whilst 7,230,993 gallons were of unexceptionable quality. The water he praises is drawn from deep wells in the chalk by the Kent and Colne Valley Companies, and by the Tottenham Local Board of Health, of which the quality is described as so excellent as to render comparison with river waters superfluous. "It is very desirable both in the interests of temperance and public health, that this delicious water should, as soon as possible, be substituted for that portion of the Metropolitan supply which is drawn from polluted rivers. This spring water, of unsurpassed purity, palatability, and wholesomeness is everywhere abundant in the Thames basin. In dry seasons it constitutes the sole supply of the river, and even after the most protracted drought more than 350,000,000 of gallons of it flow over the weir at Teddington, whilst a further large volume of it joins the Thames lower down. Surely it cannot be beyond the powers of Parliament and engineers to collect and preserve from irretrievable sewage pollution a small fraction of this prodigal supply, and to distribute it to those portions of London which at present drink it after it has been mixed with the sewage of more than half a million of people." The natural filtration it undergoes through an enormous thickness of chalk renders artificial filtration unnecessary, and is the cause of its almost uniform clearness and transparency. Among other advantages due to its origin, the temperature of this water is never high enough to make it unpalatable. The maximum temperature of the Kent water in July was 57°.9 Fahr., and the minimum in March, 45°—the range of temperature thus extended through only 13o.0. Of the river waters, Professor Frankland speaks in far different terms. The range of temperature extended through no less than 250.7 Fahr., viz, from 43°.3 in March to 68° in August, when the water was vapid and unpalatable. It contained among other solid matters a small proportion of organic substances, which, always objectionable, are at times dangerous to health—the pollution being to a great extent of animal origin. The year, however, 66 was, like 1876, very favourable to the river waters; nevertheless "in the months of January, April, and December, the Thames water was delivered to consumers in such a polluted condition as to be utterly unfit for dietetic purposes."And it appears that the improvement exhibited in Thames water is to be attributed almost wholly to the more careful treatment of the water by the Companies, as evidenced by the fact that the proportion of organic impurity in the Thames water which was inefficiently treated by the Southwark Company was excessive. Of the waters supplied from the Thames, that delivered by the West Middlesex Company was the best. The late Rivers' Commissioners in their Report on the Domestic Water Supply of Great Britain (speaking with reference to the proportions of organic elements) say, "We consider that potable water which contains organic matter, even only partially derived from animal sources, should not yield much more than 0.1 part of organic carbon in 100,000 parts of water," but the maximum pollution in the Thames (January, 0.40 in 100,000 parts, chiefly organic carbon) greatly exceeded this standard. The evidence of previous sewage contamination continues without diminution, and is of much significance, owing to the likelihood of morbific matter derived from animal excreta being carried down the stream, and distributed to the customers of the Companies. The following table shows the maximum, minimum, and average proportions of organic elements (organic carbon and organic nitrogen), in each of the local Companies' waters during the year ; the amount found in the Kent Company's water being taken as unity. Source. Company. Maximum. Minimum. Average. Deep Wells Kent 1.4 0.6 1.0 West Middlesex 6.0 1.2 3.4 River Thames Chelsea 7.0 1.9 3.9 Grand Junction 6.9 1.4 3.6 The average 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 the water) was 19°.5 or parts in 1877 (19°.8 in 1876). The average hardness of the Kent Company's water (derived from the chalk) was 27°.5 or parts, and the Colne Valley Company's water only 5°.1 or parts; the water of the last named Company being softened by Clark's process before delivery, and thus rendered suitable for washing, whilst its excellence for dietetic purposes is not thereby impaired. The following table exhibits the results of observation as to the degree of efficiency of filtration of Thames waters distributed by the local Companies (monthly examination):— 67 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 As in former years, the West Middlesex Company is the only one that uniformly distributed water which, examined in a two-foot tube, presented a clear and transparent appearance: but it is admitted that the filtration of the river water generally has undergone great and continuous improvement since the year 1868, when Professor Frankland instituted these observations. When examined by the microscope the sediment deposited by turbid water on standing is almost always found to contain numbers of living and moving organisms. The subjoined table shows with what frequency these organisms have been observed in the water supplied by the local Companies (monthly examination) :— Names of Companies Number of occasions when raovine organisms were found. 1869 1870 1871 1872 1873 1874 1875 1876 1877 West Middlesex 0 0 0 0 0 0 0 0 0 Grand Junction 4 1 1 2 3 5 7 3 3 Chelsea 3 2 2 3 2 7 4 4 1 The subjoined table exhibits the averages for 1877 of solid impurity, and other particulars, the numbers relating to 100,000 parts of each water : — Name of Company. Temperature in Centigrade Degrees. Total Solid Matters. Organic Carbon. Organic Nitrogen. Ammonia. Nitrogen as Nitrates and Nitrites. Total combined Nitrogen. Chlorine. Total Hardness. Proportionate amount of organic Elements, that in the Kent Company's Water being taken as 1* Kent º 42.38 .019 .011 0 .491 .501 2.48 27.5 1.0 12.8 West Middlesex 12.1 27.41 .170 .029 0 .216 .215 1.53 19.3 3.4 Grand Junction 10.8 28.24 .176 .034 0 .216 .250 1.53 19.8 3.6 Chelsea 11.5 27.14 .195 .032 0 .224 .256 1.55 18.8 3.9 The monthly Reports of Colonel Bolton, R.E., the water examiner, which are regularly forwarded to me, contain a variety of interesting information on the state of the water in the Thames, &c., and with reference to the state of filtration, and the apparatus and machinery of supply generally. Colonel Bolton states that the Chelsea Company are now in the same favourable position as the West Middlesex, in having sufficient storage capacity and impounding reservoirs to avoid taking in water when floods prevail. The Grand Junction Company, on the other hand, is not so 68 stanced, but has arranged for the construction of suitable storage reservoirs and other works at Hampton. The filter beds at Kew of this latter Company are also to be put in thorough working condition, and the area thereof greatly extended. These much needed additions and alterations will, without doubt, greatly improve the quality of this Company's supply. The rate of filtration of the Metropolitan water supply should not exceed 540 gallons per square yard of filter bed each 24 hours, and at this rate Colonel Bolton says filtration should be effectual. The composition of the filters of the West Middlesex Company is as follows:—Harwich sand, 1 foot 9 inches; Barnes sand, 1 foot; gravel, screened to different sizes, and arranged in layers, 2 feet 3 inches. Total depth of bed, five feet. Not much progress has been made in the matter of constant supply. The West Middlesex Company is said to be giving it to some houses, and to be prepared to extend the system as required; but no steps have been taken to make the constant supply general. The Chelsea Company are moving more actively in this direction, but no reference is made to any similar action on the part of the Grand Junction Company. The difficulty arises in connection with the alterations in fittings under the Board of Trade Rules and Regulations which the Metropolitan Board of Works, the "Public Authority," deem too stringent, and they have therefore not taken the steps the law empowers to bring about a constant supply. The filthy state into which cisterns are frequently allowed to fall neutralises the efforts of the Companies, and the Water Examiner, &c., to obtain an efficiently filtered supply. In addition to this common form of neglect, the water in many cisterns is still further exposed to pollution of a dangerous character by the retention of the waste-pipe in direct connection with drains. It is in the power of the Water Companies to remedy this evil, under Regulation 14, but with the exception of the Chelsea Company, whose necessities a few years ago compelled them to economise water, and who without any great difficulty, as I was informed, succeeded in getting the waste-pipes abolished from the cisterns in their districts, nothing has been done by the Companies to effect this improvement, so obviously desirable in a sanitary point of view, excepting in houses where the fittings have been renewed on the constant supply being given. Nor have they been stimulated to action by public bodies, or by the Government, though Colonel Bolton always refers to the necessity of the alteration in his monthly reports. Dirty cisterns and waste-pipes, however, are not the only sources of fouled water. Oftentimes the cause of pollution is found in the domestic filter which some persons appear to treat as if it were indestructible, or at least 69 needed no attention. On investigation of complaints as to water being "unfit to drink," it has been found that the water, clear and transparent as supplied by the Company, had contracted all its bad qualities in the process of " purification " by the filter ! "A New Scheme of Water Supply."—Under this head I referred in my last annual report to a plan by eminent engineers to provide London with a supply of the deep well water eulogised by Professor Frankland, for dietetic and fire brigade purposes, as well as for the purchase of the interests of the Water Companies by the Metropolitan Board of Works. The Board brought in two Bills to effect these objects during the current Session of Parliament, but the opposition the Companies were able to bring to bear against them was too strong to be resisted, and both measures have been withdrawn. GAS. The subjoined tables from the reports of the Chief Gas Examiner, exhibit at a glance the chief results (quarterly averages) of the daily testings of the gas made by the Gas Light and Coke Company at Kensal Green, and supplied to the testing station at 123, Ladbroke Grove, Notting Hill. Sulphuretted hydrogen, a forbidden impurity, was invariably absent throughout the year, while ammonia was present at rare intervals only, and in such fractional quantities (far below the permitted amount), as not to call for notice. 1. With respect to Illuminating Power. The maximum, minimum, and average illuminating power in standard sperm candles are as follows :—(Statutory standard=16 candles). Maximum. Minimum. Average. Quarter ended Mar. 31st, 17.8 15.2 16.8 Quarter ended June 30th, 17.2 16.2 16.8 Quarter ended Sept. 30th, 18.3 15.5 16.8 Quarter ended Dec. 31st, 19.1 16.1 16.8 18.1 15.7 16.8 The gas which was tested on nearly every week day through, out the year fell short of the standard on two occasions onlyviz., October 12th (15.6), and October 13th (15.5 candles). 70 2. As Regards Purity. Grains of Sulphur per 100 Cubic Feet of Gas. (Permitted maximum, 25 Grains.) Maximum. Minimum. Average. Quarter ended Mar. 31st, 19.5 11.3 14.2 Quarter ended June 30th, 17.0 10.9 13.0 Quarter ended Sept. 30th, 24.0 6.2 12.2 Quarter ended Dec. 31st, 20.8 4.3 17.1 Averages 20.3 8.2 14.1 No complaint with respect to the illuminating power of the gas was made to me during the year; and satisfaction has been generally expressed at the improved lighting of the streets. The old burners adapted to burn three cubic feet of Cannel gas per hour have been removed, and suitable burners, consuming 4½ feet of common gas per hour, have been substituted. This fact notwithstanding, the actual cost of the gas consumed under the average meter system has not, I understand, been above the amount paid for gas under the old system of a fixed charge per lamp per annum. In concluding my report I have again to tender my best thanks to those official persons and others who havekindly assisted me in carrying out the duties of my department. To the services rendered to the parish by the action of the Board of Guardians and their officers, I have referred elsewhere, and I have also acknowledged the solid character of the work done by Mr. Shattock, the "Vaccination Officer. The Sub-district Registrars of Births and Deaths, Messrs. Barnes and Hume, have ever given me their cordial help in all matters connected with their department. Your Vestry have testified approval, which I cordially share, of the care and efficiency shown by Mr. Rudman in the discharge of his responsible duties as Sanitary Clerk and Special Inspector. Mr. Thomas Gaylard having satisfactorily performed his original duties as Inspector of Dustbins, has been promoted to the more responsible post of Sanitary Inspector. He and the other newly-appointed Inspectors—Messrs. Wightman, Middleweek, and Abbott —give promise of becoming efficient officers, and I have confidence that when they have acquired a thorough knowledge of their duties, they will justify the choice of your Vestry. 71 For the support I myself have received from your Vestry on all occasions, and the undeviating confidence reposed in me during a period of more than seven years, and which have greatly aided me in the discharge of the many responsible duties of the office with which I am entrusted, it is alike my duty and my pleasure to express grateful thanks. I am, Gentlemen, Your obedient Servant, T. ORME DUDFIELD, M.D., Medical Officer of Health. Vestry Hall,, Kensington, July, 1878. Note.-The forms for Table I.-VI. have been settled by the Society of Medical Officers of Health to ensure uniformity of Statistical returns. TABLE I. Estimated population of Kensington at the middle of the year 1877, 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. 1877. 151,000 19,330 4,648 2,624‡ 1,411 1876 148,000 18,944 4,499 2,896 1,417 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 2,439 1,243 1872 127,400 16,206 4,041 2,225 1,132 1871 121,500 15,394 3,804 2,360 1,131 1870 116,350 15,279 3,705 2,473 892† 1869 111,350 14,654 3,625 2,267 891† 1868 106,350 14,029 3,522 2,232 984† 1867 101,350 13,404 3,158 1,933 974† Average of 10 years, 1867 1876 124,680 16,094 3,937 2,430 ” Notes.- Population at Census, 1871, 120,234. Average number of persons per house at Census, 1871, 7.8. Area in Statute Acres, 2,190. *The population is estimated to the middle of the year. Between 1867 and 1871 inclusive, a yearly addition has been made to the population based on the known increase between the Censuses of 1801 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 1867-70, inclusive, do not include those that took place at the Superintendent Registrar's Office, concerning which I have no information. ‡ The actual number of deaths registered in the Parish was 2,568, and it includes 125 deaths of non-parishioners, which are retained as a compensative allowance for the deaths of parishioners that may have taken place in general hospitals, &c., out of the Parish. The total, 2,624, is made up by the addition of 66 deaths of parishioners from small-pox and "fever," that took place at the hospitals of the Metropolitan Sick Asylum Board. TABLE II. Showing Birth and Death Rate: Deaths of Children, and Deaths in Public Institutions 1877, and 10 previous years. The Year. Births per 1000 of the population. Death rate per 1000 living. Deaths of Children 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 1877 30.8 17.3 25.3 13.9 40.8 354* 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 17.4 28.9 15.6 44.2 264 1871 31.3 19.4 25.0 15.0 41.6 252 1870 32.1 21.2 24.0 16.4 42.9 330 1869 32.5 20.3 † † † 313 1868 33.1 21.0 † † † 303 1867 31.2 19.0 † † 40.6 221 Average of 10 Years, 1867—76. 31.9 19.5 26.4 16. 42.4 288 * Viz. The Workhouse (223), and the Hospital for Chest Diseases at Brompton (130.) †No information. Note.—The calculations 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 1877. (The Deaths in Public Institutions of non-residents being excluded) CAUSES OF 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. ZYMOTIC DISEASES 128 64 16 28 14 21 23 11 12 11 9 3 1 238 371 314 57 II. CONSTITUTIONAL 60 40 34 24 44 71 64 56 41 33 14 2 ... 134 483 395 88 III. LOCAL 235 112 59 28 16 49 89 106 177 182 112 18 406 1184 966 218 IV. DEVELOPMENTAL 210 23 4 ... 1 ... 3 2 7 18 48 20 2 23 7 340 278 62 V. VIOLENT DEATHS 12 3 2 1 3 5 3 5 14 ... 2 1 ... 17 41 29 12 NOT SPECIFIED 3 1 4 ... ... ... ...2 3 1 ... 1 ... ... 8 14 12 2 648 243 149 83 79 148 185 184 243 244 186 44 4 1040 2433 1994 439 I. ZYMOTIC DISEASES Order 1.-MIASMATIC Varicella ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Small-pox 7 I 1 5 2 3 3 ... 1 1 ... ... ... 9 24 21 3 Measles 12 21 19 ... 1 ... ... ... ... ... ... ... 52 54 19 5 Scarlet Fever (Scarlatina) 4 4 10 8 3 ... 2 ... ... ... ... ... ... 18 31 25 6 Diphtheria ... 2 2 3 1 ... ... ... 1 ... 1 ... ... 4 10 8 2 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 3 3 6 ... 1 ... ... ... ... ... ... ... ... 12 13 10 3 Whooping-cough 17 12 2 3 ... ... ... ... ... ... ... ... ... 31 34 28 6 Typhus ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 2 1 1 Enteric or Typhoid Fever ... 1 1 5 ... 3 2 ... 2 ... ... ... ... 2 14 10 4 Simple continued Fever ... 1 1 2 ... ... ... ... ... 1 ... ... ... 2 5 4 1 Erysipelas 1 1 ... ... ... 1 2 2 1 2 1 ... ... 2 11 11 ... Puerperal Fever (Metria) ... ... ... ... 3 6 3 ... ... ... ... ... ... ... 12 8 "4 Carbuncle ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 2 2 ... Diarrhœa 69 15 3 ... ... ... ... ... 2 4 2 3 1 87 99 91 8 Simple Cholera ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... 3 3 ... Ague ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism ... ... ... 1 2 1 2 2 2 3 3 ... ... ... 16 13 3 Other Zymotic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pyemia ... ... ... ... 1 1 3 2 1 ... ... ... ... ... 8 3 5 Order 2—enthetic. Syphilis 8 2 ... ... ... 2 ... 1 ... ... ... ... ... 10 13 11 2 Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3.—dietic. Privation ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Purpura and Scurvy 1 ... ... ... ... ... ... ... ... ... 2 ... ... 1 3 1 2 Alcoholism a Del. Tremens ... ... ... ... ... 1 2 2 1 ... ... ... ... ... 6 5 1 Alcoholism b Intemperance ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 3 3 ... Order 4.—parasitic. Thrush 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 5 4 1 Worms, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 64 46 28 14 21 23 11 12 11 9 3 1 238 371 314 57 II. CONSTITUTIONAL DISEASES. Order 1.—diathetic. Gout ... ... ... ... ... ... ... ... 1 2 ... 1 ... ... 4 3 1 Dropsy ... 1 ... ... ... ... ... 2 3 4 2 ... ... 1 12 11 1 Cancer ... ... ... ... ... 2 11 21 21 19 10 1 ... ... 88 68 20 Cancrum Oris(Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mortification ... ... ... ... ... ... ... ... 1 2 2 ... ... ... 5 4 1 Order 2. — TUBERCULAR Scrofula and Tuberculosis 15 7 10 3 1 ... 1 ... ... ... ... ... ... 32 37 34 3 Tabes Mesenterica 20 9 4 ... ... ... ... ... ... ... ... ... ... 33 33 28 5 Phthisis 1 ... ... 10 42 69 52 33 12 6 ... ... ... 1 225 182 43 Hydrocephalus and Tubercular Meningitis 24 23 20 11 1 ... ... ... ... ... ... ... ... 67 79 65 14 60 40 34 24 44 71 64 56 41 33 14 2 ... 134 483 395 88 III. LOCAL DISEASES. Order 1.—nervous system. Cephalitis ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 2 ... Apoplexy ... 2 ... 1 ... 1 6 15 18 13 10 2 ... 2 68 51 17 Paralysis ... ... ... 1 ... 2 1 5 9 13 9 ... ... ... 40 32 8 Insanity ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Chorea ... ... ... l ... ... ... ... ... ... ... ... ... ... 1 1 ... Epilepsy ... ... ... 1 1 1 1 1 3 ... ... ... ... ... 8 6 2 Convulsions 68 19 5 1 ... ... ... ... ... ... ... ... ... 92 93 79 14 Brain Disease, &e 4 3 3 2 ... 3 6 9 12 19 12 2 ... 10 75 66 9 Order 2.—organs of circulation. Pericarditis ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Aneurism ... ... ... ... ... 1 2 1 ... 1 ... ... ... ... 5 4 1 Heart Disease, &c ... ... ... 3 2 5 19 19 29 39 16 2 ... ... 134 108 26 Order 3.—respiratory organs. Spasm of the Glottis 3 3 ... ... ... ... ... ... ... ... ... ... ... 6 6 5 1 Laryngitis 2 1 2 ... ... ... ... 1 ... 1 ... ... ... 15 7 6 1 Bronchitis 74 48 16 2 2 5 5 9 38 40 42 8 1 38 290 245 45 Pleurisy ... 3 1 ... ... 2 ... ... 2 ... ... 1 ... 4 9 9 Pneumonia 48 26 21 6 1 9 16 10 18 19 8 1 ... 98 177 148 29 Asthma ... ... ... ... ... ... ... 3 ... 3 ... ... ... ... 6 4 2 Lung Disease, &c.. ... 14 5 4 2 1 3 5 2 2 2 3 ... ... 23 43 36 7 Order 4.—digestive organs. Gastritis ... ... ... ... ... ... 1 ... ... 1 1 ... ... ... 3 1 2 Enteritis 5 ... 3 ... ... ... ... ... 2 ... ... ... ... 8 10 7 3 Peritonitis 1 ... ... 1 ... 3 2 ... ... ... ... ... ... 1 7 5 2 Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ulceration of Intestines 3 ... ... ... ... 1 ... 1 1 ... 1 ... ... 3 7 6 1 Hernia ... ... ... ... 1 ... 1 ... 1 1 1 ... ... ... 5 3 2 Ileus ... ... ... ... 1 ... ... 1 3 1 2 ... ... ... 8 5 3 Intussusception 3 ... ... ... ... 1 ... 1 ... ... ... ... ... 3 5 2 3 Stricture of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stomach Disease, &c. 2 ... ... ... 1 1 2 2 3 6 ... 1 ... 2 18 15 3 Pancreas Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... Hepatitis ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 Jaundice 5 ... ... ... ... 1 2 ... 3 2 ... ... ... 5 13 9 4 Liver Disease, &c. ... 1 ... 1 ... 3 11 9 8 7 ... ... ... 1 40 29 11 Spleen Disease, &c. ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 2 1 1 Order 5.—urinary organs. Nephritis ... ... ... ... 1 1 I .. 1 I 1 5 4 1 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bright's Disease (Nephria) ... ... ... 1 2 1 4 10 15 3 2 ... ... ... 38 30 8 Diabetes ... ... ... ... ... ... ... ... 1 3 ... ... ... ... 4 2 2 Calculus (Stone) ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 ... Cystitis ... ... ... ... ... ... ... ... 2 6 i j ... ... 10 9 1 Kidney Disease, &c. ... ... ... ... ... 1 ... 2 2 4 1 ... ... ... 10 8 2 Order 6.—organs op generation. Ovarian Dropsy ... ... ... ... ... ... 2 2 1 2 ... ... ... ... 7 5 2 Uterus Disease, &c. ... ... ... ... ... ... 2 ... ... 2 1 ... ... ... 5 2 3 Order 7.—organs of locomotion. Synovitis (Arthritis) ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... 3 3 ... Joint Disease, &c. ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 2 ... Order 8.—INTEGUMENTARY SYSTEM. Phlegmon 3 ... 1 1 1 2 ... 1 1 2 ... ... 4 12 11 1 Ulcer ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... Skin Disease, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 235 112 59 28 16 49 89 106 177 182 112 18 1 406 1184 966 218 IV. DEVELOPMENTAL DISEASES. Order 1.—diseases of children. Premature Birth 63 ... ... ... ... ... ... ... ... ... ... ... ... 63 63 52 11 Cyanosis 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 5 4 1 Spina Bifida 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Malformations 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 Teething 13 14 ... ... ... ... ... ... ... ... ... ... ... 27 27 22 5 Order 2.—diseases of adults. Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Childbirth (see Puerperal fever) ... ... ... ... 1 2 2 ... ... ... ... ... ... ... 5 5 ... Order 3.—diseases of old people. Old Age ... ... ... ... ... ... ... ... 3 16 47 20 2 ... 88 65 23 Order 4.—diseases of nutrition. Atrophy and Debility 127 9 4 ... ... ... ... 2 4 2 1 ... ... 140 149 129 20 210 23 4 ... 1 2 3 2 7 18 48 20 2 238 340 278 62 V. VIOLENT DEATHS, &c. Order 1.—accident or negligence. Fractures and Contusions 1 2 2 1 2 3 1 2 3 ... 1 1 ... 5 19 10 9 Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burns and Scalds ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 2 2 ... Poison i ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation 8 ... ... ... ... ... ... ... 1 ... ... ... ... 8 9 7 2 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3.—homicide. Murder and Manslaughter 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 2 1 2 ... Order 4.—suicide. Wonnds: Gunshot, Cut, Stab ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 1 1 Poison ... ... ... ... 1 1 ... 2 ... ... ... ... ... 4 4 ... Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hanging ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... Otherwise ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Order 5.—execution Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths (not classed) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden deaths (cause unascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 3 2 1 3 5 3 5 4 ... 2 1 ... 17 41 29 12 Causes not specified or ill defined 3 ... 4 ... ... ... 2 3 1 ... 1 ... ... 7 14 12 2 CAUSES OF DEATH. 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. Total deaths under Five. Grand Total. Kensington town.. Brompton AGES. Sub-Districts TABLE IV. Showing Mortality from certain classes of Diseases and proportions to Population, and to 1,000 Deaths, 1877, viz.— Diseases. Total Deaths. Deaths per 1000 of Population. Proportion of Deaths to 1000 Deaths. 1. Seven Principal Zymotic Disease 338 2.2 129 2. Pulmonary (other than Phthisis) 541 3.5 206 3. Tubercular 374 2.4 142 4. Wasting Diseases of Infants (under 5) 202 1.3 77 5. Convulsive Diseases of Infants (under 5) 190 1.3 76 NOTES. 1. Includes Small Pox. Measles, Scarlet Fever, Diphtheria, Whooping Cough, "Fever" and Diarrhoea. 3. Includes Phthisis, Scrofula, Rickets, and Tabes. 4. Includes 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, 1867-76, from the seven principal Zymotic Diseases, and the number in 1877, &c. Disease. 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 Annual Average 10 years 1867—76 Proportion of Deaths to 1000 Deaths in 10 years, 1867—76 1877 Proportion of Deaths to 1000 Deaths in 1877. Smallpox 29 4 6 8 120 68 1 0 0 8 24.4 10.0 84 32.0 Measles 19 84 27 70 64 43 38 121 23 128 61.7 25.5 51 20.5 Scarlet Fever 35 170 106 198 95 29 10 32 83 59 81.7 33.7 31 11.7 Diphtheria Not separately registered. 9 14 11 14 11 26 23 17 12.5 5.1 10 3.8 Whooping Cough 68 34 71 55 72 77 44 45 107 124 69.7 28.8 34 12.9 "Fever" 46 52 42 46 48 42 41 52 29 36 43.4 17.9 27 10.3 Diarrhœa 78 113 108 154 129 110 145 112 107 126 118.2 49.0 99 37.8 Total, Kensington 275 457 369 545 539 383 290 388 372 498 411.6 170.0 339 129 Total, London 11,660 14,925 17,413 16,476 19,455 12,699 11,385 11,230 13,411 12,565 14,121 185 12,365 160 TOTAL, ENGLAND &WALES 1865-74* 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1865—74 1865—74 1875 1875 82,692 72,587 97,352 90,380 100,497 103,801 91,743 89,286 88,200 82,000 90,856 182 92,030 150 * The Totals for England and Wales are for the ten years 1865—74, compared with 1875, the last year of publication TABLE VI. Inspectors' Report of the Sanitary Work completed in the year ended March 25th, 1878. Sub-districts. No. of Complaints received during the year. No. of Houses and Premises, &c., inspected. Results of In pection. 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, &c. 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. 725 2587 691 647 152 227 93 104 114 14 41 115 22 127 ... 1850 84 74 69 19 21 15 South. 549 1972 520 493 136 189 64 73 95 5 23 76 12 86 ... 2148 52 12 52 11 10 3 Total. 1274 4559 1211 1140 288 416 157 177 209 19 64 191 44 213 ... 3998 136 86 121 30 31 18 * 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. Removal of Dust, Ashes, &c. Date of Report. North District. [South District. Request. Complnt. Total. Request. Complnt. Total. North South North South North South North South North South North South North South May 2,1877 82 128 34 31 10 8 15 10 17 26 4 0 74 51 332 23 355 341 14 355 May 2,1877 May 30 „ 74 114 39 36 12 5 10 6 16 19 3 0 54 41 162 5 167 242 15 257 May 30 „ June 27 „ 92 112 36 29 10 6 13 7 22 19 6 0 90 68 287 2 289 338 3 341 June 27 „ July 25 „ 118 122 32 35 16 7 14 9 22 17 6 0 67 56 81 ... 81 72 ... 72 July 25 „ Aug. 18 „ 92 103 26 28 12 6 15 7 25 12 4 0 65 22 61 ... 61 58 ... 58 Aug. 18 „ Sept. 19 „ 68 65 22 19 8 4 9 6 10 14 3 0 16 30 54 ... 54 40 ... 40 Sept 19 „ Oct. 17 „ 55 72 18 32 3 7 18 12 6 10 3 0 68 65 57 1 58 88 1 89 Oct. 17 „ Nov. 14 „ 62 84 24 29 7 8 8 6 14 22 5 0 55 65 110 ... 110 145 ... 145 Nov. 14 „ Dec. 12 „ 96 114 32 28 6 7 10 5 22 17 3 0 55 65 114 ... 114 133 2 135 Dec. 12 „ Jan. 9, 1878 84 98 26 32 4 4 11 7 22 14 2 0 32 37 221 2 223 191 5 196 Jan. 9,1878 Feb. 6 „ 156 92 34 26 12 6 10 4 32 16 4 0 90 64 141 ... 141 197 ... 197 Feb. 6 „ March 6 „ 284 162 39 27 8 5 9 6 26 19 5 0 124 58 112 ... 112 144 ... 144 March 6 „ April 3 „ 226 134 54 32 12 5 8 4 38 23 7 0 134 54 85 ... 85 119 ... 119 April 3 „ Totals. 1569 1400 416 387 120 78 150 79 272 228 60 — 924 676 1817 33 1850 2108 40 2148 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 1877, and in the ten years, 1867-76. 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. 1867 19.0 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 1876 19.5 22.3 498 3.3 3.6 172 162 1876 average of ten yeaRs. 19.4 23.2 412 3.2 4.2 171 184 average of ten years. 1877 17.3 21.9 339 2.2 3.6 129 160 1877 TABLE VIII. Comparative Analysis of the Mortality in all London and in Kensington, in 52 weeks, ended 29th December, 1877. 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 21.9 3.6 14.6 24.0 20.5 16.0 3.3 6.4 19.2 Kensington 17.3 2.2 13.9 25.3 23.8 12.9 1.7 5.5 13.5 TABLE IX. Showing the Principal Localities in which fatal cases of the chief Zymotic Diseases occurred in 1877. KENSINGTON TOWN REGISTRATION SUB-DISTRICT. Locality. DISEASES. Locality. DISEASES. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric. S. C.F. Diarrhœa. Total. Small Pox. Measles. Scarlet Fever. Diphtheria Whooping Cough. Typhus. Enteric S. c. F. Diarrhœa. Total. Absalom Road 1 1 .. .. .. .. .. .. 1 3 Ladbroke Grove Rd. 1 1 .. .. 1 .. 1 .. .. 4 Abingdon Road .. .. 3 .. .. .. .. .. .. 3 Lancaster Mews 1 .. .. .. .. .. .. .. .. 1 Admiral Place .. .. .. .. .. .. .. .. 3 3 Lancaster Road .. .. 2 .. 1 .. .. .. 1 4 Appleford Road 2 .. 1 .. .. .. .. .. .. 3 Ledbury Mews .. .. .. 1 1 .. .. .. 1 3 Bangor Street .. 1 .. .. .. .. .. .. 2 3 Ledbury Road .. .. .. .. .. .. 1 .. .. 1 Basing Road .. .. .. 1 .. .. .. .. .. 1 Lonsdale Yard .. 3 .. .. .. .. .. .. .. 3 Blechynden Street .. .. 3 .. .. .. .. .. 4 7 Merton Road .. .. .. 1 1 .. 1 .. .. 3 Bolton Road .. .. .. .. .. .. .. .. 3 3 Munro Mews 1 .. .. .. .. .. .. .. .. 1 Bosworth Road .. .. .. .. .. .. 1 .. 2 4 Portobello Road .. .. 1 2 .. .. .. .. 4 9 Bransford Street .. .. .. .. .. 1* .. .. .. 1 Raddington Road .. .. 2 .. .. .. .. .. .. 2 Buckingham Mews .. .. .. .. .. .. 1 .. .. 1 St. Ervan's Road 2 .. .. 1 .. .. .. 1 2 6 Chepstow Place 1 .. .. .. .. .. .. .. .. 1 St. Luke's Mews .. .. 1 .. .. .. .. .. .. 1 Cornwall Road 1 .. 1 .. .. .. .. .. .. 2 St.Katherine'sRoad .. .. .. 1 1 .. .. .. 3 †2 7 Crescent Street .. .. .. .. 1 .. 1 .. .. 2 Edenham Street 2 2 2 .. .. .. .. .. 2 8 Southam Street 1 4 1 .. 1 .. .. .. .. 7 Elgin Crescent 1 .. .. .. .. .. .. .. .. 1 Swinbroke Road .. 2 .. .. 1 .. .. .. 2 5 Golborne Gardens 2 .. 1 .. .. .. .. .. .. 3 Talbot Mews .. .. .. 1 .. .. .. .. .. 1 Golborne Road 1 2 .. .. .. .. .. .. .. 3 Testerton Street .. .. 2 .. 1 .. .. .. .. 3 Golborne Terrace 2 2 .. .. .. .. .. .. .. 4 Walmer Road 1 .. .. .. .. .. .. .. 2 3 Hansard Mews .. .. 3 .. .. .. .. .. .. 3 Western Terrace 1 .. .. .. .. .. .. .. .. 1 High Street, N.D 1 .. .. .. .. .. .. .. .. 1 WilliamStreet,N.D .. .. 1 .. .. .. .. .. .. 1 Horbury Crescent .. .. .. .. .. .. 1 .. .. 1 Wornington Road .. 4 .. .. .. .. .. .. 1 5 Ladbroke Grove .. .. .. .. 1 .. 1 .. .. 2 Workhouse .. .. .. .. 4 .. .. .. 12 16 BROMPTON REGISTRATION SUB-DISTRICT. Locality. DISEASES. Locality. DISEASES. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric. S. C. F. Diarrhoea. Total. Small Pox. Measles. Scarlet Fever. | Diphtheria. Whooping Cough. Tyhus. Enteric. S. C F. Diarrhoea. Total. Brompton Road .. .. 1 .. .. .. 1 .. .. 2 Fopstone Road .. .. .. .. .. .. 1 .. .. 1 Cathcart Road .. .. 1 .. .. .. 1 .. .. 2 Ifield Road 1 1 .. .. 1 .. .. .. 1 4 Chapel Place .. .. 1 .. .. .. .. .. .. 1 Queen's Gate .. .. 1 .. .. .. .. .. .. 1 Child's Place .. .. 1 1 .. .. .. .. .. 2 Queen's Street 1 1 .. .. .. .. .. .. 2 Clareville Grove .. 1 .. 1 .. .. .. .. .. 2 Richmond Road .. .. 1 .. 1 .. .. .. .. 2 Cromwell Road .. .. .. .. .. .. 1 .. .. 1 St. Mark's Road 1 .. .. .. .. .. .. .. .. 1 Earl's Court Road .. .. .. .. .. I* .. .. .. 1 * The validity of the diagnosis of Typhus is questioned, vide Report, page 10. t Choleraic Diarrhoea. TABLE X. PARISH OP ST. MART ABBOTTS, KENSINGTON. Return respecting the Vaccination of Children whose Births were Registered during the year 1877. DATE. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Birth List Sheets. 2 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, as shown by Report Bouk of Column 10 Successfully vaccinated. 3 Column 11. Column 13. Dead. Un-vaccinated. 6 Postponement by Medical Certificate. 8 Removal to Districts, the Vaccination Officer of which has been duly apprized. 9 Removal to places unknown, or which cannot be reached, and cases not having been found. 10 Cases still under proceedings by summons and otherwise. Insusceptible of Successful Vaccination. 4 Had Small-pox. 5 1st January to 31st Dec. Kensington 3681 3156 18 5 339 18 20 125 ... Brompton 838 733 6 ... 70 4 1 24 ... Totals 4519 3889 24 5 409 22 21 149 ... TABLE XI. LICENSED SLAUGHTER HOUSES. SOUTH OF UXBRIDGE ROAD. 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 OF UXBRIDGE ROAD. 13, Archer Mews Mr. Bawcombe 20, Bolton Mews „ Smith 195, Clarendon Road „ Rush 10, Edenham Mews „ Gibson TavistockMews PortobelloRoad „ Hughes 8,VernonMews, PortobelloRoad „ 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 Dtto ditto „ Down TABLE XII. LICENSED COW SHEDS. SOUTH OF UXBRIDGE ROAD. • LOCALITY. LICENSEE. 5, Glos'ter Grove Mrs. Reeves 7, The Mall, Notting 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 OF UXBRIDGE ROAD. 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 & McCulloch Elm Cottage, St. Mark's Road Mr. G. Attfield